Background
Study aim, theoretical framework, and terminology
Methods
Search strategies
Search strategy | Terms used** |
---|---|
[1] | “Electronic Health Record*” + implement* + hospital* |
[2] | “Electronic Health Record*” + implement* + “health care” |
[3] | “Electronic Health Record*” + implement* + clinic* |
[4] | “Electronic Patient Record*” + implement* + hospital* |
[5] | “Electronic Patient Record*” + implement* + “health care” |
[6] | “Electronic Patient Record*” + implement* + clinic* |
[7] | “Electronic Medical Record*” + implement* + hospital* |
[8] | “Electronic Medical Record*” + implement* + “health care” |
[9] | “Electronic Medical Record*” + implement* + clinic* |
[10] | “Computeri?ed Patient Record*” + implement* + hospital* |
[11] | “Computeri?ed Patient Record*” + implement* + “health care” |
[12] | “Computeri?ed Patient Record*” + implement* + clinic* |
[13] | “Electronic Health Care Record*” + implement* + hospital* |
[14] | “Electronic Health Care Record*” + implement* + “health care” |
[15] | “Electronic Health Care Record*” + implement* + clinic* |
[16] | “Computeri?ed Physician Order Entry” + implement* + hospital* |
[17] | “Computeri?ed Physician Order Entry” + implement* + “health care” |
[18] | “Computeri?ed Physician Order Entry” + implement* + clinic* |
Data analysis
Results
Paper selection
Author | Country/region | Main objective of study | Type of research | Data collection | Participants (sample size, response rate) | Hospital type | Impact factor* | Citations** |
---|---|---|---|---|---|---|---|---|
Aarts et al. [21] | The Netherlands | To examine the three theoretical aspects (social process, emergent change, socially negotiated judgments) to understand the implementation process. | Qualitative | Semi-structured interviews, observations, document analysis | 10 members of the project team from different disciplines | Teaching hospital | 4.329 | 194 |
Aarts & Berg [22] | The Netherlands | To understand the outcomes of CPOE implementation using a heuristic model and to identify factors that determine successful implementation. | Qualitative | Open interviews, observations, document analysis | 25 interviews with project team members, physicians, nurses, technical and clerical personnel | Teaching hospital & regional hospital | 1.090 | 47 |
Ash et al. [23] | USA/Virginia, Washington, California | To find out how some hospitals had successfully implemented POE. | Quantitative and Qualitative | Survey, semi-structured interviews, focus groups, observations | Quantitative: 1000 hospitals (37% response rate) Qualitative: 32 interviews with physicians, nurses, pharmacists, IT-staff, administrators | quantitative : 1000 hospitals qualitative: 2 teaching hospitals, 2 community hospitals | - | 37 |
Ash et al. [24] | USA/Virginia, Washington, California | To describe perceptions of POE held by diverse professionals at both teaching and nonteaching sites where POE has been successfully implemented. | Qualitative | Semi-structured interviews, focus groups, observations | Physicians, administrators, and information technology personnel | 2 teaching hospitals, 2 community hospitals | 4.329 | 160 |
Boyer et al. [25] | France | To examine health care professionals’ opinions on the critical events (opportunities and barriers) surrounding EMR implementation | Qualitative | Semi-structured interviews | 115 psychiatrists, nurses, psychologists and social assistants, secretaries and administrative professionals | Psychiatric teaching hospital | 0.420 | 0 |
Cresswell et al. [26] | United Kingdom | To explore how EHR has shaped professional practice and what consequences these changes had for organizational functioning, record keeping and patient care. | Qualitative | Semi-structured interviews, observations, documents | 66 users and other hospital staff, | 3 hospitals, 1 acute setting, 1 community and mental health. | - | 13 |
Ford et al. [27] | USA | To assess complete versus incomplete HIT implementation levels among U.S. hospitals in light of the various technology adoption strategies employed and to discuss the implications with respect to meaningful use for hospitals that have adopted the different HIT strategies. | Quantitative | Survey | 1,814 hospitals | All kinds of hospitals | - | 13 |
Gastaldi et al. [28] | Italy | To examine how hospital performance can be improved by enhancing and balancing knowledge exploration and exploitation capabilities through the development of an EMR. | Qualitative | Interviews, archival data | 27 interviews in three hospitals | 3 hospitals, 2 teaching and 1 non-teaching | - | 2 |
Houser & Johnson [29] | USA/Alabama | 1. To determine the status of implementation of EHRs in hospitals in the state of Alabama; 2. To assess the factors that are driving the decision making for implementation of EHRs; and 3. To assess the perceptions of HIM professionals of the benefits, barriers, and risks that are associated with implementation of EHRs. | Quantitative | Survey | 131 directors in health information management, 69% response rate | Members of the Alabama Hospital Association | - | 19 |
