“PeriGen’s analytic modules take the guesswork out of assessing fetal strips and support informed communication and data sharing among our physicians and nurses. For physicians and nurses especially, it’s helpful to have a second ‘pair of eyes’ to confirm the fetal heart rate patterns that they are viewing onscreen and that their knowledge-based treatment decisions are on the right track.”

Hollie Conner, RN, Nurse Manager, Taylor Regional Hospital

“PeriGen’s evidence-based decision support system is like having a maternal fetal expert looking over your shoulder throughout the labor process, offering reassurance and consultation when needed. When we get busy handling multiple deliveries, PeriCALM’s fetal heart monitoring and alert capabilities ensure that we stay on top of all developments. We expect our outstanding quality care for newborns and their mothers to continue and PeriGen helps assure the highest level of safety.”

Gwen Buck, Chief Nursing Officer, Gila Regional Medical Center

“PeriGen’s evidence-based fetal surveillance and decision support functionality coupled with its experience interfacing with Epic builds upon our mission to outfit our hospitals with the most sophisticated medical technology. Our goal is to facilitate the very best health outcomes for our patients, including our smallest ones and their moms.”

Gloria Solis, Chief Nursing Officer, Saint Luke's East Hospital

“PeriGen was great to work with-they get an A+ from the top on down. The company CEO has been involved throughout the process and he, as well as everyone on our team, is quickly accessible. Our PeriGen and Epic teams collaborated closely throughout the planning and installation and ensured that the needs of our Labor and Deliver clinicians and staff were addressed. The roll out was completed on time; the training and education were great; and just two weeks after we deployed PeriGen, everything is running smoothly. Everyone is excited about the data exchange between the two systems and that real-time data can be instantly accessed whenever and where ever it’s needed.”

Nyla Carswell, Director of Labor & Delivery, Mary Greeley Medical Center

Video Transcript: Cues-What it does & how it works

Welcome to this webinar on PeriWatch Cues perinatal software – What It Does & How It Works.

Today we will be discussing five issues as they relate to Cues:

What is Cues perinatal software?
What is its impact?
How does Cues work?
When does it work?
Why is it useful?

First, what is Cues? It is perinatal software that provides EFM pattern recognition. As you can see in the panel on the right, it identifies baseline, accelerations marked with green upward pointing triangle, decelerations marked with brown downward-pointing triangles, and contractions. It has been evaluated in terms of its accuracy by a panel of experts with the NICHD. They examined their levels of agreement with Cues perinatal software using over 100 tracings and reported their agreement results in kappa scores of 0.82 to 1.0. These scores represent very high levels of agreement.

But Cues does much more than simply analyze the tracing. While that is fundamental, it takes that information and presents it in very useful ways to clinicians. Here at the top, you can see 30 minutes of tracings with the Cues’ markings. Below that is a four-hour trend view. There is a slider window which always corresponds to the portion of tracing in the top panel. You can move it to select any 30 minute windows to show in the top panel so that you always can see your current tracing and the context with respect to the surrounding tracing. The bar under the four hour view reflects EFM status. Orange shows where the compressed racing has met or exceeded certain criteria or triggers set by your institution. The calculations under the window summarizes the tracing for that 30 minutes. Finally, you may choose to export these measurements to your EMR and you can edit or select some of the tracings or all of the markings to export.

What Cues does

So now that we have introduced what Cues perinatal software is, let us examine some we real experience. Here we have a panel with a orange portion in the four hour view. This orange portion reflects the portion of the tracing that has exceeded the HCA oxytocin checklist criteria. The criteria that has been exceeded are contractions. You can see that indicated in bold and caps underneath in the summary of the analysis for that window. Here are the HCA oxytocin checklist criteria, but you may choose any combination of these or any other factor as long as it’s one of the factors that we measure on the tracing. Finally markings that appear while you’re taking care of the patient will not be retained in the tracing.

