title: Success criteria for electronic medical record implementations in low-resource settings: a systematic review.
abstract: OBJECTIVE
  Electronic medical record (EMR) systems have the potential of supporting clinical work by providing the right information at the right time to the right people and thus make efficient use of resources. This is especially important in low-resource settings where reliable data are also needed to support public health and local supporting organizations. In this systematic literature review, our objectives are to identify and collect literature about success criteria of EMR implementations in low-resource settings and to summarize them into recommendations.
  
  
  METHODS
  Our search strategy relied on PubMed queries and manual bibliography reviews. Studies were included if EMR implementations in low-resource settings were described. The extracted success criteria and measurements were summarized into 7 categories: ethical, financial, functionality, organizational, political, technical, and training.
  
  
  RESULTS
  We collected 381 success criteria with 229 measurements from 47 articles out of 223 articles. Most papers were evaluations or lessons learned from African countries, published from 1999 to 2013. Almost half of the EMR systems served a specific disease area like human immunodeficiency virus (HIV). The majority of criteria that were reported dealt with the functionality, followed by organizational issues, and technical infrastructures. Sufficient training and skilled personnel were mentioned in roughly 10%. Political, ethical, and financial considerations did not play a predominant role. More evaluations based on reliable frameworks are needed.
  
  
  CONCLUSIONS
  Highly reliable data handling methods, human resources and effective project management, as well as technical architecture and infrastructure are all key factors for successful EMR implementation.
authors.affiliation: Institute of Medical Informatics, University of Münster, Münster, Germany Fleur.Fritz@uni-muenster.de.
authors.forename: Fleur
authors.initials: F
authors.lastname: Fritz
authors.affiliation: Institute of Medical Informatics, University of Münster, Münster, Germany.
authors.forename: Binyam
authors.initials: B
authors.lastname: Tilahun
authors.affiliation: Institute of Medical Informatics, University of Münster, Münster, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Dugas
mesh_terms: D003906:Developing Countries; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000941:ethics; D006295:Health Resources; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D009936:Organizational Innovation
keywords: Electronic medical record; hospital information system; implementation; low-resource setting; success criteria