JMIR Publications

ABSTRACT

Background:

Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base concerning the effects and advantages of electronic records is questionable. The outcome of health care systems is influenced by many components, making assertions about specific types of interventions difficult. Moreover, electronic records itself constitute a complex intervention offering several functions with possibly positive as well as negatives effects on the outcome of health care systems.

Objective:

To summarize empirical studies about the value of electronic medical records for hospital care published between 2010 and spring 2019.

Methods:

The authors adopted their method from previous periods in a series of literature reviews. The literature search was performed using MEDLINE with “Medical Record System, Computerized" as the essential keyword. The selection process comprised two phases looking for a consent of both authors. Starting with 1.345 references, 23 were finally included in the review. The evaluation combined a scoring of the studies’ quality, a description of data sources in case of secondary data analyses, and a qualitative assessment of the publications’ conclusions concerning the record’s impact on quality and efficiency of health care.

Results:

The majority of the studies stemmed from the USA (83%). Mostly, the studies used publicly available data (“secondary data studies”, 74%). Eighteen studies analyzed the effect of an electronic medical record on the quality of health care (79%), 16 the effect on the efficiency of health care (70%). The primary data studies achieved a mean score of 4.3 ± 1.37 (theoretical maximum 10), the secondary data studies a mean score of 7.1 ± 1.32 (theoretical maximum 9). From the primary data studies, two demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, nine out of 16 respective studies showed a reduction of costs (56%). Fourteen out of 18 studies showed an increase of health care quality (78%); the remaining four studies missed explicit information about the proposed positive effect.

Conclusions:

This review revealed a clear evidence about the value of electronic medical records. In addition to an awesome majority of economic advantages, the review also showed improvements in quality of care by all respective studies. The use of secondary data studies has prevailed over primary data studies in the meantime. Future work could focus on specific aspects of electronic records in order to guide their implementation and operation.