Executive summary
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, and 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).
To ensure compliance with the 2020-25 National Health Reform Agreement
(Australian Government Department of Health, 2022), so that value for
money can be achieved in an area where competition for resources and
funding is fierce, this scoping literature review will identify the
available evidence, what opportunities there are for improvement, and
where Australia has excelled.
Evidence check question
This review was guided by the question: ‘Has the success of electronic
medical record (EMR) implementation been evaluated both quantitatively
and qualitatively in the Australian health care system?’
Objective
To review available evidence evaluating EMR implementation across all
health settings in Australia, to identify current knowledge gaps, and
provide recommendations for future research on evaluation strategies.
Summary of methods
A scoping literature review of primary, peer-reviewed, academic
literature was performed by a single researcher to identify and map the
available evidence over the past decade (2012-2022) in Australia only.
The PRISMA-ScR methodology was followed, with critical appraisal of
individual evidence sources assessed against the MMAT integrity
checklist. A thematic analysis of findings was then performed on the
shortlisted articles. Because there was no primary data collection
involved, ethical approval was not required (Griffith University, 2022).
Key findings
25 papers met the inclusion criteria. Approximately half of the studies
(n=12) were qualitative, nine were quantitative in nature, and four were
mixed-methods studies. There was an even split of studies in the
Victorian and New South Wales (NSW) settings (32% each) and just 8% in
Queensland. The remainder did not define the location.
14 studies targeted nurses, three targeted midwives, allied health
professionals, and aged care workers, seven targeted pharmacy staff, and
eight targeted doctors/medical staff. Only seven were pre-post studies,
most of which (n=5) were quantitative & based in NSW.
11 of the 25 studies disclosed which EMR system was being assessed, the
majority of which were from Cerner (Cerner Millennium).
High-level findings were grouped into the following topics shown in Figure 1 below.