Software configuration

Technical infrastructure changes may be necessary prior to the initial configuration of FetaLink. In addition, further build work might be required to tailor FetaLink to the needs of clinicians.

Infrastructure

Most Cerner services are cloud-based, but FetaLink needs a lot more bandwidth to host data locally, and this infrastructure needed to be in place prior to configuration. Cerner provided details of the minimum requirements for the servers and, using these, ICHT went through the standard procurement channels.

Once this was in place, the ICT Senior Clinical Project Manager worked alongside the Server Management team (part of the Operations Team in IT), making holes in the firewall to allow the data to flow from one area to another.

Process

ICHT worked with Cerner to adapt the system to the specific needs of ICHT.

Using the ‘data collection worksheets’ provided by Cerner, the Working Group, along with the midwives, consultants and the Cerner FetaLink team discussed the build specifications (e.g. annotations, sequencing of annotations, patient display, drop-down lists, etc.) that needed to be altered. Cerner then integrated them into the system and presented the results back to ICHT in a demonstration. The final FetaLink product was developed from this iterative process.

‘If there were display or design options, the working group would predominantly make that decision, and then reflect back to the steering group – this decision has been made, these are the reasons, these are the pros and cons, and these are the implications of what we’re doing.’
– Change Lead

In terms of the on-screen display, ICHT opted for the foetal strip to display 1cm/hour so that it would look similar to the paper foetal strip that the clinicians were used to using previously.

Key lessons

IT infrastructure upgrades might be necessary; the amount of back-end operations on the servers and firewall should not be underestimated.
The build is not necessarily the most time-consuming aspect; setting up the hardware and kit and mapping and agreeing on changes to physical workflows were the most challenging parts.
It’s good to have a clinical lead involved in decision making around configuration. It is likely that the heavy involvement of the ICHT Clinical Lead contributed to the successful tailoring the software to the needs of the clinical teams.

Supporting evidence

The importance of IT infrastructure upgrades in the context of the implementation of FetaLink (or other foetal monitoring systems) should not be underestimated. Other international case studies stress that, early on in the planning process, it is essential to collaborate with the vendor to gather the necessary IT and network requirements to ensure successful deployment (eHealth Ireland, 2018; Ministry of Health of British Columbia and EY, 2017).

With regards to the adaptation of the physical workflows and software configuration, it is likely that the involvement of clinical teams in the decision making contributed to a smooth “go-live”. Both the American Nurses Association and the Ministry of Health of British Columbia (among others) argue that clinical monitoring documentation systems (particularly those used in high-pressure situations), need to be adapted to the needs of the clinical teams, making sure that display options, terminology and annotations options are aligned to the reporting requirements of the adoption organisation and with relevant directives or policies. They also argue effective documentation can only take place if the documentation software is well-integrated into clinical workflows, as otherwise clinical staff either do not have time to record information effectively or have to spend excessive amounts of time annotating information, at the expense of patient care.

References

Cypher, R.L., 2018. Electronic Fetal Monitoring Documentation. The Journal of perinatal & neonatal nursing, 32(1), pp.24-33.

eHEalth Ireland (2018). Enterprise Case Study: Using IT to Improve Ireland’s Public-Sector Healthcare. Available here. (accessed: 18/02/2019

Ministry of Health of British Columbia and Ernst and Young (2017). Review of Island Health’s IHealth Electronic Health Record System. Available here. (accessed: 19/02/2019)

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