Impact of electronic medical record on physician practice in office settings: a systematic review

Abstract

Background Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned. Results For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives. In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process. Conclusions Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.

Association of Patient Recall, Satisfaction, and Adherence to Content of an Electronic Health Record (EHR)-Generated After Visit Summary: A Randomized Clinical Trial

“…A recent systematic review of the effects of EHRs in office settings does not mention the potential role of the AVS in supporting desired care outcomes. 6 The extant literature on the AVS is limited to a study of patient attitudes about the use of the AVS in clinical settings. 7 In an editorial on the rapid development and adoption of computerized clinical decision support systems deployed within EHRs, Garg and Tonelli 8 note the gap between the availability of electronic innovations and any accompanying scientifically developed information in relation to their effects on patient outcomes and cost.…”

Capsule Commentary on Persell et.al., Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: a Cluster Randomized Trial

“…3 For clinicians and administrators, this study provides an example of how data can be used to automate routine tasks while supporting patients and clinicians to achieve evidenceinformed decision-making. Unfortunately, electronic health records are not a panacea 4 and many providers are unable to fully leverage data for quality improvement. 5 Furthermore, this study aimed to improve primary prevention of cardiovascular disease; practices with limited quality improvement resources should focus on higher-risk populations.…”

How does Canada stack up? A bibliometric analysis of the primary healthcare electronic medical record literature

“…2 However, realising these potential benefits is dependent on not just EMR acquisition, but by its comprehensive use by practitioners and integration into their practice. 3 There is some research evidence which shows an association between EMR use and improved patient care, for example, in preventive care and the management of disease. 3 However, the majority of these studies have been conducted outside Canada.…”

“…3 There is some research evidence which shows an association between EMR use and improved patient care, for example, in preventive care and the management of disease. 3 However, the majority of these studies have been conducted outside Canada. The true potential promise of EMRs in primary health care practice will likely not be realised without knowledge of how to effectively implement this technology, and how to ABSTRACT Background Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care.…”