Learning Outcomes

• Understand the health information management considerations for electronic medical records (EMRs)/electronic health records (EHRs) at various levels and their impact on healthcare delivery, consumers, and data management.
• Evaluate the factors in choosing an EMR solution, including functionality, usability, interoperability standards, and resources to make decisions and introduce solutions to enhance healthcare operations.
• Identify the success factors and challenges in the implementation and maturation of EMR/EHR systems.
• Propose solutions to address challenges to EMR/EHR implementation, maximising their value and effectiveness.

Introduction

Electronic medical records (EMRs) and electronic health records (EHRs) represent a significant advancement in the management of health information. Digital records are designed to streamline the collection, storage, retrieval, and sharing of health information, ultimately improving the quality of care. Digital records capture structured and unstructured data and can be analysed to understand health service utilisation, disease, and treatment patterns. This chapter explores the considerations for managing health information through EMRs and EHRs, examining their distinctions, implementation, and impact.

Background and Context

EMRs are foundational to a digitally enabled healthcare system. Organisational EMRs collect vast volumes of data at a very granular level. Countries such as Singapore and Australia have implemented longitudinal health summary records often referred to as EHRs providing vital information across jurisdictions and compiling a lifelong health repository. In Europe, the United Kingdom, and other countries, the term electronic health record refers to clinical records maintained by hospitals, primary care, and aged care providers. In Australia, electronic medical record is used to describe detailed records held by healthcare providers, while electronic health records are a longitudinal digital record accessible by healthcare providers and users.

Healthcare systems that are responsive to health care user needs and preferences can lead to better health outcomes and a more efficient healthcare system (Havana et al., 2023). Digital health solutions such as electronic health and medical records are vital to support the delivery of care at the right time, in the right place and by the appropriate provider. EMRs and EHRs are implemented to support clinicians and healthcare providers to provide seamless and integrated care, and support health care users to achieve improved health outcomes Owens et al cited in (Almond & Mather, 2023). Person-centred service delivery can empower individuals to manage their health, disease, and treatment (Havana et al., 2023). Real-time access to health information enhances decision-making, personalised care, and fosters collaboration between users and providers.

Achieving the United Nations’ Sustainable Development Goals (SDGs), particularly Goal 3: Good Health and Well-Being, requires innovative approaches to improve healthcare delivery, equity, and outcomes on a global scale (United Nations, 2023). Health information systems, particularly EMRs and EHRs, play a central role in supporting these objectives by providing a foundation for data-driven decision-making and resource allocation (Stephen et al., 2024; Vos et al., 2020). These digital tools can facilitate the collection, management, and analysis of health user information, enhancing healthcare operations while tracking progress toward SDG health targets (United Nations, 2023). The chapter on Patient Safety and Sustainable Development Goals Through the Lens of Health Information Management also describes this integral role.

Data from EMRs/EHRs can drive healthcare improvement and performance. Predictive analytics using routinely collected data can enhance healthcare outcomes by identifying trends, optimising resources, and supporting preventive health measures (Canfell, Chan, et al., 2024; Kumar & Suthar, 2024; Obermeyer et al., 2019).

This chapter explores the importance of longitudinal records and data linkage, and the critical factors for successful EMR implementation. The functionality and usability of EMRs, adoption of interoperability standards, and maturity and value of EMR systems are also examined. The goal is to highlight how EMRs can transform healthcare delivery into a more efficient, effective, and person-focused system.

Difference Between EMR and EHR

The introduction touched on the difference between EMRs and EHRs. This differentiation is important. Essentially, EMRs are digital counterparts to traditional paper charts, primarily used to document a person’s diagnosis and treatment history within a single healthcare setting, such as a hospital, community health centre, aged care home, or general practice. EMRs have the potential to streamline clinical workflows, improve record-keeping, and enhance patient care within that specific organisation. In contrast, EHRs are designed to transcend individual care settings by enabling the secure sharing of health information across multiple providers, organisations, and even with healthcare users themselves (McGinn et al., 2012). EHRs serve as a comprehensive, longitudinal health record, capturing data from “cradle to grave” to provide a holistic view of an individual’s health journey over their lifetime. This fundamental distinction highlights the broader, integrative role of EHRs in supporting coordinated care, enhancing healthcare user outcomes, and driving population health initiatives; whereas EMRs remain important for managing care at a local organisational level. Understanding these differences is critical to appreciating their respective contributions to modern healthcare systems and achieving data-driven improvements in care delivery.

Health Information Management Considerations for EMRs/EHRs

EMR/EHR systems provide significant benefits for data management, healthcare providers, and consumers. By consolidating healthcare user data, including demographics, medical history, treatments, and outcomes, these systems ensure standardised, real-time data availability for clinical decision-making, resource allocation, and health policy development (Serbanati, 2020). At an institutional level, they can enhance operational efficiency by avoiding repeat diagnostics and medication interactions and improving workflows. For consumers, EMR/EHR systems enable better access to personal health information, fostering greater healthcare user engagement and autonomy in care management (Serbanati, 2020). However, successful implementation requires leadership, change and project management, resource allocation (Abdelhak & Hanken, 2016; Arabi et al., 2022), data security, privacy, governance, and interoperability to maximise their impact across the health ecosystem (Tertulino et al., 2024).

