Identification of the Barriers and Effectiveness of Using Electronic Health Record Systems among the Population of UK - Systematic Review Proposal

Running head: ELECTRONIC HEALTH RECORDS
IDENTIFICATION OF THE BARRIERS AND EFFECTIVENESS OF USING
ELECTRONIC HEALTH RECORD SYSTEMS AMONG THE POPULATION OF
UK - SYSTEMATIC REVIEW PROPOSAL
Name of the Student
Name of the University
Author Note

1
ELECTRONIC HEALTH RECORDS
Abstract
An electronic health record (EHR), frequently referred to as electronic medical
record (EMR). It is referred as systematized collection of population and patient health
information which is stored electronically in a digital format. These records are often shared
across different health care settings, with the purpose of improving patient health and
preventing medication errors. The records are generally shared through enterprise-wide
information systems or network-connections, or other information exchanges and networks.
EHRs most often include a wide range of data that includes medical history, demographics,
allergies, medication and immunization status, radiology images, laboratory test results,
personal statistics like weight and age, billing information and vital signs. EHR systems are
formulated for storing patient data accurately. They also help to capture the state of patients,
across time. These records eliminate the necessity for tracking down the previous paper
medical records of a patient and also provide assistance in ensuring legibility and reliability
of the collected data. Further benefits of the electronic health records are related to reducing
or eliminating risks of data replication, owing to the presence of a single modifiable file.
Hence, this ensures presence of updated files that reduces associated risks of losing
paperwork. EHRs have been significantly effective while extracting medical data, for
examining potential trends and changes in the health status of a patient. This report contains a
research proposal that will aim to investigate the effectiveness of these electronic health
records, upon being implemented across healthcare settings in the UK. Furthermore, it will
also evaluate the challenges that might be encountered during such implemented. The
aforementioned research objectives will be accomplished by conducting a qualitative
systematic review of articles, relevant to the research question.
Keywords: electronic health records, medical records, patients, effectiveness, challenges

2
ELECTRONIC HEALTH RECORDS
Table of Contents
1. Introduction............................................................................................................................5
1.1. Background of the research.............................................................................................5
1.2. Rationale of the research.................................................................................................5
1.3. Research Objectives........................................................................................................7
1.4. Research Questions.........................................................................................................7
1.5. Summary of research.......................................................................................................8
2. Literature Review...................................................................................................................9
2.1. Literature Search Process................................................................................................9
2.2. Main Theoretical Perspectives........................................................................................9
2.2.1. Conceptual Framework of Electronic Health Record..............................................9
2.2.2. Benefits of the Framework.......................................................................................9
2.2.3. Implementation in the United Kingdom................................................................10
2.2.4. Disadvantages of the Framework...........................................................................10
2.3. Strengths and Weaknesses of the Literature.................................................................11
2.4. Similarities and Differences in the Literature...............................................................11
2.5. Inconsistencies in the Literature....................................................................................12
2.6. Gaps in the literature.....................................................................................................12
2.7. Interrelationships between Previous Literature and the Proposed Study......................13
2.8. Justification for the Constraints in the Literature Review............................................13
2.9. Scoping Review............................................................................................................13
2.10. Nature of the Research Approach to be adopted.........................................................14

3
ELECTRONIC HEALTH RECORDS
3. Methodology........................................................................................................................15
3.1. Methods.........................................................................................................................16
3.1.1. Search strategy.......................................................................................................16
3.1.2. Study Selection...........................................................................................................16
3.1.3. Inclusion criteria.....................................................................................................17
3.1.4. Exclusion criteria...................................................................................................17
3.1.5. Quality assessment.................................................................................................18
3.1.6. Assessment of risk bias..........................................................................................19
3.2 Data extraction...............................................................................................................21
3.3 Data synthesis.................................................................................................................21
3.4 Ethical assessment..........................................................................................................24
3.5 Informed consent............................................................................................................25
3.6 Ethical approval by the ethics review board..................................................................26
3.7 Conflict of interests........................................................................................................27
4. Limitations of the systematic review...................................................................................28
5. Dissemination.......................................................................................................................29
References................................................................................................................................30
Appendix 1...............................................................................................................................36
Appendix 2...............................................................................................................................37
CASP analysis for Article 1.................................................................................................37
CASP analysis for Article 2.................................................................................................41

