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March 2020 - Version 5
BORN Information System User Guide
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Contents List of Figures ................................................................................................................................. 3 List of Tables................................................................................................................................... 5 The Better Outcomes Registry & Network (BORN) ........................................................................... 6 Background .................................................................................................................................... 6 Privacy ........................................................................................................................................... 7 BORN Information System (BIS) ...................................................................................................... 8 Description ..................................................................................................................................... 8 Methods of Data Entry .................................................................................................................... 9 Midwifery/Hospital Collaboration ................................................................................................... 9 Where to go for Help .................................................................................................................... 10 BIS Messaging System ................................................................................................................... 15 BIS Enhancements ........................................................................................................................ 16 Data Entry .................................................................................................................................... 17
Browser Information ................................................................................................................. 17 Logging into the BIS .................................................................................................................. 17
Multi-Factor Authentication .......................................................................................................... 19 Who Authenticates with a PIN? ..................................................................................................... 20 Who Authenticates with a Phone? ................................................................................................ 20 Login Process ................................................................................................................................ 20 Authenticate with PIN .................................................................................................................. 21 Authenticate with Phone .............................................................................................................. 21
Landing Page ............................................................................................................................ 23 Patient Profile Overview ........................................................................................................... 28 Save, Proceed, Submit, & Cancel Encounters ............................................................................. 30 Antenatal General Encounter .................................................................................................... 32
Pre-population ............................................................................................................................. 32 Labour/Birth Mother Encounter .................................................................................................... 39 Birth Child Encounter .................................................................................................................... 55 Postpartum Mother Encounter ..................................................................................................... 59 Postpartum Child Encounter ......................................................................................................... 65 NICU/SCN Encounter .................................................................................................................... 70 BIS Downtime Forms .................................................................................................................... 82 Reconciliation ............................................................................................................................... 85 Data Quality Management ............................................................................................................ 86 Monthly Acknowledgement Process.............................................................................................. 87 End-of-Fiscal-Year Requirements ................................................................................................... 88 Data Use ...................................................................................................................................... 89
Big Picture Data Use .................................................................................................................. 89 In Focus – How Can You Use the Data? ...................................................................................... 90
Appendices ................................................................................................................................... 91 Appendix A - List of Hospitals .................................................................................................... 91 Appendix B - List of Midwifery Practice Groups .......................................................................... 97 Appendix C - List of Birth Centres............................................................................................... 99 Appendix D - Completing the BIS for Hospital Births under the Care of a Midwife ..................... 100 Appendix E - Uncommon Scenarios ......................................................................................... 103
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List of Figures Figure 1 - Data Sources Included in the BIS ................................................................................................... 8 Figure 2 - Overview of Resources Available ................................................................................................ 10 Figure 3 - Field-Level Help ........................................................................................................................... 12 Figure 4 - Page-Level Help ........................................................................................................................... 13 Figure 5 - Login Page Resources .................................................................................................................. 13 Figure 6 - Data Dictionary ............................................................................................................................ 14 Figure 7 - How to Access BIS Messaging ..................................................................................................... 15 Figure 8 - Accessing the BIS from the BORN Website (step 1) .................................................................... 18 Figure 9 - Accessing the BIS from the BORN Website (step 2) .................................................................... 18 Figure 10 - Member Login Page .................................................................................................................. 19 Figure 11 - Multi-Factor Authentication ...................................................................................................... 19 Figure 12 - BIS MFA Login ............................................................................................................................ 20 Figure 13 - Authenticate with PIN ............................................................................................................... 21 Figure 14 - Authenticate with Phone .......................................................................................................... 21 Figure 15 - Authenticate with Phone .......................................................................................................... 22 Figure 16 - Change Organization ................................................................................................................. 22 Figure 17 - Landing Page ............................................................................................................................. 23 Figure 18 - Work Lists .................................................................................................................................. 24 Figure 19 - Patient Records ......................................................................................................................... 24 Figure 20 - Patient Search ........................................................................................................................... 25 Figure 21 - Patient Search - no match ......................................................................................................... 26 Figure 22 - Advanced Patient Search .......................................................................................................... 26 Figure 23 - Create a Patient ......................................................................................................................... 27 Figure 24 - Patient Profile Demographics Tab ............................................................................................. 28 Figure 25 - Patient Profile - Name & Address History Tab .......................................................................... 29 Figure 26 - Save Button ............................................................................................................................... 30 Figure 27 - Proceed Button ......................................................................................................................... 30 Figure 28 - Submit Button ........................................................................................................................... 30 Figure 29 - Error Messages .......................................................................................................................... 31 Figure 30 - Cancel Button ............................................................................................................................ 31 Figure 31 - How to Add the Antenatal General Encounter ......................................................................... 32 Figure 32 - How to Select the Patient ID ..................................................................................................... 33 Figure 33 - Antenatal General Encounter: History Tab ............................................................................... 33 Figure 34 - Antenatal General Encounter: Pregnancy Tab .......................................................................... 35 Figure 35 - Maternal Height ........................................................................................................................ 37 Figure 36 - Pre-Pregnancy Weight ............................................................................................................... 38 Figure 37 - How to Add the Labour/Birth Mother Encounter ..................................................................... 39 Figure 38 - Labour/Birth Mother Encounter: Admission Tab ...................................................................... 40 Figure 39 - Labour/Birth Mother Encounter: History Tab ........................................................................... 41 Figure 40 - Labour/Birth Mother Encounter: Pregnancy Tab ..................................................................... 43 Figure 41 - Labour/Birth Mother Encounter: Intrapartum Tab ['Maternal Outcome = no transfer'] ......... 46 Figure 42 - Labour/Birth Mother Encounter: Intrapartum Tab ['Maternal Outcome = transfer to other hospital'] ...................................................................................................................................................... 46 Figure 43 - Labour/Birth Mother Encounter: Birth Tab ['Type of Birth = Spontaneous Vaginal'] ............... 48 Figure 44 - Labour/Birth Mother Encounter: Birth Tab ['Type of Birth = No Labour Cesarean Section'] ... 50 Figure 45 - Labour/Birth Mother Encounter: Outcome Tab ....................................................................... 53
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Figure 46 - Prompt to Create a Child Record .............................................................................................. 54 Figure 47 - Create Child Record - Demographics Page ................................................................................ 54 Figure 48 - How to Add the Birth Child Encounter ...................................................................................... 55 Figure 49 - Birth Child Encounter: Birth Tab ............................................................................................... 56 Figure 50 - Select Pregnancy Screen ........................................................................................................... 59 Figure 51 - How to Add the Postpartum Mother Encounter....................................................................... 60 Figure 52 - Postpartum Mother Encounter: Summary Tab ......................................................................... 60 Figure 53 - Postpartum Mother Encounter: Summary Tab [Document Additional Transfers] ................... 62 Figure 54 - Postpartum Mother Encounter: Summary Tab [Transfer/Readmission Information] .............. 62 Figure 55 - How to Add the Postpartum Child Encounter ........................................................................... 65 Figure 56 - Postpartum Child Encounter: Newborn Status Tab .................................................................. 66 Figure 57 - Postpartum Child Encounter: Discharge Summary Tab ............................................................ 68 Figure 58 - How to Add the NICU/SCN Encounter ...................................................................................... 70 Figure 59 - NICU/SCN Encounter: Admission & Demographics Tab............................................................ 71 Figure 60 - NICU/SCN Encounter: Health Status Tab .................................................................................. 73 Figure 61 - NICU/SCN Encounter: Interventions Tab .................................................................................. 75 Figure 62 - NICU/SCN Encounter: Screening Tab ........................................................................................ 77 Figure 63 - NICU/SCN Encounter: Discharge/Outcome Tab ........................................................................ 79 Figure 64 - Where to Find BIS Downtime Forms ......................................................................................... 82 Figure 65 - BORN Data Quality Framework ................................................................................................. 83 Figure 66 - Data Quality Management Cycle............................................................................................... 84 Figure 67 - Where to find the 'Reconciling and Acknowledging Data' document ...................................... 85 Figure 68 - Where to find 'BIS Reports for Hospital Users' Guide ............................................................... 86 Figure 69 - How to Acknowledge Data ........................................................................................................ 87 Figure 70 - End-of-Year Communication Example ...................................................................................... 88 Figure 71 - Who Uses the Data you Enter? ................................................................................................. 89 Figure 72 - Clinical Reports .......................................................................................................................... 90 Figure 73 - Baby born in ER of birthing hospital prior to admission to L&D ............................................. 103 Figure 74 - Baby born en route to L&D unit (ie. elevator, hallways etc). .................................................. 104 Figure 75 - Unplanned birth in non-obstetrical inpatient unit of birthing hospital .................................. 105 Figure 76 - Unattended home birth with mother & child admitted to non-birthing hospital .................. 106 Figure 77 - Unplanned birth outside of a birthing hospital and under the care of a midwife .................. 107 Figure 78 - Unplanned birth outside of a birthing hospital, not under the care of a midwife.................. 108 Connect with Us
on Twitter!
@BORNOntario
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List of Tables Table 1 - Detailed Description of User Resources ....................................................................................... 10 Table 2 - Antenatal General Encounter: History Tab Data Elements .......................................................... 34 Table 3 - Antenatal General Encounter: Pregnancy Tab Data Elements ..................................................... 36 Table 4 - Labour/Birth Mother Encounter: Admission Tab Data Elements ................................................. 40 Table 5 - Labour/Birth Mother Encounter: History Tab Data Elements ...................................................... 41 Table 6 - Labour/Birth Mother Encounter: Pregnancy Tab Data Elements ................................................ 44 Table 7 - Labour/Birth Mother Encounter: Intrapartum Tab Data Elements .............................................. 47 Table 8 - Labour/Birth Mother Encounter: Birth Tab Data Elements ......................................................... 51 Table 9 - Labour/Birth Mother Encounter: Outcome Tab Data Elements .................................................. 53 Table 10 - Birth Child Encounter: Birth Tab Data Elements ........................................................................ 57 Table 11 - Postpartum Mother Encounter: Summary Tab Data Elements.................................................. 61 Table 12 - Postpartum Mother Encounter: Summary Tab [Transfer/Readmission Data Elements] ........... 63 Table 13 - Postpartum Child Encounter: Newborn Status Tab Data Elements ........................................... 66 Table 14 - Postpartum Child Encounter: Discharge Summary Data Elements ............................................ 69 Table 15 - NICU/SCN Encounter: Admission & Demographics Tab Data Elements .................................... 72 Table 16 - NICU/SCN Encounter: Health Status Tab Data Elements ........................................................... 74 Table 17 - NICU/SCN Encounter: Interventions Tab Data Elements ........................................................... 76 Table 18 - NICU/SCN Encounter: Screening Tab Data Elements ................................................................. 78 Table 19 - NICU/SCN Encounter: Discharge/Outcome Tab Data Elements ................................................ 80
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The Better Outcomes Registry & Network (BORN)
Background BORN traces its roots to the 1980s and the Perinatal Education Program of Eastern Ontario (PEPEO). Dr. Patricia Niday, who envisioned the use of data to support better obstetrical and neonatal care, led the program. As hospitals throughout the region began to see the value of aggregating data to examine outcomes and identify areas for improvement, PEPEO became the Perinatal Partnership Program of Easter and Southeastern Ontario (PPPESO). Together with other Ontario perinatal networks, the organization began to lobby the provincial government for funding to expand the database, which was renamed the Niday Perinatal Database in the late 1990s. When the Child Health Network for the Greater Toronto Area (GTA) member hospitals joined the program in 2003 – adding 51% of Ontario births to the system – the database was still housed within PPPESO and the Children’s Hospital of Eastern Ontario (CHEO); however, it then became known as the Ontario Perinatal Surveillance System (OPSS). Under founding director Jim Bottomley, OPSS developed the Niday NICU/SCN module, extended its partnerships and encouraged more Ontario hospitals to contribute data. The government’s first provincial report on perinatal care was produced in 2006. Concurrently, reorganization with the Ministry of Health led to the formation of the Maternal Child Health Strategy Division. Responsible for a number of maternal child data sources in the province, the division quickly recognized the value of integrating data within a privacy environment to facilitate and improve care. The Ministry directed OPSS to bring together data from prenatal screening, the Fetal Alert Network (FAN) (for congenital anomalies), the Ontario Midwifery Program (OMP), the Niday perinatal and NICU/SCN modules, and Newborn Screening Ontario (NSO). With new provincial funding, OPSS was rebranded as the Better Outcomes Registry & Network (BORN) Ontario in 2009. The five founding partner groups, BORN staff and project consultants worked to design and build the new BORN Information System (BIS) while still carrying out partner program activities, and using the existing data to support quality improvement and practice. Full registry status was granted in October 2011, and the BIS was launched on January 23, 2012. The first year data was officially collected in the BIS was fiscal year 2012-2013. Historical data from the Niday Perinatal Database for fiscal years 2010-11 and 2011-12 have also been integrated and mapped to the BIS (and are available to users).
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Privacy
BORN Ontario is a prescribed registry under the Personal Health Information Protection Act, 2004 (PHIPA). As a registry, BORN is afforded the authority to collect, use and disclose personal health information without consent for the purpose of facilitating or improving the provision of healthcare. This special authority requires BORN to develop and adhere to rigorous privacy policies that have been reviewed and approved by the Information and Privacy Commissioner of Ontario. The registry’s information practices and procedures are approved by the Information and Privacy Commissioner of Ontario every three years.
BORN uses personal health information to ensure healthcare providers and organizations have the necessary knowledge to assess and improve the quality of services available to mothers, infants and children in Ontario.
The information is also summarized to produce reports and analyses for planning and management of the healthcare delivery system at the organizational, provincial, LHIN or other regional levels. Public reports do not contain personal health information or identify individuals; these analyses provide aggregated data only. The reports are made available online through reporting.
Personal health information within BORN is protected by administrative, physical and technological controls that adhere to industry best practices for security and safeguards against unauthorized accidental or intentional release of information.
Examples of these protections include state-of the-art electronic security, requirements to educate all users in their responsibilities to protect the data and report any problems, and places of business with appropriate locks and other physical controls.
Details of BORN Ontario’s privacy policies, frequently asked questions, and other information can be found under Privacy Resources on the BORN website. If you have questions or concerns about the BORN Ontario privacy program, please contact our BORN Ontario Privacy Officer: [email protected] BORN Ontario CHEO Research Institute | Centre for Practice-Changing Research Building 401 Smyth Road, Ottawa, ON | K1H 8L1 613.737.7600
BORN Ontario is
proud to be a trusted
steward of personal
health information.
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BORN Information System (BIS)
Description The BIS enables the collection of and access to data on every birth in Ontario. Sourced from hospitals, birthing centres, labs, midwifery practice groups and clinical programs (See Figure 1 - Data Sources Included in the BIS), the data are collected through a variety of mechanisms including HL7, batch upload (automated extraction and uploads from health record system), and manual data entry. Information is reported via standard reports, data downloads, and analytical tools within the BIS. Data are collected from a number of sources including:
• Fertility clinics (IVF Cycles) • Prenatal screening (PNS) laboratories • Birthing Hospitals (pregnancy, labour/birth, postpartum, NICU/SCN) • Midwifery Practice Groups (pregnancy, labour/ birth, postpartum) • Birthing Centres (pregnancy, labour/birth, postpartum) • Newborn screening (NSO) laboratory • Prenatal screening and newborn screening follow-up clinics • Primary Care EMR’s • Applied Behavioral Analysis (ABA) Autism Treatment Centres
For a list of all organizations contributing data on births to the BIS, see Appendix A – List of Hospitals; Appendix B – List of Midwifery Practice Groups; and Appendix C – List of Birth Centres. Figure 1 - Data Sources Included in the BIS
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Methods of Data Entry Some organizations manually enter Information into the BIS, some upload batches of information electronically, and some use a combination of the two. Organizations choose the method that makes the most sense for them. 1. Manual Data Entry
• Nurses and Midwives enter information in ‘real time’ (i.e. at time of labour and birth or within 24 hours of discharge).
