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Table 2 Critical factors for adopting clinical information systems included in the literature review

From: A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review

Study Critical adoption factors Country Practicea Settingb Attention levelc Code for the critical adoption factord Usee Study typef
Zheng, Padmana et al. [11] Ease of use, time efficient, lack of relevance of the reminders, concerns about time and efficiency impacts, disruption in physician-patient communication. USA L O P 6 V Q
Berner, Detmer et al. [6] The development of scalable, interoperable systems. Communication among clinical systems. USA L NS NS 5 NS D
Middleton, Hammond et al. [22] Limited demonstrated value of electronic health records in practice, variability in the viability of the information systems, promotion of system standards. USA B B B 5, 6 NS D
Poissant, Pereira et al. [15] Time for patient care, user satisfaction, accuracy of the information, overall impact on workflow, the degree of exposure to a implemented system, reception of support from clinical leaders and training support, impact of system on an ensemble of work processes and outputs. NS NS NS NS 2, 3, 4, 6 NS D
Poon, Jha et al. [27] Lack of data standards, lack of interoperability between different data sources, negative impact of system implementation on productivity, usability issues, adaptability of the system to the different workflow patterns. USA B B B 2, 5, 6 NS D
Liu, Wyatt et al. [34] To bring about the intended user actions or behaviour. NS NS NS NS 6 NS D
Ammenwerth, Iller et al. [24] Usability and user friendliness of software, stability and flexibility of software, intensive user support, overall affects of the system on personnel workflow. Germany L I S 1, 2, 3, 4, 5, 6 NS D
Sittig, Krall et al. [73] Behind schedule alerts. USA L B B 2 M C
Shah, Seger et al. [4] Accurate clinical documentation, linkage of patient information from all clinical data repositories, minimized workflow interruptions. USA L O P 2, 4, 5, 6 M Q
Ford, Menachemi et al. [2] Influence and promote physicians' internal social networks. USA S O NS 1 NS A
Chismar and Wiley-Patton [63] Internet applications perceived usefulness, the importance and utility of the internet technology in performing daily tasks. USA S NS NS 6 V Q
Simon, Kaushal et al. [64] Loss of productivity. USA B O B 6 NS Q
Despont-Gros, Mueller et al. [35] Clinical information system characteristics (information system quality, interface characteristics, information quality), use/context/environment (ease of use, perceived usefulness), process characteristics (user participation). NS NS NS NS 6 NS D
van der Meijden, Tange et al. [36] System quality, information quality, user satisfaction, individual impact. NS NS I NS 6 NS D
Ash and Bates [7] Personal concerns about workflow, one-on-one communication and training. USA B B NS 1,2,3,4 NS A
James [8] Complexity of the systems and lack of data standards that permit exchange of clinical data, privacy concerns and legal barriers. Europe, USA, Canada, Australia, New Zealand S O P 5 NS D
Callen, Braithwaite et al. [46] Individual differences in terms of collaborative activities, authority level among physicians, and attitudes to -and use of- computers at the point of care. Australia L I S 1, 6 M C
Chismar and Wiley-Patton [65] Usefulness and job relevance. USA B NS S 6 V Q
Hollingworth, Devine et al. [3] Detrimental impact on workflow. USA L O S 2 M C
Jerome, Giuse et al. [75] Clinical workflow, newsletter services. USA L O P 1, 2 V A
Joos, Chen et al. [25] Communication among physicians, remote access, system speed, system efficiency, computer skill, computer-based documentation. USA L O P 1, 3, 4, 6 NS D
Linder, Schnipper et al. [43] Falling behind schedule, usability issues, concern about losing data, feeling that using the computer in front of the patient is rude. USA L O P 2, 6 M C
Dixon and Stewart [44] Ability and willingness to transfer knowledge and skills from one task to another, work knowledge. Canada NS O P 2, 6 V C
Rouf, Chumley et al. [28] Perform more complete histories and documentation; receive significantly more feedback from their preceptors on their electronic charts than on paper charts; concerns about the potential impact of the EHR on their ability to conduct the doctor-patient encounter. USA L B P 2, 4, 6 M D
Saleem, Patterson et al. [26] Integration of system to workflow, the ability to document system problems and receive prompt administrator feedback, poor usability. USA L O P 1, 2, 3, 6 M D
Sequist, Cullen et al. [74] Decreasing in the amount of time available to talk with patients, clinical productivity loss, available technical support. USA L O P 2, 3 M C
Teich, Osheroff et al. [5] Usability problems, lack of integration to important data from the system, uneven availability and management of best-practice system knowledge. USA L O P 3, 4, 5, 6 NS D
Terry, Thorpe et al. [31] The presence of a champion, training, the readiness of health care providers to accept the system. Canada L O P 3, 4, 6 NS D
Zaidi, Marriott et al. [60] System easy to learn, easy to show others how to use the system, easy to find additional information, and easy to use it within their daily workflow. Australia L NS NS 2, 6 M Q
Krall and Sittig [47] System ease of satisfying for work activities, and degree to which it support or disrupt workflow. USA L O P 2, 6 M C
Krall and Sittig [29] User centered design system, system perceived usefulness, alert or reminder must appear either at the appropriate time for consideration and action, or in a manner in which the user can determine if and when to evaluate and respond to it. USA L O P 2, 6 M D
Aarts, Doorewaard et al. [53] Compatibility of the system with the
workflow, attitude of the users to information systems.
