Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Integrated care among healthcare providers in shared maternity care: what is the role of paper and electronic health records?

Glenda Hawley A C E , Julie Hepworth B , Claire Jackson A and Shelley A. Wilkinson A C D
+ Author Affiliations
- Author Affiliations

A Australian Primary Health Care Research Institute (APHCRI), Centre of Research Excellence in Primary Health Care Microsystems, School of Medicine, Discipline of General Practice, The University of Queensland, Level 8 Health Sciences Building, Building 16/910, Royal Brisbane & Women’s Hospital, Herston, Qld 4029, Australia.

B School of Public Health & Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia.

C Mater Research, Mothers & Babies Theme, Mater Health Services, Raymond Terrace, South Brisbane, Qld 4101, Australia.

D Department of Nutrition and Dietetics, Mater Health Services, Raymond Terrace, South Brisbane, Qld 4101, Australia.

E Corresponding author. Email: glenda.hawley@uq.edu.au

Australian Journal of Primary Health 23(4) 397-406 https://doi.org/10.1071/PY16081
Submitted: 29 June 2016  Accepted: 6 February 2017   Published: 13 June 2017

Abstract

This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.

Additional keywords: allied health, GP, midwives, paper hand-held record.


References

Ajami S, Bagheri-Tadi T (2013) Barriers for adopting Electronic Health Records (EHRs) by physicians. Acta Informatica Medica 21, 129–134.
Barriers for adopting Electronic Health Records (EHRs) by physicians.CrossRef |

Almond H, Cummings E, Turner P (2013) Australia’s personally controlled electronic health record and primary healthcare: generating a framework for implementation and evaluation. Studies in Health Technology and Informatics 188, 1–6.

Batterham R, Southern D, Appleby N, Elsworth G, Fabris S, Dunt D, Young D (2002) Construction of a GP integration model. Social Science & Medicine 54, 1225–1241.
Construction of a GP integration model.CrossRef | 1:STN:280:DC%2BD383ltVOntw%3D%3D&md5=97ecc5da77ff8b34c41ddbdfded4356aCAS |

Coiera E (2011) Do we need a national electronic summary care record? The Medical Journal of Australia 194, 90–92.

Downe S, Finlayson K, Fleming A (2010) Creating a collaborative culture in maternity care. Journal of Midwifery & Women’s Health 55, 250–254.
Creating a collaborative culture in maternity care.CrossRef |

Eggleton M (2014) Privacy fears limit e-health. Financial Review, 25 June 2014, pp. 1–6. (Fairfax Media: Sydney, NSW, Australia) Available at http://www.afr.com/p/business/healthcare2-0/privacy_fears_curb_health_ growth_kxxq9sVuxrKDFz6enebgWP [Verified 2 April 2017]

Elo S, Kaariainen M, Kanste O, Polkki T, Utriainen K, Kyngas H (2014) Qualitative content analysis: a focus on trustworthiness. SAGE Open 4, 1–10.
Qualitative content analysis: a focus on trustworthiness.CrossRef |

Fawdry R, Bewley S, Cumming G, Perry H (2011) Data re-entry overload: time for a paradigm shift in maternity IT? Journal of the Royal Society of Medicine 104, 405–412.
Data re-entry overload: time for a paradigm shift in maternity IT?CrossRef |

Graetz I, Reed M, Shortell S, Rundall T, Bellows J, Hsu J (2014) The association between EHRs and care coordination varies by team cohesion. Health Services Research 49, 438–452.
The association between EHRs and care coordination varies by team cohesion.CrossRef |

Greenhalgh T (1997) How to read a paper: papers that go beyond numbers (qualitative research). British Medical Journal 315, 740
How to read a paper: papers that go beyond numbers (qualitative research).CrossRef | 1:STN:280:DyaK2svmtVersg%3D%3D&md5=63242a0acf33e4ddcb51b825b768e381CAS |

Greenhalgh T, Keen J (2013) England’s national programme for IT. British Medical Journal 346, f4130
England’s national programme for IT.CrossRef |

Gunn J (2003) Shared antenatal care – where has it been and where is it heading. Australian Family Physician 32, 100–101.

