Effects Of Electronic Medical Record Research Articles

Effect of electronic records on mortality among patients in hospital and primary healthcare settings: a systematic review and meta-analyses.

Electronic medical records or electronic health records, collectively called electronic records, have significantly transformed the healthcare system and service provision in our world. Despite a number of primary studies on the subject, reports are inconsistent and contradictory about the effects of electronic records on mortality. Therefore, this review examined the effect of electronic records on mortality. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline. Six databases: PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched from February 20 to October 25, 2023. Studies that assessed the effect of electronic records on mortality and were published between 1998 and 2022 were included. Joanna Briggs Institute quality appraisal tool was used to assess the methodological quality of the studies. Narrative synthesis was performed to identify patterns across studies. Meta-analysis was conducted using fixed effect and random-effects models to estimate the pooled effect of electronic records on mortality. Funnel plot and Egger's regression test were used to assess for publication bias. Fifty-four papers were found eligible for the systematic review, of which 42 were included in the meta-analyses. Of the 32 studies that assessed the effect of electronic health record on mortality, eight (25.00%) reported a statistically significant reduction in mortality, 22 (68.75%) did not show a statistically significant difference, and two (6.25%) studies reported an increased risk of mortality. Similarly, among the 22 studies that determined the effect of electronic medical record on mortality, 12 (54.55%) reported a statistically significant reduction in mortality, and ten (45.45%) studies didn't show a statistically significant difference. The fixed effect and random effects on mortality were OR = 0.95 (95% CI: 0.93-0.97) and OR = 0.94 (95% CI: 0.89-0.99), respectively. The associated I-squared was 61.5%. Statistical tests indicated that there was no significant publication bias among the studies included in the meta-analysis. Despite some heterogeneity among the studies, the review indicated that the implementation of electronic records in inpatient, specialized and intensive care units, and primary healthcare facilities seems to result in a statistically significant reduction in mortality. Maturity level and specific features may have played important roles. PROSPERO (CRD42023437257).

Using Emr In A Corporate Hospital: Healthcare Providers Perspective From Bangladesh

Background: An Electronic Medical Record (EMR) is an essential tool for delivering high-quality healthcare in a hospital. In recent years, hospitals have increased their investment in EMRs to improve the level of integrated management of information. The purpose of this study was to explore the perspectives of using EMR among healthcare providers (HCPs) in a corporate hospital in Bangladesh.
 Methods: This cross-sectional study was conducted among 153 HCPs (doctors, nurses, lab technicians, drug dispensers, billing managers, and administrative personnel) who have access to EMR and working in a selected corporate hospital of Dhaka city. The study period was January to December 2019. HCPs were selected by convenience sampling technique. Data were collected by face-to-face interview using semi structured questionnaire. Data analysis was done by IBM SPSS software. Ethical issues were maintained strictly.
 Result: Study revealed that 59.5% HCPs were in the age group of 18-29 years with the mean age being 29.26 (±7.58) years. Only 32.7% HCPs had previous experience of using this type of software before working in the current hospital and 62.7% got technical training on EMR within the current hospital. The majority (81.7%) of the HCPs found that the technical training was effective for using the EMR software. The difficulty of using EMR was significantly associated with the age (p<0.001), gender (p<0.001), professional status (p<0.001) and highest level of education (p<0.001) of the HCPs. HCPs ability to overcome job related challenges was significantly associated with the professional status of them (p<0.001). HCPs perception regarding effectiveness of EMR was found significantly associated with their place of technical training (p=0.004) and duration of the training (p=0.012).
 Conclusion: EMR can be a helpful tool for the health service providers to provider health services at the corporate hospitals. Digital literacy need to be increased among the HCPs to ensure effective use of EMRs. Regular maintenance and upgrades of the technology infrastructure are necessary for advanced record-keeping and quality service.
 JOPSOM 2021; 41(2):12-19

Named entity recognition of Chinese electronic medical records based on a hybrid neural network and medical MC-BERT

