I recently returned from a five-week deployment in Sierra Leone working on the Health Information System of a large Ebola treatment centre. My role was to support clinicians working in Ebola wards in all aspects of clinical data capture, and to communicate the daily and weekly centre health statistics to the centre management team and to external stakeholders to increase understanding of the disease and its management.
Daily deadlines present challenges for accurate reporting, but these were overcome by the work of dedicated and highly motivated national staff. Whilst it was relatively straightforward to obtain information held in administrative areas within the centre (such as numbers of admissions, discharges and deaths) capturing data held on the Ebola treatment wards proved more difficult. Gaining access to that information, for example the progression of clinical symptoms and drug administration, was however critical for (1) facilitating effective ongoing patient care; and (2) its potential future use for helping people within and outside of Sierra Leone learn more about the disease and its management.
Staff working on an Ebola ward are required to wear full personal protective equipment (PPE), which is restrictive, very hot and claustrophobic. Putting the suit on is laborious comparable to preparing for scuba diving, requiring meticulous checks and a mandatory buddy system. When exiting an Ebola ward, PPE removal (decontamination) must be performed under the watchful guidance of trained WASH staff. Critically for information management, this level of infection control means that nothing can leave an Ebola ward, making paper-based data collection very challenging. Non-ideal solutions included radioing clinical information out to colleagues, or completing paper forms from memory outside of the wards. Filling paper forms from memory was particularly problematic, due to a possible 10+ minute queue for decontamination, a 10+ minute decontamination process, and an additional 5 minute walk back to where the form would be completed.
An innovative solution was the installation of specialist Ebola symptom and management tracking software on (water and chlorine-proof) tablet-PCs, that could remain in the wards and wirelessly send clinical data to an external server location. Training of (100+) national and international clinical staff on use of the software and tablets took place from two weeks prior to launch, including continuous capture of user feedback that was provided back to developers working around the clock to improve the system. Tablet security was an ongoing debate – whether or not anyone would steal tablet-PCs from an Ebola ward was something that divided opinion (equally between national and international staff). In the end we “trusted in people” and after marking the tablets as a deterrent (see picture) placed them in highly visible ward locations. Initial feedback on the system was positive, and further more formal evaluation is ongoing. Critical aspects for adoption of such as system in this environment (apart from quality of software design) were responsiveness to clinicians, continuous ongoing training and a regular presence of motivated and dedicated support staff at clinical shift changeover.