1st Annual EUBIROD meeting Dasman Center for Research and Treatment of Diabetes, Kuwait City Kuwait City, Kuwait, 2nd-4th May 2009

Discussion on Theme 3: Implementation and Usage

First BIRO Academy Residential Course, Kuwait City, Kuwait, 2nd May 2009

In introducing the discussion, Prof. Joseph Azzopardi asks whether anything changed in Cyprus after the introduction of the diabetes register. Are doctors feeling that they are wasting their time, or do they see it as an interesting initiative for patients? According to Vivie Traynor, people have become aware that with the help of an electronic database, it is now possible to understand if patients attend the clinic regularly or not, something obvious that before was indeed not possible. That simple thing is now perceived to be very useful for all. Dr.Mona Al Khawari, Head of the Pediatric Diabetic Clinic at Al Amiri Hospital in Kuwait City, underlines that that experience is very important for those who are starting a register, e.g. the Kuwaiti colleagues. How long did it take to introduce the system, and what was the motivations that you induced into health professionals to do the job? According to Vivie, in the beginning people were not sure, but after a short while the same patients requested this, and they have become the best ambassadors for the adoption of BIRO. Certainly, it takes a long time to implement a system like this, particularly for the doctors. Some level of influence must be exerted, which is particularly difficult compared to the private sector, given that there is no economic incentive to do it.

Prof.Azzopardi asks how secure the system really is. Peter Beck underlines that, despite of all the work done, it still remains a good question. Sending aggregated data is of course less sensitive than other forms of communications. The Java communication technology in place is the same used for banks, so we are quite confident that the level of protection is high. However, to enhance security it is essential that the server is properly maintained (firewalls, etc). Tania Di Iorio underlines that the retention site (server location) complies with the EU Data Directive, so these measures are due to be implemented, particularly in Italy.

Dr.Michael Jecht makes the question on the number of characteristics to be transferred to the BIRO application. Valentina Baglioni clarifies that there are only few items that are mandatory, but of course a very small number of columns sent in aggregate tables would jeopardise the production of BIRO indicators. In other terms, that centre would only contribute to the BIRO report for few outputs. For Simion Pruna, that naturally happens in networks (e.g. ophtalmologists) that are mainly interesed in specific parameters. For Peter, there is a need to set options for choosing which source contributes to which indicator, based upon the quality and other issues. For Carine de Beaufort, all sources must be certified and agreed in advance, to understand what we compare each other. For Fabrizio Carinci this problem applies to centres that can have multiple ways to produce BIRO tables, due to an abundance of data sources.

Christian Awaraji from Dasman asks about electronic certificates (PKI), and who would distribute them. Peter answers that there will be no external authority, and the operation would be directly managed by the Consortium that will distribute them.

Scott Cunningham makes the question on whether the XML Adaptor producing the BIRO export is actually needed to do this task, or it may be skipped by centres using their own export software to do it. Valentina clarifies that, provided that the translation is made correctly, then it is also possible to directly create the local Postgres database and use it to launche the statistical engine. By the way, such operation can be tricky and quite risky, as any mistakes would compromise the correct execution of the software and/or the production of accurate statistical reports.