Further analysis allowed the above topics to be grouped into the following high-level themes for discussion:

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 its evidence base. However, given the complexity of 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, particularly 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.

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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, to 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).

The World Health Organisation in their National eHealth Strategy Toolkit (World Health Organization & International Telecommunication Union, 2012) emphatically states the importance and benefits of results-based management (a framework used by the United Nations). This is crucial in the health sector to optimize scarce resources, improve accountability, and enhance the sustainability and effectiveness of operations or program activities. Monitoring and evaluation of eHealth strategies (including EMR implementation) enable quantification of outcomes being delivered and can help communicate this to stakeholders (for example, for investment purposes), and allow corrective action to address outcomes not achieved.

In 2013, The Victorian Auditor-General’s Report on Clinical ICT Systems in the Victorian Public Health Sector identified that the department and health services are unable to report on benefits realization or outcomes from clinical ICT systems (EMRs). Therefore, the Department of Health cannot have effective financial oversight or be able to assess value for money between varying EMR / clinical ICT systems (Victorian Auditor-General’s Office (VAGO), 2013).

Although this is the landscape in Victoria, it should be noted that the digital health strategies of other states all emphasize the importance of ensuring value for money is obtained from technologies, processes, and systems through the use of a benefits realization framework (ACT Government (Health), 2019; Government of Western Australia Department of Health, 2019; Northern Territory Government, 2020; NSW Government, 2021; Queensland Government, 2015; Rockliff, 2021).

Australia needs to bolster its own national evidence base surrounding the outcomes of EMR implementation because Australia faces unique geographical, funding, and political challenges not faced by other origins of literature such as the US and Europe (Jedwab et al., 2019).

Almost ten years on from when Australia started its digital health journey of EMR rollouts (Duckett, 2018b; Jedwab et al., 2019), how much practice has been translated into research, accessible for future learning and optimization of decision-making?

To comply with the 2020-25 National Health Reform Agreement (Australian Government Department of Health, 2022), so value for money can be achieved in an area where competition for resources and funding is fierce, this scoping literature review will identify the current evidence base, where there are opportunities for improvement, and where Australia has excelled.

This report will reference the technology in question as EMR(s), which includes research using the interchangeably used terms in Table 1 below .