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Samples of Major U.K. Data Definitions
Comments relevant to virtually all major U.K. maternity and perinatal data definitions except the EEPD.
Vol IV. “Resource Document” and Vol V. Draft Phase 1 “Logical Prioritisation” 1. Exclusive focus on “Secondary Data for Analysis” rather than “Individual Patient Care” even though good Secondary Data, by definition, must depend on good Primary Data. Incompatible data requirements are inevitable unless the source is clearly defined. The general assumption seems to be either a) that computers are magic or b) that someone somewhere has to manually re-enter the data into each separate database in a format which fits each different data requirement. 2. Such datasets are definitely not designed to be part of an electronic patient record but exclusively as an electronic database for analysis. Yet for no good reason, at far too early a stage, most such documents are created in a database format rather than as a word-processed document for easy analysis and modification. As a result they are almost impossible for health care staff to comment on or to revise, and have to be extensively modified to be used in an EPR .
3. No allowance for combinations not listed e.g. what if both “Prostaglandin” and “Syntocinon” have been used in an individual; for Individual Care EPRs separate items must always be documented separately. 4. Not chronologically arranged therefore impractical to compare with other similar complex dataset definitions. 5. No flow-patterning to reduce workload. e.g. No preceding “Was there a labour? 6. No free text option to clarify “Other” 7. No list of excluded items - with a documented reason why.
8. No clear criteria for inclusion or exclusion of potential items.
For a full discussion see the paper “The Mandatory Detailed Analysis of all Individual Care EPR data items this can be found on the EEPD at www.fawdry.info\EEPDPCFILES\01_ESSAYS\B_EPRS\05_ANALYSIS\Analysis.pdf NHS-IA Maternity Care Data Project - Data Dictionary (Mainly 1998-2001)
Entity: Induction
Item:
Definition:
The date on which induction of labour is commenced.
Category Values:
Definition:
The method used for the induction of labour.
Category Values:
NHS-IA Maternity Care
Data Project - Data Dictionary
Definition:
The time when induction of labour is commenced.
Category Values:
As taken from the web site: www.nhsia.nhs.uk/mcd/pages on 3rd March 2003. Website still in existence 22nd May2007 at which time it included the following - “Most recently updated 29 March 2007.” This comes (as always in strict alphabetical order) just after: “Entity: Haemoglobin. Item: Haemoglobin at Booking. Definition. The mother’sHaemoglobin at booking or recorded as early as possible during the pregnancy” followed by “Entity: Healthcare Professional Attendance: Items:Date Attended; Date Called; Duration Time Called/Time Attended; Time Attended; Time Called” and just before: “Item: Induction Reason”followed by “Entity: Intended Place of Delivery. Item: Intended Place. Definition: The mother’s intention for place of delivery” followed by “Entity:Interval From Decision to conceive to Pregnancy. Item: Interval in months. Definition: The time from a woman’s decision to conceive to actualpregnancy, recorded in months. Unplanned pregnancies will be recorded as 0” Useful in simple classical IT - Inappropriate in medical IT. Comment (see also Introductory Comments above) So unrelated to a functioning maternity computer system that I don’t know where to start. Total Focus on “Secondary Data Collection for Analysis” rather than “Individual Patient Care” No free text option to clarify “Other” No flow- pattern. e.g. No preceeding “Was there a labour? Dominated by unrealistic IT academic concepts and created by someone who clearly seems never to have written a single line of real computer code in their life.
