Appl Clin Inform 2015; 06(04): 669-676
DOI: 10.4338/ACI-2015-05-RA-0062
Research Article
Schattauer GmbH

Does an Electronic Health Record Improve Completeness of Prenatal Studies?

T.A. McLean
1   Kaiser Permanente, Obstetrics and Gynecology, Livermore, CA, United States
,
A.K. Lewkowitz
2   UCSF, Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA, United States
,
E. Test
2   UCSF, Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA, United States
,
M.G. Zlatnik
2   UCSF, Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA, United States
› Author Affiliations
Further Information

Correspondence to:

Tracey McLean
Department of Obstetrics and Gynecology
The Permanente Medical Group
Livermore, CA

Publication History

received: 16 May 2015

accepted in revised form: 21 September 2015

Publication Date:
19 December 2017 (online)

 

Summary

Objective: To determine whether implementation of an electronic health record (EHR) would increase the rate of prenatal Human Immunodeficiency Virus (HIV) and purified protein derivative (PPD) testing.

Methods: Eligible participants received prenatal care and delivered at term at a single academic institution in March-April 2011, March-April 2012, and March-April 2013. As part of routine prenatal care, all women were tested for HIV and tuberculosis (via a PPD test) during each pregnancy. The 2011 cohort was charted on paper. The 2012 and 2013 cohorts were charted via EHR. To appear in the prenatal labs display in EHR, PPD results must be manually documented, while HIV results are uploaded automatically. Documentation of PPD and HIV tests were analyzed.

Results: The 2011, 2012, and 2013 cohorts had 249, 208, and 190 patients, respectively. Complete PPD and HIV results were less likely to be charted in the 2012 EHR cohort compared to the paper chart cohort (72.1% vs. 80.1%; p=0.03). This was driven by fewer documented completed PPD tests (2011 83.9% vs. 2012 72.6%; p=0.003). PPD test documentation improved non-significantly to 86.2% in the 2013 EHR cohort (p=0.5). HIV documentation rates increased from 95.2% in the paper chart cohort to 98.6% in the 2012 EHR cohort (p=0.04), and to 98.9% in the 2013 EHR cohort (p=0.03).

Conclusions: EHR implementation corresponded with a marked decrease in documentation of PPD test completion. HIV documentation rates improved. PPD results were likely charted incorrectly in provider notes due to training deficiencies and lack of standardization, which did not improve significantly after retraining.


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Conflicts of interest

The authors report no conflict of interest. There was no source of financial support for this study, nor funding from any organization.

  • References

  • 1 Blumenthal D. Stimulating the adoption of health information technology. New Engl J Med 2009; 360 (15) 1477-1479.
  • 2 Metz JP, Son SJ, Winter RO, Chae S. Increasing timely and available prenatal studies by electronic health records. J Am Board Fam Med 2011; 24 (04) 344-350.
  • 3 Persell SD, Kaiser D, Dolan NC, Andrews B, Levi S, Khandekar J, Gavagan T, Thompson JA, Friesema EM, Baker DW. Changes in performance after implementation of a multifaceted electronic-health-record based quality improvement system. Med Care 2011; 49 (02) 117-125.
  • 4 Varroud-Vial M. Improving diabetes management with electronic medical records. Diabetes Metab 2011; 37 (Suppl. 04) S48-S52.
  • 5 Eden KB, Messina R, Li H, Osterweil P, Henderson CR, Guise JM. Examining the value of electronic health records on labor and delivery. Am J Obstet Gynecol 2008; 199 (03) 307. e1–e9.
  • 6 Poon EG, Wright A, Simon SR, Jenter CA, Kaushal R, Volk LA. Relationship between use of electronic health record features and health care quality: results of a statewide survey. Med Care 2010; 48 (03) 203-209.
  • 7 Samaan ZM, Klein MD, Mansour ME, DeWitt TG. The impact of the electronic health record on an academic pediatric primary care center. J Ambul Care Manage 2009; 32 (03) 180-187.
  • 8 Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in U. S. Hospitals. New Engl J Med 2009; 360 (16) 1628-1638.
  • 9 American Academy of Pediatrics & The American Congress of Obstetricians & Gynecologists.. Guidelines for Perinatal Care: 7th Edition. Elk Grove Village (IL), Washington (DC): AAP, American College of Obstetricians and Gynecologists; 2012
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  • 11 Pham-Thomas N, Pereira N, Powel AM, Croft DJ, Guilfoil DS, and Montgomery OC. Outcomes of Effective Transmission of Electronic Prenatal Records from the Office to the Hospital. Obstet Gynecol 2014; 124 (02) 317-322.
  • 12 Communicable Disease Control and Prevention, San Francisco Department of Public Health.. Tuberculosis in San Francisco, 2014. http://sfcdcp.org/document.html?id=974 .

Correspondence to:

Tracey McLean
Department of Obstetrics and Gynecology
The Permanente Medical Group
Livermore, CA

  • References

  • 1 Blumenthal D. Stimulating the adoption of health information technology. New Engl J Med 2009; 360 (15) 1477-1479.
  • 2 Metz JP, Son SJ, Winter RO, Chae S. Increasing timely and available prenatal studies by electronic health records. J Am Board Fam Med 2011; 24 (04) 344-350.
  • 3 Persell SD, Kaiser D, Dolan NC, Andrews B, Levi S, Khandekar J, Gavagan T, Thompson JA, Friesema EM, Baker DW. Changes in performance after implementation of a multifaceted electronic-health-record based quality improvement system. Med Care 2011; 49 (02) 117-125.
  • 4 Varroud-Vial M. Improving diabetes management with electronic medical records. Diabetes Metab 2011; 37 (Suppl. 04) S48-S52.
  • 5 Eden KB, Messina R, Li H, Osterweil P, Henderson CR, Guise JM. Examining the value of electronic health records on labor and delivery. Am J Obstet Gynecol 2008; 199 (03) 307. e1–e9.
  • 6 Poon EG, Wright A, Simon SR, Jenter CA, Kaushal R, Volk LA. Relationship between use of electronic health record features and health care quality: results of a statewide survey. Med Care 2010; 48 (03) 203-209.
  • 7 Samaan ZM, Klein MD, Mansour ME, DeWitt TG. The impact of the electronic health record on an academic pediatric primary care center. J Ambul Care Manage 2009; 32 (03) 180-187.
  • 8 Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in U. S. Hospitals. New Engl J Med 2009; 360 (16) 1628-1638.
  • 9 American Academy of Pediatrics & The American Congress of Obstetricians & Gynecologists.. Guidelines for Perinatal Care: 7th Edition. Elk Grove Village (IL), Washington (DC): AAP, American College of Obstetricians and Gynecologists; 2012
  • 10 Bernstein PS, Farinelli C, Merkatz IR. Using an electronic medical record to improve communication within a prenatal care network. Obstet Gynecol 2005; 105 (03) 607-612.
  • 11 Pham-Thomas N, Pereira N, Powel AM, Croft DJ, Guilfoil DS, and Montgomery OC. Outcomes of Effective Transmission of Electronic Prenatal Records from the Office to the Hospital. Obstet Gynecol 2014; 124 (02) 317-322.
  • 12 Communicable Disease Control and Prevention, San Francisco Department of Public Health.. Tuberculosis in San Francisco, 2014. http://sfcdcp.org/document.html?id=974 .