Selecting an appropriate EMR solution is a critical step in enhancing healthcare. This section outlines the key factors that decision-makers must evaluate to ensure the chosen system meets the needs of their healthcare environment.

“People need reasons to change. A case for change is a concise collection of evidence that can be easily communicated to demonstrate the reasons for change and the risks of not changing. Taking the time to develop a convincing case for change is a worthwhile investment as it will help stakeholders clearly understand what, why and how of your project (NSW Agency for Clinical Innovation, 2024)”

Leadership and project and change management are vital for EMR adoption. Effective leadership involves developing a clear vision with realistic goals to gain commitment to the project. Successful EMR implementation requires a leadership team that includes practicing clinicians from all professional streams (Scott et al., 2019), reflecting users’ key role in adoption. Training and support are essential components of implementation. Conducting well-timed training sessions tailored to address the specific needs of staff ensures that all users are adequately prepared to utilise the new system. Continuous technical support provides a safety net as staff adapt to the technology. Workflow redesign is essential to assess and improve existing workflows to integrate the EMR system into daily operations (Scott et al., 2019). This ensures that the new system enhances, rather than disrupts, the efficiency of healthcare delivery (Arabi et al., 2022).

Change management is often neglected during EMR implementation and is key to success. Project management helps to ensure EMR projects are achieved and completed within budget and time frames. Planning for risks and risk management is integral to successful EMR projects.

Financial considerations, such as understanding and managing costs and potential benefits are important in EMR projects. This involves developing a clear business case prior to implementation and careful budgeting and planning to ensure that the implementation is economically viable (Arabi et al., 2022). Resourcing for clinical and other staff to redesign workflows, and deliver training and support to users must be included in project budgets. When adopting EMRs, it is important to allocate additional resources and dedicate time to lead and manage change and complete the tasks required for implementation (Greenhalgh & Abimbola, 2019). The availability of technical infrastructure, funding, and skilled personnel is crucial for the EMR implementation. Without adequate resources, even an advanced EMR system may fail to deliver its full potential (Bostan et al., 2024).

EMR implementation presents opportunities and challenges. Success relies on strong change management strategies, comprehensive training programs, and ongoing stakeholder engagement (Arabi et al., 2022; Scott et al., 2019). Critical challenges include resistance to change, high initial costs, technical barriers, and ensuring data privacy and cybersecurity. Achieving interoperability across fragmented healthcare systems remains a significant hurdle (Kosteniuk et al., 2024).

To successfully implement electronic medical and health records, it is crucial to invest in scalable solutions, particularly in resource-limited settings. This ensures systems can grow with operational demands (Rigby & Ammenwerth, 2016; World Health Organization, 2021). Selecting vendors that promote interoperability is important. Adherence to national and global data exchange standards and encouraging cross-platform integration can create unified health information systems that facilitate seamless data sharing and collaboration (Australian Digital Health Agency, 2023; Kuo & Lee, 2018; Palma, 2022).

Prioritising usability and training is essential to ensuring these systems are user-friendly, and clinicians can be supported to do their work (Lloyd et al., 2021; Lloyd et al., 2024). Through iterative design processes and targeted training programs, healthcare providers can be empowered to use the systems effectively and improve overall efficiency and patient care (Carayon et al., 2021; Tao et al., 2020). Addressing data privacy is also essential. Implementing robust cybersecurity measures, governance frameworks, and legal compliance safeguards against breaches and misuse (Murdoch, 2021; Office of the Australian Information Commissioner, 2023; Ruotsalainen & Blobel, 2020).

Consideration of human factors is essential in the implementation of EMRs. A human factors design focus on the interaction between humans and technology. This consideration ensures that the systems are user-friendly, efficient, and safe. Through understanding human factors, EMR implementation can improve user satisfaction, reduce errors, and enhance overall system performance (Dubé et al., 2025; Kushniruk et al., 2014; Vasquez et al., 2024). Engaging users early in EMR implementation assists in developing solutions that meet healthcare providers and patients’ needs.

Private Sector Considerations

The private health sector faces unique challenges during EMR procurement and implementation processes; for example, private providers lack the size of public health care organisations, which can limit an organisation’s ability to leverage economies of scale during the procurement process. Funding drivers for these projects will differ in the private sector, as the funding will need to be generated from existing revenue streams.  The drivers for implementing EMRs can differ for private providers, with a focus on the following:

• Improvements in quality of care. By providing comprehensive and up-to-date patient information, EMRs enable healthcare providers to make more informed and timely decisions (Cahill et al., 2025). Standardised data collection templates (Rowlands et al., 2022) and clinical pathways within EMRs help reduce inconsistencies in patient care, and contribute to safer health care (Australian Commission on Safety and Quality in Healthcare, 2021; Neame et al., 2019). EMRs can alert providers to issues such as drug interactions or allergies, thereby reducing the risk of preventable harm. With access to detailed patient histories and evidence-based guidelines, healthcare providers can tailor treatments to each patient’s specific needs, enhancing the appropriateness of care. EMRs can facilitate better communication between patients and providers, allowing for personalised and consumer-centred care. Data collected through EMRs can be used to monitor patient outcomes and identify areas for quality improvement, leading to continuous enhancements in healthcare delivery (Keasberry et al., 2017; Shaw et al., 2018; Woods et al., 2023).
• Compliance with the Standards for Safety and Quality and to gain accreditation, including the ability to capture clinical indicators and quality data (Australian Commission on Safety and Quality in Healthcare, 2021). Capturing real-time data in the EMR removes the need for workarounds, reducing manual data collection and collation in spreadsheets and other tools. This creates efficiencies and removes the potential for error. Timely data also enable real-time responses.
• Health insurance fund requirements for data on diagnosis, treatment, and costs that could influence contract negotiations and reporting.
• Integrated care models that require healthcare records that encompass the patient journey from inpatient services to in-home and outpatient care post discharge.

