Achieving Safe Motherhood and the neonate by using Interactive Medical Intelligence
Author: G. Pregenzer MD, FACOG, FACS, FICS
Affiliation: Somerset Medical Center;
Robert Wood Johnson University Hospital; Somerville, New Jersey, USA
&
Verify-IMI, Warren, New Jersey, USA
Presenter: Gerard Pregenzer MD, FACOG, FACS, FICS
London, England
April 24-26, 2017
Introduction
The application of the computer and Information Technology has had the promise of dramatically improving the medical care worldwide for over a decade now.
The landmark report in the United States by the Institute of Medicine in 2000, “To Err is Human, building a safer Health System” indicated that up to 90,000 Americans die from medical errors largely attributed to illegibility of medical orders and directives.
The current electronic medical record systems used worldwide certainly solve the illegibility concerns. But the question remains, what about true quality of care?
The vast majority of systems today are used for tracking billing, and checking on inventory issues. None of the systems evaluated by the authors have a check and balance system to assist the clinician in determining if a medical mistake has occurred.
A system was developed which, we believe, has taken Information Technology in medicine to the next level.
The new system is not a medical record system but rather an interactive medical intelligence system. Such a system has the ability to assist the clinician to accurately, efficiently and rapidly deliver obstetrical care and dramatically reduce, if not, eliminate medical errors.
Material and Methods
Seven busy obstetrical practices were selected to transfer the patient clinical information from their system, both paper and electronic based, into the Interactive Medical Intelligence system.
Over a 1,000 pregnancies were followed until delivery.
The number of omissions or inactions identified by the Interactive Medical Intelligence system were determined and tabulated.
These were compared to the risks identified by the traditional methods and some of the standard commercial Electronic Medical Record vendors.
| Missed by Obstetrical Practices | ||||||
| Annually in USA | ||||||
| Category | # omissions/inactions per 1,000 | 4,300 | ||||
| History of HSV | 8 | 34,400 | ||||
| History of LEEP | 7 | 30,100 | ||||
| Maternal blood type not obtained | 4 | 17,200 | ||||
| IVF not noted | 7 | 30,100 | ||||
| Previous myomectomy | 3 | 12,900 | ||||
| Sickle cell trait | 1 | 4,300 | ||||
| USG of Cervix not measured in High Risk for PTL | 8 | 34,400 | ||||
| (+) Group B Streptococcus culture | 6 | 25,800 | ||||
| Family History or Autism, no Fragile X ordered | 4 | 17,200 | ||||
| Short interpregnancy interval not noted | 11 | 47,300 | ||||
| Missed by Obstetrical Practices | ||||
| Annually in USA | ||||
| Category | # omissions/inactions per 1,000 | 4,300 | ||
| Low MCV recorded but no action taken | 8 | 34,400 | ||
| Missing fields in chart | 106 | 455,800 | ||
| No maternal height recorded | 90 | 387,000 | ||
| No fundal height recorded | 64 | 275,200 | ||
| Elevated initial BP not acted on | 15 | 64,500 | ||
| Elevated BMI for appreciated for risk dystocia | 11 | 47,300 | ||
| Elevated BMI for appreciated for risk PTL | 11 | 47,300 | ||
| Short maternal stature not appreciated as risk for dystocia | 5 | 21,500 | ||
| At risk for GDM not offered early Glucose screening | 12 | 51,600 | ||
| History multiple abortions not noted as risk for PTL | 7 | 30,100 | ||
| Total | 388 | 1,668,400 | ||
Conclusions
As the Institute of Medicine has indicated, humans are human and are prone to making mistakes. When mistakes occur in obstetrics, the resultant problems can be lifelong for the neonate. Extrapolated over the 4.3 million births every year in the United States, approximately 1,668,000 omissions or inactions occur in the care of the pregnant patient. Some of these errors have the potential to lead to catastrophic outcomes for the child and family. This would include a financial burden and a medical legal impact affecting the family, clinician and hospital.
The dream has been to utilize computer technology to help humans identify mistakes and take corrective actions. This has not been realized until now with the development of Interactive Medical Intelligence.
In this system, data is collected during the history and physical exam. Risks are identified and diagnostics are suggested. The results of these diagnostics may further identify additional or refine the noted risks. The system never forgets, and continues to remind the clinician of outstanding results or if another test needs to be ordered. All abnormalities are noted on the front page so the clinician does not need to search the chart, especially in an emergency situation.
The Interactive Medical Intelligence system integrates with the commercial labs and interprets the data and does not depend on the commercial lab to identify abnormal labs. We have identified at least seven (7) situations when the commercial lab reported an abnormal result but did not flag the result and the result was not in red print. Unfortunately, in three situations, permanent harm occurred to the baby and litigation followed.
We believe all clinicians should use an Interactive Medical Intelligence system to act as a “check and balance” system to help protect the baby, mother and clinician.
This new system, Verify-IMI, is an interactive medical intelligence system. Such a system has the ability to assist the clinician to accurately, efficiently and rapidly deliver obstetrical care and dramatically reduce, if not, eliminate medical errors.