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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In the citing paper
“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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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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