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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MacLure, K., Stewart, D. C., & Strath, A. (2013) · European Journal of Hospital Pharmacy · doi:10.1136/ejhpharm-2013-000337 · Cited by 12
Towards Interoperability of EHR Systems: The Case of Italy
Ciampi, M., Esposito, A., Guarasci, R., & De Pietro, G. (2016) · Proceedings of the International Conference on Information and Communication Technologies for Ageing Well and e-Health · doi:10.5220/0005916401330138 · Cited by 11
“Despite such efforts in the realization of EHRs, the systems developed, both at regional and national level, are very often not able to interoperate each other (Ludwick and Doucette, 2009), due to a plethora of reasons.”
BackgroundShernoff, E. S., Lekwa, A. J., Frazier, S. L., Delmarre, A., Gabbard, J. L., Zhang, D., Bhuamik, D., & Lisetti, C. (2021) · School Mental Health · doi:10.1007/s12310-021-09469-z · Cited by 11
Xie, F., Grant, D. L., Chang, J. M., Amundsen, B. I., & Hechter, R. C. (2022) · The Permanente Journal · doi:10.7812/tpp/21.102 · Cited by 11
Management of Electronic Patient Record Systems in Primary Healthcare in a Finnish County
Mäkelä, K., Virjo, I., Aho, J., Kalliola, P., Kurunmäki, H., Uusitalo, L., Valli, M., & Ylinen, S. (2010) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2010.0031 · Cited by 11
Xia, Z., Gao, W., Wei, X., Peng, Y., Ran, H., Wu, H., & Liu, C. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228510 · Cited by 11
“Therefore, data should follow the patient instead of being confined within the boundary of the health facility [14].”
BackgroundInfluentialHealthcare workers' communicative constitution of health information technology (HIT) resilience
Barrett, A. K. (2021) · Information Technology and People · doi:10.1108/itp-07-2019-0329 · Cited by 11
Moxham, C., Chambers, N., Girling, J., Garg, S., Jelfs, E., & Bremner, J. (2012) · Health Services Management Research · doi:10.1258/hsmr.2012.012018 · Cited by 11
Uncovering Research Opportunities in the Medical Informatics Field: A Quantitative Content Analysis
Weigel, F. K., Rainer, R. K., Hazen, B. T., Cegielski, C. G., & Ford, F. N. (2013) · Communications of the Association for Information Systems · doi:10.17705/1cais.03302 · Cited by 11
“Research regarding proper project management techniques can assist in reducing the problems associated with health IS adoption and implementation [Ludwick and Doucette, 2009].”
BackgroundKamath, J. R. A., & Donahoe-Anshus, A. L. (2011) · IGI Global eBooks · doi:10.4018/978-1-60960-872-9.ch015 · Cited by 11
Clinical validity of a population database definition of remission in patients with major depression
Sicras‐Mainar, A., Blanca-Tamayo, M., Gutiérrez-Nicuesa, L., Salvatella-Pasant, J., & Navarro‐Artieda, R. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-64 · Cited by 11
“It is worth pointing out that the organization of care, through territorialbased assignment of teams and the increasing computerization of its centres provides a suitable environment to carry out these types of studies in a clinical practice environment [18,19].”
BackgroundOpen-source LIMS in Vietnam: The path toward sustainability and host country ownership
Landgraf, K. M., Kakkar, R., Meigs, M., Jankauskas, P. T., Phan, T. T. H., Nguyen, V. N., Nguyen, D. T., Duong, T. T., Nguyen, T. H., & Bond, K. B. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.06.010 · Cited by 11
“A model for implementing open-source EMR presented by Ludwick and Doucette recommends the following strategies to mitigate risks: establishing strong leadership, using accepted project management techniques, ensuring adequate staff training, and using a standards-based approach [19].”
MethodThe Role of the Researcher in Making Serious Games for Health
Kato, P. M. (2015) · IGI Global eBooks · doi:10.4018/978-1-4666-6433-3.ch072 · Cited by 29
Asthma Electronic Medical Records in Primary Care: An Integrative Review
Minard, J. P., Turcotte, S. E., & Lougheed, M. D. (2010) · Journal of Asthma · doi:10.3109/02770903.2010.491141 · Cited by 11
“A more recent literature search on the status of EMRs in primary care (24) described challenges, including general practitioners’ concerns around costs, time and training, patient safety and quality of care, need for standardization of clinical terms, and efficiency.”
BackgroundInfluentialAlzghaibi, H., & Hutchings, H. A. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1516714 · Cited by 19
Bonomi, S., Zardini, A., Rossignoli, C., & Dameri, R. P. (2015) · Lecture notes in business information processing · doi:10.1007/978-3-319-14980-6_13 · Cited by 10
An overview of electronic health information management systems quality assessment
Bouamrane, M.-M., Mair, F. S., & Tao, C. (2012) · International Workshop on Managing Interoperability and Complexity in Health Systems (MIXHS) · doi:10.1145/2389672.2389680 · Cited by 9
“- clinical data, electronic health records and clinical coding ([12, 23, 33, 37, 44, 45, 50, 52, 58]) and definition of data and information quality in eHealth ([9, 20, 24, 36, 53]) - the impact of data quality and information processing on medical records ([3, 4, 18, 22, 26, 27, 28, 31, 35, 42, 48, 55, 57]) - socio-t…”
BackgroundIfinedo, P. (2017) · International Journal of Technology Diffusion · doi:10.4018/ijtd.2017010101 · Cited by 10
“…of Technology Diffusion Volume 8 • Issue 1 • January-March 2017 2 positively influence healthcare professionals’ use of HIS and related technologies in healthcare settings merit commendation (Timmons, 2003; Ludwick & Doucette, 2009; Paré et al., 2011; Montague et al., 2013; Lee et al., 2013).”
