Electrifying the Handheld Maternity Record

Marie Lewis, Practice Development Midwife

Powys Teaching Health Board


Imagine: You are pregnant, you are receiving care from several people in different locations, you have complex needs and are required to tell your story to every clinician that provides your care, over and over and over again.

Imagine: You are a midwife, you are passionate about providing good clinical care to pregnant women but you spend most of your time completing paperwork by hand, you spend several hours with a woman completing her handheld record and then you give it to her to keep. You now have to repeat the information onto separate sheets and transcribe it to different information systems.

The current hand held paper document used in Wales is reliant on a woman to remember to take it with her, reliant on colleagues in different organisations to update it and there is no back up copy should the record be lost or damaged. Powys is a large rural county which does not have its own district general hospital, pregnancy care is shared across a wide geographical area and feeds into 11 different district general hospitals across both England and Wales. Communication and sharing information relevant to the client pathway is problematic and time consuming.


The overall aim is to reduce risk from loss of information, improve communication with all data available at the time and place that a woman is seen, to have a system that will work across both community and hospital settings but complies with the All Wales pregnancy record format and to develop the system so that it has connectivity to other data systems, such as Myrddin to allow for automatic data transfer when required. The initial project will be to provide a proof of concept for development with NWIS to enable an across Wales approach and to evaluate acceptability for use with both women using the service and the midwives.


We have partnered with Symlconnect to develop a proof of concept prototype for a smart electronic maternity record that women can have as an app on their own device. We are using PDSA cycles to develop the technology and to input smart guidelines to make the record more effective.

Methods include:

  • Mapping the current process and pathways;

  • Collecting data from time assessments;

  • Missing information mapping;

  • Identifying the risks and mitigating them;

  • Privacy impact assessments.


Our ultimate goal is to produce an interactive electronic pregnancy record with the capability to connect to other healthcare electronic systems. And also to:

  • Develop the backdrop for the All Wales pregnancy hand held record electronic format;

  • To develop links and smart technology to include alerts for midwives;

  • To develop an app for women that they can download to their own IT as a read only copy;

  • Test usability from both the midwives and the woman’s perspective;

  • Develop a prototype ready for demonstration to NWIS and ready for a further project to explore connectivity with other health care systems.

So far we have:

  • Formed a project group with Powys midwives,Symlconnect and Powys LHB managers;

  • We have reviewed the current hand held record and made suggestions for how this could be transferred into the electronic format, basic data entry, drop down menus etc;

  • We have reviewed local and national guidelines and begun to identify key aspects that could form part of the smart alerts for the midwives.

SymlConnect are building the basic electronic platform for us to test. We have made good progress but we are not finished and the work will continue over the next six months to develop the prototype. The pilot project to test with live data is likely to take 1-2 years.


  • Estimated clinical efficiency with information access on-demand, right time, right place;

  • Reduction of errors and duplications; and,

  • Potential time saving by midwives, reduction in waste.

Part of cohort Bevan Exemplar Projects 2016-17