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NMSDS compared with EEPD “Logical Priority”

15 February, 2011 (00:36) | Datasets, Initiatives, Logical Priority Standardised Q&A, National Programmes, workload | By: Helga Perry

This is a side by side comparison between the latest “National Maternity Services Dataset” January 2011
and Rupert Fawdry’s “Logical Priority” set of flow-patterned, logically and chronologically arranged set of Questions and all Allowable Answers (the minimum dataset for any functioning maternity and neonatal computer systems). The comparison is made available here for discussion and debate.

If this document does not display inline in this post, please click Download (PDF, 110.79KB) to access it, or you can go directly to http://www.fawdry.info/eepd/a_ini/nmsd/LogicalvNMSD.pdf

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Comment from Rupert Fawdry
Time February 15, 2011 at 00:52

The crucial importance of electronic data classification by value for Individual patient care; using “Smoking Habit at the time of Initial Assessment” as an example.

It has been suggested that my “labelling” of “Smoking habits at Booking” as an “Only for Analysis” (“Red”) item
might need further debate.

I hope that the following may help to put that debate in context:

From previous discussions I hope I am right in assuming that it can now be accepted

1. That hand held paper records (even using the “breakthrough” technology being piloted by the Perinatal Institute)
remain essential, – at least for the present in the U.K,

2. That even with the Perinatal Institute “breakthrough”, for the foreseeable future, analysable “initial assessment” electronic data will only be available if someone somewhere reads the paper record and then enters the data onto a computer

3. That, if we are to accept all the data that someone somewhere would like to have in electronic form,
the potential workload of electronic data entry is probably unsustainable.

4. That if that is true, it is worth trying to develop some system to prioritise what data items need to be selected as most worth having in electronic format

5. That this can be based either

a) on an attempt at a minimum data set consensus of some experts/stakeholders; (as is being attempted by the Information Centre, Leeds)

or b) that there might instead be some way to prioritise, based on what the electronic data is due to be used for. See http://www.fawdry.info/eepd/b_inp/01_eepd/WorkClassif.pdf

6. That, in the long term, option a) is not likely to succeed since there will be so many different priorities and stakeholders; and that in my personal view the NMSD is likely to be damaging to maternity care, not only here in the UK but also in the many countries world wide which look to the RCOG for leadership.

7. That my attempt at prioritising is by whether the data is used either

i) for individual patient care – with all data classified in this way (being electronic) being also available for electronic analysis for management and audit

or ii) electronic data that is, at least at present, only being collected in a way, or at a time, that is useful for later analysis

is probably/possibly a step in the right direction.

A good example of the difference is seen in the electronic data suggested
regarding the indication for an induction of labour.

The version proposed for the Logical Priority set of Questions & All Allowable Answer options is

Question: Indication for Induction / Ripening?
Allowable Answer Options:
Postdates (Default), Pre-Eclampsia (PET), Suspected Intra Uterine Growth Retardation (IUGR), Spontaneous Rupture of the Membranes (SROM), Past Obstetric History (Free Text), Other Obstetric Problems (Free Text), Maternal Pain (As reason for Induction e.g. Back, Symphysis etc) (Free Text), Maternal Distress / Social Reasons (Free text), Other (Free text)

where the answers can both be used to create the discharge letter to the GP/Health Visitor/Community Midwife
+ Long term electronic Summary of this pregnancy
AND also used for Audit, Management, Benchmarking.

[The full analysis as to how that set of answer options was selected can be seen in the discussion document at
http://www.fawdry.info/eepd/01_ess/c_datasets/C03_Inputs.pdf ]

or the equivalent being used all over South East England which requires the obstetrician to use one of the following answer options (which has to be entered on the Excel Database Caesarean Audit System available in each labour ward):

Question: Indication for induction?:
Allowable Answer Options:
Diabetes / Post Dates / SRoM / PIH / Cholestasis / Other.
with no other options, and no opportunity for free text
which is fine for Audit but of no use at all for anything other that that particular audit – (which is, in fact, quite independent from their Terranova maternity system also currently in use)

[The full set of Qs & As being used for the South East C/S Audit can be seen at http://www.fawdry.info/eepd/03_dat/p_audit/caesars/CSAuditBright10.pdf ]

If these propositions are accepted, then it becomes possible for us to have a useful debate as to whether in most UK hospitals at present”Smoking Habit at Booking” is a piece of data that should be classified as entered in an electronic format for

a) “Individual Care” + “Data for Analysis” (Green)

or if instead it should be classified as

b) “Only for Analysis” (Red)

and I would suggest that, quite rightly, in the Perinatal Institute or all other UK hand held records there is always these days a section with the written information on “Smoking Habit at Booking” so that each individual community midwife or doctor can know that an effort needs to be made to encourage that expectant mother to stop or reduce her smoking.

But that even using the new Perinatal Institute system, (which is piloting a unique and efficient, but so far expensive, way to collect electronic data), the electronic information about “Smoking Habit at Booking” is NOT (yet) used to improve the care of that individual mother. It is ONLY – so far – used to provide an audit – of the smoking habits in each district.

And therefore that a 1 in 10 ( or probably even a 1 in 100) sample is just as good as 100% electronic data in telling us,for audit and political purposes, that in that district last year for example 24% of women were smoking whereas this year only 20% were smoking at booking compared with another district where the change had been from 25% down to 15%

Hence my red colour for that data item.

Sorry to be so wordy but it is, at least to me, such an important principle.

and while I am happy to debate whether my classification decision in this particular case is right or wrong,I hope we can now see better that there are basic assumptions which we need to discuss and hopefully agree on, before debating the workload classification of any individual data item in detail.

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