Inadequate Health Records Are Failing Mothers and Providers

Janae Sharp
JULY 17, 2018
maternal health record,ob-gyn interoperability,janae sharp interoperability,hca news

On Saturday, Serena Williams became the first mother to make it to the Wimbledon tennis finals in 38 years. She was the runner-up. Her daughter was only 10 months old, and she used her opportunity to send mothers a message of hope, a call to improve maternal health.

Williams is arguably the best tennis player in history, but many fans are unaware that she came very close to dying in childbirth from a blood clot less than a year ago. Williams takes clotting medication and has a history of blood clots. Shortly after she gave birth to a healthy baby girl, she started to feel short of breath. To her dismay, she found that despite these warning signs, getting care for a life-threatening clot was not easy. The first response of the medical team was to tell her to lie down. She described her experience in Vogue magazine this past February:

“[Williams] walked out of the hospital room so her mother wouldn’t worry and told the nearest nurse, between gasps, that she needed a CT scan with contrast and IV heparin [a blood thinner] right away. The nurse thought her pain medicine might be making her confused. But Serena insisted, and soon enough a doctor was performing an ultrasound of her legs. “I was like, a Doppler? I told you, I need a CT scan and a heparin drip,” she remembers telling the team. The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs. Minutes later she was on the drip. “I was like, listen to Dr. Williams!”
One of the only reasons Williams was able to play tennis in the finals at Wimbledon is that the governing committee decided to look at her total ability and allow for the birth of her daughter in her ranking. In a ruling that is significant for maternal health and athletes, the the Wimbledon committee decided women should not lose their ranking due to pregnancy, and Williams had retained a high enough ranking to play.

We almost lost one of the best athletes in the world. Her childbirth could have ended in disaster, when despite a known history of blood clots and Williams’ own awareness of her predicament, that information was not visible in her health record. Why didn’t the nurse caring for Williams have information about her complete health history and pre-existing condition? Known medical history should affect care, and this omission almost killed her. Advocating for her own care and knowing her health history saved her life.

According to a ProPublica report on maternal health, the United States has the highest mortality rates in the developed world. And maternal mortality for black mothers is worse than other groups. To even begin to solve these problems, we need better records and more advocates demanding greater care.

Physicians Need Better Healthcare Records for Maternal Care

I spoke to Leah Torres, MD, an influential OB-GYN, about how healthcare records influence physicians at the point of care. She said it was a significant problem, that the U.S. has worse health outcomes for mothers than other countries, and it is very difficult to get information about health history from our records.
The main issue with records is that there is a lack of information. Pregnant women travel, including pregnant women with existing conditions that change how care should be delivered. Torres mentioned that one of the biggest obstacles is whether a patient can remember their history accurately. But even with a patient who can do so, emergencies are part of obstetric care. Women with extensive health histories might not have the time in an emergency situation to share such details with their physician.

“I’ve had patients that have had such a complicated history that you have to sit down with them for a half hour to go through it,” says Torres. “To have to do that every time they go in with every provider would be impossible. You never know what you are getting into. If someone is bleeding out and you don’t know that they have von Willebrand’s disease, and you have to do surgery on them, you will give them a medication and you are going to kill them.”

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Treating a patient in emergency care without health history can mean a provider follows the best care path but still may inadvertently kill their patient.

Even in cases where mothers don’t die, a lack of records creates risk for physicians. I asked Torres for an example of a situation where inadequate records affect care, and she envisioned the following common scenario:

“I’m the doc on call at labor and delivery, and an ambulance brings in a 32-week mother who was in a car accident, and she banged her head against the steering wheel. She’s unconscious and coming to. No one is with her.

“I can’t even ask her the due date.

“She looks about 32 weeks—now I’ve got to measure her belly. Am I measuring a normal baby, growth restriction, or a baby that is normal size?

“I do an ultrasound, so that could be two weeks off in either direction. I can gather records manually but without early records that say her due date is based on an early ultrasound. It gets really dangerous to not have records. It’s dangerous to not have facts.”

A lack of records puts unnecessary stress on providers. The responsibility of the health record is to facilitate great patient care. Physicians know they can’t deliver the best care possible, and the care they can deliver costs a lot, without these tools. When we don’t have adequate information about a pregnant patient, physicians often repeat costly testing, Torres noted. These tests have time delays and are part of our large healthcare spending waste.

“Because I don’t know any of this information, I’m repeating tests and subjecting the patient to more testing and costing money to the healthcare system, most likely needlessly,” Torres said. “Healthcare cost goes up, patient risk goes up, because I have to stick her with another needle.”

Providers should be given the information they need to deliver great care, at a greater value.

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