The main aims of the HOME study (Home monitoring of pregnancies at risk) are to assess if home monitoring with maternal blood pressure and fetal heart rate patterns of selected high-risk pregnancies is feasible, safe, cost-efficient, and simultaneously empowers the users.
Norway ranks among top countries providing universal high quality pregnancy care, with excellent maternal and fetal outcomes. High-risk pregnancies often require long-term hospitalization or outpatient maternal and/or fetal monitoring, placing a burden on patients, hospital resources and society. The demand for intensified pregnancy surveillance and interventions is increasing, due to the increased prevalence of risk factors like obesity and advanced maternal age, as well as altered guidelines resulting in increasing labor induction rates, to the point that Norway today lacks midwives.
Some small studies from other countries indicate that home monitoring of maternal blood pressure and fetal heart rate patterns is safe, but health economics studies are lacking, as is the integration of such at home-generated e-health data into the existing hospital electronic health record (EHR) system.
Our innovation includes an important step towards integrating data from home monitoring of high-risk pregnancies into the pregnancy EHR system (e.g. fetal heart rates), but also in enabling future machine learning studies of fetal heart rate patterns and assessment of placenta-related biomarkers for individual risk profiling. Our project will also pave the way for an ambitious long-term goal of integrating such data into a national EHR system, accessible to the patient and health care providers.
Our group of collaborators is well suited to responding to this societal need for bringing specialist pregnancy care to users outside the hospital and to meet the industry-related challenges of strictly regulated privacy demands for safe transfer, integration and storage of e-health data into the hospital data and medical journal systems.
The first goal of the HOME study was achieved in 2023, by showing that extensive home monitoring is technically feasible. This represents a breakthrough, which opens for other forms of home monitoring procedures. The technical solutions developed by the fetal monitoring supplier Medexa for Helse sørøst and Oslo University Hospital (OUS) included adaptation to the Nemo supplier's fetal heart rate (CTG) receiver system. Adaptations were made to the Milou system to receive data from the patient's home (configuration, port openings, licenses and web services). The Nemo application was adapted to handle a network without a general internet access, and to the Norwegian language (user interface, subtitles in Norwegian for films and manuals).
An effective and seamless ICT (information and communication technology) interface between medical equipment and a central data receiver at the hospital is ensured for the HOME study at OUS by "extending" (tunneling) the local hospital network to the patient. This simplifies processes with solution design and risk assessment, as the equipment environment is unchanged. This helps avoiding an increase in the hospital's equipment inventory. The work to establish this solution, based on Extreme Networks' technology, was developed by OUS and implemented by our service provider, Sykehuspartner.
We have developed a new communication interface in the Dignio app that is adapted to the patient group, in collaboration with Dignio. Symptom-related forms for the patient's registration of clinical measurements and subjective symptoms at home have been developed in collaboration with obstetricians and midwives at OUS, as well as users. Personnel training has been carried out and manuals developed for the clinical monitoring part of the study. After the start of the HOME study, the Dignio system was chosen as the general solution for digital patient communication at OUS. Work is ongoing to get the patient registered data from the app into the general electronic patient record system at the hospital. Equipment has been purchased for the patients to use at home, including validated blood pressure devices, temperature meters, and C-reactive protein-analytical items. A user guide has been created for the various diagnostic groups. By autumn 2024, approximately 100 controls and 4 home-monitored pregnant women have been included in the HOME study.
Parallel to the technical developments, a qualitative expectations study was conducted, in which both women with ongoing and previous high-risk pregnancies, as well as obstetricians and midwives, participated in focus group interviews. The results were published in 2023 and showed that emphasis was placed on the importance of predictable follow-up and that the women have good access to competent healthcare personnel at the hospital in case of uncertainty or questions. This input was taken into account in the further development of home monitoring procedures.
Norway ranks among top countries providing universal high quality pregnancy care, with excellent maternal and fetal pregnancy outcomes. High-risk pregnancies often require long-term hospitalization or outpatient maternal and/or fetal monitoring, placing a burden on patients, hospital resources and society. The demand for intensified pregnancy surveillance and interventions is increasing, due to the increased prevalence of risk factors like obesity and advanced maternal age, as well as altered guidelines resulting in increasing labor induction rates, to the point that Norway today lacks midwives.
Some small studies from other countries indicate that home monitoring of maternal blood pressure and fetal heart rate patterns is safe, but health economics studies are lacking, as is the integration of such home-generated eHealth data into the existing hospital electronic health record (EHR) system. The main aims of the HOME study (Home monitoring of pregnancies at risk) are to assess if home monitoring of selected high-risk pregnancies for maternal and fetal wellbeing is feasible, safe (in a clinical trial), cost-efficient, and simultaneously empowers the users.
Our innovation lies not only in being the first to integrate home monitoring of high-risk pregnancies into the pregnancy EHR system, but also in enabling future machine learning studies of fetal heart rate patterns and assessment of placenta-related biomarkers for individual risk profiling. Our project will also pave the way for an ambitious long-term goal of integrating such data into a national EHR system, accessible to the patient and health care providers.
Our group of collaborators is well suited to responding to this societal need for bringing specialist pregnancy care to users outside the hospital and to meet the industry-related challenges of strictly regulated privacy demands for safe transfer, integration and storage of eHealth data into the hospital data and medical journal systems.