FEATURE WOMENS HEALTHCARE 031
MULTIPLE CARE LOCATIONS A pregnant woman often receives care from more than one location during the course of her pregnancy. She may visit her primary care provider office, her obstetric- or midwifery clinic, a hospital, a diagnostic centre, and perhaps even receive home care visits, all of which may require the use of more than one type of documentation. Often, there is a lack of standardization in documentation across these various venues of care, creating a challenge for the provider who wishes to compare the woman’s clinical results over time. A well-designed electronic health record which suppor ts the ability to record information across the pregnancy continuum brings all of her pregnancy-related results into one centralized place for review and treatment.
DECISION SUPPORT Many of the diagnostic tests that are performed during pregnancy correspond with the gestational age of the baby and need to be completed at specific points in time. Some tests may not be accurate unless they are done during a certain age, identifying conditions that may put the woman or her unborn child at risk. For example, pregnant women are often screened for gestational diabetes at around 24 weeks gestation, because that is when the condition begins to show itself. Women who are diagnosed with gestational diabetes early in the course of the disease can be actively managed by their providers throughout the pregnancy, reducing the risks associated with this condition. Paper records make this process difficult, because they force the provider to rely on manual methods for tracking the timing of tests and their results. Electronic systems have the ability to automate the daily calculation of the woman’s current estimated gestational age, pushing the suggested plans of care to the provider. In the gestational diabetes example, the physician or midwife can view an automated message that reminds them that the patient is now 24 weeks gestation and the glucose tolerance test has not yet been ordered. Rules and alerts such as this one can help catch things that may have been missed by a busy clinician. They also help reduce the time clinicians spend tracking information.
Another benefit of electronic systems is the capability to include
graphs that automatically post results in meaningful way. This pushes visual cues to the clinician that support quick and easy clinical decision-making. Examples of graphs used in pregnancy care include the partogram, which displays information about a woman’s labour progress over time, and the hyperbilirubinemia graph, which helps to manage newborn jaundice by automatically displaying bilirubin results and treatments which correspond to the newborn’s days of life.
CONFIDENTIALITY AND ACCESSIBILITY Protecting patient privacy is an important part of maintaining healthcare records. Because of the many visits over time that occur during the course of a typical pregnancy, the healthcare record may pass through many hands. The ability to track the people who are viewing this sensitive information can be challenging with paper records. Electronic health records require system logins by authorized users, which helps to accurately track who has accessed the woman’s information, thus protecting her intimate healthcare details. Electronic records also support the ability to restrict specific users from
interacting with the record in a way that might not be desired. For instance, it is possible to limit the ability for certain types of clinicians to place electronic orders on a patient. Healthcare organizations can design the electronic system in a way that supports their specific workflows as appropriate, automating the access as needed and resulting in confidential and safe treatment. Another barrier identified with paper records is that they can
only be accessed by one person at a time, limiting the availability of pertinent medical information which may be needed for decision- making. During critical times of a woman’s pregnancy, such as during intrapartum (labour and delivery) care, timely and safe access to all patient information is imperative. Electronic health records support the ability for more than one authorized clinician to view and interact with the record in those types of situations.
MOVING TOWARDS ELECTRONIC HEALTH RECORDS FOR PREGNANCY In recent years, there have been a number of electronic documentation systems made available which cater to the specific conditions of pregnancy, childbirth, and the newborn. Although these niche systems support the unique documentation needs of pregnancy quite well, they often lack integration with the woman’s complete health record. This leads to silos of information that do not correlate with non-pregnancy- specific healthcare details such as the woman’s past medical history, her laboratory results, her past procedures, and her family history. The obstetrical healthcare provider may be more focused on pregnancy- related information, and may not have easy access to information about other health conditions. Extra steps must be taken to duplicate the information into the pregnancy record. This increases time and can also lead to discrepancies in the record, which could impact care. An electronic health record that supports the ability to document all aspects of a woman’s care, including pregnancy and childbirth, eliminates that problem.
ELECTRONIC FETAL MONITORING Frequent assessment of foetal heart rate is an important indirect measure of foetal oxygenation in antepartum and intrapartum care, especially when combined with information about the mother’s uterine contractions. Electronic foetal monitoring uses a bedside device to record the simultaneous measurement of the foetal heart rate and uterine contractions, creating a visual waveform that can viewed by maternity clinicians, and it can be added to the patient’s health record as a permanent document. It helps to tell the story of the mother and her foetus as they progress through the last stages of the pregnancy. Being able to see a continuous reading of the baby’s heartbeat allows obstetric clinicians to intervene quickly if there are signs of concern. The electronic foetal heart monitor device produces a long continuous strip of paper on which is printed the waveform and allows the clinician at the bedside to made quick notations on the strip to show bedside interventions. Although the electronic foetal monitor tracing does not provide everything there is to know about the foetal condition, it is a helpful tool that can be used for clinical decision support. The saved foetal monitor strips become a permanent part of the patient health record, and can be used for a retrospective review for clinical or legal evaluation.
“Often, there is a lack of standardization in documentation across these various venues of care, creating a challenge for the provider who wishes to compare the woman’s clinical results over time”
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