META-ANALYSIS: IMPACT OF ELECTRONIC HEALTH RECORD SYSTEMS ON QUALITY OF PRIMARY CARE WITHIN ESSENTIAL PUBLIC HEALTH FUNCTION FRAMEWORK
Аннотация
Аbstract
Objective
To study the impact of electronic health records systems in primary health care facilities on improving the quality of care to ensure a sustainable organizational structure as an essential public health function of public health.
Materials and methods
The search was carried out in the MEDLINE, EMBASE, CINAHL databases and in the Cochrane Central Register of Controlled Trials. The search strategy was based on the PICO Framework. The studies selected for the meta-analysis were published between 01/01/2010 and 05/01/2023. Two authors independently reviewed article titles and abstracts for eligibility. Information from the search was deduplicated using EndNote X9, imported into Covidence Systematic Review for review. Statistical processing was performed in RStudio 2023.03.1 Build 446 (Posit Software, PBC).
Results
A literature search identified 640 studies, and 11 manuscripts were included in the review. Meta-analysis showed that the use of electronic health records (EHRs) helps to reduce the time to complete medical records by 33.4% (95% CI = 0.8% to 1.2%; p < 0.007), promotes adherence to clinical recommendations (RR 1.30; 95% CI = 1.04 to 1.79; p = 0.05) and reduces prescribing errors (RR 0.44; 95% CI = 0.34 to 0.53; p < 0.001), which undoubtedly improves the quality of medical care.
Conclusion
This study validates EHRS's positive influence on enhancing care quality in PHC settings, chiefly by streamlining documentation, decreasing prescription errors, and aligning workflow with clinical guidelines. Findings aid informed EHRS adoption decisions for healthcare and public health professionals.
Об авторах
Nargiza YussupovaКазахстан
1. Выпускник докторантуры по специальности "Общественное здравоохранение" НАО "Казахский национальный медицинский университет имени С.Д.Асфендиярова"
2. Менеджер по международному сотрудничеству в РГП на ПХВ "Казахский научный центр дерматологии и инфекционных заболеваний" МЗ РК
Botagoz Turdaliyeva
Казахстан
Vitaliy Koikov
Казахстан
Irina Son
Россия
Zhupar Аtalykova
Казахстан
Список литературы
1. References
2. Pronovost P.J. High-Performing Health Care Delivery Systems: High Performance Toward What Purpose? Jt Comm J Qual Patient Saf. 2017 Sep;43(9):448-449. doi: 10.1016/j.jcjq.2017.06.001. Epub 2017 Jul 24. PMID: 28844230.
3. Jedwab R.M., Franco M., Owen D., Ingram A., Redley B., Dobroff N. Improving the Quality of Electronic Medical Record Documentation: Development of a Compliance and Quality Program. Apple Clinic Inform. 2022 Aug;13(4):836-844. doi: 10.1055/s-0042-1756369. Epub 2022 Sep 7. PMID: 36070801; PMCID: PMC9451950.
4. Essential public health function Suggested citation. ns, health systems and health security: developing conceptual clarity and a WHO roadmap for action. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO.
5. "SIXTY-NINTH WORLD HEALTH ASSEMBLY. (2016). WHA69.1. Resolution adopted by the World Health Assembly on 28 May 2016. Geneva: World Health Organization.
6. Slabkiy, G.A., Parhomenko, G.Y. (Kyiv), State Institution "Ukrainian Institute for Strategic Studies of the Ministry of Health of Ukraine." INTERNATIONAL APPROACHES TO PUBLIC HEALTH DEVELOPMENT. UKRAINE. HEALTH OF THE NATION | 1(21).2012.
7. Strengthening Public Health Services in the European Region – Brief Overview of Source Documents for the European Action Plan. Retrieved from: http://www.euro.who.int/__data/assets/pdf_file/0007/172681/RC62-id05-final-Rus.pdf?ua=1.
8. Graeme N. Forrest and others, Use of Electronic Health Records and Clinical Decision Support Systems for Antimicrobial Stewardship, Clinical Infectious Diseases, Volume 59, Issue suppl_3, October 2014, Pages S122–S133, https://doi.org/10.1093/cid /ciu565
9. Joynt K.E., Bhatt D.L., Schwamm L.H., Xian Y., Heidenreich P.A., Fonarow G.C., Smith E.E., Neely M.L., Grau-Sepulveda M.V., Hernandez A.F. Lack of impact of electronic health records on quality of care and outcomes for ischemic stroke. J Am Call Cardiol. 2015 May 12;65(18): 1964-72. doi: 10.1016/j.jacc.2015.02.059. PMID: 25953748.
10. Kee K.W., Char C.W., Yip A.Y. A review on interventions to reduce medication discrepancies or errors in primary or ambulatory care setting during care transition from hospital to primary care. J Family Med Prim Care 2018; 7:501-6.
11. Tsai C.H., Eghdam A., Davoody N., Wright G., Flowerday S., Koch S. Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content. Life (Basel). 2020 Dec 4;10(12):327. doi: 10.3390/life10120327. PMID: 33291615; PMCID: PMC7761950.