• Health Records Coders or Unit Clerks enter Information ‘retrospectively’ (e.g. after 24 hours of discharge) by chart abstraction or downtime forms.
2. Batch Upload • A Nurse, Clinical Application Specialist, Unit Clerk, or another designated person uploads
information from the Electronic Medical Record or Clinical System (e.g. OBIPS, GE Centricity, Epic, Meditech, Cerner) into the BIS. For more information about Batch Upload, visit the BORN website: https://www.bornontario.ca/en/data/training.aspx Click on ‘Get my Data In’, and then scroll down to ‘Batch Upload Resources.’
3. Hybrid Data Entry
• A Nurse, Clinical Application Specialist, Unit Clerk, or another designated person uploads certain encounters (e.g. labour, birth) and manually enters the others (e.g. postpartum, NICU)
Midwifery/Hospital Collaboration Nurses and midwives enter labour/birth, and postpartum information into the BIS. Midwives have a specific set of data elements in the BIS relevant to the care they provide. Midwives and nurses share another set of data elements relevant to hospital care. Depending on how they log into the BIS, Midwives can enter information on behalf of their Midwifery Practice Group or on behalf of the Hospital. See Appendix D - Completing the BIS for Hospital Births under the Care of a Midwife’ for more information on midwives entering ‘hospital’ encounters. BORN Coordinators can facilitate conversations between Midwifery Practice Groups and Hospitals to help determine the best collaborative process for data entry. The goal is to ensure information for all women and infants is entered in the BIS and to ensure appropriate data is shared across organizations to meet program management and reporting requirements.
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Where to go for Help If you have questions or need more information, you have many options for help. As illustrated in Figure 2, the BORN Coordinators, BORN Help Desk staff and the BORN Local Administrator at your organization are key resources. You can also find many helpful tools and documents in the BIS or on the BORN website. Please note, the BIS and the BORN website are two separate websites. The BORN website is open to the public, but the BIS is restricted to authorized users. See Table 1 for a more detailed summary of the resources available to you and how to access them. Figure 2 - Overview of Resources Available
Table 1 - Detailed Description of User Resources Resource Name
Description How to Access
PEOPLE BORN Coordinators
BORN Coordinators provide education, training, and support related to the BIS. They can help you with data entry, reconciliation, data quality, acknowledgement, and enhancements. If you have a
Coordinator Contact Information is located on the BORN website: https://www.bornontario.ca/en/about-born/coordinators/
• BORN Coordinators• BORN Help Desk staff• BORN Local Administrator
People
• Resources located on Login Page• Field-Level Help• Page-Level Help
BORN Information System (BIS)
• Data Dictionary• Data Collection & Reporting ResourcesBORN website
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Resource Name
Description How to Access
question and don’t know who should address it, start with your BORN Coordinator.
BORN Helpdesk
BORN Helpdesk staff can help you troubleshoot technical problems. For more details - such as information to provide when calling the Helpdesk or how to take a ‘screen shot’ of your computer screen – please go the BORN website: https://www.bornontario.ca/en/about-born/help-desk-team.aspx
Phone: Toll free: 1-855-881-BORN (2676) Email: [email protected]
BORN Local Administrator
Your Local Administrator can help with administrative functions like setting up your BIS username and password, changing your password, and providing access to reports etc.
Ask your manager or director who the Local Administrator is at your organization.
BORN INFORMATION SYSTEM (BIS) Field-Level Help
Field-Level Help is built-in information at your fingertips as you enter data in the BIS. If you have a question about a data field, simply scroll over the data field name and a question mark (“?”) will appear (See Figure 3 - Field-Level Help ). Double click and the definition of the data field will appear.
Access Field-Level Help during data entry in the BIS.
Page-Level Help
Page-Level help can be accessed as you are entering data into the BIS. Look for the question mark Help icon located at the top right corner of the page you’re working on (See Figure 4 – Page-Level Help). When you click the Help icon a pop-up screen appears and provides information and tips for entering data on that specific page.
Access Page-Level Help during data entry in the BIS.
Resources Located on Login Page
For your convenience, links to several commonly referenced documents such as the BIS User Guide, BIS
Access these resources at the BIS Login Page.
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Resource Name
Description How to Access
Downtime Forms, and MND Criterion Reference Guide - are available on the BIS login page. See BIS login page.
BORN ONTARIO WEBSITE Data Dictionary
The BORN Data Dictionary is a great online tool listing ALL BORN data elements, including their definitions and associated pick-list values (i.e. response options). You can search by keyword, view all data elements for a specific encounter, or make a data request (See BORN Data Dictionary).
Access the Data Dictionary from the BORN Ontario website: https://www.bornontario.ca/en/data/data-dictionary-and-library.aspx
Data Collection and Reporting Resources
Located on the BORN Ontario website, this collection of resources includes:
• Webinars • Videos • Quick-reference Guides • Downtime Forms • BORN Information Bits • File Specifications
Access this collection of resources on the BORN Ontario website: https://www.bornontario.ca/en/data/training.aspx
Figure 3 - Field-Level Help
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Figure 4 - Page-Level Help
Figure 5 - Login Page Resources
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Data Dictionary Figure 6 - Data Dictionary
Data Dictionary
The online Data
Dictionary is a list of
BORN data elements,
including their definitions
and associated pick-list
values (where applicable)
that are available in the
BORN Information
System (BIS).
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BIS Messaging System Anytime you need to send a message containing personal health information (PHI), use the BIS Messaging System.
The BIS Messaging system was created to allow you to communicate with BORN employees in a safe and secure manner. It allows you to send personal health information (PHI) without worrying about accidental disclosure. BIS Messaging looks similar to a regular email program (i.e. outlook, Gmail, etc.), but is restricted to the BORN Information System (BIS). It cannot be used to send email outside of the BIS or to other users in your organization – only BORN employees. Access the BIS Messaging System by clicking on any of the following: • The ‘Messaging’ link in the top navigation bar • The ‘Messaging’ link in the Quick Links section • The Envelope icon in the top right corner of the page See Figure 7 – How to Access BIS Messaging For more details about using the messaging system, please visit the BORN website: https://www.bornontario.ca/en/data/get-data-in.aspx. Click on ‘BIS Messaging User Guide.’ Figure 7 - How to Access BIS Messaging
Never email, fax, or text PHI!
What are some Examples of PHI?
• Patient Name • Patient Chart
Number • Patient OHIP
Number
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How can I send PHI?
The ONLY safe way to send PHI is by BIS Messaging. Before you send any email, double-check for PHI. When in doubt, use BIS Messaging.
BIS Enhancements
An ‘Enhancement Request’ form is available in the BIS to allow you to submit your suggestions for changes and improvements. To access the form, log into the BIS and click “Help”. Click on “Enhancement Request Form” under the Quick Links tab and the complete the form: 1. Give your request a title. 2. Provide a detailed description of the enhancement. Please include the following information if
possible: • Data Element Name • Relevant Encounter(s) • The problem or issue • The change(s) you would like to see to address the problem • Any evidence or clinical practice guidelines that support the change
3. Select the appropriate enhancement category from the list 4. [Optional] Attach supporting documentation (i.e. screen shot) 5. [Note: Your email address and phone number will automatically populate from your BIS profile]. Edit
this information if necessary 6. Click “Submit” to send the request Each request is reviewed and prioritized, and a decision is made to either accept or decline the request based on a review of impact, functional improvement, and clinical relevance. We appreciate your recommendations; your input helps us improve the BIS!
Do you have a suggestion or an idea you want to run by us?
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Data Entry
Browser Information A browser is a program used to navigate the internet (e.g. Internet Explorer, Chrome, Firefox, etc.). You can access the BIS using the following browsers: Firefox, Chrome, Internet Explorer, Safari and EDGE. If you’re not sure which one you are using, go to http://www.whatsmybrowser.org/.
Logging into the BIS You can log into the BIS a couple of different ways. The most common way is from within your hospital network. Certain users, however, will need to access the BIS from outside the hospital network. Midwives, for example, need to access the BIS from their Midwifery Practice Groups office (outside a hospital network). Access the BORN Information System: https://www.bornontario.ca/en/data/access-the-born-information-system.aspx You can also access the BIS from the BORN website by going to www.bornontario.ca and clicking on ‘BORN Information System’ from the menu at the top of the page. See Figure 8 (Accessing the BIS from the BORN website).
Did you Know…
We have a BIS Training
Site? It mirrors the real
site, but doesn’t contain
real data. It’s a great
resource for training new
users. Talk to your BORN
Coordinator about access.
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The next screen allows you to choose to access the BIS from within the hospital network or from outside the hospital network. Figure 8 - Accessing the BIS from the BORN Website (step 1)
Figure 9 - Accessing the BIS from the BORN Website (step 2)
Regardless of the way you access the BIS, you will be directed to the Member Login Page (See Figure 10). Enter your username and password (provided by your Local Administrator). For more details about your Local Administrator, see Table 1 - Detailed Description of User Resources
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Figure 10 - Member Login Page
Before you can enter data into the BIS, you must read and agree to the following: “Access to information is limited to authorized users of the BORN Ontario Information System only. I am aware that BORN Ontario has directives, policies and procedures related to health information privacy and security. I agree that I am responsible for understanding and complying with these directives. By entering the system I may be exposed to confidential personal health information. I understand that I am only permitted to access patient information to the extent necessary for me to provide patient care or perform my duties. I understand that I am responsible for ensuring it is maintained in a confidential and secure manner and is protected from unauthorized use, disclosure or inappropriate disposal. My access activity is monitored by BORN Ontario and may be terminated for non-compliance. Non-compliance may also result in a breach of my local privacy policies and subject to local ramifications.” This agreement is also listed in the “My Profile” section of the BIS.
Multi-Factor Authentication To access the BIS, Multi-factor Authentication (MFA) is required. MFA is a security enhancement that asks you to present two pieces of evidence – your credentials – when logging in to your account. Your Login information (username/password) is one credential. The other credential will either be a: Figure 11 - Multi-Factor Authentication
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Who Authenticates with a PIN? Individuals who only access the BIS from within their organization (Hospitals, Some Public Health Units, Prenatal Screening Ontario, Newborn Screening Ontario) will use a PIN (some exceptions apply). Examples:
• Nurses • Clerks • Genetic Counselors • Hospital Leadership
Who Authenticates with a Phone? Individuals who access the BIS from other settings (Midwifery Practice Groups, Some Public Health Units, BORN Ontario, Fertility Treatment Centres, Birth Centres, Screening Labs) will use a mobile or direct-dial phone to receive a one-time code or call. Examples:
• Midwives/Midwfiery Practice Groups • Public Health Nurses • Sonographers • Fertility Clinic Staff • BORN Ontario Staff
Login Process 1. Go to https://my.bornontario.ca. 2. Choose ‘Log in and authenticate with PIN’ or ‘Log in and authenticate with phone’. If you are not sure which to choose, please contact the BORN Lead at your organization. 3. Type in your username and password (See Figure 10 – Member Login Page). Figure 12 - BIS MFA Login
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Authenticate with PIN For those who Log in and authenticate with PIN:
• Type in your PIN code. Figure 13 - Authenticate with PIN
Authenticate with Phone For those who Log in and authenticate with phone:
• Choose to receive a one-time code by text OR receive a phone call.
Figure 14 - Authenticate with Phone
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Do You Work at More than One Hospital Location? If you work at multiple organizations or for more than one site within an organization, be careful to choose the correct hospital when you login to the BIS. (See Figure 11 – Change Organization).
Figure 15 - Authenticate with Phone
Figure 16 - Change Organization
Authenticate with Phone: Type in your one-time code. If you choose to receive a phone call, once you accept the phone call (press #) you will automatically be logged in.
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Landing Page The Landing Page is your main (home) page in the BIS and displays Announcements, Work Lists (Maternal and Child), Patient Records, Quick Links and the Maternal Newborn Dashboard. See Figure 17 – Landing Page). Note: the visibility of some features is dependent on the permissions associated with your account. Figure 17 - Landing Page
Always check the Announcements section for updates, notifications, and important news. The Work Lists (See Figure 18 - Work Lists) provide a visual overview of patient records. For example, you can easily see: • Record status - Which encounters have been submitted? Which ones need more work? • Record links - Have the mom and baby records been linked? You can also access encounters from the Work List and short-list patients - making data entry simpler. If a colleague at your hospital has started a record for a patient, the patient will appear on the Work List for a period of time. If one or more encounters for the patient are in draft, the record sits on the Work List as a reminder it needs to be completed. When all encounters are submitted, the record drops off the list (within 24 hours). If you don’t want to scroll through a long list of patient records, use the ‘Patient Search’ function (i.e. enter an OHIP number), to short-list the patient you want in the Work List.
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Figure 18 - Work Lists
The Patient Records section only displays the encounters you have created or updated (as opposed to Work Lists which displays every record for your organization). See Figure 19 – Patient Records). By default, it will display the records created in the last 14 days that are in ‘draft’ status. If you want to see records from a different time period or records that are not in draft status, you can change the display parameters. Figure 19 - Patient Records
The Maternal Newborn Dashboard (MND) is an audit and feedback tool that provides feedback on six key performance indicators, compares performance to established benchmarks (and other hospitals), and provides signals to trigger action if performance is sub-optimal. For more information on the MND, see the BORN Ontario website: https://www.bornontario.ca/en/data/reports-for-hospitals.aspx
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As mentioned earlier, you can access patient records from the Maternal or Child Work List. But what if a record has NOT been started at your hospital? Use the Patient Search function. The Patient Search tool allows you to search the BIS for a specific patient by entering: an OHIP number, an ID Number or a combination of the patient’s last name, first name, and date of birth (DOB). See Figure 20 – Patient Search.
Figure 20 - Patient Search
If one or more matches are found in a search, the Search Results screen will display. Click on the desired patient to open the patient record. If no matches are found based on your search criteria, the Search Results screen will indicate “No records to display” (See Figure 21 – Patient Search – no match). At this point, you can either perform an advanced search or create the patient.
If you have an OHIP number, always use this to search for a patient.
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Figure 21 - Patient Search - no match
The Patient Advanced Search tool provides you with the ability to search patients with more detailed search parameters (see Figure 22 – Advanced Patient Search). Figure 22 - Advanced Patient Search
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If you cannot find the patient (i.e. no record has been created for that patient at your organization), you will need to create a patient record (see Figure 23 - Create a Patient). Figure 23 - Create a Patient
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Patient Profile Overview Once you have found (or created) the patient record, enter information in the Demographics & ID tab (date of birth, primary language). See Figure 24 – Patient Profile Demographics Tab.
Figure 24 - Patient Profile Demographics Tab
To edit a patient’s address or create a new name for a patient, use the Name & Address History tab. (See Figure 25 – Patient Profile – Name & Address History).
