Evaluation of the SIMI system, an experimental computerised network for the surveillance of communicable diseases in Italy

In Italy, the current communicable disease notification system is organised as follows: in each region, Local Health Units (LHU) fill in and forward c ase report forms (CRF) to the Regional Health Authority, which send aggrega ted and individual notifications to several central-level institutions. In most regions, all data are recorded manually on hard-copy. Although most re levant data from CRFs are eventually entered into a computerised database a t the National Institute of Statistics (ISTAT), the national database is on ly available 3-4 years later and no data-quality control is performed at th at time. To improve the quality and timeliness of notification, in 1994, th e Istituto Superiore di Sanita (the National Institute of Health) began to develop an experimental computerised surveillance network for communicable diseases (referred to as `SIMI'). Specifically, a software was created and distributed to the LHUs and the Regional Health Authorities; staff training was performed; and feedback and analyses of collected data was promoted. S IMI was evaluated in the 13 regions that were participating in 1997 (out of a total of 20 regions in Italy), using criteria commonly used for surveill ance systems (i.e., completeness and coherence of data, case definitions, c osts, timeliness, and feedback). SIMI was implemented at a limited cost and the data collected were observed to have had a high degree of completeness and internal consistency. The SIMI system has since been adopted for the r outine notification of communicable diseases in nearly all regions. Similar evaluations will be necessary for assessing the performance of the various notification systems used across Europe and to include them in a European network.