Paper citation State MMAT Score Method Context Discipline Brand Topics Theme Evaluation measures Evaluation time Key findings
South et al., 2022
VIC
4
Quantitative
Large paediatric teaching hospital (tertiary & quaternary services)
Multiple / all
Epic
Patient outcomes
Quality & safety
355,709 hospital discharges ITS analysis
2 years pre and post EMR implementation
Sustained decrease (22%) in in-hospital mortality rate following EMR implementation, resulting in one less death per fortnight hospital. Supports investment in EMR systems.
Wynter et al., 2021
VIC
5
Qualitative
Tertiary metropolitan public hospital
Nurses Midwives
-
Workforce satisfaction Usability
Workforce factors
Focus groups (retrospective)
12 months post-EMR implementation
Nurses and midwives had mixed experiences of EMR. Significant training & ongoing support required 12 months following implementation. Negative impacts associated with workflow and patient care.
Witkowski et al., 2021
VIC
5
Qualitative
Tertiary metropolitan public hospital, orthopaedic outpatient clinic
Medical professionals (intern, Resident, Non-accredited registrar, accredited registrar, consultant)
-
Documentation
Service delivery
Retrospective medical record review
Not defined
Overall improvement in orthopaedic documentation in EMR vs paper record but deficiencies in documentation remain. Deficiencies not solved solely with technology. Discharge summaries completed 100% EMR vs 82.5% paper.
Lloyd et al., 2021
All
5
Qualitative
Multiple: Hospitals Primary care Nurses Medical professionals / doctors
-
Workforce satisfaction Usability
Workforce factors
Retrospective, observational online cross-sectional survey. Use of validated NuHISS tool.
Not defined
Nurses and medical professionals have different experiences with EMR usability, dependent on the sector they work in and usability feature measured. Technical quality features were more positively experienced by doctors in the primary care sector than nurses as well as ease of obtaining patient information and prevention of errors. In hospitals, nurses experiences with EMRs were more positive regarding support for routine task completion, learnability, ease of obtaining patient information and entry of patient data.
Firman et al., 2021
QLD
5
Qualitative
Tertiary hospital
Multiple
-
Documentation Medication management Medication safety Service delivery Quality & Safety
Records assessed for appropriateness of timing of collection, compliance to recommended Therapeutic Drug Monitoring (TDM) guidelines, and pharmacist documentation.
2-year retrospective audit. 2016 (paper) vs 2018 (ieMR).
No significant differences between ieMR and paper but there was increased sufficient data to calculate BMI (86%) vs 14% paper based.
Dabliz et al., 2021
NSW
5
Qualitative
Tertiary 750-bed teaching hospital, specialised 12-bed outpatient oncology unit
Nurses Medical professionals / doctors Pharmacists
Cerner
Workforce satisfaction Usability
Workforce factors
Semi-structured interviews assessing usability, using validated unified theory of acceptance and use of technology (UTUAT)
6 months post EMR implementation
Nurses demonstrated overall satisfaction with EMR. Doctors and pharmacists co-perceived usability problems related to restricted autonomy and system complexity. UTAUT framework is useful to evaluate usability of EMR. EMR design can reduce mental effort to search for patient information.
Curtis et al., 2021 NSW 4 Quantitative 4 NSW Hospitals Nurses Cerner Documentation Service delivery Observational pre-post: completion of industry screening tools for substance abuse, falls, and pressure injuries 1 year pre-and post-EMR implementation Increased efficiency noted post-EMR implementation (nursing). Substance use screening & Waterlow screening increased after EMR but OMS (falls) sightly decreased. Proportion with all 3 screens completed increased post-EMR. Overall completion rate low (documentation completion cannot be solved with technology alone).
Bingham et al., 2021
VIC
5
Quantitative
Quaternary hospital – medical / surgical wards
Nurses
-
Medication management Efficiency
Service delivery
Longitudinal quantitative direct observational pre and post time and motion study - using validated Work Observation Method by Activity Timing (WOMBAT)
Immediately prior to, and 6 months post- EMR implementation
Non-significant increase in proportion of time spent on direct care with EMR vs paper. Nurses spent more tasks at bedside vs nursing station.A significant proportion on time spent in transit and indirect work was reduced post EMR. Less interruptions with EMR.