BackgroundNamed entity recognition (NER) of electronic medical records is an important task in clinical medical research. Although deep learning combined with pretraining models performs well in recognizing entities in clinical texts, because Chinese electronic medical records have a special text structure and vocabulary distribution, general pretraining models cannot effectively incorporate entities and medical domain knowledge into representation learning; separate deep network models lack the ability to fully extract rich features in complex texts, which negatively affects the named entity recognition of electronic medical records.MethodsTo better represent electronic medical record text, we extract the text’s local features and multilevel sequence interaction information to improve the effectiveness of electronic medical record named entity recognition. This paper proposes a hybrid neural network model based on medical MC-BERT, namely, the MC-BERT + BiLSTM + CNN + MHA + CRF model. First, MC-BERT is used as the word embedding model of the text to obtain the word vector, and then BiLSTM and CNN obtain the feature information of the forward and backward directions of the word vector and the local context to obtain the corresponding feature vector. After merging the two feature vectors, they are sent to multihead self-attention (MHA) to obtain multilevel semantic features, and finally, CRF is used to decode the features and predict the label sequence.ResultsThe experiments show that the F1 values of our proposed hybrid neural network model based on MC-BERT reach 94.22%, 86.47%, and 92.28% on the CCKS-2017, CCKS-2019 and cEHRNER datasets, respectively. Compared with the general-domain BERT-based BiLSTM + CRF, our F1 values increased by 0.89%, 1.65% and 2.63%. Finally, we analyzed the effect of an unbalanced number of entities in the electronic medical records on the results of the NER experiment.

Assessing the Effect of Electronic Medical Record Note Template on Firearm Access Screening in High-Risk Children.

Children who survive a suicide attempt are at greater risk of later dying by suicide. Firearm screening and provision of lethal means restriction counseling may improve the safety of this high-risk cohort. Our objective was to determine firearm screening rates among children hospitalized after suicide attempts. We also assessed the effects of templating firearm screening questions into the psychiatric consultation note. This retrospective pre- and postintervention study identified children <19 years old admitted after a suicide attempt from January 1, 2016 to March 1, 2020. In mid-2017, the psychiatry consult note incorporated a previously available optional firearm screening tool as an embedded field (intervention). The intervention effect on proportion of children at high risk screened for firearm access was assessed by interrupted time series analysis. Of 26 088 total admissions, 357 met inclusion criteria. The majority were teenagers (15 years old, interquartile range 14 to 16), 275 were female (77%), and 167 were White (47%). Overall, 286 (80%) of patients had firearm access screening documentation. Of the 71 (20%) without screening, 21 (30%) were discharged from the hospital; 50 (70%) were transferred to psychiatric facilities. There was no significant difference in screening rates after the intervention (Intervention shift P = .74, slope P = .85). Many children were not screened for firearm access after a suicide attempt requiring hospitalization despite the screening tool integration. Multidisciplinary quality improvement efforts are needed to ensure that this critical risk reduction intervention is implemented for all patients after a suicide attempt.

Effect of computer use on physician-patient communication using interviews: A patient perspective

BackgroundA commonly stated barrier to adoption of electronic medical record (EMR) is fear of a negative impact on physician-patient communication. Systematic reviews have shown that there is limited literature addressing the patients’ perspective as compared to the physicians’ perspectives. AimThis study aims to understand patients’ perspective on the effect of EMR on physician-patient communication in an ambulatory setting. Design and settingsThis is a qualitative study using semi-structured interviews with 49 patients at a multi-physician family medicine clinic in a large academic medical center in Beirut, Lebanon. Materials and methodsAt the end of the visit with the physicians, the patients were approached by the clinical assistant to conduct an interview concerning the patient-doctor communication in the presence of electronic medical record. The interview was conducted in a private office by an experienced researcher. ResultsAlmost all patients reported that computer use during the encounter did not affect the quality of communication with their physician. Five themes emerged from the analysis of the interviews: (1) EMR use in clinic is considered a necessity; (2) EMR use by physicians is efficient in record keeping and information retrieval; (3) physicians balance between using the computer and paying attention to patients; (4) computer use by physicians might affect communication about personal and intimate issues; (5) concomitant computer use while listening to the patient was not considered disturbing. ConclusionsMost patients appreciated EMR use by physicians during the clinical encounter and acknowledged its benefits despite the presence of some concerns. Most patients did not consider that EMRs affect communication with physicians negatively especially when used in a balanced manner. Attention rather than eye contact is what mattered the most for patients.

