Background/Objectives: Alcohol-related frequent attenders (ARFAs) constitute a small but resource-intensive emergency department (ED) population. Methods: Following PRISMA-ScR guidelines, we searched MEDLINE, PsycINFO, CINAHL Complete, and EMBASE from inception to May 2025 for empirical studies examining ED frequent attendance with alcohol involvement. Definitions had high heterogeneity; therefore, narrative synthesis was conducted. Results: A total of 73 studies were included, most retrospective (57.5%), encompassing sample sizes from 14 to over 4.1 million participants: 59 frequent attender (FA) studies with alcohol subgroup analyses and 14 pure ARFA studies. Research was concentrated in North America and Europe (56/73, 76.7%), with limited Asia-Pacific representation (21.9%). Seven distinct definition threshold categories were identified (≥2 to ≥20 visits annually); 31.5% utilised different definitions. Qualitative studies (n = 6) identified push factors (dependence, mental health crises, housing instability, fragmented services) and pull factors (24/7 access, crisis care model, immediate service) driving frequent attendance. Eight studies evaluated interventions; all employed non-randomised designs examining case management, integrated pathways, and community-based treatments. Conclusions: Critical gaps include the absence of standardised definitions for comparison across studies, a concentration of research in Western settings limiting global applicability, and insufficient rigorous intervention evidence. Priorities include developing empirically validated definitions, expanding non-Western research, and conducting randomised controlled trials with adequate follow-up.

Objectives To evaluate the association between asthma-related emergency department (ED) visits and weather, air quality, monsoons, haze and cultural festivals in Singapore.Design Retrospective cohort study.Setting A public healthcare cluster that covers 20% of the nation’s adult asthma population.Participants 2617 adult patients accounting for 5337 asthma ED visits between 2016 and 2024.Primary and secondary outcome measures Temperature, rainfall, wet bulb temperature (WBT), wind speed and Pollution Standards Index (PSI) were correlated with asthma ED counts at 0–7 day lags. Associations between ED visits and monsoons, transboundary haze and cultural festivals were evaluated using one-way analysis of variance. Weekly seasonal ARIMA models with exogenous regressors were fitted, incorporating PSI as a covariate and adjusting for demographic, clinical and socioeconomic factors.Results Asthma ED visits were positively correlated with PSI (lag 0: r=0.142; 95% CI 0.107 to 0.178) and inversely correlated with rainfall (lag 3: r=−0.062; 95% CI −0.099 to –0.026) and WBT (lag 1: r=−0.067; 95% CI −0.104 to −0.031). Wind speed (lag 2: r=−0.049; 95% CI −0.086 to –0.013) and ambient temperature (lag 6: r=−0.045; 95% CI −0.081 to –0.008) showed weaker inverse associations. Mean PSI was higher during haze (82.67 vs 51.46, p<0.001) and festival periods (53.42 vs 51.57, p=0.001). Mean ED visits fell across successive haze events (2.60 in 2016, 2.36 in 2019, 1.46 in 2023) but peaked during the Northeast monsoons despite lower PSI, indicating weather influences beyond ambient pollution.Conclusions PSI–ED association peaked on the same day of exposure but was no longer significant after adjusting for demographic and clinical factors. Pollution-linked festivals, transboundary haze and the Northeast monsoon were associated with increased asthma ED visits

Asthma inhalers are significant contributors of greenhouse gas emissions. However, less is known about the potentially avoidable carbon footprint i.e. medication wastage and oversupply. We aimed to analyse dispensing patterns and carbon footprints of asthma inhalers, quantify medication wastage, and identify determinants of medication oversupply. We reviewed the asthma-related dispensation records from 2015 to 2019, in an anonymised, cluster-wide repository linking electronic medical, pharmacy and administrative records, containing patient and visit details on demographics, comorbidities, GINA step, and site of care. Medication wastage, a visit-level measure, was defined as the number of inhalers dispensed in excess of the quantity required during each refill interval. Medication oversupply, a patient-level aggregated measure defined by medication possession ratio (MPR) > 1.2, where MPR equals total dispensed days (summed across all maintenance inhalers) divided by the follow-up period. All analyses were performed using R Studio. 205,337 inhaler units were dispensed over the study period, contributing an estimated 1,541,591 kgCO2e. The most frequently prescribed inhalers were SABA MDIs (79,007 units; 38.5

