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How To Be In Two Places At Once: Multimedia OB


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Multimedia OB Topic Jump Menu
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Just what is "multimedia OB"?
- Medicolegal implications




This innovative new management technique, says Jason Collins, will help you to more effectively serve your patients, both in labor and those in your waiting room.
Imagine your summer vacation: You've decided to go to the Grand Canyon, and you've arranged for your partner to cover for you. You pack several suitcases and make the long trip. But when you finally arrive at the site, you're blindfolded and placed in front of a small metal box from which a tape-recorded voice describes the canyon.

This scenario isn't all that different from what happens when a laboring patient presents at the hospital while you're across town at your office. You have prepared for this event by providing prenatal care and counseling, but when the time comes you are essentially blindfolded, forced to rely on only a single source of information -- the nurse's oral report.

Not so with multimedia obstetrics. Essentially a computer-aided patient-management system, it recombines familiar medical instruments in new ways to improve our ability to provide and document quality patient care.

In this article, I describe the technique and examine its impact on the daily practice of OBG.

Just what is 'multimedia OB'?
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Multimedia OB integrates computers with other tools (ultrasound, EFM) and with other people (patients, nurses). Please understand, I'm the perfect example of a computer-illiterate obstetrician. But my office's PC station, the heart of the system, is extraordinarily easy to use.

Let's say a woman comes into my office at 8 weeks' gestation. At that visit, and at every subsequent visit before delivery, I record her vitals, fetal measurements, complications and so on in her chart -- it just happens that her chart is on the computer. I also explain that when she arrives at the hospital for delivery, I'll be able to pull up her chart and conduct a videoconference with her even if I'm not at the hospital.

Then, when I get a call from an L&D nurse saying that my patient (now at 37 weeks') has arrived at the hospital, 2-cm dilated, I don't necessarily have to rush out and leave the patients in my waiting room wondering if they'll ever get to see me.

Instead, I go to the PC station. I open the patient's computerized chart, then pull up the EFM reading now being taken at North Shore Regional Medical Center. To top it all off, I conduct a videoconference via a robotic camera that is mounted to a PC station in L&D. I can maneuver that camera from my own PC station, panning from the patient to the father to the nurse, or zooming in on, say, the blood pressure monitor.

In this way, I can make fully informed decisions about the woman's condition and about whether I should go to the hospital immediately or continue to see other patients. In the latter case, I usually return to the computer station after every one or two office visits to check on the woman and offer her emotional support.

But as enthusiastic as I am about this system, it's possible that my patients are even more pleased. Over the past year, I've followed 30 labors with this approach, and patient response has been consistently encouraging. Women who felt abandoned when, after a cursory exam, their Ob/Gyn disappeared until minutes before their child's birth, regard videoconferencing as an attractive alternative.

Medicolegal implications
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When patients are happy with their care and feel that you did the best you could for them, they're much less likely to sue you in the aftermath of a poor outcome. But when a technique is as unusual as this one, one of the first questions inevitably is, "What about lawsuits?"

However, there really is no medicolegal issue here. If anything, the system acts as a legal shield by improving your documentation abilities. Everything from the patient's chart to a photographic image of the placenta is permanently stored on disk. I even include a two-minute video clip of the delivery, thus recording the condition of the baby at the moment of delivery.

During deliveries, a nurse starts the camera, which I have already positioned to provide a view from over my shoulder. Out of regard for patient privacy, the mother's legs and perineum are draped. At present, I video only uncomplicated vaginal deliveries, although I plan to soon tape cesarean sections and forceps deliveries, as well.

Hopefully by this time next year we will also be able to store an image of the placental lab results. Hand-written charts will soon be the Model Ts of documentation; PCs will be the Porsches.

And not only is the new mother happy because you didn't "abandon" her, the patients in your waiting room are happy because they don't have to wait as long or reschedule as often as they used to. And your insurer is happy because it knows you are monitoring your patients as closely as possible.

The field of OBG has made great strides over the years. We've seen a progression from sterile and separate labor and delivery rooms to melded L&D rooms, to labor-delivery-recovery suites. We've also seen technology improve to include ultrasound, EFM, laparoscopy and now multimedia OB. Next, I think, we'll witness the reengineering of obstetrical instruments and gauges, so that a single glance will give us all the information we could want without the need for separate blood pressure, EKG and electronic fetal monitoring machines.

It's true that the initial financial investment in multimedia is high: Between $30,000 and $40,000 are needed to set up the monitor, robotic camera, CODEC transmission system, speakers and pentium-based PC. But it's also true that everyone, even managed care administrators, will soon understand the system's long-term value. After all, HMOs want us to justify everything we do and to explain the reasons for given outcomes. That is much easier with multimedia obstetrics.

BY JASON H. COLLINS, M.D.
Published in OBG MANAGEMENT, May 1996

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