A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach?
OBJECTIVE
To analyse the impact of computer-based patient record systems (CBPRS) on medical practice, quality of care, and user and patient satisfaction.


METHODS
Manual and electronic search of the Medline, Cochrane, and Embase databases.


METHODS
Selected articles were published from 2000 to March 2003. CBPRS was defined as computer software designed to be used by clinicians as a direct aid in clinical decision making. To be included, the systems should have recorded patient characteristics and offered online advice, or information or reminders specific to clinicians during the consultation.


METHODS
Keywords used for the search were: electronic record, informatic record, electronic medical record, electronic patient record, patient order entry, computer-based patient system, clinical decision support systems, and evaluation.


RESULTS
Twenty-six articles were selected. Use of a CBPRS was perceived favourably by physicians, with studies of satisfaction being mainly positive. A positive impact of CBPRS on preventive care was observed in all three studies where this criterion was examined. The 12 studies evaluating the impact on medical practice and guidelines compliance showed that positive experiences were as frequent as experiences showing no benefit. None of the six studies analysing the impact of CBPRS on patient outcomes reported any benefit.


CONCLUSIONS
CBPRS increased user and patient satisfaction, which might lead to significant improvements in medical care practices. However, the studies on the impact of CBPRS on patient outcomes and quality of care were not conclusive. Alternative approaches considering social, cultural, and organizational factors may be needed to evaluate the usefulness of CBPRS.
Delpierre
Cyrille
C
Centre Hospitalo Universitaire Purpan, Service des Maladies Infectieuses et Tropicales, Toulouse, France. cisih@chu-toulouse.fr
Cuzin
Lise
L
Fillaux
Judith
J
Alvarez
Muriel
M
Massip
Patrice
P
Lang
Thierry
T
D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000592:standards*; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design