The DOI matches its Crossref record; 56 of the 57 references it cites were found in a registry or an index.
Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries
Abstract
The adoption of health information systems is seen world wide as one method to mitigate the widening health care demand and supply gap. The purpose of this review was to identify the current state of knowledge about health information systems adoption in primary care. The goal was to understand factors and influencers affecting implementation outcomes from previous health information systems implementations experiences. A comprehensive systematic literature review of peer reviewed and grey literature was undertaken to identify the current state of knowledge regarding the implementation of health information systems. A total of 6 databases, 27 journal websites, 20 websites from grey sources, 9 websites from medical colleges and professional associations as well as 22 government/commission websites were searched. The searches returned almost 3700 article titles. Eighty-six articles met our inclusion and exclusion criteria. Articles show that systems' graphical user interface design quality, feature functionality, project management, procurement and users' previous experience affect implementation outcomes. Implementers had concerns about factors such as privacy, patient safety, provider/patient relations, staff anxiety, time factors, quality of care, finances, efficiency, and liability. The review showed that implementers can insulate the project from such concerns by establishing strong leadership, using project management techniques, establishing standards and training their staff to ensure such risks do not compromise implementation success. The review revealed the concept of socio-technical factors, or "fit" factors, that complicate health information systems deployment. The socio-technical perspective considers how the technical features of a health information system interact with the social features of a health care work environment. The review showed that quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation. The fact that no articles were found reviewing the benefits or drawbacks of health information systems accruing to patients should be concern to adopters, payers and jurisdictions. No studies were found that compared how provider-patient interactions in interviews are effected when providers used electronic health information systems as opposed to the paper equivalent. Very little information was available about privacy and liability.
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“A team-based partnership approach, collaborative efforts and good coordination between stakeholders and organisations were all shown to be important for implementation [34, 41, 55, 77].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
In the citing paper
“Non-clinical staff often had better knowledge of optimising processes compared to clinicians [77]”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
In the citing paper
“different members of the workforce brought different perspectives and skills to the implementation [77].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
In the citing paper
“patient values and preferences [3, 33] and concerns about clinician-patient relationships [42, 77] impeded implementation”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
In the citing paper
“Resistance to change caused by disagreement with the evidence, negative beliefs about the usefulness or added value of the intervention or belief that the intervention was not part of their role were commonly described as a barrier to implementation [3, 14, 35, 41, 67–70, 76, 77, 80].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
In the citing paper
“Previous personal experience in clinical practice or with the information system affected professional attitudes to a new system or intervention [54, 66, 77, 81].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
In the citing paper
“Effective project management (e.g. using an incremental approach over time according to a strategic plan allowing a transition period between old and new system) was shown to facilitate implementation [77].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
In the citing paper
“Incentives by government organisations and other external stakeholders may facilitate adoption by healthcare organisations [17, 18, 39, 48, 49].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
In the citing paper
“Financial incentives include the provision of initial funds to cover upfront costs [49], financial sponsorship [39], reimbursements for adoption [19, 30, 31, 36], and pay-for-performance initiatives [24, 36, 37, 49].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
In the citing paper
“Providing a period of transition in which end users can become familiar with and learn how to use new systems has been advocated [39, 50].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
In the citing paper
“Incremental implementation strategies where features are made available to users according to a plan were cited as preferable to ‘big bang’ approaches to implementation within complex organisations [39, 49].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
In the citing paper
“Our study was UK-based, although the challenge of implementing effective decision support for prescribing, and specifically the problem of alert fatigue, is international.12 24 50”
From ‘Too much, too late’: mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing (2013) · cites this paper as [50]
In the citing paper
“Difficulties in eHealth implementation are international phenomena, with similar problems being widely reported [102-105].”
From Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress (2012) · cites this paper as [105]
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“Often there are also reports of organizational inadequacies for effective and efficient implementation of disease surveillance [35].”
BackgroundAn Organizational Culture-Based Theory of Clinical Information Systems Implementation in Hospitals
Montreal, H., Rivard, S., Lapointe, L., Kappos, A., & Montreal, H. (2011) · Journal of the Association for Information Systems · doi:10.17705/1jais.00258 · Cited by 81
“Because CISs directly support the actual practices of clinicians within a hospital, they need to fit work processes (Littlejohns et al., 2003; Aarts et al., 2004; Ludwick & Doucette, 2009).”