Jaana et al. [30] | USA/Iowa | To present an overview of clinical information systems (IS) in hospitals and to analyze the level of electronic medical records (EMR) implementation in relation to clinical IS capabilities and organizational characteristics. | Quantitative | Survey | 116 CEOs or CIOs, 84% response rate | Nonfederal hospitals | - | 3 |
Katsma et al. [31] | The Netherlands | To contribute to the developments in method engineering, which promises a better participation of the user. | Qualitative | Interviews | 12 people, being supported sponsor, process owner or key-user | 4 hospitals | - | 4 |
Ovretveit et al. [32] | Sweden | To describe and assess an implementation in one hospital and analyze this in relation to factors suggested by previous research to be important for successful implementation as well as in relation to a published USA case study, which used similar methods. | Qualitative | Interviews | 30 persons, project leaders, supervisors, heads of division and clinics, instructor, nurses, physicians, and doctor secretary | Teaching hospital | 2.480 | 86 |
Poon et al. [33] | USA | To provide more insight into the challenges to CPOE implementation. | Qualitative | Interviews | 52 CIOs/CFOs/CMOs and senior managers from 26 hospitals (46 hospitals were contacted: 57% response rate | Both teaching and non-teaching hospitals | 3.748 | 269 |
Rivard et al. [34] | Canada | To propose a substantive theory – a theory developed for a particular area of inquiry (Gregor, 2006) – to provide an organizational culture-based explanation of the level of difficulty of a CIS implementation and of the implementation practices that can help reduce the level of difficulty of this process. | Qualitative | Interviews | 43 people, physicians, nurses, and administrators | 3 hospitals, 2 teaching and 1 community hospital | 2.654 | 9 |
Scott et al. [35] | USA/Hawaii | To examine users’ attitudes to implementation of an electronic medical record system in Kaiser Permanente Hawaii. | Qualitative | Interviews | 26 senior physicians, managers and project team members | One hospital, 4 clinics | 13.511 | 174 |
Simon et al. [36] | USA/Massachusetts | To identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation | Qualitative | Interviews, observations | 24 physicians, nurses and pharmacists | 5 community hospitals | - | 2 |
Takian et al. [37] | England | To report on a case study of the implementation of an EHR (RiO) into a mental health setting delivered though the NPfIT and analyzed using our adapted ‘socio technical changing framework’. | Qualitative | Interviews, observations, document analysis | 48 interviews with senior managers, implementation team members, healthcare practitioners | Mental health hospital | 2.254 | 0 |
Ward et al. [38] | USA | To examine the impact of clinical information system implementation on nurses’ perceptions of workflow and patient care throughout the implementation process. | Quantitative | Survey | 705 nurses | Rural hospital | - | 3 |
Ward et al. [39] | USA | To examine staff perceptions of patient care quality and the processes before and after implementation of a comprehensive clinical information system (CIS) in critical access hospitals (CAHs). | Quantitative | Survey | 840 nurses, providers, and other clinical staff | Critical access hospitals | 2.540 | 0 |
Weir et al. [19] | USA/Utah | To identify factors that discriminate successful from non-successful implementation of OE/RR 2.5 in order to prepare for the next version. | Quantitative | Survey | 52 medical administration staff, administrators, support staff, users (ward clerks, physicians, and nurses), and physician opinion leaders (92 received survey, thus 57% response rate) | 6 hospitals | - | 29 |
Yoon-Flannery et al. [40] | USA/New York | To determine pre-implementation perspectives of institutional, practice and vendor leadership regarding best practice for implementation of two ambulatory electronic health records (EHRs) at an academic institution. | Qualitative | Interviews | 31 interviews with institutional leaders, practice leaders and vendor leaders. | Teaching hospital | - | 25 |
Theoretical perspectives of reviewed articles
Author | Theoretical framework |
---|---|
Aarts et al. [21] | Three theoretical aspects: 1) sociotechnical approach, 2) emergent change with an unpredictable outcome, and 3) “success” and “failure” are socially negotiated judgments and is determined by the fit between work processes and information technology. |
Aarts & Berg [22] | A model on success or failure of information systems with four variables: (1) information system, (2) support base, (3) medical work practices, and (4) hospital organization. Successful implementation of an information system (1) is defined as the capability to create a support base (2) for the change of (medical) work practices (3) induced by the system (4). |
