Examining the Value of Electronic Health Records on Labor and Delivery

Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 10/2008; 199(3):307.e1-9. DOI: 10.1016/j.ajog.2008.07.004
Source: PubMed


The objective of the study was to evaluate the impact of an electronic health record (EHR) on documentation completeness and patient care in a labor and delivery unit.
We conducted a pre- and postintervention study to compare documentation quality and workflow before and after EHR implementation. Documentation was compared using chi(2) and Fisher's exact tests. Objective observers measured workflow activities across all shifts before and after EHR implementation and activities were compared using Kruskal-Wallis tests and analysis of covariance.
Paper admission records were significantly more likely to miss key clinical information such as chief complaints (contractions, membrane status, bleeding, fetal movement, 10-64% vs 2-5%; P < .0001) and prenatal laboratory results and history (Varicella, group B Streptococcus, human immunodeficiency virus, 26-66% vs 1-16%, P < .0001). Both direct patient care and computer activities increased after EHR implementation (2 vs 12 and 12 vs 17 activities/shift, respectively, P < .0001).
The introduction of an obstetric EHR improved documentation completeness without reducing direct patient care.

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    • "In addition, they valued information technology that is accessible at any point of care. An American study showed that on the labour ward more vital clinical information was missing when paper records were used compared to electronic health records [24]. Hence, modern information technology is not only important to facilitate communication between levels of care but also between professionals within primary or within secondary care. "
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    ABSTRACT: Continuity of care during labour is important for women. Women with an intrapartum referral from primary to secondary care look back more negatively on their birh experience compared to those who are not referred. It is not clear which aspects of care contribute to this negative birth experience. This study aimed to explore in-depth the experiences of women who were referred during labour from primary to secondary care with regard to the different aspects of continuity of care. A qualitative interview study was conducted in the Netherlands among women who were in primary care at the onset of labour and were referred to secondary care before the baby was born. Through purposive sampling 27 women were selected. Of these, nine women planned their birth at home, two in an alongside midwifery unit and 16 in hospital. Thematic analysis was used. Continuity of care was a very important issue for women because it contributed to their feeling of safety during labour. Important details were sometimes not handed over between professionals within and between primary and secondary care, in particular about women's personal preferences. In case of referral of care from primary to secondary care, it was important for women that midwives handed over the care in person and stayed until they felt safe with the hospital team. Personal continuity of care, in which case the midwife stayed until the end of labour, was highly appreciated but not always expected.Fear of transportion during or after labour was a reason for women to choose hospital birth but also to opt for home birth. Choice of place of birth emerged as a fluid concept; most women planned their place of birth during pregnancy and were aware that they would spend some time at home and possibly some time in hospital. In case of referral from primary to secondary care during labour, midwives should hand over their care in person and preferrably stay with women throughout labour. Planned place of birth should be regarded as a fluid concept rather than a dichotomous choice.
    BMC Pregnancy and Childbirth 03/2014; 14(1):103. DOI:10.1186/1471-2393-14-103 · 2.19 Impact Factor
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    • "HIT applications in NHFs may affect pregnancy outcomes in hospitals because timely access to accurate information from a woman's OB/GYN visits is critical to properly managing her pregnancy on the inpatient unit, particularly for high-risk cases (Miller, Yeast, and Evans 2003; Cherouny et al. 2005; Eden et al. 2008). Some of the technologies adopted by NHFs, such as clinical data repositories, are specifically designed to improve the flow of clinical information across facilities within a health care system, and thereby directly improve care. "
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    ABSTRACT: Examine whether health information technology (HIT) at nonhospital facilities (NHFs) improves health outcomes and decreases resource use at hospitals within the same heath care network, and whether the impact of HIT varies as providers gain experience using the technologies. Administrative claims data on 491,832 births in Pennsylvania during 1998–2004 from the Pennsylvania Health Care Cost Containment Council and HIT applications data from the Dorenfest Institute. Fixed-effects regression analysis of the impact of HIT at NHFs on adverse birth outcomes and resource use. Greater use of clinical HIT applications by NHFs is associated with reduced incidence of obstetric trauma and preventable complications, as well as longer lengths of stay. In addition, the beneficial effects of HIT increase the longer that technologies have been in use. However, we find no consistent evidence on whether or how nonclinical HIT in NHFs affects either resource use or health outcomes. Clinical HIT applications at NHFs may reduce the likelihood of adverse birth outcomes, particularly after physicians and staff gain experience using the technologies.
