Study protocol: A qualitative study exploring service users’ and healthcare professionals’ opinions of electronic maternity notes

Hsu Phern Chong; Patricia Apenteng; Pamela Nayyar; Richard Lilford

doi:10.3310/nihropenres.14243.1

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Study Protocol

Study protocol: A qualitative study exploring service users’ and healthcare professionals’ opinions of electronic maternity notes

[version 1; peer review: awaiting peer review]

Hsu Phern Chong¹, Patricia Apenteng¹, Pamela Nayyar¹, Richard Lilford¹

PUBLISHED 15 Jul 2026

Author details Author details

¹ University of Birmingham, NIHR Midlands Patient Safety Research Centre, Murray Learning Centre, Edgbaston, Birmingham, B15 2TT, UK

Hsu Phern Chong
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Patricia Apenteng
Roles: Methodology, Writing – Review & Editing

Pamela Nayyar
Roles: Project Administration

Richard Lilford
Roles: Conceptualization, Methodology, Writing – Original Draft Preparation

OPEN PEER REVIEW

REVIEWER STATUS AWAITING PEER REVIEW

Abstract

Background

Electronic maternity records have been introduced in the NHS on a large scale over the last decade, but with little evaluation. The project seeks to understand the views of service users and healthcare providers on electronic maternity records in relation to patient safety and clinical decision support.

Methods

We will explore users’ experiences of using electronic health records, including any challenges they have faced. Healthcare professionals will be invited to participate using the researchers personal contacts, snowballing and advertisement through the Royal College of Obstetricians and the Royal College of Midwives. Service users will be invited to participate through advertisements in local centres, charitable organisations who have involvement with women’s health, and social media. Interviews will be transcribed, then coded and themes analysed using NVivo.

Conclusions

Our work will provide insights into existing practice and how to optimise the use of electronic maternity notes to improve patient safety.

Plain Language Summary

Since the 1960s, pregnant women in England would carry paper handheld notes as a record of their pregnancy. This allowed healthcare professionals to write notes about the care given during their appointment, as well as results (from blood tests and scan reports). This changed in 2016, and electronic maternity notes have gradually been introduced so nearly all hospitals now offer this instead. Women now access their care through an app on mobile devices whereas doctors and midwives use computers to enter information. Since its introduction, no formal evaluation has taken place to assess how useful (or not) electronic maternity notes are.

We are going to ask pregnant or recently pregnant women about what they think of their electronic notes, especially if they have faced any difficulties. We are also going to speak to doctors who look after pregnant women and midwives about their views, and whether they think it could be improved. Our work will consist of interviews with at least 20 healthcare professionals and 30 pregnant (or recently pregnant women) until no new information is found. The results will all be anonymised then “coded” so that themes can be identified. We hope that this work will provide new insights, especially in regard to tools that can be incorporated to improve patient safety.

Keywords

Electronic maternity notes, Badgernet, Epic, pregnant, pregnancy, postnatal, patient safety

Corresponding author: Hsu Phern Chong

Competing interests: No competing interests were disclosed.

Grant information: This study is funded by the National Institute for Health and Care Research (NIHR) Midlands Patient Safety Research Collaboration [(PSRC], NIHR 20429]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2026 Chong HP et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Chong HP, Apenteng P, Nayyar P and Lilford R. Study protocol: A qualitative study exploring service users’ and healthcare professionals’ opinions of electronic maternity notes [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:90 (https://doi.org/10.3310/nihropenres.14243.1) First published: 15 Jul 2026, 6:90 (https://doi.org/10.3310/nihropenres.14243.1) Latest published: 15 Jul 2026, 6:90 (https://doi.org/10.3310/nihropenres.14243.1)

Introduction

Electronic Medical Records have revolutionized healthcare by providing efficient, accurate, and accessible patient information. An excellent overview about the computer based remains relevant today- EMRs should “improve the quality of access to clinical data, integrate information over time and different settings, make knowledge available and provide decision support”.¹ Electronic medical records have been used in primary care for many decades. They have also been introduced into acute medical care and more recently maternity care.^2,3

