Health workforce groups

Health workforce groups were generally represented evenly, with the exception of allied health staff and midwives being underrepresented in the literature. This impacts usability and worker satisfaction, as this often depends on the features being used in the EMR (Lloyd et al., 2021).

Context

Most studies (n=18) were conducted in tertiary hospitals. Two studies included primary care, four were based in aged care, and one was in a government-funded regional drug and alcohol service.

Approaches to evaluation: existing standards

10 of the 25 studies did not use a standardized tool, industry key performance indicators (KPIs) or acknowledged audit criteria to evaluate their area of interest.
One study stated they used ‘documentation standards’ but did not further define what they were (Wang et al., 2012). Existing auditing guidelines included:
Some studies also referenced the use of work sampling (E. Munyisia et al., 2014; E. N. Munyisia et al., 2012).

Approaches to evaluation: time and motion studies and before-and-after studies

Time and motion studies benefitted from the use of industry-validated tools, such as the Work Observation Method By Activity Training (WOMBAT) (Bingham et al., 2021; Westbrook et al., 2019) which was most popular, and Suggested Time and Motion Procedures (STAMP) structured observation tool (Walker et al., 2020).
An interrupted time series (ITS) analysis was used in in the most recent study by South et al. (2022): a before and after study of 355,709 hospital discharges, over an eight-year period, at a paediatric teaching hospital.
In 2013 standard Department of Health Emergency Department (ED) KPIs were used to determine the impact of an EMR on ED service delivery (Mohan et al., 2013).

Approaches to evaluation: user experience

For user experience, Lloyd et al. (2021) used the validated National Usability-Focused HIS Scale (NuHISS) tool successfully, and promoted its future use. Dabliz et al., (2021) used the Unified Theory of Acceptance and Use of Technology (UTUAT) model.

Links between evidence themes

As referenced in Figure 3 , articles often reported on more than one topic. For example, 10 of the 25 shortlisted studies reported on workforce satisfaction, and the same proportion reported on usability. Other topics reported together were typically medication management & efficiency, and medication safety with medication management. These will be elaborated on in the discussions section.