Further analysis allowed the above topics to be grouped into the
following high-level themes for discussion:
- Quality & safety
- Service delivery
- Workforce-related
Conclusion
There is no consistent framework to evaluate EMR implementation in
Australia, making return on investment, and impacts on healthcare
delivery difficult to define. Overall, Australia has answered the call
to arms to increase its evidence base. However, given the complexity of designing and executing research in this field, the quality and
quantity of available evidence may not be sufficient to drive policy
reform or recommendations for future evaluation strategies, particularly since most
of the evidence is qualitative. The evidence captured in this scoping
review generally supports EMR implementation, demonstrating benefits
such as improved efficiency, safety, and patient outcome; though is
constrained by research based on various EMR systems in different
settings and among different user groups. The use of validated,
standardized evaluation tools such as WOMBAT, STAMP, and NuHISS is
advocated to ensure consistency and reliability in future evaluations.
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Main Body
Background
An EMR is an electronic medical record, also known as an electronic health
record (EHR), and is a computerized database containing patient
information (demographics, admission data, clinical notes, test results,
medications, etc.) and accounting information (McGraw-Hill, 2002). EMRs
often include additional features to streamline care, such as decision aids for clinicians, to theoretically improve efficiency and
reduce human error in healthcare (Australian Digital Health Agency,
2021; Duckett, 2018b).
The Australian public health system has only started to implement EMRs
and related technologies to advance digital health over the past decade
or so, amongst a complex and fragmented funding system shared between
the Commonwealth and the States and Territories (Duckett, 2018b; Jedwab
et al., 2019).
The World Health Organisation in their National eHealth Strategy Toolkit
(World Health Organization & International Telecommunication Union,
2012) emphatically states the importance and benefits of results-based
management (a framework used by the United Nations). This is crucial in
the health sector to optimize scarce resources, improve accountability,
and enhance the sustainability and effectiveness of operations or program
activities. Monitoring and evaluation of eHealth strategies (including
EMR implementation) enable quantification of outcomes being delivered
and can help communicate this to stakeholders (for example, for
investment purposes), and allow corrective action to address outcomes
not achieved.
In 2013, The Victorian Auditor-General’s Report on Clinical ICT Systems
in the Victorian Public Health Sector identified that the department and
health services are unable to report on benefits realization or outcomes
from clinical ICT systems (EMRs). Therefore, the Department of Health
cannot have effective financial oversight or be able to assess value
for money between varying EMR / clinical ICT systems (Victorian
Auditor-General’s Office (VAGO), 2013).
Although this is the landscape in Victoria, it should be noted that the
digital health strategies of other states all emphasize the importance
of ensuring value for money is obtained from technologies, processes,
and systems through the use of a benefits realization framework (ACT
Government (Health), 2019; Government of Western Australia Department of
Health, 2019; Northern Territory Government, 2020; NSW Government, 2021;
Queensland Government, 2015; Rockliff, 2021).
Australia needs to bolster its own national evidence base surrounding
the outcomes of EMR implementation because Australia faces unique
geographical, funding, and political challenges not faced by other
origins of literature such as the US and Europe (Jedwab et al., 2019).
Almost ten years on from when Australia started its digital health
journey of EMR rollouts (Duckett, 2018b; Jedwab et al., 2019), how much
practice has been translated into research, accessible for future
learning and optimization of decision-making?
To comply with the 2020-25 National Health Reform Agreement
(Australian Government Department of Health, 2022), so value for money
can be achieved in an area where competition for resources and funding
is fierce, this scoping literature review will identify the current
evidence base, where there are opportunities for improvement, and where
Australia has excelled.
Definitions and key terms
This report will reference the technology in question as EMR(s), which
includes research using the interchangeably used terms in Table
1 below .
Table 1 Definitions of interchangeable EMR key terms used in search
strategy