The size of private health care organisations may impact the availability of staff to support large scale implementation.  Without the scale of public hospitals, a lack of expertise within organisations will influence procurement and implementation processes and increase the need for external support. The lean staffing models that private providers use increase initial implementation costs because external resources will be required to support the process.

Organisations will often seek partnerships with EMR vendors to reduce the initial outlay and leverage vendors’ expert knowledge.  The cost of the EMR and the limited funding streams in private hospitals will influence the choice between best of breed, with modules from multiple vendors versus integrated solution from a single vendor. Integrated solutions often require higher initial expenditure as opposed to spreading the expense over time as each module is implemented. The risk of fragmented systems and the requirements for multi-vendor systems integration is often traded for lower cost products.

Addressing these considerations and challenges, EMR/EHR systems can play a transformative role in achieving SDG health-related targets. Through their ability to provide foundational health data, enhance care delivery, and drive policy interventions, these systems contribute to a more sustainable, equitable, and data-driven healthcare future.

Health Information Management at Various Levels

Health information management (HIM) professionals play a pivotal role in leading EMR adoption, ensuring that systems meet user requirements, comply with privacy regulations, and advocate for interoperability at various levels of healthcare delivery. From individual providers to nationwide health systems, each level presents unique challenges and opportunities for HIM practices.

Provider Level

At the provider level, EMRs are used to manage health information within a single setting. EMRs have been implemented in community health centres, primary care practitioner’s offices (GPs, allied health practitioners), and aged and acute care settings. At the provider level, the EMR is the electronic version of the paper chart. Advantages of the EMR are that it can be viewed by more than one healthcare provider at a time in real-time and data can be analysed to understand health trends and patterns of utilisation within the setting. Provider EMRs offer various functionalities, including scheduling, clinical documentation, and prescription and medication management. In the United States, where many EMR vendors have originated, these systems have also been implemented to maximise billing and reimbursement. Provider EMRs have been identified to improve efficiency, reduce errors, and enhance care by providing quick access to health information (Canfell, Woods, et al., 2024; Woods et al., 2023). However, downsides have been identified in the literature, including burnout, data burden, note bloat, and usability (Hettinger et al., 2021; Kaipio et al., 2019; Kushniruk et al., 2014; Lloyd et al., 2021; Lloyd et al., 2024; Melnick et al., 2021; Thomas Craig et al., 2021; Tyllinen et al., 2018).

Network Level

At the network level, the summary EHR can facilitate the sharing of health information across multiple providers, improving coordination of care. In New South Wales (NSW), Australia, hospitals within each local health district utilise a unified instance of the EMR (eHealth NSW, 2025). This approach enables seamless sharing of patient information across facilities within the same district.

Regional Level

Regional health information systems share health information across different healthcare providers within a region, enhancing public health monitoring and response. Different approaches have been adopted to address this, with some Australian states moving to a single digital patient record (eHealth NSW, 2025). Tasmania aspires to an EMR that integrates pre-hospital and hospital records (Tasmanian Department of Health, 2022)

Hong Kong Hospital Authority’s EMR, the Clinical Management System serves as a unified platform for managing patient records across all public hospitals (Hong Kong Government, 2020). Complementing this, the Electronic Health Record Sharing System facilitates data sharing between public and private health providers, enabling a patient-centric approach to care (Hong Kong Government, 2020).

National Level

At a national level, summary EHRs support large-scale health information exchanges, enabling comprehensive data analysis for policymaking and research. In a country such as Australia, this means that valuable summary health information can be accessed outside of the consumer’s state of residence and be available when travelling in the event of ill health (Australian Digital Health Agency, 2024).

In the 2021 survey conducted by the Organisation for Economic Co-operation and Development (OCED), several countries reported they had implemented nationwide EHRs including Estonia, Finland, Hungary, and Iceland (Slawomirski et al., 2023).

Longitudinal Records and Data Linkage

Longitudinal records support data collection and the ability to track information over time, providing a comprehensive view of an individual or population’s health. Data linkage involves connecting different data sources to create longitudinal records.

Singapore’s National Electronic Health Record system is designed to create a unified health record for each patient, known as the “One Patient, One Health Record” initiative (Ministry of Health Singapore, 2025). This system allows healthcare providers across the country to access a patient’s summary health record securely and efficiently, ensuring coordinated and patient-centric care (Ministry of Health Singapore, 2025; synapxe). The National Electronic Health Record includes key health information, such as patient demographics, admission and visit history, discharge summaries, lab test results, radiology results, medication history, and records of surgeries or procedures. This centralised repository helps reduce duplicate tests, minimise medical errors, and improve the overall quality of care (Ministry of Health Singapore, 2025; synapxe).

Australia has made large investments in the My Health Record system over many years and is available to all citizens (Australian Digital Health Agency, 2024). The My Health Record is a secure online summary of health information, allowing consumers and their healthcare providers to access and share health information for better coordinated care. It includes personal health summaries, Medicare information, and emergency contacts, with personal control over managing access (Australian Digital Health Agency, 2024).