RISCOS: EEPD.05_LOGICAL.dEG-27 (3rd April 2008) Rupert Fawdry 2004 -8 “Logical Prioritisation” Perinatal Dataset. Page vi
The Perinatal Institute - M.A.N.N.E.R.S. Dataset initiative (2000 - current)
Labour onset
To record any intervention in process of labour INPUT OPTIONS Mutually exclusive: None − Caesarean before labour / Spontaneous / Induction-RipeningDATA ORIGIN Commissioning Data Set, Hospital Episode Statistics, West Midlands Advisory Board - Maternity Method of induction
To record any intervention in process of labour Same section from
To facilitate audit of standards of care in labour The Perinatal Institute
INPUT OPTIONS Non-mutually exclusive: MANNERS - Maternity
Hospital Episode Statistics, West Midlands Advisory Board - Maternity a) Any patient centred EPR dataset needs clear flow-patterning, yet none is yet included in the official MANNERS maternity dataset. For example “Labour Onset?” needs to be preceded by “Was there a Labour?” and “Method of Induction?” needs to be preceded by “Was Labour Induced?” etc b) Computer programs cannot cope with the concept of “Non-mutually exclusive” Each of the above items must separately be answered “Yes or No or Don’t know” For a full comparison with this document see the EEPD Vol. III. at www.fawdry.info\EEPDPCFILES\03_DATASETS\X_COMPARE\500cfM.pdf ---------------------------------------------------------------------------------------------------------------------------------------------------------
The National Maternity Services Dataset Initiative (2005 - Current)
F1. Birth - Mother, Initial
Formal Induction of Labour Reason (First)
Formal Induction of Labour Method (First) Onset of Labour (Method)Formal Induction of Labour Date (First) Formal Induction of Labour Gestation (First) [Gestation]Formal Induction of Labour Place (First) National Maternity
Services Dataset
(from “Questions only” 18 page version) (Full version is a 400 size A3 page long) Procedure (Membrane Sweep)Procedure Date (Membrane Sweep) Procedure (Amniotomy)Procedure Date (Amniotomy) Comment (see also Introductory Comments above) Presented as an Excel spreadsheet, in colour, on a total of 300 pages of A3 paper when fully printed out! This is naturally impossible for almost anyone to printout and properly analyse. It can still be accessed on via the E.E.P.D.
Volume III Datasets. Section C. All Births. The full version does suggest some allowable answer options but there is crucially no flow-patterning whatsoever and even more inadequately most items are purely “Paralysis by Analysis” items and many crucial “Individual Patient Care” questions are completely missing! e.g.
“Reason for Induction?” or even more important “Was there a Labour?” etc RISCOS: EEPD.05_LOGICAL.dEG-26 (1st June 2007) Rupert Fawdry 2004 -7 “Logical Prioritisation” Perinatal Dataset. Page vii
Scottish Morbidity Record (Ch. 8. SMR 02-Maternity Discharge)
Version 1.2E. Edinburgh Aug 1999. May well have been modified since then
Induction Of Labour
Definition: Induction of labour indicates the type of induction used actively to start labour by clinical intervention.
Some of the means used to induce labour can also be used to augment pre-existing labour that is not progressing.
Induction designed to start labour must not be confused with the augmentation of labour.
Scottish Morbidity Record
Prostaglandins (includes cervical priming) SMR 02 (1999 version)
Points to Note (from SMR documentation)1.
It is important to note that induction of labour is a procedure to start labour off and is usually a planned procedure. Theadmission reason in these cases will probably be Code 22 (pregnant but not in labour).
Code 0 should be used when any of these procedure are used to assist or augment labour. Do not confuse inductionmethods with similar procedures used to assist or augment labour which has already started.
Comment (see also Introductory Comments above). Again reasonable for data collection but very little use in the creation of an Electronic Patient Record which focuses on Individual Patient Care. Again no free text option to clarify “Other” No flow-pattern. e.g. No preceeding “Was there a labour? etc. For any Individual Care EPR separate items must be separate. Not “ARM + prostaglandins” etc EEPD Volume V. Logical Prioritisation (This Document)
Was there Labour before Birth?
Comment. This document focuses on the care of each Individual Patient on an electronic database. Electronic documenting of the exact medication prescribed on every mother only makes sense when there is electronic prescribing. It is therefore strongly suggested that a paper record of the All Phases of Maternity EPR A2: Cost Neutral type and dose of medication is quite sufficient in all Phase 1 systems, except when there is a requirement for a short term of 1 in n sample audit.
E1-C. Ripenings and/or Inductions
Type of Onset of Labour (Spontaneous or Induced/Ripening)?