Hawley et al undertook systematic review on electronic maternity notes (electronic maternity notes) vs paper handheld records in 2014 with the aim of evaluating completeness of data entry, experiences of maternity service users and providers about these, and whether there were process improvements.⁴ None of the 43 included studies evaluated electronic maternity notes from the UK, and none of the evaluated effect of electronic records on data set completeness. They also described positive impressions from patients regarding use of an internet device, ease of understanding, were assisted with education and recollection of appointments. Eighty percent of users whose records were held on a USB device felt safer and would use it again. However, there were a few concerns about confidentiality and access; and when data was missing, the patients were expected to recall information. Clinicians in the same systematic review, were concerned about patient confidentiality and when relevant information was not available. Benefits in terms of legibility, increased reliability and going paperless were reported by clinicians, who opined that paper records were thought to contain too many prompts and increased the administrative workload. Kearney et al⁵ observed that the desire to complete the electronic maternity notes in acceptable form could detract from normal clinical care- a problem observed in very early examples of electronic medical records in the early 1980s.⁶ Kearney et al also found that many staff retained a preference for paper notes when the electronic maternity notes were introduced.⁵ Patients on the other hand, were generally positive about their electronic maternity notes. Forster et al conducted a patient survey using a structured questionnaire to evaluate pregnant patients’ perceptions of an electronic maternity notes in Brisbane, Australia.⁷ There was a high level of satisfaction amongst patients: 78.8% found it easy to navigate the record, 70.5% agreed that the electronic maternity notes improved access to pregnancy information and accuracy and 66% agreed that the electronic maternity notes improved their ability to understand and recall appointments.

Electronic medical records frequently include decision support functions- usually in the form of prescribing support⁸ that has been shown to reduce medication error,⁹ Inbuilt algorithms exist to support decision making in maternity.^10–12 However, a study of VTE risk assessment showed that only 21% of patients had their VTE assessment on the electronic record when it was first introduced.¹¹ Thus it cannot be assumed that EMRs with prompts will always result in high compliance. Many other factors can affect uptake. Neither the Forster nor Kearney studies evaluated clinical decision support tools within electronic maternity notes.^5,7

There are a wide range of providers of electronic maternity notes. Badgernet has the predominant market share as an electronic maternity notes provider and is used in 47 (40%) hospitals in England (personal communication). In contrast, Epic is a specialty agnostic all-inclusive EPR with a built-in maternity module (Stork). Whilst it is a major provider in North America, the maternity module is used in only six hospitals in England at present (personal communication). These two systems have different features that might have influenced stakeholder perceptions. First, Badgernet has limited integration with non-maternity systems in an institution (for example- lack of electronic prescribing, imaging requests). Epic is a hospital wide system incorporating many services such as pharmacy, laboratories, imaging and neonatal wards. Second, Badgernet comes with extensive in-built decision support while any decision support in Epic must be generated by individual providers at their discretion. Thus, electronic systems in maternity have been introduced to the NHS on a large scale over the last decade with a minimum of evaluation as described above. The introduction of these systems, one could argue, represents a large uncontrolled experiment. Moreover, this is a service change whose evaluation is long overdue, because it interacts directly with the clinical workflow and the lived experiences of service users and providers.

Aims and objectives

The project seeks to understand the views of service users and health care providers of electronic maternity notes. We selected these (Badgernet and EPIC Eelectronic maternity notes) systems to explore stakeholder views of the relative strengths and weaknesses of these and other potential differences between the two systems.

Methods and analysis

Patient & public involvement

The study is supported by the PPI panel of the Midlands Patient Safety Research Collaboration. Two PPI representatives reviewed the study protocol, patient facing documents and interview schedules, provided feedback and edited for clarity where required. When we discussed the conduct of interviews, it was suggested that group interviews may be challenging to organise owing to professional working time constraints, and for service users, disruption to their personal lives. Participants will therefore be offered a choice of one to one interviews in a range of modalities [either by video (Microsoft Team’s/Zoom)] or by telephone. Our PPIE group also advised that we inquire about difficulties accessing electronic maternity notes and the explore the reasons why these were experienced if present.

The PPI panel will provide insights from the patients and public perspective at each stage of the project. We will discuss findings as they emerge and assess the meaning and relevance. They will also be involved in interpreting the study findings and highlighting findings that are most relevant to them and contribute to the development of recommendations. They will be consulted on approaches for dissemination to extend the reach of the study findings and contribute to any public facing outputs including a lay summary of the research findings.

