Introduction
The past few decades have seen an expansion in the role of technology in healthcare reflected in the introduction of information technologies into the healthcare system. Electronic medical records (EMRs) are one form of information technology which can impact patient health outcomes.1 2 EMRs are computerised patient records introduced in the early 1970s as a way to organise, secure, complete and improve the quality of patient healthcare records.3 Around the turn of the century, EMRs gained attention because of the perceived and expected benefits they could offer the healthcare system which included: organisation of patient healthcare information, improving coordination of care as well as easier electronic access to medical information and expert opinion.4 5 With their creation and introduction into primary healthcare, EMRs were expected to have a positive impact on the quality of healthcare. This was expected to be realised through the use of EMRs to improve data quality through the recording of patient information and perform primary healthcare functions. This drove organisations and governments to create programme to promote the adoption of EMRs into the healthcare system.4
The distinction between EMR adoption and use is not clearly defined in the literature. However, for the purposes of this review, adoption of EMRs is defined as simply the introduction of EMRs into primary healthcare practice. The use of EMRs is the second step following adoption, involving practitioners using EMRs and their features to perform daily primary healthcare practice functions. A national survey in 2015 showed that the adoption of EMRs into primary healthcare practices is on the rise in Canada while EMR use is still low in comparison.6 7 The US Centers for Medicare and Medicaid Services (CMS) defined meaningful use as: ‘Using (EMRs) to: improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. Maintain privacy and security of patient health information’.8 For the purposes of this review, improved EMR use is defined as using EMRs according to the above definition. Some studies suggest that to achieve noticeable improvements in patient health outcomes following adoption, improving the use of EMRs is necessary.9–12 Therefore, improving the use of EMRs to achieve desirable health outcomes has attracted recent attention.13 The mechanisms to improving EMR use however, have not yet been determined. Therefore, this systematic review aims to review the literature to identify interventions and their effect on improving EMR use in primary healthcare settings in hopes of bridging the gap between adoption and use of EMRs.