Walker et al., 2020
QLD
5
Quantitative
Tertiary hospital
Nurses
Cerner
Documentation Medication management Efficiency
Service delivery
Structured, continuous observation time and motion (STAMP) observation
Pre-post (2.5 years): 18 months post-EMR implementation
The move from paper-based records to integrated electronic health record did not significantly change the amount of nursing time at the bedside, or for the preparation and administration of ordered medications. Significant increase in median time for documentation activities 18 months following rollout
Schwarz et al., 2020
QLD
4
Qualitative
Hospital
Allied health professionals
Cerner
Workforce satisfaction Usability Efficiency Workforce factors Service delivery
Cross-sectional electronic survey
Varied: largest site survey disseminated 7 months post-implementation
Minimal effect on workplace anxiety and stress, quality of patient care, speed or efficiency. Inability to practice EMR hinders implementation.
Qian et al., 2020 QLD 4 Quantitative Government funded regional drug and alcohol service - - Documentation Service delivery Longitudinal retrospective descriptive data analysis of patient records 40-month longitudinal post-EMR implementation Error rates change over the course of the implementation phases but eventually stabilise. Among all types of errors, service option error accounted for more than half. Errors can help to tailor training.
Eden et al., 2020
QLD
5
Qualitative
Large public tertiary university hospital (one of Australia’s first digital tertiary-care university hospitals)
All, including administrative staff, executive staff, & patients
-
Workforce satisfaction Usability Medication management Workforce factors Service delivery
Single-site case study: semi-structured interviews + focus groups, observations and documentation
Immediately & 6 months post-EMR implementation
New positive perception of EMR: improvements in accountability for care, individual career development, time management, positive impacts re secondary use of data, but mixed findings re availability of real-time data. Many participants attributed success to the hospital’s effective preparation of the workforce, such as establishing a change-ready culture.
Westbrook et al., 2019
Not Stated
3
Quantitative
Australian & English teaching hospitals (wards of)
Pharmacists
-
Medication management Efficiency
Service delivery
Parallel, cross-country, direct observational time and motion studies, using validated WOMBAT tool.
6-month + post-EMR implementation
Increased time spent in medication review post-implementation. Workgroup impacted pharmacists the same in Australia and UK – supports increased applicability of international studies to Australia.
Devchand et al., 2019
VIC
4
Quantitative
Tertiary care referral hospital, ICU
Infectious disease clinician, ICU consultants, Infectious disease fellow, Pharmacists
Cerner
Medication safety Medication management Quality & Safety Service delivery
Cross-sectional prospective review: The ”5 moments of Antimicrobial Prescribing” to antimicrobial stewardship (AMS) compliance.
12 months pre- and post-implementation
Integration of EMR with an ICT-AMS program allowed implementation of a new AMS service, which was associated with a high clinician compliance and improved antibiotic appropriateness. The ”5 moments of Antimicrobial Prescribing” metric provides a framework for measuring AMS recommendation compliance.
Baysari et al., 2019
NSW
4
Qualitative
Paediatric hospital
Pharmacists
Cerner
Workforce satisfaction Medication management Workforce factors Service delivery
Semi structured interviews
4 months pre- and 1-year post-EMR implementation
EMR implementation increased pharmacists’ workload with additional tasks: they were required to review more information and absorb additional information, which increased stress.
Van de Vreede, Clifford & McGrath, 2018
VIC
4
Qualitative
8 hospitals
All, including midwives
Multiple
Workforce satisfaction Usability Medication management Patient safety
Workforce factors
Survey
Various – during & post-EMR implementation
56% agree EMRs reduced potential for medication errors and 58% consider EMRs have introduced new types of errors. Most common issues raised re non-intuitive processes, time-consuming and overreliance on technology. 48% have observed, investigated, or reviewed near misses/errors in EMRs. Errors identified (195 of 664) were incorrect patient selection and incorrect dose scheduling, resulting in dose duplication.
Poon et al., 2018
VIC
1
Mixed methods
Hospital, outpatient dermatology clinic
Medical staff
Custom
Workforce satisfaction Usability Efficiency Patient safety Workforce Factors Service delivery Quality & Safety
Qualitative data obtained by survey, combined with administrative data (number of patients seen per session).
