Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation

Ian A. Scott A B C , Clair Sullivan A and Andrew Staib A
+ Author Affiliations
- Author Affiliations

A Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia. Email: clair.sullivan@health.qld.gov.au; andrew.staib@health.qld.gov.au

B School of Medicine, University of Queensland, Brisbane, Qld, Australia.

C Corresponding author. Email: ian.scott@health.qld.gov.au

Australian Health Review 43(3) 302-313 https://doi.org/10.1071/AH17153
Submitted: 4 July 2017  Accepted: 29 January 2018   Published: 24 May 2018

Abstract

Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation.

Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads.

Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation).

Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation.

What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care.

What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care.

What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.


References

[1]  National Audit Office. The national programme for IT in the NHS: an update on the delivery of detailed care records systems. Report by the Comptroller and Auditor General, London. 2011. Available at: www.nao.org.uk/publications/1012/npfit.aspx [verified 1 March 2017].

[2]  Balka E. Getting the big picture: the macro-politics of information system development (and failure) in a Canadian hospital. Methods Inf Med 2003; 42 324–30.
Getting the big picture: the macro-politics of information system development (and failure) in a Canadian hospital.Crossref | GoogleScholarGoogle Scholar |

[3]  Ellingsen G, Monteiro E. Big is beautiful: electronic patient records in large Norwegian hospitals 1980s–2001. Methods Inf Med 2003; 42 366–70.
Big is beautiful: electronic patient records in large Norwegian hospitals 1980s–2001.Crossref | GoogleScholarGoogle Scholar |

[4]  D’Avolio LW. Electronic medical records at a crossroads: Impetus for change or missed opportunity? JAMA 2009; 302 1109–11.

[5]  Ford EW, Menachemi N, Peterson LT, Huerta TR. Resistance is futile: but it is slowing the pace of EHR adoption nonetheless. J Am Med Inform Assoc 2009; 16 274–81.
Resistance is futile: but it is slowing the pace of EHR adoption nonetheless.Crossref | GoogleScholarGoogle Scholar |

[6]  Kellermann AL, Jones SS. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Aff (Millwood) 2013; 32 63–8.
What it will take to achieve the as-yet-unfulfilled promises of health information technology.Crossref | GoogleScholarGoogle Scholar |

[7]  Mozaffar H, Cresswell KM, Williams R, Bates DW, Sheikh A. Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study. BMJ Qual Saf 2017; 26 722–33.
Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

[8]  Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V, Petrakaki D, Crowe S, Marsden K, Robertson A, Morrison Z, Klecun E, Prescott R, Quinn C, Jani Y, Ficociello M, Voutsina K, Paton J, Fernando B, Jacklin A, Cresswell K. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in ‘early adopter’ hospitals. BMJ 2011; 343 d6054
Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in ‘early adopter’ hospitals.Crossref | GoogleScholarGoogle Scholar |

[9]  O’Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med 2010; 25 177–85.
Are electronic medical records helpful for care coordination? Experiences of physician practices.Crossref | GoogleScholarGoogle Scholar |

[10]  Ratwani R, Fairbanks T, Savage E, Adams K, Wittie M, Boone E, Hayden A, Barnes J, Hettinger Z, Gettinger A. Mind the gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation. Appl Clin Inform 2016; 7 1069–87.
Mind the gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation.Crossref | GoogleScholarGoogle Scholar |

[11]  Berg M. Implementing information systems in health care organizations: myths and challenges. Int J Med Inform 2001; 64 143–56.
Implementing information systems in health care organizations: myths and challenges.Crossref | GoogleScholarGoogle Scholar |

[12]  Aarts J, Berg M. A tale of two hospitals: a sociotechnical appraisal of the introduction of computerized physician order entry in two Dutch hospitals. Stud Health Technol Inform 2004; 107 999–1002.