    Health Services Research 06/2012; 48(1). DOI:10.1111/j.1475-6773.2012.01441.x · 2.78 Impact Factor
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    ABSTRACT: HintergrundIn dieser Simulationsstudie sollten mithilfe der videobasierten Fehleranalyse die Inhalte einer papierbasierten notärztlichen Dokumentation mit der Einsatzrealität verglichen werden. MethodeZwei standardisierte Szenarien [ST-Elevations-Myokardinfarkt (STEMI) und Polytrauma] wurden von 29Notarztwagen- (NAW-)Teams am Simulator absolviert. Die Szenarien wurden nach 12 bzw. 14min beendet. Jeder Notarzt erhielt danach 10min zur Dokumentation. Videobasiert wurden ausgewählte Dokumentationsmerkmale und alle applizierten Medikamente hinsichtlich der Übereinstimmung von simulierter Einsatzrealität und Dokumentation überprüft. ErgebnisseInsgesamt 20Dokumentationsmerkmale bzw. Aktionen beim STEMI und 16 beim Polytrauma wurden ausgewertet (exklusive Medikationen). STEMI-Szenario: insgesamt 469Aktionen; 271 (58%) wurden korrekt, 94 (20%) nichtkorrekt und 104 (22%) überhaupt nicht dokumentiert, obwohl die Aktion durchgeführt worden ist. Es erfolgten 140Medikationen, davon wurden 31 (22%) „nichtkorrekt“ und 14 (10%) trotz Applikation „nicht dokumentiert“. Polytraumaszenario: 401 analysierte Aktionen; 244 (61%) wurden korrekt und 101 (25%) nichtkorrekt dokumentiert. Bei 56 (14%) unterblieb die Dokumentation trotz Durchführung der Maßnahme bzw. Aktion. Bei 138 applizierten Medikationen wurde bei 31 (22%) eine „nichtkorrekte“ und bei 16 (12%) eine „fehlende“ Dokumentation festgestellt. SchlussfolgerungVerbesserungen der Dokumentationsqualität müssen erreicht werden. Elektronische Dokumentationssysteme könnten hierbei in Zukunft unterstützen. Dazu sind weitere Studien erforderlich. BackgroundThe aim of this study was to examine documentation quality in physician staffed emergency medical services (EMS). This study compared simulated on-site care with the associated patient records written by EMS physicians. MethodsFor this study two standardized simulated case scenarios, ST segment elevation myocardial infarction (STEMI) and major trauma with traumatic brain injury were designed by an expert committee. Overall 29 EMS teams each consisting of 1 EMS physician and 2 paramedics ran through the scenarios on high fidelity patient simulators and each scenario was videotaped. The scenarios were stopped after 12min for STEMI and after 14min for major trauma independent of the actions carried out and each EMS physician then had 10min to document this initial phase on standardized protocol sheets. The videotaped scenarios were analyzed by two independent investigators. Documentation of predefined contents and all drug dosages were checked against the simulated on-site care. The data were evaluated and classified as correct, incorrect or missing documentation although action performed. ResultsWritten consent for data analysis was provided by 28 teams. Overall 20 parameters and actions in the STEMI scenario and 16 in the major trauma scenario as well as all drug dosages were evaluated. For the scenario STEMI 469 actions were analyzed of which 271 (58%) were correct, 94 (20%) incorrect and 104 (22%) had missing documentation. A total of 140 medications were administered of which 31 (22%) were documented incorrectly and 14 (10%) were not documented. For major trauma 401 actions were analyzed of which 244 (61%) were correct, 101 (25%) incorrect and 56 (14%) had missing documentation. In this scenario the teams administered 138 medications of which 31 (22%) were documented incorrectly and 16 (12%) were not documented. Infused amounts of crystalloids and colloids were mostly documented correctly in this case (35 correct /6 incorrect/8 not documented). Documentation of several clinical parameters was carried out predominantly correctly, e.g. initial blood pressure (STEMI: 25/2/1, major trauma: 21/4/2) and initial ECG rhythm (STEMI: 27/0/1, major trauma: 26/0/1). Documentation of other clinically relevant parameters was often performed incorrectly: 12-lead ECG in STEMI (5/9/12) and capnometry in major trauma (9/4/7). No team used a pain scale to assess the level of pain in the STEMI scenario but 12 EMS physicians documented an accordant value (numerical rating scale) on the patient records. Furthermore some parameters could be identified where documentation was mostly missing although they were measured, e.g. onset of symptoms in STEMI (5/4/15) and reduced level of consciousness and bradypnea in major trauma (9/2/17). ConclusionPatient safety can be reduced if relevant preclinical data are not transmitted correctly to the admitting hospital. Therefore there is a need to improve documentation quality in EMS. Electronic documentation, training of EMS staff and quality management programs might offer solutions. Because of the small sample size further studies are needed to evaluate the validity of these results. SchlüsselwörterDokumentation–Ärztlicher Rettungsdienst–Computersimulation–Videoaufzeichnung KeywordsDocumentation–Emergency medical services–Computer simulation–Video recording
    Der Anaesthesist 01/2011; 60(3):221-229. DOI:10.1007/s00101-010-1790-y · 0.76 Impact Factor
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