Ash et al. [23] | None |
Ash et al. [24] | None |
Boyer et al. [25] | None |
Cress-well et al. [26] | Study draws on Actor-Network Theory, which helps to investigate how the centrally procured EHR has plays an active role in shaping social relationships. |
Ford et al. [27] | HIT adoption strategies: (1) Single-vendor strategy, (2) Best of Breed strategy, and (3) Best of Suite strategy. |
Gastaldi et al. [28] | The notion that the capability of any organization to create sustainable organizational value not only resides in the ownership of knowledge assets guaranteeing the present competitive advantage (knowledge exploitation), but also in the ability to understand and govern the continuous development of knowledge assets necessary to renew its organizational capabilities (knowledge exploitation). |
Houser & Johnson [29] | None |
Jaana et al. [30] | None |
Katsma et al. [31] | IT implementation success is determined by quality (relevance) times acceptation (participation). Relevance is defined as the degree to which the user expects that the IT system will solve his problems or help to realize his actually relevant goals. Participation of employees is perceived to increase their acceptation of the IT system. Effectiveness of participation is moderated by organizational receptiveness, individual ego development, and knowledge availability. |
Ovretveit et al. [32] | None |
Poon et al. [33] | None |
Rivard et al. [34] | A culture-based explanation of the level of difficulty of a CIS implementation, using an integration perspective (basic assumptions are shared among the members of the collective), a differentiation perspective (subgroups within a collective have inconsistent interpretations), and a fragmentation perspective (members within a collective sometimes manifest multiple interpretations, irrespective their subgroup). |
Scott et al. [35] | None |
Simon et al. [36] | None |
Takian et al. [37] | A sociotechnical framework as identified by Aarts et al. (2004), underscoring the emerging nature of change. |
Ward et al. [38] | None |
Ward et al. [39] | None |
Weir et al. [19] | None |
Yoon-Flannery et al. [40] | None |
Implementation-related findings
Category A - context
General finding | Finding code | Article numbers |
---|---|---|
Large (or system-affiliated), urban, not-for-profit, and teaching hospitals are more likely to have implemented an EHR system due to having greater financial capabilities, a greater change readiness, and less focus on profit. | A1 | 27/29/30/32 |
EHR implementation requires the selection of a mature vendor who is committed to providing a system that fits the hospital’s specific needs. | A2 | 28/32/33 |
The presence of hospital staff with previous experience of Health Information Technology increases the likelihood of EHR implementation as less uncertainty is experienced by the end-users. | A3 | 19/29/32/37/38 |
An organizational culture that supports collaboration and teamwork fosters EHR implementation success because trust between employees is higher. | A4 | 23/24/25/35 |
EHR implementation is most likely in an organization with little bureaucracy and considerable flexibility as changes can be rapidly made. | A5 | 19/25 |
EHR system implementation is difficult because cure and care activities must be ensured at all times. | A6 | 28/34/39 |
A1: Large (or system-affiliated), urban, not-for-profit, and teaching hospitals are more likely to have implemented an EHR system due to having greater financial capabilities, a greater change readiness, and less focus on profit
A2: EHR implementation requires the selection of a mature vendor who is committed to providing a system that fits the hospital’s specific needs
A3: The presence of hospital staff with previous experience of health information technology increases the likelihood of EHR implementation as less uncertainty is experienced by the end-users
A4: An organizational culture that supports collaboration and teamwork fosters EHR implementation success because trust between employees is higher
A5: EHR implementation is most likely in an organization with little bureaucracy and considerable flexibility as changes can be rapidly made
A6: EHR system implementation is difficult because cure and care activities must be ensured at all times
Category B - content
General finding | Finding code | Article numbers |
---|---|---|
Creating a fit by adapting both the technology and work practices is a key factor in the implementation of EHR. | B1 | 19/21/26/28/31/37 |
Hardware availability and system reliability in terms of speed, availability, safety, and a lack of failures, are necessary to ensure EHR use. | B2 | 19/24/25/29/30/35/37/40 |
To ensure EHR implementation, the software needs to be user-friendly with regard to ease of use, efficiency in use, and functionality. | B3 | 19/24/32 |
An EHR implementation should contain adequate safeguards for patient privacy and confidentiality. | B4 | 25/29/37/40 |
