StartSmart(TM): Health Information Technology to Improve Adherence to Prenatal Guidelines (Colorado)

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Summary:

Many conditions and lifestyle factors during pregnancy impact a woman’s health as well as the health of her child--some effects lasting long after birth. Despite advancements in perinatal health care, infant morbidity and mortality have seen little improvement in this country, and rates of severe maternal morbidity have continued to rise. Evidence points to a link between poor perinatal outcomes and pregnancy health risks, and yet adherence to prenatal guidelines that address these risks is not optimal. In addition, pregnant women are not consistently counseled on protective factors that can influence pregnancy outcomes, such as immunizations, nutrition, physical activity, and sleep. The use of technology to generate individualized, evidence-based recommendations around pregnancy risk and protective factors may lead to improved outcomes.

This project will develop StartSmartTM, a mobile health (mHealth) application that will include screening, decision support, and brief interventions for the following factors in pregnancy: weight status and related conditions, substance use, emotional conditions, and protective factors such as immunizations, prenatal vitamins, physical activity, and sleep. The application will be Fast Health Interoperability Resources (FHIR)-compliant, capable of future integration with the electronic health record (EHR) integration, allowing bi-directional data exchange, and “one record per patient,” with all health data in one place allowing for the reuse of data, decreasing duplicate collection and documentation.

The specific aims of this project are as follows:

  • Develop StartSmartTM to screen pregnant women for health risk and protective factors throughout pregnancy and to generate individualized, evidence-based recommendations for these factors 
  • Alpha test StartSmartTM and refine technology based upon patient and provider feedback. 
  • Beta test and refine StartSmartTM based on patient and provider feedback on acceptability and usability. 

An iterative process will be used to develop and test the prototype using feedback from focus groups and individual interviews with providers and pregnant women. A systems engineer with workflow expertise will observe the use of the application in the clinic setting and evaluate the impact on patient flow as well as workload for medical assistants and front desk staff. Future interoperability with electronic health records will be tested by establishing StartSmartTM connectivity with a publicly available and FHIR-compliant server.

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