Theoretical framework

Our qualitative evaluation of electronic maternity notes is underpinned by Normalisation Process Theory (NPT). NPT explores the factors influencing the normalisation and routine embedding of interventions into everyday practice. Its practical value is provision of a means to assess implementation from the user’s perspective. The theory incorporates four constructs: coherence (or sense-making), cognitive participation, collective action and reflexive monitoring ( Table 1). These constructs interact and influence one another.

Table 1. Normalisation Process Theory.

NPT components	Questions to be considered
Coherence	Do patients and healthcare professionals understand why electronic maternity notes have been implemented? Does it make sense or appear to be relevant to patients?
Cognitive participation	How are patients and staff engaging with electronic maternity notes? Did patients invest time in getting to know how to navigate the electronic maternity notes? Is it promoting or impeding their involvement in their maternity care? Is it promoting or impeding the work of healthcare professionals?
Collective action	What work has been done to enable the intervention to happen? Is electronic maternity notes perceived as beneficial?
Reflexive monitoring	What effects have EMR had (positive and negative)? Have there been opportunities to feed this back formally/informally?

Study design

This is a qualitative study comprising of semi-structured interviews that will take place on a one to one basis in England, UK.

Sampling technique

The sampling methods we plan to use include purposive maximum variation sampling combined with snowball sampling. Service users and healthcare professionals, will be purposively sampled from the responses received to ensure representation from hospitals that utilise Badgernet and Epic electronic maternity notes.

Service users of electronic maternity notes

We will recruit pregnant women from different stages of pregnancy (including being up to 6 months post-partum) and from different parts of England. We will include within our sample primiparous as well as multiparous women, women with and without medical conditions and those who are under midwifery and consultant led care.

Healthcare professionals

We will select participants based on specific characteristics within maternity to capture a wide range of views. Sampling will be based on the location of maternity unit, electronic maternity notes used, and the professional background of doctors and midwives, such as years since qualification, the level of care provided (community, primary, secondary, or tertiary), region (rural or urban), and the IMD quintile of practice for those in England, as well as gender. Adding snowball sampling will help us reach more participants. We will use the ascribed assignation of neonatal unit size attached to the maternity unit as a proxy for complexity. Level 3 Neonatal unit facilities cater for gestational ages from 24 weeks, thus we would expect an associated level of complexity of maternity patients who birth in a hospital with such facilities.

Participant recruitment

Service users of electronic maternity notes

Patient recruitment will be undertaken via local and national advertisements in the following ways:

Social media platforms: X (formerly known as Twitter), Facebook, Instagram, Snapchat and Tiktok.

Mother and Baby groups: We will ask Mother and Baby groups to advertise the study in their groups. We will also visit groups across the West Midlands to tell them about the study and answer any questions.

Chat groups: We will post the advert in the following chat groups: Mumsnet, NetMums and Reddit.

Relevant charities and community groups: Pregnancy and Babies Charities Network (PBCN) and related charities such as MumsAid and Baby Lifeline.

We will also recruit via our links with the University of Birmingham patient and public representatives. Respondents to the adverts for the study will be advised to contact the research team directly (eg via phone or email) to discuss participation and be screened for eligibility. All recruitment will take place outside of the NHS and there will be no NHS resources or NHS staff time involved in the study.

Healthcare professionals

We will use a mixture of recruitment methods to recruit a variety of clinicians and service users from units that currently utilise Badgernet and EPIC electronic maternity records. Initial recruitment of obstetricians and midwives will take place through the research team’s personal and professional networks. Local and national advertisements, social media advertising, and promotion through professional societies such as, but not limited to the Royal College of Obstetricians and Royal College of Midwifery will also be undertaken. All participants will be provided with a participant information leaflet.

Eligibility

Eligibility will be confirmed using a screening questionnaire that will allow us to recruit from different parts of the country and from a range of maternity units. Semi-structured interviews will be conducted in English and thus this will be a pre-requisite for all participants. Interviews will be undertaken following informed consent.

Inclusion criteria

Service users of electronic maternity notes

We will recruit pregnant women or within six months of having a baby in England aged 18 years and above. Only those who have experience of using either Badgernet or Epic maternity notes will be included. The interviews will be conducted virtually, and participants will receive a £25 gift voucher after the interview.

Healthcare professionals

NHS registered obstetricians and midwives currently working in a hospital that utilises either Badgernet maternity notes or Epic electronic patient records (or both) will be recruited.

Exclusion criteria

Inability to consent or unwillingness to consent to the study. We opted to excluded pregnant healthcare professionals to avoid a conflict of views, student healthcare professionals, and healthcare professionals who used other forms of maternity notes such as paper, or from other providers that were neither Badgernet nor Epic.

