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Twelve Points for cost-effective, clinician-friendly Maternity IT

18 June, 2011 (21:32) | Data quality, EPR, hand held records, Interoperability, maternity care, Midwifery, Paper Records, Patient-Centered Care, perinatal data, Standardisation, workload | By: rupertfawdry

Twelve Point Summary

Why an open-source internet initiative will eventually be recognised as essential for cost-effective further progress in Maternity IT and other shared hospital / community health care systems.

  1. Reliable computer access cannot be guaranteed in shared Hospital / Community Health Care.
    Despite various experimental schemes, Electronic Patient Records alone have not yet proved themselves to be practical or cost-effective when medical care needs to be provided by several different disciplines working in many different places because neither patients nor health care staff have guaranteed reliable access at all times to a single electronic system.
  2. In maternity care electronic access can only be guaranteed in:
    1. Obstetric Ultrasound Department
    2. Delivery Suite
    3. Maternity Wards
    4. Special Care Baby Units

    5. – and also in some hospitals

    6. At the time of the Initial Assessment
  3. Paper Records are therefore irreplaceable.
    Paper records, especially the hand-held record, will continue to have an irreplaceable role in all shared care health systems, because of the open readability and flexibility of paper. In all shared care we need therefore to work out how to cope with hybrid paper and electronic IT systems.
  4. A Comprehensive Collection and Analysis of Existing Paperwork is essential.
    The only long-term solution to the complexity involved is to start by taking full account of all relevant existing paperwork, including:

  5. Easy Access to Existing Paperwork.
    Assembling and documenting all the relevant paper work takes years.
    Once assembled it needs to be easily accessible to those wishing to take full account of all relevant material.
    This is best achieved by an internet-based Repository or Storehouse of pdfs and hyperlinks.
    All medical computer systems depend on work of this sort, but this writer is not aware of open access to the basis for other medical computer systems, such as is now being provided by the EEPD.
  6. Decisions about INPUTS are the bedrock foundation of all Electronic Patient Records.
    In each medical speciality, electronic records will never be cost-effective until each potential data item is fully analysed and there is standardisation of logically- and chronologically-arranged, flow-patterned electronic INPUTS of each question and all allowable answer options.
    The quality of output data will always depend on the standardisation of inputs.
    Always remember that “Every Extra Keystroke Costs.”
  7. Analysable Electronic Records are like Rigid Railways not Flexible Roads.
    Any free text, when not entered in a totally structured fashion, can be read, but can only rarely be used for anything else.
    And just as it is impossible to integrate different complex railway systems after they have been built, it will also never be cost-effective to attempt more than minimal interoperability between different incompatible medical databases after they have been created.
    And, like different incompatible railway systems, after their installation, complex medical computer systems (as required for maternity care) can only be significantly upgraded by being completely and expensively replaced!
    (see also
  8. Clinical Expertise essential.
    IT experts, however good, cannot provide the detailed understanding which is essential.
    Itʼs as if the taxpayer were paying printers to create best-selling publications with writers only acting as occasional unpaid advisors.
    Only clinicians with a clear understanding of what computers can and cannot do are able to provide the knowledge required.
    Sadly, there are very few hospital clinicians worldwide who are also sufficiently “IT Nerds” as to have the motivation, the time and the opportunity to provide what is required.
  9. Therefore, a Generic approach is mandatory.
    It is pointless to continue to waste such invaluable expertise on scores of separate incompatible and commercially confidential computer systems.
    At present it is as if each different maternity computer system is written in a different language or uses a unique coding system.
  10. A Wiki approach via the Internet is going to be essential.
    The task is so large that it can only be achieved using a collaborative Wiki approach over the Internet.
  11. Highest Quality Displays and Printouts needed.
    The risk of human errors depends on the information displayed on the VDU and the quality of all computer printouts.
    The data entry workload of front-line clinicians depends on the full analysis of the electronic inputs into different medical computer systems and on how many proformas can, in full or in part, be created as computer printouts.
  12. Either the EEPD will eventually succeed
    or, starting all over again, something similar will need to be re-created.



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