Custom Procedure Logging Application Facilitates Real-Time Accurate Data Entry for Fellowship Programs

To the Editor,

Subspecialty fellowship education in anesthesiology allows trainees to develop expertise in a specific field, and creates leaders who will provide excellent patient care, develop practice guidelines to support evidence-based practice, educate future anesthesiologists, and innovate to push the field forward. The pain medicine fellowship was first accredited by Accreditation Council for Graduate Medical Education (ACGME) in 1989, and the regional anesthesiology and acute pain medicine fellowship was recently accredited in 2017. With accreditation came curricular requirements to ensure competency in multiple domains. Procedural and consult case logs are a major component to ensure adequate clinical experience.

Case logs traditionally rely on self-reporting, which is fraught with possible sources of error, such as delays in data input, transcription errors, or inaccurate recall [1]. In fact, manual self-reporting captures only 60% of actual clinical experiences [2]. Several publications have described the use of anesthesia information management systems to facilitate case logging for anesthesia residency programs via automated generation of reports [1, 3, 4]. Use of automated quick response (QR) codes generated at the end of a case to facilitate case logging using a smartphone increased anesthesiology resident case logging from 46% to 96% [5].

Creation of anesthesia information management systems can be time-consuming and may not be feasible for smaller subspecialty fellowship programs. There are no formal uniform methods to log cases for fellowships in currently existing Graduate Medical Education (GME) management systems. While ACGME accredited Regional and Pain Medicine fellowship programs have generalized requirements for procedures, there is no centralized platform available to log these cases. This is in contrast to anesthesiology residency programs which require residents to document cases through an ACGME system or similar IT program (e.g., MedHub). Most fellowship programs use “homemade” solutions, such as editable online spreadsheets or documents. Here we describe a web-based application for real-time case logging that could be easily implemented without a need to interface with the electronic health record. This unique web-based app creates an easily accessible webpage for direct case logging in real time that can be customized to individual fellowship programs and their curricular needs.

In order to address this need, a custom procedure logging application was written in Django, an open-source Python web framework specializing in robust database storage, not paired to any existing electronic medical record system (see Figure 1). Trainees access the application to log procedures via web browser, often using their mobile phones (usable on all devices) immediately after completing a clinical procedure. Because mobile phones are readily available to users, logging a procedure becomes more convenient.

Figure 1

[Screenshot from app]. (A) Custom menu for logging new procedures. (B) Optional procedure details with custom default values. (C) Composite summary of logged procedures for individual trainees.

In addition to storing individual logged procedures, the application database holds an abstract representation of the “menu” of procedures available for each training program, including procedure types (e.g., “epidural block”) and associated options (e.g., “lumbar” vs “thoracic,” “midline” vs “paramedian”). This architecture allows the flexibility to build and modify custom menus for each training program and assign sensible default values, streamlining the experience of the trainee when logging procedures. Authentication is performed with a custom URL-encoded token for each user, avoiding the necessity of a login step when a trainee uses a bookmark stored on their personal device.

Basic reporting functions have been implemented, including tallying procedures performed based on ACGME required categories. Certain procedure choices—for example, “unilateral” vs “bilateral” blocks and the number of levels at which certain truncal blocks are performed—may be indicated as “multipliers,” allowing for one logged procedure to count multiple times in summary tallies. For more detailed offline analysis, the application enables bulk export of logged procedures as a platform-independent comma-separated value file. All entered information is de-identified and poses no security risks or Health Insurance Portability and Accountability Act (HIPPA) violations.

We believe this application is a helpful adjunct to training programs not already using an automated information management system for procedural case logging. Use of this interface promotes timely data entry, thus facilitating accurate reflection of actual clinical experiences. As with any self-reported case logging system, the accuracy is dependent on the logger. However, because cases are entered on readily accessible mobile phones for this system, we predict better accuracy and compliance. This real-time data permits the trainee, faculty, and program director to reflect on their clinical experience and to update curricula to optimize learning opportunities throughout the academic year. In the future, we would like to make this application readily available for all trainees from any institution to utilize.