BackgroundYen, P., McAlearney, A. S., Sieck, C. J., Hefner, J. L., & Huerta, T. R. (2017) · JMIR Medical Informatics · doi:10.2196/medinform.7476 · Cited by 91
“From that perspective, understanding the adaptiveness, or HIT adaptation in this process, is thus significant in our understanding of HIT implementation success [50].”
Backgrounddos Santos, A. D. F., Sobrinho, D. F., Araújo, L. L., Procópio, C. D. S. D., Lopes, É. A. S., Lima, A., dos Reis, C. M. R., de Abreu, D. M. X., Jorge, A. D. O., & Machado, A. T. G. D. M. (2017) · Cadernos de Saúde Pública · doi:10.1590/0102-311x00172815 · Cited by 82
Lanham, H. J., Leykum, L. K., & McDaniel, R. R. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000263 · Cited by 75
Horsky, J., McColgan, K., Pang, J. E., Melnikas, A., Linder, J. A., Schnipper, J. L., & Blackford Middleton, A. (2010) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2010.05.010 · Cited by 76
“Among the core predictors of quick adoption and successful implementation are the design quality of the graphical user interface and functionality, along with socio-technical factors [7].”
BackgroundBarbarito, F., Pinciroli, F., Mason, J., Marceglia, S. R. F., Mazzola, L., & Bonacina, S. (2012) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2012.01.006 · Cited by 76
Organizational strategies for promoting patient and provider uptake of personal health records
Wells, S., Rozenblum, R., Park, A., Dunn, M., & Bates, D. W. (2015) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-003055 · Cited by 67
“Taking this socio-technical perspective(33) necessitates organizations to understand their processes of care and how people interact with each other, so they can work out how a new system will best fit in.(29) Consistent with this notion, our study Table 3: Advice for successful implementation: quotes from interviewees”
BackgroundInfluentialAdoption factors of electronic health record systems
Spatar, D., Kok, O. M., Basoglu, N., & Daim, T. (2019) · Technology and Society · doi:10.1016/j.techsoc.2019.101144 · Cited by 68
McAlearney, A. S., Robbins, J., Kowalczyk, N. K., Chisolm, D. J., & Song, P. H. (2012) · Medical Care Research and Review · doi:10.1177/1077558711436348 · Cited by 94
“In ambulatory settings, many factors contribute to slow EHR adoption rates and low levels of system use (e.g., Bates, 2005; Ford, Menachemi, Peterson, & Huerta, 2009; Lee, Cain, Young, Chockley, & Burstin, 2005; Simon et al., 2007; Ludwick & Doucette, 2009).”
BackgroundBarriers and facilitators to Electronic Medical Record (EMR) use in an urban slum
Jawhari, B., Keenan, L., Zakus, D., Ludwick, D., Isaac, A., Saleh, A., & Hayward, R. S. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.07.015 · Cited by 72
Self-citationNajaftorkaman, M., Ghapanchi, A. H., Talaei‐Khoei, A., & RAY, P. K. (2014) · Journal of the Association for Information Science and Technology · doi:10.1002/asi.23181 · Cited by 71
“…2012; Cotea, 2010; Davidson & Heslinga, 2006; Ford, 2012b; Gans et al., 2005; Hewitt, 2009; Holden, 2011; Jha et al., 2009; Kemper et al., 2006; Ludwick & Doucette, 2009; Miller & Sim, 2004; Pinaire, 2009; Randeree, 2007; Rao et al., 2011; Simon et al., 2007; Singh et al., 2012; Sittig &…”
InfluentialHealth providers’ communication skills training affects hypertension outcomes
Sany, S. B. T., Peyman, N., Behzhad, F., Esmaily, H., Taghipoor, A., & Ferns, G. A. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1395002 · Cited by 69
“Further, patients report good communication with their health care providers who have more years of experiences compared to those with limit-experiences (Ludwick and Doucette 2009, Ha and Longnecker 2010).”
BackgroundAli, M. K., Shah, S., & Tandon, N. (2011) · Journal of Diabetes Science and Technology · doi:10.1177/193229681100500310 · Cited by 67
Anonymization of Longitudinal Electronic Medical Records
Tamersoy, A., Loukides, G., Nergiz, M. E., Saygın, Y., & Malin, B. (2012) · IEEE Transactions on Information Technology in Biomedicine · doi:10.1109/titb.2012.2185850 · Cited by 68
“(EMR) systems [2], [3] and are increasingly repurposed to support clinical research (see, e.”
