title: Impact of electronic medical record on physician practice in office settings: a systematic review.
abstract: BACKGROUND
  Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.
  
  
  RESULTS
  For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.
  
  
  CONCLUSIONS
  Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.
authors.affiliation: School of Health Information Science, University of Victoria, P,O, Box 3050 STN CSC, Victoria V8W3P5, Canada. fylau@uvic.ca
authors.forename: Francis
authors.initials: F
authors.lastname: Lau
authors.forename: Morgan
authors.initials: M
authors.lastname: Price
authors.forename: Jeanette
authors.initials: J
authors.lastname: Boyd
authors.forename: Colin
authors.initials: C
authors.lastname: Partridge
authors.forename: Heidi
authors.initials: H
authors.lastname: Bell
authors.forename: Rebecca
authors.initials: R
authors.lastname: Raworth
mesh_terms: D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000458:organization & administration / Q000706:statistics & numerical data; D005194:Family Practice; D006801:Humans; D010817:Physician-Patient Relations; D011314:Preventive Health Services; D011446:Prospective Studies