Background
Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.
Results
For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.
In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.
Conclusions
Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.
ObjectiveThis scoping review aims to determine the size and scope of the published literature on shared decision making (SDM) using personal health record (PHR) technology and to map the literature in terms of system design and outcomes.
Materials and MethodsLiterature from Medline, Google Scholar, CINAHL, Engineering Village and Web of Science (2005Science ( -2015 using the search terms personal health records, shared decision making, patient-provider communication, decision aid and decision support was included. Articles (n = 38) addressed the efficacy or effectiveness of PHRs for SDM in engaging patients in self-care and decision-making or ways patients may be supported in SDM via PHR.
ResultsAnalysis resulted in an integrated SDM-PHR conceptual framework. An increased interest in SDM via PHR is apparent with 55% of articles published within last 3 years. Sixty percent of the literature originates from the United States. Twenty-six articles addressed a particular clinical condition, with 10 focused on diabetes and one-third offered empirical evidence of patient outcomes. The tethered and standalone PHR architectural types were most studied while the interconnected PHR type was the focus of more recently published methodological approaches and discussion articles.
DiscussionThe study reveals a scarcity of rigorous research on SDM via PHR. Research has focused, on one or a few of the SDM elements and not on its intended complete process.
ConclusionJust as PHR technology designed on an interconnected architecture has the potential to facilitate SDM, the integration of the SDM process into PHR technology has the potential to drive PHR value.
BACKGROUND
In August 2010, the Canadian Health Libraries Association / Association des bibliothèques de la santé du Canada (CHLA / ABSC) distributed a survey to its members and the larger health library community in Canada. The purpose of the survey was to guide the CHLA / ABSC Board of Directors in creating the 2011-2013 Strategic Plan, to understand the demographics of health information professionals in Canada, and to understand the perceived value of CHLA / ABSC membership. Of the 186 respondents, 157 were current CHLA / ABSC members, representing 46% of the membership. This article examines the results of this survey and also compares the results to similar surveys CHLA / ABSC administered in
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