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BORN ONTARIO PROVINCIAL ROUNDS

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www.BORNOntario.ca

info@BORNOntario.ca

@BORNOntario

Better Outcomes Registry & Network (BORN) Ontario

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The presentation will begin momentarily.

The Development of the “New”

Ontario Perinatal Record

Project Co-Chairs:

Anne Biringer MD CCFP FCFP, University of Toronto, Mt. Sinai Hosp.

Ann Sprague RN PhD, BORN Ontario

BORN PROVINCIAL ROUNDS – Jan 21, 2016

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Learning Objectives

• To describe the process of developing the new

Ontario Perinatal Record

• To describe new items and screening tools

embedded in the revised Ontario Perinatal

Record

• To outline the implementation process for the

new record and the accompanying guide

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• OAR developed and housed within OMA– No ongoing resources/plan for subsequent updates

• Last update 2005, many changes in clinical practice since then

• Increased use of EMRs, however no plan for electronic functionality

• BORN pilot with 2 vendors in 2012/13 demonstrated the desire for electronic functionality, however a content update was requested

History

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Vision for the Future

• Housed at PCMCH and version control will be

maintained

• Ongoing involvement by professional

organizations for 3-5 year updates

• Data to BORN from EMRs to reduce

duplication of data entry

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• To review and update the

current OAR, Post-Partum

Record and OAR User Guide

for both content and EMR

functionality.

• Partnership between

PCMCH, BORN Ontario and

the OMA, with the support

of the AOM.

Purpose of Working Group

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Working Group - MembershipName Role Organization

Dr Anne Biringer (Co-Chair) Family Physician Mount Sinai Hospital - Toronto

Dr Ann Sprague (Co-Chair) Scientific Manager BORN Ontario

Dr Debra Boyce Family Physician Partners in Pregnancy - Peterborough

Dr Doug Cochen Obstetrician Queensway-Carleton - Ottawa

Dr Barb de Vrijer Obstetrician/MFM London Health Sciences Centre

Dr Jessica Dy Obstetrician The Ottawa Hospital

Ms Dara Laxer Senior Policy Analyst Ontario Medical Association

Dr Stan Lofsky Family Physician North York General Hospital

Ms Matthuschka Sheedy Health Promotion Best Start

Dr Bill Mundle Obstetrician/MFM Windsor Regional Hospital

Ms Claudia Steffler Nurse Practitioner Maternity Care Centre - Hamilton

Ms Julie Toole Midwife/ Risk Analyst Association of Ontario Midwives

Ms. Doreen Day Committee Resource PCMCH

Ms. Anna Bucciarelli Committee Resource PCMCH

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Working Group - ConsultantsName Role Organization

Dr. Cindy Lee Dennis Women’s Mental Health University of Toronto

Dr. Dawn Kingston RN/Mental Health University of Alberta

Dr. Nan Okun MFM & Prenatal screening University of Toronto

Dr. Anne McLeod Medicine/Haematology University of Toronto

Dr. Mark Yudin OB/GYN, Infectious Diseases University of Toronto

Ms. Shelley Dougan Screening Specialist BORN, Ontario

Dr. Lisa Graves Family med/Substance abuse University of Toronto

Dr. Denice Feig Medicine, Endocrinology University of Toronto

Dr. Peter Selby Family med/Substance abuse University of Toronto

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• Stakeholder input sought

• “What are your the 3-5 changes you

would like to see?”:

– Content changes

– Functionality updates

OAR Survey

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• Survey sent to the following OAR user groups (> 350

responses):

– Obstetricians

– Family Physicians

– Midwives

– Nurse Practitioners

– RNs

• Feedback also received from practitioners in:

– Mental Health

– Public Health

– Genetics

– Paediatricians

OAR Survey Audience

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OAR Survey Results – Highlights

• Update Lab and Ultrasound sections

– i.e. Include TSH, Parvo, Ferritin, Hb

Electrophoresis, NIPT, age for amnio

• Update demographics

• More detail regarding alcohol and drug use

• More detail regarding breastfeeding

• More psychosocial information

– i.e. Social determinants of health

• Weight gain guidelines/advice

• Relevance of physical exam?

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Content Review Process

• Review of the OAR involves:

– Reviewing survey results

– Consulting current guidelines/best evidence

– Consulting other provincial/national antenatal records

– Expert consultation where required, i.e.

Depression/anxiety screening, alcohol/substance use,

genetic screening

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When considering changes to the clinical content/data elements:1) Is it evidence informed clinical care?

2) Is it/should it be part of the standard care pathway? Does it apply to most women?

3) Does it contribute to patient safety?

4) Does it contribute to population health?

When considering changes to the functionality of the form:1) Does it have the potential to facilitate care (e.g. evidence, reminders, flags)?

2) Is it user friendly? (e.g. flow, accessibility, ability to use it ,read it and receive it from other care providers, space to add to it when needed)

3) Does it facilitate information flow between care providers?

4) Are the data elements in alignment with those of BORN (i.e. terminology)

5) Is the requested change technically feasible?

Decision Making Criteria

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Ontario Perinatal Record (OPR)

• Note the name change!

• Not yet final

– Reviewed by OMA, OCFP, CMPA, AOM, HIROC

– Received feedback by over 120 individuals/organizations

– Currently incorporating feedback and reviewing with the

working group

• Graphic lay-out for paper version still needs

work – what you see here isn’t what you get!

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OPR – Are you Excited?

OPR1 -Demographics

OPR1 – Pregnancy Summary & Hx

DRAFT

M edical H isto ry and P hysical Exam (pro vide details in co mments)

DRAFT

M edical H isto ry and P hysical Exam (pro vide details in co mments)

DRAFT

M edical H isto ry and P hysical Exam (pro vide details in co mments)

DRAFT

OPR 1 - Physical Exam and Initial Labs

DRAFT

OPR2 - Demographics, Problem list,

Immunoprophylaxis

OPR2 – Visit Summary

DRAFT

OPR2- Genetics

DRAFT

OPR2- U/S

DRAFT

OPR2 – Discussion Topics

DRAFT

Updates – OPR2 – Additional Labs

DRAFT

Updates –OPR Screening Tools

DRAFT

Updates –OPR Screening Tools

DRAFT

Updates –OPR Screening Tools

DRAFT

OPR - EPDS

DRAFT

Updates –OPR Screening Tools

OPR3 – PP Visit

OPR3 – PP Visit

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What’s gone from OPR?

• No symphysis fundal height graph

• No risk stratification

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OPR User Guide

• New resource

– Accompanying document clarifies how to

complete each data point

– Connects reader to guidelines to care

• e.g. indications for ASA in pregnancy

– More details on how to ask questions

• e.g. intimate partner violence

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Home Page

www.omama.com

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• New resource LIVE

• Customized for Ontario women and care

providers.

• Will compliment the discussion topics on OPR

and provide women with credible pregnancy

information.

• Designed for one-stop information shopping

Website and app

www.omama.com

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OPR – CHALLENGES!

• Process is time consuming (last OAR took 5

years!)

• Many stakeholders with differing opinions

• Challenge of convening busy clinicians for full

day meetings – everyone worked as

volunteers!

• Staggered implementation depending on

paper or EMR

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EMR Version – What’s Happening?

• Functionality being planned at next set of

meetings

• 3 vendors to start

• Working on others but need you to lobby

your EMR vendor if you want this!

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OPR - Next Steps

• Graphic design and formatting (paper version)

• Working on functionality for EMR version

• Completing the user guide

• Incorporating feedback

– Multiple comments about size/legibility

– Recommendations to consider a 3-pg record

• Pilot testing

• Wider implementation

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? Questions

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