Ethical and regulatory considerations

Recruitment

Whilst aiming for heterogeneity, we cannot in a study of this scale, include all the diverse groups that may be affected. In particular, patients who are not fluent in English and those who are unable to hear will not be included. We are conscious of this factor. We propose further studies that will address these groups given the particular salience of inequality in maternity services (19).

Participant distress during interviews

It is not the purpose of the interview to explore any upsetting topic areas, however it is possible that participants might reveal upsetting or distressing information during the interview. If any participant becomes distressed during the interview, they will be advised to take a break or stop the interview completely. They will be reassured that they do not have to answer any questions that they do not want to. Also, before the interview, we will emphasize that we only expect them to share with us what they are comfortable to share (as stated in the Participant Information Sheet). The researcher who will interview patients is experienced in interviewing vulnerable people about sensitive topics and is well trained to deal with such situations, and where necessary, will be able to direct participants to appropriate support.

Conduct of the interview

The interviews will be conducted by Dr Chong or Dr Apenteng, both of whom are independent of the patients’ clinical care team. Participants will be offered a choice of one to one interviews in a range of modalities [either by video (Microsoft Team’s/Zoom)] or by telephone. Interviews will be recorded and transcribed.

Saturation

The service user and healthcare professionals interviews will be conducted until there is a lack of new data, themes or ideas to provide new insights.¹³ We anticipate up to 30 pregnant (or recently pregnant) women and up to 25 obstetricians and midwives providing care for pregnant women who have experience of using Badgernet or Epic electronic maternity notes. Numbers will remain flexible to ensure that the overall sample and associated data have sufficient information power to develop new knowledge in relation to the research questions. A systematic review of saturation and sample size by Hennink suggests that the sample size is adequate to achieve saturation as this is typically achieved in under 25 interviews (Range 9–17 interviews) with strong external reliability.¹⁴

Data collection, analyses and storage

Interviews will be recorded and transcribed. All recordings will be anonymised and stored securely. Nvivo (version 14.3, Lumivero) will be used for qualitative data analysis.

Data collection

Demographics for healthcare professionals participating in the study will be captured to note their role, age, year of qualification and duration in post or speciality, ethnicity and gender. For patient participants, age, ethnicity, current gestation (or time elapsed since birth), number of previous pregnancies and index of multiple deprivation will be captured.

Data analysis

Data will be analysed using codebook thematic analysis.^15,16 This is an iterative approach to qualitative data analysis that employs both deductive and inductive coding. We will start with a set of a priori codes and allow new codes to emerge during coding. We are interested in the following five themes:

1. Data input/entry using electronic maternity notes
2. Usability
3. Impact on doctor patient interactions
4. Impact on logistics/efficiency in care delivery and patient safety
5. Knowledge, perceptions and experiences on clinical decision support within electronic maternity notes

Data storage

The study staff will ensure that the participants’ anonymity is maintained. The participants will be identified only by a participant ID number on all trial documents and any electronic database. All documents will be stored securely and only accessible by study staff and authorised personnel. The study will comply with the Data Protection Act, which requires data to be anonymised as soon as it is practical to do so. Electronic files will be stored on University of Birmingham servers, in folders that are only accessible to study researchers when they are logged into University machines using a password. Identifiable data will be stored in a password-protected file separate from the anonymised research data. Paper files will be kept in locked filing cabinets and the University of Birmingham.

Peer review

We have hosted three stakeholder meetings to gain insights into the importance of our work and invited feedback regarding the study protocol. Attendees comprised of doctors (midwives, obstetricians, obstetric physician and neonatal consultants), midwives and lay persons. At these meetings, the attendees highlighted a need to harness the use of technology for improving patient safety, and this included the use and optimisation of electronic maternity notes. The interview guide for healthcare professionals has been developed with this feedback in mind.

Conclusion

Electronic maternity notes are used widely in England. Whilst improvements are observed compared with paper handheld maternity notes, qualitative appraisal of these have not recently been undertaken. Concerns from our PPIE group and stakeholders have highlighted a potential impact of digital poverty on access to care and on patient safety. Thus, the work proposed here will inform future studies on how to improve these.

