1. The new BC (electronic) Antenatal Record John Robertson, Lee Saxell, Lily Lee, Peter Everett OSCAR User Meeting May 3rd, 2013

2. Outline 1.Perinatal Services BC Project Overview 2.BC Maternity Care Pathway and Evidence 3.Project Scope 4.Requirements Development Process 5.BC Antenatal Record (BCAR) Architecture 6.Demo 7.Pilot Participation 8.Pilot Evaluation

3. Perinatal Services BC Project Overview Objectives: Improve practitioner use of high quality clinical practice guidelines and pathways for antenatal care Assess user acceptance of enhanced functionality in BCAR Develop specifications for BC eMR vendors to facilitate adoption of evidence-based clinical pathway

4. BC Maternity Care Pathway

5. Project Scope Create advanced OSCAR form(s) enabling: Logical flow and easier navigation (inter & intra form) Real-time calculations, alerts, highlights & graphs Standardized variables and error checking Linked supporting information Extensible

6. Requirement Development Process

8. BCAR Architecture Revised architecture for: “unlimited” space for input of information “logical” sequence based upon process 22 “alerts” at 3 levels (inline, submit, server) A single continuous yet sectioned form Ability to change input form or report without effecting the other

9. BCAR 2013 Demo http://vimeo.com/65191283

10. Alerts (1) Alert nameAlert messageTriggered by Patient data incompleteKey patient information is missing incomplete demographics Allergies yesAllergy risk presentAllergy box checked yes Allergies blankAssess for allergiesAllergies blank Rh negativeRhIG at 28 weeks; repeat antibody titres 24 - 28 weeks Blood type Rh negative checked BMI Over 30Screen for GDM in 1st trimesterCalculated BMI over 30 BMI Over 40Screen for GDM in 1st trimester, recommend antenatal anesthesia consult Calculated BMI over 40 Prenatal genetics screening SIPS #1: 10 - 13+6 wks; SIPS #2: 15 - 20+6 wks; NT: 11 - 13+6 wks; Quad: 15-20+6 wks; AFP: 15-20+6 wks Alert appears for any GA less than 21 weeks. Alert to turn off when Prenatal genetics screening selection made on AR 2 i.e. FTS, SIPS, IPS, Quad, Declined.

11. Alerts (2) Alert nameAlert messageTriggered by US assessmentEligible for dating or detailed US Gestation age less than 24 weeks and 0 days by LMP or US box blank on record First trimester labCheck initial lab resultsTrigger for new patient. Turn off when lab is done Gestational diabetes screen GTT 24 - 28 weeksTrigger starts at 18 weeks + 0 days (confirmed EDD), turned off when GD screen completed Group B StrepGBS 35 - 37 weeks Turn on at 32 weeks and 0 days (confirmed EDD) until the test is completed, results positive or negative or declined selected Group B Strep positiveEligible for intrapartum Abx GBS positive box checked off Check fetal presentationConfirm fetal presentation, offer ECV if breech Gestational age from 32 weeks and 0 days to 36 weeks and 0 days (confirmed EDD), then turned off at 36 weeks + 1 day

12. Alerts (3) Alert nameAlert messageTriggered by Menstrual cycle irregular Request dating ultrasound Irregular menstrual cycle checked off Risks screen Screen for sickle cell anemia and thalassemia Relevant ethnicity origin checked Hb less than 115 Consider tests for ferritin and Hb electrophoresis Hb 105 - 114 Hb less than 105 Consider tests for ferritin, Hb electrophoresis and iron supplementation Hb 104 or lower EDPSComplete EPDS 28 - 32 weeks Gestation age at 28 weeks and 0 days (confirmed EDD) until date or score are entered Rubella non- immune Vaccination after delivery indicated If rubella non-immune box checked HBsAg PositiveVaccination after delivery indicated if Hepatitis B surface antigen positive status selected

13. Pilot Three clinics participating Conversion of 2007/2012 records to 2013 version (working with OSPs) Phased-in pilot launch in May 2013 Pilot for 4 months then evaluates

14. Pilot Evaluation Structure – User acceptance Process – Usability of the BCAR within eMR as a tool to facilitate quality antenatal care Outcome – Timeliness and completion of assessment

15. Thank You Acknowledgement to Steering Committee: Colleen Kirkham, Vancouver David Page, Chilliwack Joan Robillard, Vancouver John Robertson, Chilliwack Karen Buhler, Vancouver Lee Saxell, Vancouver Morgan Price, Victoria PSBC: Lily Lee (Project Lead), Kim Williams, Kenny Der Developer: Peter Everett, OSCARprn BORN Ontario: Doug Cochen, Mari Teitelbaum Project Management: Michael Pluscauskas