Readers Write: Bridging the Outcomes Gap: Transforming Maternal and Fetal Health Outcomes with EHR Technology

Bridging the Outcomes Gap: Transforming Maternal and Fetal Health Outcomes with EHR Technology
By Janet Desroche

Janet Desroche is associate vice president at Meditech.

Despite spending more on healthcare than any other high-income country, the United States continues to struggle with a maternal health crisis, yielding outcomes that are significantly worse than those of peer nations. 

The US reported 22 maternal deaths for every 100,000 live births in 2022. That rate was double or triple that of most other high-income countries, many of which report fewer than five deaths per 100,000 live births. Over 80% of these deaths are considered preventable, which underscores the urgent need for systemic improvements in care delivery.

These outcomes are characterized by severe disparities. Black women are at a disproportionately higher risk, with a pregnancy-related mortality ratio more than double that of white women. Furthermore, fetal and neonatal outcomes remain a concern. Infants born small for gestational age (SGA), with neonatal abstinence syndrome (NAS), or with intrauterine growth restriction (IUGR) face increased risks of adverse neurodevelopmental outcomes, including cognitive delays and neuromotor disabilities.

Programs That Measure and Recognize Care Quality

Several initiatives have been established to identify and recognize organizations that are delivering optimal care. Globally, the World Health Organization’s “baby-friendly” hospital designation recognizes facilities that adhere to the highest standards of care for breastfeeding and mother-baby bonding.

Nationally, the Centers for Medicare & Medicaid Services (CMS) established the “birthing-friendly” designation, a public-facing quality status that helps families choose hospitals that have demonstrated a commitment to maternal health. This designation identifies facilities that participate in Perinatal Quality Collaboratives and implement evidence-based safety bundles to improve outcomes.

Additionally, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have standardized “levels of maternal care.” This framework promotes regionalized care, which ensures that high-risk pregnancies are matched with facilities that are equipped with the appropriate subspecialists and critical care resources, ranging from Level I (basic care) to Level IV (regional perinatal health care centers).

Leveraging Technology and the Electronic Health Record for Positive Impact

Healthcare organizations are using their EHRs to incorporate evidence-based guidance. By embedding best practices and clinical decision support directly into the workflow, they are driving early detection and timely intervention for the leading causes of maternal morbidity. These interventions are associated with improved outcomes and tangible lives saved. 

• Obstetric hemorrhage. Obstetric hemorrhage is a leading preventable cause of maternal death. To address this, EHR toolkits now align with the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) guidelines, replacing visual estimation of blood loss with quantitative measurement. The system automatically calculates quantitative blood loss (QBL), determines the hemorrhage stage (Stage 1–3), and prompts the care team with stage-specific interventions and order sets, ensuring that life-saving protocols are initiated immediately.
• Preeclampsia and hypertension. Timely recognition of hypertensive crisis is critical to preventing stroke and seizure. Advanced surveillance tools can monitor vital signs in real time, flagging patients who meet specific criteria, such as systolic blood pressure greater than 160 or diastolic pressure greater than 110, that persist for 15 minutes.
• Maternal sepsis. Early recognition reduces sepsis mortality. EHR surveillance systems continuously analyze patient vitals and lab results to identify those meeting sepsis criteria. Once identified, automated screening tools and order sets guide clinicians to immediately initiate evidence-based care bundles.
• Maternal addiction and opioids. Technology also plays a vital role in combating the opioid epidemic’s impact on maternal and fetal health. ACOG and SMFM recommend a non-punitive approach to improve outcomes for pregnant women with opioid use disorder that includes universal screening, early intervention and referral, medication for opioid use disorder (MOUD), naloxone access, and postpartum support. These interventions have been incorporated into many EHRs and can be effective in improving outcomes and reducing harm.
• Infection control. Beyond sepsis, surveillance dashboards help differentiate between active infections (like C. difficile) and colonization. This automation reduces unnecessary testing and isolation while ensuring compliance with stewardship protocols.

Organizations have used their EHR to achieve measurable improvements in maternal care and safety. EHR surveillance supports Joint Commission measures by identifying hemorrhage and hypertension risks early and prompting treatment protocols early to reduce maternal complications. Decision support tools within an EHR can help ensure SEP-1 compliance and reduce sepsis mortality rates. These features show how EHRs embed best practices into workflows and support earlier intervention, enabling healthcare systems to move beyond reactive care to proactive, lifesaving management of maternal and fetal health.