Author contribution

Contributor Role	Role Definition
Conceptualization	Hsu Chong and Prof Richard Lilford.
Data Curation	Not applicable
Formal Analysis	Not applicable
Funding Acquisition	Prof Richard Lilford
Investigation	Hsu Chong and Patricia Apenteng
Methodology	Hsu Chong, Prof Richard Lilford and Patricia Apenteng
Project Administration	Pam Nayyar
Resources	NIHR Midlands Patient Safety Research Centre
Software	University of Birmingham
Supervision	Not applicable
Validation	Not applicable
Visualization	Not applicable
Writing – Original Draft Preparation	Hsu Chong and Prof Richard Lilford
Writing – Review & Editing	Hsu Chong, Prof Richard Lilford and Patricia Apenteng

Ethical approvals

Ethical approval has been obtained from the University of Birmingham Research Ethics Committee (REC) before the start of the study (ERN_4299). All correspondence with the REC will be retained. The Investigators will ensure that this study is conducted in accordance with the principles of the Declaration of Helsinki. The Investigator will ensure that this study is conducted in accordance with relevant regulations and with Good Clinical Practice.

Consent

Participants will be provided with a written patient information leaflet. Consent will be sought and obtained by written or verbal means. Verbal consent will be obtained for example when access to the written consent form is unavailable, or if the participant expresses a preference for this. Consent will include the use of pseudonymised data sharing. A copy of the signed informed consent will be given sent by email to the participant. The original signed form will be retained at the study site.

RCOG stakeholder group members

Dr Caroline Gillett, Assistant Professor in Patient and Public Involvement and Engagement. University of Birmingham.

Dr Nadia Sarween, Consultant Obstetric Physician. University Hospitals Birmingham NHS Foundation Trust and Birmingham Women’s Hospital.

Dr Samantha Slee, Consultant Neonatologist. Alder Hay NHS Foundation Trust, Liverpool.

Dr Shazia Hoodbhoy, Consultant Neonatologist. Cambridge University Hospitals NHS Foundation Trust.

Dr Fran E Carroll, Head of Research Partnerships, Royal College of Obstetricians and Gynaecologists.

Dr Sara Webb, Head of Information and Research Services. Royal College of Midwives.

Doris Hayford, Professional Advisor Midwife in Digital. Royal College of Midwives.

Dr Yee Yin Chan, Consultant Obstetrician and Lead for Fetal Monitoring, Barts Health NHS Foundation Trust.

Dr Trent Corr, Consultant Obstetrician, Countess of Chester Hospital.

Dr Erum Khan, Consultant Obstetrician, Milton Keynes University Hospital.

Dr Abigail Merriel, Senior Clinical Lecturer in Obstetrics and NIHR Advanced Fellow. University of Liverpool.

Dr Farah Siddiqui, Consultant Fetal and Maternal Medicine. University Hospitals of Leicester NHS Foundation Trust.

Dr Soha Sobhy, Associate Clinical Professor (University of Birmingham) and Consultant Obstetrician, Birmingham Women’s and Children’s NHS Foundation Trust.

Dr Valencia Kabeya, Research Fellow, Midlands Patient Safety Research Collaboration (Maternity).

Data availability

This is a study protocol and no data is associated with this manuscript.

Acknowledgements

We are grateful to Prof Laura Jones for her contributions to the study design. We also thank our stakeholders for their valuable contributions in revising and providing input into the study design, conception of the questionnaires and interview guide. We acknowledge our PPIE group members, Sadia and Emily for their input into the trial materials.

Reporting guidelines

The consolidated criteria for reporting qualitative studies (COREQ): 32 item checklist will be utilised to ensure completeness of reporting standards.¹⁷