[13]  Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care – an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 542–9.
Unintended consequences of information technologies in health care – an interactive sociotechnical analysis.Crossref | GoogleScholarGoogle Scholar |

[14]  Cucciniello M, Lapsley I, Nasi G, Pagliari C. Understanding key factors affecting electronic medical record implementation: a sociotechnical approach. BMC Health Serv Res 2015; 15 268
Understanding key factors affecting electronic medical record implementation: a sociotechnical approach.Crossref | GoogleScholarGoogle Scholar |

[15]  Sullivan C, Staib A, Ayre S, Daly M, Collins R, Draheim M, Ashby R. Pioneering digital disruption: Australia’s first integrated digital tertiary hospital. Med J Aust 2016; 205 386–9.
Pioneering digital disruption: Australia’s first integrated digital tertiary hospital.Crossref | GoogleScholarGoogle Scholar |

[16]  Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS Med 2010; 7 e1000217
Guidance for developers of health research reporting guidelines.Crossref | GoogleScholarGoogle Scholar |

[17]  van der Meijden MJ, Tange HJ, Troost J, Hasman A. Determinants of success of inpatient clinical information systems: a literature review. J Am Med Inform Assoc 2003; 10 235–43.
Determinants of success of inpatient clinical information systems: a literature review.Crossref | GoogleScholarGoogle Scholar |

[18]  Hung S, Hung W, Tsai C, Jiang S. Critical factors of hospital adoption of CRM system: organisational and information system perspectives. Dec Supp Syst 2010; 48 592–603.
Critical factors of hospital adoption of CRM system: organisational and information system perspectives.Crossref | GoogleScholarGoogle Scholar |

[19]  Castillo VH, Martínez-García AI, Pulido JR. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Med Inform Decis Mak 2010; 10 60
A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review.Crossref | GoogleScholarGoogle Scholar |

[20]  McGinn CA, Grenier S, Duplantie J, Shaw N, Sicotte C, Mathieu L, Leduc Y, Légaré F, Gagnon MP. Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med 2011; 9 46
Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review.Crossref | GoogleScholarGoogle Scholar |

[21]  Boonstra A, Versluis A, Vos JF. Implementing electronic health records in hospitals: a systematic literature review. BMC Health Serv Res 2014; 14 370
Implementing electronic health records in hospitals: a systematic literature review.Crossref | GoogleScholarGoogle Scholar |

[22]  Ben-Zion R, Pliskin N, Fink L. Critical success factors for adoption of electronic health record systems: literature review and prescriptive analysis. Inf Syst Manage 2014; 31 296–312.
Critical success factors for adoption of electronic health record systems: literature review and prescriptive analysis.Crossref | GoogleScholarGoogle Scholar |

[23]  Nguyen L, Bellucci E, Nguyen LT. Electronic health records implementation: an evaluation of information system impact and contingency factors. Int J Med Inform 2014; 83 779–96.
Electronic health records implementation: an evaluation of information system impact and contingency factors.Crossref | GoogleScholarGoogle Scholar |

[24]  Kruse CS, Kristof C, Jones B, Mitchell E, Martinez A. Barriers to electronic health record adoption: a systematic literature review. J Med Syst 2016; 40 252
Barriers to electronic health record adoption: a systematic literature review.Crossref | GoogleScholarGoogle Scholar |

[25]  van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, Seydel ER. A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res 2011; 13 e111
A holistic framework to improve the uptake and impact of eHealth technologies.Crossref | GoogleScholarGoogle Scholar |

[26]  Wen KY, Gustafson DH, Hawkins RP, Brennan PF, Dinauer S, Johnson PR, Siegler T. Developing and validating a model to predict the success of an IHCS implementation: the Readiness for Implementation Model. J Am Med Inform Assoc 2010; 17 707–13.
Developing and validating a model to predict the success of an IHCS implementation: the Readiness for Implementation Model.Crossref | GoogleScholarGoogle Scholar |

[27]  Murray E, May C, Mair F. Development and formative evaluation of the e-Health Implementation Toolkit (e-HIT). BMC Med Inform Decis Mak 2010; 10 61
Development and formative evaluation of the e-Health Implementation Toolkit (e-HIT).Crossref | GoogleScholarGoogle Scholar |

[28]  Commonwealth Department of Health. EHR implementation go-live planning checklist. Providers and professionals. 2012. Available at: http://www.healthit.gov/sites/default/files/tools/nlc-ehr-implementation-go-live-planning-checklist.docx [verified 29 July 2015].

