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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Items 401–500 of 666
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“For instance, Ludwick and Doucette (2009), using a systematic literature review of peer-reviewed and grey literature, focused on electronic medical record (EMR) adoption and lessons learned from HIS adoption experience in seven countries.”
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“Learn from the past and others (Ludwick and Doucette 2009; Schmulson et al. 2014) Studying the success and failures can help prevent and avoid mistakes in conjunction with turning a bad situation around”
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“…record of their key health history and care within the health system, and share encounter information available electronically with authorized health care providers and the individual anywhere, anytime in support of high quality care (e.g. Canada Health Infoway, 2006; Ludwick & Doucette, 2009).”
BackgroundRadio Frequency Identification Technologies and Issues in Healthcare
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“4 Changes to legislation, policy and governmentmandated financial factors (incentives or penalties) [156, 258, 393, 394, 390, 399] [388, 241, 400, 395, 224, 225, 401, 399, 402] 5 Capital investment, implementation, maintenance and support costs [154, 240, 234, 393, 235, 241, 403, 242, 243, 262, 264, 390, 225, 237, 238…”
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“In this era of Industry 4.0, the implementation of health information technology is one way to mitigate future disparities (Ludwick & Doucette, 2009).”
InfluentialMathenge, W. C., Uwizeye, O., Whitestone, N., & Cherwek, D. H. (2026) · Dialogues in Health · doi:10.1016/j.dialog.2026.100332 · Cited by 1
“Research consistently shows that the failure of a healthcare technology is often not due to technical flaws but to organizational barriers, such as poor workflow integration, lack of supportive management, and misaligned policies [11,12].”
Methods for Interpretation of Data in Medical Informatics
Mirkin, B. (2013) · Studies in computational intelligence · doi:10.1007/978-3-319-00029-9_2 · Cited by 1
Research on text data mining of hospital patient records within Electronic Medical Records
Kushima, M., Araki, K., Suzuki, M., Yamazaki, T., & Sonehara, N. (2014) · Joint International Conference on Soft Computing and Intelligent Systems and International Symposium on Advanced Intelligent Systems (SCIS&ISIS) · doi:10.1109/scis-isis.2014.7044651 · Cited by 1
Perumal, R., & Desai, H. B. (2014) · South African journal of information management · doi:10.4102/sajim.v16i1.617 · Cited by 1
Electronic Decision Support in Diagnosis of Heart Disease
Armstrong, G., Cave, A., & Delany, R. (2012) · Procedia Technology · doi:10.1016/j.protcy.2012.09.075 · Cited by 1
Time does not heal usability issues!
Janols, R. (2012) · Australian Conference on Computer-Human Interaction (OzCHI) · doi:10.1145/2414536.2414582 · Cited by 1
“INTRODUCTION Research has for decades shown that it is hard to deploy information technology (IT) in health care settings (Southon et al., 1997, Ludwick and Doucette, 2009, Leonard, 2004, Kreps and Richardson, 2007, Berg, 2001, Nilsson, 2007).”
BackgroundEMRs are here to stay, but ...
Chrones, J. (2015) · Europe PMC (PubMed Central) · Cited by 1
Double Entry Data Capture as an Alternative Solution for Quality of E-Health Records
Ndume, V. A., Nkansah-Gyekye, Y., & Ko, J. (2014) · International Journal of Computer Applications · doi:10.5120/16204-5490 · Cited by 1
LiSE: A Personal Booklet for Health Care Annotation
Macrì, M., Mastratisi, M. A., Mirarchi, D., Francesco, E. D., Granata, L., Tradigo, G., Guzzi, P. H., & Veltri, P. (2015) · IEEE International Conference on Healthcare Informatics (ICHI) · doi:10.1109/ichi.2015.51 · Cited by 1
“Index terms: Electronic Clinical Records; Health Process Management; Personalized Clinics I. INTRODUCTION Recent legislation has stimulated Italian National Health Service and healthcare companies the rapid adoption of electronic clinical records, an already active reality in many other countries.”
BackgroundInfluentialICTs, E-health, and Multidisciplinary Healthcare Teams
Olaniran, B. A. (2016) · International Journal of Privacy and Health Information Management · doi:10.4018/ijphim.2016070105 · Cited by 1
Cavalini, L. T., & Cook, T. W. (2012) · Cited by 1
Thorsen, B., Nilsen, G. S., & Moe, C. E. (2012) · Cited by 1
Biometric authentication for securing life cycle management of electronic patient records
Salleh, M. I. M., Rosman, M. R. M., & Yaacob, R. A. (2011) · International Conference on Computer Applications and Industrial Electronics · doi:10.1109/iccaie.2011.6162205 · Cited by 1
“Although the adoption of EMR is relatively new in Malaysia, the efforts in ensuring the security and confidentiality of medical records are becoming an increasingly need as modern information and communication technologies (ICTs) have been integrated into existing medical services.”
BackgroundHealthcare IT Value Hierarchy Framework for the Small Physician Practices Context
Wallace, S., & Iyer, L. (2017) · Journal of the Midwest Association for Information Systems · doi:10.17705/3jmwa.00033 · Cited by 1
“While there have been multiple studies on HIT in hospitals and large practices, there have been few studies that have directly examined HITs in Small Physician Practices (SPP) (Ludwick & Doucette, 2009).”