Background:The landscape of guideline-based asthma treatment in Asia remains unclear. Objective:Leveraging current evidence, we predicted the long-term economic impact of guideline-based asthma treatment in Asian countries, using Singapore as a case study. Methods:We systematically reviewed evidence between 2014 and 2024 on asthma prevalence, adherence to inhaled corticosteroid (ICS) with or without long-acting β-agonist (LABA), and frequency of short-acting β-agonist (SABA) use in Asian asthma populations. We developed a time-in-state model for the joint impact of ICS/ICS-LABA adherence and SABA use on the economic and humanistic burden of uncontrolled asthma during 2024 to 2043. Accordingly, we projected 20-year total direct costs, indirect costs, and quality-adjusted life-years (QALYs) lost associated with uncontrolled asthma in Singapore and assessed the varied impact of guideline-based asthma treatment. Results:Among 28 Asia-based, population-level studies, asthma prevalence was 1% to 12% in adults and 2% to 14% in children. ICS/ICS-LABA adherence, reported in only 3 countries, ranged from 10% to 90%; average SABA use was 2.5 to 6.4 canisters/year. In Singapore, under current trends of ICS/ICS-LABA adherence and SABA use, the 20-year burden of uncontrolled asthma is SGD$2.772 billion in direct costs, SGD$5.670 billion in indirect costs, and 58,872 QALYs lost. Optimizing guideline-based treatment nationwide (ICS/ICS-LABA medication possession ratio = 0.8, SABA use = 1 canister/year) reduces 20-year direct costs, indirect costs, and QALYs lost by 27.7%, 23.8%, and 28.8%, respectively. Conclusions:Population-based evidence on guideline-based asthma treatment in Asia is limited. Population-level modeling of its economic impact, using minimal key evidence, revealed substantial reduction in societal economic and humanistic burden in Asian countries such as Singapore.

PURPOSE:The prevalence and economic burden of asthma across the public healthcare landscape in Singapore is substantial, where the asthma patient journey often transitions between primary care (PC) and specialty care (SC) settings. PATIENTS AND METHODS:This study used the SingHealth COPD and Asthma Data Mart, a repository of clinical and administrative data from patients with asthma or chronic obstructive pulmonary disease, to collect real-time, real-world data across a range of demographics, disease severities and treatment pathways. RESULTS:Key differences were identified among patients treated in PC, SC, or both (PC/SC). There were more patients of Chinese ethnicity and ex-smokers among those treated in SC versus PC or PC/SC. Patients in SC also had a lower mean Asthma Control Test score (17.93 [standard deviation: 4.92]) versus the other groups (PC: 20.32 [4.37], p < 0.001; PC/SC: 19.65 [4.55], p < 0.001). More patients used low-dose inhaled corticosteroids in the PC (76.95 %) than SC group (60.1 %). Patients treated in PC/SC were older and had more frequent emergency department visits (0.54 [1.17] vs PC: 0.04 [0.16], p < 0.001; SC: 0.35 [0.92], p < 0.001) and exacerbations per patient/year (2.31 [3.37] vs PC: 1.48 [2.56], p < 0.001; SC: 0.96 [2.67], p < 0.001), and higher proportions had comorbidities versus PC or SC. Overall, nearly half of patients had uncontrolled asthma, 58.88 % of whom were in the PC group. CONCLUSION:Findings of this study provide greater understanding of the asthma public healthcare landscape in Singapore, allowing for the identification of current gaps in care, particularly for high-risk groups that may benefit from optimised treatment.

