OB 2010: Utilization of a Customized, Computerized Pregnancy Data Management and Decision Support Program to Optimize Prenatal Care in a Residency Clinic Timothy Heilmann, MD The Williamsport Hospital Family Medicine Residency Program
An Unfortunate Occurrence…
What is it that makes providing high quality Prenatal Care so challenging? n n n n n Unique data set Large volume of pertinent patient information Multiple co-existing problems Numerous screening, treatment, and prevention recommendations Management extended over time Record availability at the point of care Limited time for thorough documentation Data collection for quality and billing purposes Potential for litigation
Limitations of paper-based prenatal records n n n Do not promote thorough documentation in an efficient manner Do not allow for dynamic, problem-focused care over time Limited capacity to prompt and remind Only available in one location at a time; moving charts between locations creates potential for lost charts, delay in access to critical data, etc. Data not easily accessible for quality of care analysis Paper system is expensive, bulky, disorganized, and often illegible
Limitations of commercial EMR’s n n n Expensive! Often provide features and functionality not needed in prenatal care Not configured for collecting, tracking, and displaying information unique to prenatal care Not easily configured or updated to promote current “best practices” Limited capacity to “prompt” indicated interventions over the course of pregnancy
Desired features of an “ideal” prenatal record system: n n n n Automatic calculation of various parameters (EGA, Due Date, etc. ) Imbedded “best practice” guidelines and protocols Automated and user-generated prompts and reminders Problem-based design Intuitive, efficient interface Automated generation of forms, requisitions, and reports ALL patient data only “one click away”
Our process: n n n Develop and continually update set of evidence-based prenatal protocols Incorporate protocols and standard care into prenatal database “Build” and efficient, user-friendly interface Maximize prompts, reminders, and information at the point of care Continually refine and enhance system based on user feedback
What we came up with: Majella Prenatal Care Record (Gerard Majella – Patron Saint of Pregnancy and Childbirth)
Majella Gestational Age Calculation
Majella Flow Data and Problem List
Majella Allergy Documentation
Majella Lab Results and Missing Labs
Majella Smoking Cessation Support
Majella Pregnancy Plans
Majella Missing Data Prompt
Majella Flu Shot Reminder
Majella Imbedded Prenatal Protocols
Majella Prenatal Teaching Record
Majella Miscellaneous Records
Did all this work make any difference? ? ?
Rh Negative Patients Antibody Screening + Rho. GAM 100% 50% 94% (33/35) 100% (36/36) PRE-Majella POST-Majella
Documented Smoking Status (Initial Visit) 100% 50% 97% (50/52) 100% (48/48) PRE-Majella POST-Majella
Documented Smoking Status (3 rd Trimester) 100% (48/48) 50% 43% (22/52) PRE-Majella POST-Majella
Depression Screening 100% (48/48) 50% 17% (9/52) PRE-Majella POST-Majella
Screening for BV in Patients with Previous Pre-Term or LBW 100% (5/5) 50% 21% (2/8) PRE-Majella POST-Majella
Screening for Asymptomatic Bacteruria (No Sx or Dx’ed UTI) 100% 50% 95% (46/48) 95% (42/44) PRE-Majella POST-Majella
Documentation of PP Contraception Plan 100% (48/48) 50% 27% (13/46) PRE-Majella POST-Majella
VBAC Counseling Completed & Documented by End of 4 th Month 100% 50% 62% (21/34) PRE-Majella 83% (43/52) POST-Majella
Documented Encouragement to Receive Influenza Immunization 100% (98/98) 50% 69% (38/55) PRE-Majella POST-Majella
Patients Agreeing to Receive Influenza Immunization 100% 50% 74% (73/98) 40% (22/55) PRE-Majella POST-Majella
Conclusion: A well-designed computerized prenatal care database and decision-support tool can significantly improve the capacity to provide high-quality, evidence-based prenatal care!
QUESTIONS?
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