Electronic Clinical Tracking: Two Direct-Entry Midwifery Schools Transition from Paper to Online

AUGUST 2013 Enews Articles

Electronic Clinical Tracking: Two Direct-Entry Midwifery Schools Transition from Paper to Online
by Mary Yglesia

As the Practicum Coordinator for the Department of Midwifery at Bastyr University, a good portion of my job is tracking our students’ clinical hours, client contacts and clinical skills. We have a relatively small program, but with 43 students in Practicum and almost 60 preceptors I have 100+ people to keep track of! The paper systems we created and used for decades served us well and we knew them intimately so even considering making a change felt stressful. But I couldn’t deny that the system was beginning to collapse under its own weight. Bigger filing cabinets and hiring another staff person didn’t seem to be an appropriate solution, but what?

As academic trends move toward legitimizing and even embracing competency based educational programs as progressive and appropriate, especially for adult learners, we can claim that midwifery clinical training has always been competency based. Time is variable but essential skills must be assessed by experienced clinicians using standardized tools with which to measure and document mastery of those skills. At the culmination of years of experience midwifery students must demonstrate mastery of the competencies of an entry-level midwife. The task of the schools is to create an effective system for tracking student experiences and documenting the progression of clinical skills from beginner student to professional midwife.

With these things in my mind, I had a chance conversation with Heidi Fillmore from Birthwise Midwifery School at the MANA conference at Asilomar last fall. We began talking about clinical tracking and the challenges that we face as school administrators. She told me that they had just made the switch to an electronic tracking system offered by a company called TyphonGroup. Ah ha! Now this is interesting I thought! So, I began my investigation…

What really are the problems with the paper system? In a word – inefficiency!

  • Wasteful of resources—paper, printers, envelopes, mail, etc.
  • Lag time between students documenting their clinical experiences and preceptors signing off.
  • Data has to be manually inputted into data entry systems like Access or on spreadsheets.
  • Data is not easily compiled or retrieved for students who are not on campus.
  • Late paperwork! Incomplete paperwork! Illegible writing! Bad math!
  • No easy way to track preceptor data – contracts, licenses, contacts, history, etc.

What are the needs of our midwifery program?

  • Accurate, timely data collection of student clinical hours, client contacts, and clinical skills.
  • Clinical site tracking – preceptor contact information, credentialing, contracts, communications, preceptor evaluations, etc.
  • Verification of student clinical experiences by preceptors.
  • Evaluations of student clinical skills through quarterly reports.
  • Reports: student clinical numbers and skills toward meeting graduation requirements, preceptor credentials, preceptor evaluations, etc.
  • Tracking of student information—CPR, NNR, immunizations, HIPAA training, etc.

What are the alternatives to a paper tracking system?

The current trajectory is toward electronic platforms for our work; whether it is shopping, paying bills, buying an airplane ticket or charting in EMR, the modern world has expectations of access, speed and efficiency. In the future EMR systems like Private Practice will likely include clinical tracking of student experiences or perhaps they will have an interface with other products that track this data. In the meantime, as school administrators, we still must dot every “i” and cross every “t” and we need some help doing it!

You can build your own online tracking system. My admittedly limited experience in this area is that it is first hard to build something that will meet all your needs and then, and almost more importantly, is keeping your system secure, HIPAA compliant and making routine updates and improvements. This requires expertise that is typically out of the skill set of midwifery school administrators, which means hiring a web designer, which is an expensive and risky option.

You can subscribe to an online system. I looked into TyphonGroup, the online system that Birthwise was using. Susi Delaney, formerly the Clinical Director and current faculty and preceptor for Birthwise Midwifery School, was very helpful to me and shared her experiences in this process. (See Susi Delaney’s very helpful article in this issue: Advantages, Disadvantages and Tips.) Another good resource for information in researching options is the article “Electronic Clinical Logs,” by R. D. Squires. This article looks at opportunities and barriers to electronic clinical tracking systems and a list of criteria to use in evaluating the different products available.

If you are going to purchase or subscribe to an electronic system, it is unlikely that the product will exactly fit the needs of your organization and you will have to find your comfort zone for making adjustments. It is important when you are researching your options that you provide the company representative with a list of the graduation requirements that you have to track and get assurance that their system will track the data you need.

For our purposes I gathered together some Department personnel and arranged for a demo of Typhon’s system. The demo was thorough and very informative and we all left that presentation feeling excited about the potential this offered our midwifery program. The system was robust, intuitive and customizable, the price was right – an annual fee for the organization and a one-time, per student fee that is actually small enough that it could be passed on to the student. Seemed like a good fit!

Making the transition from paper to electronic tracking

With full input from my colleagues and the blessing of our Department Chair, I wrote up my proposal to the University leadership emphasizing that in order to increase numbers of students (and keep them!) we have to improve the efficiency of our systems. We must respond to the needs of a changing student body that is increasingly adept at online navigation and expects the convenience of keyboarding information and data collection and communication. Students want to see their “numbers” and track their experiences in real time. They want to use their own clinical data to better integrate their learning experiences and to be able to document their experiences for their own research, for certification, licensure or for post-graduation programs.

Likewise preceptors want a system that is easier, that allows them the opportunity to review and verify student experiences at times that are convenient for their schedules. It is also critical that school administrators have the tools and internal systems to track our preceptors and students, to keep their records up-to-date and have accurate information and reports for our own audits and for accreditation. Our proposal was approved, we signed up for a subscription to TyphonGroup NPST and now the real work could begin!

With the introduction of any new system, the beginning is the hardest. Changing the way you think and creating a new way to work requires time and serious thought. You have to write new policies, create tutorials, test them, fix them, launch them and then fix them again. Developing effective training tools for students and preceptors requires a lot of creativity. Like Birthwise, I created both written instructions with lots of screen shots and also created video tutorials using Adobe Presenter.

Electronic clinical skills tracking is not a panacea. Orientation and training takes time and you will encounter resistance. Preceptors who are already busy people will likely resist adding a new task to their plates and it will take a while before they learn that this new way will ultimately be easier than the old way. But if you create good training materials and you offer good support, they will come around.

Birthwise Midwifery School staff were very helpful to me in my process, and in the true spirit of AME’s goal of supporting educators through connection, collaboration and coordination, feel free to contact me with any questions you might have. I’m happy to help in any way I can!

Mary Yglesia is the Practicum Coordinator for Bastyr University’s Department of Midwifery, sits on the board of directors of the Midwifery Education Accreditation Council (MEAC) and the Association of Midwifery Educators (AME). You can reach her at myglesia@bastyr.edu.


Good article for assessing and implementing electronic clinical tracking systems:

Online clinical tracking system providers:

Research on effectiveness of online clinical tracking:

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