SynthesisThe Milbank quarterly2009
Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method.
Synthesis in The Milbank quarterly, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 101 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
101 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Pooled it
- Pooled it
- The impact of eHealth on the quality and safety of health care: a systematic overview.PLoS medicine · 2011Pooled it
- Sustainable procurement practices in sub-Saharan African health systems: a scoping review protocol.BMJ open · 2026Article
- Article
- Partial pictures: what routine health data can and cannot tell us about the quality of maternal and neonatal health services in Tanzania.Health policy and planning · 2026Article
- Evaluating the Effectiveness of Health Information Management Systems in Facilitating Quality Healthcare Service: A Cross-Sectional Study.Health science reports · 2026Article
- Interdisciplinary systems may restore the healthcare professional-patient relationship in electronic health systems.Journal of the American Medical Informatics Association : JAMIA · 2026Article
- Safe harboring and governance: Lakota relational systems as context for women's health integration.Frontiers in sociology · 2026Article
- Policy context and digital development: a comparative study of trajectories in 4 Canadian academic health centers over 30 years.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Design and Implementation of an Electronic Patient Record via Adaptation of Existing Hospital Software.Cureus · 2025Article
- Tensions in large-scale electronic health record implementations: insights from a meta-synthesis.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Article
- Challenges and Facilitation Approaches for the Participatory Design of AI-Based Clinical Decision Support Systems: Protocol for a Scoping Review.JMIR research protocols · 2024Article
- Designing for digital transformation of residency education - a post-pandemic pedagogical response.BMC medical education · 2023Article
- Evaluation Methods in Clinical Health Technologies: A Systematic Review.Iranian journal of public health · 2023Review
- The practical ethics of repurposing health data: how to acknowledge invisible data work and the need for prioritization.Medicine, health care, and philosophy · 2023Article
- Exploring facilitators of the implementation of electronic health records in Saudi Arabia.BMC medical informatics and decision making · 2022Article
- Best Practices on Big Data Analytics to Address Sex-Specific Biases in Our Understanding of the Etiology, Diagnosis, and Prognosis of Diseases.Annual review of biomedical data science · 2022Review
- Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equity.International journal for equity in health · 2022Article
41 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
contextThe extensive research literature on electronic patient records (EPRs) presents challenges to systematic reviewers because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches.
methodsUsing the meta-narrative method and searching beyond the Medline-indexed literature, this review used "conflicting" findings to address higher-order questions about how researchers had differently conceptualized and studied the EPR and its implementation.
findingsTwenty-four previous systematic reviews and ninety-four further primary studies were considered. Key tensions in the literature centered on (1) the EPR ("container" or "itinerary"); (2) the EPR user ("information-processer" or "member of socio-technical network"); (3) organizational context ("the setting within which the EPR is implemented" or "the EPR-in-use"); (4) clinical work ("decision making" or "situated practice"); (5) the process of change ("the logic of determinism" or "the logic of opposition"); (6) implementation success ("objectively defined" or "socially negotiated"); and (7) complexity and scale ("the bigger the better" or "small is beautiful").
conclusionsThe findings suggest that EPR use will always require human input to recontextualize knowledge; that even though secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper may offer a unique degree of ecological flexibility; and that smaller EPR systems may sometimes be more efficient and effective than larger ones. We suggest an agenda for further research.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.