Innovation of Health Data Governance in Emergency Settings
A Case from Emergency Response Units in Portugal
Introduction
In multi-site and resource-constrained health settings, particularly in emergency contexts, information recording and reporting remain fragile. Documentation still often relies on paper and Excel, causing duplicate entry, costly manual aggregation, and avoidable errors [1, 2]. When standardized reporting is required, e.g. Emergency Medical Teams (EMT) Minimum Data Set, retrospective compilation turns daily reports into a major operational burden and weakens data completeness, consistency, and comparability, limiting quality management and continuous improvement [1]. Meanwhile, many digital tools fail under weak or offline connectivity, reducing situational awareness and coordinated resource deployment [3–5]. Hence, an integrated, low-connectivity system embedded in frontline workflows is needed to enable efficient capture, automatic aggregation, and standardized reporting.
A Digital Clinical Documentation and Reporting System Embedded in Frontline Workflows
Holl et al. (2024) introduced Red Cross Red Crescent Health Information System (RCHIS), which is an Electronic Medical Record (EMR) and Health Information System (HIS) custom-built for Emergency Response Units (ERUs) and supports clinical documentation and operational reporting in low-connectivity or offline settings [1]. By automatically generating daily WHO EMT Minimum Data Set reports, it reduces frontline management burden, and its first pilot demonstrated strong usability and a feasible training-of-trainers (ToT) rollout pathway.
Following a 2015 needs assessment and solution scan, the authors found existing tools could not meet key requirements of emergency units such as rapid deployment, offline operation, multi-role collaboration, standardized daily reporting, and therefore developed RCHIS. In May 2022, the system was piloted by the Portuguese Red Cross during the Fátima pilgrimage (around 200,000 participants), using a training-of-trainers approach and enabling real-time reporting for operational coordination. The system runs on Android tablets and Windows laptops, works fully offline with later synchronization, stores data securely in Microsoft Azure, and uses an on-site ERU server for local buffering and device sync.
Implications
The RCHIS case highlights key implications for health information system practice across four management lenses. First, the pilot shows that a training-of-trainers approach is well suited to highly mobile contexts: a small group of experienced users is trained first and then supports other staff during deployment, allowing the system to be rolled out quickly and at scale [6]. Then, the pilot’s short training time underscores that low training costs depend not only on delivery formats but also on workflow-sensitive design (eg, structured mandatory reporting fields with free text elsewhere). For cross-organizational coordination and network governance, standardized datasets such as the EMT Minimum Data Set function as boundary objects: real-time aggregation can improve coordination-unit decision making and inter-institutional efficiency, but only if roles are clarified regarding standard setting, data use, and accountability for data quality, supported by multi-stakeholder governance and co-creation. For data governance, risk, and compliance, integration into clinical tasks requires early SOP development, interoperability with coordination tools, and formalized consent processes for emergency contexts to avoid trust and compliance risks [7]. Finally, RCHIS illustrates a deployment–feedback–iteration learning loop, where continued use, iterative development, and ongoing super-user training turn system capability into an organizational asset and enable replication across settings [8].
Further reads here
References
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[https://doi.org/10.1186/s13031-024-00585-6][PMID: 38589881]
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[https://doi.org/10.1080/01436597.2019.1650263]
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