Authors' objectives

To answer the question: in the out-patient primary care setting, does the use of electronic medical records lead to improved surrogate patient outcomes?

Searching

The authors searched MEDLINE from 1966 to 1999. The reference lists of retrieved studies were also reviewed.

Study selection

Assessment of study quality

The authors developed a quality-rating scale based on the instrument developed by Jadad et al. (see Other Publications of Related Interest). The scale included 5 items:

1. Was the study described as randomised?

2. Was there a control group?

3. Was the study described as single-blinded?

4. Was there a description of patient withdrawal and drop-outs?

5. Was the impact of potentially-confounding interventions minimised?

One point was awarded for each 'yes' answer and zero points for 'no' answer on the quality-rating scale. Additional points were given where the method of randomisation was reported and where the control group was concurrent. Each study could, therefore, receive a maximum score of seven.

The authors did not state how many reviewers performed the quality assessment.

Data extraction

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Specific data extracted included: system and study details; study design and number of participants and/or providers; primary outcome(s); benefit (yes or no); and comments.

Methods of synthesis

Results of the review

Sixteen studies met the inclusion criteria: 9 studies assessed hybrid EMR systems and were all randomised controlled trials (RCTs); 7 studies assessed complete EMR systems and included 2 RCTs, 2 non-randomised controlled trials, and 3 non-randomised sequential studies. The total number of patients and providers is unclear as it was not reported for every study.

The authors stated that the trials were of varying quality, conducted in dissimilar centres, and employed a variety of EMRs. The quality scores ranged from 1 to 4 points out of a possible 7. Only one study was judged to be single-blind.

Most of the included studies evaluated the impact of EMR-generated reminders on provider and patient compliance with health maintenance interventions.

Seven trials of three complete EMRs were included, and all 7 reported a benefit of EMR use. Nine trials of three hybrid EMRs were included, of which 8 reported a benefit of EMR use. The study which reported no benefit of EMR use evaluated remote access to EMR on emergency department visits and hospitalisation rates.

Authors' conclusions

Evidence from published trials suggests that utilisation of either complete or hybrid EMRs can improve some surrogate out-patient care outcomes. However, rigorous trials that evaluate their impact on morbidity and mortality, and employ current technologies are required before widespread adoption of EMRs can be confidently recommended.

CRD commentary

Overall the methodological quality of this trial was mixed. The original review question was revised as no published trials were found which assessed the original outcome measures, i.e. patient morbidity and mortality. Consequently, the revised review question covered a broad subject area and the inclusion criteria were not stated clearly. The search strategy was adequate (a complete list of search terms are reported to be available on the web, but could not be located by the reviewer), although the authors could have searched additional databases. In addition, there was no attempt to locate unpublished studies or search grey literature. The authors provided details about the method of assessment of study validity and reported the number of authors who undertook the selection of studies, but no details were provided regarding the process of, or how many reviewers carried out, data extraction. Study details were reported adequately in the tables and text of the review.

The authors address the methodological limitations of the review and the conclusions do appear to follow from the results.

Implications of the review for practice and research

Practice: The authors state that the use of either hybrid or complete EMRs in the outpatient primary care setting can be cautiously supported on the basis of their ability to improve provider and patient compliance with screening interventions, as well as to improve prophylactic and active problem treatment rates for a small range of clinical problems.

Research: The authors state that 'studies of EMR that employ current technologies, examine their impact on patient morbidity and mortality, and are conceptualised to investigate the most likely advantages of electronic systems are urgently needed'.

Bibliographic details

Jerant A F, Hill D B. Does the use of electronic medical records improve surrogate patient outcomes in outpatient settings. Journal of Family Practice 2000; 49(4): 349-357. [PubMed: 10778842]

Other publications of related interest

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.

Indexing Status

Subject indexing assigned by NLM

MeSH

Ambulatory Care; Family Practice; Humans; Medical Records; Patient Simulation; Quality of Health Care

AccessionNumber

12000001077

Database entry date

30/11/2001

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.