12. Agoritsas T., Merglen A., Courvoisier D.S., Combescure C., Garin N., Perrier A., Perneger T.V. Sensitivity and predictive value of 15 PubMed search strategies to answer clinical questions rated against full systematic reviews. J Med Internet Res. 2012 Jun 12;14(3): e85. doi: 10.2196/jmir.2021. PMID: 22693047; PMCID: PMC3414859.
13. Kwon Y., Lemieux M., McTavish J., Wathen N. Identifying and removing duplicate records from systematic review searches. J Med Libr Assoc. 2015 Oct;103(4):184-8. doi: 10.3163/1536–5050.103.4.004. PMID: 26512216; PMCID: PMC4613377.
14. Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., Chou R., Glanville J., Grimshaw J.M., Hróbjartsson A., Lalu M.M., Li T., Loder E.W., Mayo-Wilson E., McDonald S., McGuinness L.A., Stewart L.A., Thomas J., Tricco A.C., Welch V.A., Whiting P., Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372: n71. doi: 10.1136/bmj. n71. PMID: 33782057; PMCID: PMC8005924.
15. Janett R.S., Yeracaris P.P. Electronic Medical Records in the American Health System: challenges and lessons learned. Cien Saude Colet. 2020 Mar;25(4):1293-1304. doi: 10.1590/1413-81232020254.28922019. Epub 2019 Oct 22. PMID: 32267432.
16. Dara Koper and others, Frequency of medication errors in primary care patients with polypharmacy, Family Practice, Volume 30, Issue 3, June 2013, Pages 313–319, https://doi.org/10.1093/fampra/cms070
17. Säfholm, S., Bondesson, Å. & Modig, S. Medication errors in primary health care records; a cross-sectional study in Southern Sweden. BMC Fam Pract 20, 110 (2019). https://doi.org/10.1186/s12875-019-1001-0.
18. Al Alawi S., Al Dhaheri A., Al Baloushi D., et al. Physician user satisfaction with an electronic medical records system in primary healthcare centers in Al Ain: a qualitative study. BMJ Open 2014;4: e005569. doi:10.1136/bmjopen-2014-005569.
19. Wetterneck T.B., Walker J.M., Blosky M.A., Cartmill R.S., Hoonakker P., Johnson M.A., Norfolk E., Carayon P. Factors contributing to an increase in duplicate medication order errors after CPOE implementation. J Am Med Inform Assoc. 2011 Nov-Dec;18(6):774-82. doi: 10.1136/amiajnl-2011-000255. Epub 2011 Jul 29. PMID: 21803925; PMCID: PMC3198002.
20. Shabbir S.A., Ahmed L.A., Sudhir R.R., Scholl J., Li Y.C., Liou D.M. Comparison of documentation time between an electronic and a paper-based record system by optometrists at an eye hospital in south India: a time-motion study. Comput Methods Programs Biomed. 2010 Dec;100(3):283-8. doi: 10.1016/j.cmpb.2010.04.003. Epub 2010 May 11. PMID: 20462653.
21. Banerjee D., Thompson C., Kell C., Shetty R., Vetteth Y., Grossman H., DiBiase A., Fowler M. An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard. J Am Med Inform Assoc. 2017 May 1;24(3):550-555. doi: 10.1093/jamia/ocw150. PMID: 28011593; PMCID: PMC7651943.
22. Armor B.L., Wight A.J., Carter S.M. Evaluation of Adverse Drug Events and Medication Discrepancies in Transitions of Care Between Hospital Discharge and Primary Care Follow-Up. J Pharm Pract. 2016 Apr;29(2):132-7. doi: 10.1177/0897190014549836. Epub 2014 Oct 13. PMID: 25312264.
23. Chen J., Cutrona S.L., Dharod A., Bunch S.C., Foley K.L., Ostasiewski B., Hale E.R., Bridges A., Moses A., Donny E.C., Sutfin E.L., Houston T.K. iDAPT Implementation Science Center for Cancer Control. Monitoring the Implementation of Tobacco Cessation Support Tools: Using Novel Electronic Health Record Activity Metrics. JMIR MedInform. 2023 Mar 2;11: e43097. doi: 10.2196/43097. PMID: 36862466; PMCID: PMC10020903.
24. Pohlmann S., Kunz A., Ose D., Winkler E.C., Brandner A., Poss-Doering R., Szecsenyi J., Wensing M. Digitalizing Health Services by Implementing a Personal Electronic Health Record in Germany: Qualitative Analysis of Fundamental Prerequisites from the Perspective of Selected Experts. J Med Internet Res. 2020 Jan 29;22(1): e15102. doi: 10.2196/15102. PMID: 32012060; PMCID: PMC7016629.
25. Robinson K.E., Kersey J.A. Novel electronic health record (EHR) education intervention in large healthcare organization improves quality, efficiency, time, and impact on burnout. Medicine (Baltimore). 2018 Sep;97(38): e12319. doi: 10.1097/MD.0000000000012319. PMID: 30235684; PMCID: PMC6160120.
