Pilot of a Child Health Electronic Surveillance System (CHESS) in Malta

Following a 6-year period of system design and planning, the Primary Health Care Department in Malta introduced a Child Health Electronic Surveillance System (CHESS) within Well Baby Clinics and primary schools. The primary aim was to computerize all activities of the child surveillance system to create an electronic health record which could eventually be linked to the child's hospital, immunization and referral records. Data generated will be used to monitor the quality of the programme by identifying process and output indicators. Identified indicators included uptake of check-ups at different ages, number of defaulters, age at which check was carried out versus target age and outcome for components of check-ups. The aims of the pilot were to test the electronic system on site and monitor its performance in terms of the efficiency of data entry and quality of clinical data management. The possibility of collecting useful information on some of the identified 38 core child health indicators for Europe has been evaluated. A period of pilot testing was performed in one Well Baby Clinic. Prior to running the system, all users were trained and additional staff was appointed to take on responsibilities for maintenance and troubleshooting. Testing was performed during clinical appointments held from October 2006 to December 2006. Initial feedback from users was positive. They felt confident with the system and agreed that it improved efficiency and quality of the clinical information. Computer use during clinical sessions did not prolong encounter time. Backup systems were in place but were not activated. Parents have also commented positively on the use of the system as they were able to request a printout of their child's clinical examination. Nurses felt that planning for scheduled clinics was easier as no paper records needed prior retrieving. Preliminary data showed that 42% of children aged 6-8 weeks were breastfed; most parents were not concerned about their preschool child's growth or development. Physical abnormalities were identified in 7% and in 4.5% developmental abnormalities were detected. Growth data showed that 4% of preschoolers had weights above the 97th centile for age.