Why the EEPD?
EEPD Structure
Slide Shows
Publicity Flier
Help Please
New Words and Concepts
I.  Discussion Topics
 II.  Nightmares!
 III.  Datasets(>80)
 IV.  Data Resource
 V.  Logical Priority
VI.  Perinatal RIOs
VII.  Prognosis
VIII.  Signposts
IX.  Leaflet Lists & Links
 X.  Whiteboards
 XI.  Casenotes
XII. Proformas (inc. Gyn)
XIII. Computer Printouts
XIV. Care Paths
XV. S.IN.B.A.D s
XVI. Questionnaires
XVII. Codes
XVIII. Audit Benchmarking
XIX. Filofaxes Mnemonics
XX. Anecdotal Evidence
XXI. Training
XXII. Organisation
XXIII. Equipment
XXIV. Leaflets (inc. Gyn)
XXIV. Safe Motherhood
XXVI. Neonatology
XXVII. Gynaecology
A. Initiatives
B. Related WEB sites
C. Commercial IT
D. IT Contracts
E. IT Programs
F. Publications
G. Contacts
RISCOS essential
About R Fawdry
Feedback
EPR News
Acknowledgements
Web Design

 

    Previous Volume    Next Appendix

 

EEPD. Appendix A.

Maternity & Neonatal IT initiatives 

Volume Editor:  Helga Perry and Rupert Fawdry (So far)

Current Mastercopy is with: RF (as “PanelA-8RF.pages”)

If interested in the possibility of editing this volume Click here

 Discussion Links: None specific yet.  Use EEPDtalk at www.eepd.org.uk

Help others to improve their paper and electronic records.

 

Summary

 

Over the past 30 years there have been a whole series of United Kingdom initiatives (all paid for by the tax-payer) with often minimal overlap between such initiatives, either on paper, or regarding personnel involved, (apart from the fact that I have been a voluntary, unpaid “expert adviser” to almost all of them, with my “expert advice” always ignored, hence my spending well over £100,000 of my own income to try with the EEPD to do what I have long been convinced was really needed!). 

 

It is intended that this appendix should facilitate access to as many relevant documents or websites as possible.  

 

The present chaotic situation is summarised diagrammatically in

 

www.fawdry.info/eepd/00_ima/poster/13a_Mountain.pdf and

 

www.fawdry.info/eepd/00_ima/poster/07_Chasm.pdf

 

and a discussion document on what is really required in any dataset relevant to Perinatal Medicine can be see at  

 www.fawdry.info/eepd/01_ess/c_datasets/C01_Credible.pdf

 

For the MINIMUM dataset which is useful for the care of Individual Expectant Mothers and not just for Managers to analyse see the Logical Priority MINIMUM DATASET - Anything less is useless for Individual Care

http://www.fawdry.info/index.php?&id=25

 

The Three Main national U.K. Perinatal Data / 

Electronic Records Initiatives

 

In the light of my long knowledge and involvement in maternity data and maternity records (ever since 1979); and the fact that I had provided the knowledge engineering for what was one of the most successful U.K. maternity computer system (Protos - now iSoft/Evolution - at one time 40/200 total U.K. sites) and that I was personally involved in one way or another in most of the maternity IT initiatives in Britain over the past 25 years, (See www.fawdry.info/eepd/a_ini/RFandIT.pdf) I seem to have acquired more information about what has been happening in maternity NHS-IT than anyone else that I have yet met.

 

In particular I have been involved as an unpaid advisor to all the three largest U.K. government funded attempts to provide the basis for progress in maternity computing, - each of them costing the taxpayer a total of about half a million pounds each.  As far as I am aware none of them has proved to be of any use in any functioning perinatal computer system.

 

Sadly the present situation can still be summarised in my “Berlin Wall” diagram, See www.fawdry.info/eepd/00_ima/poster/06_BerlinW.pdf

 

As can be seen, almost all those which have been funded by central government have not provided anything useful at all!

