Delpierre C et al. 2004 "A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach?"

Delpierre C, Cuzin L, Fillaux J, et al. A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach? Int J Qual Health Care 2004;16(5):407-416.
"Purpose. To analyse the impact of computer-based patient record systems (CBPRS) on medical practice, quality of care, and user and patient satisfaction.
Data sources. Manual and electronic search of the Medline, Cochrane, and Embase databases.
Study selection. Selected articles were published from 2000 to March 2003. CBPRS was defined as computer software designed to be used by clinicians as a direct aid in clinical decision making. To be included, the systems should have recorded patient characteristics and offered online advice, or information or reminders specific to clinicians during the consultation.
Data extraction. Keywords used for the search were: electronic record, informatic record, electronic medical record, electronic patient record, patient order entry, computer-based patient system, clinical decision support systems, and evaluation.
Results. Twenty-six articles were selected. Use of a CBPRS was perceived favourably by physicians, with studies of satisfaction being mainly positive. A positive impact of CBPRS on preventive care was observed in all three studies where this criterion was examined. The 12 studies evaluating the impact on medical practice and guidelines compliance showed that positive experiences were as frequent as experiences showing no benefit. None of the six studies analysing the impact of CBPRS on patient outcomes reported any benefit.
Conclusions. CBPRS increased user and patient satisfaction, which might lead to significant improvements in medical care practices. However, the studies on the impact of CBPRS on patient outcomes and quality of care were not conclusive. Alternative approaches considering social, cultural, and organizational factors may be needed to evaluate the usefulness of CBPRS."
"To analyse the impact of computer-based patient record systems (CBPRS) on medical practice, quality of care, and user and patient satisfaction."
Type Clinic
Primary care and specialty care
not applicable
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
The functions varied across the articles reviewed.
Workflow-Related Findings
"Three studies analysed nurse satisfaction with the introduction of CBPRS in their practice. A global increase in satisfaction was observed in two studies. In another study, reduced administrative work and increased accessibility to care protocols, especially for young nurses, were reported. Negative points were the lack of flexibility of these tools, the loss of nurses' judgment, and the additional workload. Nevertheless, nurses stated their desire to continue working with an informatic system in all three studies."
"Two studies analysed patient satisfaction, and patients were found to have a positive opinion of CBPRS in both. A mean score of 4.6 on a general satisfaction scale of 0-5 was reported. Patients did not report a reduction in eye-to-eye contact with the use of CBPRS, and found medical visits more effective. However, fear concerning data confidentiality was observed in both studies."
Three studies found an increase in the length of consultation with an electronic medical record (EMR) ranging between 2.2 and 9.3 minutes. One study found the length of consultation to be reduced and one study found the time unchanged.
"Three studies analysed the impact of CBPRS on the content of the consultation. Some variables, such as questions regarding mental health or behaviour such as tobacco consumption were more frequently recorded as items of the CBPRS."
"Thirteen studies analysed physician perception for CBPRS use. Physician satisfaction with the system was reported in nine studies. The positive points reported were improved knowledge of patients' medical history, better medical examination, and improvement in quality of care. In four studies, physicians were asked if they wanted to continue working with CBPRS: all studies reported positive responses."
"Factors influencing perception of the system were ... Users' characteristics. Perception of CBPRS was better for community-based physicians than for academic-based physicians. Physicians accustomed to working with a computer had a better perception of CBPRS"
"Factors influencing perception of the system were its characteristics, such as its interface and ease of use... Four studies raised some points of dissatisfaction. CBPRS was perceived as a physical barrier that could have a negative impact on the patient-physician relationship, particularly by reducing eye-to-eye contact. Concerns were expressed about data confidentiality, personal and professional privacy, bug management, and the additional work for physicians."
Study Design
Systematic literature review
Study Participants
Twenty-six studies were examined: ten randomized control trials, 11 pre-post, three cross-sectional, and two using qualitative interviews.