June 2014
Maternity Information Update: Issue 3
Work on developing a new way of collecting, sharing and viewing maternity information continues, as part of
the Maternity Information Systems Programme
Maternity Information Update is a regular newsletter bringing you the latest programme news. You can
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the newsletter.
In this issue:

Focus on Cheryl Benn – Chair, Maternity Clinical Reference Group

MidCentral and Whanganui DHBs close to going live on new systems

New neonatal clinical information system pilot

Maternity View relies on sequence of events

Milestones

Privacy impact assessment completed

How the systems will work

Next steps
Focus on: Cheryl Benn – Chair, Maternity Clinical Reference Group
Cheryl Benn loves a challenge, and says that – as Chair of the
Maternity Clinical Reference Group (MCRG) – it's just as well!
Implementation of the national maternity clinical information system
(MCIS) is being led by a national steering group, assisted by separate
clinical reference groups for the maternity and neonatal systems and
an advisory group of consumers. The groups are working to complete
the design and configuration of the new systems.
The MCIS will electronically collect and link relevant information. It will enable health professionals like
midwives, GPs, hospital doctors, nurses and hospital and community specialists to work together more
effectively, as all relevant information will be pulled together and viewed in one place by women and the
health professionals caring for them.
Cheryl is a LMC midwife doing home and hospital births, and Regional Midwifery Advisor for MidCentral and
Whanganui DHBs. She became Chair of the MCRG just over a year ago. Cheryl, who is South African-born and
educated, says her role as chair of the group is incredibly busy and challenging, but also very rewarding.
"I've had to rearrange my life a bit. I do a lot of testing of the system from home at night, and there have
been regular weekly Webex meetings of the MCRG with Scotland-based vendor Clevermed early in the
morning, to fit in with the time difference. The MCRG also has to report monthly to the national steering
group.
"But as a practicing LMC, if there's a woman with a clinical problem or in labour, I just have to go and forgo
meeting attendance whether the meeting is in Wellington or by phone or Webex!"
Cheryl says she's spent a lot of time engaging with LMCs, finding out how computer literate they are, and
talking to them about the new system.
"Midwives as a workforce tend to be older and so levels of computer literacy vary quite a lot – I wasn't that
computer 'language' literate myself when I started on this project but my knowledge has grown. Some
midwives I talk to are really excited about the new system, while others are a bit slower to warm to it."
Cheryl believes the new system will see women receiving better care in the long run.
"LMCs will be able to communicate more easily with the other health services a pregnant woman is using, so
we will have better information about the woman. At the moment, LMCs don't always receive all the
information they need once a woman has been seen in clinic or in hospital and discharged back to LMC care.
The new system will also reduce some of the more repetitive parts of our job, such as filling in multiple forms
requiring similar information.
"For women, it will mean they will eventually be able to see all their information electronically in one place –
and before too long, on their smartphone, laptop or iPad."
She says one of the great pleasures of the project for her has been working with the clinicians who have
been helping to 'New Zealand-ise' the system.
"They are helping us with language and workflow, and have just been so good and so patient and made the
job so much easier."
She says as the go-live date gets closer for MidCentral and Whanganui DHBs, there's some nervous
anticipation and some frustration as well.
"We know people are watching us and waiting to see what happens. We are waiting to see too! We know
there will be challenges and that – as with any new software system – it won't be perfect from day one.
"But we're confident we're going through a very thorough testing and implementation process, and are
really excited about the introduction of a new system that will make important information about a woman's
pregnancy more available to those who need it."
MidCentral and Whanganui DHBs close to going live on new systems
For Judith Wallace, being the 'first cab off the rank' implementing the
national maternity clinical information system (MCIS) has been
exciting, challenging and a steep learning curve.
"Everything we do is new and we are the first DHB implementing
MCIS," says Judith who is the Senior Project Manager MCIS for
MidCentral and Whanganui DHBs.
The DHBs are working together to implement the MCIS with the MidCentral go-live date early August this
year, and the Whanganui date early-to-late August.
"Initially, the current systems, and the new system will be run in parallel," Judith says.
"Pregnant women on the existing DHB system will stay on that system, while – after go-live – all new
bookings will go into the MCIS. The approach of a staged implementation will enable an easier transition,
ideally with fewer issues, and allow staff to become familiar with the multiple new business processes which
may initially involve extra work for them.
"As a project team, we are very aware of the need for 'change management' and want to ensure we embark
on a successful journey."
Clinical Director Regional Women's Health Service and obstetrician Dr Digby Ngan Kee says another big
advantage of the new maternity information system is that it will provide an accurate database to better
manage DHB maternity services.
"For example, people have been advocating for a national perinatal database for years. Once the MCIS is
nationwide, it will enable us to audit all sorts of things in our local maternity services – from perinatal
mortality to post-partum haemorrhage.
"The system will also mean much improved communication between health professionals – particularly
when it extends to general practice."
The maternity system will eventually offer real time foetal monitoring, which Dr Ngan Kee says will be an
extremely valuable tool.
"There are concerns about adverse outcomes resulting from inaccurate CTG interpretation. Real-time CTG
monitoring through the MCIS is potentially a valuable tool to produce more accurate CTG assessment and
