Incorporating Scannable Forms into Immunization Data Collection Processes: A Mixed-Methods Study

Christine L Heidebrecht,David L Buckeridge,Jeffrey C Kwong,Sherman D Quan,Jennifer A Pereira,Faron Kolbe,Susan Quach,Michael Finkelstein,Patrick Tang

doi:10.1371/journal.pone.0049627

Christine L Heidebrecht, David L Buckeridge + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0049627

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Abstract

IntroductionIndividual-level immunization data captured electronically can facilitate evidence-based decision-making and planning. Populating individual-level records through manual data entry is time-consuming. An alternative is to use scannable forms, completed at the point of vaccination and subsequently scanned and exported to a database or registry. To explore the suitability of this approach for collecting immunization data, we conducted a feasibility study in two settings in Ontario, Canada.Methods and FindingsPrior to the 2011–2012 influenza vaccination campaign, we developed a scannable form template and a corresponding database that captured required demographic and clinical data elements. We examined efficiency, data quality, and usability through time observations, record audits, staff interviews, and client surveys. The mean time required to scan and verify forms (62.3 s) was significantly shorter than manual data entry (69.5 s) in one organization, whereas there was no difference (36.6 s vs. 35.4 s) in a second organization. Record audits revealed no differences in data quality between records populated by scanning versus manual data entry. Data processing personnel and immunized clients found the processes involved to be straightforward, while nurses and managers had mixed perceptions regarding the ease and merit of using scannable forms. Printing quality and other factors rendered some forms unscannable, necessitating manual entry.ConclusionsScannable forms can facilitate efficient data entry, but certain features of the forms, as well as the workflow and infrastructure into which they are incorporated, should be evaluated and adapted if scannable forms are to be a meaningful alternative to manual data entry.

Highlights

Individual-level immunization data captured electronically can facilitate evidence-based decision-making and planning
Scannable forms can facilitate efficient data entry, but certain features of the forms, as well as the workflow and infrastructure into which they are incorporated, should be evaluated and adapted if scannable forms are to be a meaningful alternative to manual data entry
These included Halton Region Health Department (HRHD), a local public health department serving the general population, and Rockwood Terrace (RT), a continuing care organization in Grey Bruce region administering influenza vaccines to employees. (Rockwood Terrace administers vaccinations to its residents, but resident immunizations forms were not included in this pilot work.) We assessed the feasibility of scannable forms by examining data quality, efficiency, and usability

Summary

Introduction

Individual-level immunization data captured electronically can facilitate evidence-based decision-making and planning. Several jurisdictions across Canada use this approach [2], but in circumstances where electronic data capture at the point of vaccination is not feasible, initial capture on paper forms followed by manual data entry is required to populate electronic immunization information systems (IIS), a resourceintensive process [3]. One alternative is to use scannable forms, which facilitate automated data transfer from paper forms to electronic databases or registries This approach to data collection has been applied in various clinical and research settings [4,5,6,7,8,9,10], and we hypothesized that it would be more efficient and accurate than manual data entry [11,12,13].

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