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Volume 6. Maternity and Neonatal "R.l.O.s"
(“Realistic Input-output Opportunities”)
Volume Editor: Rupert Fawdry (So far) To see a sample page Click here
Current Master copy is with: RF (as “Panel06-6RF.pages”)
If interested in the possibility of editing this volume Click here
To see a sample page Click here
Discussion Links: http://eepd.org.uk/?p=202
Outline of a R.I.O Click Here
This volume will eventually become one of the largest of all since its aim is a detailed and precise documentation of what may appropriately occur at each Realistic Input/Output Opportunity (R.I.O)
The definition of a R.I.O. is a time when, in the process of medical (e.g. maternity and neonatal) care, it is likely to be practical for a health professional to interact, cost effectively, with a reliable and accessible electronic computer system (VDU, keyboard & printer) of gradually increasing complexity.
Each maternity and neonatal R.I.O. having been identified, this volume then attempts to identify in detail
a) What paper documents are needed at that time
b) Who should be present, if possible
c) What whiteboard data display outputs, data inputs and automatic or optional printouts may eventually be appropriate on each such occasion.
In the absence of finding a suitable word for such occasions, the writer has invented the acronym “Realistic Input-Output Opportunity” or “R.I.O.“
(Updated 18 Nov 2010)
Computers in a hospital setting will only reduce the workload, stress and fear of litigation of health care workers (and be cost effective) when they provide “Individual Patient Care” especially “Patient Encounter Assistance” of the highest standard. For the acute specialties (medicine, surgery, gynaecology, maternity care, paediatrics, orthopaedics etc.) this will depend on
Identifying and Exploiting R. I. O.s (Realistic Input/Output Opportunities)
Forget about replacing all hospital paper records in acute specialities worldwide with an electronic record. If everyone concerned with pregnancy care could carry something like an iPhone it would be technically possible. But in a world where two thirds of birth take place without a trained attendant it is so impractical that it will almost certainly never happen, or will prove so expensive as to only be relevant to wealthy clients of wealthy countries. (Sadly, millions will continue to be wasted on such fantasies by the combination of gullible clinicians and plausible computer salespeople - while women continue to die from anaemia and infection).
Conditions required for a fully electronic maternity system (PDF)
It is therefore essential to identify when it might be truly practical for data from paper records to be efficiently input into a computer terminal, without too much extra work for staff.
The computer can then be used to create an automatic output of sufficient useful paper printouts (expert suggestions, patient information leaflets, staff guidelines, letters and memos, and eventually laboratory requests etc.) as to make the work at data entry worthwhile in assisting the health worker with the care of that individual patient.
To be welcomed by staff the majority of such RIOs (especially “Patient Encounter Assistance” RIOs) will need to include at least the following:
a) Presentation of important data already on the computer on a “White Board” (but only data which is currently relevant, e.g. Rubella Status only after the end of a pregnancy), then
b) an opportunity for Flow-Patterned Data Entry, without re-entry of data already entered elsewhere on the electronic record. Next,
c) a presentation of context-relevant Risks of various adverse outcomes e.g. Postpartum haemorrhage, followed by
d) Expert Action Suggestions or “Signposts” (never rigid rules, protocols or guidelines: the art of professional judgement is far too complex for such simplicities). Such “Action Suggestions” are based on electronic “Trigger Data” items or combinations.
e) information including data entry criteria and patient leaflet information about any relevant Clinical Trials, and finally
f) proposals for Paper or Electronic Outputs. Such outputs will include not only Memos, Letters and Proformas and Summaries but also individualised Patient Information Leaflets, incorporating plain English consent forms specific to any proposed procedure.
Because of the complexity of the computer programming involved, this cannot be achieved by any local IT initiatives. Instead it will depend on the creation of computer specifications for national (and eventually international) use which will also in turn depend on:
High Quality Standardised National Paperwork
A significant number of well motivated and experienced clinicians will need to be inspired (and funded?) to work creatively over many years to create high quality (nationally?) standardised paperwork - Casenotes, Protocols, Patient Information Leaflets, Guidelines, Operation proformas etc (See EEPD Volumes 11-14)
All hospital doctors will then gradually have to be persuaded to use a much more structured style of recording medical information e.g. National Pregnancy Record, Operation Proformas etc,
These principles have been clearly established during the development of the Protos Maternity and Diabetic Computer System at many different hospitals over the past 20 years.
Rupert Fawdry (Updated 18 Nov 2010)