Summary
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.
Keywords
Electronic health record - prenatal care
