The vision for maternity services in England and Wales was outlined in the report of the National Maternity Review (2016). This envisaged a service that is
‘…safer, more personalised, kinder…; where every woman has access to information to enable her to make decisions about her care…’
In 2014, the UK government published ‘Personalised Health and Care 2020. Using Data and Technology to Transform Outcomes for Patients and Citizens’. This envisaged the better use of data across health & social care and that pregnant women will use apps to access their maternity records by 2018.
Central to these reports is the harnessing of data to provide better, more personalised and more accessible & responsive services. Substantial work has been undertaken. However, as a clinician at the coalface, and a user of health and social care services, there has been very little ‘effective’ change in the last 10 years. This is puzzling given the blistering pace of digital transformation in other industries. At the heart of this puzzle is the imperative to transform health records, the primary source of data.
Electronic Vs Digital health records
The phrases ‘Electronic health records (EHRs)’ and ‘Digital health records’ are used interchangeably. At My CaPl, we make a very clear distinction between these two tools.
An electronic health record is a computerised version of paper health records. You put data in, you get same data out and the computer adds little value beyond a write-read medium. Such computerisation is a necessary first step to creating a digital health record – where the computer transforms and adds value to the data. In effect, we consider a digital health record to be an electronic health record + substantial use of algorithms, big data analysis and / or artificial intelligence (AI). This distinction is vital: the computerisation of health records has potential benefits but comes at a price.
The Medscape Electronic health records report (2016), for instance, found that erosion of the physician-patient relationship is physicians' most prominent gripe regarding EHRs. In the report, 57% of respondents said that EHRs reduce face-to-face time with patients, and 50% noted a reduction in the number of patients they can see. There is also an emerging association between the use of EHRs and physician burn-out.
This price is worth paying if there are substantial gains through ‘digitization’ and automation. Otherwise, widespread adoption of EHRs in an already stretched service could be catastrophic. It is no surprise that clinicians balk at the adoption of EHRs.
The Pregnancy CaPl digital maternity platform
An effective maternity digital records platform should have 2 components: a user-friendly, woman-owned component that is seamlessly linked to a clinical component. Computers & smart phones should be harnessed to provide automated risk assessment and care planning in order to reduce the risk of error, reduce variations in care and facilitate alternative models of care.
The platform was the subject of a Maternity Safety Innovation project funded by the UK Department of Health, which concluded that it could be integrated into existing digital systems in two different NHS Trusts.
Women will carry their full maternity records on their smart phones and have access to automated individualized clinical risk assessment, antenatal care plans and evidence-based information including animated videos. Woman-centred tools such as contraction timer, kick counter and birth plan template make the Pregnancy CaPl app a consumer product as well as a clinical record. The clinician component has been developed in collaboration with obstetricians and midwives across 4 continents with a focus on safety, simplicity and UK guidelines.
Transforming maternity care
We view digital platforms like Pregnancy CaPl as a first step in the digital transformation of maternity care. Artificial intelligence and big data analysis will be used to support emergency, intra-partum and post-natal care. Wearable devices will allow remote monitoring, moving information from the woman to her phone to hospital systems and applying algorithms and AI to support decisions. We believe that such systems can cut the cost of antenatal care by 30-50% while improving pregnancy outcomes. We remain conscious of issues like acceptability but at the very least, women will have a choice.
Dr Paul Ayuk
BSc (Hons), MB.BS (Hons), MRCOG, PhD
Consultant Obstetrician & CEO