PCC Obstetric Care Module OCM

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PCCObstetric Care Module (OCM)
Greg Shorr, M.D. (contractor) OIT November 12,
2009
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PCC MCH Modules

• MCH Modules
• Well Child Module (WCM)
• Obstetric care Module (OCM)
• Multi-modal
• PCC
• PCC
• Data Entry
• EHR
• Stand alone workstations
• National standards and guidelines
• Schedule
• Well child in beta at Cherokee and SEARHC (beta
  build 2)
• OB Alpha Spring 2007

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Well Child Module

• Covers birth to age 21
• Incorporates over 3000 knowledgebase items
• Developmental assessment guidelines
• Exams
• Patient education
• ASQ (End user license required 175 / facility)
• Autism screening
• Will cover all 5 modalities
• Designed to be linked to moms prenatal record
• Useful features
• Automated growth grid graphing
• Prints take home immunization history
• Generates the correct ASQ form with imbedded
  identifiers

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Obstetric Care ModuleObjectives

• Reduce the fragmentation of the OB record and
  promote the integration and re-use of critical
  information
• If a data element already exists in RPMS, use it
  and share it with other packages (e.g., birth
  history numbers)
• Promote a common set of guidelines to standardize
  prenatal services throughout Indian Country
• Insure that each patients OB data set is
  complete, valid, and easily available

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3 Prenatal Views

• Visit (V OB file)
• Snapshot of OB findings from a specific visit
• Supports billing and other pre-existing
  applications (e.g., health summary)
• Provides the documentation required for
  medico-legal purposes
• Pregnancy (CURRENT PREGNANCY file)
• View of a patients current prenatal status that
  is constantly overwritten as new information is
  recorded
• Content flow charts, delivery record, plans and
  referrals, 1st well child form
• Contains information that can link the mothers,
  fathers, and child records
• Moms total OB Hx (OB HISTORY file)
• Contains a longitudinal overview of mothers OB
  record spanning all pregnancies
• Supports the long-term re-use of information
• Content Risk Factors, Delivery summary, past
  pregnancy summaries, birth record numbers, etc.

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Obstetric Care ModuleFeatures

• The OCM captures and encapsulates a complex data
  set that is collected piecemeal over an extended
  period of time.
• The OCM provides a customized data collection
  instrument for each obstetric visit including the
  first prenatal visit, all follow up prenatal
  visits, a labor and delivery (LD) admission (or
  referral visit), and the post partum visit.
• The OCM enables reuse of data from previous
  pregnancies and other RPMS records so that there
  is greater continuity of information flow and
  better data quality.

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Obstetric Care ModuleFeatures (cont.)

• Record keeping efficiency is improved because
  providers can build on information captured
  during previous pregnancies and other encounters
  without having to start over
• The data entry process is streamlined and tightly
  integrated with the record keeping requirements
  of specific OB visits
• Data captured in the OCM is immediately available
  for direct patient care, system management, and
  quality assessment
• The OCM includes a Knowledgebase containing
  hundreds of standards, guidelines and patient ED
  topics.
• The OCM includes an Excel-like knowledgebase
  manipulator tool so that local / national domain
  experts to update the knowledgebase

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Obstetric Care Module Features (cont.)

• A seed well child record can be automatically
  established / populated based on information
  collected on OB forms from the latest pregnancy.
• The alpha release of the OCM does not support the
  linking process that is required to reuse and
  view prenatal information from within the infants
  record
• However, the necessary infrastructure to support
  this functionality is included in the release, so
  it will be quite possible to add this
  functionality in the future
• Data about the current pregnancy that is linked
  to the mother (and, if possible, the father and
  offspring) is stored in the CURRNT PREGNANCY file

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Logic / Process for Linking the Moms OB Record
to the Childs Record

• Add code to the check in process (for women and
  children) that determines if the clerk should try
  to establish a link between the mother and child
• If patient is an adult woman, check to see if
  there is a recent prenatal record and if its
  past the EDD
• Check to see if the patient is lt2
• If either of the above is true, check link status
• If there is no link in the patients record (or a
  flag that says we checked previously and no link
  is possible) AND the mother has a prenatal
  record at this site AND the child has a record at
  this site
• If the patient is the mom, the check-in clerk is
  asked to positively identify the offspring
• If the patient is a child, the check-in clerk is
  asked to positively identify the mother
• If a positive ID is made, the mothers record is
  automatically linked to her childs record

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A Few words aboutPatient Education

• The OCM follows ACOG guidelines for patient
  education with the approval of the IHS Patient Ed
  Group. New topics have been added to the
  EDUCATION TOPIC file
• The V PATIENT ED file has been extended to store
  individual discussion topics that compose the
  main patient ed topic
• In the past, these subtopics were hidden within a
  text blob and unavailable as discreet entities
• All changes are backward-compatible with existing
  applications
• All topics presented within the OCM can be
  updated using the knowledgebase manipulator tool

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Knowledgebase Tool
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Lab ResultsObjectives, Issues and Solutions

• Objective Insure that the required prenatal lab
  results can be viewed in one, easily-accessible
  place on the form
• Issue Lab results come from many sources.
  Current results may not be stored in RPMS at the
  time of the prenatal visit
• For example, HIV tests and the Triple (Quad)
  screen may be sent to outside labs that do not
  interface directly with RPMS
• Solution Allow providers to write in lab
  results that are not available from RPMS
• Write-in results are treated as free text notes
• Write-in results are not verified
• A write-in result may be limited to date and
  value only
• Write in results can only be viewed on the
  prenatal form
• Write-in results are NOT entered into the Lab
  Package
• If a result is stored in the Lab Package, it will
  supercede a write-in result

