Table 3 Summary of narrative synthesis findings
Review findings (subthemes and summaries) | Contributing studies | CERqual confidence in the evidence |
|---|---|---|
Technology | ||
EMR system's functionality – user-friendliness of EMR system, ease of use, and the comprehensiveness of clinical functionalities that fit the main medical tasks of PCPs impacted their use of advanced EMR features | Shachak et al. [45], Raymond et al. [43], Paré et al. [41], Goetz et al. [7] | Moderate confidence |
People | ||
Physician characteristics – gender was found to have an impact on the mature use of EMRs; advanced EMR features were more often used by female physicians | Low confidence | |
EMR experience – use of advanced EMR features increased most among female PCPs who had the least EMR experience | Randhawa et al. [10] | Very low confidence |
Physician perception – PCPs who perceived that the use of advanced EMR features would have a positive effect on their individual performance (e.g., communication, interaction with patients and other care providers) and their clinic’s performance (e.g., quality of care and patient safety) used advanced EMR features | Low confidence | |
Awareness of EMR functionality – PCPs’ lack of awareness of all the available advanced EMR features could be a barrier to the maturing of their use of EMRs | Moderate confidence | |
Physician readiness – lack of physician readiness to use advanced EMR features even though they had the capability could be a barrier to their mature use of EMRs | Low confidence | |
Physician motivation – PCPs’ motivation to improve and become proficient in using EMRs was found to facilitate their mature use of EMRs. Whereas PCPs that were not motivated continued to use basic functions and consciously ignored advanced EMR features | Moderate confidence | |
User satisfaction – EMR user satisfaction could facilitate the mature use of EMRs | Moderate confidence | |
Physician availability – inadequate time to learn more advanced EMR features and to invest in continuous learning to better use them was found to prevent mature use by PCPs | Low confidence | |
Habitual use – successful performance of clinical tasks with only basic use of EMRs was found to be a barrier to mature use of EMRs | Trudel et al. [18] | Very low confidence |
Patient concerns – the impersonality of EMR data entry during medical exams led to physicians’ dissatisfaction with and resistance to using advanced EMR features | Goetz et al. [7] | Very low confidence |
Organization | ||
Practice type – advanced EMR users have been shown to be affiliated in a practice with an integrated delivery system where PCPs collaborate closely with other health and social services professionals, that shares resources, and that is eligible for financial incentives | Moderate confidence | |
Practice size – PCPs in larger practices (5 or more full-time-equivalent PCPs) were more likely to be advanced EMR users compared to PCPs from smaller practices (less than 2 full-time PCPs) | Moderate confidence | |
Organizational objectives – clinical objectives to use EMRs on a daily basis and integrate them into the organization were absent or secondary once a clinic’s operational objectives for EMR use had been met. In addition to a business-oriented motivation, thwarted any effort to extend EMR use was found to be a barrier to the mature use of EMRs | Trudel et al. [18] | Very low confidence |
Team-based care – team-based methods such as assigning responsibility to nurses or other staff to enter patient data into EMRs or retrieve it allowed physicians to focus on patient care and facilitated the use of advanced EMR features | Goetz et al. [7] | Very low confidence |
Transition planning – planning for changes in roles and responsibilities, redesigning work processes, and developing up-to-date policies and procedures in a practice when implementing advanced EMR features facilitated their advanced use | Goetz et al. [7] | Very low confidence |
Resources | ||
Vendor training – limited and poor quality vendor training such as short training sessions and material based on theory rather than clinical practice, biased physicians towards using only basic EMR features | Low confidence | |
Training – adequate training (e.g., video training, training focused on clinical benefits, group training, procedural work flow manuals, 1-on-1 guidance) increased PCPs’ use of advanced EMR features | Low confidence | |
Coaching and peer mentoring – coaching by consultants and peer mentoring increased PCPs’ mature use of EMRs | Moderate confidence | |
Sharing resources – sharing technical assistance was found to be associated with multifunctional health information technology capacity, electronically exchanging patient information, and electronic patient access | Very low confidence | |
Financial incentives – PCPs that received or were eligible for financial incentives were more likely to be able to use advanced EMR features (e.g., electronically exchanging patient information with physicians outside of their practice) | Very low confidence | |
Technical support – adequate technical assistance, such as EMR vendors, a health information technology department, or an in-house EMR “go-to person” who supported the configuring of new EMR features and training staff, was a critical factor in the use of advanced EMR features | Goetz et al. [7] | Very low confidence |
Resource availability – limited sources of information about EMRs was found to prevent their mature use | Trudel et al. [18] | Very low confidence |
Policy | ||
Policies to increase EMR use – PCPs from small practices in countries that had collaborative and regional policies to increase the spread and use of health information technology were shown to have multifunctional capacity | Schoen et al. [3] | Low confidence |