Text box 4 Electronic data management — reflections and lessons learned from VCH

Although VCH employs an electronic hospital information system (HIS), at the time this project was initiated, the system had not been implemented in the ED because a specific emergency care module was yet to be developed. While VCH staff considered utilising the interface designed for the outpatient department, it did not have sufficient functionality to capture and aggregate ED performance data.

An interim solution was developed to facilitate triage and emergency care data management while awaiting extension of the HIS to the ED. Step 1 involved reviewing the existing patient registration form and updating this to incorporate triage information and other relevant variables. This process was led by VCH staff and ultimately resulted in the rollout of a new clinical form that was better suited to local purposes.

Second, a simple electronic data entry form was developed to allow a data clerk to transfer handwritten information, in deidentified form, from the clinical form into an electronic database. Jotform (San Francisco, CA, USA) was used, because this platform is compliant with Health Insurance Portability and Accountability Act requirements (ensuring high standards of data protection) and allows offline access via its accompanying app. This functionality was thought to be important, because in the event of the loss of an Internet connection, data entry could be maintained. Data entered during offline periods is subsequently uploaded when a connection is re-established.

Third, a spreadsheet was designed within Google Sheets (Mountain View, CA, USA) to allow data aggregation and visualisation. Deidentified data entered into Jotform is automatically imported into this file through an integration function. This data is collated in a hidden worksheet, which functions as the data source for the rest of the spreadsheet. The entire document is password protected and requires two-factor authentication to access.

A series of worksheets were developed to function as dashboards. Formulas were used to calculate frequencies and percentages and present this data as tables and graphs for a variety of time periods (daily, weekly, monthly or yearly). For instance, a dashboard developed to aggregate monthly performance data displays data about the number of presentations, patient demographics and referral patterns, emergency care time intervals (e.g. time to assessment and total ED length of stay), compliance with time targets and disease surveillance. A screenshot of the frequency data is provided at Fig. 3.

A separate dashboard was created to facilitate the reporting of weekly syndromic surveillance data, as required by the Ministry of Health. This displays the presentation frequencies for 12 specific, pre-defined syndromes and diagnoses, identified by clinicians and recorded on the patient’s form at the time of the encounter. This data can then be submitted to the Ministry of Health as required.

The major impediment to the effective utilisation of this system has been data entry capacity. Although it requires less than 1 min to enter data from a patient’s clinical form into the electronic registry, remaining up to date with data entry has proved to be a challenge. This experience is not unique to VCH.

This simple, low-cost electronic registry has facilitated the capture and collation of important ED data. It has been used for reporting and audit purposes and has the potential to facilitate epidemiological and systems research. Overall, it has been a positive addition to the quality improvement toolkit at VCH ED.

On the back of this experience, VCH is now a pilot site for the WHO International Registry on Trauma and Emergency Care [42]. This new system uses the same workflows but a different registry platform, allowing comparison of data between sites and countries. An evaluation of the registry is expected to be published shortly.