born ontario provincial rounds - prenatal screening ontario · •to describe new items and...
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BORN ONTARIO PROVINCIAL ROUNDS
CONTACT US:
www.BORNOntario.ca
@BORNOntario
Better Outcomes Registry & Network (BORN) Ontario
Live tweeting! Join the
conversation using
#BORNRounds
The presentation will begin momentarily.
The Development of the “New”
Ontario Perinatal Record
Project Co-Chairs:
Anne Biringer MD CCFP FCFP, University of Toronto, Mt. Sinai Hosp.
Ann Sprague RN PhD, BORN Ontario
BORN PROVINCIAL ROUNDS – Jan 21, 2016
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Learning Objectives
• To describe the process of developing the new
Ontario Perinatal Record
• To describe new items and screening tools
embedded in the revised Ontario Perinatal
Record
• To outline the implementation process for the
new record and the accompanying guide
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• OAR developed and housed within OMA– No ongoing resources/plan for subsequent updates
• Last update 2005, many changes in clinical practice since then
• Increased use of EMRs, however no plan for electronic functionality
• BORN pilot with 2 vendors in 2012/13 demonstrated the desire for electronic functionality, however a content update was requested
History
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Vision for the Future
• Housed at PCMCH and version control will be
maintained
• Ongoing involvement by professional
organizations for 3-5 year updates
• Data to BORN from EMRs to reduce
duplication of data entry
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• To review and update the
current OAR, Post-Partum
Record and OAR User Guide
for both content and EMR
functionality.
• Partnership between
PCMCH, BORN Ontario and
the OMA, with the support
of the AOM.
Purpose of Working Group
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Working Group - MembershipName Role Organization
Dr Anne Biringer (Co-Chair) Family Physician Mount Sinai Hospital - Toronto
Dr Ann Sprague (Co-Chair) Scientific Manager BORN Ontario
Dr Debra Boyce Family Physician Partners in Pregnancy - Peterborough
Dr Doug Cochen Obstetrician Queensway-Carleton - Ottawa
Dr Barb de Vrijer Obstetrician/MFM London Health Sciences Centre
Dr Jessica Dy Obstetrician The Ottawa Hospital
Ms Dara Laxer Senior Policy Analyst Ontario Medical Association
Dr Stan Lofsky Family Physician North York General Hospital
Ms Matthuschka Sheedy Health Promotion Best Start
Dr Bill Mundle Obstetrician/MFM Windsor Regional Hospital
Ms Claudia Steffler Nurse Practitioner Maternity Care Centre - Hamilton
Ms Julie Toole Midwife/ Risk Analyst Association of Ontario Midwives
Ms. Doreen Day Committee Resource PCMCH
Ms. Anna Bucciarelli Committee Resource PCMCH
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Working Group - ConsultantsName Role Organization
Dr. Cindy Lee Dennis Women’s Mental Health University of Toronto
Dr. Dawn Kingston RN/Mental Health University of Alberta
Dr. Nan Okun MFM & Prenatal screening University of Toronto
Dr. Anne McLeod Medicine/Haematology University of Toronto
Dr. Mark Yudin OB/GYN, Infectious Diseases University of Toronto
Ms. Shelley Dougan Screening Specialist BORN, Ontario
Dr. Lisa Graves Family med/Substance abuse University of Toronto
Dr. Denice Feig Medicine, Endocrinology University of Toronto
Dr. Peter Selby Family med/Substance abuse University of Toronto
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• Stakeholder input sought
• “What are your the 3-5 changes you
would like to see?”:
– Content changes
– Functionality updates
OAR Survey
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• Survey sent to the following OAR user groups (> 350
responses):
– Obstetricians
– Family Physicians
– Midwives
– Nurse Practitioners
– RNs
• Feedback also received from practitioners in:
– Mental Health
– Public Health
– Genetics
– Paediatricians
OAR Survey Audience
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OAR Survey Results – Highlights
• Update Lab and Ultrasound sections
– i.e. Include TSH, Parvo, Ferritin, Hb
Electrophoresis, NIPT, age for amnio
• Update demographics
• More detail regarding alcohol and drug use
• More detail regarding breastfeeding
• More psychosocial information
– i.e. Social determinants of health
• Weight gain guidelines/advice
• Relevance of physical exam?
