The UK government had intended to introduce a comprehensive EHRs system in England by 2020. These EHRs would run across primary, secondary, and social care linking data in a single digital platform. This systematic review's objectives were to identify studies that compare EHRs in terms of direct comparison between systems and evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching EMBASE and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and SQuaRE’s eight characteristics: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After review of titles and abstracts, this was filtered down to 40 studies as per exclusion and inclusion criteria set out in our study selection. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE respectively. Nineteen studies addressed functional suitability, n=18 performance efficiency, n=12 compatibility, n=25 usability, n=6 reliability, n=2 security, n=16 maintainability, and n=13 portability. Epic was the most studied EHR system and one of the most implemented vendors in the USA market, and one of the top ten in UK. It is difficult to assess which is the most advantageous EHR system currently available when looking at them in accordance with SQuaRE’s eight characteristics for software evaluation.

Objectives: This is the first systematic review to look at all published data on EHRs to determine which systems are advantageous. Design: A systematic review was performed by searching EMBASE and Ovid MEDLINE between 1974 and November 2019. Participants: All original studies that appraised EHR systems were included. Main outcome measures: EHR system comparison, implementation, user satisfaction, efficiency and performance, documentation, and research and development. Results: The search strategy identified 701 studies, which were filtered down to 46 relevant studies. Level of evidence ranged from 1 to 4 according to the Oxford Centre for Evidence-based Medicine. The majority of the studies were performed in the USA (n = 44). N=6 studies compared more than one EHR, and Epic followed by Cerner were the most favourable through direct comparison. N=17 studies evaluated implementation which highlighted that it was challenging, and productivity dipped in the early phase. N=5 studies reflected on user satisfaction, with women demonstrating higher satisfaction than men. Efficiency and performance issues were the driving force behind user dissatisfaction. N=26 studies addressed efficiency and performance, which improved with long-term use and familiarity. N=18 studies considered documentation and showed that EHRs had a positive impact with basic and speciality tasks. N=29 studies assessed research and development which revealed vast capabilities and positive implications. Conclusion: Epic is the most studied EHR system and the most commonly used vendor on the market. There is limited comparative data between EHR vendors, so it is difficult to assess which is the most advantageous system.