More Blood Questionnaire Changes
Last year I wrote about some huge changes to the questions in the Canadian Blood Services questionnaire. Recently I donated blood, and I discovered that the process has been revamped in some dramatic ways:
- The questionnaire is no longer administered on paper. You now sign into a tablet and complete the questionnaire on a screen.
- There is no longer a distinction between "high-risk" and "regular" questions. You now answer all the questions on the tablet (by yourself, in the privacy of a cubicle).
- Some questions have changed format. For example, the question about acupuncture has been split off into its own question.
- Although the question has not been changed yet, as of August 15 the deferral period for men who have sex with men will be dropped from five years to one year.
- Each question is accompanied with an icon that indicates its content.
These alterations fundamentally change the way that Canadian Blood Services screens for blood. By far the biggest change is eliminating the in-person questionnaire for high-risk questions. My understanding is that these high-risk questions would be asked in person because it is more difficult for people to lie to a human than to lie on paper (or on a tablet). Maybe there is some new research that refutes this understanding. We had better believe so; otherwise we have just increased the insecurity of the blood supply considerably.
I can understand why CBS wants to make everything electronic. Transcribing questions from paper to computers is inefficient and error prone. But I have a number of questions and criticisms around this:
- How secure are the wireless networks that are being used to transmit this information? Is the subnet blocked off from the rest of the Internet? Is it secured with strong encryption? This is medical data that is being thrown out over radio waves.
- How often do these tablets get sanitized? I can just imagine them being vectors of germs during flu season. The nurses go out of their way to use fresh gloves every time they touch a donor, but for some reason donor after donor can touch the same screen.
- This is a minor point, but now that the questionnaire is electronic it becomes much more difficult for me to monitor the questions for changes in policy. My days of monitoring CBS policy are probably over.
- What happens if the wireless (or the Internet? Yeesh.) goes out? Does that mean that nobody can donate blood?
The computer interface itself needs work. I messed up a question, and by the time I realized my error I was unable to backtrack through the questionnaire to fix my answer. The button you press to complete the questionnaire and sign out is completely unintuitive to the point where there were paper signs in the booth indicating what we needed to press.
On the other hand, answering questions one by one might mean we pay closer attention to them. I had not realized that acupuncture was on the list of "fun things that were banned" until doing the questionnaire on tablet, even though I have looked at the paper version of the questionnaire many times.
I am not as enthusiastic about the reduced men who have sex with men deferral as many other people might be, because I am more inclined to believe that most men who have sex with other men have multiple concurrent partners, and multiple concurrent partners increase the risk of disease transmission significantly. The blood website claims that the agency is considering behaviour-based screening, which would likely be an improvement. This won't help donors from Latin America, though, who will still be hit with the Chagas deferral (and which nobody seems to care about as much as they care about gay men being able to donate blood).
Canadian Blood Services is always changing its workflow. This feels like the most drastic change in some time (although I bet the nurses on shift would disagree). I am not sure how I feel about them. I worry that the safety of Canada's blood supply is being compromised, but we can all hope these fears are unfounded.