WHEN? Only if “Was there Labour before Birth?” = Yes (90%?) EEPD Volume V
Induction and / or RipeningUnknown Logical Prioritisation Definitions
All Phases of Maternity EPR A2: Cost Neutral --------------------------------------------------------------------------------------------------------------------------------------------------------- EEPD Volume IV. Resource Document (Only part of the relevant section)
E1-C. RIPENINGS OR INDUCTIONS
Was there a Previous Failed Induction Attempt? [Protos .ZMLSN]
EEPD Volume IV
Yes (Free text opportunity) [OPCS: R228, Read: .7F173]Unknown Resource Document
COMMENT Could have been a failed Induction attempt followed by C/S. REASON FOR EPR DATA ENTRY PATIENT ENCOUNTER ASSISTANCE (BIRTH & POST-NATAL) None?
DATASETS (MAINLY FOR LATER ANALYSIS) Standards / Quality & Governance
WORKLOAD & COST All Phases of Maternity EPR
B1: Retrospective Analysis only (”Below the Line”) Bias against routine Maternity EPR recommendation
If 100% + Look Up (10 secs) + Data entry by Midwife. then U.K. Annual Extra Workload: 1,550 hours. Annual Cost: £31,000.
RISCOS: EEPD.05_LOGICAL.dEG-27 (3rd April 2008) Rupert Fawdry 2004 -8 “Logical Prioritisation” Perinatal Dataset. Page viii
Was there Labour before Birth? [Protos: .ZMLSO,,, Euroking: ???, SMIS: ???, MANNERS: ]
WHEN? All (100%)Yes (90%?)NoUncertain - Possible Early Labour REASON FOR EPR DATA ENTRY
PATIENT ENCOUNTER ASSISTANCE (BIRTH & POST-NATAL) Indirectly needed for Method of Birth etc
DATASETS (MAINLY FOR LATER ANALYSIS) Settatree / Standards
WORKLOAD & COST All Phases of Maternity EPR
A2: Cost Neutral (”Above the Line”)
“Logical Prioritisation”
Full Maternity EPR only, [Pregnancy Summary} E1-C. Ripenings or Inductions
Type of Onset of Labour (Spontaneous or Induced/Ripening)? [Protos .ZMLS1]
WHEN? Only if “Was there Labour before Birth?” = Yes (90%?)Spontaneous Onset of LabourInduction and / or Ripening [OPCS: X351, Read: .7L160]Unknown DEFINITION? Scottish SMR02 Definition: Induction of labour indicates the type of induction used actively to start labour by
clinical intervention. Some of the means used to induce labour can also be used to augment pre-existing labour that is not
progressing. Induction designed to start labour must not be confused with the augmentation of labour.
WORDING OF OTHER DATASETS KornerMat: Method of onset of labour Spontaneous; Elective C-S; Surgical (ARM); Oxytocics; Surgical
& Oxytocics | RCOG Annual: Number of patients having Induction of Labour - does not include augmentation | ENB Annual: Number of
Planned Inductions | Maternity Tail: Labour Onset Method | Scottish SMR02: 0 None; 1 Artificial rupture of membranes (ARM); 2 Oxytocics;
3 ARM + Oxytocics; 4 Prostaglandins (includes cervical priming); 5 ARM + prostaglandins; 6 Prostaglandins and Oxytocics; 7 Prostaglandins
and ARM and Oxytocics; 8 Other; 9 Not Known. Points to Note: 1. It is important to note that induction of labour is a procedure to start
labour off and is usually a planned procedure. The admission reason in these cases will probably be Code 22 (pregnant but not in labour). 2.
Code 0 should be used when any of these procedure are used to assist or augment labour. Do not confuse induction methods with similar
procedures used to assist or augment labour which has already started.| Revised Korner Maternity Proposals: Onset of Labour. 1.
Spontaneous, 2. Labour following Induction or Ripening, 3. Caesarean before the onset of labour, 8. Unknown, 9. Other (e.g. Labour
following a Road Accident???)
