In a maternity shared-care environment, what do we know about the paper hand-held and electronic health record: a systematic literature review

Abstract

BackgroundThe paper hand-held record (PHR) has been widely used as a tool to facilitate communication between health care providers and a pregnant woman. Since its inception in the 1950s, it has been described as a successful initiative, evolving to meet the needs of communities and their providers. Increasingly, the electronic health record (EHR) has dominated the healthcare arena and the maternity general practice shared-care arrangement seems to have adopted this initiative. A systematic review was conducted to determine perspectives of the PHR and the EHR with regards to data completeness; experiences of users and integration of care between women and health care providers.MethodA literature search was conducted that included papers from 1985 to 2012. Studies were chosen if they fulfilled the inclusion criteria, reporting on: data completeness; experiences of users and integration of care between women and health care providers. Papers were extracted by one reviewer in consultation with two reviewers with expertise in maternity e-health and independently assessed for quality.ResultsA total of 43 papers were identified for the review, from an initial 6,816 potentially relevant publications. No papers were found that reported on data completeness in a maternity PHR or a maternity EHR, in a shared-care setting. Women described the PHR as important to their antenatal care and had a generally positive perception of using an EHR. Hospital clinicians reported generally positive experiences using a PHR, while both positive and negative impressions were found using an EHR. The few papers describing the use of the PHR and EHR by community clinicians were also divergent and inconclusive with regards to their experiences. In a general practice shared-care model, the PHR is a valuable tool for integration between the woman and the health care provider. While the EHR is an ideal initiative in the maternity setting, facilitating referrals and communication, there are issues of fragmentation and continued paper use.ConclusionsThere was a surprising gap in knowledge surrounding data completeness on maternity PHRs or EHRs. There is also a paucity of available impressions from community clinicians using both forms of the records.

Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory

“…This is consistent with a systematic review of paper and electronic health records within a maternity shared-care environment that reported that whilst women and healthcare professionals generally spoke positively about paper records, they held mixed opinions towards electronic maternity records [9]. Additionally, and in support of our study’s findings, whilst health professionals largely accepted the electronic record and felt it increased the reliability and legibility of information they found it time consuming and reported issues with accessing computers [9]. …”

“…This particular setting was selected as record keeping in maternity care differs to other specialties as women are responsible for their paper records, with their care documented on the paper record at each visit to community or hospital-based healthcare [9]. Paper records have been widely used in maternity care since the co-operation card was introduced in the UK in 1956, which made paper records a successful and integral tool for maternity shared care [10].…”

“…Paper records have been widely used in maternity care since the co-operation card was introduced in the UK in 1956, which made paper records a successful and integral tool for maternity shared care [10]. A recent systematic review noted that clinicians working within the GP-maternity shared care environment had positive perceptions of the paper record; however the response to electronic records was more mixed [9]. Given the enduring positivity toward paper records and observed reticence toward electronic systems amongst clinicians, by exploring in-depth the process of implementation and the extent to which the electronic health record had become embedded into routine practice, important insights could be uncovered.…”

Electronic health record for clinical intervention in children with language disorders

“…O RSE pode, também, facilitar a tomada de decisão clínica através do acesso a registos de informação sobre a saúde do utente, onde e quando se torna necessário. Desta forma, os registos eletrónicos podem levar a um aumento considerável na qualidade e fiabilidade das informações relacionadas com o utente, melhorando os cuidados de saúde, nomeadamente através da partilha dessa informação clínica [4]. O estudo de Hripcsak, Vawdrey, Fred e Bostwick [5] demonstra que os registos eletrónicos garantem a continuidade do tratamento, proporcionam a comunicação efetiva entre os diferentes membros de equipas de profissionais de saúde, asseguram a qualidade do apoio e permitem um acesso mais rápido e completo aos processos dos utentes.…”

Development and Evaluation of a Perinatal Service Delivery Web Platform for Prenatal Care Coordinators (Preprint)

“…These systems also improve experiences in the field, providing structure to MHWs interviews with patients, allowing for organization, accurate data collection and increased confidence on behalf of the MHWs [8]. But, due to usability challenges, MHWs still prefer PHRs to EHRs [12].…”