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Volume 5. A draft set of flow-patterned
& all allowable Answer Options
which give “Logical Priority”
to “Individual Care”
Volume Editors: Rupert Fawdry and Helga Perry
Current Master copy of Panel05 is with: RF (-13RF.pages)
To see a sample page Click here
Discussion Link: http://eepd.org.uk/?p=438
“If electronic records are to fulfill their potential,
the best precise wording, and the appropriate flow-patterned timing(s),
for each electronic Question
and all allowable Answer Options
needs to be open-access fully documented
on the internet - once and properly"
It is clearly impossible to agree internationally (or even nationally!) immediately on the electronic standardisation of every potential question and every potential answer in all of maternity and neonatal care.
The task is too great.
But if Electronic Patient Records are to fulfil their full potential one must start somewhere, since without such bedrock standardisation it will never be cost effective:
a) to write the complex computer programs which will provide both immediate, individualised, on-screen timely information about both a “Prognosis of Risks” and, more important, any appropriate “Action Suggestions” based on single or groups of “Trigger Data”
b) to create high quality individualised computer printouts.
c) Incidentally to provide internationally standardised detailed and reliable complex data for analysis, audit and benchmarking and
d) to allow standard sets of data either i) to be transferred from one electronic system to another e.g. from a primary care system to and from a maternity or anaesthetic or theatre system (see Volume 15. S.IN.B.A.D.S: Standard INterprogram Bundles of Associated Data) or ii) the same set of data from a single massive database will need be selected as appropriate in a particular context
Until there is adequate standardisation staff will continue to waste time re-entering the same data into independent computer systems for different purposes together with a multitude of different paper proformas e.g. Hydatidiform Mole Registrations, Adoption Proformas, Post-Mortem requests, Health Visitor Records, UKOSS forms etc. - neglecting the mothers and babies under their care because of so much time spent on paperwork and electronic data-entry.
Priority for Data Standardisation
Standardisation is proposed as a FIRST priority ONLY for those items which would seem to be of value in the care of individual (expectant) mothers and babies (“Patient-Centred IT care“) whenever there is a “Four (or Five) Guaranteed Places“ Maternity & Neonatal EPR Computer System.
FOUR PLACES Perinatal computer systems are defined as those where Terminals & Printers are always reliably available:
a) whenever Scans are done
b) in the Delivery Suite
c) in all Maternity Wards & Obstetric Theatres
d) in all Neonatal Care Units.
FIVE PLACE SYSTEMS
Also sometimes [e) Initial Assessment also]
Data needed for use in these places is often, to save time later, entered earlier - in another place such as a secretaries office. However, if, after being entered electronically, the data is not accessed again for any purpose then the system should still be categorised as a “Four Place System”. If “Initial Assessment” data is used for Individual Care at places other than the four places above then the system should be categorised as a “Five Place System”. (For a more detailed analysis see the Contents Section
IMPORTANCE AS A SPINE FOR OTHER DATA
This chronologically-based, flow-patterned data-set not only helps to prioritise the massive amount of work involved; but also provides a clear “spine” into which it becomes easier to fit any proposed additional data items.
(Updated 30 Sep 2010)
Volume 5. The draft chronologically arranged, flow-patterned
”Logical Priority” set of questions and all allowable answers,
is, by far, the most important part of the EEPD website project.
It has been, (and, as far as I know, still is) unique in the following.
1. The first U.K. (anywhere?) attempt known to me to provide, in draft form, open-access complex documentation with the following characteristics:
a. Openly Accessible on the web for worldwide viewing and feed-back As far as possible avoids any overlap between identical electronic data items used in different contexts e.g. The Neonatal Care set of Questions and Answers should not include the baby’s “Method of Birth” or “Birth Weight” since these data items are part of the dataset for every birth. The subsections of both the EEPD Volume 4. (Resource Document) and this volume address this essential requirement. See the index for these documents for further information.
b. Complex questions are separated into their component parts e.g. Pain relief options involving the Anaesthetic department need to be separate from those only involving the midwives. Too often traditional coding has involved separate problems in one code e.g. Premature Twins.
c. Complex enough to be useful for “individual care” maternity and neonatal electronic records.
d. yet the Minimum which facilitates a functioning Individual Patient-care Orientated perinatal computer system
e. as a result, with the Potential for International Standardisation.
This being the essential foundation for further progress in maternity computing
g. suggests a full list of All Allowable Answer Options,
h. with “Other (free text)” always allowing free text option whenever appropriate.
i. with “Unknown (free text)” always available if appropriate
2. The only maternal or paediatric dataset so far seen which uses a logical (workload / cost), rather than the current arbitrary basis (i.e. a whole series of incompatible short term expert advisory committees) for the selection of items for inclusion or exclusion. This basis is summarised here.
3. The only project which not only documents what has been included, but also, through the EEPD Volume 4. (The Resource Document), documents those data items which, for what I have described above as a FOUR PLACES system, have been excluded or not so far been prioritised, and gives reasons for this.
Until we standardise on the kind of foundation which the “Logical Prioritisation” dataset now provides electronic patient records created by different organisations or commercial companies will remain incompatible. This will not only limit their use for statistical purposes; but, much more importantly, without much more standardisation it will make it much more difficult and expensive to use the power of IT to encourage a better quality of care for individual patients.
Two Crucial Foundation Concepts in the EEPD
This draft is an attempt to provide a standardised, chronologically-based, flow-patterned set of data definitions both for the wording of the question and for the allowable answer options.
It forms one of the two most crucial parts of the EEPD website.
The second crucial concept concerns the need to accept a hybrid system of paper records and electronic records with full documentation of what should happen at each maternity or neonatal RIO (Realistic Input/Output Opportunity).
Essential Spine for Additional Data Items
The “Logical Prioritisation” chronologically-based, flow-patterned set of draft question and answer definitions not only helps to prioritise the massive amount of work involved; but also provides a clear “spine” into which it becomes easier to fit all future proposed all additional data items.
Any Feedback very welcome
Rupert Fawdry (Updated 9 Nov 2010)