EHR implementations require a vendor who is willing to adapt its product to hospital work processes. | B5 | 32/33 |
B1: Creating a fit by adapting both the technology and work practices is a key factor in the implementation of EHR
B2: Hardware availability and system reliability, in terms of speed, availability, and a lack of failures, are necessary to ensure EHR use
B3: To ensure EHR implementation, the software needs to be user-friendly with regard to ease of use, efficiency in use, and functionality
B4: An EHR implementation should contain adequate safeguards for patient privacy and confidentiality
B5: EHR implementation requires a vendor who is willing to adapt its product to hospital work processes
Category C - process
General finding | Finding code | Article numbers |
---|---|---|
Due to their influential position, management’s active involvement and support is positively associated with EHR implementation, and also counterbalances the physicians’ medical dominance. | C1 | 19/24/25/32/33/34/35 |
Participation of clinical staff in the implementation process increases support for and acceptance of the EHR implementation. | C2 | 19/25/26/28/32/35/36 |
Training end-users and providing real-time support is important for EHR implementation success. | C3 | 19/29/32/36 |
A comprehensive implementation strategy, offering both clear guidance and room for emergent change, is needed for implementing an EHR system. | C4 | 19/21/25/26/28/31/37/40/36 |
Establishing an interdisciplinary implementation group consisting of developers, members of the IT department, and end-users fosters EHR implementation success. | C5 | 19/32/36 |
Resistance of clinical staff, in particular of physicians, is a major barrier to EHR implementation, but can be reduced by addressing their concerns. | C6 | 22/24/26/28/29/33/36 |
C7: Identifying champions among clinical staff reduces resistance. | C7 | 32/33/36 |
Assigning a sufficient number of staff and other resources to the EHR implementation process is important in adequately implementing the system. | C8 | 19/26/32/33/36 |
C1: Due to their influential position, management’s active involvement and support is positively associated with EHR implementation, and also counterbalances the physicians’ medical dominance
C2: Participation of clinical staff in the implementation process increases support for and acceptance of the EHR implementation
C3: Training end-users and providing real-time support is important for EHR implementation success
C4: A comprehensive implementation strategy, offering both clear guidance and room for emergent change, is needed for implementing an EHR system
C5: Establishing an interdisciplinary implementation group consisting of developers, members of the IT department, and end-users fosters EHR implementation success
C6: Resistance of clinical staff, in particular of physicians, is a major barrier to EHR implementation, but can be reduced by addressing their concerns
C7: Identifying champions among clinical staff reduces resistance
C8: Assigning a sufficient number of staff and other resources to the EHR implementation process is important in adequately implementing the system
Discussion
Subject | Related findings | Nr. of articles |
---|---|---|
Leadership and involvement in the process | C1, C2, C5, C8 | 10 |
Vendor | A2, B5 | 3 |
Implementation strategy | C4, C5, | 10 |
Role of clinical staff (in particular the physicians) | C6, C7, | 8 |
Users’ skills/experience | A3, C3 | 6 |
EHR system | B2, B3 | 8 |
Patient issues | A6, B4, | 7 |
Hospital demographics | A1 | 4 |
Organizational culture | A4 | 4 |
Organizational structure | A5 | 2 |
Fit between work processes and EHR system | B1 | 6 |
Conclusions
Appendix
Appendix A - List of databases
Web of Knowledge
EBSCO
The Cochrane Library
Appendix B - Quality assessment
Criteria qualitative studies | [21] | [22] | [24] | [25] | [26] | [28] | [31] | [32] | [33] | [34] | [35] | [36] | [37] | [40] |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Question/objective sufficiently described? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 1 | 2 |
Study design evident and appropriate? | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
Context for the study clear? | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 2 | 1 |
Connection to a theoretical framework/wider body of knowledge? | 2 | 1 | 0 | 2 | 1 | 0 | 2 | 2 | 0 | 2 | 1 | 0 | 2 | 1 |
Sampling strategy described, relevant and justified? | 0 | 0 | 2 | 2 | 2 | 2 | 1 | 0 | 1 | 2 | 1 | 2 | 2 | 2 |
Data collection methods clearly described and systematic? | 1 | 1 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 1 | 1 | 2 | 1 | 2 |
Data analysis clearly described and systematic? | 0 | 0 | 1 | 1 | 1 | 2 | 0 | 1 | 1 | 2 | 1 | 2 | 1 | 2 |
Use of verification procedure (s) to establish credibility? | 0 | 2 | 2 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 2 | 0 |