References

1. Dick RS, Steen EB, Detmer DE: Computer-Based Patient Record: An Essential Technology for Health Care National Academies of Sciences, Engineering, and Medicine. Washington (DC), USA: The National Academies Press; 1997; 256.
2. Better Births: Improving outcomes of maternity services in England – A Five Year Forward View for maternity care. London, UK: NHS England; 2016; 126.
3. Cockburn N, Osborne C, Withana S, et al.: Clinical decision support systems for maternity care: a systematic review and meta-analysis. EClinicalMedicine. 2024; 76: 102822. PubMed Abstract | Publisher Full Text | Free Full Text
4. Hawley G, Janamian T, Jackson C, et al.: 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 Childbirth. 2014; 14: 52. PubMed Abstract | Publisher Full Text | Free Full Text
5. Kearney L, Craswell A, Cole R, et al.: Woman-centred care and integrated electronic medical records within Australian maternity settings: Point prevalence audit and observational study. Midwifery. 2023; 123: 103718. PubMed Abstract | Publisher Full Text
6. Brownbridge G, Lilford RJ, Tindale-Biscoe S: Use of a computer to take booking histories in a hospital antenatal clinic. Acceptability to midwives and patients and effects on the midwife-patient interaction. Med. Care. 1988; 26(5): 474–487. PubMed Abstract | Publisher Full Text
7. Megan Forster M, et al.: Maternity patients' access to their electronic medical records: use and perspectives of a patient portal. Health Inf. Manag. 2015; 44(1): 4–11. Publisher Full Text
8. Buzancic I, Koh HJW, Trin C, et al.: Do clinical decision support tools improve quality of care outcomes in the primary prevention of cardiovascular disease: A systematic review and meta-analysis. Am J Prev Cardiol. 2024; 20: 100855. PubMed Abstract | Publisher Full Text | Free Full Text
9. Ruutiainen H, Holmström AR, Kunnola E, et al.: Use of Computerized Physician Order Entry with Clinical Decision Support to Prevent Dose Errors in Pediatric Medication Orders: A Systematic Review. Paediatr. Drugs. 2024; 26(2): 127–143. PubMed Abstract | Publisher Full Text | Free Full Text
10. Felisberto M, Lima GS, Celuppi IC, et al.: Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis. Health Informatics J. 2024; 30(2): 14604582241263242. PubMed Abstract | Publisher Full Text
11. Ahmad AN, Byrne ML, Imambaccus N, et al.: Venous thromboembolism capture on electronic systems in obstetrics patients at St Thomas' Hospital. BMJ Qual. Improv. Rep. 2016; 5(1). Publisher Full Text
12. Brocklehurst P, Field D, Greene K, et al.: Computerised interpretation of the fetal heart rate during labour: a randomised controlled trial (INFANT). Health Technol. Assess. 2018; 22(9): 1–186. PubMed Abstract | Publisher Full Text
13. Saunders B, Sim J, Kingstone T, et al.: Saturation in qualitative research: exploring its conceptualization and operationalization. Qual. Quant. 2018; 52(4): 1893–1907. PubMed Abstract | Publisher Full Text | Free Full Text
14. Hennink M, Kaiser BN: Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc. Sci. Med. 2022; 292: 114523. Publisher Full Text
15. Braun V, Clarke V: Toward good practice in thematic analysis: Avoiding common problems and be (com) ing a knowing researcher. Int. J. Transgender Health. 2023; 24(1): 1–6. PubMed Abstract | Publisher Full Text | Free Full Text
16. Braun V, Clarke V: Using thematic analysis in psychology. Qual. Res. Psychol. 2006; 3(2): 77–101. Publisher Full Text
17. Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care. 2007; 19(6): 349–357. PubMed Abstract | Publisher Full Text

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Version 1

VERSION 1 PUBLISHED 15 Jul 2026

Author details Author details

¹ University of Birmingham, NIHR Midlands Patient Safety Research Centre, Murray Learning Centre, Edgbaston, Birmingham, B15 2TT, UK

Hsu Phern Chong
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Patricia Apenteng
Roles: Methodology, Writing – Review & Editing

Pamela Nayyar
Roles: Project Administration

Richard Lilford
Roles: Conceptualization, Methodology, Writing – Original Draft Preparation

Competing interests

No competing interests were disclosed.

Grant information

This study is funded by the National Institute for Health and Care Research (NIHR) Midlands Patient Safety Research Collaboration [(PSRC], NIHR 20429]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Published: 15 Jul 2026, 6:90

https://doi.org/10.3310/nihropenres.14243.1

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© 2026 Chong HP et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Chong HP, Apenteng P, Nayyar P and Lilford R. Study protocol: A qualitative study exploring service users’ and healthcare professionals’ opinions of electronic maternity notes [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:90 (https://doi.org/10.3310/nihropenres.14243.1)

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[1] 1. Dick RS, Steen EB, Detmer DE: Computer-Based Patient Record: An Essential Technology for Health Care National Academies of Sciences, Engineering, and Medicine. Washington (DC), USA: The National Academies Press; 1997; 256.

[2] 2. Better Births: Improving outcomes of maternity services in England – A Five Year Forward View for maternity care. London, UK: NHS England; 2016; 126.

