Table 1.

Summary of the studies extracted that show the relationship between doctors and patients when using the EMRs.

Date/Author	Title	Methodology	Primary outcomes	Secondary outcome
1-Al Farsi (6)	Use of Electronic Medical Records in Oman and Physician Satisfaction	Nonexperimental “survey” research, Included 70 physicians Age of physician is from 30 to 65 years. Included both female and Male physicians.	EMR improves the communication between department in 95% Improves the quality care of patient (85%); Retrieval and entry of patient information is accurate and easy way (80%) Access to the system is easy and available (70%) Reduces medical errors (67%) Enhances the productivity (59%).	80% agreed the EMR system required increased confidentiality. The EMR system is underutilized (75% of physicians agree); hospital is still using a paper system in some departments (74%); Disease coding represents a major problem (70%); The EMR system is time consuming (67% agree); Speed of the system is too slow (60%). Participants’ feedback: Each doctor receives a specific access password that changes periodically. // Train and advise staff on the requirements of patient // Information privacy and encourage their input on how protection should be developed.
2-Al-Azmi et al. (7)	Patients’ Satisfaction with Primary Heath Care in Kuwait After Electronic Medical Record Implementation	Descriptive cross-sectional A random sample of 200 people (at age of 18 years and above) Structured questionnaire Exit interview (47.5%) were males and 52.5% were females	81.5% of them agreed that EMRS improved the physician performance. System helped to improve not only arrangement of patient's turn (93.0%), but dispense medication from pharmacy (92.0%) Improved accuracy and easiness of follow up for health status was 89.5% System improved time spent to retrieve medical record (78.5%) and that for receiving medication (82.0%).	Physician selection or waiting time. The system did not achieve much improvement in physician selection (29.5%) or waiting time (25.5%). 13.2% of the participants did not like physician's handling of computers in the examination room as this decreases his attention and communication.
3-Al-Mujaini et al. (8)	Satisfaction And Perceived Quality of An EMR System in A Tertiary Hospital in Oman	A cross-sectional survey including 200 physicians in Oman over 6 months. Response rate was 70.5% (141/200) Of the 141 respondents; 55 (39%) were consultants, 28 (19.9%) were registrars and 21 (14.9%) were senior house officers (SHO). Eighty-one (57.4%) participants were males. The majority of the participants were in the third to fourth decade of age.	(15.4%) Respondents rated the EMR to be a success in improving their work in terms of quality, performance, and timelines Factors affecting poor ratings: (OR = 1.3 95% 0.2 7.3) not working with patients (15.6%) rated the current EMR system as an effective tool.	29.4% of respondents considered EMR not worth the time and effort required to use it. In our study, the low satisfaction associated with junior designations and respondents with low familiarity with computers may be related to this fact (67.4%) Reported increasing difficulty with the performance of work after applying the EMR system. The overall quality of work was perceived not to have changed (41.2% of the respondents) or declined (27.4% of the respondents). 60% of users still resorted to paper records for some tasks not supported by EMR, such tasks included statistics, codification, and patient transfers between institutions. difficulty in transferring older paper-based records to the EMR system, issues based on long-term preservation and storage of data, as well as how to ensure the physical and virtual security of the archives, software problems of codification (standards that help to ensure that clinical information input and retrieval are not arbitrary), and customization (system adapted for the users and tailored to workflows specific to a user site) (68.1%) had prior training on the use of the EMR system
4-Al-Jafar (9)	Exploring Patient Satisfaction Before and After Electronic Health Record (EHR) Implementation: The Kuwait Experience	A random sampling 700 subjects The majority of participants (67 percent) were 19 to 34 years of age.	EHRs increase trust in doctors 27% Doctor pays more attention to typing, and EHRs increase trust in physicians) varied from 36 to 50 percent EHRs affect relationship with doctors 27%	At visit, doctor pays more attention to typing 17%
