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:
- Therapeutic drug monitoring guidelines (Firman et al., 2021)
- The ‘Five Moments of Antimicrobial Prescribing’ (Devchand et al.,
2019)
- National Inpatient Medication Chart (NIMC) audit criteria (McLain et
al., 2017)
- Aged Care Accreditation Standards (Jiang et al., 2016)
- Current national screening tools for substance abuse, falls, and
pressure injuries (Curtis et al., 2021)
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.