Conclusions supported by the results? | 1 | 2 | 2 | 2 | 2 | 0 | 1 | 2 | 2 | 2 | 2 | 2 | 1 | 2 |
Reflexivity of the account? | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 2 | 2 | 2 |
Total score/possible maximum score |
10/20
|
12/20
|
15/20
|
15/20
|
15/20
|
13/20
|
10/20
|
13/20
|
11/20
|
15/20
|
10/20
|
17/20
|
16/20
|
16/20
|
Criteria quantitative studies | [27] | [29] | [30] | [44] | [38] | [39] | [19] |
---|---|---|---|---|---|---|---|
Question/objective sufficiently described? | 2 | 2 | 2 | 1 | 2 | 2 | 2 |
Study design evident and appropriate? | 2 | 2 | 2 | 1 | 2 | 2 | 2 |
Method of subject/comparison group selection or source of information/input variables described and appropriate? | 1 | 2 | 1 | 1 | 2 | 1 | 2 |
Subject (and comparison group, if applicable) characteristics sufficiently described? | 2 | 2 | 2 | 1 | 2 | 2 | 1 |
If interventional and random allocation was possible, was it described? | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
If interventional and blinding of investigators was possible, was it reported? | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
If interventional and blinding of subjects was possible, was it reported? | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Outcome and (if applicable) exposure measure (s) well defined and robust to measurement/misclassification bias? Means of assessment reported? | 0 | 2 | 1 | 0 | 2 | 2 | 2 |
Sample size appropriate? | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
Analytic methods described/justified and appropriate? | 1 | 1 | 2 | 0 | 0 | 1 | 2 |
Some estimate of variance is reported for the main results? | 1 | 0 | 2 | 0 | 1 | 1 | N/A |
Controlled for confounding? | 2 | 1 | 2 | 0 | 1 | 1 | N/A |
Results reported in sufficient detail? | 2 | 2 | 2 | 1 | 2 | 2 | 2 |
Conclusions supported by the results? | 1 | 2 | 2 | 2 | 2 | 2 | 2 |
Total score/possible maximum score |
16/22
|
19/22
|
20/22
|
9/22
|
18/22
|
18/22
|
17/18
|
Qualitative criteria mixed methods studies | [23] | [43] |
---|---|---|
Question/objective sufficiently described? | 1 | 2 |
Study design evident and appropriate? | 2 | 2 |
Context for the study clear? | 2 | 1 |
Connection to a theoretical framework/wider body of knowledge? | 0 | 1 |
Sampling strategy described, relevant and justified? | 1 | 0 |
Data collection methods clearly described and systematic? | 1 | 1 |
Data analysis clearly described and systematic? | 1 | 0 |
Use of verification procedure (s) to establish credibility? | 0 | 0 |
Conclusions supported by the results? | 1 | 1 |
Reflexivity of the account? | 0 | 0 |
Quantitative criteria mixed methods studies
| ||
Question/objective sufficiently described? | 1 | 2 |
Study design evident and appropriate? | 2 | 2 |
Method of subject/comparison group selection or source of information/input variables described and appropriate? | 2 | 1 |
Subject (and comparison group, if applicable) characteristics sufficiently described? | 1 | 0 |
If interventional and random allocation was possible, was it described? | N/A | N/A |
If interventional and blinding of investigators was possible, was it reported? | N/A | N/A |
If interventional and blinding of subjects was possible, was it reported? | N/A | N/A |
Outcome and (if applicable) exposure measure (s) well defined and robust to measurement/misclassification bias? Means of assessment reported? | 2 | 0 |
Sample size appropriate? | 2 | N/A |
Analytic methods described/justified and appropriate? | 2 | 0 |
Some estimate of variance is reported for the main results? | 1 | 0 |
Controlled for confounding? | N/A | N/A |
Results reported in sufficient detail? | 2 | 0 |
Conclusions supported by the results? | 2 | 1 |
Total score/possible maximum score
|
26/40
|
14/38
|
Appendix C - All findings
Author | Findings | Category |
---|---|---|
Ash et al. [23] | Trust between administrators and physicians seems to be a necessary ingredient tot successful implementation. | A4 |
Ash et al. [24] | Organizational issue fostering implementation: a strong culture | A4 |
Ash et al. [24] | Organizational issue fostering implementation: a history of collaboration and teamwork | A4 |
Boyer et al. [25] | A favorable strategic factor is creating a favorable organizational culture. | A4 |
Boyer et al. [25] | The establishment of a multidisciplinary team to deal with her related issues prevents conflict and stimulates collaboration. | A5 |
Ford et al. [27] | For-profit hospitals are half as likely to have fully implemented an EHR as their nonprofit counterparts. | A1 |
Ford et al. [27] | System-affiliated hospitals were 31 percent more likely than were unaffiliated facilities to have successfully implemented an EHR. | A1 |
Gastaldi et al. [28] | Willingness to avoid pure cost-oriented vendors. | A2 |
Gastaldi et al. [28] | Diffused pressures to realize the EMR as soon as possible, because physicians’ data sharing is needed. | A6 |
Houser & Johnson [29] | Rural hospitals are less likely to have completed implementation of an EHR system compared to urban and suburban hospitals. | A1 |
