Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 21, 2022
Date Accepted: Aug 23, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review
ABSTRACT
Background:
Electronic health records (EHR) and poor systems interoperability are well-known issues in the use of health information technologies worldwide in most high-income countries. Despite the abundance of literature exploring their relationship, its practical implications on patient safety and quality of care remain unclear.
Objective:
To examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income healthcare settings.
Methods:
A systematic search was conducted using four online medical journal repositories and grey literature sources. Publications included were published in English between 2010-2020, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by three researchers in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias assessments was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and the Cochrane Risk of Bias 2 (RoB2) tools. Findings were aggregated and presented as a narrative synthesis.
Results:
Ten studies met the inclusion criteria to be included in our review. Findings were categorised into five common outcome measures: patient safety events, medication safety, data quality, productivity, and cost-savings. EHR interoperability was found to positively influence medication safety, reduce patient safety events, and lower costs. Improvements to time-savings and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty due to the heterogeneity in outcome measures used and notable variation in study quality.
Conclusions:
The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect the extensive heterogeneity in the interventions, designs, and outcome measures used. The establishment of common health information technologies research outcome measures would support higher quality research into the topic. Future research efforts should focus on patient perspectives given the growing trend for patient involvement and stewardship over their own electronic clinical data. Clinical Trial: PROSPERO registration number CRD42020209285
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