Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole, and today we're joined by Dr. Amber Watters, a leading obstetrician gynecologist and the driving force behind the groundbreaking obstetrics application LaborLink. This phone-based app has reshaped the landscape of labor and delivery, streamlining patient care and physician workflows.

Thank you so much for being with us, Dr. Watters. As we start with the first of our interview themes here today, we have a few of them. Improvements in operational flow. Can you walk us through the pivotal role that fetal heart tracings play in labor and delivery. How do these tracings impact patient care and clinical decisions?

Amber Watters, MD: Yes. Thank you, Melanie, so much for having me. so fetal heart rate tracings, we really think of as an additional vital sign for our patient, our second patient on labor and delivery, which is the baby. We have to monitor those fetal heart rate tracings continuously throughout labor. there's a lot of argument as to the impact of those on the medical outcomes, but we won't talk about those right now, because in our current landscape, over 95% of patients in labor will have their fetal heart rate tracing monitored continuously.

That means that throughout a labor course, which can be over 20 to 24 hours for first-time parents, we'll look at that tracing at least every 30, 60, 90 minutes, depending on the stage of labor. And that really gives us information about safety of baby throughout the laboring course and about progress of the labor.

So it's something that we have to be in touch with very frequently, throughout our call shifts and throughout the labor course. And so we're always accessing those tracings to make sure that the care that we're providing is appropriate to keep the labor moving forward and to keep the birthing person and the fetus safe.

Melanie Cole, MS (Host): What an innovative app that is. Dr. Watters, how has the LaborLink app improved the process of assessing fetal health during labor? Can you share an example for us?

Amber Watters, MD: Yeah, so our previously existing technology was the original way that we would review these fetal heart rate tracings, which was from a printout at the bedside in the patient's room.

As you can imagine, that's incredibly cumbersome and you're not continuously at the bedside throughout those 20 to 24 hour labor courses. And so we really needed an easier solution for how to look at those tracings. What existed was an electronic interface, that would take about six screens to navigate.

As anyone who's done anything on computers these days knows, you have to wake up the machine and go through the home screen and log in, and work through all of your different applications to get to the data that you need. That existing process took about two to four minutes to load, and if you were monitoring this labor again for 20 to 24 hours, you would want to be looking at that continuously in between the other tasks that you're accomplishing.

So it was cumbersome, it was limited to either having to be at the patient's bedside or on a computer, and, our tasks also during call shifts include things like circumcisions, rounding on patients, you're on different floors, you're in different environments. What LaborLink does is it's an application that's immediately available on your phone, mobile device or on a personal computer.

It can, load that information that you need within five seconds, and it includes about an hour of data. Where I've seen it really impact me is throughout my, call shifts. If I'm on a different floor getting ready to do a circumcision, for example, and a nurse would ask me to review the tracing of one of my patients in labor.

Previously, I would have had to step away from the baby, pull up the tracing on a computer. wait that time for that to load, and then be able to assess what was going on. Now I can do that in less than five seconds from my phone, and then I know whether it's safest for me to return the baby and return to the labor floor, or whether I can, you know, make a recommendation for how to proceed with the patient in labor and then continue with the task I'm doing.

So it really just helps ensure that I'm giving attention to wherever the most urgent clinical need is at that time. Thank

Melanie Cole, MS (Host): you for telling us the challenges that doctors faced with the previous process for FHT review and how the LaborLink addressed those challenges. So our next question theme, Dr. Watters, is physician well-being and support. To me, this is so important, and as obstetrics and gynecology is really often a stressful and demanding field, how does LaborLink contribute to that reducing stress and supporting the well-being of OBGYNs? This is so important.

Amber Watters, MD: Thank you, Melanie. Yes, I think it's it's managing the multiple demands on a physician during that same shift.

We know that we're often balancing more than one thing at a time and being able to complete the work needed to take care of patients with less friction just really takes some of that burden off. So LaborLink, we are hopeful, we are hopeful that because it is easier and faster for clinicians to access, that it will take away some of that friction of, of finding a computer or going to the computer or loading the tracing, during the shifts, and that that will hopefully make those call shifts less, less, stressful.

We also know that it's sometimes really challenging for us to document, when you're managing those multiple clinical demands at once. Unlike most clinical fields, obstetricians will document frequently, I talked about 30, 60, 90, every couple of hours, depending on the labor course. And that can be really tricky.