Implementation and Health Information Management Practice

Introducing an EMR system involves key considerations for HIM practice. HIM professionals work to ensure that effective governance of record systems is in place (Kemp et al., 2021). Health information professionals are involved in all phases of EMR acquisition from inception, to development of the business case, to selection of products, and finally, implementation.

Ensuring interoperability and integration with existing systems is critical to avoid data duplication. Establishing reference files for demographic details, disease classification, provider codes, and other key data items ensures consistency and accuracy. Standardised codes and terminologies help avoid errors and discrepancies enabling effective data analytics and reporting. Structured and standardised data formats support trend analysis, performance measurement, audit, data quality assessment, and service improvement.  (Abdelhak & Hanken, 2016; Hardy, 2024; Owen et al., 2023).

The figure below shows the reference architecture for a health information system and would be tailored to meet reporting and stakeholder requirements (Tummers et al., 2021). This figure provides an example of where reference files may be necessary. Hospitals and general practices should collect data in standardised formats to ensure that the information is comparable and can be aggregated for national health statistics and research. Reference files and data dictionaries are critical requirements for the Australian Institute of Health and Welfare (2025), as they provide standardised terms and protocols for data collection, and maintain consistency across health, community services, and housing sectors, supporting reliable national data collection and reporting, which is essential for informed decision-making and policy development.

HIM professionals are central to data integrity, quality, and accuracy in EMR systems. When entering information into an EMR system, it is important to consider the methods used for data capture and ways to reduce the data collection burden for staff (Sittig et al., 2025). This can be achieved by interfaces between EMR systems and monitoring devices, voice capture, templates, scanning, and the use of bar-codes. Data quality measures help avoid “garbage in, garbage out”, where inaccurate data leads to unreliable and contested outputs.

Protecting consumer and patient information is an essential concern for health information managers and in any EMR or information system implementation. Robust security measures, such as encryption, access controls, and regular security assessments are essential to prevent unauthorised access and data breaches (Boonstra et al., 2014; Sittig et al., 2025). The EMR system and complementary systems like medical imaging and pathology must be able to communicate and exchange data seamlessly with other healthcare systems and providers; while a commitment to standards and their adoption is essential to support continuity of care and comprehensive patient records (Boonstra et al., 2014; Sittig et al., 2025).

Adequate and fit for purpose training and support are vital for effective EMR use, particularly in the highly mobile healthcare workforce (Ting et al., 2021). Continuous education ensures staff and clinicians can leverage new system features and software upgrades. HIM professionals often lead upskilling efforts for professional, administrative, and coding staff.

Compliance with relevant laws and regulations, such as Australia’s Privacy Act and Freedom of Information Act is another critical aspect of EMR implementation (Office of the Australian Information Commissioner, 1982, 1988). HIM professionals ensure proper reporting and adherence to legal requirements. Workflow redesign and effective change management strategies are essential to a smooth transition and to address any resistance from staff during EMR implementation (Boonstra et al., 2014).

Functionality and Usability of EMRs

EMRs are designed to enhance healthcare delivery by digitising information and streamlining workflows. The EMR system’s functionality must support core clinical operations, including healthcare user documentation, decision support, and reporting capabilities. These functionalities are essential for maintaining comprehensive, contemporaneous and accurate clinical records, crucial for effective and safe patient care (Australian Commission on Safety and Quality in Healthcare, 2021; Bhati et al., 2023; Sittig et al., 2025). The table below shows the EMR functionalities that should be considered when purchasing solutions.

Useability Considerations

According to ISO/IEC 9241-11, usability is the degree to which a product or service can be used by specific users to achieve specific goals with effectiveness, efficiency, and satisfaction in a given context of use (International Standards Organisation, 2010). The EMR system must be intuitive and user-friendly to minimise the burden on clinicians and optimise adoption (Lloyd et al., 2021; Lloyd et al., 2024). A system that is difficult to navigate can lead to frustration and decreased efficiency, whereas a user-friendly interface can enhance productivity and satisfaction among healthcare providers (Franks et al., 2024). Interfaces should be learnable and intuitive, enabling users to locate and input information quickly, ensuring ease of navigation. As overloading users with alerts and excessive information can lead to “alert fatigue” (Henry, 2023; Lloyd et al., 2024; Thomas Craig et al., 2021), cognitive load reduction is essential. EMRs must align with clinical workflows, supporting rather than hindering tasks to ensure seamless integration with workflows (Donohue-Ryan et al., 2023; Lloyd et al., 2024). Features such as error-checking algorithms and clear visual layouts help minimise errors and reduce the risk of data entry mistakes. Systems should be accessible across devices, such as desktops, tablets, and mobiles, enabling clinicians to work efficiently from any location.

Usability principles can be applied to improve user experience through appropriately designed user interfaces  (Nielsen, 2024). Nielsen’s (2024) usability heuristics are practical rules of thumb when evaluating EMR systems.