BackgroundKester, Q.-A. (2017) · Lecture notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering · doi:10.1007/978-3-319-66742-3_27 · Cited by 1
“Medical record histories of patients are very critical in understanding behavior and traits of diseases over time [5, 6].”
BackgroundeHealth Infrastructures and Security in Portuguese Hospitals: Benchmarking with European Hospitals
Carvalho, J. V., Rocha, Á., & Abreu, A. J. (2018) · Advances in intelligent systems and computing · doi:10.1007/978-3-319-74980-8_1 · Cited by 1
Kobusinge, G. (2020) · doi:10.5121/csit.2020.100502 · Cited by 1
“Yet according to [16] a system is as good as its implementation process.”
BackgroundTHE RIGHT BALANCE BETWEEN TECHNOLOGY AND PATIENT CARE
Mohammed, H. (2018) · Mansoura Nursing Journal · doi:10.21608/mnj.2018.150638 · Cited by 1
Explicit and Implicit Section Identification from Clinical Discharge Summaries
Abbas, A., Hussain, J., Afzal, M., Bilal, H. S. M., Lee, S., & Jeon, S. (2022) · International Conference on Ubiquitous Information Management and Communication (IMCOM) · doi:10.1109/imcom53663.2022.9721771 · Cited by 1
Genetic Data Governance in Japanese Hospitals
Suzuki, M. Y., Ohnuki, Y., & Takeshita, K. (2023) · Asian Bioethics Review · doi:10.1007/s41649-023-00242-9 · Cited by 1
“…in clinical oncology, and patients’ concerns about privacy have required the management of genetic information to be addressed (Annas 1993; Ludwick and Doucette 2009; Rothman et al. 2012; Peters and Khan 2014; Papoutsi et al. 2015; Entzeridou et al. 2018; Eno et al. 2020; Issa et al.…”
BackgroundBreaking the 80:20 rule in health research using large administrative data sets
Vik, S., Seidel, J. E., Smith, C. J., & Marshall, D. A. (2023) · Health Informatics Journal · doi:10.1177/14604582231180581 · Cited by 1
“Health care research projects frequently involve integration of multiple large data sets, such as electronic medical records from practitioners ’ of fi ces 1,2 and population-based linked administrative health data for physicians ’ claims, hospital stays and medication records.”
BackgroundChoironi, E. A., & Heryawan, L. (2023) · Jurnal Ilmiah Informatika Global · doi:10.36982/jiig.v13i3.2691 · Cited by 5
Jormanainen, V. J. (2024) · Communications in computer and information science · doi:10.1007/978-3-031-59080-1_6 · Cited by 1
Federated learning in healthcare: A systematic review of evolution from traditional paper records
Garg, R., Varia, M., Gorimar, U., Siganporia, A., & Gupta, N. (2024) · AIP conference proceedings · doi:10.1063/5.0228108 · Cited by 1
Implementing Scanned Medical Record Systems in Australia
McAuley, E., Unnithan, C. R., & Karamzalis, S. (2012) · International Journal of E-Adoption · doi:10.4018/jea.2012100103 · Cited by 1
“A study by Ludwick and Doucette (2009) in seven countries revealed that the adoption rates for medical records are on the rise amidst concerns regarding privacy and safety of patients.”
BackgroundZardini, A., Rossignoli, C., Suppa, A., Ricciardi, F., & Benetollo, P. P. (2014) · International Journal of Healthcare Technology and Management · doi:10.1504/ijhtm.2014.067130 · Cited by 1
“Matters could be further complicated by the organisation’s culture; therefore, the culture must also be evaluated carefully during both the design and the implementation phase (Pagliari, 2007; Ludwick and Doucette, 2009; Boonstra and Broekhuis, 2010).”
Backgroundde Oliveira, J. F. (2014) · Revista de Gestão em Sistemas de Saúde · doi:10.5585/rgss.v3i1.82 · Cited by 1
Review of Factors Impacting Decisions Regarding Electronic Records
Hogaboam, L., & Daim, T. U. (2016) · Innovation, technology and knowledge management · doi:10.1007/978-3-319-17975-9_6 · Cited by 1
Shieh, M., Chang, C.-H., Shieh, Y. Y., Lee, T., & Goodwin, S. (2013) · IEEE International Conference on Consumer Electronics - Berlin (ICCE-Berlin) · doi:10.1109/icce-berlin.2013.6698060 · Cited by 1
“Ludwick et al pointed out the necessity of maintaining a balanced socio-technical perspective [4].”
BackgroundWASF — Weighted average based subjective feedback system for E-healthcare services
Silas, S., Rajsingh, E. B., & Issac, T. (2016) · International Conference on Next Generation Computing Technologies · doi:10.1109/ngct.2016.7877386 · Cited by 1
“The escalation in the number of healthcare services has ensured the significant role of information technology [20] in providing suitable healthcare service.”
BackgroundParthasarathy, R. (2017) · Digital Commons-DePaul (DePaul University) · Cited by 1
Development of an “Alert Framework” Based on the Practices in the Medical Front
Takuya, S., Araki, K., Yamazaki, T., Koichi, K., Maeda, M., Kushima, M., & Araki, S. (2018) · Journal of Medical Systems · doi:10.1007/s10916-018-0967-9 · Cited by 1
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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