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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Oct 13, 2020
Open Peer Review Period: Oct 13, 2020 - Dec 8, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Which electronic health record system should we use? - a systematic review

  • Vanash Patel; 
  • George Garas; 
  • James Hollingshead; 
  • Drostan Cheetham; 
  • Thanos Athanasiou; 
  • Vanash Patel; 



Electronic health records are digital records of a patient’s health and care. At present in the UK, patients may have several paper and electronic records stored in various settings. The UK government, via NHS England, intends to introduce a comprehensive system of electronic health records in England by 2020. These electronic records will run across primary, secondary and social care linking all data in a single digital platform.


This is the first systematic review to look at all published data on EHRs to determine which systems are advantageous.


Design: A systematic review was performed by searching EMBASE and Ovid MEDLINE between 1974 and November 2019. Participants: All original studies that appraised EHR systems were included. Main outcome measures: EHR system comparison, implementation, user satisfaction, efficiency and performance, documentation, and research and development.


The search strategy identified 701 studies, which were filtered down to 46 relevant studies. Level of evidence ranged from 1 to 4 according to the Oxford Centre for Evidence-based Medicine. The majority of the studies were performed in the USA (n = 44). N=6 studies compared more than one EHR, and Epic followed by Cerner were the most favourable through direct comparison. N=17 studies evaluated implementation which highlighted that it was challenging, and productivity dipped in the early phase. N=5 studies reflected on user satisfaction, with women demonstrating higher satisfaction than men. Efficiency and performance issues were the driving force behind user dissatisfaction. N=26 studies addressed efficiency and performance, which improved with long-term use and familiarity. N=18 studies considered documentation and showed that EHRs had a positive impact with basic and speciality tasks. N=29 studies assessed research and development which revealed vast capabilities and positive implications.


Epic is the most studied EHR system and the most commonly used vendor on the market. There is limited comparative data between EHR vendors, so it is difficult to assess which is the most advantageous system.


Please cite as:

Patel V, Garas G, Hollingshead J, Cheetham D, Athanasiou T, Patel V

Which electronic health record system should we use? - a systematic review

JMIR Preprints. 13/10/2020:24962

DOI: 10.2196/preprints.24962


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