5-Al-Rowibah et al. (10)	The Impact of Computerized Physician Order Entry on Medication Errors and Adverse Drug Events.	Cross-sectional research design at the King Fahad Medical City Hospital (KFMCH) of the Kingdom of Saudi Arabia (KSA). 93 physicians	88% of the physicians agreed that the use of CPOE improved their performance 76% reported that the use of CPOE increased their productivity 56% of the participants agreed that CPOE was a simple system 64% reported that it was easy to use.	44 percent of the physicians agreed that CPOE lacked a user guide during medication ordering
6-Al Alawi et al. (11)	Physician User Satisfaction with an Electronic Medical Records System in Primary Healthcare Centres in Al Ain: A Qualitative Study	A total of 23 physicians—focus groups A descriptive qualitative study conducted in primary healthcare centres (PHC) in Al Ain, United Arab Emirates (UAE).	Physicians expressed satisfaction with the orders and results of laboratory and radiology functions Physicians satisfied with the electronic prescription function, stating that it reduced errors and saved time. Physicians’ perceptions about patient reaction were mixed. unhappy because of the disturbed patient–doctors’ relationship waiting time increased due to data entry causing more frustration to the patients. Difficulty in use at the beginning ▸ Training was sufficient and good Past computer skills ▸ Different users’ generations with different, computer skills The impression about the pre-completed notes ▸ Precompleted notes definitely saves time Doctor–patient relationship • No eye contact • Waiting time is more • Patients are accepting the system because it is reflecting an advance modern of technology. Many physicians were concerned about their patients’ perception about the new technology. They felt that many patients were unhappy but indicated that few patients approved and made positive remarks to their physicians.	The impression about the pre-completed notes and no eye contact Many physicians were pleased about the orders and results of laboratory and radiology as they emphasised that this is the strongest point in the EMR system. Participants identified the messaging system within the EMR software as a practical, useful, and important tool for enhancing efficiency within the team. Major barriers to implementation and adoption included computer literacy, training, and time. Participants mentioned the loss of confidentiality in the patient's files, because anybody who has access could open any file.
7-Alasmary et al. (12)	The Training on Clinical Productivity and User Satisfaction In Using The Electronic Medical Record In Saudi Arabia	123 physicians and nurses A cross-sectional study design	Self-reported system productivity and satisfaction was statistically correlated at p < 0.01 (R = 0.509)	?
8-Alharthi et al. (13)	Physician Satisfaction with Electronic Medical Records in a Major Saudi Government Hospital	220 physicians—115 included 71% were male, 64% were Saudi, Cross-sectional analytical observational study Average age was 39.8 years. Government hospital in the Eastern Province, Kingdom of Saudi Arabia The tool used to collect the data was a self-administered survey based on the DeLone and McLean model	Only 40% were satisfied with the system; furthermore, 61% were willing to totally abandon the system and go back to paper records. Of the physicians surveyed, 90%wanted to change the system, and 70% of those who did not want to go back to a paper system wanted to change this system. 60%of the physicians agreed with Information is accurate”, “relevant” About 50% agreed with the statements “features allow me to perform my work well” and “the performance of the system is reliable” “system easy to use” and “security is acceptable”, were satisfactory to about 65% Fewer than half of the respondents agreed “the system is fast” and “the system is integrated with my workflow”.	Only 48% of the system was integrated well with their workflow The physicians in our study might also have been experienced computer users but expected more sophisticated training. Additionally, only half found that the system support was acceptable. The screen layout was acceptable to 62% of the physicians, who considered that information was presented in a suitable format. The physicians were not satisfied with the completeness or accuracy of the information: only 45% reported that the information was complete and 64% that it was accurate. The system was considered easy to use by 64% of the physicians, a finding similar to those of other studies. 58% of the physicians were dissatisfied with the speed of the system, reporting that it took a long time to move between screens and that the system was slow to start up.
