title: Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review.
abstract: BACKGROUND
  Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users.
  
  
  METHODS
  Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users.
  
  
  RESULTS
  Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities.
  
  
  CONCLUSIONS
  This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.
authors.affiliation: Research Centre of the Centre Hospitalier Universitaire du Québec, Québec, QC, Canada.
authors.forename: Carrie Anna
authors.initials: CA
authors.lastname: McGinn
authors.forename: Sonya
authors.initials: S
authors.lastname: Grenier
authors.forename: Julie
authors.initials: J
authors.lastname: Duplantie
authors.forename: Nicola
authors.initials: N
authors.lastname: Shaw
authors.forename: Claude
authors.initials: C
authors.lastname: Sicotte
authors.forename: Luc
authors.initials: L
authors.lastname: Mathieu
authors.forename: Yvan
authors.initials: Y
authors.lastname: Leduc
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gagnon
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D002170:Canada; D003625:Data Collection / Q000379:methods / Q000592:standards; D057286:Electronic Health Records / Q000458:organization & administration* / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation / Q000379:methods / Q000458:organization & administration; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*