Houser & Johnson [29] | Government-owned or not-for-profit hospitals more often implemented a complete EHR system compared to for-profit hospitals. | A1 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of knowledge of EHR systems. | A3 |
Jaana et al. [30] | Critical Access Hospitals (CAH) in Iowa have significantly lower EMR levels compared to non-CAHs. | A1 |
Jaana et al. [30] | A higher number of staffed beds and available slack resources is positively associated with higher clinical IS scores and EMR levels. | A1 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is the local hospital control of selection of the system. | A2 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is previous computer or EMR experience. | A3 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is the academic medical centre being more change ready. | A1 |
Poon et al. [33] | A barrier to implementing CPOE is product and vendor immaturity. | A2 |
Poon et al. [33] | Product and vendor immaturity can be overcome by selecting a vendor who is committed to the CPOE market. | A2 |
Poon et al. [33] | Product and vendor immaturity can be overcome by ensuring a long-term trusting relationship of the vendor with the hospital. | A2 |
Rivard et al. [34] | The difficulty of a CIS implementation is explained by quality of care. | A6 |
Scott et al. [35] | The organizational culture of cooperative values minimized resistance to change early on. | A4 |
Takian et al. [37] | In order to successfully implement an EHR stakeholders, and their computer literacy and ability to access the technology, need to be identified prior to planning to procure and implement EHR software. | A3 |
Ward et al. [38] | Nurses who had previous experience with EHRs at other hospitals expressed more positive views towards an EHR. | A3 |
Ward et al. [38] | Nurses with more years of health care experience had less favorable perceptions towards an EHR compared to nurses with less years of experience. | A3 |
Ward et al. [39] | The staff perceived the EHR/CPOE implementation not to have disrupted the existing care processes. | A6 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is an uncooperative or computer phobic attitude of physicians. | A3 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is bureaucracy preventing change and interdepartmental conflict. | A5 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is health care providers that don’t know how to type. | A3 |
Weir et al. [19] | Support staff identify the barrier bureaucracy significantly more often than physicians. | A5 |
Aarts et al. [21] | Implementation of a CPOE is both a social process and contains technical issues, which increases complexity. | B1 |
Aarts et al. [21] | Creating fit between technology and work practices is a key factor for successful implementation of information systems. | B1 |
Ash et al. [24] | Technical/implementation issue fostering implementation: speed of the system | B2 |
Ash et al. [24] | Technical/implementation issue fostering implementation: the ability to group orders into order sets | B3 |
Ash et al. [24] | Technical/implementation issue fostering implementation: the possibility to make clinical pathways available to health care teams, | B3 |
Ash et al. [24] | Technical/implementation issue fostering implementation: the possibility to enter orders from remote locations. | B2 |
Ash et al. [24] | Organization of information issue fostering implementation: the information must be organized in a manner designed to mimic the way in which people use the information, which is generally not in a structured, hierarchical manner. | B3 |
Boyer et al. [25] | The technical aspects of an EMR have an important place but do not necessarily guarantee a successful implementation of EMR. | B2 |
Boyer et al. [25] | A barrier in implementing an EMR is less confidentiality in information sharing between patient and professional. | B4 |
Cresswell et al. [26] | A barrier in implementing an EHR is limited ability to customize the software. | B1 |
Gastaldi et al. [28] | Being able to deal with technical problems related to the customization of the system. | B1 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of structured technology. | B2 |
Houser & Johnson [29] | Perceived barriers of implementing an EHR system are privacy and confidentiality issues. | B4 |
Katsma et al. [31] | Compatibility of the EPR with working processes can also be reached by changing the work processes. | B1 |
Ovretveit et al. [32] | A factor in implementing an EMR system is the ease of navigation, efficiency in use and accessibility of the system. | B3 |
Ovretveit et al. [32] | A factor in implementing an EMR system is the absence of failures | B2 |
Ovretveit et al. [32] | A factor in implementing an EMR system is physicians’ acceptance and implementer’s responsiveness to concerns. | B5 |
