Project Overview
An NHS Integrated Care Board managing maternity services for 18,000 births per year across 3 acute trusts need...
Technology Stack
Compliance & Standards
The Challenge
An NHS Integrated Care Board managing maternity services for 18,000 births per year across 3 acute trusts needed a unified digital maternity record — replacing paper-based BadgerNet (legacy maternity system) with a FHIR R4-native digital platform. DTAC all 5 domains, DCB0129 (maternity is highest-risk clinical specialty — 50% of clinical negligence claims), NHS Maternity Digital Care Records (MDCRs — national programme), FHIR R4 (Maternity FHIR Implementation Guide), NHS England Better Births national requirements, and UK GDPR Article 9 were mandatory. Budget: £110,000.
Our Approach
NHS Maternity FHIR Implementation Guide
structured clinical records across pregnancy journey.
Key FHIR resources
CarePlan (maternity care plan per pregnancy), Observation (blood pressure, urinalysis, fundal height, foetal heart rate), Procedure (antenatal appointments, scans, birth), Condition (obstetric diagnoses — gestational diabetes, pre-eclampsia), and Patient (mother) + RelatedPerson (baby).
UK Core profiles
all FHIR resources validated against NHS UK Core R4 maternity profiles — SNOMED CT and dm+d codes.
Booking appointment
first antenatal visit → full demographic and medical history → care plan created.
DCB0129 Maternity Clinical Safety
Maternity is the highest-risk clinical specialty for clinical negligence (NHSLA — 50% of NHS litigation costs).
Critical safety hazards in maternity records
- 1wrong gestation calculated → wrong management plan, mitigated by LMP-based calculation with sonographer confirmation,
- 2missed high-risk flag → no consultant review, mitigated by automatic high-risk pathway trigger (BMI >35, previous caesarean, GDM),
- 3foetal movement reduction not acted on → foetal death, mitigated by RCOG guidance integration (Stillbirth & Neonatal Death charity SANDS).
NHS MDCR National Programme Integration
NHS England Maternity Digital Care Records (MDCRs) programme: national interoperability standard for maternity records — patient-held record accessible via NHS App.
Platform
MDCR FHIR API (publish maternity record to NHS Spine → accessible via NHS App).
Patient app
React Native PWA — mother can view her own maternity record, birth preferences, and scan reports.
MDCR compliance
NHS England MDCR technical specification (published 2023) — structured data fields mapped to FHIR R4 resources.
NHS antenatal screening
Down's syndrome, Edwards' and Patau's (combined test), spina bifida (nuchal translucency scan), sickle cell and thalassaemia, HIV, hepatitis B, rubella, and STIS.
Results management
screening result → risk level → pathway trigger (high risk → referral to foetal medicine).
Nuchal translucency measurement
FHIR Observation resource with SNOMED CT code, measurement value, gestational age at scan, and calculated risk ratio (combined test calculation).
The Results
DTAC approved all 5 domains.
NHS MDCR compliance certified.
Platform live at 20 weeks, £102,000 — under budget. 18,000 maternities per year supported across 3 trusts.
NHS App maternity record access: 68% of pregnant women activated.
DCGH2 (Saving Babies' Lives Version 3) compliance: platform integrates all 5 elements (foetal movement, CTG, smoking cessation, growth monitoring, umbilical artery Doppler).
Clinical negligence risk reduction: Trust NHSLA assessment cited improved documentation as material risk reduction.
WCAG 2.1 AA: zero non-compliances.
“NHSLA cited improved documentation as material clinical negligence risk reduction. In maternity that is the highest-stakes sentence in any project review. 68% NHS App activation — pregnant women are using it. DTAC first submission. NHS MDCR compliance certified. DCB0129 accepted first submission — the maternity clinical safety work was the most important thing we built." — Director of Midwifery, NHS Trust (name withheld)”
Project Details
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