Use case for midwife views patient record before visiting patient

Brief description

Before the first appointment for a maternity referral the midwife needs to collect all information about the patient in order to provide the best possible care during pregnancy. The midwife seeing the patient will have full access to the patient’s GP record ensuring that the patient receives the best possible standard of care.

Use case justification

Clinical and administration:

• Access to accurate information at the point of care reducing the opportunity for errors to occur.
• Reduction in clinical time wasted, away from the patient, collecting and collating information.
• Reduction in clinical time wasted, away from the patient, manually updating IT systems.
• Reducing the paper flow through departments/organisations by utilising the system workflow to manage tasks using staff time efficiently.

Patient-focused:

• Security of patient information is maintained and improved through the reduction of paper-based ‘patient identifiable documents’ in use within departments.
• Increased patient/clinician time due to reduction in clinician time spent collecting and transcribing information away from the patient.
• Increased patient safety due to the reduction in manual transcription errors.
• Better patient experience as they are not being asked for information which should already be available to the clinician.

Primary actors

• Midwife
• Maternity clinical system
• GP Connect
• GP clinical system

Secondary actors

• Patient

Triggers

• Patient self refers/is referred to the maternity clinic after becoming pregnant.

Preconditions

• The patient’s details have been verified and entered on the maternity system.
• Maternity staff have the correct/appropriate system access rights.
• The patient’s GP has agreed to share patient information via GP Connect.
• The patient allows this shared information to be viewed/used by GP staff.
• Electronic interactions between maternity system/GP Connect/GP clinical system have been correctly configured.

Postconditions

• On success:
  • Clinical information is imported and made available to the clinician.
• Guaranteed:
  • All the relevant available information on the patient’s medical history has been viewable on the maternity system used by midwives.

Basic flow with alternative and exception flows

Step	Description
Step 1	Patient is referred to the maternity services (antenatal).
Step 2	Patient attends antenatal appointment with midwife.
Step 3	The midwife logs into their usual maternity system.
Step 4	Midwife searches for patient via NHS Number.
Step 5	The maternity system will request the patient’s current medications and allergies that are held in the patient’s registered GP practice system via the GP Connect service.
Step 6	GP Connect and the GP practice system will check that the maternity organisation is allowed access to the data and that the patient has not objected to their data being shared.
Step 7	GP clinical system provides the patient’s medical record. This will include: Acute medications Current repeat medication issues Medication marked as prescribed elsewhere Allergies Current and past problems and diagnosis Associated to antenatal - for example, diabetes, HIV Current referrals Vaccinations Compliance aids Preferred pharmacy Carer information Clinic appointments Key warnings and alerts Tests Investigations Mental Health Demographics Blood type/group Blood abnormalities Social history (especially risk factors) Relevant family history Latest pregnancy status Confirmed pregnancy test (for majority of women this does not happen, take the patient’s word unless they are very unsure).
Step 8	The maternity system imports the all information supplied from the GP practice. This data is now available for clinicians to view.
Alternative path
Step 6a	Where there are not the appropriate permissions to share the data, GP Connect returns an error message saying the information cannot be returned. The midwife will manage their patient based on the information they have available.