[29]  MacFarlane A, Clerkin P, Murray E, Heaney DJ, Wakeling M, Pesola UM, Waterworth EL, Larsen F, Makiniemi M, Winblad I. The e-Health Implementation Toolkit: qualitative evaluation across four European countries. Implement Sci 2011; 6 122
The e-Health Implementation Toolkit: qualitative evaluation across four European countries.Crossref | GoogleScholarGoogle Scholar |

[30]  Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. Int J Med Inform 2003; 69 235–50.
Implementing computerized physician order entry: the importance of special people.Crossref | GoogleScholarGoogle Scholar |

[31]  Howell JM, Boies K. Champions of technological innovation. The influence of contextual knowledge, role orientation, idea generation, and idea promotion on champion emergence. Leadersh Q 2004; 15 123–43.
Champions of technological innovation. The influence of contextual knowledge, role orientation, idea generation, and idea promotion on champion emergence.Crossref | GoogleScholarGoogle Scholar |

[32]  Boyer L, Samuelian JC, Fieschi M, Lancon C. Implementing electronic medical records in a psychiatric hospital: a qualitative study. Int J Psychiatry Clin Pract 2010; 14 223–7.
Implementing electronic medical records in a psychiatric hospital: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

[33]  Simon SR, Keohane CA, Amato M, Coffey M, Cadet B, Zimlichman E, Bates DW. Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study. BMC Med Inform Decis Mak 2013; 13 67
Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

[34]  Gastaldi L, Corso M. Smart healthcare digitalization: using ICT to effectively balance exploration and exploitation within hospitals. Int J Eng Bus Manag 2012; 4 1–13.

[35]  Øvretveit J, Scott T, Rundall TG, Shortell SM, Brommels M. Improving quality through effective implementation of information technology in healthcare. Int J Qual Health Care 2007; 19 259–66.
Improving quality through effective implementation of information technology in healthcare.Crossref | GoogleScholarGoogle Scholar |

[36]  Houser SH, Johnson LA. Perceptions regarding electronic health record implementation among health information management professionals in Alabama: a statewide survey and analysis. Perspect Health Inf Manag 2008; 5 6

[37]  Ash J, Gorman P, Lavelle M, Lyman J, Fournier L. Investigating physician order entry in the field: lessons learned in a multi-center study. Stud Health Technol Inform 2001; 84 1107–11.

[38]  Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff (Millwood) 2004; 23 184–90.
Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals.Crossref | GoogleScholarGoogle Scholar |

[39]  Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform 2013; 82 e73–86.
Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review.Crossref | GoogleScholarGoogle Scholar |

[40]  Ramirez A, Carlson D, Estes C. Computerized physician order entry: lessons learned from the trenches. Neonatal Netw 2010; 29 235–41.
Computerized physician order entry: lessons learned from the trenches.Crossref | GoogleScholarGoogle Scholar |

[41]  Bergman M, Lundberg S. Tender evaluation and supplier selection methods in public procurement. J Purchasing Supply Manage 2013; 19 73–83.
Tender evaluation and supplier selection methods in public procurement.Crossref | GoogleScholarGoogle Scholar |

[42]  Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study. BMJ 2005; 331 1313–16.
Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

[43]  Lapointe L, Rivard S. Getting physicians to accept new information technology: insights from case studies. CMAJ 2006; 174 1573–8.
Getting physicians to accept new information technology: insights from case studies.Crossref | GoogleScholarGoogle Scholar |

[44]  Leonard KJ. The role of patients in designing health information systems: the case of applying simulation techniques to design an electronic patient record (EPR) interface. Health Care Manag Sci 2004; 7 275–84.
The role of patients in designing health information systems: the case of applying simulation techniques to design an electronic patient record (EPR) interface.Crossref | GoogleScholarGoogle Scholar |

[45]  Jones JL. Implementing computerized prescriber order entry in a children’s hospital. Am J Health Syst Pharm 2004; 61 2425–9.

