Delivering on digital
With many local maternity services in England still reliant on paper notes, the MTP’s digital workstream has much ground to make up. Midwives looks at the progress made and the latest on transformation in Scotland.
'Harnessing digital technology’ is one of nine workstreams within the Maternity Transformation Programme (MTP), but it underpins much of the vision set out within the Better births maternity review.
The aim is to make it easier for health professionals to collect and share data with each other and their clients. There are four main areas of focus: harnessing data gathered by maternity services to improve safety, enabling the systems in use across the country to ‘talk’ to one another, improving online information, and developing personal health records for women.
Each objective has its own array of challenges – but getting them right means better opportunities for learning, improved productivity, greater choice and personalisation for women, and ultimately safer care for women and babies.
Julia Gudgeon, clinical adviser to the digital maternity programme at NHS Digital, says one of the biggest challenges services face is the current lack of interoperability – the ability of the various systems to ‘talk to each other’ and share information.
To overcome this barrier, NHS Digital is working with the RCM and others to create a standard that will dictate how information has to be recorded.
Julia explains: ‘If I’m looking after a woman in the Midlands who’s travelled up from London, even though she’s booked in London, I can access the platform and pull up her information in my system. When providers are all talking the same language, a woman’s data can travel safely across the country.’
The new standard is being finalised, and the interoperability platform should be up and running in two years. ‘It will make a huge difference,’ says Julia.
Exploiting the data
Another primary area of focus is around the Maternity Services Data Set (MSDS).
‘Our aim with MSDS version two is to ensure the data is used to benchmark and improve,’ says Julia. ‘NHS Digital is planning to support this launch with a maternity data viewer, which will make it easy to review and compare information.
‘If we really embrace digital technology, you would see a massive impact on clinical safety. Data might seem very dull, but it can save women’s lives.’
Calderdale and Huddersfield NHS Foundation Trust has already harnessed the power of its data, following the introduction of the maternity electronic patient record (EPR) three years ago, providing end-to-end notes for all care delivered from the point of booking until discharge.
Dr Anne-Marie Henshaw, associate director of nursing and HoM at the trust, says the new system has had ‘a direct impact on improving quality and safety across the service’.
‘The maternity dashboard allows us to compare our data with other local services as well as regionally and nationally, which has directly affected care delivered to our women and changes to practice for the better,’ she says.
The EPR has transformed how the team is able to access and use data, allowing them to identify patterns and trends with a few clicks rather than trawling through paper records.
‘The system allows us to investigate the data really thoroughly and put changes in place,’ says Anne-Marie. ‘For example, data retrieved from the system allowed the trust to successfully submit a business case for an additional middle-grade obstetrician out of hours.’
ePHR and online information
One of the biggest changes on the horizon is the electronic personal health record (ePHR) for maternity. More than just digital maternity notes, ePHR should create a digital space that enables women to take greater control of their health and care.
As well as including health records, appointments, prescriptions and test results, it could allow women to communicate with the professionals involved in their care, share information about their health, complete questionnaires and receive information relevant to their pregnancy.
‘Women were very clear in Better births that their records are theirs, and they want to own them,’ says Julia. ‘We are taking tiny steps towards this.’
BadgerNet, a new paperless maternity record system introduced at Epsom and St Helier University Hospitals NHS Trust, has already made headway providing this ‘digital space’.
Katie Hamilton, IT midwife leading on its implementation, says the system is linked with others in the hospital, meaning ‘everything is in one place so a midwife can securely review a woman’s records’.
Crucially, it also allows women to see their information through a smartphone app, including their maternity notes, upcoming appointments and useful resources.
‘The midwife can add the information and any advice she wants to give to a woman’s clinical notes. The woman would then get a text to say her app had been updated and could go in and see it,’ Katie explains.
‘It’s a massive culture change,’ she adds. ‘But it has been really positively received by midwives. Now there is an app for everything, so it’s not that revolutionary for the women. They have been told they are pioneers on the system, and they have been really receptive and positive.’
Another ongoing task is improving online information. Julia says: ‘In Better births, women felt there was so much information out there that they didn’t know what was and what wasn’t safe.
‘NHS Choices is currently working with users to review how information is presented, and ensuring content reflects the maternity care women can expect from their midwife.’
Digital maturity assessments
While some services are already reaping the benefits of improved digital technology, others have a longer journey ahead. With such an array of provision and practices, NHS Digital is undertaking a comprehensive digital maturity assessment (DMA) of maternity services in England.
Every trust offering maternity services has returned its digital maturity survey. This is the beginning of a benchmarking exercise across a range of measures, including digital strategy and leadership, staff training and sharing of digital records.
It will not only reflect a clear picture of how far maternity services have to go, but also provide a route map to help them get there, says Julia.
‘We have a team of analysts ready to start crunching the data to create a picture of what digital looks like in maternity services, which we will report to the Maternity Transformation Board.
‘Then we are going to create bespoke reports for each local maternity system, to show where they are doing well and those areas where they need to improve. The report will give them a toolkit to improve the areas they’re struggling with.’
RCM practice and standards professional advisor Rachel Scanlan says that the RCM is looking at how it can support members through the transitions.
‘There is a lot of change happening very quickly, particularly in the digital area, and we don’t want anyone to feel overwhelmed or left behind.’
She points out that of the 134 DMA surveys returned, 76% were completed by midwives.
Rachel concludes: ‘It can feel like a lot of work and another thing on the list, but I think this is an opportunity for midwives to shine, to take the bull by the horns and lead the way.’
Benefits of ePHRs
- Visability, control and understanding of health information
- Increased ownership and improved outcomes for safety
- Fewer barriers with healthcare professionals
- Critical reminders around screening and immunisations
- Reduced administrative burden
- Enhanced relationship with women
- Convenient, effective interaction
- Safer, better and increased value