At the first Perinatal Work-Group meeting in 2002, physicians of a large, multi-hospital system, established a continuum, perinatal electronic health record (EHR) as a top priority. Soon after, the EHR became not only a company but also a national priority. The federal government established EHR standards and began incentivizing EHR development.  Concurrently, quality measure groups and payers began demanding accurate, timely data that could be produced only with an EHR.  This environment provided the opportunity for perinatal leaders of the system’s one-hundred-eleven perinatal services around the country to begin the journey to an enterprise EHR.

Proposed change:

Perinatal Nursing representatives began collaboration to establish documentation templates with standard data elements and reports. Expectations for documentation templates included: utilization of evidence when evidence was available; compliance with national regulatory standards and professional organization guidelines; and, support for enterprise initiatives.  Implementation of the documentation data base at the first site highlighted the need for consistent education for end users, standard policies and procedures, and an established leadership structure to maintain the standard approach with future deployments.  The second implementation demonstrated  to information system and clinical leaders that a standard network and interfaces were  imperative to reach the goal of an enterprise perinatal EHR.  Contracts for volume purchases, utilization of wide area networks, and consistent network architecture and interfaces decreased financial investment while enhancing efficiency of design and implementation of the standard perinatal EHR.

Implementation, outcomes and evaluation:

Currently, twenty-five perinatal services have implemented the standard EHR. Eighty-Eight perinatal services have committed to installation of the perinatal EHR by December, 2012.  Pre-implementation assessments were completed for designated sites and post implementation surveys will occur ninety days after implementation.  Standard reports are generated by the facilities.  Facilities report improved documentation and clinician satisfaction approximately ninety days after implementation. Documentation screens, technology, and resources will continue to be refined as obstetrical provider documentation templates are created and additional interfaces are built.

Implications for nursing practice:

Identified keys to successfully deployment of a perinatal EHR include administrative support, clinical leadership, intradepartmental collaboration, and clinician engagement.  Well designed tools such as a project management and transition plans, network architecture, policies and procedures, and educational resources are also critical to success.

Enterprise, perinatal EHR standardization will promote quality care, provide data on 220,000 births annually, and provide lessons learned for other enterprise hospitals as well as other hospitals and systems on their EHR journey.

Keywords:

electronic health record;  perinatal data; perinatal documentation; change process; perinatal quality; perinatal technology