The experiences and perceptions of users of an electronic patient record system in a pediatric hospital setting: a systematic review

Context: With the ever-increasing need for digital health innovations, the transition to electronic patient records (EPR) is an integral part of the digital health revolution. There is an increasing body of literature on EPR use in the adult hospital setting, particularly related to adoption as a result of financial incentives in the United States (US). The experiences and perceptions of EPR users within the pediatric hospital setting are less well understood, despite the advent of patient portals accessible by children and young people (CYP) and their parents, which bring new benefits and challenges for them and healthcare professionals alike. Objectives: The aim of this review was to understand the experiences and perceptions of all relevant stakeholders using an EPR system in the pediatric hospital setting, including the use of an EPR-linked patient portal. Methods: Studies were identified through electronic database and citation searching, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted in EMBASE, EMCARE, MEDLINE, Cochrane Library, Web of Science, Scopus, CINAHL, and PsycINFO electronic databases to identify literature published 2010-present, in addition to manual searching of conference abstracts, and research reports searched via the Health Research Authority website. Inclusion criteria were studies reporting on an EPR system in use in hospital setting where child patients (from 0 to 17.9 years) are cared for, with or without an EPR-linked patient portal. Results: Thirty-six out of 42,946 articles were eligible for inclusion, almost two-thirds were studies conducted in the US. A wide range of benefits, challenges, and information and support needs were reported. Strategies for successful implementation and design improvements were suggested, as was desirable portal functionality and parental intention to use, or reasons for not using the portal. Several ethical and legal issues were raised. Conclusions: Experiences of using EPRs and patient portals were wide-ranging with challenges more prevalent soon after implementation. Although tailoring information and support to users' individual needs and practice context can be complex, this is essential to enable prolonged utility, user satisfaction and engagement, which, in turn, will promote effective care provision. Disease-specific portals may increase utility, and taking into consideration children's and young people's needs and preferences is essential.