This is not a new problem. Until the early 1980s, activity data was usually obtained manually from surgical records. By using the operation protocols, it was possible to gather information on the number of operations, operating theatres, surgeons and teams, and then use this data to prepare annual reports and operation lists for candidates who needed documents, etc. Over thirty years ago, as a thoracic surgeon at Oslo University Hospital, Rikshospitalet, I took the initiative to establish an expanded register known as Datacor (4). The database contained risk factors, technical surgical data and outcomes, and healthcare personnel carried out structured registration before, during and after the surgery. In the period 1989–2016, Datacor delivered monthly activity and quality reports. In addition, data were delivered to the Norwegian Register for Cardiac Surgery (5) and the European Adult Cardiac Surgical Database (6).
Operations and interventions are still being performed in Norway without sufficient, ongoing quality control. Quality control should be a requirement
Registering data is a time-consuming process, and should therefore be limited to only what is necessary. It is hard to find motivation for registering data that will not be used. In my experience, it is best to start with a small database and then add more elements as needed. Based on the exact definition of the factors, the registration itself should be limited to a 'yes' (in a logical field) or the numeral 1 (in a numeric field). Experience shows that forcing the person doing the registration to answer 'no' in 20–30 fields does not improve on the registration. The risk factors and quality indicators chosen for inclusion will vary from discipline to discipline. The Norwegian Directorate of Health has developed and defined an excellent set of indicators for a range of disciplines (7). The database program should also automatically check for age and gender (the ninth digit in the national identity number), as well as calculate body mass index, body surface area, kidney function (creatinine clearance), risk score and, if desired, DRG code.
Many colleagues want to use simpler databases that allow them to perform analyses and create reports themselves. Hospital owners most often want centralised storage of large amounts of data (8). Good access control and secure storage are probably more important than the choice of database. Regardless of the platform, the new databases must be able to meet the EU's requirements regarding protection of personal data (9).