REASON FOR EPR DATA ENTRY INDIVIDUAL PATIENT CARE (BIRTH & POST-NATAL) Birth Event Summary
DATASETS (MAINLY FOR LATER ANALYSIS) Korner Maternity / RCOG Annual / ENB Annual / Tail / Contract / CESDI96 / Thames /
Robson / Benchmarking / Standards / Revised Korner Maternity Proposals
WORKLOAD & COST All Phases of Maternity EPR
A2: Cost Neutral (”Above the Line”)
“Logical Prioritisation”
FINAL EPR VISIBILITY? Pregnancy Summary (Only if “Induction and / or Ripening”) Induction Date / Induction Time?SOURCE: Maternity Care Data Project. Definition: The date on which induction of labour is commenced. The time at which induction of labour commenced. 24 hour clock.
C2: Paper Record enough - Mat EPR unjustifiable extra work (Maybe one day on a Pharmacy System) Phase 1 Perinatal EPR Rejection Recommended
See below - ARM (Y/N/?) separate from Medical Induction (Y/N/?),, separate from Medical Induction Drugs each one separately (Y/N/?)!!! Comment. Aim: A full analysis of every separate data item ever proposed on paper or for electronic entry. Including, crucially, all items suggested by someone but rejected for electronic data entry. The potential financial and workload cost of each proposed item is also documented. Needs much further woirk to include (and classify) many more items as as “Rejected for any Phase 1 perinatal system. Possible Inclusion in Full Electronic System.” CRUDE COST/WORKLOAD ASSUMPTIONS. U.K.Birthrate 580,000 per year. Wages + Overheads for Data Entry by Midwife = £20 / hour. RISCOS: EEPD.05_LOGICAL.dEG-26 (1st June 2007) Data Entry Work: 4 secs if “Known” or “Quick Look up“, 10 secs if “Time Consuming” or “Ask Patient ”. % = % about whom data is needed.
Rupert Fawdry 2004 -7 “Logical Prioritisation” Perinatal Dataset. Page ix
BOLD =“Logical Prioritisation” † = Must be removed when data is anonymised
R Fawdry 2004-7 EEPD.05_LOGICAL.dEG-26 (1st June 2007) [Birth Event Section Page 9 of 42] Page ix
Indication for Induction or Ripening? ®-MAT
WHEN? Only if “Type of Onset of Labour?” = Induced and / or Ripening (20%?)Postdates Suspected Intra Uterine Growth Retardation (IUGR) Spontaneous Rupture of the Membranes (SROM) Past Obstetric History (Free Text Opportunity)Other Obstetric Problems (Free Text Opportunity)Maternal Pain (As reason for Induction e.g. Back Pain, Symphysis Pain etc) (Free Text)Maternal Distress / Social Reasons (Free Text Opportunity)Other (Free Text Opportunity) WORDING OF OTHER DATASETS MCDP-DD-V3: I3. Entity: Induction. Item: Induction Reason. Definition: The reason why an induction is undertaken. Category Values: -Abnormalblood flow studies; -Abnormal CTG; -Abnormal/unstable lie; -Ante-partum haemorrhage; -Breech presentation; -Diabetes; -Essential hypertension; -Fetal abnormality; -Intrauterine death; -Intrauterine growth retardation; -Intrauterine infection; -Macrosomia; -Maternal request; -Multiple pregnancy; -Oligohydramnios; -Other - fetal reason; -Other - maternal reason; -Polyhydramnios; -Poor obstetric history; -Post maturity; -Pre labour rupture of membranes; -Pregnancy induced hypertension; -Reduced fetal movements; -Rhesus disease; -Social reason.
