title: The electronic Trauma Health Record: design and usability of a novel tablet-based tool for trauma care and injury surveillance in low resource settings.
abstract: BACKGROUND
  Ninety percent of global trauma deaths occur in under-resourced or remote environments, with little or no capacity for injury surveillance. We hypothesized that emerging electronic and web-based technologies could enable design of a tablet-based application, the electronic Trauma Health Record (eTHR), used by front-line clinicians to inform trauma care and acquire injury surveillance data for injury control and health policy development.
  
  
  METHODS
  The study was conducted in 3 phases: 1. Design of an electronic application capable of supporting clinical care and injury surveillance; 2. Preliminary feasibility testing of eTHR in a low-resource, high-volume trauma center; and 3. Qualitative usability testing with 22 trauma clinicians from a spectrum of high- and low-resource and urban and remote settings including Vancouver General Hospital, Whitehorse General Hospital, British Columbia Mobile Medical Unit, and Groote Schuur Hospital in Cape Town, South Africa.
  
  
  RESULTS
  The eTHR was designed with 3 key sections (admission note, operative note, discharge summary), and 3 key capabilities (clinical checklist creation, injury severity scoring, wireless data transfer to electronic registries). Clinician-driven registry data collection proved to be feasible, with some limitations, in a busy South African trauma center. In pilot testing at a level I trauma center in Cape Town, use of eTHR as a clinical tool allowed for creation of a real-time, self-populating trauma database. Usability assessments with traumatologists in various settings revealed the need for unique eTHR adaptations according to environments of intended use. In all settings, eTHR was found to be user-friendly and have ready appeal for frontline clinicians.
  
  
  CONCLUSIONS
  The eTHR has potential to be used as an electronic medical record, guiding clinical care while providing data for injury surveillance, without significantly hindering hospital workflow in various health-care settings.
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Eiman
authors.initials: E
authors.lastname: Zargaran
authors.affiliation: Department of Geography, Simon Fraser University, Vancouver, BC, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schuurman
authors.affiliation: Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
authors.affiliation: South African Medical Research Council, Cape Town, South Africa.
authors.forename: Richard
authors.initials: R
authors.lastname: Matzopoulos
authors.affiliation: Department of Geography, Simon Fraser University, Vancouver, BC, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cinnamon
authors.affiliation: Trauma Services, Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Tracey
authors.initials: T
authors.lastname: Taulu
authors.affiliation: Department of Geography, Simon Fraser University, Vancouver, BC, Canada.
authors.forename: Britta
authors.initials: B
authors.lastname: Ricker
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC, Canada; Trauma Services, Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: David Ross
authors.initials: DR
authors.lastname: Garbutt Brown
authors.affiliation: Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Navsaria
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC, Canada; Trauma Services, Vancouver General Hospital, Vancouver, BC, Canada. Electronic address: morad.hameed@vch.ca.
authors.forename: S Morad
authors.initials: SM
authors.lastname: Hameed
mesh_terms: D001291:Attitude of Health Personnel; D001955:British Columbia; D016208:Databases, Factual; D019049:Developed Countries; D003906:Developing Countries; D057286:Electronic Health Records; D005240:Feasibility Studies; D006295:Health Resources; D006801:Humans; D020407:Internet; D063731:Mobile Applications; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods*; D012985:Software Design; D013019:South Africa; D014194:Traumatology; D014584:User-Computer Interface; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy
keywords: GSH; Groote Schuur Hospital; LMIC; eTHR; electronic Trauma Health Record; low- and middle-income countries