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Content Review Process
• Review of the OAR involves:
– Reviewing survey results
– Consulting current guidelines/best evidence
– Consulting other provincial/national antenatal records
– Expert consultation where required, i.e.
Depression/anxiety screening, alcohol/substance use,
genetic screening
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When considering changes to the clinical content/data elements:1) Is it evidence informed clinical care?
2) Is it/should it be part of the standard care pathway? Does it apply to most women?
3) Does it contribute to patient safety?
4) Does it contribute to population health?
When considering changes to the functionality of the form:1) Does it have the potential to facilitate care (e.g. evidence, reminders, flags)?
2) Is it user friendly? (e.g. flow, accessibility, ability to use it ,read it and receive it from other care providers, space to add to it when needed)
3) Does it facilitate information flow between care providers?
4) Are the data elements in alignment with those of BORN (i.e. terminology)
5) Is the requested change technically feasible?
Decision Making Criteria
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Ontario Perinatal Record (OPR)
• Note the name change!
• Not yet final
– Reviewed by OMA, OCFP, CMPA, AOM, HIROC
– Received feedback by over 120 individuals/organizations
– Currently incorporating feedback and reviewing with the
working group
• Graphic lay-out for paper version still needs
work – what you see here isn’t what you get!
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OPR – Are you Excited?
OPR1 -Demographics
OPR1 – Pregnancy Summary & Hx
DRAFT
M edical H isto ry and P hysical Exam (pro vide details in co mments)
DRAFT
M edical H isto ry and P hysical Exam (pro vide details in co mments)
DRAFT
M edical H isto ry and P hysical Exam (pro vide details in co mments)
DRAFT
OPR 1 - Physical Exam and Initial Labs
DRAFT
OPR2 - Demographics, Problem list,
Immunoprophylaxis
OPR2 – Visit Summary
DRAFT
OPR2- Genetics
DRAFT
OPR2- U/S
DRAFT
OPR2 – Discussion Topics
DRAFT
Updates – OPR2 – Additional Labs
DRAFT
Updates –OPR Screening Tools
DRAFT
Updates –OPR Screening Tools
DRAFT
Updates –OPR Screening Tools
DRAFT
OPR - EPDS
DRAFT
Updates –OPR Screening Tools
OPR3 – PP Visit
OPR3 – PP Visit
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What’s gone from OPR?
• No symphysis fundal height graph
• No risk stratification
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OPR User Guide
• New resource
– Accompanying document clarifies how to
complete each data point
– Connects reader to guidelines to care
• e.g. indications for ASA in pregnancy
– More details on how to ask questions
• e.g. intimate partner violence
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Home Page
www.omama.com
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• New resource LIVE
• Customized for Ontario women and care
providers.
• Will compliment the discussion topics on OPR
and provide women with credible pregnancy
information.
• Designed for one-stop information shopping
Website and app
www.omama.com
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OPR – CHALLENGES!
• Process is time consuming (last OAR took 5
years!)
• Many stakeholders with differing opinions
• Challenge of convening busy clinicians for full
day meetings – everyone worked as
volunteers!
• Staggered implementation depending on
paper or EMR
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EMR Version – What’s Happening?
• Functionality being planned at next set of
meetings
• 3 vendors to start
• Working on others but need you to lobby
your EMR vendor if you want this!
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OPR - Next Steps
• Graphic design and formatting (paper version)
• Working on functionality for EMR version
• Completing the user guide
• Incorporating feedback
– Multiple comments about size/legibility
– Recommendations to consider a 3-pg record
• Pilot testing
• Wider implementation
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? Questions
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