Hawley G, Janamian T, Jackson C, Wilkinson S (2014a) In a maternity shared-care environment, what do we know about the paper hand-held and electronic health record: a systematic literature review. BMC Pregnancy and Childbirth 14, 52
In a maternity shared-care environment, what do we know about the paper hand-held and electronic health record: a systematic literature review.CrossRef |

Hawley G, Jackson C, Hepworth J, Wilkinson S (2014b) Sharing of clinical data in a maternity setting: how do paper hand-held records and electronic health records compare for completeness? BMC Health Services Research 14, 650
Sharing of clinical data in a maternity setting: how do paper hand-held records and electronic health records compare for completeness?CrossRef |

Hawley G, Hepworth J, Jackson C, Wilkinson S (2016) From maternity paper hand-held records (PHR) to electronic health records (EHR): what do women tell us about their use? Australian Journal of Primary Health 22, 339–348.
From maternity paper hand-held records (PHR) to electronic health records (EHR): what do women tell us about their use?CrossRef |

Heatley M, Kruske S (2011) Defining collaboration in Australian maternity care. Women and Birth; Journal of the Australian College of Midwives 24, 53–57.
Defining collaboration in Australian maternity care.CrossRef |

Homer CSE, Catling-Paull CJ, Sinclair D, Faizah N, Balasubramanian V, Foureur MJ, Hoang DB, Lawrence E (2010) Developing an interactive electronic maternity record. British Journal of Midwifery 18, 384–389.
Developing an interactive electronic maternity record.CrossRef |

Howell KE (2013) ‘An Introduction to the Philosophy of Methodology.’ (SAGE Publications Ltd: London, UK)

Jackson C, Nicholson C (2008) Making integrated healthcare delivery happen – a framework for success. Asia Pacific Journal of Health Management 3, 19–24.

Liamputtong P (2009) ‘Qualitative Research Methods’, 3rd edn. (Oxford University Press: Melbourne, Vic., Australia)

Lluch M (2011) Healthcare professionals’ organisational barriers to health information technologies – a literature review. International Journal of Medical Informatics 80, 849–862.
Healthcare professionals’ organisational barriers to health information technologies – a literature review.CrossRef |

Mater Health Services and South East Alliance of General Practice (2013) ‘Mater Mothers’ Hospital GP Maternity Shared Care Guideline Mater Privacy Office, 2012. Mater Shared Electronic Health Record: Information for Pregnant Women and Their Representatives.’ (Mater Health Services: Brisbane, Qld, Australia)

Mater Privacy Office (2012) Mater shared electronic health record: information for pregnant women and their representatives. pp. 1–6. Mater Health Services, Brisbane, Qld, Australia.

McDonald K (2012) Mater puts expectant mothers online. Pulse+IT, 8 March 2012. (Simon James: Sydney, NSW, Australia Available at https://www.pulseitmagazine.com.au/news/australian-ehealth/885-feature- mater-puts-expectant-mothers-online [Verified 2 April 2017]

McDonald K (2014) The 2014 eHealth year in review: part one. Pulse+IT, 14 December 2014. (Simon James: Sydney, NSW, Australia) Available at http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2214:the-2014-ehealth-year-in-review-part-one&catid=16:australian-ehealth&Itemid=328 [Verified 2 April 2017]

McDonald K (2015a) Facts and figures for the PCEHR as system nears third birthday. Pulse+IT, 1 June 2015 (Simon James: Sydney, NSW, Australia) Available at http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2462:facts-and-figures-for-the-pcehr-as-system-nears-third-birthday&catid=16:australian-ehealth&Itemid=328 [Verified 2 April 2017]

McDonald K (2015b) Team-based care using home monitoring technologies. Pulse+IT, 27 January 2015 (Simon James: Sydney, NSW, Australia) Available at https://www.pulseitmagazine.com.au/news/australian-ehealth/2255-team-based-care-using-home-monitoring-technologies [Verified 2 April 2017]

Murphy J (2015) Patients to get new myHealth Record: $485m ‘rescue’ package to reboot Labor’s e-health failures. (Department of Health, Commonwealth of Australia: Canberra, ACT, Australia) Available at https://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley050.htm [Verified 10 May 2015]

O’Sullivan TA, Billing NA, Stokes D (2011) Just what the doctor ordered: moving forward with electronic records (viewpoint). Nutrition & Dietetics: the Journal of the Dietitians Association of Australia 68, 179–184.
Just what the doctor ordered: moving forward with electronic records (viewpoint).CrossRef |

Patton MQ (2002) ‘Qualitative Research & Evaluation Methods’, 3rd edn. (Sage Publications: Thousand Oaks, CA, USA)

