Do electronic medical records really change maternity care? A 12-year interrupted time series analysis within the...

Electronic medical records (EMRs) are widely used in maternity care, but their longer-term effects across multiple domains of the Quintuple Aim remain uncertain. This study examined whether EMR use following implementation in December 2017 was associated with temporal changes in health outcomes, patient-experience proxies, and resource use.

We conducted a 12-year interrupted time series analysis at a high-volume metropolitan maternity service in Queensland, Australia, following implementation of the EMR. Population-level data from the Queensland Perinatal Data Collection were used to analyse 43,162 pregnancy episodes between January 2013 and December 2024. Monthly indicators spanning health outcomes, proxies for antenatal care utilisation and continuity of care, and resource use were analysed using adjusted segmented regression with month-of-year fixed effects and Newey-West standard errors.

EMR use was associated with selective, domain-specific temporal changes. Stillbirth declined by 2.41 per 1,000 births at implementation (p = 0.040), and neonatal death before hospital discharge declined by 2.09 per 1,000 live births (p = 0.011), followed by a post-implementation increase of 0.18 per 1,000 live births per month (p = 0.043). The trend in Apgar score < 7 at 5 min declined by 0.02 percentage points per month (p = 0.004). Most other health outcomes showed no statistically significant immediate or trend changes. Antenatal care utilisation indicators showed statistically significant post-implementation trend changes consistent with stabilisation after earlier improvements. Caesarean section increased by 2.08 percentage points at implementation (p = 0.030) and by 0.14 percentage points per month thereafter (p < 0.001). Other resource-use indicators showed no statistically significant evidence of efficiency gains.

EMR use was associated with mixed, domain-specific temporal changes. It appeared to modulate existing maternity care trajectories, with no broad, uniform improvement or harm across the three Quintuple Aim domains examined. These findings should be interpreted in the context of concurrent changes in maternity clinical practice and advances in care over the study period.