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Figure 25 - Patient Profile - Name & Address History Tab
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Save, Proceed, Submit, & Cancel Encounters In the next section, you will learn how to enter information into various enounters (i.e. antenatal general, labour/birth mother, birth child, postpartum mother, postpartum child). Before addressing data entry for specific encounters, however, you need to know some important information applicable to all encounters. If you need to leave the screen while entering information into an encounter, you must Save the information you have already entered so it is not lost. (See Figure 26 – Save Button). Once an encounter is saved, it will be marked with a ‘Draft’ status in the system. Figure 26 - Save Button
Clicking on Proceed (See Figure 27 – Proceed Button) will save the information you have entered for that tab, as well as run the field validations for that tab. Figure 27 - Proceed Button
Once the data has been saved and validated, you will be taken to the next tab in that encounter to continue data entry. When all tabs have been completed, you are required to Submit the encounter (See Figure 28 – Submit Button). The system will run validation rules in each tab to ensure all required fields have been completed correctly and the data is compliant with the verification rules. Figure 28 - Submit Button
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If errors are detected, a red exclamation mark will appear on the tab with the error(s) and an error message will display. (See Figure 29 – Error Messages). After making the necessary corrections, click Submit . Figure 29 - Error Messages
Clicking on the Cancel button (See Figure 30 – Cancel Button) while completing data entry for an encounter will take you back to the patient profile screen. If there have been changes made to any of the fields of a tab, clicking on the Cancel button will alert you that any information you have entered into that encounter since the last save will be discarded. Figure 30 - Cancel Button
Uncommon Scenarios
The majority of births you enter into the BIS will be
straightforward, but once in a while you may come across a more unusual scenario that
you’re not sure how to enter. Check ‘Appendix E –
Uncommon Scenarios’ for help. If your scenario is not
explained, contact your BORN Coordinator for help.
32
Antenatal General Encounter This encounter captures information relevant to the antenatal period (i.e. obstetrical history, exposures, complications etc.). It can be completed during an antenatal visit or a maternal registration appointment. If completed during a registration appointment, the information will flow forward and populate subsequent encounters (i.e. Labour/Birth Mother encounter). Pre-population saves time and effort for nurses entering subsequent encounters as they only need to verify the information. If a patient has more than one antenatal visit at the same organization, the information is captured and updated in a single Antenatal General encounter for that organization. Once you have entered your patient’s demographic information and have selected the correct pregnancy, go to the navigation tree and click the orange plus sign beside the Antenatal General encounter. (See Figure 31 – How to Add the Antenatal General Encounter).
Pre-population Pre-populated data must be verified and updated as required. For example, an L&D nurse might need to update pre-populated information in the Labour/Birth Mother Encounter. This information - potentially entered months earlier during an antenatal visit - may no longer be correct/valid.
The Antenatal General Encounter is mandatory for midwifery practice group users, but optional for hospital users.
Figure 31 - How to Add the Antenatal General Encounter
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After clicking the orange plus sign to add an Antenatal General encounter, you will be prompted to link a Patient ID to the encounter (See 32 – How to Select the Patient ID). Select an existing patient ID or select ‘None of the Above / Add New ID’. Click the OK button to continue. Figure 32 - How to Select the Patient ID
History Tab and Pregnancy Tab The Antenatal General encounter has two tabs: the History tab and the Pregnancy tab (See Figure 33 – Antenatal General Encounter: History Tab and Figure 34 – Antenatal General Encounter: Pregnancy Tab). Tables 2 and 3 outline the data elements found on the History tab and the Pregnancy tab respectively. Figure 33 - Antenatal General Encounter: History Tab
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Table 2 - Antenatal General Encounter: History Tab Data Elements Data Element Instructions & Tips Maternal Health Conditions
Select all maternal health conditions and/or complications including those pre-existing, diagnosed during pregnancy or active during pregnancy.
Mental Health Concerns
Indicate any maternal mental health concerns during this pregnancy including those pre-existing, diagnosed during pregnancy or active during pregnancy. Both diagnosed or self reported.
Woman Abuse
The self-disclosed threat of or actual physical, sexual, psychological, emotional or financial abuse.
Gravida
Indicates number of pregnancies the women has experienced, including current pregnancy
Number of Previous Term Pregnancies
The total number of previous pregnancies delivered at greater than or equal to 37 weeks and 0 days gestation. Multiple gestations are counted as one birth event.
Number of Previous Preterm Pregnancies
The total number of previous pregnancies delivered at less than 37 weeks and 0 days gestation. Multiple gestations are counted as one birth event.
Number of Previous Abortions
The total number of spontaneous or therapeutic abortions occuring prior to 20 completed weeks gestation. Spontaneous losses include ectopic pregnancy, missed abortion, blighted ova, and molar pregnancy.
Number of Living Children
Number of living children at the time of pregnancy. Biological only, carried by mother, not nessarily cared for by mother and excludes adopted because this refers to mother’s pregnancy history.
Number of Previous Stillbirths
The total number of previous pregnancies resulting in a stillbirth. A stillbirth is defined as a product of conception weighing 500 grams or more or of 20 or more weeks gestation which, after being completely delivered, shows no sign of life. Intentional termination of pregnancy that meet either criterion are also classified as stillbirths in Ontario.
Number of Previous Vaginal Births
The total number of prior pregnancies resulting in a vaginal birth occuring at greater than or equal to 20 completed weeks gestation. Number excludes current pregnancy. Multiple gestations are counted as one birth event.
Number of Previous Cesarean Births
The total number of previous pregnancies resulting in a cesarean birth occuring at greater than or equal to 20 weeks and 0 days gestation. Number excludes current pregnancy. Multiple gestations are counted as one birth event.
Number of Previous VBACs
The total number of previous vaginal births after cesarean section (VBAC).
Parity The number of previous births (term + preterm). Automatically calculated
Need more information about a particular data element or the response options? Check out the BORN Data Dictionary.
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Pregnancy Tab
Figure 34 - Antenatal General Encounter: Pregnancy Tab
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Table 3 - Antenatal General Encounter: Pregnancy Tab Data Elements Data Element Instructions & Tips Maternal Height Maternal height, measured in imperial or metric units. (See Figure 35 –
Maternal Height for more details). Reported in metric units (i.e. in BIS Reports).
Pre-Pregnancy Weight
The mother’s self-reported weight closest to conception and no later than 12 weeks of gestation (metric or imperial units).
Pre-Pregnancy BMI
Maternal pre-pregnancy Body Mass Index (BMI) defined as weight in kilograms divided by the square of the height in metres (kg/m²). This is automatically calculated when Maternal Height AND Pre-Pregnancy Weight are entered.
Number of Fetuses Number of fetuses in the current pregnancy. Type of conception
Method of conception for this pregnancy; indicates if reproductive assistance was required to achieve current pregnancy.
Estimated Date of Birth (EDB)
Best estimate of date of birth determined by ultrasound or mathematical calculation using Niagele’s rule. Same as EDC and EDD. EDB is the preferred term. The rule estimates the expected date of delivery (EDD) by adding one year, subtracting three months, and adding seven days to the first day of a woman’s last menstrual period. (Select date from calendar or enter date: dd-MMM-yyy)
EDB Determined By
Method by which the estimated date of birth was determined for prenatal screening.
First Trimester Visit
Indication that mother had a prenatal care visit with a regulated health care provider during the first trimester (<13 weeks of pregnancy) of the current pregnancy.
Antenatal Healthcare Provider
Designation of health care providers (HCP) that provided antenatal care.
Prenatal Education
Indicate whether mother attended any prenatal education classes during the current pregnancy. This includes online education requiring registration or enrolment as well as in-person classes.
Intention to Breast Feed
Identifies whether the mother intends to breast feed her infant. Self-reported during pregnancy or at time of birth.
Folic Acid Maternal use of folic acid prior to and during pregnancy. Smoking at first prenatal visit
Self-reported amount of smoking per day at time of first prenatal visit.
Resides with smoker at first prenatal visit
At time of first prenatal visit, self-reported indication of whether woman resides with smoker.
Alcohol Exposure in Pregnancy
Self-reported alcohol consumption during pregnancy. If the amount of drinking varied over the course of the pregnancy, estimate the total and average it out over the entire pregnancy. Select the one that represents the highest exposure or impact. ‘Episodic excessive drinking (binging)’ is considered the greatest impact. If mother reported drinking ‘More than one drink per week’ and binge drinking, select ‘Episodic excessive drinking (binging)’.
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Data Element Instructions & Tips Cannabis Exposure in Pregnancy
Self-reported cannabis use during pregnancy.
Drug & Substance Exposure in Pregnancy
Indicate maternal self-reported drug and substance use during pregnancy. This refers to the use of street drugs and the inappropriate use of prescription and non-prescription drugs.
Medication Exposure in Pregnancy
Indicate type of prescription and non-prescription (over-the-counter) medications taken during this pregnancy.
Infection & Pregnancy
Identification of infections affecting this pregnancy. Select all that apply.
Progesterone taken daily for spontaneous preterm birth prevention.
Indicate whether progesterone is taken daily, any time after 16 weeks gestation. DO NOT include if progesterone is used only in first trimester.
ASA (aspirin) taken daily for preeclampsia prevention.
Indicate whether ASA (aspirin) is taken daily for preeclampsia prevention, any time after 12 weeks’ gestation. DO NOT include if aspirin is used only in first trimester.
Diabetes and Pregnancy
Indicate maternal diabetic status during this pregnancy.
Hypertension Disorder in Pregnancy
Identification of all hypertensive conditions and the progression of hypertensive conditions the women experienced during this pregnancy.
Complications of Pregnancy
Pregnancy related complications experienced during this pregnancy. Select all that apply.
Maternal height can be entered in inches, feet (ft.) and inches or centimeters (cm). (See Figure 30 – Maternal Height). Select the preferred unit of measurement and then enter the numerical value. For example, if a mother is 5’4”, you could enter this information in any of the following ways:
Figure 35 - Maternal Height
OR OR
If the maternal height is unknown, click on the “Maternal Height Unknown” checkbox.
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You have the choice to enter the maternal pre-pregnancy weight in pounds (lbs.) or kilograms (kg) (See Figure 36 - Pre-Pregnancy Weight). Select the preferred unit of measurement and then enter the numerical value. For example, if a mother weighs 130 lbs., you could enter this information in either of the following ways:
Figure 36 - Pre-Pregnancy Weight
OR If the maternal pre-pregnancy weight is unknown, click on the “Maternal Weight Unknown” checkbox.
Uncommon Scenarios
The next section focuses on entering
labour and birth details. The majority of
births you enter into the BIS will be
straightforward, but once in a while you
may come across a more unusual scenario
that you’re not sure how to enter. Check
‘Appendix E – Uncommon Scenarios’ for
help. If your scenario is not explained,
contact your BORN Coordinator for help.
39
Labour/Birth Mother Encounter All women who give birth require a labour/birth mother encounter. This encounter captures the experience through the first hour postpartum. In the case of multiple gestation - where both babies are born at your organization - only create one Labour/Birth Mother encounter. For fields such as ‘Presentation’ and ‘Type of Birth’, enter the birth information for the first-born baby. When you create the child records, you will have the opportunity to add in more detail about the births of both babies. Once you have searched for your patient’s information and have selected the correct pregnancy, go to the navigation tree and click the orange plus sign beside the Labour/Birth encounter. After clicking the orange plus sign to add a Labour/Birth Mother encounter, you will be prompted to link a Patient ID to the encounter. When creating an encounter, the system requires that you select either an existing patient ID to link all new encounters or specify a new patient ID (See Figure 32 - How to Select the Patient ID). Figure 38 shows the Admission tab for the Labour/Birth Mother Encounter Table 4 describes these data elements.
Figure 37 - How to Add the Labour/Birth Mother Encounter
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Figure 38 - Labour/Birth Mother Encounter: Admission Tab
Table 4 - Labour/Birth Mother Encounter: Admission Tab Data Elements Data Element Instructions & Tips Admission Date
The date of maternal admission to hospital that results in the birth of her baby. Most often admission is inpatient but birth and transfer may occur without inpatient admission - may use ambulatory care admit time or ER triage time. (Select date from calendar or enter date: dd-MMM-yyy)
Admission Time The time of maternal admission to hospital that results in the birth of her baby. Most often admission is inpatient but birth and transfer may occur without inpatient admission - may use ambulatory care admit time or ER triage time. (Enter time in 24 hour clock format: hh:mm)
Admission by Healthcare Provider
Indicates health care provider type responsible for admission to Labour and Birth.
Maternal Transfer From
Indicate whether Maternal transfer occurred or not. If there was a Maternal transfer, select originating location. Otherwise, select No Transfer
Maternal Transfer From Hospital
Select hospital name from list provided. (Conditional field – visible if Maternal Transfer From = Hospital).
Reason for Maternal Transfer From
Indicates the primary reason for maternal transfer (From) (Conditional field – visible if a maternal transfer occurred)
Barrier to Maternal Transfer
Indicate all barriers to maternal transfer. ‘Barriers to maternal transfer’ is a conditional field that is visible when a baby less than 30 weeks is born at a Level 1 or Level 2 hospital.
Maternal Transfer From Home Birth/MW Care
Select Midwifery Practice Group name from list provided. (Conditional field – visible if Maternal Transfer From = Home Birth/MW Care).
Comments Hospital specific comment (Free text) (Optional)
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Figure 39 shows the data elements appearing on the History tab. For a detailed desription of these data elements, see Table 5. Figure 39 - Labour/Birth Mother Encounter: History Tab
Table 5 - Labour/Birth Mother Encounter: History Tab Data Elements Data Element Instructions & Tips Maternal Health Conditions
Select all maternal health conditions and/or complications including those pre-existing, diagnosed during pregnancy or active during pregnancy.
Mental Health Concerns
Indicate any maternal mental health concerns during this pregnancy including those pre-existing, diagnosed during pregnancy or active during pregnancy. Both diagnosed or self reported.
Woman Abuse
The self-disclosed threat of or actual physical, sexual, psychological, emotional or financial abuse.
Gravida
Indicates number of pregnancies the women has experienced, including current pregnancy
Number of Previous Term Pregnancies
The total number of previous pregnancies delivered at greater than or equal to 37 weeks and 0 days gestation. Multiple gestations are counted as one birth event.
Number of Previous Preterm Pregnancies
The total number of previous pregnancies delivered at less than 37 weeks and 0 days gestation. Multiple gestations are counted as one birth event.
Number of Previous Abortions
The total number of spontaneous or therapeutic abortions occuring prior to 20 completed weeks gestation. Spontaneous losses include ectopic pregnancy, missed abortion, blighted ova, and molar pregnancy.
42
Data Element Instructions & Tips Number of Living Children
Number of living children at the time of pregnancy. Biological only, carried by mother, not nessarily cared for by mother and excludes adopted because this refers to mother’s pregnancy history.
Number of Previous Stillbirths
The total number of previous pregnancies resulting in a stillbirth. A stillbirth is defined as a product of conception weighing 500 grams or more or of 20 or more weeks gestation which, after being completely delivered, shows no sign of life. Intentional termination of pregnancy that meet either criterion are also classified as stillbirths in Ontario.
Number of Previous Vaginal Births
The total number of prior pregnancies resulting in a vaginal birth occuring at greater than or equal to 20 completed weeks gestation. Number excludes current pregnancy. Multiple gestations are counted as one birth event.
