The Canadian Agency for Drugs and Technologies Health (CADTH) is a non-profit organization that works to provide healthcare decision makers with evidence-based reports, data, and tools. A long-standing client of Industrial, CADTH reached out to our team after taking ownership of the Canadian Medical Imaging Inventory (CMII) database from CIHI - the Canadian Institute of Health Information.
What is the CMII database?
The CMII database houses data that is collected from healthcare facilities across Canada. Hospitals and other facilities complete the survey to record their inventory of imaging equipment including CT (Computerized Axial Tomography), MRI (Magnetic Resonance Imaging), PET (Positron Emission Tomography), and SPECT (Single Photon Emission Computed Tomography).
Solution # 1: Leverage CADTH's existing website
CADTH's website runs on the Drupal Content Management System (CMS). In the first year of CADTH's management of the CMII survey, we worked with them to leverage Drupal's web forms module to allow users to submit their responses to the survey. While this was a cost effective option that didn't require any custom development, the end result was less than ideal for end users and CADTH's administrators who needed to analyze and report on the data.
Learning from user feedback
After analyzing feedback from this first version of the survey, it was clear that a more robust survey application was needed to increase the number of respondents and to provide administrators with improved access to data. CADTH was aiming to reach a broad user group who would be accessing the application from within their healthcare environments. Working closely with CADTH, key requirements were identified:
- Rarely would one person complete the entire survey. We needed to account for multi-user access to the survey from different departments within a facility.
- It would be difficult for the survey to be completed in a single session. A significant amount of detailed data is collected and this meant the ability to save and return to the survey over multiple sessions was key.
- Often the survey would be completed by a healthcare group (such as a municipal hospital group) that represented multiple facilities. We needed to allow for multiple facility data entry by any user, and the ability for administrators to add in new facilities if requested.
- The user would be completing the survey from within their facility during regular working hours, in addition to their normal duties. The survey had to be very easy to use ensuring swift and efficient progress without the need for user training.
- Facilities would typically have more than one type of equipment (e.g. CT scanning equipment and MRI equipment), and multiple units of each type of equipment. The system had to be flexible to support multiple entries of multiple equipment types.
- CADTH wanted users to access the survey through the cadth.ca website, where login accounts were already supported. The survey application had to support single sign on (SSO) to avoid creating another set of login accounts.
- Access to the completed survey data by CADTH's experts would be critical. These staff would validate the data, send follow-up questions to users, and extract the data for analysis and reporting.
- Data storage for the survey had to remain in Canada, given the sensitivity of the data being collected.
- Users from across Canada, including Quebec, would complete the survey, and as such the interface for the survey had to be available in English and French.
Landscape review of software solutions
As a first step, our team worked with CADTH to conduct a landscape review of potential off-the-shelf software that met our requirements. Several solutions were considered, with FluidSurvey (owned by SurveyMonkey) standing out as the only potential contender.
FluidSurvey was Canadian-based, and was the only off-the-shelf system that could support storage of survey data in Canada. It also supported both English and French survey interfaces. While FluidSurvey was a strong contender, SurveyMonkey announced that they were discontinuing FluidSurvey and porting all FluidSurvey customers to their SurveyMonkey application.
SurveyMonkey was hosted in the US, and didn't have some of the advanced features such as clean multilingual support and advanced logic for collection of complex survey data.
Solution #2: An integrated, user-friendly web application
It became clear that the best approach to meet CADTH's need would be the development of a custom software application. This approach would give CADTH complete control over how the survey was structured, ensuring the optimal data entry flow for users combined with targeted administrative functions for CADTH staff.
A multi-tiered solution was designed by Industrial's technology and UX teams that included the following infrastructure:
- Storage of facility and user data in Wicket - https://wicket.io - an API-first web application that is specifically built for integration with other applications. Wicket would be used to store all user data and management of facilities.
- Access to the survey through CADTH's existing Drupal website, running on Drupal. The solution would see us extend the MyCADTH secure area of the website to utilize Wicket's single-sign-on technology.
- Development of a custom web application for the survey itself, using the modern Ruby on Rails web framework, and data storage on CADTH's existing Canadian-based hosting infrastructure. The survey would be tightly integrated with the CADTH website for access by users.
The final solution
Following an iterative development process that saw CADTH review early prototypes through to the final application, the CMII survey was launched to users for collection of data.
CADTH staff use the Wicket Administrative Panel to manage facility and user data, as seen in the screenshot below.
The CMII application is accessed through the MyCADTH area of the Drupal website for authorized users, as seen in the screenshot below.
Users complete the survey by going through a multi-step process that has been designed to make the process smooth and efficient. The interface is responsive, meaning respondents can complete the survey on any device, and users can access the survey over multiple sessions (save and continue later). The application's structure is highly flexible, allowing users to add or remove equipment records across the various imaging equipment types.
The new CMII application has been a success for CADTH, with positive user feedback, an increase in responses, and high quality data for CADTH's experts to analyze and report on.
Is your organization considering a custom web application for the collection of sensitive data? Get in touch with Industrial today to learn how our team of UX designers and technical engineers can help drive results.