It’s been described as a “landmark project”, unique across the world, the first national electronic health record for all mothers and babies — and no-one disputes that.
The Maternal and Newborn Clinical Management System (MN-CMS) promises to eventually provide “a seamless, complete and reliable source of all the information clinicians require to quickly and to accurately make care decisions for the optimal wellbeing of mothers and infants across Ireland”.
As the system develops, it will be “able to create algorithms that will warn clinicians on risk factors [such as sepsis] and give guidance and support in making decisions”.
“Timesaving alone, in documenting babies’ care, will improve productivity,” said Richard Corbridge, the HSE’s outgoing chief information officer, last January.
So far, the €35m IT system has struggled to live up to its billing. Rolled out in Cork University Maternity Hospital (CUMH) last December — the first hospital in the country to “go live” — staff have told theof significant teething problems, not least trying to get used to a system in constant clinical use while at the same time delivering care to women and babies.
The HSE itself said staff needed 10,000 hours of training and the go-live date at CUMH was delayed six months. Moreover, despite having paid €35m for the system to American multinational Cerner, the HSE had to bring in outside consultants Deloitte to get it over the line in Cork and Kerry because its own clinical and business staff did not have the expertise to “ensure a successful go live”. Deloitte cost €700,000. Further outside support is being sought for rollout to the Rotunda Hospital and the National Maternity Hospital.
However, the latest criticism of the system comes from a different angle. This time it’s GPs.
Within the Irish maternity service, GPs and hospital obstetricians operate a shared-care model. It requires expectant mums to bring their A4 chart to every appointment, giving both sides sight of how the pregnancy is progressing.
GPs had expected that one of the benefits of the new MN-CMS would be an end to the paper files and a ready exchange of digital information between themselves and maternity hospitals. After all, GPs have been operating their own digital systems for years and looked forward to a time when hospitals closed that digital gap.
However, for reasons that are as yet unexplained, a €35m system was installed in two maternity hospitals without any link-up with GPs’ IT systems. The upshot is staff at CUMH and University Hospital Kerry (UHK) have to manually input data into a “slimmed- down” chart for every antenatal visit, as well as inputting the information electronically in the MN-CMS.
Aside from staff resenting time-wasting duplication — which could have been avoided had the “digital gap” been spotted in time to rectify before the MN-CMS went live — the margin for human error increases with staff workload against a background of tight resources.
The Irish College of General Practitioners (ICGP), which is supportive of the MN-CMS as “a good advance in patient care”, says members of its Cork faculty identified the inability of the two IT systems to communicate last November, before the go-live in Cork and Kerry, and received assurances that it would be rectified in six months. That deadline has come and gone. Currently, intensive testing is ongoing in an effort to get the two systems talking. But any apparent solution to the problem will first have to be piloted. This could mean further delays in the national rollout of the MN-CMS, already significantly behind schedule.
Two ICGP members with an involvement in GP IT are reluctant to point the finger on who “dropped the ball on this one”. Conor O’Shea, ICGP national co-ordinator, GP IT group, says that, in the immediate build-up to the system going live in CUMH, “it was noted that the ability to send electronic messages from GP to the new system was not built-in — which was of concern to us.”.
“Colleagues in Cork correctly said this was a problem,” said Dr O’Shea. “They [the Cork faculty] said to the ICGP that ‘we need joined-up records’.
“They agreed but said it will take time. They suggested using paper in the meantime. Cork GPs are not delighted to have to continue with paper.”
In any event, Dr O’Shea believes a solution is not far off, but concedes that general practice is a long way ahead of public hospitals when it comes to the use of electronic health records.
“General practices are small, flexible units which makes it easier to make decisions and get things done. Historically that’s the reason why we are 15 years ahead. But there’s been huge work done in the last three years to digitise the health services,” he says, particularly with the eHealth strategy.
Cork GP Frank Hill says there’s an acceptance that linkage is required between the GP and hospital systems, and when this is achieved, the outcome will be fantastic, because for the first time maternity patient information will be available at the push of a button to both GPs and hospital clinicians in structured electronic file format.
“We’ve been waiting a lot of years for this to happen, and we’re delighted that it is,” he says. However GPs were hoping to have piloted the ‘fix’ in Cork by last Easter and that hasn’t happened.
Dr Hill, who’s been “paperless for 23 years” says the delay “is at the hospital end in terms of re-jigging the system”. And retrofits can be tricky.
“But when it does happen, it will be an enormous breakthrough,” he says.
He says it’s “disappointing that such a narrow view was taken” when the MN-CMS was being developed, and the mistake was it was designed for maternity hospitals and not maternity services. He says it is a “complicated system” and the “blinkers were on, to get it done, get it finished”. Clinicians were among those involved — they completed a full clinical validation of the design and build of the MN-CMS. The lack of link-up means, for now, GPs are likely to make more referrals [of expectant mums to the maternity hospital] “because we can’t be sure what we are dealing with” if charts appear incomplete.
“The risk is it will increase pressure on the hospital when they are already trying to deal with the new system,” says Dr Hill.
His advice to pregnant women is to bring the paper chart to every antenatal visit until the two systems are compatible.
As long as women brought the charts to every appointment and made sure they were completed they should “work fine”, said Dr Hill.