Examining the Value of Electronic Health Records on Labor and Delivery
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.
[Show abstract] [Hide abstract] 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.0Comments 7Citations
- "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 . 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. "
[Show abstract] [Hide abstract] 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.0Comments 2Citations
- "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. "
[Show abstract] [Hide abstract] ABSTRACT: In health care industry, EHR has been advocated to improve care quality. The journey toward the development and adaptation of EHR should be holistic and integrate all the EHR's building blocks-health record management, business process improvement (BPI), collaboration and innovation, change management, user governance, etc.-that are intertwined together as like the links of a chain to improve quality of health care services. These cornerstones that shares common features with quality principles will pave the way for implementing EHR. To go along with quality features and take advantage of quality principles namely "quality maturity" builds a solid foundation for adaptation of EHR. Therefore, the recent theories of EHR success go far beyond technical rationales and focus on organizational and managerial factors in quality improvement. The milestone of quality concept in information system success is revealed in Delone and Mclean's model which launches system quality, information quality, service quality, as distinct elements of the IS success. EHR is a means to an end -to improve quality within enterprises- based on quality approaches. In this regards, more research should be conducted to investigate the relationship between of organization's quality maturity and EHR development success.0Comments 10Citations
- "ISO/TC 176, defined the eight quality management principles including customer focus, leadership, involvement of people, process approach, system approach to management, continual improvement, etc.456. The health care industry has not been invulnerable of these changes and faces a myriad of pressures to cut costs and offer high quality care78910. IOM have promoted EHR as key strategy to implementing quality and it has recently become a pressing issue for medical practices11121314. EHR is part of the operating core of the organization and its adaptation involves the design, delivery and use of the software system in the organization; The systems uses information technology, manual system (paper-based record), organizational context, innovation, support of stakeholders and customers to improve efficiency and effectiveness in health care [15, 16]. "