Implementation of electronic health record : a systematic review

Abstract

Introduction: Electronic Health Records (EHR) has been introduced into various countries over decades. The aim of its integration into clinical practices is to improve healthcare quality and efficiency, as well as to save costs in a long-term use. However, after years of implementation, different studies have reported the impacts of EHR use, including both positive and negative ones. Arguments have been raised about whether the implementation of EHR is worthwhile and can really be beneficial to healthcare delivery system. This review is targeted at assessing the related researches about EHR implementation to provide a summary of its benefits and shortcomings, and the reasons behind them.

Methods: A systematic review of multiple relevant literatures published from 2003 to 2014 was conducted in Pubmed, Wiley Online Library, JAMIA, ProQuest, and JAMA evaluating the implementation of EHR and its clinical and physician outcomes. Main results were studied and summarized, and STROBE was adopted for quality assessment.

Results: Fourteen studies were included for the systematic review. Most of the studies were conducted in the US, where others were done in similarly developed economies. Also, over half of the researches show that EHR implementation is beneficial to improve quality of healthcare delivery in terms of cost reduction and quality improvement. However, negative results were also observed in five studies, indicating complexity of use and possible emergence of adverse events.

Conclusion: EHR appears to be time and money saving in a long-term implementation. Nevertheless, barriers exist including difficulty of adoption and lack of initial investment and professional training. Similarly, most physicians believe that use of EHR will improve health care quality and efficiency. However, the documentation and operation keep them from quickly adopting EHR.