- Multidimensional Data Model
- High Performance
The 1,400 bed teaching hospital at Leicester Royal Infirmary, founded in 1771, is certainly not stuck in the past when thinking about its information needs. The newly formed Women’s Hosptial, within the Infirmary, is at the cutting edge of technical sophistication with its maternity system that will give them a flying start into the twenty-first century. In between delivering more than 5,800 babies each year and juggling a constantly strained NHS budget, the Obstetric Unit has gone high-tech in an impressive way.
“Until 1993 we had no way of knowing what work we had done in any depth or accuracy,” said Leicester Royal Infirmary Midwife and Clinical System Manager, Fran Gill. “Everything had to be counted manually, such as different types of deliveries. All paperwork was recorded by hand and some facts would be recorded serveral times by clinical staff onto different forms.
“The need for better quality information which is entered only once by the clinician who does the job, led to Euro-King being selected as the system of choice for this busy and forward thinking unit,” continued Gill. “The features that we appreciate are the flexibility to tailor the system to our own practice and the ease of data entry for busy clinical people.”
We found tremendous advantages in building our product in Caché.
Alan Browne, Group Technical Director
Euro-King lies at the heart of their new systems, providing an integrated suite of applications from European Information Technology (EIT). Euro-King is a suite of modular clinical applications specifically tailored for maternity systems and developed in the new Caché post-relational database from InterSystems.
Surrey-based EIT has been operating in the area of women’s health for the past 15 years developing, installing and supporting user friendly clinical application systems. The company developed its pioneering maternity Euro-King modules in InterSystems’ Caché post-relational database.
“We were thinking of developing a post-relational database of our own to cope with the many complexities involved in handling records and data of multiple pregnancies, especially with infertility treatments where anonymity is sometimes involved,” said Alan Browne, Group Technical Director for EIT.
“Any database that has to express such complex data relationships needs a robust development environment. We found tremendous advantages in building our product in Caché. The multidimensional model means that we can store multiple types and pieces of data about a patient, such as lab results, ultrasound, X-rays, and GP notes that can be held together, rather than in a series of relational tables that would need to be linked together,” continued Browne. “Caché’s sparse array also ensures performance is maintained which can be critical in a health care environment. This, combined with Caché’s interface with the Web and Microsoft ODBC, has resulted in one of the most powerful development platforms on the market.”
The Leicester Royal Infirmary went live with its first Euro-King module in August 1993 with the Midwives Delivery and the Doctor’s Operative Delivery Record. The module records labor and birth, and produces a maternal summary. For operative deliveries, clinicians record their findings and produce a record of the procedure for the notes. The system provides clear, legible documents to a standard specified and agreed by the Trust.
“This has provided us with in-depth statistics,” said Gill. “All the complexities of gestations, outcomes, and multiple pregnancies are available to us at a key stroke. All the facts and figures that allow us to review our practice both from a clinical and management perspective are easily accessible.”
Caché’s sparse array also ensures performance is maintained which can be critical in a health care environment.
Alan Browne, Group Technical Director
Gill and her team then went live with the Transfer to the Community module in 1997. This documents all the facts that other health professionals need to know at the time of discharge, thereby improving the quality of information sent ot both GP’s and Health Visitors. The new mothers also receive advice leaflets from the system tailored to their individual need and circumstances.
“This has sped up the whole transfer process and protected patient confidentiality at the same time. Ward clerks are kept where they are most valuable – on the ward – and no longer have to run information around the hospital on pieces of paper.
To date, more than 900 people have been trained on the system and between 350-400 people are currently accessing the applications. Based on a central PC, Euro-King is connected to the hospital’s Novell Network and is interfaced with the central Patient Administration System (PAS), provided by HBO which also is also based on an on InterSystems database.
“Euro-King is very simple to use with excellent internal validation built into the system,” said Gill. “Midwives are starting to appreciate the advantages of computing that are not immediately apparent, for example, producing lists of deliveries for individual midwives to keep their personal registers up-to-date.”
The hospital will, in future, be recording Antenatal admissions and discharges through the system, as well as incorporating a brand new Community Midwife Activity module.
“This is really important from a management point of view. Mothers need more choice in the type of care they receive,” said Gill. “There’s no need to bring everyone to a hospital Antenatal clinic when the Community midwife can see them where it’s more convenient for the mother. We are also trying to achieve better continuity of care so women know their midwife well. To measure all this we have to be able to track the midwives’ community work accurately and this is what the new module will achieve.
With NHS funding constantly under pressure, this will also track the amount of work done for other authorities and ensure the hospital is properly reimbursed.
“Cross border activity is a big issue in many Trusts at present. Some women are cared for antenatally and postnatally by our midwives, but actually deliver elsewhere. Under present arrangements, the hospital where the delivery takes place gets funded for the whole pregnancy and birth episode. With Euro-King, we’re able to monitor this work and ensure correct allocation of funds,” added Gill.
“We’re seeing an increase in the number of home deliveries. Last year, for example, we assisted sixty-four home deliveries. That’s sixty-four deliveries that otherwise wouldn’t have appeared on the PAS, and therefore wouldn’t have gotten paid.
More importantly, we are able to provide a greatly improved quality of care to pregnant women, new mothers and their babies, which is really what it’s all about in the first place,” said Gill.