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A Clinician Led User Group                          Model to Enhance the                           Development of an      ...
Context of midwifery services in         New ZealandIn 2010, New Zealand had:   o 64,331 births   o about 95% in one of th...
Maternity Hospitals in New Zealand      New Zealand has 83 maternity      hospitals.      58 are midwifery run with no m...
The NZ maternity service is based on continuity of                  care called the Lead Maternity Carer (LMC) model.     ...
Information sharing points                               .           Notification of pregnancy to GP or MW                ...
Information sharing points                                                                      .                         ...
The role of the Midwifery and Maternity                           Providers Organisationo    Established by the New Zealan...
The Challenge of finding an electronic                  Maternity Practice Management System                              ...
MMPO management of midwifery data                             and payments    Woman                                       ...
MMPO Maternity Notes and MPMS.
Next step: what if the hospital has the                          same software?                             LMC midwife & ...
Northland and Otago DHBs moved to                    using the Maternity Plus system.o In 2007 Northland and in 2008 Otago...
User Group Model in action.o The Group consists of medical, midwifery and IT representation from both  DHBs, LMC midwifery...
Advantages of this approacho The number of potential changes are reduced to those critical and  agreed to be clinically im...
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A Clinician-led User Group Model to Enhance Development of an Electronic Maternity Record System

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Chris Hendry
New Zealand Institute of Community Health Care
(Friday, 10.30, Innovation in Practice 2)

After spending 6 years trialling 3 different electronic practice management systems for community midwives, in 2004, the Midwifery and Maternity Provider Organisation (MMPO) settled on an ‘off the shelf’ maternity PMS product. Midwives soon learned the value of a maternity specific PMS and worked with the vendor to enhance the product more. In 2008, the first of 2 District Health Boards also introduced the same software into their maternity service. In order to reduce the risk of system being hybridisation, the MMPO, DHBs and other users of the same software formed a national user group to guide future development of the product.
The user group works in partnership with the software designer and owner and is heavily represented by practicing clinicians, midwives and obstetricians which has enable the clinical application of the software to be developed more in keeping with day to day needs of the service.
This presentation will track progress of the development over time and identify key achievements such as being able to transfer the electronic record from the midwife’s PMS to the hospital when the woman is admitted, the development of a soft copy of the maternity record for women and the development of standardised reports for use in benchmarking between provider groups both in the community and hospital.

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Transcript of "A Clinician-led User Group Model to Enhance Development of an Electronic Maternity Record System"