[46]  Rahimi B, Moberg A, Timpka T, Vimarlund V. Implementing an integrated computerized patient record system: towards an evidence-based information system implementation practice in healthcare. AMIA Annu Symp Proc 2008; 2008 616–20.

[47]  Hier DB, Rothschild A, LeMaistre A, Keeler J. Differing faculty and housestaff acceptance of an electronic health record. Int J Med Inform 2005; 74 657–62.
Differing faculty and housestaff acceptance of an electronic health record.Crossref | GoogleScholarGoogle Scholar |

[48]  Miller RH, Sim I. Physicians’ use of electronic medical records: barriers and solutions. Health Aff (Millwood) 2004; 23 116–26.
Physicians’ use of electronic medical records: barriers and solutions.Crossref | GoogleScholarGoogle Scholar |

[49]  Darbyshire P. ‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information. J Clin Nurs 2004; 13 17–25.
‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information.Crossref | GoogleScholarGoogle Scholar |

[50]  Vishwanath A, Singh SR, Winkelstein P. The impact of electronic medical record systems on outpatient workflows: a longitudinal evaluation of its workflow effects. Int J Med Inform 2010; 79 778–91.
The impact of electronic medical record systems on outpatient workflows: a longitudinal evaluation of its workflow effects.Crossref | GoogleScholarGoogle Scholar |

[51]  Katsma CP, Spil TAM, Ligt E, Wassenaar A. Implementation and use of an electronic health record: measuring relevance and participation in four hospitals. Int J Healthc Technol Manag 2007; 8 625–43.
Implementation and use of an electronic health record: measuring relevance and participation in four hospitals.Crossref | GoogleScholarGoogle Scholar |

[52]  Aarts J, Ash J, Berg M. Extending the understanding of computerized physician order entry: implications for professional collaboration, workflow and quality of care. Int J Med Inform 2007; 76 S4–13.
Extending the understanding of computerized physician order entry: implications for professional collaboration, workflow and quality of care.Crossref | GoogleScholarGoogle Scholar |

[53]  Niazkhani Z, Pirnejad H, Berg M, Aarts J. The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. J Am Med Inform Assoc 2009; 16 539–49.
The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review.Crossref | GoogleScholarGoogle Scholar |

[54]  Moody LE, Slocumb E, Berg B, Jackson D. Electronic health records documentation in nursing: nurses’ perceptions, attitudes, and preferences. Comput Inform Nurs 2004; 22 337–44.
Electronic health records documentation in nursing: nurses’ perceptions, attitudes, and preferences.Crossref | GoogleScholarGoogle Scholar |

[55]  Karsh BT. Beyond usability: designing effective technology implementation systems to promote patient safety. Qual Saf Health Care 2004; 13 388–94.
Beyond usability: designing effective technology implementation systems to promote patient safety.Crossref | GoogleScholarGoogle Scholar |

[56]  Ward MM, Vartak S, Schwichtenberg T, Wakefield DS. Nurses’ perceptions of how clinical information system implementation affects workflow and patient care. Comput Inform Nurs 2011; 29 502–11.
Nurses’ perceptions of how clinical information system implementation affects workflow and patient care.Crossref | GoogleScholarGoogle Scholar |

[57]  Ward MM, Vartak S, Loes JL, O’Brien J, Mills TR, Halbesleben JR, Wakefield DS. CAH staff perceptions of a clinical information system implementation. Am J Manag Care 2012; 18 244–52.

