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The pregnancy register is entered. When will it be obligatory to register pregnancy with a doctor?

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From Wednesday, July 6, doctors may, but do not have to, enter information about the patient’s pregnancy in the medical records. In three months, from October 6, they will have such an obligation. – Software suppliers are not ready for it yet – says Tomasz Zieliński, family doctor, vice-president of the Federation of Healthcare Employers’ Associations, Zielona Góra Agreement. According to the Ministry of Health, reporting pregnancies is in the patient’s interest, but some women, doctors and lawyers fear that such sensitive data may fall into the wrong hands.

On July 6, 2022, the regulation on the detailed scope of medical event data processed in the information system and the method and dates of transferring such data to the Medical Information System (SIM) entered into force. Pursuant to the new regulation, the doctor will enter into the SIM information about the blood group, allergies, implants, the commencement and termination of hospitalization, data for the identification of the medical entity and medical devices, the ICF code for therapeutic rehabilitation and information about pregnancy. For now, there is an adaptation period for the new law.

– It means that from Wednesday, July 6 to September 30, doctors may enter data on pregnancy into the electronic medical records as optional, i.e. not obligatory. They can enter them, but don’t have to. From October 1, 2022, they will be obliged to do so, explains Dr. Radosław Tymiński, attorney-at-law specializing in medical law and author of the PrawLekarzy.pl blog.

The pregnant womanShutterstock

Women are afraid of criminal consequences

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Although the Ministry of Health has repeatedly emphasized in the media that “the regulation does not create any pregnancy registry”, patients are not so sure. Gynecologists admit that women have been asking for a year about the need to enter information about pregnancy in their medical records, and some ask not to do so. Many are concerned about the situation in which they will lose their pregnancy and will have to explain themselves for a miscarriage. They are not sure they will not be accused of having an abortion, and they will not be able to explain otherwise. Many pregnancies are terminated spontaneously, at home, not in hospital.

The capital gynecologist Ryszard Rutkowski agrees that the information about pregnancy itself is important medical information and its inclusion in the documentation should not raise concerns. – It’s just that we live in a country where the gynecologist is afraid to perform an abortion that saves the patient’s life for fear of criminal sanctions – emphasizes the doctor who admits patients under NHF.

Controversy over the project of the Institute of Family and Demography and the pregnancy registryTVN24

Michał Gontkiewicz, gynecologist-obstetrician from the Hospital in Płońsk (Mazowieckie Voivodeship), has been hearing questions about entering pregnancies in the register for a year, when the regulation on entering pregnancy data was still at the design stage. Now they got stronger again. The doctor understands women – a miscarriage is in itself a traumatic experience, and now it will develop the fear of the possible consequences of an act that the patient did not commit. In his opinion, this may translate into a reduction in fertility. Five other obstetrician gynecologists from all over the country tell us about similar concerns. They prefer not to speak under their surnames because – as they say – the subject is “slippery” and you can easily expose yourself the Ministry of Health. “And no one wants to be in control,” explains one of them.

Lawyer: such data has been collected for a long time

Doctor Hab. Radosław Tymiński reassures: – This data is already collected in medical records today, because information that the patient has certain medical devices in the body, for example a pacemaker, or that the patient is pregnant, is clinically important for everyone. doctor. For example, it is important for a radiologist who cannot perform an X-ray in a pregnant patient, but other imaging tests, or for every doctor who needs to know about pregnancy, so as not to accidentally prescribe drugs with a potential teratogenic effect, i.e. harmful to the fetus – explains.

It clarifies that the law requires a doctor to report pregnancy information, not pregnancy diagnosis. What does it mean? – That he does not have to have an ultrasound or betaHCG (human chorionic gonadotropin produced by the placenta, a hormone whose high concentration tells about pregnancy – editor’s note) to diagnose pregnancy. It is enough for the patient to tell him about it. This is data from a medical interview that the doctor should already enter into the medical records – explains the lawyer.

It’s just that – as Dr. Artur Drobniak, a gynecologist-obstetrician from the Supreme Medical Council, explains – information about pregnancy is entered in the medical records only by the obstetrician and – if the patient does not consent to it – no other doctor has access to it. It will change now.