Number of Previous Cesarean Births
The total number of previous pregnancies resulting in a cesarean birth occuring at greater than or equal to 20 weeks and 0 days gestation. Number excludes current pregnancy. Multiple gestations are counted as one birth event.
Number of Previous VBACs
The total number of previous vaginal births after cesarean section (VBAC).
Parity The number of previous births (term + preterm). Automatically calculated
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Figure 40 - Labour/Birth Mother Encounter: Pregnancy Tab
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Table 6 - Labour/Birth Mother Encounter: Pregnancy Tab Data Elements Data Element Instructions & Tips Maternal Height Maternal height, measured in imperial or metric units. (See Figure 35 –
Maternal Height for more details). Reported in metric units (i.e. in BIS Reports).
Pre-Pregnancy Weight
The mother’s self-reported weight closest to conception and no later than 12 weeks of gestation (metric or imperial units).
Pre-Pregnancy BMI
Maternal pre-pregnancy Body Mass Index (BMI) defined as weight in kilograms divided by the square of the height in metres (kg/m²). This is automatically calculated when Maternal Height AND Pre-Pregnancy Weight are entered.
Maternal Weight at end of Pregnancy
Maternal self-reported weight closest to the end of pregnancy (metric or imperial units).
Maternal Weight Gain in Pregnancy
Calculated field.
Number of Fetuses Number of fetuses in the current pregnancy. Type of conception Method of conception for this pregnancy, indicates if reproductive assistance
was required to achieve current pregnancy. Estimated Date of Birth (EDB)
Best estimate of date of birth determined by ultrasound or mathematical calculation using Niagele’s rule. Same as EDC and EDD. EDB is the preferred term. The rule estimates the expected date of delivery (EDD) by adding one year, subtracting three months, and adding seven days to the first day of a woman’s last menstrual period. (Select date from calendar or enter date: dd-MMM-yyy)
EDB Determined By
Method by which the estimated date of birth was determined for prenatal screening.
First Trimester Visit
Indication that mother had a prenatal care visit with a regulated health care provider during the first trimester (<13 weeks of pregnancy) of the current pregnancy.
Antenatal Healthcare Provider
Designation of health care providers (HCP) that provided antenatal care.
Prenatal Education
Indicate whether mother attended any prenatal education classes during the current pregnancy. This includes online education requiring registration or enrolment as well as in-person classes.
Intention to Breast Feed
Identifies whether the mother intends to breast feed her infant. Self-reported during pregnancy or at time of birth.
Folic Acid Maternal use of folic acid prior to and during pregnancy. Smoking at first prenatal visit
Self-reported amount of smoking per day at time of first prenatal visit.
Resides with smoker at first prenatal visit
At time of first prenatal visit, self-reported indication of whether woman resides with smoker.
Maternal smoking at time of labour/admission
Self-reported amount of smoking per day closest to the time of labour/admission
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Resides with smoker at time of labour/admission
Indicate if mother resided with smoker at time of labour/admission.
Alcohol Exposure in Pregnancy
Self-reported alcohol consumption during pregnancy. If the amount of drinking varied over the course of the pregnancy, estimate the total and average it out over the entire pregnancy. Select the one that represents the highest exposure or impact. ‘Episodic excessive drinking (binging)’ is considered the greatest impact. If mother reported drinking ‘More than one drink per week’ and binge drinking, select ‘Episodic excessive drinking (binging)’.
Cannabis Exposure in Pregnancy
Self-reported cannabis use during pregnancy.
Drug & Substance Exposure in Pregnancy
Indicate maternal self-reported drug and substance use during pregnancy. This refers to the use of street drugs and the inappropriate use of prescription and non-prescription drugs.
Medication Exposure in Pregnancy
Indicate type of prescription and non-prescription (over-the-counter) medications taken during this pregnancy.
Infection & Pregnancy
Identification of infections affecting this pregnancy. Select all that apply.
Group B Strep Screening Results (35-37 wks.)
Indicates whether GBS screening (between 35-37 wks) was done and the results when screening was done.
Reason GBS Screening Not Done
Provide the reason why Group B Screening was not done. (Conditional field – Mandatory if “Group B Strep Screening Results (35-37 wks)” = “Not Done”)
GBS Screening Date
The date that GBS Screening test was done. Enter for the most recent GBS Screening Date, i.e. the one closest to the date of birth. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Optional if “Group B Strep Screening Results (35-37 wks)” = “Done, negative result”)
Progesterone taken daily for spontaneous preterm birth prevention.
Indicate whether progesterone is taken daily, any time after 16 weeks gestation. DO NOT include if progesterone is used only in first trimester.
ASA (aspirin) taken daily for preeclampsia prevention.
Indicate whether ASA (aspirin) is taken daily for preeclampsia prevention, any time after 12 weeks’ gestation. DO NOT include if aspirin is used only in first trimester.
Diabetes and Pregnancy
Indicate maternal diabetic status during this pregnancy.
Hypertension Disorder in Pregnancy
Identification of all hypertensive conditions and the progression of hypertensive conditions the women experienced during this pregnancy.
Complications of Pregnancy
Pregnancy related complications experienced during this pregnancy. Select all that apply.
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Figure 41 - Labour/Birth Mother Encounter: Intrapartum Tab ['Maternal Outcome = no transfer']
Figure 42 - Labour/Birth Mother Encounter: Intrapartum Tab ['Maternal Outcome = transfer to other hospital']
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Table 7 - Labour/Birth Mother Encounter: Intrapartum Tab Data Elements Data Element Instructions & Tips Type of Labour
Indicates whether the labour started spontaneously, was induced mechanically or pharmacologically or did not labour prior to C/Section
Group B Strep Antibiotics
Indication that mother was treated with antibiotics for Group B Streptococcus in the intrapartum period.
Antenatal Steroids
Indication that corticosteroid medication was administered between 24-34 weeks gestation to mother at risk of preterm birth.
Fetal Surveillance
Indicate all fetal surveillance methods that were used at any time during this admission (including admission EFM strips)
Augmentation
Interventions used to improve the quality and effectiveness when labour start is spontaneous. (Conditional field – Mandatory if “Type of Labour” = “Spontaneous”)
All Indications for Induction of Labour
All indications for induction of labour. Induction refers to initiation of labour. (Conditional field – Mandatory if “Type of Labour” = “Induced”)
Primary Indication for Induction of Labour
Indicate the primary medical or non-medical reason for labour induction. Select one from list selected in “All Indications for Induction of Labour”. (Conditional field – Mandatory if “Type of Labour” = “Induced”)
Bishop Score
Indicate Bishop score, a pre-labour evaluation used in predicting whether induction of labour will be successful . (Conditional field – Mandatory if “Type of Labour” = “Induced”)
Cervical Ripening Prior to Induction
Indicate interventions used to ripen cervix for labour. (Conditional field – Mandatory if “Type of Labour” = “Induced”)
Methods of Induction
Indicates all methods of induction used to initiate and establish effective labour. (Conditional field – Mandatory if “Type of Labour” = “Induced”)
Maternal Outcome Maternal disposition. (Depending on your response to this question, other fields may become visible. For example, if you choose ‘transfer to other hospital’, the Intrapartum Pain Management and Labour and Birth Complications fields appear)
Intrapartum Pain Management
Indicate use of pharmacological and non-pharmacological methods for the management of labour pain (Note: this field is only visible in this tab if mom was transferred out prior to birth, otherwise your are required to answer this in the Birth tab)
Labour & Birth Complications
Indicate all intrapartum complications during this labour and birth. (Note: this field is only visible in this tab if mom was transferred out prior to birth, otherwise your are required to answer this in the Birth tab)
Maternal Transfer Date
Mandatory if mother is transferred from your facility to another hospital prior to birth (Note: this field is only visible in this tab if mom was transferred out prior to birth, otherwise your are required to answer this in the Birth tab)
Maternal Transfer Time
Mandatory if mother is transferred from your facility to another hospital prior to birth (Note: this field is only visible in this tab if mom was transferred out prior to birth, otherwise your are required to answer this in the Birth tab)
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Figure 43 - Labour/Birth Mother Encounter: Birth Tab ['Type of Birth = Spontaneous Vaginal']
Depending on your response to ‘Type of Birth’, certain data elements will become visible. For example ‘Type of Cesarean Section’ will ONLY become visible if ‘Type of Birth’ = “Induced or Spontaneous Labour Cesarean Section”; or “No Labour Cesarean Section”).
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Figure 44 - Labour/Birth Mother Encounter: Birth Tab ['Type of Birth = No Labour Cesarean Section']
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Table 8 - Labour/Birth Mother Encounter: Birth Tab Data Elements Data Element Instructions & Tips Type of Birth Indicate how the baby was born. Presentation Indicate presenting part of fetus during birthing process. Forceps/Vacuum Indicate use of Forceps and/or Vacuum to assist birth.
Episiotomy
Indication whether episiotomy was performed and type of incision. (Conditional field – Mandatory if “Type of Birth” = Assisted Vaginal” or “Spontaneous Vaginal” or “Induced or Spontaneous Labour Cesarean Section”).
Perineal Laceration
Indicate whether tear of perineum occurred during intrapartum period. If more than one tear occurred, select the one that has the most clinical significance. This is a single select field. (Mandatory if “Type of Birth” = Assisted Vaginal” or “Spontaneous Vaginal” or “Induced or Spontaneous Labour Cesarean Section”)
If C/S Type
Indicate if cesarean section was planned (as scheduled), planned (not as scheduled), or unplanned (Conditional field – Mandatory if “Type of Birth” = “Induced or Spontaneous Labour Cesarean Section”; or “No Labour Cesarean Section”).
All Indication(s) for C/S
Indicate all medical and non-medical indications for cesarean section. (Conditional field – Mandatory if “Type of Birth” = “Induced or Spontaneous Labour Cesarean Section”; or “No Labour Cesarean Section”).
Primary Indication for C/S
Indicate the primary medical or non-medical reason for cesarean section. (Select one from list selected in “All Indications for C/S”) (Conditional field – Mandatory if “Type of Birth” = “Induced or Spontaneous Labour Cesarean Section”; or “No Labour Cesarean Section”).
Anesthesia for C/S
Indicate all types of anesthesia used during cesarean section. Select all that apply. (Conditional field – Mandatory if “Type of Birth” = “Induced or Spontaneous Labour Cesarean Section”; or “No Labour Cesarean Section”).
Date Fully Dilated
The date at complete cervical dilation. To be completed with Time Fully Dilated data element. (Select date from calendar or enter date: dd-MMM-yyy) (Mandatory if “Type of Birth” = Assisted Vaginal” or “Spontaneous Vaginal” ).
Time Fully Dilated
The time (24 hour clock) at complete cervical dilation (dilatation). If Time Fully Dilated is unknown (e.g. baby born on route to hospital) then estimate based on Time Started Pushing and Time of Birth. If Time Started Pushing is prior to Time Fully Dilated then Time Started Pushing=Time Fully Dilated. (Enter time in 24 hour clock format: hh:mm) (Mandatory if “Type of Birth” = Assisted Vaginal” or “Spontaneous Vaginal”).
Date Started Pushing
The date when mother initiates pushing. To be completed with Time Started Pushing data element. (Select date from calendar or enter date: dd-MMM-yyy) (Mandatory if “Type of Birth” = Assisted Vaginal” or “Spontaneous Vaginal”)
Time Started Pushing
The time (24 hour clock) when mother initiates pushing. If Time Started Pushing is unknown (e.g. baby born on route to hospital) then estimate based on Time of Birth. Time Started Pushing should not be before Time Fully Dilated but the encounter can be submitted if Time Started Pushing is up to 5 hours before. (Enter time in 24 hour clock format: hh:mm) (Mandatory if “Type of Birth” = Assisted Vaginal” or “Spontaneous Vaginal”)
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Labour & Birth Complications
Indicate all intrapartum complications during this labour and birth.
Intrapartum Pain Management
Indicate use of pharmacological and non-pharmacological methods for the management of labour pain
Newborn DOB
Newborn day/month/year of birth. (Select date from calendar or enter date: dd-MMM-yyy).
Time of Birth
The time (24 hour clock) when baby is born (Enter time in 24 hour clock format: hh:mm).
Maternal Age at time of Stillbirth or Live Birth
Calculated field indicating maternal age at time of live birth or stillbirth.
Birth Location The location where the birth occurred (hospital, home, other).
Healthcare Provider who caught/delivered baby
Identify the health care provider who actually caught/delivered (had hands on) the baby. Select one. This field is entered by midwives and hospital staff so the language 'caught' refers to midwifery and 'delivered' refers to hospital settings. If the person who caught/delivered the baby is not a health care provider, select 'Unattended (None)'.
Other Care Providers Present at Time of Labour and/or Birth
List other care providers present at time of labour and/or birth (Optional field)
ID of Healthcare Provider Attending Birth
Identification of most responsible person attending delivery. Unique ID by hospital choice, CPSO# or initials - for internal organization use only. (Optional field)
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Figure 45 - Labour/Birth Mother Encounter: Outcome Tab
Table 9 - Labour/Birth Mother Encounter: Outcome Tab Data Elements Data Element Instructions & Tips Birth Order
Indicates the birth order of each baby (Twin A = first born, Twin B = second born), irrespective of live birth or still birth.
Pregnancy Outcome
Indicates the actual outcome of this pregnancy, including live births, still births, terminations and losses.
Gestational Age at Birth
The infant's gestational age at the time of birth derived using EDB and DOB in weeks and days. (Calculated field)
Maternal Outcome Maternal disposition (Mandatory field)
Intrapartum Duration (Hours)
The duration of Intrapartum Length of Stay in hospital (in hours) from Maternal Admission date/time to date/time of Birth. (Calculated field)
Once you have submitted the Labour/Birth Mother encounter you will be prompted to create a child record (See Figure 46 - Prompt to Create a Child Record).
You must create a child record, even if the birth outcome is a stillbirth >= 20 weeks In multiple gestation scenarios, you must create a record for each child.
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Figure 46 - Prompt to Create a Child Record
Once you have selected “Yes,” you will automatically be directed to the child demographics page. Complete the information and click “Create patient.” (See Figure 47 – Create Child Record – Demographics Page). Figure 47 - Create Child Record - Demographics Page
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Once the child is created, you will be automatically directed to the Birth tab in the Birth Child encounter. The child’s name appears underneath the mother’s name in the navigation tree. You can now move between the mother and child records from the navigation tree. The name section of the record you are currently working in will appear orange in colour while the name of the ‘non-active’ record is grey.
Birth Child Encounter The Birth Child encounter documents the child’s birth experience through to the first hour postpartum. Some information from the Birth Mother encounter and Create Child Record screen will prepopulate the Birth Child encounter. Validate the accuracy of this information and edit as necessary. Once you have searched for your patient’s information, go to the navigation tree and click the orange plus sign beside the Birth Child encounter. Figure 48 - How to Add the Birth Child Encounter
After clicking the orange plus sign to add a Birth Child encounter, you will be prompted to link a Patient ID to the encounter. When creating an encounter, the system requires that you select either an existing patient ID to link all new encounters or specify a new patient ID. (See Figure 32 - How to Select the Patient ID).
