Impact of real-time clinical decision support in electronic medical record system on the quality of clinical practice and patient outcomes in inpatient obstetric settings

Background: Real-time clinical decision support provides a systematic approach to improve quality of care. However, few studies demonstrated quantitative evidence to support the relationship.

Objective: Impact of electronic medical record (EMR) system with real-time clinical decision supports (the complete EMR) on clinical practice and outcomes in inpatient Obstetric settings was evaluated. Two clinician advisory mechanisms which differed in frequency and intensity were hypothesized to result in differences in clinicians' adherence to best practice and differences in clinical error and adverse outcomes.

Methods: A time-series study was conducted to estimate the clinicians' adherence to clinical suggestions between different implementation periods of advisory mechanisms. The dependent variables are the proportion of clinicians' adherence to the system suggestion, the elapsed time of responding to it, and the incidence of adverse outcomes of fetus deliveries. Logistic regression and analysis of covariance were applied with controls for age, site of operation, and type of suggestion. Data was collected from data warehouse generated by the system. 31,236 of delivery cases over four years from four hospitals in Washington, DC and Baltimore, MD areas were analyzed.

Results: System suggestions related to estimated fetal weight and pelvimetry in the intense period had 1.23 times higher probability of actual performance than that in the standard period. There was no significant difference in the delayed performance between the two periods. The suggested clinical actions were received more adherence than the suggested documentations. Fetuses delivered in the intense period had 32% lower risk of newborn seizures than pre-implementation period, after controlling for patients' age and site of operation.

Conclusion: More frequent and intense clinical advisory mechanism for the complete EMR system results in better performance of the necessary documentations and clinical actions. This study demonstrates an example of evaluating the effect of information technology on patient outcomes and clinical practice.