[58]  Saleem JJ, Russ AL, Sanderson P, Johnson TR, Zhang J, Sittig DF. Current challenges and opportunities for better integration of human factors research with development of clinical information systems. Yearb Med Inform 2009; 18 48–58.
Current challenges and opportunities for better integration of human factors research with development of clinical information systems.Crossref | GoogleScholarGoogle Scholar |

[59]  Kuhn T, Basch P, Barr M, Yackel T, Medical Informatics Committee of the American College of Physicians Clinical documentation in the 21st century: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med 2015; 162 301–3.
Clinical documentation in the 21st century: executive summary of a policy position paper from the American College of Physicians.Crossref | GoogleScholarGoogle Scholar |

[60]  Banner L, Olney CM. Automated clinical documentation: does it allow nurses more time for patient care? Comput Inform Nurs 2009; 27 75–81.
Automated clinical documentation: does it allow nurses more time for patient care?Crossref | GoogleScholarGoogle Scholar |

[61]  Schumacher RM. Commentary: electronic health records and human performance. J Oncol Pract 2010; 6 125–6.
Commentary: electronic health records and human performance.Crossref | GoogleScholarGoogle Scholar |

[62]  Zahabi M, Kaber DB, Swangnetr M. Usability and safety in electronic medical records interface design: a review of recent literature and guideline formulation. Hum Factors 2015; 57 805–34.
Usability and safety in electronic medical records interface design: a review of recent literature and guideline formulation.Crossref | GoogleScholarGoogle Scholar |

[63]  Ahmed A, Chandra S, Herasevich V, Gajic O, Pickering BW. The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance. Crit Care Med 2011; 39 1626–34.
The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance.Crossref | GoogleScholarGoogle Scholar |

[64]  Zheng K, Haftel HM, Hirschl RB, O’Reilly M, Hanauer DA. Quantifying the impact of health IT implementations on clinical workflow: a new methodological perspective. J Am Med Inform Assoc 2010; 17 454–61.
Quantifying the impact of health IT implementations on clinical workflow: a new methodological perspective.Crossref | GoogleScholarGoogle Scholar |

[65]  Fonville A, Choe EK, Oldham S, Kientz JA. Exploring the use of technology in healthcare spaces and its impact on empathic communication. In: Proceedings of the 1st Association of Computing Machinery International Health Informatics Symposium, Arlington, Virginia, USA, 11–12 November 2010, pp 497–501.

[66]  Yoon-Flannery K, Zandieh SO, Kuperman GJ, Langsam DJ, Hyman D, Kaushal R. A qualitative analysis of an electronic health record (EHR) implementation in an academic ambulatory setting. Inform Prim Care 2008; 16 277–84.

[67]  Meigs SL, Solomon M. Electronic health record use a bitter pill for many physicians. Perspect Health Inf Manag 2016; 13 1d

[68]  Chisolm DJ, Purnell TS, Cohen DM, McAlearney AS. Clinician perceptions of an electronic medical record during the first year of implementaton in emergency services. Pediatr Emerg Care 2010; 26 107–10.
Clinician perceptions of an electronic medical record during the first year of implementaton in emergency services.Crossref | GoogleScholarGoogle Scholar |

[69]  Ash JS, Bates DW. Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion. J Am Med Inform Assoc 2005; 12 8–12.
Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion.Crossref | GoogleScholarGoogle Scholar |

[70]  Fichman RG, Kohli R, Krishnan R. The role of information systems in healthcare: current research and future trends. Inf Syst Res 2011; 22 419–28.
The role of information systems in healthcare: current research and future trends.Crossref | GoogleScholarGoogle Scholar |

[71]  Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163 1409–16.
Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review.Crossref | GoogleScholarGoogle Scholar |

[72]  Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, Taylor R. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood) 2005; 24 1103–17.
Can electronic medical record systems transform health care? Potential health benefits, savings, and costs.Crossref | GoogleScholarGoogle Scholar |

