|
Aaronson et al. (2001) [33]
|
SQ (USA)
|
NR
|
NR
|
NR
|
Neutral: Prior computer experience.
|
NR
|
Positive: Training length.
|
NR
|
NR
|
NR
|
NR
|
|
Alasmary et al. (2014) [61]
|
SQ + QI (Sauda Arabia)
|
NR
|
NR
|
Positive: Improved clinical productivity.
|
Positive: Computer literacy.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Christensen & Grimsmo (2008) [48]
|
FG + SQ (Norway)
|
Negative: Time-consuming navigation; Lack of accessible patient reports.
|
Negative: Impact on clinician-patient relationship.
|
Positive: Time-saving e.g. automated prescription renewal/key administrative and clinical information.
|
NR
|
Negative: Shifted administrative workload from health secretaries to PCPs.
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
De Lusignan et al. (2003) [49]
|
QI (UK)
|
Negative: Challenging to locate appropriate Read Codes. Positive: Templates/lists of key codes helpful.
|
Negative: Challenging to record emerging diagnoses/vague symptoms; Risk of stigmatising patients.
|
Positive: Supported audit and feedback to demonstrate quality of care.
|
NR
|
NR
|
NR
|
NR
|
Positive: Financial support.
|
NR
|
NR
|
|
Desroches et al. (2013) [34]
|
SQ (USA)
|
Negative: Difficult to generate specific lists of patients.
|
Positive: Existing experience/meaningful EMR use.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Djalali et al. (2015) [50]
|
CSQ (Switzerland)
|
NR
|
Negative/neutral: impact on workflow processes; Impact on physician-patient-relationship
|
Negative/neutral: Impact on quality of care. Positive: impact on operating costs, time, cooperation and provision patient reports.
|
Positive: Younger, less clinicially experienced PCPs.
|
Positive PCPs based in a group practice compared to single-handed practice.
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Dossa & Welch (2015) [35]
|
QI (USA)
|
NR
|
Negative: Challenging to record sensitive information; Risk of stigmatising patients.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
Positive: Availability of robust EMR privacy laws.
|
NR
|
|
Doyle et al. (2012) [36]
|
QI (USA)
|
Positive: Improved organization and accessibility.
|
Negative: Impact on patient interaction.
|
Positive: Impact on medication management.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Emani et al. (2014) [37]
|
CSQ (USA)
|
NR
|
NR
|
Negative/neutral: Impact on medical errors; effectiveness/patient-centered/quality of care.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Ernstmann et al. (2009) [51]
|
SQ (Germany)
|
Negative: System specification did not meet needs.
|
NR
|
Positive: Impact on medication errors; communication; administration time.
|
NR
|
NR
|
Positive: Training to improve system familiarity.
|
NR
|
NR
|
Positive: Belief that PCP interests were considered by policy makers/ represented by medical associations.
|
NR
|
|
Goetz Goldberg et al. (2012) [38]
|
SQ + QI (USA)
|
Negative: Difficult to navigate; Not customizable; Difficult to track patients; Disruptive impact of system failures.
|
Negative: Impact on patient interaction.
|
Positive: Impact on organization, accessibility, accuracy of patient data; Impact on communication; Potential to generate patient reports; Potential to support quality-improvement. Negative: Time-commitment.
|
NR
|
Positive: PCPs based in a group practice compared to single-handed practice.
|
Positive: PCPs based in practices that redesigned work processes, policies and procedures to support implementation
|
NR
|
Negative: Cost of upgrading system.
|
NR
|
NR
|
|
Greiver et al. (2011) [59]
|
FG (Canada)
|
Negative: Complex/ inflexible system; Software interface issues and immaturity; Adverse impacts of IT structural failures inc. lack of technical support.
|
Negative: Impact on patient interaction.
|
Negative: Reduced efficiency e.g. additional data entry time. Positive: Improved efficiency e.g. automated prescription renewals/consultation letters; Quality/accessibility of patient records.
