What MSIS is
The Surveillance System for Communicable Diseases is one of nine health registries established pursuant to the Personal Health Data Filing Systems Act (1). The MSIS regulations contain provisions on collection and processing of health information in the registry (2). According to the Act relating to the control of communicable diseases, the Norwegian Institute of Public Health shall ‘monitor the national and participate in monitoring of the international epidemiological situation, undertake research in the area of control of communicable diseases and provide help and advice to authorities, health personnel and the population regarding communicable diseases and their prevention and control’ (3). MSIS is an important tool in this work, including in the context of discovery and control of outbreaks of communicable diseases locally, nationally and internationally. The registry is updated on a daily basis, and data are published continuously via www.msis.no. The municipal health services can use MSIS data to monitor their local epidemiological situation. Data from the registry are also reported to international institutions such as the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC).
Norway is in an exceptional position in having national registries that can be linked with the aid of personal identification numbers, and there is an increasing demand for registry data for research purposes, especially when linked to information from other health registries, including MSIS. Surveillance systems in other countries tend to use the same definitions of cases, and registry data are therefore well suited to comparisons across countries. Research on data related to communicable diseases has the potential to produce new and important knowledge on their prevalence and causes, as well as the effects of various control measures.
The diseases in MSIS are divided into three groups – A, B and C. The Group A diseases (such as measles, salmonella, tuberculosis and hepatitis C) are reported with personal and detailed information on each case. Reports of infections in Group B (HIV, gonorrhoea and syphilis) are de-personalised with a view to protection of privacy and because of concerns for stigmatisation. The doctors report diseases in groups A and B on an ongoing basis to the Norwegian Institute of Public Health and the chief medical officer in the patient’s home municipality. Microbiology laboratories report cases directly to MSIS. Group C diseases (genital chlamydia, Clostridium difficile and until recently also influenza) are monitored without inclusion of personal data and with less information on each case. These reports are submitted by the laboratories in batches at varying time intervals.
Gradually, electronic reporting to MSIS by laboratories has been introduced, and as of 1 June 2015 approximately 25 per cent of the reports for Group A are submitted electronically, while the rest are sent by mail. All reports from clinicians are still sent by mail. There is a strong need for establishment of an electronic solution for reporting to MSIS by clinicians.
Over the years the scope of the reporting system has grown considerably, and now includes 67 notifiable diseases or conditions. This provides a broad picture of the epidemiological situation in Norway. Many of the diseases have been notifiable ever since the establishment of the registry, and some have been removed and new diseases have been added.
It is worrisome that a considerable proportion of the cases are reported only by the laboratories. After a comprehensive round of reminders for Groups A and B, approximately 80 per cent reporting by clinicians was registered in 2014. This results in poorer information on the prevailing situation and entails consequences for monitoring, recommendations and research. The low reporting rate can most likely be attributed to a cumbersome system with no opportunities for electronic submission and increased reporting requirements.