Which Electronic Health Record System Should We Use? A Systematic Review

The UK government had intended to introduce a comprehensive Electronic Health Record (EHR) system in England by 2020. These EHRs would run across primary, secondary, and social care, linking data in a single digital platform. The objectives of this systematic review were to identify studies that compare EHR in terms of direct comparison between systems and to evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching Embase and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and the eight characteristics of SQuaRE: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After a review of titles and abstracts, this was filtered down to 40 studies as per the exclusion and inclusion criteria set out in our study. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE, respectively - 19 studies: functional suitability, performance efficiency: 18 studies, compatibility: 12 studies, usability: 25 studies, reliability: 6 studies, security: 2 studies, maintainability: 16 studies, portability: 13 studies. Epic was the most studied EHR system and one of the most implemented systems in the US market and one of the top ten in the UK. It is difficult to assess which is the most advantageous EHR system when they are assessed by SQuaRE's 8 characteristics for software evaluation.