|
Negative: Lack of basic IT/keyboard skills; Limited benefits for older PCPs.
|
NR
|
Negative: Lack of ongoing training post-implementation; Lack of technical support. Positive: Having designated champion to support/problem solve.
|
NR
|
Negative:Cost of system installation
|
NR
|
NR
|
|
Holanda et al. (2012) [62]
|
CSQ (Brazil)
|
Negative: Speed; Technical failures; Lack of functionality e.g. checking lab results. Negative/neutral: Accessibility of previous notes; Ability to review medication list.
|
NR
|
Negative: Speed in comparison to paper records.
|
Neutral: Length of clinical experience;.Positive: Basic computer literacy; Being female; Younger PCPs.
|
Positive: Seeing less than 16 patients per half-day.
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Keddie & Jones (2005) [52]
|
CSQ (UK)
|
Negative: Incompatibility with secondary care systems; Inability to transfer records between practices.
|
Negative: Intrusion of PC in consulting room; Lack of fit with current work practices.
|
Negative: Time-consuming.
|
NR
|
NR
|
Negative: Lack of training; lack of technical support.
|
NR
|
Negative: Cost of system installation.
|
Negative: Concerns about the medico-legal implications; Llack of policy-maker support for implementation.
|
NR
|
|
Loomis et al. (2002) [39]
|
CSQ (USA)
|
NR
|
NR
|
Positive: More secure and confidential than paper records.
|
Negative: Being a non-EMR user.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Meade et al. (2009) [53]
|
SQ (Ireland)
|
NR
|
NR
|
Negative: Time-consuming.
|
Negative: Lack of basic computer skills.
|
NR
|
Negative: Poor training.
|
NR
|
Negative: Cost of introducing system.
|
NR
|
NR
|
|
O’Malley et al. (2010) [65]
|
QI (USA)
|
Negative: Lack of system interoperability; Lengthy/ irrelevant problem lists.
|
Negative: Mismatch with work practices; Lack of usefulness for complex patients/situations.
|
Positive: Comprehensive/consistent/ accessible documentation; Automated record completion; Quality and efficiency of patient care.
|
NR
|
Negative: Limited impact on collaborative decision making.
|
NR
|
NR
|
Negative: Lack of financial and other incentives; Emphasis on use for billing and litigation prevention.
|
NR
|
NR
|
|
Or et al. (2014) [63]
|
QI + SQ (Hong Kong)
|
Positive: Accessible/efficient user-system interaction/interface; System flexibility and reliability.
|
Negative: Impact on patient interaction; Slower workflow.
|
Positive: Potential to improve medication management and/or patient safety issues. Negative: Burdensome data migration process and disruption to work processes
|
Negative: Lack of basic computer skills.
|
NR
|
Positive: Provision of post-implementation technical support and training.
|
NR
|
Negative: Cost of introducing system.
|
NR
|
NR
|
|
Pare et al. (2014) [60]
|
SQ (Canada)
|
Negative: Poor quality systems e.g. usability, security); Lack of system interoperability.
|
Negative: Adverse impact on doctor–patient relationship.
|
Negative: Costs greater than potential benefits.
|
Negative: Lack of basic computer skills.
|
NR
|
Negative: Lack of expertise in EMR systems; Transience of software vendors; Lack of technical support.
|
NR
|
NR
|
NR
|
NR
|
|
Pizziferri et al. (2005) [40]
|
SQ (USA)
|
NR
|
Negative: Reduced time spent with patients.
|
Positive: Improved quality, access, and communication of records.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Pocetta et al. (2015) [54]
|
QI (Italy)
|
NR
|
NR
|
Positive: Improved effectiveness and efficiency eg via audit-and-feedback. Negative: Time-consuming, esp. recording lifestyle data.
|
NR
|
NR
|
NR
|
NR
|
Negative: Lack of financial incentives; Lack of professional recognition for the additional work involved.
