Article

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

ABSTRACT

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.
    Full-text · Article · Mar 2014 · BMC Pregnancy and Childbirth
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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.
    Preview · Article · Jun 2012 · Health Services Research
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