REASON FOR EPR DATA ENTRY PRIMARY USE (BIRTH & POST-NATAL) Discharge Letter(s)
SECONDARY USE Standards
WORKLOAD & COST All Phases of Maternity EPR
A2: Cost Neutral (”Above the Line”)
“Logical Prioritisation”
EVENTUAL ELECTRONIC INFLOW? [To Primary Care EPR]TEXT OUTPUT None?FUTURE EPR VISIBILITY? Full Maternity EPR only MOST RECENT UPDATE Release 2.0 (Feb) Medical Method for Ripening &/or Induction? ®-MAT WHEN? Only if “Type of Onset of Labour?” = Induced and / or Ripening (20%?)YesNoUnknown WORDING OF OTHER DATASETS Settatree: Prostaglandins − None; Before contractions; After onset of contractions; Inapplicable;Unknown | MCDP-DD-V3: I2. Entity: Induction. Item: Induction Method. Definition: The method used for the induction of labour. CategoryValues: -ARM; -ARM and Syntocinon; -Mechanical; -Mifepristone; -Misoprostol; -Other; -Prostaglandin: E1; -Prostaglandin: E2; -Prostaglandins; -Syntocinon. | Toronto Perinatal Consensus 1994. 90. If Induced: Medical Induction; Surgical Induction REASON FOR EPR DATA ENTRY PRIMARY USE (BIRTH & POST-NATAL) None?
SECONDARY USE Thames / Settatree
WORKLOAD & COST All Phases of Maternity EPR
B1: Retrospective Analysis only (”Below the Line”)
Bias against Routine Mat EPR Recommendation
If 100% + Look Up (10 secs) + Data Entry by Midwife. then U.K. Annual Extra Workload: 1,550 hours. Annual Cost: £31,000 EVENTUAL ELECTRONIC INFLOW? NoneTEXT OUTPUT None?FUTURE EPR VISIBILITY? Full Maternity EPR only MOST RECENT UPDATE Release 2.0 (Feb 2006) Prostin Formulation?
SOURCE Protos Attribute
WORKLOAD & COST. All Phases of Maternity EPR C2: Paper Record enough - EPR unjustifiable extra work
Maternity EPR Rejection Recommended
Number of Prostin Insertions?
SOURCE Protos: .ZMLI5
WORKLOAD & COST. All Phases of Maternity EPR C2: Paper Record enough - EPR unjustifiable extra work
Maternity EPR Rejection Recommended
Date of 1st Prostin insertion?
SOURCE Protos: .ZMLI7
WORKLOAD & COST. All Phases of Maternity EPR C2: Paper Record enough - EPR unjustifiable extra work
Maternity EPR Rejection Recommended
Induction Date?
SOURCE MCDP-DD-V3: I1. Entity: Induction. Item: Induction Date. Definition: The date on which induction of labour is commenced. Category Values: -Date
WORKLOAD & COST. All Phases of Maternity EPR. C2: Paper Record enough
Bias against Automatic EPR Recommendation
Induction Time?
SOURCE MCDP-DD-V3: I4. Entity: Induction. Item: Induction Time. Definition: The time at which induction of labour is commenced. Category Values: -Time (24 hour clock)
WORKLOAD & COST. All Phases of Maternity EPR. C2: Paper Record enough
Bias against Automatic EPR Recommendation
Time of 1st Prostin insertion?
SOURCE Protos: .ZMLID
All Phases of Maternity EPR C2: Paper Record enough - EPR unjustifiable extra work
Maternity EPR Rejection Recommended
Date of Last Prostin Insertion?
SOURCE Protos: .ZMLI6
All Phases of Maternity EPR C2: Paper Record enough - EPR unjustifiable extra work
Maternity EPR Rejection Recommended
Time of Last Prostin Insertion?
SOURCE Protos: .ZMLIE
All Phases of Maternity EPR C2: Paper Record enough - EPR unjustifiable extra work
Maternity EPR Rejection Recommended
CRUDE COST/WORKLOAD ASSUMPTIONS. U.K.Birthrate 580,000 per year. Wages + Overheads for Data Entry by Midwife = £20 / hour. Data Entry Work: 4 secs if “Known” or “Quick Look up“, 10 secs if “T RISCOS: EEPD.05_LOGICAL.dEG-27 (3rd April 2008) ime Consuming” or “Ask Patient ”. % = % about whom data is needed.