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Figure 49 - Birth Child Encounter: Birth Tab
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Table 10 - Birth Child Encounter: Birth Tab Data Elements Data Element Instructions & Tips Date of Birth
Newborn day/month/year of birth. (Select date from calendar or enter date: dd-MMM-yyy)
Time of Birth The time (24 hour clock) when baby is born. (Enter time in 24 hour clock format: hh:mm)
Birth Location The location where the birth occurred (hospital, home, other). Birth Hospital
The name of the hospital where the birth occurred if Birth Location = hospital. Includes all Ontario hospitals with and without birthing centres and some out-of-province and out-of-country hospitals.
Birth Centre
Birth Centre (Conditional field – Mandatory if “Birth Location” = “Birth Centre”).
Type of Birth Indicate how the baby was born. Birth Order
Indicates the birth order of each baby (Twin A=first born, Twin B=second born), irrespective of live birth or stillbirth.
Presentation
Indicate presenting part of fetus during birthing process. .
Forceps/Vacuum
Indicate use of Forceps and/or Vacuum to assist birth (Mandatory field).
APGAR 1 Indicate APGAR score at 1 minute of age. APGAR5 Indicate APGAR score at 5 minutes of age. APGAR10 Indicate APGAR score at 10 minutes of age (Conditional field –
Mandatory if “APGAR5” is less than 7) Neonatal Resuscitation (first 30 minutes of life only)
Indicate all methods used for newborn resuscitation (Mandatory field).
Birth Outcome Indicates the actual outcome of this pregnancy, including live births, still births, terminations and losses.
Neonatal Death
Indicate whether neonatal death occurred. Mandatory on Birth Child encounter if Birth Outcome=Live Birth. (Not visible on Birth Child encounter if Birth Outcome=Stillbirth). Mandatory on Postpartum Child and NICU encounters.
Delayed Cord Clamping Indicates if delayed cord clamping occurred during birth. Delayed Cord Clamping duration
Indicate duration of delayed cord clamping in minutes and seconds.
Birth Weight
Indicate newborn birth weight (grams) (Free text) Conditional field – Mandatory if “Birth Weight Unknown” is not selected)
GA at Birth
The infant's gestational age at the time of birth derived using EDB and DOB in weeks and days. (Calculated field)
Neonatal Transfer to NICU/SCN
Used to identify newborn’s transfer to the NICU (Conditional field – Mandatory if “Birth Outcome” ≠ “Stillbirth”).
Reason for Neonatal Transfer
Indicates the primary reason why a newborn was transferred to a NICU/SCN (Conditional field – Mandatory if “Neonatal Transfer to NICU/SCN” is completed).
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Neonatal Transfer to Hospital
Indicate name of hospital where neonate was transferred to following birth (Conditional field – Mandatory if “Neonatal Transfer to NICU/SCN” = “Transfer to NICU/SCN other hospital).
Neonatal Transfer to NICU/SCN Date
Indicate date neonate was transferred to NICU/SCN (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Neonatal Transfer to NICU/SCN” is completed).
Neonatal Transfer to NICU/SCN Time
Indicate time neonate was transferred to NICU/SCN (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Neonatal Transfer to NICU/SCN” is completed).
Arterial cord blood test status Indicate status of arterial cord blood test. Arterial Cord Blood pH
Indicate results of arterial umbilical cord blood pH as reported by birth hospital (Free Text) (Optional field).
Arterial cord blood base excess/deficit
Indicate results of arterial umbilical cord blood sampling indicating base excess or deficit as reported by birth hospital (Free Text) (Conditional field – Optional if “Arterial cord blood test status” = “Done”).
Venous cord blood test status Indicate venous umbilical cord blood test status. Venous Cord Blood pH
Indicate results of venous umbilical cord blood pH as reported by birth hospital (Free Text) (Optional field).
Venous cord blood base excess/deficit
Indicate results of venous umbilical cord blood sampling indicating base excess or deficit as reported by birth hospital (Free Text) (Conditional field – Optional if “Venous cord blood test status” = “Done”).
Newborn Congenital Anomalies Identified
Indicate whether there were suspected or confirmed newborn congenital anomalies.
Newborn Congenital Anomalies Suspected
Identify all suspected congenital anomalies. (Conditional field –If “Newborn Congenital Anomalies Identified” = “Suspected or Confirmed” then either “Newborn Congenital Anomalies Suspected” or “Newborn Congenital Anomalies Confirmed” must be specified)
Newborn Congenital Anomalies Confirmed
Identify all congenital anomalies that were confirmed prenatally or after birth. (Conditional field –If “Newborn Congenital Anomalies Identified” = “Suspected or Confirmed” then either “Newborn Congenital Anomalies Suspected” or “Newborn Congenital Anomalies Confirmed” must be specified)
Neonatal Birth Complications Indicate all newborn complications and/or conditions. Infant Early attachment Indicate early attachment method at birth. (Conditional field –
Mandatory if “Birth Outcome” = “Live Birth”) Reason for No Skin-to-Skin If ‘No skin-to-skin contact within the first 2 hours post-birth’ is
selected above, then ‘Reason for No Skin-to-skin’ becomes visible. Baby Positioned to breastfeed Indicate “Yes, No or Unknown.” Baby breastfeeding behaviours observed
If ‘Baby Positioned to Breastfeed’ = ‘Yes’, then ‘Baby Breastfeeding Behaviours Observed’ becomes visible. Indicate behaviours observed.
Comments Hospital specific comment. (Free Text) (Optional field)
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Postpartum Mother Encounter This encounter reflects the course of care experienced by a woman from one hour post birth to discharge from hospital (care during the first hour post birth is captured in the Labour/Birth Mother encounter). Search for the patient; if a match exists in the system, it will be presented to you, along with the patient’s EDB (See Figure 50 – Select Pregnancy Screen). Select the relevant pregnancy for which you are entering data by clicking the button beside the EDB and then clicking the select button. If you do not see the patient’s EDB for the relevant pregnancy, click the ‘Show all Pregnancies’ button. Figure 50 - Select Pregnancy Screen
Once you’ve found the patient and the correct pregnancy, click the orange plus sign beside the Postpartum Mother encounter. (See Figure 51 – How to Add the Postpartum Mother Encounter).
Did you Know…
The ‘Newborn Profile on Discharge
Report’ – designed for distribution to
patients (and ultimately their primary
healthcare provider) - is an overview of
the labour, birth, and early newborn
experience? Pregnancy risk factors, birth
complications, APGAR scores, cord blood
gases, gestational age,
hyperbilirubinemia treatment, infant
feeding, and antibiotic treatment are
among the elements listed on the report.
Space for hand written notes/comments
is also included.
59
Figure 51 - How to Add the Postpartum Mother Encounter
After clicking the orange plus sign to add a Postpartum Mother encounter, you will be prompted to link a Patient ID to the encounter. When creating an encounter, the system requires that you select either an existing patient ID to link all new encounters, or specify a new patient ID (See Figure 32 – How to Select the Patient ID). Complete the Summary tab in the Postpartum Mother encounter (See Figure 52 – Postpartum Mother Encounter: Summary Tab) and Table 11 - Postpartum Mother Encounter: Summary Tab Data Elements Figure 52 - Postpartum Mother Encounter: Summary Tab
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Table 11 - Postpartum Mother Encounter: Summary Tab Data Elements Data Element Instructions & Tips Was the patient admitted to this organization for Postpartum Care only? (The birth did not occur at the admitting hospital)
Select Yes – if the mother was admitted for postpartum care only after delivery at another Ontario birthing facility or at home under midwifery care. Complete the new fields that become visible. Note: A labour encounter and/or Birth Mother encounter is needed for births that occur outside of a birthing facility or at home without midwifery attendance. Births occurring outside of Ontario do not need a Labour/Birth Mother or Birth Child encounter created.
Admission Date
The date of maternal admission to postpartum care. (Select date from calendar or enter date: dd-MMM-yyy)
Admission Time
The time of maternal admission to postpartum care. (Enter time in 24 hour clock format: hh:mm)
Admission by Healthcare Provider
Indicates health care provider type responsible for admission to postpartum. (Conditional field – Mandatory if “Birth Location” ≠ “Home” or “Other”)
Maternal Transfer From
Indicate where the mother was transferred from. Select originating location. (Conditional field – Mandatory if “Birth Location” ≠ “Home” or “Other” or if “Admitted for postpartum care only” = Yes)
Maternal Transfer From Hospital
Maternal transfer from hospital. (Conditional field – visible if “Maternal Transfer From” = “Hospital”)
Maternal Transfer From Home Birth/MW Care
Maternal transfer from home birth/MW care. (Conditional field – visible if “Maternal Transfer From” = “Home Birth/MW Care”)
Maternal Transfer From Birth Centre
Maternal transfer from birth centre. (Conditional field –visible if “Maternal Transfer From” = “Birth Centre”)
Reason for Maternal Transfer From
Indicates the primary reason for maternal transfer (From). (Conditional field – Mandatory if “Maternal Transfer From” ≠ “No Transfer”)
Date of Delivery/Newborn DOB
Newborn Day/month/year of birth. (Select date from calendar or enter date: dd-MMM-yyy) (Mandatory field)
Time of Birth
The time (24 hour clock) when baby is born. (Enter time in 24 hour clock format: hh:mm) (Optional field)
Type of Birth Indicate how the baby was born. Birth Location The location where birth occurred (hospital, home, other). Birth Hospital
The name of the hospital where the birth occurred if Birth Location = hospital. Includes all Ontario hospitals with and without birthing centres and some out-of-province and out-of-country hospitals. (Conditional field – Mandatory if “Birth Location” = “Hospital”)
Birth Centre
The name of the birth centre where the birth occurred. (Conditional field – Mandatory if “Birth Location” = “Birth Centre”)
Pregnancy Outcome Indicates the actual outcome of this pregnancy, including live births, still births, terminations and losses.
Postpartum Complication
Indicate maternal medical complications occurring in the postpartum period.
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Was Postpartum Breastfeeding Education and Support Provided
Indicate breastfeeding support provided. If “yes” indicate type of breastfeeding education and support. If “no” indicate reasons why breastfeeding education and support was not provided.
Healthy Baby Healthy Children (HBHC) Screen
Indicate Healthy Baby Healthy Children (HBHC) Screen completion status.
Reason HBHC screen not sent to PHU
Indicate reason that HBHC Screen was not comleted. (Conditional field – Mandatory if “Healthy Baby Healthy Children (HBHC) Screen” = “Completed and not sent to H.U.” or “Not Completed”)
Maternal Outcome Maternal Disposition Maternal Hospital Length of Stay
The total length in stay (in days) at the hospital. (Calculated Field)
Comments Hospital specific comment. (Free Text) (Optional field) If the mother experienced readmission or multiple transfers to/from the postpartum unit, use the “Click for Additional Transfer” button to enter information about the transfers (See Figure 53 – Postpartum Mother Encounter: Summary Tab [Document Additional Transfers]. Figure 53 - Postpartum Mother Encounter: Summary Tab [Document Additional Transfers]
You will be asked to confirm that you want to add another transfer; click the OK button. A new set of data elements will appear within the postpartum summary tab (See Figure 54 – Postpartum Mother Encounter: Summary Tab [Transfer/Readmission Information]). Figure 54 - Postpartum Mother Encounter: Summary Tab [Transfer/Readmission Information]
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Table 12 - Postpartum Mother Encounter: Summary Tab [Transfer/Readmission Data Elements] Data Element Instructions & Tips Maternal Transfer Back/Readmission Date
The date on which the patient transferred back or was re-admitted. (Select date from calendar or enter date: dd-MMM-yyy). (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes”)
Maternal Transfer Back/Readmission Time
The time at which the patient transferred back or was re-admitted. (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes”)
Maternal Outcome
Maternal Disposition. (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes”)
Maternal Discharge Date
The day/month/year of maternal discharge from hospital or transfer from the unit or hospital. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Discharged Home”)
Maternal Discharge Time
The time (24 hour clock) of maternal discharge from hospital or transfer from the unit or hospital . (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Discharged Home”)
Maternal Transfer To
Indicates which hospital a woman goes to when she is transferred out. (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Transfer to other hospital”)
Reason for Maternal Transfer
Indicates the primary reason for maternal transfer (To). (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Transfer to other hospital”)
Maternal Transfer Out Date
The day/month/year of maternal discharge from hospital or transfer from the unit or hospital. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Transfer to other hospital”)
Maternal Transfer Out Time
The time (24 hour clock) of maternal discharge from hospital or transfer from the unit or hospital . (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Transfer to other hospital”)
Reason for Maternal Transfer
Indicates the primary reason for maternal transfer (To). (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Transfer to ICU/CCU” or “Transfer to other non-obstetrical unit, same hospital”)
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Maternal Transfer Out Date
The day/month/year of maternal discharge from hospital or transfer from the unit or hospital. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Transfer to ICU/CCU” or “Transfer to other non-obstetrical unit, same hospital”)
Maternal Transfer Out Time
The time (24 hour clock) of maternal discharge from hospital or transfer from the unit or hospital . (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Transfer to ICU/CCU” or “Transfer to other non-obstetrical unit, same hospital”)
Maternal Death Date
The day/month/year of maternal death. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Maternal Death”)
Maternal Death Time
The time (24 hour clock) of maternal death. (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Was the patient transferred back to postpartum care?” = “Yes” and “Maternal Outcome” = “Maternal Death”)
Maternal Hospital Length of Stay
The total length in stay (in days) at the hospital. (Calculated Field)
Comments Hospital specific comment. (Free text) (Optional)
Did you Know…
BORN isn’t just about
babies! We are also
involved in child-focused
initiatives such as the
‘Enhanced 18-month
Well-Baby Visit’ Project.
64
Postpartum Child Encounter This encounter reflects the course of care experienced by a newborn from one hour post birth to discharge from hospital (care during the first hour post birth is captured in the Birth Child encounter). A single Postpartum Child encounter is entered within one organization. The easiest way to create a postpartum child encounter is either from the child’s navigation tree. Once you have searched for your patient’s information and found the correct record, go to the navigation tree and click the orange plus sign beside the Postpartum Child encounter. (See Figure 55 – How to Add the Postpartum Child Encounter)
Figure 55 - How to Add the Postpartum Child Encounter
After clicking the orange plus sign to add a Postpartum Child encounter, you will be prompted to link a Patient ID to the encounter. When creating an encounter, the system requires that you select either an existing patient ID to link all new encounters, or specify a new patient ID (See Figure 32 – How to Select the Patient ID). Complete the Newborn Status tab and the Discharge Summary tab of the Postpartum Child encounter (See Figure 56 – Postpartum Child Encounter: Newborn Status Tab and Figure 57 – Postpartum Child Encouter: Discharge Summary Tab).
65
Figure 56 - Postpartum Child Encounter: Newborn Status Tab
Table 13 - Postpartum Child Encounter: Newborn Status Tab Data Elements Data Element Instructions & Tips Was the patient admitted to this organization for Postpartum Care only? (The birth did not occur at the admitting hospital)
Select Yes – if the mother was admitted for postpartum care only after delivery at another Ontario birthing facility or at home under midwifery care. Enter the new fields that become visible. Note: A Labour/Birth Mother encounter is needed for births that occurred outside of a birthing facility or at home without midwifery attendance.
