epidata as relational database for disaster electronic medical record
In 2006, our region suffered massive flooding. We even had to evacuate one hospital to another. We opened an evacuation shelter in the gymnasium at the local university. One section was basically a field hospital for the medically needy evacuees. Our patient record-keeping at that time was a little week.
We recently suffered another massive flood, several-fold worse than 2006. 30,000 people, 15% of our county's population,were evacuated. We had 1800 people in an evacuation shelter in that same gymnasium. About 100 were "medical needs" evacuees--oxygen, BiPAP, skilled nursing needs, etc. Our record keeping was better this time, but still left something to be desired.
I'm brainstorming ideas, both paper and electronic. Does anyone have any experience using Epidata as a relational database, so as to serve as a simple lightweight electronic medical record during a disaster?
Thanks.
--Chris Ryan, MD Clinical Associate Professor of Family Medicine SUNY Upstate Medical University, Binghamton, NY and Medical Director, Broome County Health Department
Heemskerk 31/10/2011
Hello dr. Chris Ryan, I have quite some experience in making relational databases in EPIDATA 3.1, mainly in the field of registering hospital infections. When I try to immagine your needs, you need something that is ready incase of a new flood occurring again. Do you already have a list of the variables that you want to register ? How can a person in your country be identified with certainty ? In Holland we use a " CIVIL NUMBER "that is unique for the person.
You may send me in a letter the ideas you already have and I will try to help you out, is there urgency right now ?
Yours, Louk Meertens MD, pediatrician (pensioner) Heemskerk , The Netherlands
email direct: loukmeertens@hetnet.nl
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Chris:
The principles of a relational database in EpiData Entry are very simple and totally straight forward from the perspective of concept and from the grammar how to link two files.
It gets a bit trickier in the EpiData Analysis part: the merging is simple, but the "reshuffling" from vertical to horizontal to go from visits with case information to cases with multiple visit information takes a bit more. If it comes to that, you may find the extensive documentation in our EpiData course on my web site (see link at the bottom) helpful. On the web site go to "EpiData course" in the navigation panel, and in the opening page look for Part D, Exercise 1 and download the PDF files both of "Task" and "Solution".
Hans
On 20:59, epidata-list@lists.umanitoba.ca wrote:
Hans and Louk, thank you for your interest, and Louk for your generous offer. I may be in touch with you by email directly. Yes, this would be something in preparation for the next flood/other disaster.
My thoughts are still very tentative, but what I envision is roughly:
1. A .rec file of evacuees. As each evacuee arrives, they are undergo a brief interview by Health Department or Red Cross worker: basic demographics, name, address, birthdate, etc, date/time of arrival to the shelter, and then some screening medical/nursing questions to assess their needs. Evacuees with needs intense enough will get triaged to the "medical" section of the shelter, while others will get triaged to the "general population" part of the shelter. Besides just gathering data, Epidata could help with interactive prompts. For example, "Do you require oxygen?" If yes, Epidata flashes a message, "assign to medical shelter. Do you want to override?" (Oxygen use is one of our criteria for being in the medical shelter.)
2. A RELATEd .rec file containing the names and doses of the evacuees medicines. This file, given to our supporting pharmacies, could be very useful: "Here's a list of all the meds we will need at the shelter." There would be a 1:many relationship between a record in the evacuee file (#1 above) and the records in this "medications" file.
3. Another RELATEd .rec file for "encounters," which are anything you do with an evacuee during their stay in the shelter: obtain and record vital signs, give a medicine, give some other treatment, send to the emergency department, etc. Each would be date/time stamped, of course. There would be a 1:many relationship between a record in the evacuee file (#1 above) and the records in this "encounter" file.
Louk, there is no universal identifying number in the US. I would use pre-numbered wristbands; the number on the band would be the person's ID number while in the shelter, and we would put a matching wristband on them upon arrival and registration.
Thanks for your thoughts and advice.
--Chris
Christopher W. Ryan, MD SUNY Upstate Medical University Clinical Campus at Binghamton 425 Robinson Street, Binghamton, NY 13904 cryanatbinghamtondotedu
"Observation is a more powerful force than you could possibly reckon. The invisible, the overlooked, and the unobserved are the most in danger of reaching the end of the spectrum. They lose the last of their light. From there, anything can happen . . ." [God, in "Joan of Arcadia," episode entitled, "The Uncertainty Principle."]
epidata-list@lists.umanitoba.ca wrote:
Dear Chris:
Just a brief question here: "No universal identifying number in the US"? Doesn't everybody have a social security number given at birth or for people coming after birth to the US, when they pick up work?
Hans
On 20:59, epidata-list@lists.umanitoba.ca wrote:
It probably wouldn't work for children. In Canada, we have universal health care numbers in all provinces, but there are significant limitations (by law) on what can be done with them. In many provinces, public health services cannot be linked to that number! Jamie
On 2011-11-01, at 3:49 PM, epidata-list@lists.umanitoba.ca wrote:
Because of huge identity theft problems, the SSN is rarely used outside of financial or legal transactions where it is legally required. I refuse to give it to anyone unless there is a legal requirement to do so. A study relying on SSNs triggers major IRB concerns about confidentiality. The SSN isn't given at birth, but at some point when a financial relationship is established (e.g., a bank account is opened). It used to be used as an ID number on drivers licenses and school IDs, but by law it is never used for those purposes any longer.
________________________________ From: "epidata-list@lists.umanitoba.ca" epidata-list@lists.umanitoba.ca To: epidata-list@lists.umanitoba.ca Sent: Tuesday, November 1, 2011 3:49 PM Subject: Re: Re: [EpiData-list] epidata as relational database for disaster electronic medical record
Dear Chris:
Just a brief question here: "No universal identifying number in the US"? Doesn't everybody have a social security number given at birth or for people coming after birth to the US, when they pick up work?
Hans
On 20:59, epidata-list@lists.umanitoba.ca wrote:
_______________________________________________ EpiData-list mailing list EpiData-list@lists.umanitoba.ca http://lists.umanitoba.ca/mailman/listinfo/epidata-list
. Years ago a US citizen needed a SSN by age 2, but now I believe it is assigned with submission of a birth certificiate. But as others have described, it is a bad idea to use it for general identification purposes. Hence my idea of a shelter-specific arbitrary ID number.
--Chris
On Tue, Nov 1, 2011 at 8:44 PM, epidata-list@lists.umanitoba.ca wrote:
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