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.

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 Zealand
director@mmpo.org.nz

2. Context of midwifery services in
New Zealand
In 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. Maternity Hospitals in New Zealand
New Zealand has 83 maternity
hospitals.
58 are midwifery run with no medical
obstetric services.

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 midwife
o 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 be
available 24/7.
Full time = Caring for 20-30 women
at a time.

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.
LMC
Continuity 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. 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. The role of the Midwifery and Maternity
Providers Organisation
o 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. 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. 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 reports
Midwifery research Professional analysis of midwifery activities.
Annual reports

10. MMPO Maternity Notes and MPMS.

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 Booking
Woman
LMC LMC Well child
Midwife’s Admission Midwife’s Provider
Electronic Electronic
Midwifery Labour and birth Midwifery General
MMPO PMS PMS practitioner
Midwife Postnatal inpatient
Other
Providers
Discharge
Woman’s electronic copy (USB stick)

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. 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. Advantages of this approach
o 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.