Audit of Portugal’s national information system for pregnancy termination: compliance and usability

Portuguese legislation mandates a national information system to register all pregnancy terminations performed in the National Health Service, supporting surveillance and service planning. Concerns about data completeness, validation rules and usability prompted an independent audit. We conducted a technical audit of the restricted-access electronic reporting form and underlying database. The assessment covered form structure, mandatory variables, validation rules, error notifications, conditional logic, usability and interoperability. Each criterion was scored against predefined standards, with 75% set as the minimum compliance threshold. Compliance proportions were calculated overall, by audit domain and by individual item. Overall compliance was 60.5%, with 83.0% conformity in form design but only 43.0% in system functionalities. Mandatory fields and legal options were largely present, but important weaknesses persisted. The system lacked automatic cross-field validation, global error alerts before submission and mechanisms to prevent duplicate records. Validation rules accepted implausible numeric values and inconsistently enforced gestational age limits, while conditional display of key fields was sometimes incorrect. Usability problems included outdated user guidance, missing explanatory legends and browser incompatibilities. No systematic logging or reporting of data entry errors was in place. The current pregnancy termination information system does not adequately support reliable registration and surveillance. Priority actions include modernising the platform, strengthening cross-field and range validation, implementing a pre-submission final check and preventing duplicate entries. Improving usability, interoperability and error monitoring will strengthen data integrity, timeliness and governance, supporting safer and more equitable sexual and reproductive health services.

Key messages

• The current pregnancy termination information system in Portugal has major functional weaknesses that limit data reliability, surveillance and service planning.

• Stronger validation rules, duplicate prevention, user-friendly design and routine error monitoring are needed to improve governance and data quality.