Admission Date
The date of admission to postpartum care. (Select date from calendar or enter date: dd-MMM-yyy)
Admission Time
The time of admission to postpartum care. (Enter time in 24 hour clock format: hh:mm)
Birth Location The location where birth occurred (hospital, home, other). Birth Hospital
The name of the hospital where the birth occurred if Birth Location = hospital. Includes all Ontario hospitals with and without birthing centres and some out-of-province and out- of-country hospitals. (Conditional field – Mandatory if “Birth Location” = “Hospital”)
Birth Centre
The name of the birth centre where the birth occurred. (Conditional field – Mandatory if “Birth Location” = “Birth Centre”)
Newborn Transfer From To track neonatal transfers and discharges. Newborn Transfer From Hospital
Indicate name of hospital where neonate was transferred from following birth. (Conditional field – Mandatory if “Newborn Transfer From” = “Hospital-Name”)
66
Newborn Transfer From Home Birth/MW Care
Indicate name of midwifery practice groupl where neonate was transferred from following birth. (Conditional field – Mandatory if “Newborn Transfer From” = “Home Birth/MW Care”)
Newborn Transfer From Birth Centre
Indicate name of birth centre where neonate was transferred from following birth. (Conditional field – Mandatory if “Newborn Transfer From” = “Birth Centre”)
Newborn Date of Birth
Newborn day/month/year of birth. (Select date from calendar or enter date: dd-MMM-yyy)
Time of Birth
The time (24 hour clock) when baby was born. (Enter time in 24 hour clock format: hh:mm) (Optional field)
Type of Birth Indicate how the baby was born. Birth Order
Indicates the birth order of each baby (Twin A=first born, Twin B=second born), irrespective of live birth or still birth.
Birth Weight Indicate newborn birth weight (grams). (Free text) GA at Birth
The infant’s gestational age at the time of birth derived using EDB and DOB in weeks and days. (Calculated field)
Baby’s sex Indicate sex of baby on visual exam. Arterial cord blood test status Indicate status of arterial cord blood test. Arterial Cord Blood pH
Indicate results of arterial umbilical cord blood pH as reported by birth hospital. (Free Text) (Conditional field – Mandatory if “Arterial cord blood test status” = “Done”)
Arterial cord blood base excess/deficit
Indicate results of arterial umbilical cord blood sampling indicating base excess or deficit as reported by birth hospital. (Free Text) (Conditional field – Optional if “Arterial cord blood test status” = “Done”)
Venous cord blood test status Indicate venous umbilical cord blood test status. Venous Cord Blood pH
Indicate results of venous umbilical cord blood pH as reported by birth hospital. (Free Text) (Conditional field – Mandatory if “Venous cord blood test status” = “Done”)
Venous cord blood base excess/deficit
Indicate results of venous umbilical cord blood sampling indicating base excess or deficit as reported by birth hospital. (Free Text) (Conditional field – Optional if “Venous cord blood test status” = “Done”)
Neonatal Birth Complications Indicate all newborn complications and/or conditions. Neonatal Health Conditions Indicate type(s) of neonatal health problems diagnosed during stay. Newborn Congenital Anomalies Identified
Indication whether there were suspected or confirmed newborn congenital anomalies.
Newborn Congenital Anomalies Suspected
Identify all suspected congenital anomalies. (Conditional field –If “Newborn Congenital Anomalies Identified” = “Suspected or Confirmed” then either “Newborn Congenital Anomalies Suspected” or “Newborn Congenital Anomalies Confirmed” must be specified)
Newborn Congenital Anomalies Confirmed
Identifies congenital anomalies that were confirmed prenatally or after birth. (Conditional field –If “Newborn Congenital Anomalies Identified” = “Suspected or Confirmed” then either “Newborn Congenital Anomalies Suspected” or “Newborn Congenital Anomalies Confirmed” must be specified)
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Figure 57 - Postpartum Child Encounter: Discharge Summary Tab
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Table 14 - Postpartum Child Encounter: Discharge Summary Data Elements Data Element Instructions & Tips Bilirubin Measured Within 72 Hours of Birth
Bilirubin measured within 72 hours of birth.
Hyperbilirubinemia Requiring Treatment
Indicates whether hyperbilirubinemia required treatment. (Conditional field – Mandatory if “Neonatal Health Conditions” = “Hyperbilirubinemia”)
Hyperbilirubinemia Treatment
Hyperbilirubinemia Treatment. (Conditional field – Mandatory if “Hyperbilirubinemia Requiring Treatment” = “Yes”)
Highest Serum Bilirubin > 340 mmol/L
Indicates whether highest serum bilirubin > 340. (Conditional field – Optional if “Bilirubin Measured Within 72 Hours of Birth” = “Total Serum Bilirubin (TSB)”)
Highest Serum Bilirubin > 425 mmol/L
Indicates whether highest serum bilirubin > 425. (Conditional field – Optional if “Highest Serum Bilirubin > 340 mmol/L” = “Yes”)
Pain Relief Measures During Newborn Screening or Serum Bilirubin
Pain Relief Measures During Newborn Screening or Serum Bilirubin.(Conditional field – Mandatory if “Bilirubin Measured Within 72 Hours of Birth” = “Total Serum Bilirubin (TSB)” or if “Newborn Screening Ontario (NSO)” = “Obtained”)
Neonatal Death Indicate whether neonatal death occurred. Neonatal Death Date
Indicate day/month/year of neonatal death. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Neonatal Death” ≠ No)
Neonatal Death Time
Indicate time (24 hour clock) of neonatal death. (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Neonatal Death” ≠ “No”)
Age at Neonatal Death Age at neonatal death. (Calculated field) Newborn Hearing Screen Result
The result of the Auditory Brainstem Response (ABR) or Distortion Product Otoacoustic Emission (DPOAE) newborn hearing screen test done during the hospital stay .
Infant Feeding Newborn feeding from birth to discharge from hospital or birth centre.
Reason for Breast Milk Substitute
Conditional field – Mandatory if infant feeding response is anything other than breast milk.
Consent for Use of Breast Milk Substitute
Conditional field – Mandatory if infant feeding response is anything other than breast milk.
Newborn Discharged or Transferred To:
To track neonatal transfers and discharges. (Conditional field – Mandatory if “Neonatal Death” = “No”)
Newborn Discharge/Transfer date
Indicate day/month/year when newborn was discharged or transferred from postpartum care.
Newborn Discharge/Transfer time
Indicate time (24 hour clock) when newborn was discharged or transferred from postpartum care.
Discharge Weight Indicate newborn weight at discharge from hospital (grams). Enter 0 if weight is unknown.
Comments Hospital specific comment. (Free text) (Optional field)
69
NICU/SCN Encounter This encounter captures information about babies who are cared for in a neonatal intensive care unit (NICU) or special care nursery (SCN).
Once you have searched for your patient’s information and have selected the correct pregnancy, go to the navigation tree and click the orange plus sign beside the NICU/SCN encounter (See Figure 58 – How to Add the NICU/SCN Encounter). Figure 58 - How to Add the NICU/SCN Encounter
After clicking the orange plus sign to add a NICU/SCN encounter, you will be prompted to link a Patient ID to the encounter. When creating an encounter, the system requires that you select either an existing patient ID to link all new encounters, or specify a new patient ID (See Figure 32 – How to Select the Patient ID). Complete all five tabs in the NICU/SCN encounter (See Figures 58-63).
Information entered is limited to the care experience for the current admission. A NEW NICU/SCN encounter must be created for each re-admission.
70
Figure 59 - NICU/SCN Encounter: Admission & Demographics Tab
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Table 15 - NICU/SCN Encounter: Admission & Demographics Tab Data Elements Data Element Instructions & Tips NICU/SCN Type
Indicates whether it is NICU or SCN. (Conditional field – Each hospital will be identified at the organization level as having a NICU, an SCN, both, or neither. If the organization only has either a NICU or an SCN, the field will be automatically set to the applicable value. If the organization has both NICU and SCN, this field is required)
Birth Location The location where the birth occurred (hospital, home, other).
Birth Hospital
The name of the hopsital where the birth occurred if Birth Location =hospital. Includes all Ontario hospitals with and without birthing centres and some out-of-province and out-of-country hospitals. (Conditional field – Mandatory if “Birth Location” = “Hospital”)
Birth Centre
Indicate the name of the Birth Centre where the birth occurred. (Conditional field – Mandatory if “Birth Location” = “Birth Centre”)
NICU Admit Date
Indicate day/month/year when neonate admitted to NICU/SCN. (Select date from calendar or enter date: dd-MMM-yyy)
NICU Admit Time
Indicate time (24 hours clock) when neonate admitted to NICU/SCN. (Enter time in 24 hour clock format: hh:mm)
Neonatal Transferred From
To track neonatal transfers and discharges.
Neonatal Transfer Hospital
Indicate name of hospital where neonate was transferred from following birth. (Conditional field – Mandatory if “Neonatal Transferred From” = “Other Hospital”)
Neonatal Transfer Birth Centre
Indicate name of Birth Centre where neonate was transferred from following birth birth. (Conditional field – Mandatory if “Neonatal Transferred From” = “Birth Centre”)
Gestational Age at Birth
The infant’s gestational age at the time of birth derived using EDB and DOB in weeks in days. (Calculated field)
Birth Weight
Indicate newborn birth weight (grams). (Free text) (Conditional field – Mandatory if “Birth Weight Unknown” is not selected)
Admission Temperature (C)
Temperature of newborn upon admission to NICU. (Free text)
Admission Head Circumference
Head circumference in cm of newborn upon admission to NICU. (Free text)
Admission Weight Weight of newborn in grams upon admission to NICU. (Free text) Transport Personnel In
Identify the personnel who accompanied the neonate during transport from another hospital/site. (Conditional field – Mandatory if “Neonatal Transferred From” = “Other Hospital”)
Days of Age on Admission
Age of the newborn in days upon admission to NICU.(Calculated field)
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Figure 60 - NICU/SCN Encounter: Health Status Tab
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Table 16 - NICU/SCN Encounter: Health Status Tab Data Elements Data Element Instructions & Tips APGAR1 APGAR score at 1 minute. APGAR5 APGAR score at 5 minutes. APGAR10 APGAR score at 10 minutes. (Conditional field – Mandatory if
“APGAR5” is less than 7) Neonatal Resuscitation (first 30 minutes of life only)
Indicate all methods used for newborn resuscitation.
Neonatal Resuscitation – Initial Gas used
Indicate initial gas used to resuscitate newborn. (Conditional field – Mandatory if “Neonatal Resuscitation (first 30 minutes of life only)” ≠ “None”)
Neonatal Resuscitation – Maximum of Oxygen in % provided during resuscitation
Maximum of Oxygen in % provided during neonatal resuscitation. (Free text) (Conditional field – Mandatory if “Neonatal Resuscitation (first 30 minutes of life only)” ≠ “None” OR if “Neonatal Resuscitation – Initial Gas Used” = “Supplemental Oxygen”)
Arterial cord blood test status Indicate status of arterial cord blood test. Arterial Cord Blood pH
Indicate results of arterial umbilical cord blood pH as reported by birth hospital. (Free Text) (Conditional field – Mandatory if “Arterial cord blood test status” = “Done”)
Arterial cord blood base excess/deficit
Indicate results of arterial umbilical cord blood sampling indicating base excess or deficit as reported by birth hospital. (Free Text) (Conditional field – Mandatory if “Arterial cord blood test status” = “Done”)
Venous cord blood test status Indicate venous umbilical cord blood test status. (Mandatory field) Venous Cord Blood pH
Indicate results of venous umbilical cord blood pH as reported by birth hospital. (Free Text) (Conditional field – Mandatory if “Venous cord blood test status” = “Done”)
Venous cord blood base excess/deficit
Indicate results of venous umbilical cord blood sampling indicating base excess or deficit as reported by birth hospital. (Free Text) (Conditional field – Mandatory if “Venous cord blood test status” = “Done”)
Neonatal Birth Complications Indicate all newborn complications and/or conditions. Neonatal Health Conditions Indicate type(s) of neonatal health problems diagnosed during stay. Newborn Congenital Anomalies Identified
Indication whether there were suspected or confirmed newborn congenital anomalies.
Congenital Anomalies Suspected
Identify all suspected congenital anomalies. (Conditional field –If “Newborn Congenital Anomalies Identified” = “Suspected or Confirmed” then either “Fetal Anomalies Suspected” or “Fetal Anomalies Confirmed” must be specified)
Congenital Anomalies Confirmed
Identifies congenital anomalies that were confirmed prenatally or after birth. (Conditional field –If “Newborn Congenital Anomalies Identified” = “Suspected or Confirmed” then either “Fetal Anomalies Suspected” or “Fetal Anomalies Confirmed” must be specified)
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Figure 61 - NICU/SCN Encounter: Interventions Tab
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Table 17 - NICU/SCN Encounter: Interventions Tab Data Elements Data Element Instructions & Tips Neonatal Therapies/Interventions
Indicate all neonatal therapies and/or interventions during NICU/SCN stay.
Neonatal Pain Management Neonatal Pain Management.
Neonatal Surgery Indicate type(s) of surgical procedure(s) performed on neonate.
Highest Mode of Respiratory Support
Highest mode of respiratory support for neonate.
Respiratory Support in Hospital
Types of respiratory support used on the neonate in the hospital. (Conditional field – Mandatory if “Highest Mode of Respiratory Support” ≠ “None” AND “NICU/SCN Type” = “NICU”)
Oxygen Therapy Days: Indicate number of days neonate received oxygen therapy. (Conditional field – mandatory if “Respiratory Support in Hospital” = “Oxygen”)
Non-invasive Ventilation Days:
The total number of days neonate received Non Invasive Ventilation. (Conditional field – mandatory if “Respiratory Support in Hospital” = “Non-Invasive Ventilation”)
Invasive Ventilation Days: Indicate total number of days that invasive ventilation was used. (Conditional field – mandatory if “Respiratory Support in Hospital” = “Invasive High Frequency Ventilation” or “Intermittent Positive Pressure Ventilation”)
Feeding Methods in Hospital
Infant feeding methods while in hospital. (Conditional field – Mandatory if “Neonatal Death” = “No”)
Nutritional Support in Hospital
Nutritional support in hospital. (Conditional field – Mandatory if “Neonatal Death” = “No”)
Reason for Breast Milk Substitute in Hospital:
Reason for Breast Milk Substitute in Hospital.
Consent for Use of Breast Milk Substitute
Conditional field – Mandatory if infant feeding response is anything other than breast milk.
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Figure 62 - NICU/SCN Encounter: Screening Tab
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Table 18 - NICU/SCN Encounter: Screening Tab Data Elements Data Element Instructions & Tips Newborn Screening Indicate whether newborn screening (NSO) was offered. Bilirubin Measured Within 72 Hours of Birth
Bilirubin Measured Within 72 Hours of Birth.
Pain Relief Measures During Newborn Screening Or Serum Bilirubin
Pain Relief Measures During Newborn Screening Or Serum Bilirubin. (Conditional field – Mandatory if “Newborn Screening” = “Obtained” or “Bilirubin Measured Within 72 Hours of Birth” = “Total Serum Bilirubin (TSB)”)
Hyperbilirubinemia Requiring Treatment
Indicates whether hyperbilirubinemia required treatment. (Conditional field – Mandatory if “Neonatal Health Conditions” = “Hyperbilirubinemia”)
Hyperbilirubinemia Treatment
Hyperbilirubinemia treatment. (Conditional field – Mandatory if “Hyperbilirubinemia Requiring Treatment” = “Yes”)
Newborn Drug Screen Indicate whether newborn drug screening done and if so, select type.