Germany L NS NS 2, 6 M A
Ash, Lyman et al. [45] System usability, training, support, and time (compatibility with the workflow), communication among physicians. USA L I S 1, 2, 3, 4, 6 M C
Audet, Doty et al. [79] Lack of standard for information systems. USA B NS NS 5 NS C
Bates, Cohen et al. [77] Promote use of standards for data and systems; develop systems that communicate with each other. USA B NS NS 5 NS D
Christensen and Grimsmo [48] To find methods that can make a better
representation of information in large patient records, prevent electronic patient records from contributing to increased administrative workload of physicians.
Norway L O P 2, 6 V C
Clayton, Narus et al. [52] The perceived value of enhanced communications; the system functionality, response time and reliability; patient load of the physician in system learning phase. USA L O P 1, 2, 6 V A
Gadd and Penrod [54] Demonstration of value-added for the effort required to use electronic medical record, and its ability to facilitate efficient clinical workflows without negative effects. USA L O S 2, 6 NS A
Granlien and Simonsen [78] Poor integration with the general practitioners' existing IT systems. Denmark S O P 5 V D
Halamka, Aranow et al. [33] Interoperability limitations, lost productivity. USA L B B 5, 6 B D
Kern, Barrón et al. [49] Provide higher quality ambulatory care. USA S O P 6 V C
Leung, Yu et al. [62] Lack of technical support in case of system failure, lack of knowledge and perceived difficulty in learning new technology, lack of perceived benefits from computerization of clinical practice. Hong Kong NS NS NS 3, 6 NS Q
Lo, Newmark et al. [55] Time and workflow concerns. USA L O S 2, 6 V A
Melles, Cooper et al. [37] The flexibility of a computer interface, the speed and efficiency of a clinical computer system. USA L O S 6 NS D
Menachemi, Ettel et al. [61] The time needed to data entry in a system, the disruption of workflow, the lack of uniform data standards within the industry. USA B B B 2, 5, 6 NS Q
Nilasena and Lincoln [58] Focus on the end users' preferences in creating forms or screens to document care. USA L O S 6 V E
Palm, Colombet et al. [57] Overall service quality of the clinical information system. France L I S 6 NS A
Pare, Sicotte et al. [50] Psychological ownership of a clinical information system. Canada L NS NS 6 V C
Payne, Perkins et al. [32] Application functionality, speed, note writing time requirements, data availability, training need. USA L I S 3, 6 NS D
Penrod and Gadd [51] Improvements in quality and communications, impact on workflow. USA L O P 1, 2, 6 NS A
Rodriguez, Murillo et al. [59] Usability concerns in the graphical user interface of a system. USA L NS NS 6 NS E
Rosenbloom, Grande et al. [30] Integration of a system in the workflow, prefilled templates through simple typed entry, reuse captured notes on subsequent encounters with patients, interoperability of the system with other organization systems. USA L I S 2, 5, 6 V D
Rosenbloom, Qi et al. [56] Systems having greater functionality, workflow considerations. USA L B S 2, 6 V A
Schade, Sullivan et al. [38] Improved quality and consistency of care, practice efficiencies that have both timesaving and revenue generating effects, and potential shielding from malpractice claims. UK NS O P 6 NS D
Vishwanath, and
Scamurra [42]
Systems tend to not be very easy to use, loss of control over business processes, inability to master the system, lack of clear usefulness USA NS NS NS 6 NS D
Stutman, Fineman et al. [39] Frequency and utility of the alerts in a system. USA L I S 6 V D
Tamblyn, Huang et al. [40] Level to which the patient data are complex and fragmented. Canada S O P 6 V D
Garrett, Brown et al. [41] Usefulness and complexity of the system. USA B B NS 6 V D
Weir, Lincoln et al. [76] Early and intensive support, and 24 hour available assistance. USA L B B 3, 4 V A
Lorenzi et al. [67] Disturbs in workflow, electronics health records are more difficult to use than paper-based records. USA S O B 2, 6 NS D
Morton and Wiedenbeck [86] Provide technical support in a timely manner. USA L NS NS 3 NS C
Rahimi et al. [68] System was not adapted to their work routines; systems compatibility with professional values and needs, and its complexity of use. Sweden L O P 2, 6 M C
Thyvalikakath et al. [70] Problematic interface and interaction designs that led to usability problems. USA S I S 6 NS C
Trivedi et al. [69] Concerns about negative impact on workflow, potential need for duplication during the transition from paper to electronic systems of medical record keeping. USA L O S 2, 6 NS C
Trimmer et al. [66] The formal training and assistance by coworkers, the use of system knowledge base, the ease of use of the system. USA L O P 1, 3, 4, 6 M D
DesRoches, Campbell et al. [87] Quality of communication
with other providers, timely access to medical
records, avoiding medication errors, finding an electronic-records system to meet needs
USA B O B 1, 6 NS C
Bates [88] System interoperability with other applications USA NS NS NS 5 NS D
Kemper, Uren et al. [89] No improvement in patient care or clinical outcomes, physician resistance, increase in physician workload, interference with doctor-patient relationship, inability to interface with existing systems USA B O P 5, 6 NS C
  1. a Type of practice: S = small, L = large, B = Both, NS = Not specified
  2. b Type of setting: I = impatient, O = outpatient, B = Both, NS = Not specified
  3. c Attention level: P = Primary, S = Specialty, B = Both, NS = Not specified
  4. d Critical adoption factor: 1 = communication among users, 2 = workflow impact, 3 = technical support, 4 = expert support, 5 = interoperability, 6 = attitude towards information systems
  5. e System use: M = mandatory, V = voluntary, B = Both, NS = Not specified
  6. f Study type: D = descriptive; C = cross-sectional; A = Analytical (cross-sectional comparative, case control, cohort/prospective); E = Experimental; Q = Quasi-experimental (before-after, pre-experimental)