|
NR
|
NR
|
|
Prazeres (2014) [55]
|
SQ (Portugal)
|
NR
|
Neutral: Impact on patient interaction; Length of consultation time.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Rose et al. (2005) [41]
|
FG (USA)
|
Negative: Difficult to navigate and access patient notes; Lack of available screen real estate/ cluttered screen. Positive: Use of screen contrast/ colour; Ability to customize.
|
Negative: Mismatch with existing workflow patterns.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Rosemann et al. (2010) [56]
|
SQ (Switzerland)
|
NR
|
Negative: Impact on patient interaction; Impact on doctor-patient relationship.
|
Negative: Cost-benefit ratio.
|
Positive: Younger PCPs
|
Positive: PCPs based in group practices.
|
NR
|
NR
|
NR
|
Negative: Concerns re data security law.
|
NR
|
|
Sequist et al. (2007) [42]
|
SQ (USA)
|
Negative: Technical limitations eg slow response time.
|
Negative: Impact on patient interaction.
|
Negative: Clinical productivity loss; Patient privacy/safety. Positive: Quality of care.
|
Positive: More clinical experience Negative: Lack of basic computer skills.
|
NR
|
Negative: Lack of technical support; Lack of training.
|
NR
|
NR
|
NR
|
NR
|
|
Shachak et al. (2009) [64]
|
QI (Israel)
|
Positive: Data-related comprehensiveness, organization, and readability.
|
Positive: Reduced cognitive load; Simple to use. Negative: Impact on patient interaction.
|
Positive: Automated review of patients’ medical histories/ test results; Provided clinical decision aids; Enhanced patient safety. Negative: Introduced new types of medical errors e.g. typos.
|
Positive: Advanced computer/ communication skills.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Steininger & Stiglbauer (2015) [57]
|
SQ (Austria)
|
NR
|
NR
|
Negative: Impact on patient privacy.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Stream (2009) [43]
|
SQ (USA)
|
NR
|
NR
|
Negative: Productivity loss.
|
NR
|
Positive: Presence of students and residents in practice; Attitude of individual practices; Being based in group rather than solo practices.
|
NR
|
NR
|
Negative: Start-up financial costs, ongoing financial costs and training costs; Pay-for-performance and interest free loans. Positive: Grants and increased reimbursement.
|
NR
|
NR
|
|
Villalba-Mora et al. (2015) [58]
|
SQ (Spain)
|
NR
|
Positive: Availability of ePrescription/ patient management services e.g. appointments and referrals.
|
NR
|
Positive: Being female; Having basic computer skills; Use of internet outside the workplace.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Williams et al. (2011) [44]
|
QI (USA)
|
Negative: Accessing/ navigating family history information.
|
Positive: Helping to directing patient care; Building relationship/rapport.
|
Positive: Increase in practice efficiency.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Wright & Marvel (2012) [45]
|
SQ (USA)
|
NR
|
NR
|
NR
|
Positive: Younger PCPs.
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
|
Yan et al. (2012) [46]
|
SQ (USA)
|
Negative: Technical limitations.
|
Negative: Adverse impact on -patient interaction.
|
Negative: Substantial productivity loss against limited direct benefits.
|
Negative: Older PCPs; Lack of EMR experience; Lack of computer skills.
|
Neutral: Practice size.
|
Negative: Training needs.
|
NR
|
Negative: Substantial financial costs.
|
Negative Lack of uniform industry EMR standards.
|
NR
|
|
Zhang et al. (2016) [47]
|
QI (USA)
|
Positive: Use of templates. Negative: Time consuming functions e.g. clinical reminders; Technical limitations e.g. slow user interface, lack of shortcuts; limited flexibility
|
Positive: Promoted patient engagement as viewing tool. Negative: Adverse impact on -patient interaction.
|
Negative: Productivity loss
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
NR
|
