Implementing electronic health records in hospitals: a systematic literature review

Abstract

BackgroundThe literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementers.MethodsA systematic literature review of empirical research on EHR implementation was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant references in the selected articles were also analyzed. Search terms included Electronic Health Record (and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following requirements: (1) written in English, (2) full text available online, (3) based on primary empirical data, (4) focused on hospital-wide EHR implementation, and (5) satisfying established quality criteria.ResultsOf the 364 initially identified articles, this study analyzes the 21 articles that met the requirements. From these articles, 19 interventions were identified that are generally applicable and these were placed in a framework consisting of the following three interacting dimensions: (1) EHR context, (2) EHR content, and (3) EHR implementation process.ConclusionsAlthough EHR systems are anticipated as having positive effects on the performance of hospitals, their implementation is a complex undertaking. This systematic review reveals reasons for this complexity and presents a framework of 19 interventions that can help overcome typical problems in EHR implementation. This framework can function as a reference for implementers in developing effective EHR implementation strategies for hospitals.

Electronic Health Record Implementation Strategies

“…The governmental action forced health care providers to change the normal operating procedures concerning the protection of personal medical information Implementation of EHRs is not an optional activity for hospital administrators and health care providers because of government legislation (Brumen et al, 2013). Hospital administrators have a stake in fulfilling their responsibility for implementation, patient care, and financial incentives (Boonstra et al, 2014). However, Eastaugh (2013) analyzed data from an independent firm's survey of hospital chief financial officers resulting in evidence of a lack of knowledge and strategy concerning total-cost-of-ownership.…”

Physicians' Use of Mandatory Information Systems: An Exploratory Research in German Hospitals

“…Or, as Abouzahra et al put it: "the benefits of HIS can only be reached if they are used in practice." [15, p.14] Due to their important role in hospital settings medical personnel is often considered to be the main obstacle to successful IT deployment [16,17]. This leads to the guiding hypotheses of this study that physicians and HIT do not go well together.…”

“…Numerous papers and several literature reviews [2,15,17,20] show the enormous amount of research dedicated to investigate the enablers but mainly inhibitors to hospital medical personnel HIT usage. Unfortunately, Boonstra, Versluis and Vos [17, p.16] come to the conclusion that "the literature is diffuse, and articles seldom build on earlier ones to increase the theoretical knowledge […]".…”

NETIMIS: Dynamic Simulation of Health Economics Outcomes Using Big Data

“…In health, the big data in EHRs has the potential to be re-used to reduce the cost and transform the nature of research [12]. There are major challenges however -EHRs are still relatively new, their adoption has frequently been problematic [13], there are issues associated with research access to sensitive and confidential patient data [14] and there are concerns about the quality of this data [15] and therefore its suitability for research [16].…”