BORN Ontario, along with eHealth Ontario, is engaged in a pilot project to integrate prenatal best-practice clinical guidelines into Electronic Medical Record (EMR) systems in Ontario, thereby helping physicians optimize the care provided to their obstetrical patients.
Ontario physicians and midwives use the standardized Ontario Antenatal Record (OAR) forms to guide and to record prenatal care. These forms, which capture the patient’s entire prenatal history, are transferred to the intended birthing hospital near the time of delivery.
Best practice guidelines for prenatal care are available, but are not currently integrated into existing EMRs. The absence of integrated guidelines can impact care. For example, we know that approximately 28% of women who give birth do not receive prenatal screening; this may be the result of screening not being offered, testing not being offered at the appropriate time, or in some cases, women choosing not to be screened.
Integrating best practice guidelines into EMRs could conceivably enhance a number of care practices including diabetes screening, fetal growth evaluations, and life style counselling.
Completion of the antenatal forms is a critical part of the care pathway, but in some cases, the forms do not reach the birthing hospital in time for the delivery. When the healthcare provider does not have access to these forms, it poses unnecessary risk to both the mother and baby and increases costs to the system (i.e. without the antenatal forms, the blood work and ultrasounds have to be repeated prior to delivery).
In addition to the integration of clinical guidelines, key aspects of the project include:
- Enabling the information gathered at these prenatal visits to be transmitted to the BORN repository via EMR;
- Working with hospital stakeholders to understand future opportunities for the transmission of the OAR forms;
- Evaluating the impact of integration on participating family health teams.
This project aims to provide physicians and midwives with access to the information they need, when they need it, a key underpinning of the eHealth Strategy.
A Request for Proposals was issued in December 2012 for EMR participation and awarded in February 2013. Two EMR vendors and 10 Family Health Teams (FHTs) were engaged to develop and to implement the EMR clinical guidelines and data transmission requirements for inclusion to the BORN Information System.
The project went live in the Fall 2013.