 

In reverse chronological order:

 

C. National Maternity Services Data Development Project (NMSD2005 - 07, 2009-current) 

 

To see the official NMSD Excel file dated 21st January 2011 click on this

 

www.fawdry.info/eepd/a_ini/nmsd/NMSD2010.xls

 

to understand the jargon

 

click here www.fawdry.info/eepd/a_ini/nmsd/NMSDJargon.pdf

 

 or you can try to see the most recent version on the Information Centre website at

 

http://www.ic.nhs.uk/services/datasets/document-downloads/maternity

 

Since such an Excel file is in the form of almost unreadable columns of small print and requires an A3 size coloured printer, has no flow-patterning I have taken all the text and re-formatted it so that ordinary doctors and midwives can more easily see what it includes, and what is missing.  The re-formatted version using exactly the same text can be seen here:

 

www.fawdry.info/eepd/a_ini/nmsd/NMSD2011.pdf

 

This version is said to document 192 items of data.  This was clearly such nonsense.  An example of such nonsense can be seen at www.fawdry.info/eepd/a_ini/nmsd/NMSDNonsense.pdf 

 

I therefore spent unpaid hours carefully separating the different questions. A proper analysis of the total number of data items required by management is about 450 as can be seen from the following full analysis 

 

www.fawdry.info/eepd/a_ini/nmsd/NMSD2011Plus.pdf

 

Assuming that computer terminals would for many years in the UK only be guaranteed at four places, a) labour ward, b) scan room c) maternity wards and d) special care units,  I also classified each of the 450 data items by their value in the care of individual mothers

By clicking here you can see an early version of their “Final Report”

www.fawdry.info/eepd/a_ini/nmsd/FinalReportv0-2.pdf

And for my conclusion against a checklist of what is required from any Perinatal Dataset see

www.fawdry.info/eepd/a_ini/nmsd/CheckNMSD.pdf

 

====================================================================

 

This initiative started with high hopes in November 2005

 

By 2007 there were 663 data items on massive Excel spreadsheets - 400 pages of A3 coloured paper.  distributed electronically for comment via the internet.

 

As far as I can see it has never been studied in detail by any health professional but myself.  How could they unless they had access to an A3 coloured printer?  The fact that it has never been checked by clinicians can be confirmed by seeing mistakes which would have been obvious to any doctor or midwife!

 

My conclusion is that those who are responsible for this initiative did not understand how maternity care works; and even more damaging did not understand how computers work  Guided by a project executive board, not one of whom seems to have had any hands-on IT database or programming experience.  Still in 2010 acts as if computers were magic and ignores totally the basic principle that “Every Extra Keystroke Costs” both in time and in wages. In particular it failed to recognise the need to prioritise Individual Patient Care rather than the collection of data for management as illustrated by www.fawdry.info/eepd/00_ima/Towers.pdf   ???

 

This most expensive failure provoked me to try to set out the criteria for any useful future perinatal data initiative as can be seen at  

 www.fawdry.info/eepd/01_ess/c_datasets/C01_Credible.pdf

 

and the assessment table as set out in

 

 www.fawdry.info/eepd/01_ess/c_datasets/C01_CheckList.pdf

B. The Maternity Care Data Dictionary Project. 

- MCDD (1998-2001) 

 

November 1998.  Project started with a day long discussion in my own home.  Very promising start but later totally lost it’s way. Took all the questions and answers in the Protos system, arbitrarily changed the wording, for example from “Birth:Second Stage Start Time” to  “Labour: Second Stage Start Time”  to  and then re-arranged the questions alphabetically. so that they could all fit into a standard database!

 

An alphabetical dictionary is only useful if the names and content of the area covered has been agreed before starting to write the dictionary.  Just as the English language had to be in common use before any dictionaries could be created, so there has to be a complete agreement on all definitions in a neonatal IT system before sorting the agreed terms alphabetically. You don’t first create a dictionary and then write the world’s first stories!

 

Outcome was therefore, quite rightly, finally rejected by NHS-IT management.

 

Again, despite major expense, this failed to provide virtually anything that has proved to be useful; mainly because those who controlled the funding totally failed to appreciate the level of complexity involved. As with almost all other initiatives those involved failed to appreciate the need for any criteria for the inclusion or exclusion of individual data items or the need to provide the detailed analysis required for each item.

