ArticleJournal of the American Medical Informatics Association : JAMIA2025
Tensions in large-scale electronic health record implementations: insights from a meta-synthesis.
Article in Journal of the American Medical Informatics Association : JAMIA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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
2 citing papers in PubMed.
- Effectiveness of the Prospective Prescription Review System in Reducing Irrational Prescriptions at a Tertiary Specialty Hospital: Retrospective Cohort Study.JMIR formative research · 2026Article
- Data in Diabetic Foot Care: From Current State to a Management Framework for Implementation.Journal of clinical medicine · 2025Review
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
objectiveTo synthesize knowledge on tensions characterizing large-scale electronic health record (EHR) implementations. MATERIALS AND
methodsA qualitative meta-synthesis was conducted by searching Scopus, Web of Science, MEDLINE, and CINAHL databases to find studies focusing on large-scale EHR implementations in OECD countries. An extraction table was completed to describe key characteristics of cases, and instances of tensions were extracted within each study based on a conceptual definition.
resultsTwenty-six qualitative studies were included, covering eleven unique large-scale EHR implementation projects. Cases were in Europe (n = 6), North America (n = 4), and Southeast Asia (n = 1). Analysis yielded twenty-one types of tensions associated with five primary objects: people, power, resources, system, and vision. Twelve tensions were found in multiple cases while fifteen were associated with more than one object. DISCUSSION: Results are aligned with the notion that tensions are inherent to organizational phenomena, showcasing their enduring nature across geographic, temporal, and technological contexts. The diversity of these tensions and their associated object(s) refer to critical, interrelated components of EHR systems implementation that are exacerbated in large-scale projects, and which can affect the implementation across its entire lifecycle.
conclusionStakeholders involved in projects to modernize healthcare through the large-scale implementation of EHRs are prone to experience multiple tensions. Attention to the emergence of the tensions identified in this study helps to understand their impacts on projects and stakeholders. Tensions and their associated objects undergird the sociotechnical nature of these complex projects and the need to manage them effectively.
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.