  1. 1. A Clinician Led User Group Model to Enhance the Development of an Electronic Maternity Record Dr Chris Hendry Executive Director MMPO System. Christchurch New Zealanddirector@mmpo.org.nz
  2. 2. Context of midwifery services in New ZealandIn 2010, New Zealand had: o 64,331 births o about 95% in one of the 83 maternity hospitals in the country o At least 1015 midwives followed their women into the maternity hospital to continue providing care. o 900 of these midwives were not employed by the hospital.
  3. 3. Maternity Hospitals in New Zealand New Zealand has 83 maternity hospitals. 58 are midwifery run with no medical obstetric services.
  4. 4. The NZ maternity service is based on continuity of care called the Lead Maternity Carer (LMC) model. The woman chooses an LMC within the first 14 weeks of pregnancy.Care provided by the LMC midwifeo average 14 visits in pregnancy (home and clinic rooms)o continuous care during labour (home and/or hospital)o Daily visiting and assessments during the inpatient stay (48Hrs)o at least 7 postnatal visit (5 at home)The LMC or back-up needs to beavailable 24/7.Full time = Caring for 20-30 womenat a time.
  5. 5. Information sharing points . Notification of pregnancy to GP or MW Antenatal assessment by LMC. Antenatal HIV screening Pregnancy Antenatal scan & Blood tests. Cervical Screening register. LMCContinuity of care by LMC (For some) Specialist consultation. Care 10 – 15 Antenatal visits with LMC. Medical certificate to employer. Booking into Hospital for Birth. Further scan and blood tests. Hospital admission (LMC). Hospital Birth notification (BDM). Labour & birth information. care Postnatal inpatient care. New Born hearing screening LMC Discharge from Hospital. Immunisation register. care Home base postnatal care (5 visits). Birth notification to GP. Postnatally Referral to well child provider (at 2 weeks). Birth registration (BDM). Discharge from LMC to GP (6 weeks).
  6. 6. Information sharing points . Notification of pregnancy to GP or MW Antenatal assessment by LMC. Antenatal HIV screening Pregnancy Antenatal scan & Blood tests. Cervical Screening register. LMC Continuity of care by LMC (For some) Specialist consultation. Care 10 – 15 Antenatal visits with LMC.Midwife: Medical certificate to employer. Hospital Booking into Hospital for Birth.interface Further scan and blood tests. Hospital admission (LMC). Hospital Birth notification (BDM). Labour & birth information. care Postnatal inpatient care. New Born hearing screening LMC Discharge from Hospital. Immunisation register. care Home base postnatal care (5 visits). Birth notification to GP. Postnatally Referral to well child provider (at 2 weeks). Birth registration (BDM). Discharge from LMC to GP (6 weeks).
  7. 7. The role of the Midwifery and Maternity Providers Organisationo Established by the New Zealand College of Midwives in 1997 to assist case loading (self-employed) midwives with an efficient ‘midwifery friendly’ practice management service.o Goal to find a suitable PMS that enables midwives to meet the NZCOM quality assurance requirements for their peer review process.o From 2003 onwards we have provide LMC midwives with a comprehensive electronic maternity PMS.o Now have a membership of almost 900 self-employed midwives throughout New Zealand.o A by-product of the PMS is a midwifery activities and outcomes database which has built to 30,000+ women and their babies/year by 2010.
  8. 8. The Challenge of finding an electronic Maternity Practice Management System for Midwives.o We commenced the ‘hunt’ in the mid 1990s. Enlisted a software developer who, following months of free midwifery advice sold the product to hospitals.o Recruited another software developer who did the same.o Moved to a using GP PMS vendor. Their system was not adaptable enough to meet changes to MOH payment systems or midwifery reporting requirements. Also charged steeply for any changes/upgrades.o 2003 wiser, we entered into a partnership with a small maternity software developer in Auckland. Solutions Plus who was adaptable enough to meet our needs in a timely way at reasonable cost.
  9. 9. MMPO management of midwifery data and payments Woman NZCOM Electronic MMPO receives Midwifery MMPO Midwifery data in Data outcome PMS hard copy Data (SPSS) Midwife MMPO (MMPO Notes) maternity or electronically Claims notes Ministry of Health Payments to the midwife Payments to the MMPO Practice reportsMidwifery research Professional analysis of midwifery activities. Annual reports
  10. 10. MMPO Maternity Notes and MPMS.
  11. 11. Next step: what if the hospital has the same software? LMC midwife & hospital staff LMC midwife LMC midwife providing care providing care providing care Hospital BookingWoman LMC LMC Well child Midwife’s Admission Midwife’s Provider Electronic Electronic Midwifery Labour and birth Midwifery GeneralMMPO PMS PMS practitionerMidwife Postnatal inpatient Other Providers Discharge Woman’s electronic copy (USB stick)
  12. 12. Northland and Otago DHBs moved to using the Maternity Plus system.o In 2007 Northland and in 2008 Otago DHBs moved to the maternity Plus system.o The local LMC midwives were very familiar with this software.o The risk for midwives was the ‘hospitalisation’ of the software and hybridisation leading over time to different versions of the product.o National User Group model was developed and facilitated by the vendor.o All needed to agree to changes (not necessarily additions) to the system.
  13. 13. User Group Model in action.o The Group consists of medical, midwifery and IT representation from both DHBs, LMC midwifery representatives and MMPO representation as well as representation from independent users of the system.o Lists of suggested improvements and additions to the system are collected and sent for comment from the group by the developer.o An annual meeting is held with up to 20 people attending from the group.o An agenda for the meeting is prepared before hand with suggested adaptations to the system for discussion.o The developer facilitates the meeting and systematically goes through the agreed list for discussion.o The meeting concludes with agreed changes, timeframes and members feeling they have had a chance to share their concerns and desires.
  14. 14. Advantages of this approacho The number of potential changes are reduced to those critical and agreed to be clinically important.o Shared understanding of the need to keep the system stable and consistent.o With about 80% of attendees also clinicians using the system, there is a sense that ‘the dog is wagging the tail’.o There is more of a group approach (DHB and LMCs) to bedding the system into the hospital.o There is more potential for true benchmarking as the systems are identical and there is an agreed understanding of the content.o There is a true passion for improving the product because we can see that change is possible.

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