Inhaled corticosteroid (ICS) is the mainstay therapy for asthma, but general adherence is low. There is a paucity of real-world inhaler prescribing and adherence data from Asia and at the population level. To address these gaps, we performed a real-world data analysis of inhaler prescribing pattern and adherence in a multi-ethnic Asian asthma cohort and evaluated the association with asthma outcomes. We performed a retrospective analysis of adult asthma patients (aged ≥18 years) treated in the primary and specialist care settings in Singapore between 2015 to 2019. Medication adherence was measured using the medication possession ratio (MPR), and categorised into good adherence (MPR 0.75-1.2), poor adherence (MPR 0.75) or medication oversupply (MPR > 1.2). All statistical analyses were performed using R Studio. 8023 patients, mean age 57 years, were evaluated between 2015 and 2019. Most patients were receiving primary care (70.4%) and on GINA step 1-3 therapies (78.2%). ICS-long-acting beta-2 agonist (ICS-LABA) users increased over the years especially in the primary care, from 33% to 52%. Correspondingly, inpatient admission and ED visit rates decreased over the years. Between 2015 and 2019, the proportion of patients with poor adherence decreased from 12.8% to 10.5% (for ICS) and from 30.0% to 26.8% (for ICS-LABA) respectively. Factors associated with poor adherence included minority ethnic groups (Odds ratio of MPR 0.75-1.2: 0.73-0.93; compared to Chinese), presence of COPD (OR 0.75, 95% CI 0.59-0.96) and GINA step 4 treatment ladder (OR 0.71, 95% CI 0.61-0.85). Factors associated with good adherence were male gender (OR 1.14, 95% CI 1.01-1.28), single site of care (OR 1.22 for primary care and OR 1.76 for specialist care), GINA step 2 treatment ladder (OR 1.28, 95% CI 1.08-1.50). Good adherence was also associated with less frequent inpatient admission (OR 0.91, 95% CI 0.84-0.98), greater SABA overdispensing (OR 1.66, 95% CI 1.47-1.87) and oral corticosteroids use (OR 1.10, 95% CI 1.05-1.14). Inhaled corticosteroid (ICS) adherence has improved generally, however, poor adherence was observed for patients receiving asthma care in both primary and specialist care, and those from the minority ethnicities.

BACKGROUND:The challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to explore the potential benefits of Assertive Community Treatment (ACT) - an innovative, community-centered, harm-reduction strategy-in mitigating the frequency of ED visits, curbing Emergency Medical Services (EMS) calls, and uplifting health outcomes across a quartet of Singaporean healthcare institutions.METHODS:Employing a prospective before-and-after cohort design, this investigation targeted ARFAs aged 21 years and above, fluent in English or Mandarin. Eligibility was determined by a history of at least five ED visits in the preceding year, with no fewer than two due to alcohol-related issues. The study contrasted health outcomes of patients integrated into the ACT care model versus their experiences under the exclusive provision of standard emergency care across Hospitals A, B, C and D. Following participants for half a year post-initial assessment, the evaluation metrics encompassed socio-demographic factors, ED, and EMS engagement frequencies, along with validated health assessment tools, namely Christo Inventory for Substance-misuse Services (CISS) scores, University of California, Los Angeles (UCLA) Loneliness scores, and Centre for Epidemiologic Studies Depression Scale Revised (CESD-R-10) scores.DISCUSSION:Confronted with intricate socio-economic and medical challenges, the ARFA cohort often grapples with heightened vulnerabilities in relation to alcohol misuse. Pioneering the exploration of ACT's efficacy with ARFAs in a Singaporean context, our research is anchored in a patient-centered approach, designed to comprehensively address these multifaceted clinical profiles. While challenges, like potential high attrition rates and sporadic data collection, are anticipated, the model's prospective contribution towards enhancing patient well-being and driving healthcare efficiencies in Singapore is substantial. Our findings have the potential to reshape healthcare strategies and policy recommendations.TRIAL REGISTRATION:ClinicalTrials.gov, NCT04447079. Initiated on 25 June 2020.

