Aim

To summarize the findings from literature reviews with a view to identifying and exploring the key factors which impact on the success of an EHR implementation across different healthcare contexts.

Introduction

Despite the widely recognised benefits of electronic health records (EHRs), their full potential has not always been achieved, often as a consequence of the implementation process. As more countries launch national EHR programmes, it is critical that the most up-to-date and relevant international learnings are shared with key stakeholders.

Methods

A rapid umbrella review was undertaken in collaboration with a multidisciplinary panel of knowledge-users and experts from Ireland. A comprehensive literature review was completed (2019) across several search engines (PubMed, CINAHL, Scopus, Embase, Web of Science, IEEE Xplore, ACM Digital Library, ProQuest, Cochrane) and Gray literature. Identified studies (n = 5,040) were subject to eligibility criterion and identified barriers and facilitators were analysed, reviewed, discussed and interpreted by the expert panel.

Results

Twenty-seven literature reviews were identified which captured the key organizational, human and technological factors for a successful EHR implementation according to various stakeholders across different settings. Although the size, type and culture of the healthcare setting impacted on the organizational factors, each was deemed important for EHR success; Governance, leadership and culture, End-user involvement, Training, Support, Resourcing, and Workflows. As well as organizational differences, individual end-users have varying Skills and characteristics, Perceived benefits and incentives, and Perceived changes to the health ecosystem which were also critical to success. Finally, the success of the EHR technology depended on Usability, Interoperability, Adaptability, Infrastructure, Regulation, standards and policies, and Testing.

Conclusion

Fifteen inter-linked organizational, human and technological factors emerged as important for successful EHR implementations across primary, secondary and long-term care settings. In determining how to employ these factors, the local context, individual end-users and advancing technology must also be considered.

中文翻译：

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成功实施国家电子健康记录：快速总体审查

 目的

总结文献综述的结果，以识别和探索影响不同医疗保健背景下 EHR 成功实施的关键因素。

 介绍

尽管电子健康记录 (EHR) 的好处得到了广泛认可，但其潜力并未始终得到充分发挥，这往往是实施过程的结果。随着越来越多的国家启动国家电子病历计划，与主要利益相关者分享最新和相关的国际经验至关重要。

 方法

与来自爱尔兰的知识用户和专家组成的多学科小组合作进行了快速总体审查。跨多个搜索引擎（PubMed、CINAHL、Scopus、Embase、Web of Science、IEEE Xplore、ACM Digital Library、ProQuest、Cochrane）和灰色文献完成了全面的文献综述（2019 年）。已确定的研究（n = 5,040）符合资格标准，并由专家小组对已确定的障碍和促进因素进行了分析、审查、讨论和解释。

 结果

根据不同环境下的不同利益相关者的说法，确定了 27 篇文献综述，其中捕获了成功实施 EHR 的关键组织、人力和技术因素。尽管医疗保健环境的规模、类型和文化会影响组织因素，但每一个因素都被认为对 EHR 的成功很重要；治理、领导力和文化、最终用户参与、培训、支持、资源和工作流程。除了组织差异外，各个最终用户还具有不同的技能和特征、感知到的利益和激励以及感知到的健康生态系统的变化，这对成功也至关重要。最后，电子病历技术的成功取决于可用性、互操作性、适应性、基础设施、法规、标准和政策以及测试。

 结论

十五个相互关联的组织、人力和技术因素对于在初级、二级和长期护理环境中成功实施 EHR 非常重要。在确定如何利用这些因素时，还必须考虑当地情况、个别最终用户和先进技术。