Examining the value of electronic health records on labor and delivery

Objective: 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. Study Design: We conducted a pre- and postintervention study to compare documentation quality and workflow before and after EHR implementation. Documentation was compared using χ² 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. Results: 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). Conclusion: The introduction of an obstetric EHR improved documentation completeness without reducing direct patient care.