This study aimed to develop a cost-effective, reliable, automated, and easy-to-use electronic questionnaire that can guarantee the safety of personal data.

The Uro-Neurology department has been using 16 different paper-based questionnaires for various conditions. Maintenance of these questionnaires requires sufficient space in the department and administrative workforce. In addition, these paper-based records should be kept safe for many years as per data protection requirements. A previous audit from the same department showed that the quality of filled data needs to be improved for statistical analysis. This was due to incompletely filled questionnaires and missed papers questionnaires. 

The department made a few attempts in the past to acquire digital questionnaires to improve the quality of the data acquisition and the service in response to the audit findings. There were a set of pre-requisitions on the department while procuring any digital questionnaire solutions.  

1.	The department should not install third-party software or applications on any office computer. 
2.	It can use Ms Excel to create a digital questionnaire but should not use Macros in MS Excel.
3.	It should not use any software programme that can pull demographics or patient-sensitive information from electronic health records.
4.	It should not ask any of its patients to install any applications on their mobile phones or computers that can generate questionnaires.
5.	The IT department should approve all electronic questionnaires. 
6.	All electronic questionnaires should be compliant with the General Data Protection Regulation. 
7.	All applications used to create electronic questionnaires should be scalable and easily adaptable on versatile platforms such as mobile phones, tablets, and computers. 
And finally 
8.	Any innovation should reduce the cost of running and maintaining the service and the workload on the existing staff members. 
Considering the above constraints, the department resorted to Microsoft Power Automate (MPA) to create a digital questionnaire. MPA is one of many free-to-use inbuilt applications within the Microsoft 365 package.  It is a cloud-based application approved by the hospital IT administration. The flow chart of MPA interacting with peripheral applications is shown in Figure 1.

The department has decided to implement the SF-Qualiveen questionnaire in a digital format.  SF-Qualiveen is a simple questionnaire consisting of eight questions to assess the health-related quality of life of patients with urinary disorders in neurologic conditions (1). 

The SF-Qualiveen form was created by using MS Forms. All the questions in this questionnaire were made compulsory by default. After filling in all relevant questions, the patient can only hit the submit button. This ensures the quality of the received data for further analysis. Creating a questionnaire using MS Forms does not require programming skills; hence, all users can participate while designing a form. An SF-Qualiveen digital format link was shared via email with patients who consented to receive emails. Patients can open and fill out this questionnaire in their leisure time on their mobile phone or tablet, or personal computer. In this process, the patient does not need to install any Microsoft applications or Windows. Once the patient fills out the questionnaire, an automated acknowledgement will be displayed on the screen stating that the information was successfully conveyed to the hospital.  

MPA will be triggered automatically when the patient fills out the questionnaire. MPA will pull the data from MS Forms and populate the database on MS SharePoint. Once again, creating a database on MS SharePoint does not require any programming skills, but some familiarity is needed. MS SharePoint automatically calculates individual scores and overall scores for SF-Qualiveen. MPA takes patient input from MS Sharepoint and generates pdf formatted reports, and triggers simultaneous actions of storing the information on MS-OneDrive, sending pdf reports to administrative staff to upload onto electronic healthcare records and sending customised emails to the concerned healthcare professionals to review the patient’s feedback in real-time in pdf format. Once emails are dispatched, it auto-deletes the data on OneDrive.

Small Acorns Fund- UK donated two electronic tablets to the department (Samsung Galaxy Tab S7 12.4”). Many patients in this study used these two tablets to complete the questionnaire while in the department, but several patients preferred to use their mobile phones to complete the questionnaire.

Seventy-two patients (46 Women, 26 Men; range: 20 –78 years) consented and used the SF-Qualiveen electronic questionnaire between 1st July and 9th December 2022. Five patients (6.9%) found it challenging to use an electronic tablet (Samsung Galaxy Tab S7 12.4”) due to their dexterity issues and were helped either by their relatives or healthcare staff members. 

Patients or clinical or administrative staff members did not raise concerns using this electronic questionnaire.  No questionnaire-related information was stored on the patient’s gadgets. No episodes of system crash or loss of data or incomplete data acquisition were noted. The department invested no funds to run or maintain this electronic questionnaire. 

Clinical staff can access pdf reports with automatically calculated individual scores such as Bother with limitation, Fear, Feeling, and Fear and limitations scores. MPA can also provide anonymised data in an Excel sheet for research.

The introduction of electronic questionnaires drastically reduced staff members' workload compared to maintaining paper-based questionnaires. 

MPA was not connected or interacted with electronic patient records, so there was no breach of patient confidentiality. 

The department also created and tested questionnaires for The Neurogenic Bowel Dysfunction Score, Urinary Symptoms Profile, International Prostate Symptom score and Female Sexual Function Index scoring, which are ready for deployment. 

Patients who experienced difficulties using electronic tablets would have experienced the same difficulty when using paper-based questionnaires, but that needs to be investigated. Further studies are required to understand patients' preferences between paper-based and digital questionnaires. 

A single clinical scientist helped in creating the digital questionnaire for the department. Even though MPA does not require programming skills, some familiarity with MPA is required. Prospective departments have to invest in their staff to upgrade their IT skills.

Creating electronic questionnaires based on Microsoft Power Automate is cost-effective, reliable, safe, quick, and easy to implement in the Uro-Neurology department.