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Ob Care Module4 Forms

• First Prenatal Vist
• Follow-up Prenatal Visit
• LD / Referral Visit (read only)
• Post partum Visit

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OCM Content1st Prenatal Visit Components

• MENSTRUAL HISTORY
• BIRTH HISTORY
• PATIENT ED TOPICS
• MATERNAL MEDICAL HISTORY
• PAST PREGNACIES
• PRE-PREGNANCY WEIGHT
• FATHER
• MATERNAL SOCIAL FACTORS
• SOCIAL RISK FACTORS
• CURRENT RISK FACTORS
• GENETIC RISK FACTORS
• CURRENT PREGNANCY FINDINGS
• OPTIONAL FINDINGS

• REFERRALS
• DELIVERY DATE ESTIMATES
• PATIENT ED PARAMETERS
• CONSENTS AND REQ'D DOCUMENTS
• PLANNED DELIVERY LOCATION
• INFANT FEEDING PLAN
• ULTRASOUND FIRST VISIT
• PATIENT PLANS AND REQUESTS
• CURRENT RISK COMMENT
• MOMS WEIGHT AT HER OWN BIRTH

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OCM ContentBirth History Data Elements

• TOTAL PREG
• FULL TERM
• PREMATURE
• TAB
• SAB
• ECTOPICS
• MULTIPLE BIRTHS
• LIVING
• PARA
• AB

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OCM ContentFollow-up Prenatal Visit Components

• BIRTH HISTORY
• PATIENT ED TOPICS
• LAB GUIDELINES
• PRE-PREGNANCY WEIGHT
• SOCIAL RISK FACTORS
• CURRENT RISK FACTORS
• CURRENT PREGNANCY FINDINGS
• OPTIONAL FINDINGS
• ULTRASOUND FLOWCHART

• REFERRALS
• DELIVERY DATE ESTIMATES
• REFERRAL SUMMARY
• PATIENT ED PARAMETERS
• CONSENTS AND REQ'D DOCUMENTS
• BISHOPS SCORE
• FIRST TRIMESTER ULTRASOUND
• BIOPHYSICAL PROFILE
• PATIENT PLANS AND REQUESTS
• CURRENT RISK COMMENT
• CUMULATIVE RISK COMMENT

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OCM ContentLD / Referral Visit Components

• ULTRASOUND FLOWCHART
• REFERRAL SUMMARY
• CONSENTS AND REQESTS
• INFANT FEEDING PLAN
• FIRST TRIMESTER ULTRASOUND
• PATIENT PLANS AND REQUESTS
• CUMULATIVE RISK COMMENT
• L D BASELINE

• BIRTH HISTORY
• PATIENT ED TOPICS
• LAB GUIDELINES
• PAST PREGNACIES
• FATHER
• MATERNAL SOCIAL FACTORS
• SOCIAL RISK FACTORS
• CURRENT RISK FACTORS
• CURRENT PREGNANCY FINDINGS

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OCM ContentPost Partum Visit Components

• BIRTH HISTORY
• LAB GUIDELINES
• SOCIAL RISK FACTORS
• DELIVERY INFORMATION
• DELIVERY COMMENTS
• POST PARTUM INFORMATION
• NEONATAL RECORD
• POST PARTUM DISCHARGE INFO
• POST PARTUM PT ED TOPICS
• CUMULATIVE RISK COMMENT

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PCC Form
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EHR
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Health Summary
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Birth History 5 modalities
Birth history numbers  Total pregnancies
(0-99) 3  Total deliveries (0-99) 1  Full
term (0-99) 1  Premature (0-99)  AB
(0-99) 0  AB (0-99) 1  Ectopic (0-99)
0  Multiple births (0-99)0  Living (0-99)
1   Are you sure you want to accept these
results? Yes// Y (Yes)
BIRTH HISTORY (Last updated 3/7/07) TOTAL
PREG 5, TOTAL DELIVERIES 4, FULL TERM 2,
PREMATURE 2, TAB , SAB , ECTOPICS ,
MULTIPLE BIRTHS , LIVING CHILDREN 4, AB 1
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Prenatal Flow Chart
Date AND Gestational Age (weeks) are always
pre-filled on the form. The Gestational Age is a
computed value based on the current EDD. If the
EDD changes, all values in the Weeks column will
be automatically updated. For medico-legal
reasons, a snapshot of this flowchart will be
recorded on each prenatal visit (stored in the V
OB file). This snapshot shows the value of
Weeks at the time the flowchart was updated.
The user can only edit the top row. All other
rows are view only
If vital signs are recorded during the check in
process, they will be pre-filled in the active
row of the flowchart. If vital signs are entered
directly into the flow chart, they will be
automatically saved in the V MEASUREMENTS file of
RPMS. Weight change is a computed value (not
entered by the user) that is determined by the
current value of the pre-pregnancy weight.
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GUI Preview
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GUI Preview
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GUI Preview
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GUI Preview
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GUI Preview
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GUI Preview
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GUI Preview
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GUI Preview
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OB Care Module

• Standards
• ACOG, Senior clinicians, Patient educators
• Data Elements
• 300 New fields, 100 Guidelines
• Forms and Components
• 1st prenatal exam, F/U prenatal exam, LD
  summary, Post partum exam, Neonatal record,
  referral summary,1st well child exam
• Views
• Visit, Pregnancy, Patient (OB Hx)

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OB Care Module (cont.)

• 5 Modalities
• PCC/HS, PCC, Data Entry, EHR and Clinical
  Desktop
• Internal Integration
• Pregnancy to pregnancy, pregnancy to neonatal /
  well child
• Framework
• Component Framework