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Latin American Perinatal Information System

17 October, 2010 (20:25) | Datasets, EPR, Initiatives, Interoperability, National Programmes, Paper Records, Patient-Centered Care, perinatal data | By: Helga Perry

EEPDtalk has received some very interesting information from Jose Luis Diaz Rosello from the Latin American Center for Perinatology, reproduced here with his permission:

Dear all

Thanks for your kind invitation to comment on your area of expertise in Perinatal Software and explain CLAP/SMR/PAHO (Latin American Center for Perinatology / Women and Reproductive Health Unit  of the Pan American Health Organization) experience in Latin America and Caribbean with SIP (Perinatal Information System).

Our System aims to provide basic Evidence and Value Based good quality Primary Health Care to every woman and her newborn.

Our system is not meant to cover every problem of each pregnant woman and her infant, but gives information to understand most of each individual’s needs at every level of care.

Since 1985 we have developed software to satisfy the burden of Health Services Statistics and the first DOS version allowed us to get a unique leading position in most Public Health Ministries of the Region and approval by public hospital authorities. At that time every statistic (Caesarean section rates, number of antenatal visits, etc) was a complex hand search process and seldom done.

Since then it was named Perinatal Information System. Most professionals associate it with the software that allowed digital filing of every record, usually at discharge of the mother and baby, and a Basic Indicators Automatic Report that satisfied managerial needs.

This unique opportunity allowed us to create a standard record in one sheet and its mirror image the Perinatal Passport or Antenatal Card printed in card stock.

Since then the greatest advantage of the system has been that  works in paper. It was accepted because of the software features but is unique and useful because of the Standard Clinical Record.

Mothers carried with them all the information needed from the antenatal clinics to the hospital for delivery. (you may call it; paper telematic!)

The standard of data is reviewed and updated every two years by international consensus. As we are the technical center of the PanAmerican Health Organization, the Ministries of Health of all the 35 countries  of the region accept and contribute to the agreed  definitions for each variable. A standard  glossary of  technical terms  was accepted for the Region allowing to compare results and compile large data files from different countries.

We consider this as a very important asset. The digital era is building a Babel Tower that will preclude the needed comparisons between institutions.

Our system is also “informatic” because it helps the provider of Health Services to compare observed data with that expected. Unexpected data are highlighted when recorded in the yellow boxes.  This simple method helps to transform data into information “on site” without a computer, and thus helps in the care of each individual patient.

We have also developed simple tools like the fundal height measuring tape that has the normal values for each gestational age, providing additional references to transform data into information.

Our records have recently also been issued in ideographic format for illiterate rural healthcare providers, as well as the fundal height measuring tape and gestational wheel. This was requested by the few countries, like Peru and Bolivia, that still have some isolated rural areas with Amerindian populations.

Given that the forms are standard in all e region  it is possible to have training manuals with instructions on how to fill in the clinical records and also to use the software.

As you may have seen the software now allows data entry in a screen that is a facsimile of the clinical record. This is very “user friendly” but also adds a valuable feature. The one single sheet record can be printed as an impeccable copy of the handwritten original form. This allows an easily read paper file to be kept . Retrieving the records in the screen is also in the same format.

Finally, the rationale for the variables selected to provide the Road Map of basic perinatal care needed to be explicit for training purposes and also work as a job-aid for inservice training and updating of knowledge.  The Guidelines for the Continuum of Care of Mothers and Newborns can be downloaded from Publications in our Website.

You may see that we used a format that links the rationale for good practices with the record format. By using the Record as a reminder of what has to be asked, examined, prescribed or advised, the rationale for each Evidence and Value Based data  is linked with the Maternal Card and Clinical Record.

This strategy aims to fill the gap between knowledge and practice at the most peripheral settings of a Health Care System starting with the preservice training in the schools of Medicine, Midwifery and Nursing, when they get acquainted with the records at a time they have time to understand the basis of good practice.

Last week we presented our experience at our WHO Global Headquarters in Geneva and representatives of the AFRO Region were most interested in the system. The reason is that they are eager to improve their health services and need a standard of data to simplify the flow of information from the outpatient clinics to the maternity wards.

I hope we may keep a productive communication with your experience. Although the needs of your developed system of care may be different, I am sure that it will help us to improve ours.

Best regards

Jose Luis Diaz Rossello

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