Software not ready

Dr. Tomasz Zieliński, family doctor, vice-president of the Federation of Healthcare Employers’ Associations, Zielona Góra Agreement, has no concerns about the new regulation. – I believe that the indication in the medical event that the patient is pregnant is not a bad thing. This is important information about your health, and it is also very important for your doctor. As an advocate of the digitization of medicine, I do not see anything wrong with it, says Dr. Zieliński and reassures that pregnancy data will probably be entered into the register only from October. – Software vendors are not ready for this yet. The biggest problems arise from entering information about allergies, because you need a publicly available, i.e. provided by the e-Health Center, allergen dictionary, which is not available yet – he explains.

According to Dr. Zieliński, a doctor who is not a gynecologist enters the information about pregnancy in the medical documentation, be it paper or electronic, only when it is related to treatment. If, for example, a patient comes to him with an ankle sprain, and the treatment does not require medication that is potentially harmful to the fetus, she does not need to take this information into account. – We do not administer most medications during pregnancy, we usually avoid pharmacotherapy, especially in a critical moment, i.e. at the beginning of pregnancy – explains Dr. Zieliński.

Kamila Ferenc, Fr. "pregnancy registry": we should be vigilant

Kamila Ferenc on the “pregnancy registry”: we should be vigilantTVN24

How to use the information

If there was no such obligation before, why introduce it now? – We are dealing with computerization of health care and this is its element. I believe that for every doctor, the information that the patient is pregnant or that she has a pacemaker is important information. Of course, any information can be misused. But the regulations do not say that it should be passed on to someone who is not authorized to do so, explains Dr. Radoslaw Tymiński.

Jarosław Rybak, chief specialist in the Communication and Promotion Office at the Ministry of Health, explains that the provisions of the regulation do not regulate access to medical event data processed in SIM, “but only the detailed scope of medical event data processed in SIM, as well as the dates and manner of data transfer to system “. “Access to personal data or individual medical data from the service provider’s ICT system or the Medical Information System is generally subject to the patient’s consent. Only a strictly defined catalog of service providers has access to patient data, by operation of law. These entities include a medical worker who created an electronic medical documentation containing data of a medical worker practicing at the service provider, with whom electronic medical documentation was created, in connection with his profession, if it is necessary to conduct diagnostics or ensure continuity of treatment, a doctor, nurse or midwife of primary health care , as well as every medical worker in a life-threatening situation – specifies Rybak.

The Commissioner for Human Rights has doubts

Reporting data on pregnancies worried the Ombudsman Marcin Wiącek. “The information system in health care processes the data necessary to conduct the state health policy, improve the quality and availability of health care services and finance tasks in the field of health care. Meanwhile, the data for which the project initiator intended to expand the catalog – especially information about the recipient’s pregnancy and about products medical services implemented at the service recipient – exceed the scope of their necessity, specified in the Act on the information system in health care. The right to privacy (Article 47 of the Constitution) is guaranteed, inter alia, by the protection of personal data (Article 51 of the Constitution). The principle of information autonomy (Article 51 (2) of the Constitution) is a special expression of the right to privacy – the right to independently decide about disclosing information about himself to others and the right to control this information when it is in the possession of other entities “- wrote the Ombudsman to the Minister of Health. He emphasized that the provisions were inconsistent with the constitution because they violated the required statutory form for restrictions on the right to privacy and informational autonomy.

Concerns about the pregnancy registry

Concerns about the pregnancy registryTVN24

“The main purpose of imposing on service providers the obligation to report medical event data to SIM was to create a tool enabling them to obtain relevant and comprehensive information about the patient’s health” – the Ministry replied to the Human Rights Defender. “One cannot agree with the accusation that providing information on the patient’s health condition in the context of the services provided to him, both at the time of providing this information, as well as their subsequent use for the purpose of treatment, may be disproportionate and violate the privacy of the individual. general purposefulness of the medical interview “- argued the officials of the Ministry of Health.

However, this does not reassure the patients themselves, who are afraid of questions about a lost pregnancy. Some gynecologists believe, however, that the “register” does not change anything in this matter: – In fact, I have to enter the information about the miscarriage today. If a woman with a bleeding comes to me and admits that the reason is the termination of the pregnancy and not a spontaneous miscarriage, I should make a note of it in the documentation, even if she asks for discretion. Why? Because how can I be sure that in some time they will not change their mind and tell someone about the miscarriage and the fact that I did not enter it in the documentation? Then I am threatened with similar sanctions as today – says one of the gynecologists from central Poland.

Main photo source: Shutterstock

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