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Does an Electronic Health Record Improve Completeness of Prenatal Studies?
T A McLean1, A K Lewkowitz2, E Test2
1Kaiser Permanente, Obstetrics and Gynecology , Livermore, CA, United States.
Insights
Electronic health records (EHR) decreased purified protein derivative (PPD) test documentation but improved Human Immunodeficiency Virus (HIV) testing rates. This highlights challenges in EHR implementation for accurate prenatal screening documentation.
Area of Science:
- Healthcare Informatics
- Public Health
- Obstetrics and Gynecology
Background:
- Prenatal screening for Human Immunodeficiency Virus (HIV) and tuberculosis (via purified protein derivative [PPD] testing) is crucial for maternal and infant health.
- The implementation of Electronic Health Records (EHR) aims to streamline healthcare processes and improve data accuracy.
- Understanding the impact of EHR on the documentation rates of essential prenatal tests is vital for optimizing healthcare delivery.
Purpose of the Study:
- To evaluate the effect of Electronic Health Record (EHR) implementation on the documentation rates of prenatal Human Immunodeficiency Virus (HIV) and purified protein derivative (PPD) testing.
- To compare the documentation completeness of PPD and HIV tests between paper-based charting and EHR systems.
Main Methods:
- A retrospective study comparing three cohorts of pregnant women from March-April 2011 (paper charts), March-April 2012 (EHR), and March-April 2013 (EHR).
- Analysis of documentation rates for HIV and PPD tests, noting that PPD results required manual documentation in EHR, while HIV results were automatically uploaded.
- Statistical comparison of test documentation completeness between the paper chart cohort and the EHR cohorts.
Main Results:
- Overall documentation of complete PPD and HIV results decreased in the initial EHR cohort (2012) compared to the paper chart cohort (2011) (72.1% vs. 80.1%, p=0.03).
- This decrease was primarily driven by significantly lower documentation of completed PPD tests in the 2012 EHR cohort (72.6% vs. 83.9%, p=0.003).
- HIV documentation rates significantly improved with EHR implementation, increasing from 95.2% in 2011 to 98.6% in 2012 (p=0.04) and 98.9% in 2013 (p=0.03).
Conclusions:
- Electronic Health Record (EHR) implementation led to a significant decrease in the documentation of purified protein derivative (PPD) test completion.
- Despite initial challenges, EHR implementation corresponded with improved documentation rates for Human Immunodeficiency Virus (HIV) testing.
- Training deficiencies and lack of standardization likely contributed to PPD documentation errors in EHR, which persisted even after retraining.
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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