4
ELECTRONIC HEALTH RECORDS
1. Introduction
1.1. Background of the research
The provision of patient online record is fundamental for the purpose of the
empowerment of patients (Mold and de Lusignan, 2015). E-health is defined as an
application of information, computer or the communication technology to certain aspects of
health or health care. Electronic Health Record (EHR) is a format of patient’s medical history
which is available electronically. This record is maintained by the provider from time to time.
The record includes all the chief administrative data which is related to the patient. With the
presence of EHR, it enables to systematize the access to information which has the potential
to restructure the workflow of the clinician (Ross et al., 2016). Some of the valuable
information available electronically involves the demographics, notes of progress, problems
with medications, previous medical history, laboratory related data, various reports etc. In
context to the present-day scenario, it can be put forth that e-health is essential for resolving
problems that are present in the healthcare systems because of the ageing population,
improvement of treatments and the limited resources (Kruse et al., 2016). There has been a
widespread acceptance of the importance of e-health and the various advantages or the
benefits associated with it. It can be stated that benefits of e-health have been often slower
than the actual anticipation which is mainly because of the difficulties associated with the
implementation (Boonstra, Versluis and Vos, 2014).
1.2. Rationale of the research
In the UK, the National Health Service or the NHS has stated that it is efficient to
make the best use of the available health technologies and put forth the outcome that NHS
has previously failed miserably to make the best use of e-health due to the difficulty in

5
ELECTRONIC HEALTH RECORDS
understanding the ways to adopt and implement them. There have been various high-profile
implementation failures which continue to exist even today (Jawhari et al., 2016). This has a
severe impact on the performance and demoralizes the staff. It is necessary to highlight the
effective need for undertaking the execution of the e-health or online record service in order
to understand the factors that influences the process of implementation. It is feasible for the
healthcare department to be well equipped for the devising of strategies and interventions for
the improvement of effective use of e-health thereby addressing the barriers of the application
of using electronic health record systems (Black et al., 2011). One of the major problems
associated with the operation of electronic health record literature lies in the fact that it is
extremely fragmented across the various subspecialty areas (Scott Kruse et al., 2016). With
the wide range of reviews available on the implementation of various technologies of e-
health, it is likely to be quite difficult for the clinicians, managers as well as the policymakers
to discover and apply appropriately the various body of evidence. The potential of e-health
lies in delivering both cost effective as well as quality healthcare (Jones et al., 2014). The
expenditure on e-health by the healthcare systems and government is increasing extensively.
The literature has often described the implementation of electronic health record to be
problematic and unsuccessful. In order to identify and address the challenges or the barriers
along with the effectiveness of using electronic health record system, there is a necessity to
conduct a systematic review. With the rapid changes in the technology and the innovative
solutions, it is evolving constantly for meeting the needs of the present practice. A present
update of the review is essential for understanding the advantages and the disadvantages of e-
health (World Health Organization, 2011). The research aims towards the identification,
summarization and synthesizing the presently available evidences which will be carried out
by a systematic review for exploring the barriers and the effectiveness of associated with the
implementation of electronic health record system, across the huge range of healthcare

6
ELECTRONIC HEALTH RECORDS
settings. The study will take into consideration the healthcare sector within the United
Kingdom. This research will help to improve the practices in healthcare because it will
outline all the barriers and the benefits of employing e-health record system. By knowing
clearly about both the positive and the negative impacts it will become easier for the
healthcare sector to incorporate the essential technological innovation that will be accepted
widely by the people (Tan, 2013). The practices will be further improved because the records
of the patients will be available online that will smoothen the process to a great extent both
for the healthcare organization and the patient’s family. The context of the research question
lies in outlining the effectiveness of the electronic record system. It is necessary to first know
in detail about the benefits of the e-health system before it is implemented. Next, when it
comes to barriers, it is of equal importance to understand because every coin has two sides
(Hoholm, La Rocca and Aanestad, 2018). Like it is mandatory to know about the positive
side, similarly it is vital to go through the negative side. The research question has been
identified as an issue within the contemporary context because with the advent of technology
it is necessary to sync technological innovation within healthcare management (Smaltz and
Berner, 2007). There is an increasing importance of technology in the designing of healthcare
systems. The fervour about the potential of IT offers an array of improvement in the health
services that has resulted in the unprecedented investments in information technology. When
health services and clinical systems are based on technology it comes it various forms with
numerous aims (Board on Health Care Services, and Institute of Medicine, 2012).
1.3. Research Objectives
 To explore the current status of the electronic health record systems in UK.
 To identify the challenges of implementing e-health record system in the UK.
1.4. Research Questions
 How effective is the present electronic health record system in the UK?

7
ELECTRONIC HEALTH RECORDS
 What are the barriers to implementation of electronic health record systems in the
UK?
PICO Question
Populatio
n
Patients in UK
Interventi
on
Elimination of barriers towards optimal implementation of EHR
Comparis
on
No implementation of HER or no eradication of barriers of EHR
Outcome
s
Optimal implementation of EHRs in healthcare system
1.5. Summary of research
The research will outline the literature associated with EHR and proceed towards
outlining the methodology of the research. Literature is essential for a study to check that
sufficient research is available for conducting the review. The study will gradually proceed
towards outlining the research protocol, limitations and lastly the dissemination of the
research.