Electronic health records: Promoting systematic health behavior change among prenatal care patients

Background – Increased use of Electronic Health Records (EHRs) provides an innovative opportunity for systematic delivery of health promotion cues. However, such cues' effectiveness is a function of providers' willingness and ability to use the EHR cues. Although EHRs have been found to benefit the health care system, a recent nationwide survey of physicians, found that only around 17% of physicians use EHRs in their routine practices.

Objective/Purpose – We assessed the rate with which providers: a) documented responses to, and; b) turned off EHR prompts.

Methods – As part of a randomized controlled trial, we inserted a series of brief “electronic prompts” into the EHRs of participants at two health center-affiliated prenatal care practices -- one a faculty practice, the other a large teaching site located in the Bronx, New York caring for a predominantly underserved population. The electronic prompts cue providers to raise a series of open ended questions including concerns about breastfeeding and knowledge about the recommended time and amount to breastfeed at 5 routine visits throughout prenatal care.

Results – We inserted 445 individual prompts into 89 women's EHRs. The providers successfully addressed 291 (65%) of the prompts. Responses were documented by the providers in 116 (26%) cases. A focus group with 23 ob/gyn residents at the teaching site identified two key findings: a) being unaware of how to use the electronic health record prompt mechanism and b) inadequate knowledge to respond to the questions. In general, the residents did not feel comfortable counseling on this issue.

Discussion/Conclusions- The electronic health record can be used to provide health promotion behavior change among patients during routine visits with a solid foundation on the health promotion topic and with proper training on the use of the new technology.