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.
|