BackgroundMeidani, Z., Farzandipour, M., Gilasi, H., & Dehghan, R. (2017) · Annals of Tropical Medicine and Public Health · doi:10.4103/atmph.atmph_531_17 · Cited by 10
“A total of 19 hospitals were determined throughout Iran and the final checklist was designed based on the five main HIS areas to collect the data vendors’ key capabilities [Figure 2].[26,32-40] A trained person was appointed to collect data throughout the 19 hospitals.”
MethodConsumer Health Informatics: Engaging and Empowering Patients and Families
Pandita, D. (2022) · Springer eBooks · doi:10.1007/978-3-030-93765-2_24 · Cited by 10
Barriers Against Adoption of Electronic Health Record in Italy
Bonacina, S., Marceglia, S. R. F., & Pinciroli, F. (2011) · Journal of Healthcare Engineering · doi:10.1260/2040-2295.2.4.509 · Cited by 10
“The EHR can also be considered as a planning tool, supporting the care process, from order entry to results management, including decision support [1, 2].”
A Novel Ontology and Machine Learning Inspired Hybrid Cardiovascular Decision Support Framework
Hussain, A., Farooq, K., Luo, B., & Slack, W. V. (2015) · IEEE Symposium Series on Computational Intelligence (SSCI) · doi:10.1109/ssci.2015.122 · Cited by 13
“Finally overall findings are concluded in section 5.”
BackgroundClinical Leaders’ Self-Perceived eHealth Competencies in the Implementation of New eHealth Services
Kujala, S., Heponiemi, T., & Hilama, P. (2019) · Studies in health technology and informatics · doi:10.3233/shti190427 · Cited by 10
Potential Effects of the Electronic Health Record on the Small Physician Practice: A Delphi Study.
Sines, C. C., & Griffin, G. R. (2017) · Europe PMC (PubMed Central) · Cited by 10
Abdullah, Z. S. (2013) · eSpace (Curtin University) · Cited by 10
The Sri Lankan enigma: demystifying public healthcare information systems acceptance
Senthilrajah, T., & Ahangama, S. (2025) · BMC Health Services Research · doi:10.1186/s12913-024-12173-8 · Cited by 9
Discrete-Event Simulation for Primary Care Redesign: Review and a Case Study
Zhong, X., Williams, M., Li, J., Kraft, S. A., & Sleeth, J. S. (2016) · John Wiley & Sons, Inc. eBooks · doi:10.1002/9781118919408.ch13 · Cited by 9
Sheikh, A., Coleman, J. J., Chuter, A., Williams, R., Lilford, R. J., Slee, A., Morrison, Z., Cresswell, K. M., Robertson, A. R. R., Slight, S. P., et al. (2022) · Programme Grants for Applied Research · doi:10.3310/ksrs2009 · Cited by 12
Offenbeek, V. M., Vos, J. F. J., & Boonstra, A. (2023) · European Journal of Information Systems · doi:10.1080/0960085x.2023.2225786 · Cited by 14
“We add to organisation-level IS adoption studies (Grant, 2003; Ludwick & Doucette, 2009; S. Strong & Volkoff, 2010) that subunit-level technology’s alignment with their critical work system dependencies is a condition for organisation-wide adoption.”
MethodMachado, A. T. G. D. M., de Lima, Â. M. D., de Abreu, D. M. X., Araújo, L. L., Sobrinho, D. F., Lopes, É. A. S., Teixeira, G. H. S., & dos Santos, A. D. F. (2017) · Journal of Ambulatory Care Management · doi:10.1097/jac.0000000000000187 · Cited by 9
Khalifeh, A. F., Saleh, A., AL-Nuimat, M., Abou-Tair, D. E. D. I., & Alnuman, N. (2019) · Communications in computer and information science · doi:10.1007/978-3-030-16785-1_7 · Cited by 9
Rachmani, E., Hsu, C., Chang, P. W., Fuad, A., Nurjanah, N., Shidik, G. F., Ningrum, D. N. A., & Lin, M. (2020) · Primary Health Care Research & Development · doi:10.1017/s1463423620000018 · Cited by 9
“Several studies have reported the increasing use of health information technologies in various programs in PHC, such as inpatient electronic registry, processing, and evaluation programs and management, clinical decision support systems, surveillance, and patients monitoring (Pambudi et al., 2004; Tomasi et al., 2004;…”
BackgroundRequirements and Barriers to Pervasive Health Adoption
Postolache, G. B., Girão, P. S., & Postolache, O. A. (2012) · Smart sensors, measurement and instrumentation · doi:10.1007/978-3-642-32538-0_15 · Cited by 9
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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