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.