Newborn Drug Screen Result
Indicate result of newborn drug screening. (Conditional field – Mandatory if “Newborn Drug Screen” = “Blood” or “Hair” or “Meconium” or “Urine”)
Newborn Hearing Screen Result
The result of the Auditory Brainstem Response (ABR) or Distortion Product Otoacoustic Emission (DPOAE) newborn hearing screen test done during the hospital stay.
RSV Prophylaxis Eligible
Indicate whether neonate meets RSV prophylaxis criteria, either in season or out of season.
RSV Prophylaxis Criteria
RSV Prophylaxis Criteria. (Conditional field – Mandatory if “RSV Prophylaxis Criteria” = “Yes”)
RSV Prophylaxis Administered
Indicates whether RSV prophylaxis was administered. (Conditional field – Mandatory if “RSV Prophylaxis Criteria” = “Yes”)
ROP Eye Screening Performed
Indicate whether Retinopathy Of Prematurity (ROP) Screening initiated as per protocol.
ROP Eye Screening Type
ROP Eye Screening Type. (Conditional field – Mandatory if “ROP Eye Screening Performed” = “Yes”)
ROP Worst Stage
ROP Worst Stage. (Conditional field – Mandatory if “ROP Eye Screening Performed” = “Yes”)
ROP Treatment
ROP Treatment. (Conditional field – Mandatory if “ROP Eye Screening Performed” = “Yes”)
Neuroimaging Screening Performed
Indicates whether neuroimaging screening was performed.
Neuroimaging Screening Results Left
Neuroimaging Screening Results Left Type. (Conditional field – Mandatory if “Neuroimaging Screening Performed” = “Yes”)
Neuroimaging Screening Results Right
Neuroimaging Screening Results Right. (Conditional field – Mandatory if “Neuroimaging Screening Performed” = “Yes”)
Meets Neonatal Follow-up Criteria
Identify if neonate meets criteria for neonatal follow-up with subsequent referral completed.
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Figure 63 - NICU/SCN Encounter: Discharge/Outcome Tab
Did you Know…
You can access the NICU/SCN Profile Reports in the BIS which compare your NICU/SCN
data with your hospital peers (same level-of-care or similar birth volumes)? These
reports enable you to benchmark clinical outcomes, identify practice variations and
monitor trends.
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Table 19 - NICU/SCN Encounter: Discharge/Outcome Tab Data Elements Data Element Instructions & Tips Neonatal Death
Indicate whether neonatal death occurred. Mandatory on Birth Child encounter if Birth Outcome=Live Birth. (Not visible on Birth Child Encounter if Birth Outcome=Stillbirth). Mandatory on Postpartum Child and NICU encounters.
Neonatal Death Date
Indicate day/month/year of neonatal death. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Neonatal Death” = “Yes” or “Yes – With Termination of Pregnancy”)
Neonatal Death Time
Indicate time (24 hour clock) of neonatal death. (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Neonatal Death” = “Yes” or “Yes – With Termination of Pregnancy”)
Autopsy Consent
Indicate whether parent/guardian consent was obtained for autopsy. (Conditional field – Mandatory if “Neonatal Death” = “Yes” or “Yes – With Termination of Pregnancy”)
Age at Neonatal Death
Age at Neonatal Death. (Calculated field) (Conditional field – Mandatory if “Neonatal Death” = “Yes” or “Yes – With Termination of Pregnancy”)
Feeding Methods (on day of discharge)
Indicate infant feeding methods in NICU/SCN. (Conditional field – Mandatory if “Neonatal Death” = “No”)
Feeding Type (on day of discharge)
Feeding Type (on day of discharge). (Conditional field – Mandatory if “Neonatal Death” = “No”)
Was postpartum breastfeeding education and support provided in NICU/SCN?
“Yes”, “No” or “Unknown.”
Type of breastfeeding education and support provided
A multiselect field. Choose type of breastfeeding education and support provided.
Neonatal Discharge or Transfer to
To track neonatal transfers and discharges. (Conditional field – Mandatory if “Neonatal Death” = “No”)
Reason for Neonatal Transfer Select reason from picklist. Neonatal Transfer Hospital To
Indicate name of hospital where neonate was transferred to following birth. (Conditional field – Mandatory if “Neonatal Discharge or Transfer to” = “Transfer to other hospital”)
Transport Personnel Out
Identify the personnel who accompanied the neonate during transport to another hospital/site. (Conditional field – Mandatory if “Neonatal Discharge or Transfer to” = “Transfer to other hospital”)
NICU Discharge/Transfer Date
Indicate day/month/year when neonate discharged from NICU/SCN. (Select date from calendar or enter date: dd-MMM-yyy) (Conditional field – Mandatory if “Neonatal Death” = “No”)
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NICU Discharge/Transfer Time
Indicate time (24 hour clock) when neonate discharged from NICU/SCN. (Enter time in 24 hour clock format: hh:mm) (Conditional field – Mandatory if “Neonatal Death” = “No”)
Discharge Weight
Indicate newborn weight at discharge from hospital (grams). Enter 0 if weight is unknown. (Free text) (Conditional field – Mandatory if “Neonatal Death” = “No”)
Weight Gain/Loss
Calculation of newborn percentage of weight loss/gain at the time of discharge. (Calculated field) (Mandatory field)
Discharge Interventions in Place (on day of discharge)
Discharge Interventions in Place (on day of discharge). (Conditional field – Mandatory if “Neonatal Death” = “No”)
Discharge Head Circumference
Indicate neonatal head circumference (cm) upon discharge from NICU. (Free text)
Gestational Age at Discharge
Gestational age of premature infant at discharge from hospital. (Calculated field)
Days of Age at Discharge Age of newborn - in days - upon discharge from NICU. (Calculated field)
Comments Hospital specific comment. (Free text) (Optional field)
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BIS Downtime Forms If you do not have access to the BIS (e.g. planned outage for system update), printable downtime forms for each encounter can be found on the BORN Ontario website: https://www.bornontario.ca/en/data/get-data-in.aspx. When your access to the BIS has been restored, transfer the information from the downtime form into the BIS. Figure 64 - Where to Find BIS Downtime Forms
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Data Quality At BORN Ontario we make data privacy and data quality our highest priorities. We recognize that the quality of the data directly impacts use of the data. Our goal is to ensure that data entered into the BIS is timely, accurate, and comparable as well as usable and relevant for stakeholders. The BORN Data Quality Framework was implemented in 2013 and is based on 5 dimensions of data quality: timeliness, accuracy, comparability, usability, and relevance (See Figure 65 – BORN Data Quality Framework). For more information about data quality and specific features and functions of the BIS that support data quality, see the BORN website: https://www.bornontario.ca/en/data/promoting-data-quality.aspx Figure 65 - BORN Data Quality Framework
One of the ways we promote quality is through our Data Quality Management Cycle (See Figure 66). Data is collected by care providers, submitted (either manually or electronically), reconciled, acknowledged, and then used. Use of the data generates new questions and recommendations, which in turn affects the data elements we collect and the cycle continues.
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You have an extremely important role to play in this Data Quality Management Cycle!
Figure 66 - Data Quality Management Cycle
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Reconciliation Reconciliation refers to comparing two sets of records to make sure they are in agreement. By comparing data you have entered into the BIS with a second data source, you can confirm the accuracy of the information. For example, by comparing the number of live births entered into the BIS for a particular month with an internal documentation source (i.e. log book, ADT system, other electronic data system), you verify that the number is correct. For more information, see the Reconciling and Acknowledging Data webinar and slide deck available on the BORN website: https://www.bornontario.ca/en/data/check-my-data-quality.aspx Talk to your BORN Coordinator if you have more questions about reconciling your data. Figure 67 - Where to find the 'Reconciling and Acknowledging Data' document
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Data Quality Management Administrative Reports are very important because they flag records with incomplete or incorrect information so you can clean up the data. A variety of Administrative Reports are available to help with data cleaning: Incomplete Record Reports Missing Data Element Reports Reconciliation Reports Maternal-Infant Cross Encounter Discrepancy Reports
For detailed information on each administrative report available and its purpose, please see the BIS Reports for Hospital Users Guide. This document is available on the BORN website: https://www.bornontario.ca/en/data/look-at-my-data.aspx Figure 68 - Where to find 'BIS Reports for Hospital Users' Guide
To keep your work manageable, run administrative reports monthly (or more frequently if possible).
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Monthly Acknowledgement Process Acknowledgement is the confirmation that your data is as complete and as accurate as possible. It should only occur after: The number of live births, stillbirths, and NICU discharges have been reconciled. All issues in the ‘Incomplete Records’ reports and ‘Maternal-Infant Cross Encounter Discrepancy’
report have been addressed. When you are ready to acknowledge, log into the BIS and click on ‘Acknowledgement’ and check the appropriate boxes (See Figure 69 – How to Acknowledge Data). Figure 69 - How to Acknowledge Data
Data must be acknowledged before it will be included in clinical reports. This process of having each record submitted and reviewed for accuracy ensures the data contained in the BIS is as accurate as possible. If you have questions about data acknowledgement, talk to your BORN Coordinator.
Monthly data acknowledgement should be completed by the 15th day of the following month (i.e. January data should be acknowledged by February 15th).
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End-of-Fiscal-Year Requirements The fiscal year runs from April 1st to March 31st. At the end of the fiscal year, your BORN Coordinator will confirm that you’ve acknowledged data for all 12 months, ask you to verify key numbers (i.e. live births, still births, NICU admissions), and remind you to correct any outstanding errors. Figure 65 – End-of-Year Communication Example is an example of the type of communication you’ll receive. Figure 70 - End-of-Year Communication Example
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Data Use
Big Picture Data Use BORN data is used by a wide variety of individuals and groups (See Figure 71 – Who Uses the Data you Enter?) and for a wide variety of purposes: Generating perinatal and neonatal reports Reflective practice Performance measurement Best Practice Continuous quality improvement initiatives
Policy development Evidence-based decision making Supporting public health programming Informing research questions Examining health services issues
For a sampling of the innovative ways people are using BORN data, check out these links on the BORN website: • BORN Publications: https://www.bornontario.ca/en/publications/born-publications.aspx • Research Using BORN data: https://www.bornontario.ca/en/publications/research-that-uses-born-
data.aspx • BORN Reports: https://www.bornontario.ca/en/publications/born-reports.aspx
Figure 71 - Who Uses the Data you Enter?
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In Focus – How Can You Use the Data? Clinical reports available in the BIS are designed to help you monitor and analyze program performance and patient outcomes. You can explore trends over time and compare your data to peer hospitals and provincial rates. Clinical reports are grouped into three categories: maternal newborn standard reports; data download reports, and patient-level reports (See Figure 72 – Clinical Reports). Figure 72 - Clinical Reports
For a detailed description of each clinical report (including the indicators), please refer to the BORN website: https://www.bornontario.ca/en/data/look-at-my-data.aspx.
•Key Indicator Reports•Profile of Birth Reports•NICU/SCN Profile Reports•Baby-Friendly Reports•Robson Cesarean Section Monitoring Report
Maternal Newborn Standard Reports (frequencies & percentages)
•Encounter Lists•Patient Experience List
Data Download Reports (raw exported data for multiple patients)
•Newborn Profile at Discharge•NICU/SCN Profile at Discharge•Encounter Summary Reports•Patient Experience Report
Patient-Level Reports (summary of a single patient record; accessed WITHIN the record)
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Appendices
Appendix A - List of Hospitals
Hospital LHIN Name LHIN # PHU LOC NICU/SCN
Birth Volume
Alexandra Marine & General Hospital South West 2 Huron NI --- ≤100
Almonte General Hospital Champlain 11 Leeds, Grenville and Lanark
NI --- 251-500
Bluewater Health - Sarnia Site Erie St. Clair 1 Lambton NIIa SCN 501-1000 Brant Community Healthcare System - Brantford General Site
Hamilton Niagara Haldimand Brant 4 Brant NIIb SCN 1001-
2499
Brockville General Hospital South East 10 Leeds, Grenville and Lanark
NI --- 251-500
Cambridge Memorial Hospital
Waterloo Wellington 3 Waterloo NIIa SCN 1001-
2499 Chatham-Kent Health Alliance – Chatham
Erie St. Clair 1 Chatham-Kent NIIb SCN 501-1000
Children's Hospital of Eastern Ontario Champlain 11 Ottawa NIIIb NICU ---
Collingwood General and Marine Hospital
North Simcoe Muskoka 12 Simcoe
Muskoka NI --- 251-500
Cornwall Community Hospital - McConnell Avenue Site Champlain 11 Eastern
Ontario NI --- 501-1000
Dryden Regional Health Centre North West 14 Northwestern NI --- 101-250
Erie Shores HealthCare Erie St. Clair 1 Windsor-Essex NI --- 251-500 Georgian Bay General Hospital - Midland Site
North Simcoe Muskoka 12 Simcoe
Muskoka NI --- 101-250
Grand River Hospital - Kitchener Waterloo Site
Waterloo Wellington 3 Waterloo NIIb SCN >4000
Grey Bruce Health Services - Owen Sound South West 2 Grey Bruce NIIb SCN 501-1000
Groves Memorial Community Hospital
Waterloo Wellington 3
Wellington-Dufferin-Guelph
NI --- 251-500
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Hospital LHIN Name LHIN # PHU LOC NICU/SCN
Birth Volume
Guelph General Hospital Waterloo Wellington 3
Wellington-Dufferin-Guelph
NIIa SCN 1001-2499
Halton Healthcare Services - Georgetown Hospital Mississauga/Halton 6 Halton NI --- 251-500
Halton Healthcare Services - Milton District Hospital Mississauga/Halton 6 Halton NI --- 1001-
2499 Halton Healthcare Services - Oakville-Trafalgar Memorial Hospital
Mississauga/Halton 6 Halton NIIb SCN 1001-2499
Hamilton Health Sciences - McMaster Children's Hospital - Level 2
Hamilton Niagara Haldimand Brant 4 Hamilton NIIa SCN ---
Hamilton Health Sciences - McMaster Children's Hospital - Level 3
Hamilton Niagara Haldimand Brant 4 Hamilton NIIb NICU ---
Hamilton Health Sciences – McMaster Site
Hamilton Niagara Haldimand Brant 4 Hamilton NIIb --- 2500-
4000
Hanover and District Hospital South West 2 Grey Bruce NI --- ≤100 Hawkesbury and District General Hospital Champlain 11 Eastern
Ontario NI --- 251-500
Headwaters Health Care Centre - Orangeville Site Central West 5
Wellington-Dufferin-Guelph
NI --- 501-1000
Health Sciences North – Sudbury North East 13 Sudbury NIIc SCN 1001-
2499 Hospital for Sick Children Toronto Central 7 Toronto NIIIb NICU ---
Humber River Wilson Central 8 Toronto NI SCN 2500-4000
Huron Perth Healthcare Alliance - Clinton Public Hospital
South West 2 Huron NI --- ≤100
