Electronic Health Record: a systematic review of the implementation under the National Humanization Policy guidelines

Toledo, Patrícia Pássaro da Silva; Santos, Elizabeth Moreira dos; Cardoso, Gisela Cordeiro Pereira; Abreu, Dolores Maria Franco de; Oliveira, Alexandre Barbosa de

doi:10.1590/1413-81232021266.39872020

Patrícia Pássaro da Silva Toledo patriciapassaro@gmail.com

Laboratório de Avaliação (Laser), Departamento de Endemias Samuel Pessoa (DENSP), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). R. Leopoldo Bulhões 1480, Bonsucesso. 21041-210 Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-4013-7592

Elizabeth Moreira dos Santos

Laboratório de Avaliação (Laser), Departamento de Endemias Samuel Pessoa (DENSP), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). R. Leopoldo Bulhões 1480, Bonsucesso. 21041-210 Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-2137-7048

Gisela Cordeiro Pereira Cardoso

Laboratório de Avaliação (Laser), Departamento de Endemias Samuel Pessoa (DENSP), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). R. Leopoldo Bulhões 1480, Bonsucesso. 21041-210 Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0002-4014-0951

Dolores Maria Franco de Abreu

Laboratório de Avaliação (Laser), Departamento de Endemias Samuel Pessoa (DENSP), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). R. Leopoldo Bulhões 1480, Bonsucesso. 21041-210 Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0001-8454-327X

Alexandre Barbosa de Oliveira

Escola de Enfermagem Anna Nery, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0003-4611-1200

patriciapassaro@gmail.com

Chief editors: Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Collaborations

PPS Toledo contributed with the study design, methodology, analysis, discussion and final writing of the manuscript. EM Santos contributed with the design, methodology, discussion and final writing of the manuscript. GCP Cardoso contributed with reading and critical review of the manuscript. AB Oliveira contributed with the reading, critical review of the manuscript and methodology. DMF Abreu participated as an independent reviewer of the articles.

Record of literature searches
Search Source	Keywords, Descriptors and Boolean Operators (String)	Results
BVS Regional	(("prontuario eletronico" OR "registro eletronico de saúde" OR "sistema de registro de saúde" OR "electronic health records") AND (avaliacao OR evaluation OR assessement OR "atenção primária à saúde" OR "atenção básica à saúde" OR "gestão clínica" OR "governança clínica" OR "clinical governance")) AND (instance:"regional")	494
SciELO	("prontuario eletronico" OR "registro eletronico de saude") AND (avalia* OR "gestao da clinica")	33
OASIS IBICT	("prontuario eletronico" OR "registro eletronico de saude") AND (avaliação OR "gestao da clinica")	119
Scopus	(TITLE ("electronic health records") AND TITLE -ABS-KEY (evaluation OR assessment OR "clinical governance"))	532
Total		1,178

Cognitive domains (NHP Principles and Guidelines)		Analytical categories	Description
Guidelines	Principle	Analytical categories	Description
	Transversality	Changes in practices	Changes in the types of relationships and communication between the subjects involved in the health production processes, having the effect of destabilizing the frontiers of knowledge, the territories of power and the methods established in the creation of labor relations.
		Intra- and intergroup communication capacity	Extended and open dialogue between subjects and collectives.
		Exchange of knowledge and experiences	Exchange of knowledge and experiences between subjects and collectives.
		Horizontalization of labor relations	Organization of a matrix service network to support reference teams. Reference teams, instead of being an episodic space for horizontal integration, become the permanent and core structure of health services.
	Inseparability between management and care		Changes in the ways of care are inseparable from changes in the ways of managing and appropriating work. The inseparability between clinic and politics, between health production and subject production. Integrality of care and integration of work processes.
	Protagonism, co-responsibility and autonomy of subjects and collectives	Democratization of health actions and services	Democratization of the service management and the expansion of comprehensive health care, promoting intra and intersectoriality with sanitary responsibility agreed between managers and workers.
		Co-responsibility of care	The changes in care attain greater effectiveness when produced by the affirmation of the autonomy of the involved subjects, who contract among themselves the shared responsibilities in the care processes.
		Responsibility of professionals, managers and users	The changes in management are more effective when produced by the affirmation of the autonomy of the involved subjects, who contract among themselves the shared responsibilities in the management processes.
Comanagement		Inclusion of new subjects in planning and decision-making processes	Valuing and encouraging the inclusion of workers and users in the entire health production process.