[73]  Häyrinen K, Saranto K, Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform 2008; 77 291–304.
Definition, structure, content, use and impacts of electronic health records: a review of the research literature.Crossref | GoogleScholarGoogle Scholar |

[74]  Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med 2009; 169 108–14.
Clinical information technologies and inpatient outcomes: a multiple hospital study.Crossref | GoogleScholarGoogle Scholar |

[75]  Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood) 2011; 30 464–71.
The benefits of health information technology: a review of the recent literature shows predominantly positive results.Crossref | GoogleScholarGoogle Scholar |

[76]  Lee J, Kuo YF, Goodwin JS. The effect of electronic medical record adoption on outcomes in US hospitals. BMC Health Serv Res 2013; 13 39
The effect of electronic medical record adoption on outcomes in US hospitals.Crossref | GoogleScholarGoogle Scholar |

[77]  Jones SS, Rudin RS, Perry T, Shekelle PG. Health information technology: an updated systematic review with a focus on meaningful use. Ann Intern Med 2014; 160 48–54.
Health information technology: an updated systematic review with a focus on meaningful use.Crossref | GoogleScholarGoogle Scholar |

[78]  Keasberry J, Scott IA, Sullivan C, Staib A, Ashby R. Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice. Aust Health Rev 2017; 41 646–64.
Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice.Crossref | GoogleScholarGoogle Scholar |

[79]  Silow-Carroll S, Edwards JN, Rodin D. Using electronic health records to improve quality and efficiency: the experiences of leading hospitals. Issue Brief (Commonw Fund) 2012; 17 1–40.

[80]  Holden RJ. Physicians’ beliefs about using EMR and CPOE: in pursuit of a contextualized understanding of health IT use behavior. Int J Med Inform 2010; 79 71–80.
Physicians’ beliefs about using EMR and CPOE: in pursuit of a contextualized understanding of health IT use behavior.Crossref | GoogleScholarGoogle Scholar |

[81]  Leidner DE, Preston D, Chen D. An examination of the antecedents and consequences of organizational IT innovation in hospitals. J Strateg Inf Syst 2010; 19 154–70.
An examination of the antecedents and consequences of organizational IT innovation in hospitals.Crossref | GoogleScholarGoogle Scholar |

[82]  Zheng K, Padman R, Krackhardt D, Johnson MP, Diamond HS. Social networks and physician adoption of electronic health records: insights from an empirical study. J Am Med Inform Assoc 2010; 17 328–36.
Social networks and physician adoption of electronic health records: insights from an empirical study.Crossref | GoogleScholarGoogle Scholar |

[83]  de Veer AJ, Francke AL. Attitudes of nursing staff towards electronic patient records: a questionnaire survey. Int J Nurs Stud 2010; 47 846–54.
Attitudes of nursing staff towards electronic patient records: a questionnaire survey.Crossref | GoogleScholarGoogle Scholar |

[84]  Sykes TA, Venkatesh V, Rai A. Explaining physicians’ use of EMR systems and performance in the shakedown phase. J Am Med Inform Assoc 2011; 18 125–30.
Explaining physicians’ use of EMR systems and performance in the shakedown phase.Crossref | GoogleScholarGoogle Scholar |

[85]  Crowson MG, Vail C, Eapen RJ. Influence of electronic medical record implementation on provider retirement at a major academic medical centre. J Eval Clin Pract 2016; 22 222–6.
Influence of electronic medical record implementation on provider retirement at a major academic medical centre.Crossref | GoogleScholarGoogle Scholar |

[86]  Kazley AS, Ozcan YA. Organizational and environmental determinants of hospital EMR adoption: a national study. J Med Syst 2007; 31 375–84.
Organizational and environmental determinants of hospital EMR adoption: a national study.Crossref | GoogleScholarGoogle Scholar |

[87]  Hudson JS, Neff JA, Padilla MA, Zhang Q, Mercer LT. Predictors of physician use of inpatient electronic health records. Am J Manag Care 2012; 18 201–6.