26. Shafi S., Collinsworth A.W., Copeland L.A., Ogola G.O., Qiu T., Kouznetsova M., Liao I.C., Mears N., Pham A.T., Wan G.J., Masica A.L. Association of Opioid-Related Adverse Drug Events with Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System. JAMA Surg. 2018 Aug 1;153(8):757-763. doi: 10.1001/jamasurg.2018.1039. PMID: 29799927; PMCID: PMC6142954.
27. Liao P.J., Mao C.T., Chen T.L., Deng S.T., Hsu K.H. Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case-control study. BMJ Open. 2019 May 10;9(5): e026771. doi: 10.1136/bmjopen-2018-026771. PMID: 31079084; PMCID: PMC6530431.
28. Yagi M., Shindo Y., Mutoh Y., Sano M., Sakakibara T., Kobayashi H., Matsuura A., Emoto R., Matsui S., Nakagawa T., Ogawa K. Factors associated with adverse drug reactions or death in very elderly hospitalized patients with pulmonary tuberculosis. sci rep. 2023 Apr 26;13(1):6826. doi: 10.1038/s41598-023-33967-6. PMID: 37100850; PMCID: PMC10133295.
29. de Hoon SEM, Hek K., van Dijk L., Verheij R.A. Adverse events recording in electronic health record systems in primary care. BMC Med Inform Decis Mak. 2017 Dec 6;17(1):163. doi: 10.1186/s12911-017-0565-7. PMID: 29212497; PMCID: PMC5719640.
30. Zarrinpar A., David Cheng T.Y., Huo Z. What Can We Learn About Drug Safety and Other Effects in the Era of Electronic Health Records and Big Data That We Would Not Be Able to Learn from Classic Epidemiology? J Surg Res. Feb 2020; 246:599-604. doi: 10.1016/j.jss.2019.09.053. Epub 2019 Oct 22. PMID: 31653413; PMCID: PMC6917880.
31. Hui C., Vaillancourt R., Bair L., Wong E., King J.W. Accuracy of Adverse Drug Reaction Documentation upon Implementation of an Ambulatory Electronic Health Record System. Drugs Real World Outcomes. 2016 May 4;3(2):231-238. doi: 10.1007/s40801-016-0071-8. PMID: 27398302; PMCID: PMC4914540.
32. Kern L.M., Barron Y., Dhopeshwarkar R.V., Edwards A., Kaushal R. HITEC Investigators. Electronic health records and ambulatory quality of care. JG Intern Med. 2013 Apr;28(4):496-503. doi: 10.1007/s11606-012-2237-8. Epub 2012 Oct 3. PMID: 23054927; PMCID: PMC3599037.
33. Personal Electronic Health Records: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Mar 4. PMID: 27077167.
34. 21st century health challenges: can the essential public health functions make a difference? Geneva: World Health Organization; 2021. License: CC BY-NC-SA 3.0 IGO
35. van Fenema E.M. Meten van naleving van richtlijnen en behandelkwaliteit met data van routine outcome monitoring [Assessment of guideline adherence and quality of care with routine outcome monitoring data]. Tijdschr Psychiatr. 2017;59(3):159-165. Dutch. PMID: 28350143.
36. Cowppli-Bony A., Tretarre B., Marrer E., Defossez G., Daubisse-Marliac L., Coureau G., Minicozzi P., Woronoff A.S., Delafosse P., Molinié F. FRANCIM network. Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France. PLOS One. 2019 Oct 23;14(10): e0224275. doi: 10.1371/journal.pone.0224275. PMID: 31644603; PMCID: PMC6808419.
37. Fennelly O., Cunningham C., Grogan L., Cronin H., O'Shea C., Roche M., Lawlor F., O'Hare N. Successfully implementing a national electronic health record: a rapid umbrella review. Int J Med Inform. Dec 2020; 144:104281. doi: 10.1016/j.ijmedinf.2020.104281. Epub 2020 Sep 23. PMID: 33017724; PMCID: PMC7510429.
38. Holmes J.H., Beinlich J., Boland M.R., Bowles K.H., Chen Y., Cook T.S., Demiris G., Draugelis M., Fluharty L., Gabriel P.E., Grundmeier R., Hanson C.W., Herman D.S., Himes B.E., Hubbard R.A., Kahn C.E. Jr, Kim D., Koppel R., Long Q., Mirkovic N., Morris J.S., Mowery D.L., Ritchie M.D., Urbanowicz R., Moore J.H. Why Is the Electronic Health Record So Challenging for Research and Clinical Care? Methods Inf Med. May 2021;60(1-02):32-48. doi: 10.1055/s-0041-1731784. Epub 2021 Jul 19. PMID: 34282602; PMCID: PMC9295893.
Рецензия
Для цитирования:
, , , , . Актуальные проблемы теоретической и клинической медицины. 2025;(2):124.
For citation:
Yussupova N.S., Turdaliyeva B.S., Koikov V.V., Son I.M., Аtalykova Zh.Ye. META-ANALYSIS: IMPACT OF ELECTRONIC HEALTH RECORD SYSTEMS ON QUALITY OF PRIMARY CARE WITHIN ESSENTIAL PUBLIC HEALTH FUNCTION FRAMEWORK. Actual Problems of Theoretical and Clinical Medicine. 2025;(2):124.
