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An EHR for maternity services

Maternity and Newborn System (MN-CMS) project is focused on the design and implementation of an electronic health record (EHR) for all women and babies in maternity services in Ireland. 

This record will be the first instance of any EHR operating on a shared record basis in the Irish healthcare system and is being piloted later this year. For the first time, a baby from birth in Ireland will have its own clinical record rather than being appended to its mother’s, thus allowing a truly patient-focused care pathway to be developed and facilitated by near real-time information. 

“The maternity and newborn EHR has been customised and built by our own clinicians and will transform the delivery of care to become truly integrated. As less time is wasted on documenting the care, clinicians will have more direct contact with patients and their families, restoring much of the joy in practice that has been eroding with each new wave of nonclinical demands,” Ms Yvonne Goff, HSE Chief Clinical Information Officer told the Medical Independent (MI).

Following public procurement and the appointment of Cerner as the preferred vendor, the MN-CMS team initiated the project in March 2014. 

“The solution has been a long time in its contracting and delivery stage. Since the contract was signed in 2014, the system has been built and configured for the Irish healthcare system and a huge amount of clinical effort has been placed on the clinical validation of the system to ensure when it does go live in Ireland, it does so able to fully support the Irish healthcare system,” Mr Richard Corbridge, HSE Chief Information Officer (CIO), told MI.

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Mr Richard Corbridge, HSE CIO

How it works

Mr Corbridge explained that the MN-CMS EHR does not replace a digital solution in any maternity hospital; it takes a paper flow and enables a new process supported by a digital solution to be created. The record of both mother and baby can then be shared where appropriate to do so throughout the maternity care pathway, thus reducing the information collection burden and the risk of multiple entry-related errors in the process. 

Maternity early warning scores (iMEWS) and sepsis early warning scoring systems have been built into vital signs monitoring and observations for mother and baby within the system. In other jurisdictions where the system has been deployed, there has been a marked (85 per cent plus) reduction in issues captured by these solutions, Mr Corbridge reported.

Electronic prescribing and order communications will be implemented in all MN-CMS hospitals as part of this project. The delivery of digital discharge notes for mother and baby to GP practices via the Heathlink solution will also be implemented, creating a fully digital information journey, he said. 

Next steps

It was planned for the core deployment of the project to start in 2016 with the initial sites being Cork University Maternity Hospital (CUMH); Kerry General Hospital (maternity services); the National Maternity Hospital, Holles Street; and the Rotunda Hospital, Dublin. 

While there have been some delays, the early implementation of the system into CUMH is scheduled for go-live on 3 December and Kerry will follow in quarter-one of 2017.

“The system has been delayed by six weeks for go-live, due to a number of resource-related issues. There has been over 8,500 hours of training delivered in Cork to ensure that on go-live the system is safe and brings the benefits it has been designed to release. Whilst we are determined to drive go-live dates, we will never put the delivery of care at risk and therefore needed to postpone long enough to complete training. The implementation of the system across the rest of Ireland’s maternity hospitals will benefit from this delay and the work done here,” Mr Corbridge told MI.

The next two sites (the Rotunda and Holles Street) will follow Kerry “very quickly”, he said, and the full implementation across the remaining maternity sites is scheduled for the remainder of 2017. 

Challenges

The delivery of training and business change is challenging for each hospital with current resources, Mr Corbridge noted. The Office of the CIO has put together a proposal to bring an increased level of temporary support staff to each maternity hospital as it goes live with the MN-CMS EHR (covered within the Office of the CIO current budget). However, if additional funding could be made available for business change then this would provide more assurance to each of the go-live dates and speed up implementation, Mr Corbridge said in a recent briefing note to the Minister for Health’s office.

“The maternity system go-live will be a giant leap forward for Ireland and our healthcare system – the first instance of an EHR on a national basis that supports the delivery of integrated care is the maternity pathway. The MN-CMS will be the first time that a health record exists for a baby as an individual from birth rather than a record appended to the mother’s paper record. Through the implementation of this system we will have in place information for the delivery of person-centred and contextualised care for every baby in Ireland,” Mr Corbridge concluded.

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