Poon et al. [33] | Product and vendor immaturity can be overcome by having the vendor willing to adapt its product to hospital workflow issues. | B5 |
Scott et al. [35] | Software design and development problems increased local resistance. | B2 |
Takian et al. [37] | EHR needs to be seen as a sociotechnical entity by stakeholders, ensuring a user-centered design of EHR. | B1 |
Takian et al. [37] | Because of the huge cultural shift an EHR brings to heavily text-based notes, healthcare practitioners must be educated and protected with regards to transparency and observing confidentiality of patient notes. | B4 |
Takian et al. [37] | The safety of information access to EHR systems needs to be ensured prior to and during the implementation. | B2 |
Weir et al. [19] | A facilitating factor associated with implementation of a CPOE is sufficient functionality of the system. | B3 |
Weir et al. [19] | A facilitating factor associated with l implementation of a CPOE is the ability to customize software to meet physician needs. | B1 |
Weir et al. [19] | A facilitating factor associated with implementation of a CPOE is adequate hardware, terminals, etc. | B2 |
Weir et al. [19] | A barrier to implementation of a CPOE is insufficient functionality of the software. | B3 |
Weir et al. [19] | A barrier to implementation of a CPOE is having an insufficient number of terminals, a too slow system, and non-portable screens. | B2 |
Weir et al. [19] | A barrier to implementation of a CPOE is a user-unfriendly system. | B3 |
Weir et al. [19] | A barrier to implementation of a CPOE is a too labor intensive program. | B3 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains sufficient hardware, technical equipment, support and training. | B2 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains adequate safeguards for patient privacy. | B4 |
Aarts et al. [21] | Emergent change is a key characteristic of implementing information systems in complex organizations. | C4 |
Ash et al. [24] | Organizational issue fostering implementation: supportive leadership | C1 |
Boyer et al. [25] | The strategy used for EMR implementation is particularly important | C4 |
Boyer et al. [25] | A favorable strategic factor is active involvement of the manager. | C1 |
Boyer et al. [25] | A favorable strategic factor is regularly assessing the views of professionals to identify problems and develop support for corrective action. | C2 |
Cresswell et al. [26] | Allowing intensive user involvement in software design is favorable for embedding the system of time (particularly in smaller scale implementations). | C2 |
Cresswell et al. [26] | Acceptance of initially parallel use of paper during the implementation. | C4 |
Cresswell et al. [26] | Resistance of powerful users can lead to ‘workarounds’ | C6 |
Cresswell et al. [26] | There is time and resources available to let the users familiarize with the system. | C8 |
Gastaldi et al. [28] | Engagement of the whole organization in the process is crucial (both the creation as well as the maintenance). | C2 |
Gastaldi et al. [28] | Management of the change is crucial, particularly its initial communication. | C4 |
Gastaldi et al. [28] | Initial technological resistance of the physicians is a problem. | C6 |
Gastaldi et al. [28] | Understanding of the physicians’ necessities is important. | C6 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of employee training. | C3 |
Katsma et al. [31] | Development paradigm implementation approaches go hand in hand with high levels of implementation. | C4 |
Ovretveit et al. [32] | A helping factor in implementing an EMR system is employee involvement in many different ways. | C2 |
Ovretveit et al. [32] | A helping factor in implementing an EMR system is leadership and support by a competent on site information technology department. | C5 |
Ovretveit et al. [32] | A helping factor in implementing an EMR system is decisive and full leadership backing. | C1 |
Ovretveit et al. [32] | A factor in implementing an EMR system is user involvement in selection and development. | C5 |
Ovretveit et al. [32] | A factor in implementing an EMR system is providing education at the right times, amount and quality. | C3 |
Ovretveit et al. [32] | A factor in implementing an EMR system is strong management support. | C1 |
Simon et al. [36] | The entity that manages the implementation of CPOE needs to have representation from among the staff members (front line representation). | C2 |
Simon et al. [36] | Training end-users is important; providing real-time support is even more important. | C3 |
Simon et al. [36] | CPOE implementation requires a great deal of planning and preparation in advance. | C4 |
Simon et al. [36] | Multi-disciplinary representation of front line users and collaboration is important for the implementation of CPOE. | C5 |
Simon et al. [36] | Awareness of attitudes of anxiety and fear is important in the planning of the implementation of CPOE. | C6 |
Simon et al. [36] | The identification and support of a champion among each user group. | C7 |
