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ROGER HARMS: So, hello. My name is Roger Harms. I'm emeritus associate professor of Obstetrics and Gynecology here at the Mayo Clinic College of Medicine. And I'd like to talk to you for a few minutes about our article, OB Nest: Reimagining Low-Risk Prenatal Care as it will be appearing in the Mayo Clinic Proceedings in a future issue.
An overview of the article really consists of telling a story. Making use of a multidisciplinary team of care providers and practice design experts from the Mayo Clinic Center for Innovation, a completely new approach to routine prenatal care was envisioned and defined to the level that could be used and tested in the clinical setting. This human-centric design approach sought to meet the medical necessities of prenatal care. At the same time, enhancing the supportive nature of that care and the convenience of that care through meeting the needs of patients on a continuous real time basis.
Among the many aspects of this new design is the utilization of smartphone applications that allow continuous contact with care providers through a secure texting network. What we found was that the threshold of concern that would lead patients to actually talk to their care providers was lowered significantly by the utilization of these resources. In the case of prenatal care, much of its benefit is related to the opportunity to hear what's going on when a patient has a concern. And this method of contact seemed to make that effort more comfortable for patients.
In addition, patients monitoring of their own fetal heart rate was fun for them and did not create the anxiety that we actually anticipated. The result was there were more episodes of fetal monitoring by far in the patients with this design than those who had to wait for a month to come into the office to have the procedure performed. That is an example of how with less contact and less financial inputs on the part of the care provision, there could actually be an improvement in the monitoring quality of prenatal care through home monitoring that patients can perform.
The work was possible due to the support of Mayo Clinic resources that enhance the opportunity to envision change. Chief among those resources was the Mayo Clinic Center for Innovation, which could embed experts into the practice and design in the setting of a real world provision of care. Additionally, Mayo's self-insurance program for its own staff made the financial aspects of such an effort feasible in a world where the status quo is tied to remuneration. And others, we had the freedom without economic impact to actually experiment with how the care was provided.
In truth, the article is entirely about clinical practice. The implications for prenatal care are immediate and dramatic. Decreasing the number of necessary visits while increasing the contact between pregnant patients and their trusted care providers has the potential to revolutionize the prenatal medical experience. In addition, many other circumstances where fairly long term care that must be longitudinal and continuous could have a similar model applied to their functioning.
The implications of our article for patients are quite palpable. The approach described here not only gives patients a great deal of input on how they would prefer to receive their care, but through education and empowerment and self-monitoring, the quality of care may be enhanced through more intensive generation of data. The result could well be better care that is less intrusive on the busy life of our patients.
The next steps in this line of research involve applications to broader populations of prenatal patients, including the potential to extend the geography of care provision. Because of the decreased amount of face to face contact, the utilization of technical resources allows geography to not be an impediment to care.
The application of these design principles that are described in our article could be applied to many other clinical circumstances in which long term care is required. And patient self monitoring is not only feasible, but perhaps preferable. Diabetes care and asthma care are two potential targets that seem right for this kind of design.
Once again this article is different in that it describes how the design technique was utilized to explore a new methodology of providing patient care where the patient is empowered to do much of the monitoring but the communications tools were greatly enhanced to allow patients to communicate with their care providers more frequently and more at their time of need. This design technique gave us the opportunity to now test this procedure in the prenatal care setting. And in the future, potentially apply it to numerous other obstetrical applications. It also gives rise to the pulsatility of techniques that could be applied to the longitudinal care of many patients for whom self-monitoring could be an advantage.
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