Devices & Technology

Intelligence Meets Obstetrics through Electronic Patient Records

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By Suzi Birz, principal, HiQ Analytics

The goals are simple: improve patient care, patient safety and documentation at the point of care, all while decreasing medical malpractice risk. Sound good? That’s what E&C Medical Intelligence set out to do with the Intelligent Patient Record for Obstetrics (IPRob).

Eyal Ephrat, M.D., chief executive officer of E&C Medical Intelligence, summarized the objective of the package as producing a “quantifiable, statistical reduction in errors and better quality indicators.”

Intelligent Patient Record for Obstetrics

There are three components to the IPRob: the obstetrics chart, the best practices knowledge base and the risk management service.

The chart allows workflow of the multidisciplinary team and results in the official chart with information entered throughout the entire stay. By addressing the continuum of care in obstetrics, the collaborative effort is enhanced with one common place for the documentation of care. The system is used in the inpatient setting and in the prenatal, ambulatory setting from the first visit through the last post-partum visit six weeks after delivery. It accepts data from fetal surveillance systems and appropriately exchanges information with enterprise and ancillary clinical systems eliminating double entry.

The best practices knowledge base is customized to a specific hospital. The knowledge base includes published guidelines, information from the American College of Obstetricians and Gynecologists (ACOG) and regulations from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), as well as required practices in support of clinical activities and risk management.

“These two components combine to create a chart that understands the state of the patient and what we need to do in real time,” Ephrat explained, calling this the “best care, best documentation, best risk management approach.”

The system is used by obstetrics staff members, including physicians, nurses and midwives. Documentation is facilitated by menus, which are arranged based on the kind of documentation being entered, easing the navigation.

The system generates prompts, alerts and suggestions in a number of ways. While a clinician is documenting, the system reacts and presents to the clinician suggestions on what should be done from a care and documentation perspective. Throughout the day, information from monitors such as fetal heart rate or blood pressure is sent to the system. If the system detects changes requiring action, a prompt will be sent to the workstations on the unit. If a response is undetected by further documentation, the prompts escalate and can be programmed to page a physician. Similarly, if a patient protocol requires documentation at a particular time, prompts will be generated.

The third component is the risk management service. Before turning the system on at a hospital, E&C analyzes a statistically relevant sample of written charts to identify deficiencies and weak points. Once the system is in use, E&C returns at the end of each quarter to show areas of improvement, areas in need of continued improvement and new opportunities for improvement.

Data is entered into structured fields providing hospital staff the opportunity to use this information for quality, risk management and performance improvement. Standard reports are available on the system to respond to daily, weekly or monthly needs. In addition, report-writing tools are used to query the database for special studies or reports.

A Case in Point

Two years ago, administrators at Flushing Hospital Medical Center, in Flushing, New York, made the decision to implement the intelligent patient record for obstetrics. Since that decision, nursing staff have played a key role on committees and in quarterly reviews and updates. Nursing is essential, providing input on policy changes and staff requests.

Maria Demarinus Smilios, RNC, BSN, CCE, represents nursing in these meetings in her role as clinical nurse manager for the inpatient perinatal unit.

The system has impacts on day-to-day activities of nurses, as well as research and management responsibilities, Smilios said. One of the biggest benefits is the elimination of illegible notes and orders, preventing errors and promoting patient safety. Smilios added that having access to the prenatal portion of the chart eliminates the paper chase to get the data from clinic visits. For her management role, Smilios pointed out that the data is available post-discharge for questions that arise or for use in gathering data across the patient base.

Take-away Messages

Ephrat would like nurses to remember two things when thinking about an electronic chart: “This system understands what nurses have to document and customizes the data entry to mirror the workflow,” he said. “And the system can assist the nurse to provide better care by understanding the current situation and bringing forth the right information at the right time regarding relevant clinical actions and documentation.”

Smilios encouraged: “Do not turn away from the new and innovative. Be open to systems; give it a chance and it can be of benefit.”


E&C Medical Intelligence

Flushing Hospital Medical Center

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