A positive user experience is essential for widespread user adoption and satisfaction. Responsiveness to user inputs and the ability to customise the EMR to meet specific needs (templates, dashboards) can improve documentation quality (Rowlands et al., 2022; Smelcer et al., 2009). Features to support team-based care and documentation, and flexible documentation methods that complement clinician workflow and reduce documentation burden by reducing duplication have been identified as important (Rowlands et al., 2022). Excessive copying and pasting of text can lead to lengthy, cluttered notes, referred to as “note bloat” (Lloyd et al., 2024). EMRs should encourage concise, meaningful documentation while providing sufficient context (Strudwick et al., 2022) and enhance the patient experience by facilitating communication and transparency. Features like patient portals and shared decision-making tools help achieve this goal (Warren et al., 2019). Incorporating user feedback into system updates ensures that the EMR evolves to meet the changing needs of its users.

Health information practitioners’ involvement in procurement can contribute to the selection of systems that effectively meet end users’ needs in the following ways:

• Including well-defined usability requirements in tendering provides a tangible basis for comparative evaluation (Hettinger et al., 2021; Lloyd et al., 2024; Saari et al., 2024).
• Acknowledging only linear and easily definable use cases may lead to a lack of understanding about the usability of complex systems, such as EMRs.
• Recognising the relevant complexity of each case helps identify and focus on the most significant use cases when determining requirements and constructing usability evaluations for the procurement process.
• Usability practitioners should consider existing IT architecture and appropriate methods for using evaluation tools when defining usability evaluation criteria for the procurement of complex systems (Tyllinen et al., 2018).

Provider Adoption of Standards for Interoperability

Interoperability in health information systems enables the seamless exchange of health data across different systems and organisations and supports healthcare providers to access complete and accurate patient information. This capability also supports public health monitoring and response by facilitating the aggregation and analysis of health data from diverse sources (Kuo & Lee, 2018; Owen et al., 2023).

Interoperability is critical for the effective use of EHRs. Standards such as Health Level 7 (HL7) [opens in new tab]), Fast Healthcare Interoperability Resources (FHIR) [opens in new tab], and Digital Imaging and Communications in Medicine ensure that different systems can communicate and share information seamlessly (Abdelhak & Hanken, 2016). HL7 is a set of international standards for the exchange, integration, sharing, and retrieval of electronic health information (Owen et al., 2023). These standards define how information is packaged and communicated from one party to another, ensuring that different healthcare systems can work together seamlessly (International Standards Organization). FHIR is a standard developed by HL7 and designed to be flexible and easy to implement, using web technologies such as RESTful APIs (REpresentational State Transfer Application Programming Interfaces) , JSON (JavaScript Object Notation), and XML (eXtensible Markup Language) (Gazzarata et al., 2024; International Standards Organization, 2023; Owen et al., 2023). FHIR aims to simplify the implementation process without sacrificing information integrity, making it easier for different healthcare systems to share data and improve patient care (International Standards Organization, 2023).

Several foundational elements are necessary to achieve interoperability. Standardised data formats, such as HL7 and FHIR ensure consistent interpretation and use of data across systems (Gazzarata et al., 2024). Semantic interoperability, which involves using common data models and coding systems like SNOMED CT and ICD, preserves the meaning of data when exchanged between systems (Owen et al., 2023). Additionally, robust technical infrastructure, including Application Programming Interfaces (APIs) and secure data exchange protocols, is essential for facilitating data transfer(Owen et al., 2023).

Strong data governance and security measures are also critical to protect patient privacy and ensure compliance with legislation and regulations (Smallwood, 2018). Organisational commitment and supportive policies are required to promote data sharing and collaboration among stakeholders. By establishing these foundations, healthcare systems can achieve high levels of interoperability, leading to improved patient care, operational efficiency, and public health outcomes (Owen et al., 2023).

Adoption of Electronic Medical Records

Implementing an EMR system should be approached like any project. This means that the EMR project should have clear objectives, budgets, timeframes, and deliverables. EMR and other digital solutions and deployment of technology can be challenging, although significant improvement has been noted in recent times due to “out of the box” or “off the shelf” and “ready to go” software solutions. The days of end-user product fit requiring significant development are diminishing in the name of cost savings. Digital product suppliers are also offering more refined solutions where end-user needs are included and considered within their product development. Most organisations investing in large solutions, like EMR systems, will take a “best of breed” and “off the shelf” approach to purchase, which allows the user to contract with a software vendor to provide a fully functional product. The user knows the functionality offered by the product and exactly what is being purchased. They are often able to see these systems operating in other healthcare organisations. This is the simplest and safest (least risky) option. However, it should be recognised that these systems are not always innovative or leading-edge solutions. Any system that has been developed and implemented in several organisations will, by the nature of the fast evolution of computer systems, be old technology.

Choosing an EMR Solution

When choosing an EMR solution, health providers must evaluate a range of criteria to ensure the system aligns with clinical, operational, and strategic goals. Important considerations are shown in the table below.

Vendor relationships are an important consideration. There should be a good fit between the organisation acquiring the EMR and the vendor (Hardy, 2024). Understanding the vendor’s process for making changes, and the availability for technical support, training, and updates should be front of mind (Hardy, 2024). Speaking with other organisations that have purchased systems from vendors will provide insights into and validate the information provided by vendors. When purchasing an EMR, organisations are likely to have a relationship with vendors across many years. Effective relationships will be based upon open and professional communication and clear processes for dispute resolution (usually built into contracts) and establishing communication channels and information flow between IT, clinicians and the vendor can lead to reduced costs and better service (Hardy, 2024).