Phipps H (2001) Carrying their own medical records: the perspective of pregnant women. Australian and New Zealand Journal of Obstetrics and Gynaecology 41, 398–401.
Carrying their own medical records: the perspective of pregnant women.CrossRef | 1:STN:280:DC%2BD38%2Fmt1arsw%3D%3D&md5=8ae43c7a461a5ff9e5c3ea8485d1ceddCAS |

Pinskier N (2014) eHealth strategy is still about a paper route. Pulse+IT, 22 April 2014 (Simon James: Sydney, NSW, Australia) Available at https://www.pulseitmagazine.com.au/australian-ehealth/1844-ehealth-strategy-is-still-a-paper-route [Verified 2 April 2017]

Powsner SM, Wyatt JC, Wright P (1998) Opportunities for and challenges of computerisation. Lancet 352, 1617–1622.
Opportunities for and challenges of computerisation.CrossRef | 1:STN:280:DyaK1M%2FlslamtA%3D%3D&md5=c8d2f3e4ddbf3fd8a59b5f0911e6cc77CAS |

Price M, Singer A, Kim J (2013) Adopting electronic medical records. Canadian Family Physician Medecin de Famille Canadien 59, e322–e329.

Rodríguez C, des Rivieres-Pigeon C (2007) A literature review on integrated perinatal care. International Journal of Integrated Care 7, e28
A literature review on integrated perinatal care.CrossRef |

Schmied V, Mills A, Kruske S, Kemp L, Fowler C, Homer C (2010) The nature and impact of collaboration and integrated service delivery for pregnant women, children and families. Journal of Clinical Nursing 19, 3516–3526.
The nature and impact of collaboration and integrated service delivery for pregnant women, children and families.CrossRef |

Schreier M (2012) ‘Qualitative Content Analysis in Practice.’ (SAGE Publications: London, UK)

Sosa D (2003) Shared antenatal care. Australian Family Physician 32, 391–392.

Tavakoli N, Jahanbakhsh M, Mokhtari H, Reza Tadayon H (2011) Opportunities of electronic health record implementation in Isfahan. Procedia Computer Science 3, 1195–1198.
Opportunities of electronic health record implementation in Isfahan.CrossRef |

Tavakoli N, Isfahani SS, Piri Z, Amini A (2013) Patient access to electronic health record: a comparative study on laws, policies and procedures in selected countries. Medicinski Arhiv 67, 63–67.
Patient access to electronic health record: a comparative study on laws, policies and procedures in selected countries.CrossRef |

Tindale J, Hardiker N (2012) Use of technology in childbirth. 7. Electronic maternity records. The Practising Midwife 15, 38–41.

Wäckerle A, Blochlinger-Wegmann B, Burkhardt T, Krahenmann F (2010) Notes on a stick: use and acceptability of woman-held maternity notes. European Journal of Obstetrics, Gynecology, and Reproductive Biology 153, 156–159.
Notes on a stick: use and acceptability of woman-held maternity notes.CrossRef |

Watson BM, Heatley M, Kruske S, Gallois C (2012) An empirical investigation into beliefs about collaborative practice among maternity care providers. Australian Health Review 36, 466–470.
An empirical investigation into beliefs about collaborative practice among maternity care providers.CrossRef |

Wilson S (2012) The personally controlled health record, what could it mean for all of us? Medicus 15, 13 [Opinion]

World Health Organization, Regional Office for the Western Pacific (2006) ‘Electronic Health Records: a Manual for Developing Countries.’ (WHO: Manilla, Philippines)

Wright C (2010) Greenhalgh: troubling view of Australian e-health. eHealthCentral, 27 August 2010 (World Press Admin: Melbourne, Vic., Australia) Available at http://www.ehealthcentral.com.au/2010/08/greenhalgh-troubling-view-of-australian-ehealth/ [Verified 2 April 2017]

Xu J, Gao X, Sorwar G, Croll P (2013) Implementation of e-health record systems in Australia. The International Technology Management Review 3, 92–104.
Implementation of e-health record systems in Australia.CrossRef |

Yau GL, Williams A, Brown J (2011) Family physicians’ perspectives on personal health records, qualitative study. Canadian Family Physician Medecin de Famille Canadien 57, e178–e184.



Supplementary MaterialSupplementary Material (5.8 MB) Export Citation