JMIR Publications

ABSTRACT

Background:

As the availability of interoperable electronic health records (iEHRs) or Health Information Exchanges (HIEs) continues to increase, there is greater need and opportunity to assess the current evidence base on what works and what doesn't regarding the adoption, use and impact of iEHRs.

Objective:

The purpose of this project is to assess the international evidence base on the adoption, use and impact of iEHRs.

Methods:

We conducted a systematic review, searching multiple databases (MEDLINE, EMBASE and CINAHL) with supplemental searches conducted in Google Scholar and grey literature sources (Google, greylit.org and opengrey.eu). All searches were conducted in January/February 2017. Articles were eligible for inclusion if they were published in English, from 2006-2017, and were either an original research study or literature review. Articles needed to focus on (i) iEHRs/HIEs, (ii) across multiple health care settings, and address (iii) the adoption/use of iEHRs, and (iv) the evaluation of their impact/effectiveness.

Results:

We included 130 articles in the synthesis (113 empirical studies; 17 reviews), with the majority focused on the United States (68%). The empirical studies focused on a wide range of health care settings, with the three most prevalent settings studied including acute care (52%), primary care (39%), and emergency departments (30%). We identified 29 distinct measurement items in the 113 empirical studies that were linked to 522 specific measurement outcomes. Productivity and quality were the two evaluation dimensions that received the most attention, accounting for 14 of 29 (48%) measurement items and 306 of 522 (59%) measurement outcomes identified. Overall, the majority of the 522 measurement outcomes were positive (57%). We also identified 17 reviews on iEHR use/impact, six that focused on barriers/facilitators to adoption/implementation, and 11 focused on benefits/impacts, with the more recent reviews finding little generalizable evidence of benefit/impact.

Conclusions:

This review captures the status of an evolving and active field focused on the use/impact of iEHRs. While the overall findings suggest many positive impacts, the quality of the empirical research is variable. When broken down by specific measurement item, the results directed attention both to measurement outcomes that were consistently positive and others that were mostly negative or equivocal.