Rupert Fawdry 2004 -8 “Logical Prioritisation” Perinatal Dataset. Page x
“Logical Prioritisation” † = Must be removed when data is anonymised
R Fawdry 2004-7 EEPD.05_LOGICAL.dEG-26 (1st June 2007) [Birth Event Section Page 10 of 42] Page x
E1-D. ARTIFICIAL RUPTURE OF MEMBRANES FOR INDUCTION
Was an ARM for Induction done? ®-MAT
WHEN? Only if Type of Onset of Labour?” = “Induced and / or Ripening” (20%?)YesNoUnknown WORDING OF OTHER DATASETS Settatree: ARM − Forewaters: None; Before contractions; After onset of contractions; Inapplicable;Unknown () Method of onset of labour Spontaneous; Elective C-S; Surgical (ARM); Oxytocics; Surgical & Oxytocics (KornerMat:) Settatree:Artificial Rupture of Membranes (ARM – Forewaters) – None; Before contractions; After onset of contractions If ARM – Date and Time ofARM | MCDP-DD-V3: M3. Entity: Membranes. Item: Rupture Mechanism. Definition: The mechanism for rupture of membranes. CategoryValues: -Artificial (ARM): -Spontaneous (SROM). | Toronto Perinatal Consensus 1994. 90. If Induced: Medical Induction; Surgical Induction REASON FOR EPR DATA ENTRY PRIMARY USE (BIRTH & POST-NATAL) Discharge Letter(s)
SECONDARY USE KornerMat / Thames / Settatree
WORKLOAD & COST All Phases of Maternity EPR
A2: Cost Neutral (”Above the Line”)
“Logical Prioritisation”
EVENTUAL ELECTRONIC INFLOW? [To Primary Care EPR]TEXT OUTPUT None?FUTURE EPR VISIBILITY? Full Maternity EPR onlyMOST RECENT UPDATE Release 2.0 (Feb 2006) Induction by ARM (Date)? ®-MAT
WHEN? Only if “Was ARM for Induction done?” = Yes (10%?)[Date]Unknown REASON FOR EPR DATA ENTRY PRIMARY USE (BIRTH & POST-NATAL) Discharge Letter(s)
SECONDARY USE None Known
WORKLOAD & COST All Phases of Maternity EPR
B1: Retrospective Analysis only (”Below the Line”)
Bias against Mat EPR Recommendation
If 10% + Look Up (10 secs) + Data Entry by Midwife, then U.K. Annual Extra Workload: 155 hours. Annual Cost: £3,100.
EVENTUAL ELECTRONIC INFLOW? NoneTEXT OUTPUT None?FUTURE EPR VISIBILITY? Full Maternity EPR only MOST RECENT UPDATE Release 2.0 (Feb 2006) Induction by ARM (Time)? ®-MAT
WHEN? Only if “Was ARM for Induction done?” = Yes (10%?)[Time : 24 hour clock]Unknown REASON FOR EPR DATA ENTRY PRIMARY USE (BIRTH & POST-NATAL) Discharge Letter(s) SECONDARY USE None Known
WORKLOAD & COST All Phases of Maternity EPR
B1: Retrospective Analysis only (”Below the Line”)
Bias against Mat EPR Recommendation
If 10% + Look Up (10 secs) + Data Entry by Midwife, then U.K. Annual Extra Workload: 155 hours. Annual Cost: £3,100.
EVENTUAL ELECTRONIC INFLOW? NoneTEXT OUTPUT None?FUTURE EPR VISIBILITY? Full Maternity EPR only MOST RECENT UPDATE Release 2.0 (Feb 2006) CRUDE COST/WORKLOAD ASSUMPTIONS. U.K.Birthrate 580,000 per year. Wages + Overheads for Data Entry by Midwife = £20 / hour. RISCOS: EEPD.05_LOGICAL.dEG-26 (1st June 2007) Data Entry Work: 4 secs if “Known” or “Quick Look up“, 10 secs if “Time Consuming” or “Ask Patient ”. % = % about whom data is needed.
Rupert Fawdry 2004 -7 “Logical Prioritisation” Perinatal Dataset. Page xi
BOLD =“Logical Prioritisation” † = Must be removed when data is anonymised
R Fawdry 2004-7 EEPD.05_LOGICAL.dEG-26 (1st June 2007) [Birth Event Section Page 11 of 42] Page xi

Source: http://www.fawdry.info/eepd/05_log/dEG.pdf