Giving Birth on the Internet

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Giving Birth on the Internet

• Babies, Data, the World Wide Web
• in New York State
• Mary Applegate, MD MPH
• Bureau of Womens Health, NYSDOH

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Statewide Perinatal Data System-SPDS-
Collaboration betweenBureau of Womens Health
Vital Records SectionNew York State Department
of Health
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Improving birth outcomes in New York State

• Statewide Perinatal Data System
• Real-time, clinically relevant data for quality
  improvement and public health surveillance
• Perinatal Regionalization
• Infrastructure for quality improvement

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SPDS vision A statewide perinatal data system
that allows the Department of Health to identify,
in real-time, problems in health care delivery
and public health and that allows local
stakeholders to conduct quality assurance,
quality improvement, and community health
assessment.
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SPDS objectives

• Vital records registration
• Hospital quality improvement
• Perinatal regionalization
• Public health surveillance reporting
• Medicaid newborn enrollment

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Background

• 1995 review of maternity and newborn care in New
  York City
• Demonstrated need for data system statewide
• Regional Perinatal Data System
• Central New York Regional Perinatal Center
• Designed for quality improvement

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Technical Aspects of SPDS
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SPDS structure

• Core module
• Birth registration
• Additional quality improvement data
• Birth log
• Newborn high risk (NICU) module
• Clinical snapshot on NICU admission
• Used for risk-adjustment
• Maternal high risk module
• High-risk antepartum conditions
• Maternal transports

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SPDS modules
Core Module -all hospitals -all births
NICU
Ambulatory
High-risk modules
Optional modules
Birth log
Maternal
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Technical capabilities

• Internet-based, web-browser application
• Flexible entry of data
• Data available at multiple sites
• Automated reports
• 3 years of legacy data will be available
• Upload and download of data

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Streamlined data functions

• Multiple functions
• Vital records
• Birth log
• Graduate Medical Education tracking
• Internal quality assurance
• Accreditation reports
• State registries
• Highly cost effective for hospitals

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Birth log

• Required by hospital code
• 1ary use nosocomial infection tracking
• Paper or SPDS record
• Most fields already in core module
• Additional fields added for optional use
• Attending personnel, location of birth
• Data access restricted to hospital

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Data confidentiality

• Restricted internet web sites
• Health Provider Network
• Hospitals, physicians
• Local registrars
• Health Information Network
• State and local health departments
• Data encryption
• Authentication

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Access to SPDS

• Only valid users
• Hospitals, physicians
• Local registrars
• Health departments -- state, local
• HPN or HIN account required
• Approved by HPN coordinator at institution or
  agency
• User-ID and password assigned
• Level of access varies by user type

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Authentication of data

• Ensures integrity of
• the record
• the information contained therein
• Substitutes for handwritten signature
• User-ID and password
• System controls
• Eventually, digital certificates

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Flexibility in data entry

• Data can be entered at various times
• First prenatal visit
• Prenatal update (can replace prenatal summary
  sent to LD)
• After birth
• After NICU stay
• Data can be entered from various places
• Hospital -- LD, billing office, medical records
• Physicians office or home
• Registrars office or home

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Implementation of SPDS
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Multi-step process

• Agreement on data elements functions
• Stakeholder endorsement
• Software development
• Regulatory authority
• Assistance from Regional Perinatal Centers
• Hospital training technical support

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Statewide Roll-Out

• Currently finishing software development
• Complete beta-testing in Central NY
• Final software adjustments
• Region by region roll-out
• Upstate regions (currently using RPDS)
• Lower Hudson Valley region
• Long Island region
• New York City region

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Special note on NYC

• Separate vital records jurisdiction
• NYC will continue to use its own electronic birth
  certificate (EBC)
• Link between NYC EBC and SPDS
• ?Download data from SPDS into NYC EBC
• ?Upload data into SPDS from NYC EBC
• Decision not yet made

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Using Data to Improve Birth Outcomes
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When nothing gets measured, nothing gets
done.Margaret OKaneNCQA
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SPDS measures

• Electronic Birth Certificate elements
• Birth outcomes
• Pregnancy complications
• Risk factors
• Additional QI and PH measures
• Patient satisfaction
• Breastfeeding
• Intendedness of pregnancy
• Chart availability

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Measurement levels

• Hospital
• Neonatal mortality
• Cesarean rate
• Integrated care systems
• Adequacy of prenatal care
• Site of birth for high-risk mothers infants
• Community
• Adolescent pregnancy
• Low birthweight

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Data-driven quality improvement

• Monitor trends over time
• Compare performance with others
• statewide averages
• regional averages
• regional average among similar hospitals
• National benchmarks
• Healthy People 2010

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Whats ahead?

• Reporting from multiple sites
• User - defined fields
• Additional reports
• Additional functions/modules

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Future SPDS linkages

• Newborn metabolic screening
• Newborn hearing screening
• Immunization Registry
• Congenital Malformations Registry
• Electronic Death Registration System

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Questions and Answers
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