SECTION 2: MEASUREMENT Perinatal Information Systems for Quality Improvement: Visions for Today

Today clinical information is used for a multitude of purposes beyond patient care documentation including quality review and improvement processes, allocation of resources, budgetary and long-term planning, productivity measurement, and justification to payers for services provided. Providers in perinatal medicine are faced with the challenge of finding methods to meet these information needs. Case examples of the different approaches to collecting and using obstetric and neonatal information are described. The role of computer-based patient records is outlined and solutions available to perinatal medicine are reviewed. Pediatrics 1999;103:266–277; computer-based patient records, continuous quality, improvement, databases, information systems, perinatal medicine, neonatology. ABBREVIATIONS. JCAHO, Joint Commission on Accreditation of Healthcare Organizations; NCQA, National Committee for Quality Assurance; HEDIS, Health Plan Employer Data and Information Set; HMO, health maintenance organization; ICD-9, International Classification of Diseases, 9th edition; CPT, Current Procedural Terminology; NICU, neonatal intensive care unit; HIMSS, Health Information and Management Systems Society; HISD, Healthcare Information Systems Directory; CDC, Centers for Disease Control and Prevention; AHIMA, American Health Information and Management Association; UHDDS, uniform hospital discharge data sets; HL7, Health Level 7; NPIC, National Perinatal Information Center; VON, Vermont Oxford Network; NNIS, National Nosocomial Infection Surveillance System; ECMO, extracorporeal membrane oxygenation; NICHD, National Institutes of Child Health and Human Development; CPR, computer-based patient records; IOM, Institute of Medicine; MDS, Medical Data Systems; FHR, fetal heart rate; ODMS, obstetrical data management system. Never in the history of medicine has the demand for information been so great. In the past, patient information was primarily used by the health care team directly providing care to the patient. Now clinical information is used for a multitude of additional purposes including quality review and improvement processes, allocation of resources, budgetary and long-term planning, productivity measurement, and justification to payers for services provided.1 In 1979, 71% of hospital information system spending was on business systems for patient billing and materials management. By 1993 a dramatic shift had occurred, with 52% of health care information dollars going toward systems to handle direct clinical patient data and another 29% for miscellaneous consulting systems for use in areas other than business or direct patient documentation.2 Data requests to obstetrics and neonatology come in from other hospital departments, state and federal agencies, payers, and outside accreditation agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)3 and the National Committee for Quality Assurance (NCQA).4 Increasingly health consumer groups like the National Business Coalition on Health,5 which are charged with monitoring the costs and quality of care provided, are entering the data game. These diverse information needs in an era of health care reform and decreasing health care reimbursement present a tremendous challenge to providers seeking to enter the electronic age. There are two basic components of computerized information—the data and the software (often a database) to store and handle that data. Health care consultant Sharon Graugnard cautions, “It is important to turn raw data, of which there is plenty, into meaningful information. Technology should be the facilitator, not the solution.”6 To that end, many decisions need to predate the choice between internally building a database or selecting a vendor to help meet perinatal information needs. This article recounts examples of the experiences of perinatal care providers in developing and using a diverse range of systems to handle obstetric and neonatal information. In part all these efforts have touched on some of the following issues in making a choice of an information system for perinatal medicine: 1. Why collect data? 2. What data are needed to generate the desired outputs? 3. How are the data going to be collected? 4. Who is the data collection going to include? 5. Where will the information reside? WHY HAVE A PERINATAL INFORMATION