Study | Designa (Country) | Micro level | Meso level | Macro level | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Quality | Use and user satisfaction | Net benefits | People | Organization | Implement-ation | Healthcare standards | Funding and incentives | Legislation/policy/governance | Societal/political/economic trends | ||
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. | Â 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 | Â 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 |