[88]  Patel V, Jamoom E, Hsiao CJ, Furukawa MF, Buntin M. Variation in electronic health record adoption and readiness for meaningful use: 2008–2011. J Gen Intern Med 2013; 28 957–64.
Variation in electronic health record adoption and readiness for meaningful use: 2008–2011.Crossref | GoogleScholarGoogle Scholar |

[89]  Barnett ML, Mehrotra A, Jena AB. Adverse inpatient outcomes during the transition to a new electronic health record system: observational study. BMJ 2016; 354 i3835
Adverse inpatient outcomes during the transition to a new electronic health record system: observational study.Crossref | GoogleScholarGoogle Scholar |

[90]  Graber ML, Siegal D, Riah H, Johnston D, Kenyon K. Electronic health record-related events in medical malpractice claims. J Patient Saf 2015; in press.
Electronic health record-related events in medical malpractice claims.Crossref | GoogleScholarGoogle Scholar |

[91]  Meeks DW, Smith MW, Taylor L, Sittig DF, Scott JM, Singh H. An analysis of electronic health record-related patient safety concerns. J Am Med Inform Assoc 2014; 21 1053–9.
An analysis of electronic health record-related patient safety concerns.Crossref | GoogleScholarGoogle Scholar |

[92]  Magrabi F, Liaw ST, Arachi D, Runciman W, Coiera E, Kidd MR. Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports. BMJ Qual Saf 2016; 25 870–80.
Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports.Crossref | GoogleScholarGoogle Scholar |

[93]  Weiner JP, Kfuri T, Chan K, Fowles JB. ‘e-Iatrogenesis’: the most critical unintended consequence of CPOE and other HIT. J Am Med Inform Assoc 2007; 14 387–8.
‘e-Iatrogenesis’: the most critical unintended consequence of CPOE and other HIT.Crossref | GoogleScholarGoogle Scholar |

[94]  Bae J, Rask KJ, Becker ER. The impact of electronic medical records on hospital-acquired adverse safety events: differential effects between single-source and multiple-source systems. Am J Med Qual 2018; 33 72–80.
The impact of electronic medical records on hospital-acquired adverse safety events: differential effects between single-source and multiple-source systems.Crossref | GoogleScholarGoogle Scholar |

[95]  Sullivan C, Staib AB. Digital disruption ‘syndromes’ in a hospital: important considerations for the quality and safety of patient care during rapid digital transformation. Aust Health Rev 2017;
Digital disruption ‘syndromes’ in a hospital: important considerations for the quality and safety of patient care during rapid digital transformation.Crossref | GoogleScholarGoogle Scholar |

[96]  Lee J, McCullough JS, Town RJ. The impact of health information technology on hospital productivity. Rand J Econ 2013; 44 545–68.
The impact of health information technology on hospital productivity.Crossref | GoogleScholarGoogle Scholar |

[97]  Kossman SP. Perceptions of impact of electronic health records on nurses’ work. Stud Health Technol Inform 2006; 122 337–41.

[98]  Rahadhan P, Poon SK, Land L. Understanding unintended consequences for EMR: a literature review. Stud Health Technol Inform 2012; 178 192–8.

[99]  Stewart E, Kahn D, Lee E, Simon W, Duncan M, Mosher H, Harris K, Bell J, El-Farra N, Sharpe B. Internal medicine progress note writing. Attitudes and practices in an electronic health record. J Hosp Med 2015; 10 525–9.
Internal medicine progress note writing. Attitudes and practices in an electronic health record.Crossref | GoogleScholarGoogle Scholar |

[100]  Bowman S.. Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health Inf Manag 2013; 10 1c

[101]  Bryant AD, Fletcher GS, Payne TH. Drug interaction alert override rates in the meaningful use era: no evidence of progress. Appl Clin Inform 2014; 5 802–13.
Drug interaction alert override rates in the meaningful use era: no evidence of progress.Crossref | GoogleScholarGoogle Scholar |

