The heavy burden of data gathering on midwives and the search for clinical systems suited to midwifery practice were common themes at “Due Data”, a meeting organised by the EHI CCIO Leaders Network and the Royal College of Midwives.
Opening the meeting, EHI director, Linda Davidson, said that midwives had always been in lead in sharing information with pregnant women via the shared maternity record but there were some serious issues to be tackled in midwifery data management and information use.
“Managers have voiced their frustration to me that they are expected to produce ever more detailed information about their services and analysis of their performance with vanishingly little informatics support.
“Clinical staff, especially those in the community find themselves dealing with multiple systems many of which do not talk to one another and offer little or nothing back in terms of information to support their practice.
“While some have digipens and laptops, others still struggle along with pen and paper and duplicate data entry,” she said.
A positive example of electronic maternity record keeping came from Claire Brookes, clinical services manager, and Sharon Hackett, midwifery services manager, of Portsmouth Hospital NHS Trust. They described their award-winning service transformation using digipens and BlackBerry smartphones in the community to record and transmit information to records.
The service, which took the top prize in last year’s EHI Awards, introduced digipens for recording maternity information which can be sent to central records via the smartphones.
Benefits have included success in freeing up time to care for women and babies, reduced travelling time, some changes in working practice, the eradication duplicate entry and greater support for lone workers.
Planned developments include: a pilot site for a Personal Child Health Record (PCHR – the RedBook online); links between community midwives and the hospital maternity unit and linking community midwives with pathology services.
Patricia Reilly, IM&T clinical systems manager at the Countess of Chester Hospital, who is about to re-enter midwifery practice, spoke of the difficulty in finding systems that supported the profession’s work. So many systems on the market were from the US where there were few midwives and the role of the obstetric nurse was very different.
“I haven’t found a system out there that I would like to buy yet,” she said. Was a national solution the answer? she asked.
Reilly said it was vital that midwives got involved with informatics and made sure all their requirements were recorded before procurement of a clinical system started. She has listed 900 so far.
Bringing clinical knowledge into the IT department was invaluable, she said. Equally, those in clinical practice needed to engage with their IT departments.
“I hate to have people moaning about the IT department when I could do something about it [the source of the problem],” she said. “I wish they would send an email or stop me in the corridor.”
She echoed a general concern at the meeting about the amount of data midwives were collecting.
“There are 151 items in the new Maternity Minimum Data Set. We seem to collect lots of data but analyse only a small subset. We must do the data collection but there is little guidance on how to do it.”
Julie Tindale, who served as national clinical lead for midwifery at the Department of Health Informatics Directorate (DHID) and Connecting for Health and is a member of the Maternity Dataset Implementation Group, pointed out that without data collection for secondary uses, the answers to important questions about maternal and child health would not be known. Actual birth rates, mode of delivery of the baby and preset feeding rates at six weeks after birth were among the issues she cited.
She listed the Maternity and Children’s Data Set (MCDS) benefits:
However, Tindale acknowledged the difficulties in finding an up-to-date clinical system that has a support department that is able to ‘speak maternity’.
She suggested that the solution could lie in midwives sharing best practice; signposting to systems that work and forming local networks choosing shared or collaborative systems.
The meeting was supported by CCIO Leaders Network Foundation Sponsor: BT, Cerner and CSC.
© 2012 EHealth Media.
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The CCIO (CMIO) here in the US, serves to bridge the gap between the IT and clinical sides. More often than not, these members have utilized the systems frequently pushed down to the end-users and experienced the frustrations first-hand. From this frustration they arise to fulifill a much needed role, most often without additional compensation.
It is imperative that health-care organizations, serious about their success in implementing any IT solution, creates a role and fills it with a qualified, competent individual who can guide them through this process articulating the needs of both the clinical and IT technical side. Good Luck EHI! I am behind you too from across the pond.
There is still some way to go to persuade some people in key positions that Health Informatics is a discrete profession. At the same time, information systems are becoming a more complex and interventional part of healthcare. Translation between technical possibility and clinical need is an important role that CCIO CT/IO pairs can provide. This translation is best underpinned with some common training and professional standards. There is no time to lose in uniting the UK's activities in Health Informatics professionalisation and investing in training, including sub-specialist accreditation.
EHI's CCIO Campaign is something we think has the potential to help move things along in NHS IT, by focusing on the central role that end users, clinicians, have to play in ensuring the success of IT projects and use of information. We think that championing the development of more local clinical information leaders will benefit to local NHS organisations.
Too many past IT projects that have disappointed or struggled have suffered from not having adequate clinical leadership or engagement. Similarly, many projects that succeeded have at their heart strong clinical involvement.
Another problem is that NHS IT professionals and clinicians have often been cast as adversaries, rather than partners, and having experienced clinicians leading on information projects should help overcome this divide.
Clinical information champions and eventually CCIOs are not a magic bullet or panacea, but we hope that it will help build up local skills and grow confidence in the full potential of IT and information to deliver significant improvements in the quality of patient care.