BackgroundTen key considerations for the successful optimization of large-scale health information technology
Cresswell, K. M., Bates, D. W., & Sheikh, A. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocw037 · Cited by 70
Pomares-Quimbaya, A., Kreuzthaler, M., & Schulz, S. (2019) · BMC Medical Research Methodology · doi:10.1186/s12874-019-0792-y · Cited by 67
Ngusie, H. S., Kassie, S. Y., Chereka, A. A., & Enyew, E. B. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-07688-x · Cited by 88
Cresswell, K. M., Morrison, Z., Crowe, S., Robertson, A. R. R., & Sheikh, A. (2011) · Journal of Innovation in Health Informatics · doi:10.14236/jhi.v19i4.814 · Cited by 69
Sidek, Y. H., & Martins, J. T. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2017.08.007 · Cited by 61
“Similarly to what has been found in [46], Bru-HIMS end-users feared the potential for novel failure modes to occur due to changing working practices.”
BackgroundResultFagerlund, A. J., Holm, I. M., & Zanaboni, P. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028251 · Cited by 58
“In order to release some of the potential of health informatics systems, it has been argued that, among others, feature functionality, project management and user-related outcomes affect implementation outcomes.(12) The aim of this study was to explore GPs’ perceptions towards the use of digital health services for ci…”
BackgroundIfinedo, P. (2015) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2015.12.012 · Cited by 59
“The diffusion of such technologies in healthcare has expanded dramatically across the world, and is expected to increase in the coming years (Ludwick & Doucette 2009; Lee et al. 2013).”
Rahal, R. M., Mercer, J. G., Kuziemsky, C. E., & Yaya, S. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-021-01434-9 · Cited by 61
“However, as highlighted in previous studies [15, 59], the literature in this field may be poorly referenced within bibliographic databases because terminology is not standardized, and there is no taxonomic consensus related to health information technologies [60].”
BackgroundPutteeraj, M., Bhungee, N., Somanah, J., & Moty, N. (2021) · International Health · doi:10.1093/inthealth/ihab035 · Cited by 66
Understanding the perception towards using mHealth applications in practice
Sezgın, E., Özkan, S., & Yıldırım, S. (2016) · Information Development · doi:10.1177/0266666916684180 · Cited by 59
“In parallel, the literature reveals that healthcare technologies may not be as promising as they seem, since factors like users’ previous experiences, risk levels and organizational culture can remarkably affect the attitudes of professionals (Ludwick and Doucette, 2009; Li et al., 2013).”
BackgroundAdopting electronic medical records: are they just electronic paper records?
Price, M., Singer, A. G., & Kim, J. (2013) · Europe PMC (PubMed Central) · Cited by 60
The Heimdall framework for supporting characterisation of learning health systems
McLachlan, S., POTTS, H. W. W., Dube, K., Buchanan, D., Lean, S., Gallagher, T., Johnson, O. A., Daley, B. J., Marsh, W., & Fenton, N. (2018) · BMJ Health & Care Informatics · doi:10.14236/jhi.v25i2.996 · Cited by 59
Heponiemi, T., Gluschkoff, K., Vehko, T., Kaihlanen, A., Saranto, K., Nissinen, S. P., Nadav, J., & Kujala, S. (2021) · Journal of Medical Internet Research · doi:10.2196/27096 · Cited by 56
“Further, user involvement, strong leadership, project management techniques, and standards are important in ensuring successful implementation [3,39,40].”
Raymond, L., Paré, G., de Guinea, A. O., Poba‐Nzaou, P., Trudel, M.-C., Marsan, J., & Micheneau, T. (2015) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-015-0152-8 · Cited by 62
“An EMR can be defined as a computerized sys-tem where physicians record relevant information such as patient demographics, medical histories, consultation notes, lists of problems, allergies, vaccinations, vital signs, and prescriptions/renewals [4].”