Purpose:Patients with asthma in Singapore often have complex patient journeys, with diagnosis and management across various primary and speciality care settings. Real-world population health data is needed to identify care gaps and inform policies. Patients and Methods:This retrospective, longitudinal cohort study assessed real-world data from adults (aged ≥18 years) with asthma in the SingHealth Chronic Obstructive Pulmonary Disease and Asthma Data Mart, an integrated database of electronic medical records of patients who attended primary and/or speciality care clinics in the SingHealth Regional Health System 01/01/2015-12/31/2020. Patients were indexed by first asthma diagnosis and categorized into cohorts of index year. Patient characteristics, asthma management and outcomes were described during baseline (1-year pre-index) and follow-up periods (1-year post-index). Results:Overall, 21,215 patients were included across 4 cohorts: 2016, N=12,947; 2017, N=3419; 2018, N=2816; 2019, N=2033. Most common baseline asthma medication changed from inhaled corticosteroids (ICS) alone in the 2016 cohort (32.8% [n=4252]) to ICS/long-acting β2-agonist in the 2019 cohort (33.3% [n=677]). Asthma symptom control (mean [SD] Asthma Control Test scores) improved from 2016 to 2019 during baseline (18.38 [4.93] vs 19.87 [4.56]; p<0.001) and follow-up (18.34 [4.23] vs 21.07 [3.51]; p<0.001). Mean (standard deviation [SD]) number of exacerbations per patient during follow-up decreased from 2016 to 2019 (1.91 [3.11] vs 0.89 [2.07]; p<0.001). Mean (SD) number of emergency department visits per patient during follow-up decreased from 0.21 (0.75) in 2016 to 0.17-0.18 (0.60-0.65; p<0.001) between 2017 and 2019. Conclusion:Health status at first asthma diagnosis improved for each succeeding cohort from 2016 to 2019, along with improvements in patient management and outcomes. This reflects greater awareness of the condition and improved use of medication and referrals in recent years, suggesting policy changes and their implementation, including promotion of disease awareness and adoption of guideline recommendations, may improve asthma outcomes in Singapore.

Introduction: Asthma guidelines have advocated for the use of quality-of-care indicators (QCIs) in asthma management. To improve asthma care, it is important to identify effective QCIs that are actionable. This study aimed to evaluate the effect of the presence of 3 QCIs: asthma education, Asthma Control Test (ACT) and spirometry testing on the time to severe exacerbation (TTSE). Method: Data collected from the SingHealth COPD and Asthma Data Mart (SCDM), including asthma patients managed in 9 SingHealth polyclinics and Singapore General Hospital from January 2015 to December 2020, were analysed. Patients receiving Global Initiative for Asthma (GINA) Steps 3–5 treatment, with at least 1 QCI recorded, and at least 1 severe exacerbation within 1 year before the first QCI record, were included. Data were analysed using multivariate Cox regression and quasi-Poisson regression models. Results: A total of 3849 patients in the registry fulfilled the criteria. Patients with records of asthma education or ACT assessment have a lower adjusted hazard ratio (HR) for TTSE (adjusted HR=0.88, P=0.023; adjusted HR=0.83, P<0.001). Adjusted HR associated with spirometry is higher (adjusted HR=1.22, P=0.026). No QCI was significantly associated with emergency department (ED)/inpatient visits. Only asthma education and ACT showed a decrease in the number of exacerbations for multivariate analysis (asthma education estimate: -0.181, P<0.001; ACT estimate: -0.169, P<0.001). No QCI was significant for the number of exacerbations associated with ED/inpatient visits. Conclusion: Our study suggests that the performance of asthma education and ACT was associated with increased TTSE and decreased number of exacerbations, underscoring the importance of ensuring quality care in clinical practice.

Background: Certain alcohol misuse patients heavily utilise the Emergency Department (ED) and Emergency Medical Services (EMS) and may present with intoxication or long-term sequelae of alcohol misuse. Our study explored reasons for repeated ED/EMS utilisation and sought to understand perpetuating and protective factors for drinking. Methods: Face-to-face semi-structured qualitative interviews were conducted. Participants were recruited from an ED in Singapore. Interviews were audio-recorded, transcribed verbatim and underwent manual thematic analysis. Emergent themes were independently reviewed for agreement. Data from medical records, interview transcripts, and field notes were triangulated for analysis. Results: All participants were male (n = 20) with an average age of 55.6 years (SD = 8.86). Most were unemployed (75%), did not have tertiary education (75%), were divorced (55%), and had pre-existing psychiatric conditions (60%) and chronic cardiovascular conditions (75%). Reasons for utilisation included a perceived need due to symptoms, although sometimes it was bystanders who called the ambulance. ED/EMS was preferred due to the perceived higher quality and speed of care. Persistent drinking was attributed to social and environmental factors, and as a coping mechanism for stressors. Rehabilitation programs and meaningful activities reduced drinking tendencies. Conclusion: ED/EMS provide sought-after services for alcohol misuse patients, resulting in high utilisation. Social and medical intervention could improve drinking behaviours and decrease overall ED/EMS utilisation.

