JMIR Publications

ABSTRACT

Background:

The use of electronic medical records (EMRs)* provides potential to reduce unwarranted clinical variation and thereby improve patient healthcare outcomes. Minimization of unwarranted clinical variation may raise and refine the standard of patient care provided and satisfy the quadruple aim of healthcare. *In this paper, EMR (electronic medical record) and EHR (electronic health record) are used interchangeably.

Objective:

A systematic review of the impact of EMRs and specific sub-components (PowerPlans/SmartSets) on variation in clinical care processes in hospital settings was undertaken to summarize the existing literature on the effects of EMRs on clinical variation and patient outcomes.

Methods:

Articles from Jan 2000 - Nov 2020 were identified through a comprehensive search that examined EMR/EHRs and clinical variation or PowerPlans/Smart Sets. Thirty-six articles met the inclusion criteria. Articles were examined for evidence for EMR-induced changes in variation and effects on healthcare outcomes and mapped to the quadruple aim of healthcare.

Results:

Most of the studies reported positive effects of EMR-related interventions. All the included studies discussed clinical variation, but only a minority measured it. In those studies that did, they generally examined how changes to variation affected individual patient care while other outcomes were rarely studied. High-quality study designs were rare.

Conclusions:

The literature provides some evidence that EMRs can help reduce unwarranted clinical variation and thereby improve healthcare outcomes. However, the evidence is surprisingly thin because of insufficient attention to the measurement of clinical variation, and to the chain of evidence from EMRs to variation to healthcare outcomes.