BackgroundA web-based information system for a regional public mental healthcare service network in Brazil
Yoshiura, V. T., Marques, J. M. D. A., Rzewuska, M., Vinci, A. L. T., Sasso, A. M., Miyoshi, N. S. B., Furegato, A. R. F., Rijo, R., Del‐Ben, C. M., & Alves, D. (2017) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0117-z · Cited by 55
“Hearing experiences and addressing needs of a wide range of stakeholders in the process of development and implementation is challenging [15], but it was necessary to achieve this first Brazilian web-based system that meets specific service needs, integrate public mental health care service…”
BackgroundNadav, J., Kaihlanen, A., Kujala, S., Laukka, E., Hilama, P., Koivisto, J., Keskimäki, I., & Heponiemi, T. (2021) · Journal of Medical Internet Research · doi:10.2196/31668 · Cited by 55
“Resistance from professionals is a major problem for organizations, and therefore it is important to understand their point of view [12].”
A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland
Bouamrane, M.-M., & Mair, F. S. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-58 · Cited by 55
“systems in primary care In a systematic review of factors promoting adoption of health information management systems (IMS), Ludwick &Doucette identified a range of factors which contributed to the outcomes of system implementation: user interface design, system functionalities, system suppliers, change and risk manag…”
BackgroundSociotechnical analysis of nurses’ use of personal mobile phones at work
Bautista, J. R., & Lin, T. T. C. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.09.002 · Cited by 53
Increasing the Capacity of Primary Care Through Enabling Technology
Young, H. M., & Nesbitt, T. S. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3952-3 · Cited by 53
Joukes, E., de Keizer, N. F., de Bruijne, M. C., Abu–Hanna, A., & Ronald Cornet, A. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1681054 · Cited by 56
Robben, S. H., Perry, M., Huisjes, M., van Nieuwenhuijzen, L., Schers, H., van Weel, C., Rikkert, M. G. M. O., van Achterberg, T., Heinen, M. M., & Melis, R. J. F. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-251 · Cited by 52
“preferring personal contact, being worried about security of data and time constraints [13,24-26], even though the results on this latter barrier were somewhat mixed in our study, with about two-third of professionals reporting that they considered the time spent on using the ZWIP limited, whereas interviewees reporte…”
ResultLiu, C.-F., & Cheng, T. (2015) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-014-0125-3 · Cited by 51
Hayward, J., Thomson, F., Milne, H., Buckingham, S., Sheikh, A., Fernando, B., Cresswell, K., Williams, R., & Pinnock, H. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2012-001484 · Cited by 48
Vedel, I., Lapointe, L., Lussier, M., Richard, C., Goudreau, J., Lalonde, L., & Turcotte, A. (2011) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2011.11.002 · Cited by 49
“compare clinician–patient interactions with and without a CIS [41].”
BackgroundResultInfluentialStruik, M. H. L., Koster, F., Schuit, A. J., Nugteren, R., Veldwijk, J., & Lambooij, M. (2014) · Implementation Science · doi:10.1186/1748-5908-9-69 · Cited by 47
“Also, training in the system and adequate technical support might be necessary to counteract resistance of using EMRs [18,27,42].”
BackgroundLiang, D., Darko, A. P., & Ju, Z. (2019) · Journal of Experimental & Theoretical Artificial Intelligence · doi:10.1080/0952813x.2019.1694589 · Cited by 49
Patient perspectives on a personally controlled electronic health record used in regional Australia
Hanna, L., Gill, S. D., Newstead, L., Hawkins, M., & Osborne, R. H. (2016) · Health Information Management Journal · doi:10.1177/1833358316661063 · Cited by 48
Metadata
- Authors
- LUDWICK, D., & DOUCETTE, J.
- Affiliations
- University of Alberta (CA)
- ORCID
- DOUCETTE, J
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 78
- Issue
- 1
- Pages
- 22-31
- ISSN
- 1386-5056 (ISSN-L)
- OpenAlex
- W2005519248
- Cited by
- 668
- References
- 57
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 21 · 2023: 35 · 2022: 30 · 2021: 38 · 2020: 40 · 2019: 43 · 2018: 55 · 2017: 50 · 2016: 46 · 2015: 56 · 2014: 57 · 2013: 46 · 2012: 41
- FWCI
- 64.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Business, Management and Accounting › Management Information Systems › Information Systems Theories and Implementation
- Social Sciences › Business, Management and Accounting › Management Information Systems › ERP Systems Implementation and Impact
- Keywords
- electronic health records, health information systems, primary care, implementation outcomes, user interface design, project management, privacy concerns, patient safety, employee training, implementation barriers, cross-national comparison
- MeSH terms
- Humans, Medical Informatics, Primary Health Care, Risk Factors, Medical Records Systems, Computerized, Internationality
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