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Table 1 Findings and checklist

From: Strategies to use tablet computers for collection of electronic patient-reported outcomes

Theme Excerpt from field notes to support thematic findings Checklist for ePRO use in clinical settings
Logistics of technology Started brainstorming ideas to deal with how I am attending to infection control: sanitizing screen? Using stylus? Hand sanitizer before hand (and give to participant as a gift)? Disposable screen covers? Others? I also want to talk [electronic provider] to see if they have other suggestions. Have you attended to infection control?
  Found out today that [health authority] has not formulated a strategy for patient wireless access and requires staff members to have individual accountability for their access. As a researcher, I am neither “patient” nor “staff”. [Information Technology] confirmed that I cannot access their internet. Alternative option is to use 3G [3rd generation of mobile telephone/cellular technology]. Do you have access to the internet in the hospital/clinic/health authority?
  Advised to test iPad’s 3G connections in both home dialysis clinics. Hospital building structures and medical equipment could interfere with 3G signal. Have you tested the tablet in the clinical setting?
  We decided to set up a new contract for one of the iPads with [a different cellular provider] because in [2nd city], they have a tower nearby. Patients from [2nd city] have told me that they have better reception with this provider.  
  Using 3G will obviously have implications for printing – cannot print from iPad without internet. I need to contact [computer programmer] about purchasing router to connect iPad to printer - but without using internet signal. Do you need to print from the tablets?
  The renal services are in the process of moving from paper to electronic charting. But they aren’t there yet. In consultation with the nurses, they said they want results printed and given to them on paper. Do you need to access or synch with electronic health records?
Security [Privacy analyst] told me I need a minimum of 8 characters for the passwords on the iPads. Need to change all passwords on all iPads accordingly. Do you have your tablets password protected and encrypted?
  [Health authority] wants to know if devices will be dedicated to research use, or if they will be brought in as-needed. Definitely dedicated for research use only – will follow up with [research assistants] when they sign confidentiality agreements too.  
  Although the iPads will be securely stored in my locked office when they aren’t in use in the hospitals, we need to also have them securely stored on the days they are used for data collection. In consultation with [research assistant], we are going to buy a small box that locks and is on wheels (for easy transport of equipment and files). We’ll keep the iPads locked in the box when a patient is not using them. Where will you securely store your tablets?
  To meet [health authority] ethics standards, we need to back up all data on Health Research Data Repository [HRDR; at University of Alberta] at the end of every day of data collection. Where are you storing your data?
  Must receive confirmation of data transfer from HRDR before deleting data off of iPads. Are you frequently backing up your data?
Support [Health authority] has a requirement, as mandated by the Ministry of Health and the OIPC [Office of the Information and Privacy Commissioner], to encrypt all mobile devices used in their facilities. Need to provide proof that the encryption is enabled on tablets. Do you have support/approval from the Information Management/Information Technology department in the health setting?
  [The nurse clinician] agreed that the ward clerk can ask patients, when she calls them to remind them of their appointment, that if they are planning to participate in the study, they need to come 15 minutes early – which is fabulous! If patients are late, they will not be invited to participate. Data collection is so different when it is happening “in real time” in a clinic setting.  
  Requested approval to buy another iPad. With 3 research assistants in the clinic each day, there are times when they all could be using one with a patient. As it is now, sometimes they are waiting for a tablet, and more than anything else, we can’t interrupt the flow of the clinic. Do you have financial and technological support for tablet development?
  Need to start to set up invoice with KDQOL Complete prior to data collection so I can trial data entry onsite.  
Design Met with [academic professor] who is using iPads with healthcare professionals. Even though they are assuming many participants will know how to use tablets, they are still opting to go with a very simple layout with drop-down menu bars. The simpler, the better. Do you need to adapt the screen display for a specific population?
  Read an article on computer use with seniors. They recommended using large font, black writing on white/plain background, and no distracting images on the screens. So definitely no pop-ups or flashing stars when a survey is completed.  
  Met with [computer programmer] and he is using FileMaker Go to design the app. We’ll meet at each phase to test and revise the design. And when we are done, he’s going to provide a step-by-step set of instructions (with pictures) for use of the app, download, and transfers. Are you creating new apps to collect research data?
If yes, are you using data input time stamps?
  Time stamps will be date/minute/second. In this way, they can also be used as a back-up, secondary participant identifier because I’ll know the order of participants who volunteered on any given day at the home dialysis clinics.  
  Coons et al. [9] – need to undertake cognitive debriefing and usability testing to assess clarity, understanding, and usability of the technology. I think I would like to include brief interviews with each participant after they use the iPad. Have you attended to measurement equivalence of the electronic versus paper formats?