INTRODUCTION Excessive alcohol consumption is associated with increased morbidity and mortality, and its societal impact is substantial. The Nationwide Alcohol-related visits In Singapore Emergency departments study aims to characterise trends in ED visits involving acute and chronic alcohol consumption between 2007 and 2016. METHODS Data from the Singapore Ministry of Health, comprising all ED visits in Singapore from 2007 to 2016, were used. The data were aggregated by year and analysed for changes in prevalence and rates of ED visits for acute and chronic alcohol consumption, broken down by age, gender and ethnicity. RESULTS Over the study period, the number of ED visits involving alcohol consumption increased 98.3%, from 2236 in 2007 to 4433 in 2016. During the same period, the rate per 100 000 population increased 62.4% from 48.7 to 79.1, and total ED-related costs rose by 140%, from 528 680 to 1 269 638 SGD. The increase in alcohol-related visits rates and costs was higher than non-alcohol-related visits rates and costs, which increased by 12.1% and 115% respectively. While trends in acute and chronic alcohol-related ED visits stayed stable amongst women, they rose substantially in men. Older men aged 50-69 show the highest rates and rate of increase for both acute and chronic alcohol-related ED visits. DISCUSSION AND CONCLUSIONS Alcohol-related visits contributed disproportionately to the increasing number of ED visits in Singapore between 2007 and 2016. Older men form the demographic with the highest rates and increase in rates of alcohol-related ED visits and form a potential group for targeted intervention.

Background: Type 2 diabetes mellitus (T2DM) and its related complications represent a growing economic burden for many countries and health systems. Diabetes complications can be prevented through better disease control, but there is a large gap between the recommended treatment and the treatment that patients actually receive. The treatment of T2DM can be challenging because of different comprehensive therapeutic targets and individual variability of the patients, leading to the need for precise, personalized treatment. Objective: The aim of this study was to develop treatment recommendation models for T2DM based on deep reinforcement learning. A retrospective analysis was then performed to evaluate the reliability and effectiveness of the models. Methods: The data used in our study were collected from the Singapore Health Services Diabetes Registry, encompassing 189,520 patients with T2DM, including 6,407,958 outpatient visits from 2013 to 2018. The treatment recommendation model was built based on 80% of the dataset and its effectiveness was evaluated with the remaining 20% of data. Three treatment recommendation models were developed for antiglycemic, antihypertensive, and lipid-lowering treatments by combining a knowledge-driven model and a data-driven model. The knowledge-driven model, based on clinical guidelines and expert experiences, was first applied to select the candidate medications. The data-driven model, based on deep reinforcement learning, was used to rank the candidates according to the expected clinical outcomes. To evaluate the models, short-term outcomes were compared between the model-concordant treatments and the model-nonconcordant treatments with confounder adjustment by stratification, propensity score weighting, and multivariate regression. For long-term outcomes, model-concordant rates were included as independent variables to evaluate if the combined antiglycemic, antihypertensive, and lipid-lowering treatments had a positive impact on reduction of long-term complication occurrence or death at the patient level via multivariate logistic regression. Results: The test data consisted of 36,993 patients for evaluating the effectiveness of the three treatment recommendation models. In 43.3% of patient visits, the antiglycemic medications recommended by the model were concordant with the actual prescriptions of the physicians. The concordant rates for antihypertensive medications and lipid-lowering medications were 51.3% and 58.9%, respectively. The evaluation results also showed that model-concordant treatments were associated with better glycemic control (odds ratio [OR] 1.73, 95% CI 1.69-1.76), blood pressure control (OR 1.26, 95% CI, 1.23-1.29), and blood lipids control (OR 1.28, 95% CI 1.22-1.35). We also found that patients with more model-concordant treatments were associated with a lower risk of diabetes complications (including 3 macrovascular and 2 microvascular complications) and death, suggesting that the models have the potential of achieving better outcomes in the long term. Conclusions: Comprehensive management by combining knowledge-driven and data-driven models has good potential to help physicians improve the clinical outcomes of patients with T2DM; achieving good control on blood glucose, blood pressure, and blood lipids; and reducing the risk of diabetes complications in the long term.

