At a recent webinar for HTN Now, we welcomed Misbah Mahmood, deputy chief midwifery information officer at Leeds Teaching Hospitals NHS Trust. Misbah shared with us her insight and experience on the role of the digital midwife and the implementation of an end-to-end maternity EPR in Leeds.
Misbah began by offering an introduction and brief background on her career. “I started my midwifery training in 2013. I qualified as a midwife, and then in 2018 I started my role as a digital midwife. It was only meant to be a six-month secondment, but I really enjoyed it. In 2021, I was very honoured to receive a Florence Nightingale digital leadership scholarship; this was a real turning point in my career. It really helped to develop me as an individual and in my career. In 2022, I became the first midwife to join the digital health CNIO advisory panel, and finally, in 2023, I got the role as the deputy chief midwifery information officer, as the first person in England to get that job role.”
Misbah shared that when she joined the scholarship, she raised the question of where the midwifery information officers were in the system. “They said, ‘If you believe it, you can make it happen’. I think it’s really important, because it shows the career pathway and supports digital midwives coming into the profession.”
Next, Misbah moved on to give us a bit of background on digital midwifery and how the role has emerged and grown.
“The recognition of digital within maternity really started with the Better Births report, with the East Kent and Ockendon reports also questioning its best use. The maternity and neonatal delivery plan is the first policy document to call out digital leadership as a separate entity to digital transformation, and it’s a true turning point for the digital midwifery group.”
On her experiences, Misbah noted that some challenges faced can be focused on hardware on infrastructure to enable services. “I always say I never changed a fuse in a plug until I joined my role as a digital midwife, so the role is very varied!” However, she added, it’s about the people too. “We recognise that digital leadership is the driving force related to digital transformation. We have a national lead digital midwife, Jules Gudgeon, and we also have trust digital midwives and digital midwives within the local maternity neonatal system as well as regional. There is a variation across the country. Collectively, we’ve come together as the digital midwives leadership community, or the digital midwife army, as we’re known on Twitter.”
Digital maternity services in Leeds
Moving on to discuss her work at Leeds Teaching Hospitals, Misbah explained that her trust is a tertiary referral centre with approximately 10,000 births per year, spread across two hospital sites and into the wider community. There are 26 community teams, including specialist teams.
“On our digital team, we have two band 7 midwives; two band 6 midwives that make up one full-time equivalent; and three band 3 data quality members of our team,” she shared. “Our role is very varied and no two days are the same, but some of our main activities include maintaining our current electronic patient records, data collection and data quality, and reporting internally and externally on the maternity services data. We report on the maternity services data set every month, which is done directly through our EPR. We also keep up to date with national guidance, training, teaching, supporting our hardware, and linking in with the multi-disciplinary team, which also supports us in linking with system suppliers as well.”
Between 2014 and 2018, Misbah said, Leeds implemented its maternity EPR. She described this period as requiring “a change of leadership and also defining our referral pathways – although we have one service, we’ve got two hospital sites which work very differently, so we had to make sure that we had our processes defined before we moved to digital.”
They went live with postnatal first, which Misbah said was because they felt the risk was lower. “We have a large cohort of community midwives with varying levels of digital literacy, so we had to do quite a lot of digital literacy support and support in using hardware,” she explained. “We had to do a lot of work in the community to get our workforce up to a level where we could implement the technology.”
Moving on to 2020, Leeds implemented their online notes portal for women. “This is a two-factor authenticated portal, which allows women to view their notes and do birth plans, look at leaflets, do remote monitoring, and ask any questions. This worked really well, because the pandemic started and it allowed us to do remote consultations, which we were able to view straight away. It meant that women were really involved in their pregnancy journey. Also, we have quite a lot of women that live on the borders and choose to have some of their care in Leeds, but some of it in a different hospital. This meant that they could have their notes with them.”
The team then moved on to implementing remote monitoring of blood pressure and blood glucose, again during the pandemic. “That allowed us to reduce the footfall in the hospital and also to give women the equipment so they could monitor themselves at home.”
In 2021, as part of Misbah’s digital leadership scholarship, she had to undertake a quality improvement project. “Mine was self referral to maternity services,” she shared. “Traditionally, women would go to a GP and book an appointment to see the midwives, but we have the NICE guidelines showing that women should have antenatal care before 10 weeks gestation. Doing self referrals allows us to prioritise and personalise the care that we’re providing at Leeds.”
Misbah moved on to discuss the digital priorities at Leeds moving forward. “The first one is digital infrastructure. We currently have an end-to-end electronic patient record, which does interface with our trust EPR. We also have an interface with BadgerNet, which is a neonatal system. However, in the future, we want to develop this further and interface with the Yorkshire and Humber Care Record and develop an interface with some of our main systems, such as ICE (Integrated Clinical Environment) for pathology and Viewpoint for our foetal scanning.”
On personal health records, whilst the trust already has remote monitoring of blood pressure and blood glucose along with self referral to maternity services, Misbah explained their ambitions to “enhance this further and implement virtual wards, enhancing interoperability with third-party access. The solution that we’ve got for our personal health records has a third-party access element to it, and it also allows the women to view their notes in different languages – it works on Google API, so whatever language the woman has her phone set to, the notes can be viewed in that language.”
In addition, Misbah said, the team has developed their own public health dashboard. “We’ve worked really hard to improve the data quality, as well as making data-driven quality improvements. For example, we’ve been able to evidence the surging number of gestational diabetics that we’re getting through our service, and this has allowed us to put a business case together and get more support within our diabetic teams. Again, we want to use this data to be able to evidence and get to those real quality improvements.
“As far as innovation, our online notes are already within the cloud base, and we have two-factor authentication. However, we want to move our full EPR into the cloud and scope out many more other AI opportunities, because there’s so many with things like robotic process automation.”
Regarding workforce, Misbah noted that the EPR is accessible in the hospital and wider community; however, they face issues with connectivity in the community. “That’s one thing that we’re really working on trying to improve. Microsoft Teams has allowed us to do more training, but we want to invest more in hardware, in connectivity, and really work on developing the digital literacy of our workforce.”
Lastly, on sharing information, Misbah said: “We have quite a lot of women accessing care in different hospitals, so we want to make sure that that care is safe and we’re providing the correct information. Our current solution does offer third-party access, but we want to interface that with other systems and improve that.”
Many thanks to Misbah for taking the time to join us.