The Impact of Health Information Technology on Work Process and Patient Care in Labor and Delivery

Objective: Implementation of health information technology (HIT) is a national priority to improve patient safety, yet little is known about how electronic charting affects workflow and patient care in busy, fast-paced hospital units. Labor and delivery units are high-risk and high-cost environments in which failures in data transmission or delays in patient care can have tragic consequences. We evaluated the impact of the introduction of an inpatient electronic health record (EHR) on clinical workflow in a high-volume labor and delivery unit in a large university hospital in the United States. Methods: A work-sampling study was performed before and after implementation. Objective observers recorded workflow activities for 3.5-hour periods over nine work shifts (day, evening, night) during 2-week study periods before and after EHR implementation. Activities were standardized to counts per shift and compared using Wilcox two-sample tests. Results: For all health care workers, after introduction of an EHR, direct patient care activities increased from a mean of 12.0 to 15.4 (P = 0.004); computer activities increased from 1.9 to 8.5 (P <0.0001); and personal/idle time decreased from 3.1 to 1.4 (P = 0.0002). Conclusion: The introduction of an EHR into a busy labor and delivery setting did not reduce time spent in direct patient care activities; instead, direct patient care activities increased.