[102]  Goddard K, Roudsari A, Wyatt JC. Automation bias: a systematic review of frequency, effect mediators, and mitigators. J Am Med Inform Assoc 2012; 19 121–7.
Automation bias: a systematic review of frequency, effect mediators, and mitigators.Crossref | GoogleScholarGoogle Scholar |

[103]  Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care – an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 542–9.
Unintended consequences of information technologies in health care – an interactive sociotechnical analysis.Crossref | GoogleScholarGoogle Scholar |

[104]  Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom ST, Weaver C, Zhang J, American Medical Informatics Association Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 e2–8.
Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.Crossref | GoogleScholarGoogle Scholar |

[105]  Morrison C, Jones M, Blackwell A, Vuylsteke A. Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff. Crit Care 2008; 12 R148
Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff.Crossref | GoogleScholarGoogle Scholar |

[106]  Dagnone RV, Wilson R, Goldstein DH, Murdoch J, Rimmer MJ, Van Den Kerkhof EG. How do patients perceive electronic documentation at the bedside? J Healthc Qual 2006; 28 37–44.
How do patients perceive electronic documentation at the bedside?Crossref | GoogleScholarGoogle Scholar |

[107]  DeLone WH, McLean ER. The DeLone and McLean model of information systems success: a ten-year update. J Manage Inf Syst 2003; 19 9–30.
The DeLone and McLean model of information systems success: a ten-year update.Crossref | GoogleScholarGoogle Scholar |

[108]  Leonard KJ, Sittig DF. Improving information technology adoption and implementation through the identification of appropriate benefits: creating IMPROVE-IT. J Med Internet Res 2007; 9 e9
Improving information technology adoption and implementation through the identification of appropriate benefits: creating IMPROVE-IT.Crossref | GoogleScholarGoogle Scholar |

[109]  Thakkar M, Davis DC. Risks, barriers, and benefits of EHR systems: a comparative study based on size of hospital. Perspect Health Inf Manag 2006; 3 5

[110]  Ammenwerth E. Evidence-based health informatics: How do we know what we know? Methods Inf Med 2015; 54 298–307.
Evidence-based health informatics: How do we know what we know?Crossref | GoogleScholarGoogle Scholar |

[111]  Metro South Digital Healthcare Program Definition Team. Digital healthcare program outline business case. Brisbane: Metro South Hospital and Health Service; 2014.

[112]  Georgiou A, Vecellio E, Toouli G, Eigenstetter A, Li L, Wilson R, Westbrook JI. Monitoring the impact of the electronic medical record on the quality of laboratory test ordering practices. Stud Health Technol Inform 2013; 188 33–8.

[113]  Rumball-Smith J, Shekelle PG, Bates DW. Using the electronic health record to understand and minimize overuse. JAMA 2017; 317 257–8.
Using the electronic health record to understand and minimize overuse.Crossref | GoogleScholarGoogle Scholar |

[114]  Baillie CA, VanZandbergen C, Tait G, Hanish A, Leas B, French B, Hanson CW, Behta M, Umscheid CA. The readmission risk flag: using the electronic health record to automatically identify patients at risk for 30-day readmission. J Hosp Med 2013; 8 689–95.
The readmission risk flag: using the electronic health record to automatically identify patients at risk for 30-day readmission.Crossref | GoogleScholarGoogle Scholar |

[115]  Mueller SK, Yoon C, Schnipper JL. Association of a web-based handoff tool with rates of medical errors. JAMA Intern Med 2016; 176 1400–2.

[116]  Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, Samsa G, Hasselblad V, Williams JW, Musty MD, Wing L, Kendrick AS, Sanders GD, Lobach D. Effect of clinical decision-support systems: a systematic review. Ann Intern Med 2012; 157 29–43.
Effect of clinical decision-support systems: a systematic review.Crossref | GoogleScholarGoogle Scholar |

[117]  Coiera E. Guide to health informatics. 3rd edn. Boca Raton: CRC Press, Taylor and Francis Group; 2015.