6-12 months post-EMR implementation
Dermatology outpatient clinic numbers overall fell by 12% compared with the year before implementation - most attributed to reduction in number of review patients.
McLain et al., 2017
Not stated
3
Qualitative
2 tertiary teaching hospitals
-
CSC MedChart (Turner)
Documentation Medication management Medication safety Service delivery Quality & Safety
Retrospective descriptive study assessing paper and EMRs against National Inpatient Medication Chart (NIMC) criteria
Post-EMR implementation, time period not defined.
Results appeared superior (re compliance with NIMC audit criteria) for EMR charts than paper NIMCs for all parameters, except documentation of patient weight and indication for medication. EMRs demonstrated a higher rate of pharmacist review of medication orders than NIMC. EMRs increase clarity of prescription, reducing errors associated with these, such as error prone abbreviations (EPAs). EMRs almost entirely eliminate omitted doses due to system design.
Jiang et al., 2016 Not stated 5 Qualitative Aged care Managerial & administration staff - Regulatory requirements Quality & Safety Retrospective qualitative content data analysis using Aged Care Accreditation Standards Not defined The proportion of residential aged care homes using EMRs that met all accreditation standards was significantly higher than those using paper records. Minimal positive benefit having EMR linking to accreditation.
Qian, Yu & Hailey, 2015
NSW
4
Mixed methods
Aged care (high level of care)
Medications staff: Registered nurses Enrolled Nurses Personal carers with qualifications in medication management
-
Usability Medication management Medication safety Efficiency Workforce factors Quality & Safety Service delivery
Time-motion observation case-study
18 months+ post-EMR implementation
EMRs improved compliance with documentation requirements, freedom from signing twice, reducing types of medication documentation. No difference in time found on various activities in a medication round using EMR vs paper.
Munyisia, Yu & Hailey, 2014
NSW
4
Quantitative
Aged care (high level of care)
Registered nurses, Enrolled nurses, Personal carers
-
Efficiency
Service delivery
Observational work sampling (validated): prospective longitudinal cohort case study
Pre-post 25 month longitudinal study
Successful introduction of an EMR system in a nursing home may not interfere with nursing staff time on direct care duties.
Mohan, Bishop & Mallows, 2013
NSW
4
Quantitative
Tertiary teaching hospital
Emergency department (ED) staff
Cerner
Patient outcomes Efficiency Quality & Safety Service delivery
Retrospective quantitative observational cross-sectional analytic study (or case control as control was prior to EMR) using government KPIs for public EDs
3 months post-EMR implementation
Decreased ED KPIs 6 months post EMR implementation: statistically significant increased wait time, total treatment time, increased in did not wait rate, increased proportion of ambulance offload times longer than 30 mins.
Fairley et al., 2013
VIC
4
Mixed methods
Primary care (sexual health)
Medical professionals / doctors Nurses
-
Patient outcomes Workforce satisfaction Documentation Usability Medication management Efficiency Quality & Safety Service Delivery Workforce factors
Pre-post observational study
Not defined
EMR improved efficiency (5% more consultations per hour) & was popular with staff and patients. No difference in quality of paper vs EMR records.
Wang, Yu & Hailey 2013
Not stated
5
Qualitative
Aged care
Registered Nurses Enrolled Nurses
-
Documentation
Service delivery
Retrospective audit to assess completeness, comprehensiveness & compliance with record standards
Not defined
Overall completeness and comprehensiveness rates of admission forms were poor, but higher in electronic records vs paper. An increase in comprehensiveness rate was found in the admission forms in the EMRs vs paper (40% vs 28.6% p<0.01).
Munyisia, Yu & Hailey, 2012
NSW
5
Mixed methods
Aged care
Aged care worker Primary care giver
-
Workforce satisfaction Documentation Usability Efficiency Workforce factors Service delivery
Longitudinal cohort case study using work-sampling technique.
6-12 months post-EMR implementation
Introduction of electronic documentation might not lead to increased efficiency in documentation for caregivers. Primary caregivers found it was easier to search for electronic records rather than manually searching and retrieving paper ones. Longer documentation times were associated with poor user interfaces. Mixed paper/electronic charting may hinder realization of documentation efficiency.