improve outcomes."
Dr Ngan Kee says the consumer groups he works with are looking forward to the introduction of the
women's Maternity View (a type of patient portal), which will enable women to securely view their
maternity information online.
The New Zealand-ised maternity clinical information system was released in January 2014 by vendor
Clevermed. Scenario testing finished at the end of March, and the next version of the system was released in
early May.
Judith Wallace says all DHBs in the first group to roll out the system are now heavily involved in user
acceptance testing.
"There is a large amount of testing, feedback and re-testing needed to ensure the system that goes live is
stable and delivers what it is set up to do."
She says once the user acceptance testing is completed, staff training can begin.
"Clevermed provides 'train the trainer'-type training. Key staff will have one day of training on the new
system, and then will be responsible for training other staff who will use the system – such as midwives,
LMCs and doctors.
"Setting up training is rather challenging, because for every person attending, rosters have to be changed to
ensure their shift is covered."
Judith says another challenge has been setting up the multiple environments – test, training, trial and live.
Staff at the DHBs access these environments through the National Health IT Board's Connected Health
network, which is a reliable and secure 'network of networks' for the transfer of health information.
"People naturally have questions about confidentiality, privacy and security in relation to the transfer of
maternity and neonatal information. They are reassured when I tell them about the Connected Health
network."
Between them the two DHBs have installed over 30 new workstations in delivery suites, birthing centres,
and neonatal wards.
Judith says, as with every new project, some people can't wait to come on board, while others are more
reticent and take a bit more encouragement.
"It's all about engaging people as early as possible, being there to answer their questions, and demonstrating
to them what the new system will look like and how it will affect them.
"I've been going to staff meetings and running workshops for staff that include showing two 10-minute
videos – one about the new neonatal system and one about the new maternity system. This has given
everyone an initial understanding of what the application does and how it will assist them.
"Mostly, staff are excited about the new system and are looking forward to being able to access the
information they need about a mother and her baby in the one place."
Judith is a big advocate of the benefits the new MCIS system will bring.
"I think it's fantastic. Initially local women will be able to see information relating to their labour and birth in
one place. In the future, there will be an app available that allows them to access more of their information
from their smartphone."
MidCentral and Whanganui DHBs are two of a group of four DHBs that will be the first to go live with the
national maternity clinical information system. Judith has instigated teleconferences between the DHBs so
experiences can be shared. "As the first DHB off the block we are continually experiencing challenges and
learning exactly how the application interfaces with other applications, and needing to develop new
processes. It makes sense to work together closely and share what we've learnt."
New neonatal clinical information system pilot
MidCentral and Whanganui DHBs are also piloting the new neonatal
clinical information system (NCIS). The NCIS includes modules for
recording neonatal intensive care notes and documenting information
related to transferring babies around the country.
Information collected by the maternity information system will
transfer across to the NCIS if a baby is admitted to a neonatal
intensive care unit. Once a baby is discharged from the neonatal unit,
relevant information about them will be available to the mother and
her LMC via the maternity information system, to make the baby's record complete.
Judith Wallace, Senior Project Manager Maternity Clinical Information System for MidCentral and
Whanganui DHBs, says training on the neonatal information system started at the DHBs at the end of March,
and the pilot ran from early April to the end of May.
"We started with entering information about just one baby, and went from there. As it turned out, that baby
was transferred from MidCentral to Whanganui Hospital, so we had a great example of how the information
sharing worked – with staff at both hospitals being able to see the same information."
MidCentral and Whanganui DHBs are looking to go-live with the neonatal information system later in July.
Maternity View relies on sequence of events
The information gathered through the maternity clinical information
system will enable a 'Maternity View' to be created – a portal
clinicians and women can use to see relevant maternity information in
one place.
Programme Manager, Maternity Information Systems Programme,
John Tolchard, says the creation of the Maternity View relies on a
particular sequence of events.
"To enable a Maternity View, a number of things have to happen. For example, until the first DHB is running
the maternity clinical information system (MCIS), we can't have a Maternity View as the information to
create the Maternity View comes from the MCIS.
"There is also the need for a software change to lead maternity carers' systems so a 'flag' can be activated
when a new pregnant woman is being booked, advising the woman has chosen to have a Maternity View
created. The MCIS then creates a Maternity View for her.
"As well, there is on-going work with the consumer advisory group and other stakeholder groups to finalise
what will be able to be viewed initially. It's important we make sure the basics are working well, before
expanding the Maternity View. Initially, women will be able to see their booking, labour, birth and discharge
information online. In time, other information, such as blood test and scan results may be added."
A maternity consumer advisory group (MCAG) has been formed to advise on the development of the
Maternity View as well as other aspects of MCIS.
The group held its first meeting with vendor Clevermed in March and reviewed an early version of the portal.
The MCAG will work with the first implementing DHB/s and a small group of pregnant women and their
LMCs to further refine and enhance the Maternity View.
Milestones

