title: The impact of electronic health records on healthcare quality: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the impact of electronic health record (EHR) on healthcare quality, we hence carried out a systematic review and meta-analysis of published studies on this topic.
  
  
  METHODS
  PubMed, Web of Knowledge, Scopus and Cochrane Library databases were searched to identify studies that investigated the association between the EHR implementation and process or outcome indicators. Two reviewers screened identified citations and extracted data according to the PRISMA guidelines. Meta-analysis was performed using the random effects model for each indicator. Heterogeneity was quantified using the Cochran Q test and I2 statistics, and publication bias was assessed using the Egger's test.
  
  
  RESULTS
  Of the 23 398 citations identified, 47 articles were included in the analysis. Meta-analysis showed an association between EHR use and a reduced documentation time with a difference in mean of -22.4% [95% confidence interval (CI) = -38.8 to -6.0%; P < 0.007]. EHR resulted also associated with a higher guideline adherence with a risk ratio (RR) of 1.33 (95% CI = 1.01 to 1.76; P = 0.049) and a lower number of medication errors with an overall RR of 0.46 (95% CI = 0.38 to 0.55; P < 0.001), and adverse drug effects (ADEs) with an overall RR of 0.66 (95% CI = 0.44 to 0.99; P = 0.045). No association with mortality was evident (P = 0.936). High heterogeneity among the studies was evident. Publication bias was not evident.
  
  
  CONCLUSIONS
  EHR system, when properly implemented, can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs. Strategies for EHR implementation should be therefore recommended and promoted.
authors.affiliation: Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy paolo.campanella@icloud.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Campanella
authors.affiliation: Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Lovato
authors.affiliation: Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marone
authors.affiliation: Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Fallacara
authors.affiliation: Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Mancuso
authors.affiliation: Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Ricciardi
authors.affiliation: Department of Public Health, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Specchia
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D017598:Efficiency, Organizational; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013997:Time Factors