To promote a sustainable health and social care system, the impact on the environment should be considered and factored into purchasing decisions.(Paul et al., 2023). It involves energy efficiency, reducing electronic waste, responsible disposal practices and adopting other eco-friendly practices to mitigate the environmental footprint of IT infrastructure and operations (Paul et al., 2023). By optimising energy consumption and reducing electronic waste, health and social care organisations can lower their carbon footprint and operational expenses. Incorporating sustainability approaches not only creates value but also demonstrates corporate social responsibility. Investments in energy-saving technologies and cloud-based services also provide scalability and flexibility. Green computing in healthcare includes digitising records and imaging and reducing paper. The use of cloud-based services consolidates servers, reducing energy consumption and costs (Paul et al., 2023)

Evaluation of Different EMR Solutions

Evaluating EMR solutions requires a structured approach to compare features, costs, and vendor performances (Abdelhak & Hanken, 2016). The evaluation team should reflect the breadth of users with the ability to assess the product across the functional and technical requirements identified in the tender/procurement process. The steps to perform a robust evaluation include:

1. Needs Assessment

Identify the clinical and administrative needs for the solution. Prioritise those “must have” features (deal breakers) and those that would be nice to have. From initial discussions, stakeholders such as clinicians, IT technicians, and health administrators should be involved. The adoption of an EMR system should align with the organisation’s key strategic priorities (Hardy, 2024). The project should be identified as an organisational priority (Hardy, 2024).

2. Research

Investigate available EMR solutions in use by similar organisations. Talk to users and leaders in organisations using the EMR about various products’ strengths and weaknesses. Focus on vendors with experience in similar settings. Conducting a scan of emerging and new technologies can be helpful in determining how solutions may be impacted by technological trends.

3. Request for Proposal

Issue requests for proposal to vendors, specifying desired features, timeframes, technical requirements, and support needs (Abdelhak & Hanken, 2016; Hardy, 2024).

4. Demonstrations and Testing

Organise solution demonstrations to assess usability and functionality. Conduct testing in simulated healthcare settings to evaluate performance, relevancy, and gather user feedback.

5. Scoring and Analysis

Use weighted scoring systems to compare solutions based on criteria (e.g. functionality, cost and user satisfaction).

Cost and Support

EMR system costs includes initial setup, training, and ongoing maintenance. Providers should also consider the level of vendor support, including technical assistance and updates.

1. Initial Costs

• Hardware and infrastructure: Servers, networking, and user devices.
• Software licensing: Purchase or subscription fees for the EMR software.
• Training and change management: Expenses for onboarding staff and adapting workflows.
• Implementation: System configuration, integration with existing clinical information systems and data migration (Hardy, 2024).

2. Ongoing Costs

• Maintenance: Fees for software updates, patches and hardware upkeep.
• Hardware and equipment upgrades: Desktops, printers and other equipment need to upgraded to meet changing needs and asset retirement.
• Licensing renewals: Annual or periodic fees for continued software use.
• Support: Vendor provided help desk services and troubleshooting (Hardy, 2024).

Success Factors for Implementation

Successful implementation of EMR systems depends on factors such as stakeholder engagement, comprehensive training, and continuous support. Addressing common challenges, such as resistance to change and data migration issues is crucial for a smooth transition from paper to digital. Some factors that support successful EMR implementations are described below.

1. Importance of planning: Successful digital health implementation requires thorough planning to align with strategic goals and minimise disruptions (Abdelhak & Hanken, 2016).
2. Leadership support: Leaders should create an environment conducive to innovation and change (Lloyd et al., 2018)
3. Change management: Implementing an EMR will involve operational, strategic, cultural, and political changes. To manage change effectively, applying models such as Lewin’s 3-Step Model, ADKAR, and Kotter’s 8-Step Change Model is essential.
4. Engaging with stakeholders: Involving stakeholders early in the process will build trust and support. Identifying stakeholders and understanding their needs is crucial for assessing the project’s impact and addressing any concerns. Maintaining transparency and open communication helps manage expectations and gain stakeholder buy-in by keeping everyone informed and fostering trust.
5. Implementation foundations: Alignment of people, processes, technology, and governance is key to execution:
   • People: Engage and train staff, address resistance, and ensure digital literacy.
   • Processes: Align new systems with existing workflows or utilise the change to redesign processes for efficiency.
   • Technology: Select appropriate technology tools and ensure integration with existing systems.
   • Governance: Establish clear roles, responsibilities, and decision-making processes (Abdelhak & Hanken, 2016).
6. Evaluation and sustainability: Conduct evaluations to assess progress and outcomes through formative and summative evaluation. Track and measure the benefits of digital health implementation. Plan for long-term sustainability by addressing potential barriers and enablers. Assess and improve digital maturity to enhance the effectiveness of health information systems

Successful digital health implementation is dependent upon comprehensive planning, effective change management, stakeholder engagement, and continuous evaluation. By addressing these areas, health organisations can achieve sustainable and impactful digital transformations.

The Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework [opens in new tab] provides a comprehensive approach to understanding the complexities of adopting and sustaining health technologies such as EMR (Greenhalgh & Abimbola, 2019; Greenhalgh et al., 2010; Greenhalgh et al., 2018; Greenhalgh et al., 2017). The framework, shown in the diagram below, confirms the importance of the technology’s properties, its usability, and how well it integrates with existing systems. Clinical and cost-effectiveness, and how these benefits are distributed among stakeholders is emphasised. The framework considers the individuals and groups who will use the technology, such as patients, healthcare professionals, and caregivers, and reinforces the need to understand their readiness and capacity to adopt the technology (Greenhalgh & Abimbola, 2019; Greenhalgh et al., 2010; Greenhalgh et al., 2018; Greenhalgh et al., 2017). Understanding the organisational context and capacity to implement the technology, and how well the technology aligns with organisational goals is included. The framework examines the wider system, including regulatory, policy, and market factors that can influence the adoption and sustainability of the technology. Finally, the NASSS framework looks at how the technology and its use evolve over time (Greenhalgh & Abimbola, 2019; Greenhalgh et al., 2010; Greenhalgh et al., 2018; Greenhalgh et al., 2017). This includes the processes of adaptation and the technology’s sustainability over the long term. When implementing EMRs, using a framework such as NASSS that analyses the complexity of health care systems can help identify potential barriers and facilitators to the successful implementation and long-term use of health technologies (Greenhalgh & Abimbola, 2019; Greenhalgh et al., 2010; Greenhalgh et al., 2018; Greenhalgh et al., 2017).

Maturity of EMR Systems and Value

Digital health maturity refers to the extent to which healthcare organisations have integrated digital tools and technologies into their operations to enhance patient care, improve population health outcomes, reduce healthcare costs, and improve the work life of healthcare providers. It encompasses the development and implementation of digital health infrastructure, such as electronic health records, telehealth services, and mobile health applications, as well as the training and education of healthcare staff to effectively use these technologies (Woods et al., 2023; Woods et al., 2022). Higher levels of digital health maturity are associated with better patient experiences, more efficient healthcare delivery, and improved health outcomes (Woods et al., 2023; Woods et al., 2022).

The maturity of EMR systems can be assessed through stages such as initial adoption, optimisation, and full integration (HIMSS, 2025). Measuring the value of EMR systems involves evaluating their impact on outcomes, operational efficiency, and overall healthcare quality. Future trends include the integration of artificial intelligence and advanced analytics to further enhance the capabilities of EMR systems (Woods et al., 2022).

The Electronic Medical Record Adoption Model (EMRAM) [opens in new tab] is a framework developed by the Healthcare Information and Management Systems Society (HIMSS) (2025) to assess the maturity and effectiveness of EMR systems within healthcare organisations (HIMSS, 2025; Woods et al., 2022). EMRAM consists of eight stages, ranging from Stage 0, where no EMR systems are in place, to Stage 7, where the EMR system is fully integrated and optimised across the organisation (HIMSS, 2025). Each stage represents a higher level of sophistication and integration, with specific criteria that must be met to advance to the next stage. The model helps healthcare organisations identify their current level of EMR adoption, set goals for improvement, and benchmark their progress against other organisations (HIMSS, 2025).

Achieving higher stages of EMRAM is associated with benefits, including improved patient safety, enhanced clinical outcomes, and increased operational efficiency (HIMSS, 2025). For example, at Stage 3, healthcare organisations have implemented clinical documentation and decision support systems, which can reduce medical errors and improve the quality of care. By Stage 6, organisations have achieved advanced levels of data analytics and interoperability, enabling them to leverage health information for population health management and predictive analytics. Ultimately, reaching Stage 7 signifies that an organisation has fully integrated EMR systems that support seamless care delivery, real-time data access, and continuous quality improvement. This level of maturity not only enhances patient care, but also positions healthcare organisations to meet regulatory requirements and adapt to future technological advancements (HIMSS, 2025).

Future Trends in EMR/EHR

openEHR (2024) is a technology comprising open specifications, clinical models, and software. The various components of openEHR are produced by the openEHR community and managed by openEHR International, a non-profit organisation established in 2003 and previously overseen by the openEHR Foundation. The openEHR initiative offers numerous benefits, by enhancing the interoperability and accessibility of health data. openEHR aims to provide a standardised architecture for EHRs and seamless data exchange across different healthcare systems and platforms. openEHR is designed to support the creation of longitudinal, consumer-centred health records (Open EHR, 2024). openEHR [opens in new tab] includes valuable information on this initiative.

openEHR’s vendor-neutral approach enhances interoperability, reduces vendor lock-in. and promotes innovation by enabling the integration of best-of-breed solutions. openEHR’s use of detailed clinical models, developed by and for healthcare professionals, ensures the system meets user needs. Additionally low-code application tools support rapid customisation and deployment tailored diverse healthcare settings (Open EHR, 2024).

Personally Held Records

As global mobility increases personally held healthcare records (PHRs) offer significant benefits. They enable individuals to share their health information with multiple healthcare providers, reducing communication gaps, errors, and duplicate tests (Archer et al., 2011; Ford et al., 2016; Tang et al., 2006). PHRs support people to actively participate in their own healthcare management, track health over time, and make informed decisions critical for managing chronic conditions and reducing healthcare expenditure (Ford et al., 2016).

PHR enablers include advancements in technology and supportive government policies. For example, the Australian Government’s investment in the My Health Record system has provided a secure online summary of health information accessible to consumers and healthcare providers (Australian Digital Health Agency, 2024). My Health Record allows people to upload health information and includes Medicare data, medication details and emergency contacts, giving individuals control over who can access their records (Australian Digital Health Agency, 2024).