The Impact Associated with Cues

Now that we have introduced what Cues perinatal software can do, let us examine a real experience associated with its use. This is a large multi-facility study on mothers at term with a singleton baby. These institutions had a very active and multidisciplinary perinatal safety program. During the decade of this study there were over 78,000 births. You can see rising rates of maternal complexity. BMI greater than 40 in green, hypertension in blue, diabetes and red. All rose during this decade.

The next panel shows some outcomes. The blue columns represent cesarean section rates and you can see that they were rising until PeriGen’s patient safety modules were introduced in 2011. At that time, they stabilized. The rate of babies requiring CPR or ventilation at birth, shown in red, fell steadily over the decade and the rates of babies requiring transfer to the NICU, shown in green rose, between 2006 and 2012 and then reversed directions and fell. In fact, over the course of this study babies requiring CPR, intubation, or ventilation or transferred to the NICU fell over was fifty percent from their highest levels during that study.

How Cues Works

There are two fundamental techniques. We use digital signal processing techniques to analyze the tracing. We use this to identify regions of the fetal heart rate tracing that are flat. We find bumps which could be potentially accels or decels and Cues measures various features of them. Neural networks are the means we use to determine whether that segment of tracing is actually an accel or a specific type of decel or a baseline. Neural networks are useful in situations where there is variation in the appearance of a subject of interest. Because there are many exception to rules, neural networks can handle these biological variations and they’re very prevalent today. They’re used for medical imaging, face recognition and voice recognition. And we use them with pattern recognition in PeriWatch Cues.

Let me show you how it works. This is a recursive method. We first look for potential base lines. You can see the mark here in the upper panel. Then Cues, e using the neural network, eliminates the most unlikely ones, retaining only the more likely. Once we do a similar process for accelerations, finding all possible

accelerations, we refine the analysis to include only the more likely ones. We do the same thing for decelerations. When decelerations are detected that have a

gradual onset, we then look to see their relationship to contractions to determine whether or not they are early or late. This process is repeated until we arrive at a high level of confidence. Then patterns are merged. Event boundaries are refined and the final results are posted. Only final results are actually ever visible to the user.

When does Cues Work

It works at gestational ages of 36 weeks and beyond. It is now available for multiple births.

Why is Cues Useful

We know that there is inconsistency in human interpretation. Despite countless hours spent in training, inconsistency remains a major issue. When we looked at babies born with birth-related injury, delayed recognition and intervention remain a problem. Not much has changed in that over the past several decades and the fundamental questions that are often debated, particularly in courts of law, often revolve around how long is too long for a particular type of pattern. We know that outcome is related to the degree of abnormality, the duration of that abnormality and trends. Is that trend persistent? Is it getting worse? That’s why this sort of analysis and in particular the displays and the color coding are designed to help clinicians determine the degree of abnormality, how long is it lasted and what are the trends.

In closing, there are two other issues that I’d like to address. One is the question”Will this system lower my team’s perceived value?” Because this is a

very common question that we get. This arrow represents the general sequence of steps when using a monitoring device in clinical care. On the left, the most basic step is to obtain fetal heart rate and uterine pressure signals. The next step is to look at it, measure it. The next step is to interpret its meaning. What do

we think is happening to the baby? What do we think is causing it? What is the baby’s response?

The next step is to project what will happen. If this pattern persists how long will be the labor? How long will my baby tolerate this? And finally, of course, what should I do? It’s only the final step that actually affects outcome directly, but it is dependent upon all of the other steps. So, in answer to the question: “Will this system lower my team’s perceived value?” I think there are two parts. It depends on what you consider the main tasks of your team. If the

main task of the clinical team is to measure and record, then Cues will assist and make that less onerous, more efficient. However if the main task of the team is to understand, project and act, Cues will not lower your team’s perceived value. In fact, this is the highest value of your skilled clinical team

Thank you very much for being with us today. For more information, please complete the form above or email us at info@perigen.com