SUPPORT-AF: Piloting a Multi-Faceted, Electronic Medical Record-Based Intervention to Improve Prescription of Anticoagulation.

BackgroundOnly 50% of eligible atrial fibrillation (AF) patients receive anticoagulation (AC). Feasibility and effectiveness of electronic medical record (EMR)–based interventions to profile and raise provider AC percentage is poorly understood. The SUPPORT‐AF (Supporting Use of AC Through Provider Profiling of Oral AC Therapy for AF) study aims to improve rates of adherence to AC guidelines by developing and delivering supportive tools based on the EMR to providers treating patients with AF.Methods and ResultsWe emailed cardiologists and community‐based primary care providers affiliated with our institution reports of their AC percentage relative to peers. We also sent an electronic medical record–based message to these providers the day before an appointment with an atrial fibrillation patient who was eligible but not receiving AC. The electronic medical record message asked the provider to discuss AC with the patient if he or she deemed it appropriate. To assess feasibility, we tracked provider review of our correspondence. We also tracked the change in AC for intervention providers relative to alternate primary care providers not receiving our intervention. We identified 3786, 1054, and 566 patients cared for by 49 cardiology providers, 90 community‐based primary care providers, and 88 control providers, respectively. At baseline, the percentage of AC was 71.3%, 63.5%, and 58.3% for these 3 respective groups. Intervention providers reviewed our e‐mails and electronic medical record messages 45% and 96% of the time, respectively. For providers responding, patient refusal was the most common reason for patients not being on AC (21%) followed by high bleeding risk (19%). At follow‐up 10 weeks later, change in AC was no different for either cardiology or community‐based primary care providers relative to controls (0.2% lower and 0.01% higher, respectively).ConclusionsOur intervention profiling AC was feasible, but not sufficient to increase AC in our population.

Monitoring health IT integration--the effect of an EMR on laboratory service timeliness across six Australian hospitals.

The Electronic Medical Record (EMR) incorporates computerised provider order entry systems which allow clinicians to order diagnostic tests electronically, thus eliminating the need for cumbersome handwritten orders. In many situations the EMR relies on a manual transition of information across systems (e.g., integration with the Laboratory Information System). This study, based in a laboratory setting requiring such a transition across systems, aimed to compare the data entry time (from when a specimen arrives in the Central Specimen Reception [CSR] area of the laboratory, to when it is forwarded on for processing), along with a laboratory turnaround time (TAT) (from the time a specimen is received to the time a verified result is issued) for paper and EMR orders, for two high volume tests, across six hospitals. Results showed that the median data entry time for all hospitals combined, was three minutes shorter for EMR entered orders than paper orders. This difference was consistent and significant for Electrolytes, Urea, Creatinine (EUC) and Automated Differential (including full blood count) tests in 2010 and 2011. These decreases contributed to significantly lower median Laboratory TATs for EMR orders (for EUC tests the difference in medians was 12 minutes in 2010 and six minutes in 2011; for Automated Differential tests, the difference was four minutes in 2010 and two minutes in 2011).

Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review.

BackgroundThe intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa.MethodsA state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis.ResultsFrom an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts.DiscussionThis review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers.ConclusionThe future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

Recent perspectives of electronic medical record systems.

Implementation of electronic medical record (EMR) systems within developing contexts as part of efforts to monitor and facilitate the attainment of health-related aims has been on the increase. However, these efforts have been concentrated on urban hospitals. Recent findings showed that development processes of EMR systems are associated with various discrepancies between protocols and work practices. These discrepancies were mainly caused by factors including high workload, lack of medical resources, misunderstanding of the protocols by health workers, and client/patient practices. The present review focused on the effects of EMRs on patient care work, and on appropriate EMR designs principles and strategies to ameliorate these systems.

Future of the Smartphone for Patients and Healthcare Providers.

Future of the Smartphone for Patients and Healthcare Providers.