Our existing system was separate from where we would document. And so LaborLink also has a functionality to allow us to do, push-button documentation that just takes a couple of seconds to toggle through, and it loads immediately to the, electronic medical record within a minute. And so it's really hoping that it makes us easier for to also to complete some of those burdensome administrative tasks that are important for us in real time to inform our colleagues as to why we're providing the care that we are and what we're thinking in the moment. And then also in the future, malpractice and, and legal threats are very real in obstetrics. Most, clinicians will face over two claims in their career and more and more obstetrics.

Most obstetricians are retiring early, with the average age of stopping practice is 48, which is pretty young for a clinician when you're not done training until you're in your early 30s. So we're hopeful that this will give, really be a tool for clinicians to not only make the day-to-day friction of their work a little bit easier, but also to protect them in the future from potential, legal impact of whatever care was provided.

Melanie Cole, MS (Host): Wow, that's so interesting, and really along those same lines, Dr. Watters, the obstetric and gynecologic community has been grappling with burnout concerns, as you've just mentioned. How has the introduction of LaborLink positively impacted that work-life balance and overall satisfaction of physicians, because that's really part of the crux here, isn't it?

Amber Watters, MD:  Yeah, I think the friction of the demands of, kind of, day-to-day work are two of the things that I had mentioned a little bit, making that work a little bit easier and more seamless for doctors, and then also allowing for some protection from, legal risk in the future. I think a second really important part of of working on LaborLink over these past couple of years has been, the value that it has made clinicians feel, and that we really recognize the struggles of their clinical work, and we would really like to make that easier.

So many of the doctors who were a part of the formation of the application just like really couldn't believe that the work was technologic innovation really intended to make it easier for us to do our jobs as best as we're able. And so I think that focus on clinician workflows and what can be done to make them easier is really impactful in and of itself into making you feel valued and appreciated as a clinician.

Melanie Cole, MS (Host): I love to hear you say that. And my final question theme here is: response and feedback from OB faculty. How have your fellow obstetricians responded to LaborLink? What kind of feedback have you received, Dr. Watters?

Amber Watters, MD: Yeah, we're really lucky because I spoke about the doctors who went into creating it, and we had 13 doctors from 13 separate practices who participated in development, in testing and giving us feedback, and who were really engaged in the whole process to, to hopefully make this a useful tool. And that really helped us when we rolled out that so many positions  were just excited to have something that would make it easier for them to do, do their jobs quickly. And that really saw the work that they needed to do and, and tailored the application exactly to those clinical workflows.

So, we were really lucky in that in our first week of rolling it out, we had use by over 75% of the new users, which was really incredible. It's now been live for 10 months here on the central campus, and we just rolled out to Central DuPage, which will be our first, of the, other hospitals in the system.

and we've had, 88 users on the central campus who have used the application consistently, for the past 10 months. And so that's been really incredible to see. I get a lot of joy. I'll sometimes see clinicians who have it up on their phones as they're getting off the elevator or walking down the hallway.

And so I think it's really been wonderful to see the excitement that the OBs have had in embracing and using the application.

Melanie Cole, MS (Host): This is such cool technology, Dr. Watters. I'm so happy we're talking about this. And as we wrap up, tell us a little bit more about the collaboration process with the team behind the development.

How did their expertise contribute to the app's success? I think that's just so awesome.

Amber Watters, MD: Thanks, Melanie. Yes, this was an incredible team effort at, Northwestern with so many teams across the system that made the application possible. I think on our thank-you slide, we have like over 150 people or something crazy.

Thank you. we have a few key groups, Dr. Mazi Ademati and his research lab, which includes Stacey Caron as really the project champion from the beginning to end, and David Melnick as the engineer who did the initial creation of the LaborLink application, were incredible teammates to work with in piloting and developing the project and initial infrastructure for the application. the OB Tech Working Group is that group of the 13 doctors I alluded to that were just invaluable in telling us what they needed and in testing it initially and really making it a useful, usable tool in the end. We then had an incredible partnership with IS through Northwestern, including really Pat Kramer, and Nick Neubauer, who are very engaged in making this a systemwide supported application that can be used really for anyone who will find it helpful across the system and the infrastructure needed to maintain and support that over the long term.

And then we've had really incredible support from the leadership of Northwestern as well who saw the potential in this innovation idea, and that was really Dr. Jim Adams and then Doug King as well in recognizing the potential impact of this on clinicians and on the obstetric care that we provide and really facilitating and encouraging the development of it over the past three years.

So it's been a big team effort that has been really wonderful to see people dropping in with such expertise on all different stages of the development and to really see it out there and being used has been absolutely wonderful.

Melanie Cole, MS (Host): Congratulations Dr. Watters on such a supportive technology to help other obstetricians and gynecologists. Thank you again for joining us. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Thanks so much for joining us today.