Neonatal Database Open Source Integrated Clinical, Audit and Followup Neonatal Database Dr Ian Callander, Dr Martin Kluckow & NICUS Group (Neonatal Intensive Care Unit Study – NSW & ACT Australia) http://home.iprimus.com.au/callanders/

National Perinatal Data System Planning Workshop convened by Perinatal Services Network (NSW) in June 2004 No single existing system was ideal Duplication across AHS and States Features of the Ideal Neonatal Database are as follows ….

Data OHIO principle (Observational, Historical, Investigations, Outcomes) Observational rather then interpretative data Based on a common core data fields with national data dictionary definitions where available Real-time completion Accuracy and Completeness by use of Mandatory fields, cross validation of fields and assessment of data

Ideal features - Clinical Utility Clinical management system including alerts, links to standards, pathways and policy relevant to the clinician entering the data Discharge summaries and admission/transfer notification local hospital data collections supported A standard suite of reports as well as the ability to perform ad hoc reports Ability to collate summary statistics In-built graphing tools

Ideal features - Connectivity Integrate with obstetric data Links with other hospital systems (diagnostic reports, order-entry and prescribing systems) Integrate with electronic health record when developed Links with other healthcare providers (Hospitals, GPs, Community Midwives) Connectivity with maternal and national neonatal data collections

NSW NICUS Database subcommittee Recommended Option Develop a purpose built database using industry standard software (Microsoft SQL Server 2000 – or free MSDE) with familiar front end (MS Access 2000) Economic & Flexible Robust security and data integrity Maintain familiarity - Already a lot of experience with MS Access within NICUS group Full Expandibility and Connectivity Web-based front end could be developed later

INTERNET NSWHealth Intranet Central SQL Server Obstetrix PC Web Area Health Service (2007 achievable) Tertiary Hospital PC Web PC Web PC MSAccess PC MSAccess Local SQL Server Central SQL Server Obstetrix Non-tertiary Hospitals Obstetric currently unable to have central server for NSW – separate server in each AHS (except SSWAHS & ACT using other systems) PC MSAccess PC MSAccess NSWHealth Intranet (much politics required to allow direct connection across AHS boundaries – may send individual patient information by email using XML data packets as interim solution Local SQL Server Local SQL Server

Relationship between main patient tables tables (PMI = Baby)

Datetime Patient data is entered into PMI dependant tables (1-many) - relationships can be deduced between these tables using datetime analysis

Dropdown list items are stored as integers that relate to a _like named lookup table

Dropdown list is pulled from the appropriate lookup _table, and is specific to the baby’s date of birth and whether an audit of clinical item (allows list to change over time)

Neonatal Database Audit Module Replaced Old NICUS (CRS) on 01/01/2007 throughout NSW & ACT Clinical Module beta tested at Liverpool Hospital since March 2007, and currently rolling out to NSW perinatal units (8) Reporting Module available since November 2007 – evolving suite Followup Module under construction – expected mid 2008

Live Demonstration of Neonatal Database

The future National Infection Audit Level 2 Units connected to Level 3 units with same AHS (aim to increase network connections – ideally NSW central server) Level 1 units using an obstetric data collection to allow a true denominator Web – based input/Central server CERNER/eMR and relationship to new NICUS database – linkage, amalgamation etc Linkage to the “New ANZNN Database” (new concept) Host Prospective research projects Data Mining to detect statistical associations and suggest prospective research

Clinical Module requirements SQL Server or PC with MSDE available on hospital network with a designated administrator (administrator rights required on the database or PC) Arrange a day for installation and setup The designated administrator should be available for the whole day. Contact Ian.Callander@swsahs.nsw.gov.au Mobile 0418 638758 If you wish for an Obstetrix interface, you should liase with a member of your IT department familiar with this program. Each client PC will need to have this function installed (for further information see Martin Kluckow)