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Giving “logical priority” to individual care

3 September, 2010 (21:09) | Datasets, EPR, Logical Priority Standardised Q&A, Patient-Centered Care, R.I.O.s, S.IN.B.A.Ds, Standardisation | By: rupertfawdry

see EEPD vol. 5. A draft set of Questions and all Allowable Options… 

This is the most important section of the EEPD project.

Summary 

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 one must start somewhere if Electronic Patient Records are to fulfil their full potential, 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

d)  to allow standard sets of data to be transferred from one electronic system to another, e.g. from a primary care system to and from a maternity system (see EEPD Volume 15. S.IN.B.A.D.s: Standard INterprogram Bundles of Associated Data

Until there is adequate standardisation staff will continue to waste time filling in 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. 

Primary Data Standardisation first

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 Guaranteed Places“ Maternity & Neonatal EPR Computer System, i.e. where terminals & printers are always reliably available: 

  • a)  whenever Scans are done
  • b)  in the Delivery Suite
  • c)  in all Maternity Wards
  • d)  in all Neonatal Care Units

This emphasis has led to the “Logical Priority“ Draft International Perinatal Data Definition Proposals.

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 the first 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.

 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 because it is

  1. Probably the first U.K. (or even worldwide) attempt to provide, in draft form and openly available, a complex documentation with the following characteristics:
    • a. Chronologically arranged
    • b. Flow-patterned
    • c. Openly accessible on the web for worldwide viewing and feedback
    • d. as a result, with the Potential for International Standardisation – this being the essential foundation for further progress in maternity computing
    • e. Complex enough to be useful in all maternity and neonatal electronic records, yet
    • f. the Minimum which facilitates a functioning Individual Patient-care-orientated perinatal computer system
    • g. suggests a full list of All Allowable Answer Options, with
    • h. “Other (free text)” always allowing free text option whenever appropriate, and
    • 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 in the following link: http://www.fawdry.info/eepd/00_ima/poster/12_RFClassif.pdf
  3. The only project which, not only documents what has been included, but also, through the EEPD Volume IV. (The Resource Document), those data items which, for what I have described above as a Phase 1 system, have been excluded or not so far been prioritised, and why.

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. 


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