Impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review
File(s)
Published version
OA Location
Author(s)
Li, Edmond
Clarke, Jonathan
Ashrafian, Hutan
Darzi, Ara
Neves, Ana Luisa
Type
Journal Article
Abstract
Background: Electronic health records (EHR) and poor systems interoperability are well-known issues in the use of health information technologies worldwide in most high-income countries. Despite the abundance of literature exploring their relationship, its practical implications on patient safety and quality of care remain unclear.
Objective: To examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income healthcare settings.
Methods: A systematic search was conducted using four online medical journal repositories and grey literature sources. Publications included were published in English between 2010-2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by three researchers in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias assessments was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and the Cochrane Risk of Bias 2 (RoB2) tools. Findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for healthcare quality.
Results: Twelve studies met the inclusion criteria to be included in our review. Findings were categorised into six common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost-savings. EHR interoperability was found to positively influence medication safety, reduce patient safety events, and lower costs. Improvements to time-savings and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty due to the heterogeneity in outcome measures used and notable variation in study quality.
Conclusion: The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect the extensive heterogeneity in the interventions, designs, and outcome measures used. The establishment of common health information technologies research outcome measures would support higher quality research into the topic. Future research efforts should focus on both the positive and negative impact of interoperable EHR interventions as well as explore patient perspectives given the growing trend for patient involvement and stewardship over their own electronic clinical data.
Published Study Protocol: Electronic health records, interoperability, and patient safety in health systems of high-income countries: a systematic review protocol (BMJ Open)
Objective: To examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income healthcare settings.
Methods: A systematic search was conducted using four online medical journal repositories and grey literature sources. Publications included were published in English between 2010-2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by three researchers in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias assessments was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and the Cochrane Risk of Bias 2 (RoB2) tools. Findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for healthcare quality.
Results: Twelve studies met the inclusion criteria to be included in our review. Findings were categorised into six common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost-savings. EHR interoperability was found to positively influence medication safety, reduce patient safety events, and lower costs. Improvements to time-savings and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty due to the heterogeneity in outcome measures used and notable variation in study quality.
Conclusion: The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect the extensive heterogeneity in the interventions, designs, and outcome measures used. The establishment of common health information technologies research outcome measures would support higher quality research into the topic. Future research efforts should focus on both the positive and negative impact of interoperable EHR interventions as well as explore patient perspectives given the growing trend for patient involvement and stewardship over their own electronic clinical data.
Published Study Protocol: Electronic health records, interoperability, and patient safety in health systems of high-income countries: a systematic review protocol (BMJ Open)
Date Issued
2022-09-15
Date Acceptance
2022-08-24
Citation
Journal of Medical Internet Research, 2022, 24 (9), pp.1-15
ISSN
1438-8871
Publisher
JMIR Publications
Start Page
1
End Page
15
Journal / Book Title
Journal of Medical Internet Research
Volume
24
Issue
9
Copyright Statement
©Edmond Li, Jonathan Clarke, Hutan Ashrafian, Ara Darzi, Ana Luisa Neves. Originally published in the Journal of Medical
Internet Research (https://www.jmir.org), 15.09.2022. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly
cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright
and license information must be included.
Internet Research (https://www.jmir.org), 15.09.2022. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly
cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright
and license information must be included.
License URL
Identifier
https://www.jmir.org/2022/9/e38144
Subjects
digital health
electronic health records
health information exchange
interoperability
patient safety
systematic literature review
Developed Countries
Electronic Health Records
Humans
Income
Patient Safety
Quality of Health Care
United States
Humans
Developed Countries
Income
Quality of Health Care
United States
Electronic Health Records
Patient Safety
08 Information and Computing Sciences
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Medical Informatics
Publication Status
Published
Date Publish Online
2022-09-15