Evaluating the Impact of EMR Implementation in the Australian Health System: A Scoping Literature Review
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?’
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 a 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).
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 settings (32% each) and just 8% in Queensland. The remainder did not define the location setting.
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: patient safety, efficiency, medication management, usability, documentation, workforce satisfaction, and patient outcomes.
Evidence bases of shortlisted articles by topic (articles could be assigned more than one topic)
Further analysis allowed the above topics to be grouped into the following high-level themes for discussion:
- Quality & safety
- Service delivery
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 their evidence base. However, given the complexity 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, 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.