[3] 3. Cockburn N, Osborne C, Withana S, et al.: Clinical decision support systems for maternity care: a systematic review and meta-analysis. EClinicalMedicine. 2024; 76: 102822. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. Hawley G, Janamian T, Jackson C, et al.: 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 Childbirth. 2014; 14: 52. PubMed Abstract | Publisher Full Text | Free Full Text

[5] 5. Kearney L, Craswell A, Cole R, et al.: Woman-centred care and integrated electronic medical records within Australian maternity settings: Point prevalence audit and observational study. Midwifery. 2023; 123: 103718. PubMed Abstract | Publisher Full Text

[6] 6. Brownbridge G, Lilford RJ, Tindale-Biscoe S: Use of a computer to take booking histories in a hospital antenatal clinic. Acceptability to midwives and patients and effects on the midwife-patient interaction. Med. Care. 1988; 26(5): 474–487. PubMed Abstract | Publisher Full Text

[7] 7. Megan Forster M, et al.: Maternity patients' access to their electronic medical records: use and perspectives of a patient portal. Health Inf. Manag. 2015; 44(1): 4–11. Publisher Full Text

[8] 8. Buzancic I, Koh HJW, Trin C, et al.: Do clinical decision support tools improve quality of care outcomes in the primary prevention of cardiovascular disease: A systematic review and meta-analysis. Am J Prev Cardiol. 2024; 20: 100855. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Ruutiainen H, Holmström AR, Kunnola E, et al.: Use of Computerized Physician Order Entry with Clinical Decision Support to Prevent Dose Errors in Pediatric Medication Orders: A Systematic Review. Paediatr. Drugs. 2024; 26(2): 127–143. PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Felisberto M, Lima GS, Celuppi IC, et al.: Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis. Health Informatics J. 2024; 30(2): 14604582241263242. PubMed Abstract | Publisher Full Text

[11] 11. Ahmad AN, Byrne ML, Imambaccus N, et al.: Venous thromboembolism capture on electronic systems in obstetrics patients at St Thomas' Hospital. BMJ Qual. Improv. Rep. 2016; 5(1). Publisher Full Text

[12] 12. Brocklehurst P, Field D, Greene K, et al.: Computerised interpretation of the fetal heart rate during labour: a randomised controlled trial (INFANT). Health Technol. Assess. 2018; 22(9): 1–186. PubMed Abstract | Publisher Full Text

[13] 13. Saunders B, Sim J, Kingstone T, et al.: Saturation in qualitative research: exploring its conceptualization and operationalization. Qual. Quant. 2018; 52(4): 1893–1907. PubMed Abstract | Publisher Full Text | Free Full Text

[14] 14. Hennink M, Kaiser BN: Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc. Sci. Med. 2022; 292: 114523. Publisher Full Text

[15] 15. Braun V, Clarke V: Toward good practice in thematic analysis: Avoiding common problems and be (com) ing a knowing researcher. Int. J. Transgender Health. 2023; 24(1): 1–6. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Braun V, Clarke V: Using thematic analysis in psychology. Qual. Res. Psychol. 2006; 3(2): 77–101. Publisher Full Text

[17] 17. Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care. 2007; 19(6): 349–357. PubMed Abstract | Publisher Full Text

Study protocol: A qualitative study exploring service users’ and healthcare professionals’ opinions of electronic maternity notes

Abstract

Background

Methods

Conclusions

Plain Language Summary

Keywords

Introduction

Aims and objectives

Methods and analysis

Patient & public involvement

Theoretical framework

Table 1. Normalisation Process Theory.

Study design

Peer review

Conclusion

Author contribution

Ethical approvals

Consent

RCOG stakeholder group members

Data availability

Acknowledgements

Reporting guidelines

References

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Open Peer Review

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Open Peer Review

Reviewer Status

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Study protocol: A qualitative study exploring service users’ and healthcare professionals’ opinions of electronic maternity notes

Abstract

Background

Methods

Conclusions

Plain Language Summary

Keywords

Introduction

Aims and objectives

Methods and analysis

Patient & public involvement

Theoretical framework

Table 1. Normalisation Process Theory.

Study design

Peer review

Conclusion

Author contribution

Ethical approvals

Consent

RCOG stakeholder group members

Data availability

Acknowledgements

Reporting guidelines

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Comments on this article

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Are you an NIHR-funded researcher?

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