Many PHR systems allow secure messaging between patients and providers, making it easier to communicate and address health concerns directly and can lead to earlier interventions and improved health outcomes. PHRs that can streamline administrative processes by providing easy access to electronic prescription refills and appointment scheduling are convenient for consumers (Archer et al., 2011; Ford et al., 2016; Tang et al., 2006).

The European Commission (2024) has recommended an EHR exchange format that promotes cross-border EHR interoperability. This initiative enables EU citizens to securely access and exchange their health data across the EU , improving care quality and reducing costs by avoiding duplication of medical tests and procedures (European Commission, 2024; Raab et al., 2023). Many European countries have already launched ambitious PHR projects to advance digital health solutions (European Commission, 2024). Health information exchange facilitates the secure sharing of health information among healthcare providers to improve the quality and continuity of care (Simon et al., 2009; Slawomirski et al., 2023).

In the United Kingdom, patient record access has developed significantly, particularly in the context of GP records, due to widespread computerisation. The National Health System (NHS) app allows patients to manage their personal health records, enabling them to view their GP health records, order prescriptions, and communicate with their healthcare providers (NHS, 2024). This system aims to enhance patient engagement and improve the coordination of care (NHS, 2024).

In Ireland, access to medical records is governed by data protection laws and the Freedom of Information Act (Citizens Information Board, 2025). Patients can access their health records by writing to the Health Service Executive or through data protection requests (Citizens Information Board, 2025). There is also recognition that supporting the use of EHRs and investing in digital health can improve healthcare delivery (McDonald, 2024). This approach aligns with Europe’s goal to make health records more accessible and compatible across borders (European Commission, 2024).

Health data in EMR and EHRs have transformative potential, but often remain siloed within institutions and jurisdictions. For example, Australia’s My Health Record is limited to domestic use. However, platforms like PatientsLikeMe, Open Humans, and Health Record Banks challenge traditional models by enabling personal data sharing, self-health management, research, and clinical care (Kariotis et al., 2020). These models shift data stewardship and explore emerging data governance models, posing challenges for traditional health services and raising policy questions about the use of public good data (Kariotis et al., 2020).

Key Implications for Practice

EMR and EHRs can contribute to effective health care practice. The key implications for practice highlight the importance of careful planning, stakeholder engagement, and evaluation in the successful implementation and use of EMRs and EHRs. When adopting EMRs, health information professionals’ input into robust governance systems, interoperability standards, and user-friendly systems contribute to maximising the benefits of digital health solutions.

Health information management considerations: Effective governance for record systems is crucial. Health information professionals play a central role in ensuring data integrity, privacy, security, and interoperability. They are involved in all phases of EMR acquisition from inception to implementation

Choosing an EMR solution: Providers should consider factors such as cost, ease of use, interoperability, and vendor support. Evaluating different solutions through case studies and pilot programs can help in making informed decisions. The business case for an EMR should justify the project by evaluating benefits, costs, and risks

Functionality and Usability of EMRs: Key functionalities include clinical documentation, order entry, and decision support. Usability considerations involve the system interface, ease of navigation, and the ability to integrate with other systems. Addressing usability challenges is essential for enhancing the efficiency and satisfaction of healthcare providers.

Provider Adoption of Standards for Interoperability: Interoperability is critical for effective use of EHRs. Standards such as HL7, FHIR, and DICOM ensure that different systems can communicate and share information seamlessly. This capability supports public health monitoring and response by facilitating the aggregation and analysis of health data from diverse sources

Success Factors for Implementation: Successful implementation depends on factors such as stakeholder engagement, comprehensive training, and continuous support. Addressing common challenges, such as resistance to change and data migration issues, is crucial for a smooth transition. Effective management strategies are required to ensure a smooth transition and to address any resistance from staff

Maturity of EMR Systems and Value: The maturity of EMR systems can be assessed through stages, such as initial adoption, optimisation, and full integration. Measuring the value of EMR systems involves evaluating their impact on outcomes, operational efficiency, and overall healthcare quality. Future trends include the integration of artificial intelligence and advanced analytics to further enhance EMR systems’ capabilities.

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Image descriptions

Figure 1: A diagram depicting the decomposition of a Health Information System architecture into six main modules with 34 sub-modules. The layout is organised into boxes delineating the modules and their related sub-modules. The decomposition view helps to check for the presence of the required modules for all stakeholders.

1. The first module is Medication management, containing sub-modules related to medication handling, distribution, and safety monitoring.
2. The second module is Patient monitoring and contains sub-modules related to the assessment, admission, discharge, status, and referrals of patients, and is input for the electronic health record. The Patient monitoring module also contains a sub-module labeled Patient portal in which the patient can check his/her files.
3. The Security module with the sub-modules Authentication, Authorisation, and Security mechanisms must ensure the privacy and security of the Health Information System and its data.
4. Module number four is Planning and scheduling, with sub-modules used by various stakeholders to ensure proper care coordination.
5. The Generic MIS module is not healthcare specific. Its sub-modules are important to keep track of assets, such as staff and inventory, to provide means for organisation-wide communication, quality control, and financial affairs. 

These five modules generate data, which needs management. This happens in the sixth module, Data management, which has sub-modules to ensure proper import, sharing, analysis, and data search. Generic MIS involves Finance, Human resources, Documentation, Research and Education, Inventory and Order, Reporting, Demographics, Reimbursement, Communication, and Quality control.

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Figure 2: