The CDC Guidelines suggest that surveillance systems should be as simple as possible (in their structure and ease of operation) while still meeting their objectives84. The evaluation team found considerable variation in the arrangements for trachoma screening and data collection. The screening process is often logistically challenging and is further complicated where active trachoma screening is integrated with other childhood screening processes (notwithstanding the advantages of integration). The NTSRU has developed a series of forms for the collection of data for the national trachoma surveillance system. The evaluators consider that these forms are relatively simple, and that the associated Access database that has been developed is not too complicated. Many stakeholders did however comment that they found it difficult and time-consuming to enter data onto the NTSRU database.
As described in Chapter 3, it is almost always the case that the screening data are first collected on paper, either using the national forms (or small variants) or a more generic screening data collection form in which trachoma is a component. Although the paper forms are convenient, they add complexity to the process of data collection because they require that data collected at the person level (in the case of child screening) be summarised into the format required for national reporting. If data collection was electronic and occurred at the person level, these calculations could be automated and the summary report produced as a by-product of what would be normally regarded as good health record keeping practice. The evaluators were advised that a web-based data collection approach was investigated when the NTSRU was established; but it was found that such a system was not feasible mainly due to confidentiality issues. It is our view that the eHealth landscape has changed considerably in recent years and that it would be valuable to again investigate web-based data collection.
The evaluation has found that entry of data on trachoma is occurring in multiple places, including local regional or territory clinical information systems, as well as ad-hoc arrangements developed for the process of reporting to the NTSRU (including entry into the Access database supplied by the NTSRU). These processes often result in duplication and triplication of data entry (e.g. data entered onto paper form, onto local clinical information system, and onto NTSRU database). Stakeholders reported some cases of quadruple data entry when both local and regional clinical information systems were used in the process. In general, it appears that once data are entered into a system it is not further available for analysis (the PCIS system in the NT may be an exception). It is clear that streamlining data entry will be a key to reducing the complexity of the current arrangements.top of page
There will be challenges in achieving electronic data entry at the time of screening in many of the very remote communities participating in the national trachoma surveillance system. Likely barriers will include: absence of computers in the locations in which screening occurs, limited computer skills of staff undertaking screening, lack of integration of computer systems so that data can be entered once and then used multiple times, and competing priorities in relation to software enhancements that would better facilitate capture and transfer of information. Nonetheless the evaluation team believes that it is important that greater use of information technology is made in the data collection and transfer process, probably using a web-based system for data collection and transfer.
The use of the Access database developed by the NTSRU has greatly improved the process of transfer of the data to the national surveillance system. A number of users reported problems with the simplicity of the database and its limited functionality. A particular issue is that reports meeting local requirements cannot be easily generated from the database, hence creating a barrier to the use of the surveillance data at the local level. Some users requested that a facility to generate user defined reports (e.g. through a pivot table) be provided in the NTSRU database. The evaluators consider that an enhancement that allowed the production of reports catering to different users of the trachoma surveillance and control system would improve the simplicity of the current system (certainly in terms of feedback).
Findings: With respect to the simplicity of the current national trachoma surveillance system, the evaluation concludes that:
- the process of collecting data at local level for transfer to the national trachoma surveillance system is too complex and needs to be streamlined;
- the current surveillance system can be enhanced by:
- greater use of local information systems in the data collection process and designing data extracts programs into local systems that create data in a format consistent with the national data collection for transfer to regional/jurisdictional coordination units;
- exploring the development of a web-based system that facilitates data capture at the time of screening and transfers the aggregate level surveillance data to the NTSRU;
- developing mechanisms to facilitate the transfer of information from primary health care services to the regional/jurisdictional coordination units on adults checked for trichiasis at the time of receiving vaccinations or a healthy adult check; and
- creation of a capacity to retrieve flexible user defined reports from the NTSRU Access database (or its replacement), immediately following data entry.top of page
84Centers for Disease Control and Prevention op cit.