Logbooks - Again
Posted By Grant Forrest on 28-Mar 2011 at 12:14
Ranjit tells me that he's been asked "to take the lead in revamping the college logbook/record of clinical activity dataset".
My initials thoughts are :
- Web v Standalone app (argument for purely web-based logbook is compelling and is the accepted model for other specialties e.g.Surgery)
- Mobile apps - several exist already and there are a large number of "legacy" apps for pocket PC, palm (Psion :D ) etc
- Data set - can we agree a universal data set and a standard for data exchange (XML schema ?)
- Funding - development and recurring costs (hosting, domains etc) - presumably they want it to be free to the users again ?
- Scope - how much clinical activity should the "logbook" cover
- Non-clinical activity/SPA/portfolio included ?
- Data Protection - anonymised data avoids DPA issues which is surely preferable to every anaesthetist using the RCoA logbook having to register with the DPA (which is the situation ATM)
Posted by Adam Morley on 24-Mar 2011 09:03
A purely web-based logbook would be a bad idea for a number of reasons.
1. It requires taking time to find and log into a PC to update if you're going to do it at work. This is hard to do unless you do it at the end of the day which is ineffecient. Entering multiple sets of data is a known cause of error and being able to record each case individually would reduce this.
2. Hospital computers are often configured with legacy versions of Internet Explorer only, often take a long time to log into, often have internet connection problems.
3. Having only a web-based version will mean that there is no alternate backup of data in the event of some error. Having an smartphone/PDA app provides at least on separate backup.
Data set - I agree that ideally there should be a College approved dataset. This should be consistent across all versions (web or portable) of the logbook.
I'm not convinced (yet) that we should use XML schema, but I am sure that whatever direction this takes the data should be as portable as possible so that we can import and export data to and from whatever application we feel fit.
Scope - This could be expanded greatly and we could have different sections for different clinical activities. At the moment the record is limited to "cases" and most closely reflects theatre cases. It would be entirely sensible to include other areas of clinical work.
Posted by Grant on 24-Mar 2011 09:03
I agree that many hospitals have legacy hard and software (mine is stuck at IE6 with no upgrage path)
The expectation is that this may improve over time though, and also that more anaesthetists will turn to smartphones to overcome the limitations of hospital IT.
In terms of backup, a web-hosted solution is superior in many ways, as long as the hosting includes a nightly backup plan and there is proper disaster recovery.
Posted by paul cooper on 28-Mar 2011 12:03
The big advantage fo the original college logbook was that it was, and is , exportable in CSV, which makes it easy to put into spreadsheet, text documents , whatever. I think starting from a premise of XML will just add a layer of complexity. Is XML such a big advantage for a small dataset where all the fileds are mandatory ?
it is much easier to keep it accurate and up to date by entering data in real time in theatre. When my Palm died my logbook ceased to be updated as well, as it was too much faff collecting a sheaf of theatre lists. - but there again I dont ( at the moment) HAVE to keep one, so there wasnt that much motivation
So it needs to be updateable in real time, from wherever you are. Id go for a web based app ,as i think hospitals will increasingly be getting wireless networks. Whether the Hospital IT will allow us allto connect is another matter.
So either a web -based thing that you can access from your smartphone, or something which will synchronise to a cloud database ?
Posted by Grant on 28-Mar 2011 12:03
My point about XML was not saying that it should be the default format, just a suggestion that it could be an export format and if compliant with a relevant schema, this would make it easy for third party systems to import and display data.
Posted by Adam on 29-Mar 2011 20:03
"a web-hosted solution is superior in many ways"
Only for backup to a third party.
Grant, you stated:
"arguement for a purely web-based logbook is compelling"
A web based logbook would be excellent, but the ability to record on hand-held device would be even better. The statement I quoted (emphasis my own) suggests a web only version, which I believe the surgeons have now. That would be... shortsighted imho.
As to XML vs CSV - can't we have both? :p
Posted by Grant on 29-Mar 2011 20:03
I'm thinking along the lines of a smartphone app (c.f. Facebook) that maintains synchronicity with a corresponding web app, rather than a stand-alone smartphone app.
Re. XML/CSV - yes, the more export formats the better.
Posted by Adam on 30-Mar 2011 21:03
I think most of us would agree with both points - a synchronised wed-smartphone app that allows exporting in mutliple formats.
I think it sensible for the RCoA to use standard and up to date technology so that it's easy to update and interface with.
How do we make it happen? Is Ranjit discussing this, and with end users, before making recommendations to the college?
The other issue is instructions. It's not made explcitly clear what all the fields are for in the current logbook (v7) and I know a lot of people who have fallen foul at ARCP/RITA because of the way they've recorded things.
Posted by Alan on 01-Apr 2011 10:04
At risk of sounding like a cracked record, the logbook needs a Terms-set NOT a Data-set.
Terms can be very detailed and flexible, and are easily updated without breaking legacy logbooks.
So the actual database fields are simply:
"itemid", "date", "term", "value"
And all the details are in the "term" and "value" items. Items with the same itemid are linked - eg "AAA Repair" "Arterial line" might be linked individual items.
This works extremely well in the SCATA Portfolio. It is a bit more work designing data input and reporting, but the programmatic use of Terms sets has been around a long time.
And you have a detailed starting point for your terms in the Portfolio terms set.
But, yeah, then hard to do a quick logbook in HandBase.
Posted by Adam on 17-Jun 2011 16:06
So it seems that the e-portfolio is being piloted in various places (not at mine, sadly).
Has anyone had a chance to look at it and if so - what did you think?
Are there options for data importing or exporting? And if so what formats are being used?