JMIR Publications

ABSTRACT

Background:

Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in healthcare worldwide. However, the ongoing implementation of EHRs has the potential to harm patients and health care professionals if they are not well developed or poorly implemented and have unintended consequences. To prevent this, the involvement of users in the development and evaluation of EHRs is crucial and growing. Overall, the design of the involvement is very diverse.

Objective:

Setting, users and their needs as well as the context and practice of healthcare must be taken into account in the design and subsequently implementation of EHRs. However, many different approaches to user involvement exist, each requiring a variety of methodological choices. An overview of existing forms of user involvement, their circumstances and outcomes is needed and can provide support for the planning of new involvement processes.

Methods:

A systematic literature review was carried out to provide a data basis for future projects on which design of inclusion is worthwhile and also to show the diversity of reporting. Using a very broad search string, the databases PubMed, CINAHL, Scopus. Additionally, Google Scholar was searched. Hits were screened according to the scoping review methodology and then examined focusing on methods and materials, participants, outcomes considered, frequency and design of evaluation/development, and competencies of the researchers involved.

Results:

70 articles were included in the final analysis. There was a wide range of methods of involvement, but it was clear that medical professionals and nurses were the most frequently included groups, and in most cases were involved only once in the process. The approach of involvement (e.g. co-design) was not specified in the majority of studies (64%). Further qualitative deficiencies in the reporting were also evident in the presentation of the competences of the members of the research and development teams. Think-aloud sessions, interviews and prototypes were frequently used.

Conclusions:

This review provides insights into the diversity of healthcare professionals' involvement in the development of EHRs. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the reporting of this. This can ensure an assessment of the quality of a development and sufficient consideration of user interests and reduction of unintended consequences by focusing on usability and workload. Clinical Trial: not applicable