As the Maternal & Newborn Clinical Management System matures upgrades are required to keep up with available versions of software to support required functional changes.  The MPage upgrade brought MN-CMS from version 6.4 to version 6.10 which ensures a secure and fully supported MPages and also allows for code fixes, enhancements, and assurance that the HSE remain in line with latest functionality, stability and support model. It also addresses a number of service requests which could only be resolved through this upgrade.

Key Changes

MPages, also known as Summary Pages, are a key component of the MN-CMS Electronic Patient Record allowing customised clinical summaries of patient data. There are Summary workflow Pages for the Maternity and Gynaecology components of the patient record and this upgrade has moved the Neonatal patient record to a Workflow Summary Page also.

The upgrade brought slight changes to the look and feel of the maternity and gynaecology views and introduced a separate MPage for the partogram. But the fundamental changes that were made to the Neonate workflow summary pages streamline the Neonatal patient record user’s workspace and enables new functionality to be delivered. 

Neonatal Workflow Summary Page Development

The Neonatal summary page functionality within Cerner Millennium was no longer supported and neonatal patient record was awaiting fixes which could only be delivered on the upgraded version.  A series of Neonatal Workflow review sessions were held during the summer of 2018 at the four MN-CMS sites. The Neonatal users identified significant improvements which they would like to see as part of the Neonatal build. Following the review sessions, Cerner provided MN-CMS with a draft data collection workbook (DCW) and a joint workshop was held to finalise the Neonatal Workflow Summary Page design & content. It was agreed that the implementation of a Summary Pages Upgrade, together with the newly designed build could have significant end user benefits.  It would bring the view of the neonatal patient record in line with the rest of the MN-CMS electronic health record.

National Institute for Health and Clinical Excellence (NICE) Neonatal Jaundice Graph

The NICE Neonatal Jaundice Treatment Threshold Graph, which contains recommendations for the recognition, assessment and treatment of neonatal jaundice, was incorporated into the views of the new summary pages so as to be easily accessible to users. It is a unique ground- breaking system development supporting the management of neonatal jaundice; ensuring treatments are given for the optimal period of time to babies with hyperbilirubinaemia thereby improving; patient and family experience and efficiencies in the neonatal department of automatic plotting of bilirubin levels to the graph based on gestational age.

Project progression

Due to COVID -19 the team were unable to complete testing on site, however with the support of the local back office teams and clinical staff all testing was completed remotely complying with national infection control guidelines. Similarly face to face training of the new functionality was not possible, however a training video was created to overcome this and training was completed using the video with remote support from the MN-CMS national team

Due to the nature of the changes required for the new neonatal workflow, the Neonatal Summary Page went live in advance of the other Summary Pages. Immediate testing of the Neonatal Summary Page was carried out by the subject matter experts and the page was released within hours to users. Some minor design tweaks were implemented at the time of go-live based on the huge volumes of live patients data

All 4 MN-CMS sites went live with the Maternity and Gynaecology Summary Pages, Version 6.10 Summary Pages at the same.

Benefits

The benefits which are realised with the introduction of the MN-CMS Summary Page Upgrade to version 6.10:

• Improved patient care as a result of improved Summary Page functionality including consistency of design and behaviours
• Significant end user benefits to facilitate use of the system and overall navigation, enhanced custom configuration
• Neonatal workflow has a new Summary page in line with the Maternity and Gynaecology Summary pages to enhance access to patient information, trending views for bloods, ventilation, aEEG and summary function for apnoea/bradycardia/desats as well as improvements of vitals/ feeds/cares summary
• Lab results displays will be improved to reflect ‘Results Review’ more accurately
• The upgrade will also enable faster delivery of enhancements and corrections
• New ability in the Neonatal Summary Page to add a free text summary of patient care which is useful for handover and ward rounds

This Benefits Plan is derived from the MN-CMS project documents, Project Initiation Document (PID) and the Programme’s benefits realisation plan, and the agreement: CCN 038 which is linked to Change Request (CR) 1443 and the ICT 19285 SubP Proposal Mandate – NICU Optimisation MPages Upgrade.

NICE Jaundice Treatment Graph for baby of 31 weeks and 4 days gestation (*Test Patient)

Associated publications:

Murphy BP, O'Raghallaigh P, Carr M. Nurturing the digital baby: Open innovation for development and optimization.  Health Informatics J. 2020 Dec; 26(4):2407-2421. doi: 10.1177/1460458220906067. Epub 2020 Feb 25. PMID: 32098558.

Contact: 

Mary Mullins, Change & Transformation, Risk Management Lead, MN-CMS

email:

Mary.mullins@hse.ie