The Effects of Electronic Medical Record (EMR) System on Hospital Management Performance

The Effects of Electronic Medical Record (EMR) System on Hospital Management Performance

Implementation of an electronic medical record does not change delivery of preventive care for HIV-positive patients

PurposeThis study sought to determine the impact that an electronic medical record (EMR) had on the provision of preventive health measures – including obtaining serologies for viral hepatitis and administering vaccinations to non-immune patients – to HIV patients at a hospital-based clinic. MethodsUsing a pre–post study design, we compared rates of preventive health delivery to HIV patients at an outpatient clinic during the use of a paper medical record (PMR) and after implementation of an EMR. Retrospective chart reviews were conducted at two time points: 12–16 months prior to and 24 months following EMR implementation. The records of 160 active patients were randomly selected for review during both time periods. ResultsThere was no difference between the PMR and EMR samples with regard to the proportion of patients who had hepatitis A (83% in PMR group; 77% in EMR) and hepatitis C (94% in both groups) serologies measured or the proportion of eligible patients who were given hepatitis vaccinations. Slightly fewer patients had a serology for hepatitis B measured in the EMR sample. ConclusionsAs EMR implementation expands, it is important to evaluate the effects that EMRs have on patient outcomes, including preventive health provision. Our study showed that after implementation of an EMR, the provision of most preventive care measures did not improve. This finding is in agreement with many published studies. Some studies have found positive effects from EMRs that may be attributable to specific aspects of EMRs. Further study of the effect of specific EMR attributes on health care outcomes is needed.

The effect of electronic medical record system sophistication on preventive healthcare for women.

To observe the effect of electronic medical record (EMR) system sophistication on preventive women's healthcare. Providers in the National Ambulatory Medical Care Survey (NAMCS), 2007-8, were included if they had at least one visit by a woman at least 21 years old. Based on 16 questions from NAMCS, the level of a provider's EMR system sophistication was classified as non-existent, minimal, basic, or fully functional. A two-stage residual-inclusion method was used with ordered probit regression to model the level of EMR system sophistication, and outcome-specific Poisson regressions to predict the number of examinations or tests ordered or performed. Across the providers, 29.23%, 49.34%, 15.97%, and 5.46% had no, minimal, basic, and fully functional EMR systems, respectively. The breast examination rate was 20.27%, 34.96%, 37.21%, and 44.98% for providers without or with minimal, basic, and fully functional EMR systems, respectively. For breast examinations, pelvic examinations, Pap tests, chlamydia tests, cholesterol tests, mammograms, and bone mineral density (BMD) tests, an EMR system increased the number of these tests and examinations. Furthermore, the level of sophistication increased the number of breast examinations and Pap, chlamydia, cholesterol, and BMD tests. The use of advanced EMR systems in obstetrics and gynecology was limited. Given the positive results of this study, specialists in women's health should consider investing in more sophisticated systems. The presence of an EMR system has a positive impact on preventive women's healthcare; the more functions that the system has, the greater the number of examinations and tests given or prescribed.

Effects of electronic medical record in a Chinese hospital: A time series study

BackgroundElectronic medical record (EMR) systems have potential to improve care quality and efficiency. Yet little is known about the effects of EMR in Chinese hospitals. ObjectiveAn inpatient EMR system was implemented in a large Chinese hospital. The objective of this research was to evaluate the impact of the EMR system on efficiency, quality, and cost of inpatient care in the hospital. MethodsA five-year (2005–2009) longitudinal dataset with monthly data involving 251 physicians and 298,760 patient visits was created by querying the hospital's central database. Four key outcomes were examined: length of stay, infection rate, mortality rate, and cost per patient stay. Interrupted time series analysis was used to evaluate changes in level and slope for each outcome variable. ResultsLength of stay grew at 0.027 bed-days per month in the pre-EMR period and declined at 0.043 bed-days per month in the post-EMR period. Infection rate rose at 0.036 infections per 100 patients per month in the pre-EMR period and declined at 0.062 infections per 100 patients per month in the post-EMR period. Mortality rate grew at 0.048 deaths per 1000 patients per month in the pre-EMR period and decreased at 0.005 deaths per 1000 patients per month in the post-EMR period. Cost per patient stay declined at 33 RMB per month in the pre-EMR period and increased at 16 RMB per month in the post-EMR period. ConclusionsThe EMR was associated with the declining patterns of length of stay, infection rate, and mortality rate. It had no positive effect on patient costs.