 

For a full analysis as to why this project particular project failed see my Discussion Document entitled “Why am I now so disillusioned?” and “What can now easily be done to rescue the project?”  www.fawdry.info/eepd/01_ess/w_whistles/W02_Disill.pdf

 

A. The MUMMIES project.  (1988 - 92)

 

An Attempt to Data Model the Process of Maternity Care following Traditional IT methodology.

 

Based on a major attempt to provide an NHS-IT Common Basic Specification, as applied to Maternity Care using “Prince” project control. 

 

I myself, then of Milton Keynes, and Kevin Dalton, Senior Lecturer of Cambridge University, were co-opted as “expert advisors”  The direction and funding remained totally in the control of NHS-IT “experts”

 

2 midwives, 2 IT people, Secretary, Research Registrar (Mike Lumb).  New Offices and Equipment. Massive output of “Data Modelling” documents over four years.

 

Final Documented Direct Cost £392,635; not including the major investment of time by full time NHS-IT staff. It failed to create anything which has subsequently proved to be useful in the development of maternity computing. As far as I know, nothing now remains apart from a final report which claimed that the project had “fulfilled it’s objectives” - despite not having provided anything useful to anyone!  I recently found a copy of the final report in my attic and have scanned it for anyone who might be interested in the way in which data modelling techniques have been attempted in this area.

 

Draft Final Report. February 1992.

www.fawdry.info/eepd/a_ini/MUMMIES/mummies.pdf

What went wrong each time? 

 

All these three failed major projects had in common was that they were (and are) totally controlled by “IT” experts whose continuing employment depended on persuading their paymasters as to the value of their work.  However much, as an expert advisor, one tried to shout that “The Emperor has no clothes”, so great has been the unjustified belief by those in control in the magic of computers that the money has continued to be provided by politicians and NHS administrators, even when, over and over again, nothing useful was (and is) being created.

 

The Powerless

Each time it seemed that those who understood the problems of maternity computing were the powerless; such as a) the “IT Midwifes” who in so many hospitals have, for various reasons, been seconded to “look after” the maternity IT system; or b) those trying to sell functioning maternity systems; who had to meet the demands of each new site even when they knew that excessive local tailoring made no sense; or c) IT personnel closely involved in the above projects who came to see the nonsense of what was being attempted but could not persuade their superiors to face reality.

 

And the Powerful

And the powerful (politicians, managers and financial) continued to believe in computers as all magic

 

And so the EEPD

 

It was in the light of what I have learnt from these costly failures that this web site was created on by personal initiative and at my own experience (At today’s prices about £100,000 so far)

Other Initiatives

 

There were numerous other NHS Maternity and Perinatal Initiatives or Projects (not including Audit Initiatives), almost all also paid for by the tax-payer, only some of which are still relevant. 

 

So far the EEPD website includes some documentation concerning the following:

(much of it on the website but without hyperlinks yet due to overwork.

 

The Scottish SMR initiative (            - current)

 

The Maternity Tail

 

HES Initiative (??? - current)

 

The Brighton Maternity IT Project (

 

Benchmarking Project (

 

The Thames Project. (1999)  

Maternal and child health information systems: a validation and demonstration project 

 

The MANNERS project (??? - current)

West Midlands Perinatal Unit Data collection project

 

Maternity “Do One and Share” NHS-IT project (2005-current)

 

Original invitation circular

 

www.fawdry.info/eepd/a_ini/DOONEANDSHARE/DoOneandShare.doc   nnn

 

NHS Contract Proposals (

 

Maternity Outcome Dataset Proposals

 

Captivating Data Proposals

 

Revised Korner Proposals

 

Brief Revised Korner Proposals

 

Original Korner Initiative

 

 

Rupert Fawdry (Updated 20 Jan 2011)

 

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The EEPD by Dr. Rupert Fawdry is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/. Permissions beyond the scope of this license are available via http://eepd.org.uk/?page_id=56.
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