April 2014 – MidCentral and Whanganui DHBs started a pilot of the neonatal clinical
information system with a small number of babies to test internal workflow and the
managed service prior to a full implementation

May/June 2014 – version 2.0 of the software released

April to June 2014 – early adopter DHBs test final configuration changes to the system

Late July 2014 – MidCentral and Whanganui will go live on the new neonatal system

August to October 2014 – MidCentral, Whanganui, South Canterbury and Counties Manukau
DHBs will go live on the new maternity system
Privacy impact assessment completed
A privacy impact assessment for the project was completed in March 2014 and has been published on the
National Health IT Board's website.
The first DHBs planning to implement the system, consumers, the maternity and neonatal clinical reference
groups and the Office of the Privacy Commissioner were all involved.
It is a living document and will be reviewed and updated as the systems undergo further development
How the systems will work
Relevant information from LMC practice management systems and GP practice management systems (eg,
booking information), and from laboratories (eg, blood test results) will be transferred to a central data
repository – the Maternity Clinical Data Repository. It is then available to the Maternity Facility System for
sharing with authorised hospital doctors, midwives, nurses and other health professionals, as appropriate.
Labour and birth summary information will be transferred back to LMC practice management systems.
Women and authorised health professionals will be able to view a summary of this information through a
portal, the Maternity View.
Next steps

Specifications for an interface between community maternity practice management systems and the
national MCIS have been drafted and are with vendors for quotations.

The Maternity Information Systems Programme focus is to continue to work with the first group of
DHBs planning to go live in the next few months.

DHBs not already involved with the MCIS have been asked to advise a timeframe between June 2014
and June 2016 when they would implement the system. These responses will provide a 'roadmap' of
DHB implementation dates.

Following the implementation of the MCIS at the first group of DHBs, the Consumer Advisory Group
will work with Clevermed, a small group of woman and LMCs in both the community and hospital
setting, to further develop the Maternity View.

The Maternity Information Systems Programme will continue to work with DHBs and LMCs over the
next two years as the new system is introduced to all DHBs.
Keep up-to-date with progress
The Maternity Information Systems Programme website has the latest details on the
maternity information systems, as well as background information.
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If you have any queries, please email us at enquiries@ithealthboard.health.nz.
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