Electronic Medical Record Reminders and Panel Management to Improve Primary Care of Elderly Patients

Most elderly patients do not receive recommended preventive care, acute care, and care for chronic conditions. We conducted a controlled trial to assess the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. Physicians were assigned to 1 of the following 3 arms: EMR reminder, EMR reminder plus panel manager, or control. We assessed completion of recommended practices during a 1-year period. Among patients who had not already received the recommended care, health care proxy was designated in 6.5% of patients in the control arm, 8.8% of the EMR reminder arm, and 19.7% of the EMR reminder plus panel manager arm (P=.002). Bone density screening was completed in 17.7% of patients in the control arm, 19.7% of the EMR reminder arm, and 30.5% of the EMR reminder plus panel manager arm (P=.02). Pneumococcal vaccine was given to 13.1% of patients in the control arm, 19.5% of the EMR reminder arm, and 25.6% of the EMR reminder plus panel manager arm (P=.02). Influenza vaccine was given to 46.8% of patients in the control arm, 56.5% of the EMR reminder arm, and 59.7% of the EMR reminder plus panel manager arm (P=.002). Results were similar when adjusted for individual physician performance in the preceding year, patient age, patient sex, years cared for by the practice, and number of visits. Electronic medical record reminders alone facilitated improvement in vaccination rates and, when augmented by panel management, facilitated further improvement in vaccination rates and boosted the rates of health care proxy designation and bone density screening. clinicaltrials.gov Identifier: NCT01313169.

Realizing Electronic Medical Record Benefits

Heuristic evaluation is a type of study that is useful for uncovering usability issues in a human-computer interface such as the electronic medical record (EMR). Findings can be very useful in overcoming usability problems to better realize the benefits of the EMR. Correction of the usability violations will improve the efficiency and effectiveness of EMRs. The authors discuss their use of heuristic evaluation to assess usability issues found in their nursing electronic documentation system.

The impact of electronic medical record systems on outpatient workflows: A longitudinal evaluation of its workflow effects

Context The promise of the electronic medical record (EMR) 1 1 The electronic medical record (EMR) is defined as a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care. The central focus of such systems is clinical data and not financial or billing information. Such systems may be limited in their scope to a single area of clinical information (e.g., laboratory data), or they may be comprehensive and cover virtually every facet of clinical information pertinent to patient care (e.g., computer-based patient record systems). An ideal EMR's usually encompasses (i) a longitudinal collection of electronic health information for and about person; (ii) electronic access to person- and population-level information by authorized users. lies in its ability to reduce the costs of health care delivery and improve the overall quality of care – a promise that is realized through major changes in workflows within the health care organization. Yet little systematic information exists about the workflow effects of EMRs. Moreover, some of the research to-date points to reduced satisfaction among physicians after implementation of the EMR and increased time, i.e., negative workflow effects. A better understanding of the impact of the EMR on workflows is, hence, vital to understanding what the technology really does offer that is new and unique. Objective (i) To empirically develop a physician centric conceptual model of the workflow effects of EMRs; (ii) To use the model to understand the antecedents to the physicians’ workflow expectation from the new EMR; (iii) To track physicians’ satisfaction overtime, 3 months and 20 months after implementation of the EMR; (iv) To explore the impact of technology learning curves on physicians’ reported satisfaction levels. Design The current research uses the mixed-method technique of concept mapping to empirically develop the conceptual model of an EMR's workflow effects. The model is then used within a controlled study to track physician expectations from a new EMR system as well as their assessments of the EMR's performance 3 months and 20 months after implementation. Setting The research tracks the actual implementation of a new EMR within the outpatient clinics of a large northeastern research hospital. Participants The pre-implementation survey netted 20 physician responses; post-implementation Time 1 survey netted 22 responses, and Time 2 survey netted 26 physician responses. Intervention The implementation of the actual EMR served as the intervention. Since the study was conducted within the same setting and tracked a homogenous group of respondents, the overall study design ensured against extraneous influences on the results. Main outcome measures Outcome measures were derived empirically from the conceptual model. They included 85 items that measured physician perceptions of the EMR's workflow effect on the following eight issues: (1) administration, (2) efficiency in patient processing, (3) basic clinical processes, (4) documentation of patient encounter, (5) economic challenges and reimbursement, (6) technical issues, (7) patient safety and care, and (8) communication and confidentiality. The items were used to track expectations prior to implementation and they served as retrospective measures of satisfaction with the EMR in post-implementation Time 1 and Time 2. Results The findings suggest that physicians conceptualize EMRs as an incremental extension of older computerized provider order entries (CPOEs) rather than as a new innovation. The EMRs major functional advantages are seen to be very similar to, if not the same as, those of CPOEs. Technology learning curves play a statistically significant though minor role in shaping physician perceptions. Conclusions The physicians’ expectations from the EMR are based on their prior beliefs rather than on a rational evaluation of the EMR's fit, functionality, or performance. Their decision regarding the usefulness of the EMR is made very early, within the first few months of use of the EMR. These early perceptions then remain stable and become the lens through which subsequent experience with the EMR is interpreted. The findings suggest a need for communication based interventions aimed at explaining the value, fit, and usefulness of EMRs to physicians early in the pre- and immediate post-EMR implementation stages.

