Volume 6. Maternity and Neonatal "R.l.O.s"

(“Realistic Input-output Opportunities”) 

Volume Editor: Rupert Fawdry (so far) 

If interested in the possibility of editing this volume  Click here

To see a sample page   Click here 

Discussion Links:  http://eepd.org.uk/?p=202 

Outline of a R.I.O Click Here

Summary

 

This volume will eventually become one of the largest of all since its aim is to document, in precise detail, what may appropriately occur at each Realistic Input/Output Opportunity (R.I.O)

 

The definition of a R.I.O. is a time when, in the process of medical (e.g. maternity and neonatal) care, it is likely to be practical for a health professional to interact, cost effectively, with a reliable and accessible electronic computer system (VDU, keyboard & printer) of gradually increasing complexity.  See  www.fawdry.info/eepd/06_rio/MatList.pdf√

 

Each maternity and neonatal R.I.O. having been identified, this volume then attempts to identify in detail

 

a) what paper documents are needed at that time

b) who should be present, if possible

c) what whiteboard data display outputs, data inputs and automatic or optional printouts may eventually be appropriate on each such occasion.

 

In the absence of finding a suitable word for such occasions the writer has invented the acronym  “Realistic Input-Output Opportunity” or “R.I.O.“   

www.fawdry.info/eepd/00_ima/poster/11_RIOBoxes.pdf√  (Updated 23 Aug 2010)

Introduction

Computers in a hospital setting will only reduce the workload, stress and fear of litigation of health care workers (and thus be cost effective) when they provide “Individual Patient Care” especially “Patient Encounter Assistance” of a high standard. For the acute specialties (medicine, surgery, gynaecology, maternity care, paediatrics, orthopaedics etc.) this will depend on:

Identifying and Exploiting R. I. O.s (Realistic Input/Output Opportunities.

Forget about replacing all hospital paper records in acute specialities worldwide with a  electronic record.  If everyone concerned with pregnancy care could carry something like an iPhone it would be technically possible. But in a world where two thirds of birth take place without a trained attendant it is so impractical that it will almost certainly never happen, or will prove so expensive as to only be relevant to wealthy clients of wealthy countries.. (Sadly, millions will continue to be wasted on such fantasies by the combination of gullible clinicians and plausible computer salespersons! - while women continue to die from anaemia and infection)

Conditions required for a fully electronic maternity system

www.fawdry.info/eepd/00_ima/poster/09_WhenNoPaper.pdf√

Instead it is essential to identify when it might be truly practical for data from paper records to be efficiently input into a computer terminal, without too much extra work for staff.

The computer can then be used to create an automatic output of sufficient useful paper printouts (expert suggestions, patient information leaflets, staff guidelines, letters and memos, and eventually laboratory requests etc.) as to make the work at data entry worthwhile in assisting the health worker with the care of that individual patient.

See www.fawdry.info/eepd/00_ima/poster/11_RIOBoxes.pdf√

To be welcomed by staff the majority of such RIOs (especially “Patient Encounter Assistance” RIOs) will need to include at least the following:

a. Presentation of important data already on the computer on a “White Board” (but only data which currently relevant e.g. Rubella Status only after the end of a pregnancy),

b then an opportunity for Flow-Patterned Data Entry, without re-entry of data already entered elsewhere on the electronic record.

c then a presentation of context relevant Risks of various adverse outcomes e.g. Postpartum haemorrhage

d followed by Expert Action Suggestions or “Signposts” (never rigid rules, protocols or guidelines, The art of professional judgement is far too complex for such simplicities); such “Action Suggestions” being based on electronic “Trigger Data” items or combinations.

e information including data entry criteria and patient leaflet information about any relevant Clinical Trials,

f and finally proposals for Paper or Electronic Outputs.  Such outputs will include not only Memos, Letters and Proformas and Summaries but also individualised Patient Information Leaflets, incorporating plain English consent forms specific to any proposed procedure.

Because of the complexity of the computer programming involved this cannot be achieved by any local IT initiatives. Instead it will depend on the creation of computer specifications for national (and eventually international) use which will also in turn depend on:

B) High Quality Standardised National Paperwork

A significant number of well motivated and experienced clinicians will need to be inspired (and funded?) to work creatively over many years using Desk Top Publishing and Information Sources (e.g. Cochrane etc) to create high quality (nationally?) standardised paperwork - Casenotes, Protocols, Patient Information Leaflets, Guidelines, Operation proformas etc  (See EEPD Volumes 11-14)

All hospital doctors will then gradually have to be persuaded to use a much more structured style of recording medical information e.g. National Pregnancy Record, Operation Proformas etc,

These principles were clearly established during the development of the Protos Maternity and Diabetic Computer System at many different hospitals over the past 20 years.

  Rupert Fawdry.  (Updated 9 Aug 2010)