Simon et al. [36] | The ample presence of live, in-person support (super-users) is helpful in facilitating the CPOE implementation. | C8 |
Scott et al. [35] | The initial selection of the CIS was perceived to be detached from the local environment resulting in conflicting priorities between the organization and individual physicians. | C2 |
Scott et al. [35] | Participatory leadership was valued for selection decisions. | C1 |
Scott et al. [35] | Hierarchical leadership was valued for implementation. | C1 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is knowledgeable, cheerful support from the Information Resource Management department. | C5 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is supportive administration and chiefs of staff. | C1 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is direct involvement of physicians. | C2 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is a good working relationship with developers. | C5 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is an interdisciplinary, effective implementation group. | C5 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is a good implementation strategy. | C4 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is support by medical administration and other allied fields. | C2 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is mandatory implementation. | C4 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is good training and instruction. | C3 |
Weir et al. [19] | A barrier to the implementation of a CPOE is inadequate training, insufficient material, and residents rotation. | C3 |
Weir et al. [19] | A barrier to the implementation of a CPOE is the lack of effective, cheerful Information Resource Management support. | C5 |
Weir et al. [19] | A barrier to the implementation of a CPOE is non-supportive section chiefs of staff. | C1 |
Weir et al. [19] | Support staff identifies the facilitating factor organized, interdisciplinary implementation group significantly more often than physicians. | C5 |
Weir et al. [19] | Physicians identify the facilitating factor support of chiefs of staff and medical administration significantly more often than support staff. | C1 |
Weir et al. [19] | Physicians identify the facilitating factor mandatory implementation significantly more often than support staff. | C4 |
Weir et al. [19] | A facilitating factor associated with successful implementation of a CPOE is having a sufficient number of people for implementation and user training. | C8 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is insufficient personnel to adequately implement the system and train people. | C8 |
Weir et al. [19] | Support staff identifies the facilitating factor sufficient personnel for implementation significantly more often than physicians. | C8 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains effective, clear communication. | C4 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains careful planning for system migration. | C4 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains a sustainable business plan. | C4 |
Aarts & Berg [22] | Accepting or rejecting an information system will depend on whether those involved in the medical work practices will accept a transformation of these practices. | C6 |
Ash et al. [24] | Clinical/Professional issue fostering implementation: customization and the ability to adapt POE at the local level, creating acceptance among physicians. | C6 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of support from medical staff. | C6 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is having adequate people and financial resources. | C8 |
Poon et al. [33] | A barrier to implementing CPOE is physician and organizational resistance. | C6 |
Poon et al. [33] | Physician and organizational resistance can be overcome by addressing workflow concerns. | C6 |
Aarts et al. [21] | The implementation process of a CPOE is highly unpredictable, influenced by contingencies that were not expected nor planned for. | C4 |
Ovretveit et al. [32] | A factor in implementing an EMR system is having a physician champion. | C7 |
Poon et al. [33] | Physician and organizational resistance can be overcome by strong leadership. | C1 |
Poon et al. [33] | Physician and organizational resistance can be overcome by identifying physician champions. | C7 |
Poon et al. [33] | Physician and organizational resistance can be overcome by leveraging house staff or hospitalists. | C8 |
Rivard et al. [34] | The difficulty of a CIS implementation is explained by physicians’ medical dominance. | C1 |
Rivard et al. [34] | The difficulty of a CIS implementation is explained by other health professionals’ professional status and autonomy. | C1 |
Takian et al. [37] | Contextualization and taking heterogeneity across mental health settings is crucial to implement EHR initiatives, it might help identify areas in need of additional support. | C4 |