Introduction: Inhaled therapy, particularly inhaled corticosteroids (ICS), is the cornerstone of asthma treatment. Few studies have examined prescription patterns of inhaled therapy in primary care practice in Singapore. Aims: To retrospectively describe prescription patterns of inhaled therapy and frequency of prescription changes in primary care in Singapore. Methods: A retrospective analysis of electronic health records of two large primary care centres was conducted in adult asthmatics with ≥2 visits from 2017-2019. A prescription change was defined as change in ICS uptake, long-acting beta-2 agonist (LABA) uptake, dose, ICS medication, or inhaler device type. Logistic regression was used to examine factors associated with prescription change. Results: Data from 1307 patients (mean age 60.8 years, SD 14.1; 58.3% female) were analysed. 77.3% patients were prescribed controllers, of which 55.7% comprised combination inhalers. 24.2% patients had a prescription change (mean, 1.38; min, 1.0; max, 4.0) where 58.8% were dose changes. Factors associated with prescription change were poor symptom control, Asthma Control Test<20 (OR, 2.12; 95%CI, 1.55-2.90); exacerbations in the past year (OR, 1.61; 95%CI, 1.11-2.31); increased SABA prescription (OR, 1.17; 95%CI, 1.08-1.28); ever-smokers (OR, 1.44; 95%CI, 1.01-2.04); gastro-oesophageal reflux disease, GERD (OR, 1.94; 95%CI, 1.23-3.02). Conclusion: Prescribing practices in Singapore align with guidelines, but there is a need to improve ICS uptake as >20% were not on an ICS at the end of 2019. Identification of GERD and smoking as associated with prescription change highlights a need to advocate smoking cessation and treat symptomatic GERD in asthmatics.

Background : We describe the development of a dynamic simulation modelling framework to support agile resource planning during the COVID-19 pandemic. The framework takes into consideration the dynamic evolution of the pandemic and the rapidly evolving policies and processes to deal with the ever-changing outbreak scenarios. Methods : A specific use case based on short-term bed resource planning is described within the proposed framework. The simulation model was calibrated against historical data for the Singapore COVID-19 situation. The time period for model calibration was from 1st April till 30th April 2020. The model was used to project for bed resource needs over the period from 1st May 2020 till 31st May 2020. Multivariate sensitivity analysis was also conducted for ICU and general isolation bed demand, length-of-stay (LOS), and age-adjusted conversion rates across different care needs. The unmet needs under various scenarios were also evaluated for planning purposes. Results: Several variants of the agile resource planning model were developed to adapt to the fast-changing COVID-19 situation in Singapore. The use case demonstrated an agile adaptation of the model to account for previously unexpected scenarios. The rapid evolution of the pandemic locally revealed streams of new infections that arose from two distinct sources. The model projections were calibrated with the latest data for short-term projections. The agility in flexing plans and collaborative management structures to rapidly deploy human and capital resources to surge the level of care during the COVID-19 pandemic have proven utility in guiding the allocation of scarce healthcare resources and helped system resiliency. Conclusions : The rapidly evolving COVID-19 pandemic in Singapore has necessitated the development of an agile and adaptable modelling framework that can be quickly calibrated to changes both from demand and supply. The modelling framework is able to deploy systems modelling concepts in a holistic manner. This facilitates the evaluation of complex cause-and-effect relationships. A robust collaborative framework, coupled with the availability of in-depth domain knowledge and accurate and updated data availability ensures a model is realistic, timely and useful.

The renal cell carcinoma registry (RCCR) at the Singapore General Hospital was established in the 1980s. In 2012, the registry transited to a partially automated system using Research Electronic Data Capture (REDCap) and Oracle Business Intelligence Enterprise Edition (OBIEE), which is a platform for retrieval of electronic data from the Electronic Health Intelligence System (eHIntS). A committee was formed of experts from the department of urology and the health services research center, as well as an information technology (IT) team to evaluate the efficacy of the partially automated system. In the 5 years after the new system was implemented, 1,751 cases were recorded in the RCCR. The casefinding completeness increased by 1.9%, the data accuracy rate was 97%, and the efficiency increased by 12%. Strengths of the new system after partial automation were: (1) secure access to the registry via the hospital Web, (2) direct access to REDCap via the electronic medical records system, (3) automated and timely data extraction, and (4) visual presentation of data. On the other hand, we also encountered several challenges in the process of automating the registry, including limited IT support, limited expertise in matching data variables from RCCR and eHIntS, and limited availability and accessibility of eHIntS information for import into REDCap. In summary, despite these challenges, partial automation was achieved with the REDCap/OBIEE system, enhancing efficiency, data security, and data quality.