Comparison of documentation time between an electronic and a paper-based record system by optometrists at an eye hospital in south India: A time–motion study

Purpose The adoption of electronic medical record (EMR) system is gradually increasing. However, various time–motion studies reveal conflicting data regarding time effectiveness on workflow due to computerization. One of the major issues for physicians is their uncertainty with EMRs’ potential impact of time on workflow. A tertiary eye hospital in south India was in the process of implementing an EMR system in their ambulatory care unit. Many of the staff did not have previous computing experience and there were conflicting views on the time effectiveness of the computerized system after implementation. The management was thus interested to know the real time effectiveness of EMR in their hospital. The study compliments existing studies of this type by comparing the time efficiency of documentation time using EMR system with paper documentation in a hospital in a developing country where a transition between paper and EMR documentation was currently in progress. Methods Ten randomly selected optometrists documented the time they spent during consultation with both paper and EMR documentation. The time spent was documented for a total of 200 records (100 EMR and 100 paper records). The independent-samples t-test and analysis of variance were used to compare the means of the consultation time and calculated documentation time spent between the electronic and paper records. Results There was no statistically significant difference in the time spent for documentation between electronic and paper records. The mean time spent in documenting electronic records was 0.92 min (95% CI −3.06 to 1.14) longer than in paper records. Conclusion EMR systems can be adopted in eye hospitals without having significant negative impact on duration of consultation and documentation for optometrists. More time–motion studies that include ophthalmologists are however needed in order to get a more complete picture of time impact of the EMR system on clinical workflow in eye hospitals.

The impact of electronic medical records on patient–doctor communication during consultation: a narrative literature review

The effect of Electronic Medical Record (EMR) use on Patient-Doctor Communication (PDC) has rarely been studied. As data accumulate, the purpose of this article is to review the literature on EMR effect on PDC, to identify recurring themes and to offer preliminary guidelines and future directions for medical education and research. A database search was conducted and 14 articles that met inclusion criteria (published in the past 10 years, empirical investigations, direct assessment of the EMR impact on patient-doctor communication) were selected for review. A qualitative, grounded theory-like approach was employed to analyse the data. EMR use often has a positive impact on information exchange, but exerts a negative influence on patient centredness. Some physician characteristics such as their computer skills and behavioural style assist in overcoming this negative influence. The use of EMR exerts both positive and negative impacts on physician-patient relationships. The negative impacts can be overcome by some simple means as well as better designs of EMR systems and medical education interventions. Physicians' everyday practices of integrating EMR use into the clinical encounter as well as better design of EMR systems and EMR and communication training may facilitate PDC in computerized settings.