Adopting Electronic Medical Records in Primary Care: Lessons Learned from Health Information Systems Implementation Experience in Seven Countries

From Clinfowiki
Jump to: navigation, search

This is a review for Ludwick, D. A., and Doucette, J.'s Adopting Electronic Medical Records in Primary Care: Lessons Learned from Health Information Systems Implementation Experience in Seven Countries [1]


The adoption of health information systems is seen world wide as one method to mitigate the widening health care demand and supply gap. The purpose of this review was to identify the current state of knowledge about health information systems adoption in primary care. The goal was to understand factors and influencers affecting implementation outcomes from previous health information systems implementations experiences. A comprehensive systematic literature review of peer reviewed and grey literature was undertaken to identify the current state of knowledge regarding the implementation of health information sys- tems. A total of 6 databases, 27 journal websites, 20 websites from grey sources, 9 websites from medical colleges and professional associations as well as 22 government/commission websites were searched. The searches returned almost 3700 article titles. Eighty-six articles met our inclusion and exclusion criteria. Articles show that systems’ graphical user interface design quality, feature functionality, project management, procurement and users’ previous experience affect implementa- tion outcomes. Implementers had concerns about factors such as privacy, patient safety, provider/patient relations, staff anxiety, time factors, quality of care, finances, efficiency, and liability. The review showed that implementers can insulate the project from such con- cerns by establishing strong leadership, using project management techniques, establishing standards and training their staff to ensure such risks do not compromise implementation success. The review revealed the concept of socio-technical factors, or “fit” factors, that com- plicate health information systems deployment. The socio-technical perspective considers how the technical features of a health information system interact with the social features of a health care work environment. The review showed that quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation. The fact that no articles were found reviewing the benefits or drawbacks of health information systems accruing to patients should be concern to adopters, payers and jurisdictions. No studies were found that compared how provider–patient interactions in interviews are effected when providers used electronic health information systems as opposed to the paper equivalent. Very little information was available about privacy and liability.



Health information systems are being adopted on an international level. The rate of adoption is rising as well. With the promise of decreased errors and increased efficiency the short term problems might undermine these benefits. Shortly after adoption resistance to change by the staff, increased medical errors, and loss of productivity have been all shown to happen. The consensus on previous analyses state that implementation of the system is vital to its success.


PUBMED and MEDLINE were both used. For articles not yet catalogued in databases, general health informatics and practice journals were used. Relevant authors were also searched. The references of each article found—relevant to the study—were also scanned for relevancy. The final step was using Google.


The searches garnered nearly 3700 article titles. After applying the criteria needed to include and exclude due to relevancy, 86 articles were left. The articles were categorized based on what type of health information system they used (electronic health records, CPOE, etc..)and what health care setting they used (hospitals, general practice, etc..). The articles were studied for factors they thought relevant to implementation of health information systems.


Physicians will need financial incentives to better make sure these systems are welcomed. Governments may have to educate physicians on leadership training, project management, and product training services.


This article tackles the impending issue when it comes to health information systems; implementation and utilization in the context of an aging population and decreased physician workforce. This study is highly relevant and the implications even more so in the future.

Similar Article Reviews

An electronic medical records system for clinical research and the EMR–EDC interface


  1. Ludwick, D. A., & Doucette, J. (2009). Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. International journal of medical informatics,78(1), 22-31.