Huron Perth Healthcare Alliance - Stratford General Hospital
South West 2 Perth NIIa SCN 1001-2499
Joseph Brant Hospital Hamilton Niagara Haldimand Brant 4 Halton NIIb SCN 1001-
2499
Kingston Health Sciences Centre - Kingston General Site South East 10
Kingston, Frontenac L&A
NIIIa NICU 1001-2499
Lady Dunn Health Centre North East 13 Algoma NI --- ≤100
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Hospital LHIN Name LHIN # PHU LOC NICU/SCN
Birth Volume
Lake of the Woods District Hospital North West 14 Northwestern NI -- 101-250
Lakeridge Health Corporation – Ajax and Pickering Central East 9 Durham NIIb SCN 1001-
2499 Lakeridge Health Corporation – Oshawa Central East 9 Durham NIIc SCN 1001-
2499 Lakeridge Health Corporation - Port Perry Central East 9 Durham NI --- 251-500
l'Hôpital Montfort Champlain 11 Ottawa NIIa SCN 2500-4000
Listowel Memorial Hospital South West 2 Perth NI --- 101-250 London Health Sciences Centre - Victoria Hospital South West 2 Middlesex-
London NIIIb NICU >4000
Mackenzie Health-Richmond Hill Central 8 York NIIc SCN 2500-
4000 Manitoulin Health Centre North East 13 Sudbury NI --- ≤100 Markham Stouffville Hospital - Markham Site Central 8 York NIIc SCN 2500-
4000 McCausland Hospital North West 14 Thunder Bay NI --- ≤100 Middlesex Health Alliance - Strathroy Middlesex General Hospital
South West 2 Middlesex-London NI --- 101-250
Mount Sinai Hospital Toronto Central 7 Toronto NIIIa NICU >4000 Muskoka Algonquin Healthcare - Huntsville District Memorial Hospital Site
North Simcoe Muskoka 12 Simcoe
Muskoka NI
---
101-250
Muskoka Algonquin Healthcare - South Muskoka Memorial Hospital Site
North Simcoe Muskoka 12 Simcoe
Muskoka NI --- 101-250
Niagara Health System - St. Catharines
Hamilton Niagara Haldimand Brant 4 Niagara NIIb SCN 1001-
2499
Norfolk General Hospital Hamilton Niagara Haldimand Brant 4 Haldimand-
Norfolk NI --- 251-500
North Bay Regional Health Centre North East 13 North Bay
Parry Sound NIIc SCN 501-1000
North Wellington Health Care - Louise Marshall Hospital
Waterloo Wellington 3
Wellington-Dufferin-Guelph
NI --- ≤100
North Wellington Health Care - Palmerston District Memorial Hospital
Waterloo Wellington 3
Wellington-Dufferin-Guelph
NI --- 101-250
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Hospital LHIN Name LHIN # PHU LOC NICU/SCN
Birth Volume
North York General Hospital Central 8 Toronto NIIc SCN >4000 Northumberland Hills Hospital Central East 9 Haliburton,
Kawartha, PR NI --- 501-1000
Notre-Dame Hospital North East 13 Porcupine NI --- ≤100 Orillia Soldiers' Memorial Hospital
North Simcoe Muskoka 12 Simcoe
Muskoka NIIc SCN 501-1000
Pembroke Regional Hospital
Champlain 11 Renfrew NI --- 501-1000
Perth and Smiths Falls District Hospital - Smiths Falls South East 10
Leeds, Grenville and Lanark
NI --- 251-500
Peterborough Regional Health Centre Central East 9 Peterborough NIIb SCN 1001-
2499
Queensway Carleton Hospital Champlain 11 Ottawa NIIa SCN 2500-4000
Quinte Health Care - Belleville General South East 10
Hastings and Prince Edward Counties
NI
SCN
1001-2499
Red Lake Margaret Cochenour Memorial Hospital
North West 14
Northwestern NI
---
≤100
Riverside Health Care Facilities Inc.- La Verendrye Hospital
North West 14 Northwestern NI --- 101-250
Ross Memorial Hospital Central East 9 Haliburton, Kawartha, PR NI --- 251-500
Royal Victoria Regional Health Centre
North Simcoe Muskoka 12 Simcoe
Muskoka NIIc SCN 1001-2499
Sault Area Hospital North East 13 Algoma NIIc SCN 501-1000 Scarborough and Rouge Hospital - Centenary site Central East 9 Toronto NIIc SCN 1001-
2499 The Scarborough and Rouge Hospital - General site Central East 9 Toronto NIIb SCN 2500-
4000 Sensenbrenner Hospital North East 13 Porcupine NI --- ≤100 Sioux Lookout Meno-Ya-Win Health Centre North West 14 Northwestern NI --- 251-500
South Bruce Grey Health Centre - Walkerton South West 2 Grey Bruce NI --- 251-500
Southlake Regional Health Centre Central 8 York NIIb SCN 2500-
4000 St. Joseph's General Hospital Elliot Lake North East 13 Algoma NI --- ≤100
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Hospital LHIN Name LHIN # PHU LOC NICU/SCN
Birth Volume
St. Joseph's Health Centre Toronto Toronto Central 7 Toronto NIIb SCN 2500-
4000 St. Joseph's Healthcare Hamilton - Charlton Campus
Hamilton Niagara Haldimand Brant 4
Hamilton NIIb
SCN
2500-4000
St. Michael's Hospital Toronto Central 7 Toronto NIIc SCN 2500-4000
St. Thomas Elgin General Hospital South West 2 Elgin-St.
Thomas NIIa SCN 501-1000
Stevenson Memorial Hospital Central 8 Simcoe Muskoka NI --- 251-500
Sunnybrook Health Sciences Centre Toronto Central 7 Toronto NIIIaIII
b NICU 2500-4000
Temiskaming Hospital North East 13 Timiskaming NI --- 251-500 The Ottawa Hospital - Civic Campus Champlain 11 Ottawa NIIc SCN 2500-
4000 The Ottawa Hospital - General Campus Champlain 11 Ottawa NIIIaIII
b NICU 2500-4000
Thunder Bay Regional Health Sciences Centre North West 14 Thunder Bay NIIc SCN 1001-
2499 Timmins and District Hospital North East 13 Porcupine NIIa SCN 501-1000 Toronto East Health Network Michael Garron Hospital Toronto Central 7 Toronto NIIc SCN 2500-
4000 Trillium Health Partners - Credit Valley Hospital Mississauga/Halton 6 Peel NIIc SCN >4000
Trillium Health Partners - Mississauga Hospital Mississauga/Halton 6 Peel NIIb SCN >4000
Weeneebayko Health Ahtuskaywin - Weeneebayko General Hospital
North East 13 Porcupine NI --- 101-250
West Lincoln Memorial Hospital
Hamilton Niagara Haldimand Brant 4 Niagara NI --- 501-1000
West Parry Sound Health Centre North East 13 North Bay
Parry Sound NI --- 101-250
William Osler Health Centre - Brampton Civic Central West 5 Peel NIIc SCN >4000
William Osler Health Centre - Etobicoke General Hospital Central West 5 Toronto NIIb SCN 2500-
4000 Wilson Memorial General Hospital North West 14 Thunder Bay NI --- ≤100
Winchester District Memorial Hospital
Champlain 11 Eastern Ontario NI --- 501-1000
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Hospital LHIN Name LHIN # PHU LOC NICU/SCN
Birth Volume
Windsor Regional Hospital - Metropolitan Campus Erie St. Clair 1 Windsor-Essex NIIc SCN 2500-
4000 Wingham and District Hospital South West 2 Huron NI --- ≤100
Woodstock General Hospital South West 2 Oxford NI --- 501-1000
Did you Know…
BORN built an electronic version of the ‘Healthy Babies
Healthy Children’ screening tool in the BIS, permitting
the disclosure of relevant and timely information to
Public Health units?
Public Health Units use this screening information to
triage home visits and supportive community care for
women and newborns with the highest needs.
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Appendix B - List of Midwifery Practice Groups
Midwifery Practice Group MPG Number Access Midwives MPG159 AMMA Midwives MPG192 Barrie Midwives MPG151 Blue Heron MPG184 Boreal Midwifery Practice MPG169 Born Midwives MPG191 Burlington & Area Midwives MPG166 Cambridge Midwives MPG140 Caring Hands Midwifery Services MPG129 Community Care Midwives MPG149 Community Midwives of Brantford MPG135 Community Midwives of Halton MPG111 Community Midwives of Hamilton MPG110 Community Midwives of Kingston MPG124 Community Midwives of Ottawa MPG 197 Community Midwives of Thunder Bay MPG171 Community Midwives of Toronto MPG100 Countryside Midwifery Services MPG119 Diversity Midwives MPG146 East Mississauga Midwives MPG183 East Ottawa Midwives MPG161 Family Care Midwives MPG178 Family Midwifery Care of Guelph MPG115 Generations Midwifery Care MPG170 Genesis Midwives MPG177 Gentle Beginnings Midwifery MPG150 Grand Valley Midwives MPG190 Guelph Midwives MPG114 Huron Community Midwifery Services MPG122 K'Tigaaning Midwives MPG132 Kawartha Community Midwives MPG123 Kenora Midwives MPG144 Kensington Midwives MPG118 Kitchener Waterloo Midwifery Associates MPG142 Lincoln Community Midwives MPG189 Madawaska Valley Midwives MPG160
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Manitoulin Midwifery MPG137 Maternity Care Midwives - Thunder Bay MPG172 Midwife Alliance MPG101 Midwifery Care - North Don River Valley MPG107 Midwifery Care of Peel & Halton Hills MPG106 Midwifery Collective of Essex County MPG167 Midwifery Collective of Ottawa MPG126 Midwifery Group of Ottawa MPG127 Midwifery Services of Durham MPG108 Midwifery Services of Haliburton-Bancroft MPG175 Midwifery Services of Lambton-Kent MPG113 Midwives Collective of Toronto MPG102 Midwives Grey Bruce MPG130 Midwives of Nottawasaga MPG173 Midwives of Algoma MPG136 Midwives of Chatham-Kent MPG187 Midwives of East Erie MPG155 Midwives of Georgian Bay MPG195 Midwives of Headwater Hills MPG179 Midwives of Lindsay & the Lakes MPG157 Midwives of Middlesex and Area MPG196 Midwives of Muskoka MPG163 Midwives of Windsor MPG153 Midwives of York Region MPG152 Mountain Midwifery Care MPG 164 Neepeeshowan Midwives MPG188 New Life Midwives MPG180 Niagara Midwifery MPG112 Norfolk Roots MPG105 North Channel Midwifery MPG194 Orillia Midwives MPG181 Ottawa South MPG186 Ottawa Valley Midwives MPG128 P3 - Special Bun in the Oven MPG193 Pratique de sage-femme de Hearst MPG156 Quinte Midwives MPG162 Riverdale Community Midwives MPG103 Sage-Femme de North Bay MPG138 Sages-Femmes Renaissance Midwifery MPG139 Sages-Femmes Rouge Valley Midwives MPG154
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Seventh Generation Midwives Toronto MPG158 St. Jacobs Midwives MPG116 Stratford Midwives MPG145 Sudbury Community Midwives Practice MPG133 Talbot Creek Midwives MPG168 Temiskaming Midwifery Practice MPG182 Thames Valley Midwives MPG121 The Hamilton Midwives MPG109 The Midwife Clinic MPG183 The Midwives' Clinic of East York-Don Mills MPG147 Trillium Midwives MPG198 Uxbridge Community Midwives MPG174 Village Midwifery Care MPG185 West End Midwives MPG176 Womancare Midwives MPG120
Appendix C - List of Birth Centres
Birth Centre Active? Ottawa Birth and Wellness Centre Yes
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Appendix D - Completing the BIS for Hospital Births under the Care of a Midwife Each hospital across the province develops processes to ensure that all births get entered into the BORN Information System (BIS). At some hospitals, midwives are responsible for completing the BIS encounters whereas at other hospitals, nurses/clerks or others ensure the hospital BIS data is entered/corrected/submitted. The hospital determines who enters data and is responsible for assigning proper access and determining the best workflow process for ensuring good quality data. When a Midwife is Responsible for Completing Hospital Encounters in the BIS How do I get access to the hospital encounters? The BORN Local Administrator for the hospital will assign you access for data entry as a hospital user. You will have one user ID and password! After logging in, you will be presented with a screen with a dropdown menu that reads: ‘Select the organization for which you would like to enter data or manage information’. From here, you can select to enter the BIS either as a user of your MPG or your hospital. Entering as a hospital user will allow you to create hospital encounters; likewise, entering as an MPG user allows you to create MPG encounters. What organization encounters do I complete first? Complete the hospital encounters first (labour, birth mother and birth child). • Log in to the BIS and select the hospital as the organization • Search for your client (OHIP# is unique identifier, so most efficient for finding your client) • Select the current pregnancy • Add hospital chart number • Create and submit labour, birth mother and birth child encounters within two weeks or sooner of
the birth
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When do I create a Labour/Birth Mother and Birth Child encounter?
For every live and stillbirth
Why is it important that the hospital encounters need to be completed within two weeks of the birth? Hospitals endeavour to complete and acknowledge their BIS data by the middle of the next month. More timely data entry then promotes the opportunity to identify potential missed newborns screen. Midwives can do their separate practice group reporting at later points in time but the hospital component needs to be completed to meet hospital timelines. Who completes the PPM and PPC encounters?
There may be instances where clients are admitted to the hospital longer than the midwife is in attendance. In these situations, it may be someone for the organization who will complete and submit the postpartum mother and postpartum child encounters. This will hospital specific. Please be aware of your own hospital guidelines in this matter. What if there is a transfer of care? • Each hospital should confirm data entry responsibilities for transfers of care ahead of time • For example, if a woman’s care is transferred from midwife to obstetrician in labour and returned
postpartum, nurses will do the labour/birth encounters
Live birth - The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.
Stillbirths - Stillbirth: the complete expulsion or extraction from its mother of a product of conception either after the 20th week of pregnancy or after the product of conception has attained the weight of 500 grams or more, and where after such expulsion or extraction there is no breathing, beating of the heart, pulsation of the umbilical cord or movement of voluntary muscle (Vital Statistics Act, Ontario).
Once hospital encounters are submitted, they will pre-populate the practice group encounter after the midwife creates each MPG encounter, making data entry a straightforward experience. Midwives enter the data once only; first under the hospital and then all you need to do is create the practice group encounters.
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How do I complete the MPG encounters? • Return to the landing page of the BIS if already logged in • Click “Select Organization” on the bottom left-hand navigation menu • Select your MPG • Search for your client again, and select the current pregnancy • Create labour, birth and postpartum encounters. The encounters will pre-populate with the data
you entered into the hospital encounters. You will now be prompted to fill in the midwifery tab in each encounter for midwifery-specific data
• Submit all encounters • Create a child record. Enter the child’s first name, OHIP # (if they have one, otherwise leave it blank),
their MPG client ID number, gender, and then select “create patient”. This will prompt you to link the hospital child record to the MPG child record you are creating. Click “OK”. Create birth child and postpartum child encounters. Again, the encounters will pre-populate with data you entered from the hospital encounters, but you will now be prompted to fill in the midwifery tabs for midwifery-specific data.
• Submit all encounters Who do I contact with questions? Find your BORN Coordinator: https://www.bornontario.ca/en/about-born/coordinator-team.aspx
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Appendix E - Uncommon Scenarios Figure 73 - Baby born in ER of birthing hospital prior to admission to L&D
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Figure 74 - Baby born en route to L&D unit (ie. elevator, hallways etc).
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Figure 75 - Unplanned birth in non-obstetrical inpatient unit of birthing hospital
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Figure 76 - Unattended home birth with mother & child admitted to non-birthing hospital
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Figure 77 - Unplanned birth outside of a birthing hospital and under the care of a midwife
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Figure 78 - Unplanned birth outside of a birthing hospital, not under the care of a midwife