Analytical Categories for the Systematic Review	Articles that addressed the analytical categories (as analysis categories or in their findings)		Total
Changes in practices	O'Malley et al. 2015¹⁸18 O'Malley AS, Draper K, Gourevitch R, Cross DA, Scholle SH. Electronic health records and support for primary care teamwork. J Am Med Inform Assoc 2015; 22(2):426-434. Schenk et al. 2018²⁰20 Schenk E, Schleyer R, Jones CR, Fincham S, Daratha KB, Monsen KA. Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy: CIN Comput Inform Nurs 2018; 36(7):331-339.		2
Intra- and intergroup communication capacity	Gomes et al. 2019²¹21 Gomes PDAR, Farah BF, Rocha RS, Friedrich DB de C, Dutra HS. Electronic Citizen Record: An Instrument for Nursing Care / Prontuário Eletrônico do Cidadão: Instrumento Para o Cuidado de Enfermagem. Rev Pesqui Cuid Fundam Online 2019; 11(5):1226. Alanazi et al. 2019²²22 Alanazi B, Butler-Henderson K, Alanazi MR. The Role of Electronic Health Records in Improving Communication Between Health Professionals in Primary Healthcare Centres in Riyadh: Perception of Health Professionals. Stud Health Technol Inform 2019; 264:499-503. Rathert et al. 2017¹⁷17 Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: What does the evidence say? Patient Educ Couns 2017; 100(1):50-64. O'Malley et al. 2015¹⁸18 O'Malley AS, Draper K, Gourevitch R, Cross DA, Scholle SH. Electronic health records and support for primary care teamwork. J Am Med Inform Assoc 2015; 22(2):426-434. Sockolow et al. 2011²³23 Sockolow PS, Weiner JP, Bowles KH, Abbott P, Lehmann HP. Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site. Appl Clin Inform 2011; 02(01):18-38.		5
Exchange of knowledge and experiences	Rathert et al. 2017¹⁷17 Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: What does the evidence say? Patient Educ Couns 2017; 100(1):50-64.		1
Horizontalization of labor relations	O'Malley et al. 2015¹⁸18 O'Malley AS, Draper K, Gourevitch R, Cross DA, Scholle SH. Electronic health records and support for primary care teamwork. J Am Med Inform Assoc 2015; 22(2):426-434.		1
Inseparability between management and care	Martins et al. 2017¹⁹19 Martins APOQ, Peres AM, Gil NLM, Ros CD, Lowen IMV, Gonçalves LS. Usabilidade do prontuário eletrônico em Unidades Básicas de Saúde. Cien Cuid Saude 2017; 16(2):1-7. Godoy et al. 2012²⁵25 Godoy JSM, Gonçalves LS, Peres AM, Wolff LDG. O uso do prontuário eletrônico por enfermeiros em Unidades Básicas de Saúde brasileiras. J Health Inf 2012; 4(1):3-9. Holmes 2016²⁶26 Holmes ES. Atenção Básica como instrumento de apoio à tomada de decisão: avaliação de profissionais de saúde [dissertação]. João Pessoa: Universidade Federal da Paraíba; 2016. Schenk et al. 2018²⁰20 Schenk E, Schleyer R, Jones CR, Fincham S, Daratha KB, Monsen KA. Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy: CIN Comput Inform Nurs 2018; 36(7):331-339.		4
Democratization of health actions and services	-		0
Co-responsibility of care	Martins et al. 2017¹⁹19 Martins APOQ, Peres AM, Gil NLM, Ros CD, Lowen IMV, Gonçalves LS. Usabilidade do prontuário eletrônico em Unidades Básicas de Saúde. Cien Cuid Saude 2017; 16(2):1-7. Rathert et al. 2017¹⁷17 Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: What does the evidence say? Patient Educ Couns 2017; 100(1):50-64. O'Malley et al. 2015¹⁸18 O'Malley AS, Draper K, Gourevitch R, Cross DA, Scholle SH. Electronic health records and support for primary care teamwork. J Am Med Inform Assoc 2015; 22(2):426-434. Morrison et al. 2013²⁷27 Morrison Z, Fernando B, Kalra D, Cresswell K, Sheikh A. National evaluation of the benefits and risks of greater structuring and coding of the electronic health record: exploratory qualitative investigation. J Am Med Inform Assoc 2014; 21(3):492-500.		4
Responsibility of professionals, managers and users	-		0
Inclusion of new subjects in planning and decision-making processes	Rathert et al. 2017¹⁷17 Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: What does the evidence say? Patient Educ Couns 2017; 100(1):50-64.		1
Did not address the analytical categories proposed for this study	Mcbride et al. 2017 Yanamadala et al. 2016 Mundim et al. 2016 Gonçalves et al. 2013 Welch et al. 2007 Paek et al. 2006 Fumis et al. 2014 Lin et al. 2019 Kuo et al. 2018 Hagglund et al. 2017a Hagglund et al. 2017b Tharmalingam et al. 2016 Pandit et al. 2013 Hiligoss et al. 2013 Greenhalgh et al. 2010 Graetz et al. 2015	Kami et al. 2015 Joynt et al. 2015 Bhuyan et al. 2014 Lima et al. 2018 Colleti Junior et al. 2018 Souza et al. 2017 Farias et al. 2014 Graham et al. 2018 Ericson et al. 2017 Duarte et al. 2017 Plantier et al. 2017 Mysen et al. 2016 Ser et al. 2014 Takian et al. 2014 Silverman et al. 2014 Stewart et al. 2010	32

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Electronic Health Record: a systematic review of the implementation under the National Humanization Policy guidelines

Abstract