9-Shaker et al. (14)	Physicians’ Perception About EMR System in Makkah Region, Saudi Arabia	Cross-sectional survey 317 completed questionnaires, Age group 36–45 years Subjects were from King Fahd Hospital	Improved quality of practice was appreciated by majority, that is, 77.7% “EMRS improve quality of practice (work life)” 71.2%,	“It does not disrupt the workflow” (35.1%) “EMRS is comfortable while entering the data instead of writing” (34.8%)
10-Bani-Issa et al. (15)	Satisfaction Of Health-Care Providers with EMR And Perceived Barriers To Its Implementation In The United Arab Emirates	A cross-sectional survey of 680 health-care providers	Of the 680 participants, a total of 317 (46.6%) expressed high levels of satisfaction with the EHR system	A lack of trust in the system's reliability Inadequate computer skills and inadequate training
11-Alsohime et al. (16)	Satisfaction And Perceived Usefulness with Newly Implemented Electronic Health Records System Among Paediatricians At A University Hospital	A cross-sectional survey [112 physicians who completed the survey, 97 (86.6%) attended training courses before the implementation of new HER] distributed to all physicians working in the paediatric department of King Saud University Medical City (KSUMC)	The participants rated the perceived usefulness of the new system at 6.4/10 for patient care and physicians’ satisfaction levels were 5.2/10. The top indicator of HER usefulness was the system's ability to reduce errors and improve the quality of care [mean 3.31, SD 0.9, RII 82.8%]; The top indicator of satisfaction with the HER system was enhanced “individual performance” [mean 3.04, SD 1, RII 60.9%];	This study revealed that higher level of satisfaction was associated with the perceived positive effect of HER on individual performance and patient care. The results of this study are provided a “pediatricformatics” insight to establish specialized children hospital and similar forms of integrated paediatric health care services. Academic centres might face other difficulties in implementing HER, due to the involvement of medical students, interns, and residents in the clinic care
12-Al-Hashimi et al. (17)	The Potential For Medical Informatics In The Eastern Mediterranean Region	A feasibility study questionnaire done in December 1989 at Salmaniya Medical Centre (SMC) in the state of Bahrain.	Opinions about the current information system. Twelve of the physicians (22.2%) indicated that 30% of their time is spent on daily charting and paperwork. Knowledge about computer usage. Only 17 physicians (32.1%) had worked with computers before. Most of the physicians either “strongly agree” or “agree” (46/86.8%) that computerization will make some of the physician's duties easier Ranking of the priority of certain tasks to be computerized. The majority of the physicians ranked generating clinical reports not less than an 80% priority (38/74.5%).	Based on this study, the HIS experience in Bahrain will be different from the experience in the United States due to some factors: (a) the health care system in Bahrain is centrally organized under the Ministry of Health, b) the majority of physicians in Bahrain support the idea of HIS, based on the idea that the system will help them to optimize patient care and save time c) the majority of physicians feel that they are under pressure from increased patient flow and limited bed capacity, d) the majority of physicians believe that there is a need for more specialized physicians. One final contrast between this evidence from Bahrain and the United States is that the acceptance and diffusion of HIS among physicians in the United States was slow from the start.
13-Khalifa (18)	Perceived Benefits of Implementing And Using Hospital Information Systems And Electronic Medical Records	The study used quantitative survey methods through a questionnaire to collect data and information directly from different categories of healthcare professionals of four Saudi hospitals. Data was collected with 153 valid responses out of 300 selected participants	Participants overall agree that there is a lot of benefit from using Hospital Information system and Electronic medical records (the mean was 4.18) Participants strongly agree that the HIS and EMR improve the information access (mean was 4.49) Participants strongly agree that the HIS and EMR Increased healthcare professional Productivity (mean was 4.31) Participants strongly agree that the HIS and EMR improved efficiency and accuracy of coding and billing (mean was 4.30) Participants strongly agree that the HIS and EMR improved quality of healthcare (mean was 4.27) Participants strongly agree that the HIS and EMR Improved clinical management (mean was 4.22)	HIS and EMR can also decrease costs of some services such as medical transcription and reporting, making the work of healthcare professionals more productive.
14-Saddik and Al-Fridan (19)	Physicians’ Satisfaction with Computerised Physician Order Entry (CPOE) At the National Guard Health Affairs: A Preliminary Study	A survey was developed measuring physician satisfactions with CPOE on Likert scale.	85% of the physician perceived that the CPOE reduced patient care errors and that the order system easy to use. 50% of physician reported a positive and negative perception that Laboratory data retrieval is fast. 60% of the physician stated that they were satisfied with order entry system.	The study shoes that COPE characteristics were strongly correlated to physician satisfaction efficiency and quality of care.
15-Wali (20)	Patient Satisfaction with The Implementation of Electronic Medical Records In The Western Region, Saudi Arabia, 2018	A cross-sectional survey was conducted to explore patient satisfaction with the EMR compared to the previous PMR in 2018 in PHCs in Jeddah, KSA. The setting was the waiting areas in the PHCs, all are satellite clinics of King Abdulaziz Medical City in the Western Region, including Jeddah, Makkah, and Taif. The study was conducted over 6 months, from July 10 to December 31, 2018. The centers are Bahra, the Specialized Polyclinic, King Faisal Residential City Clinic in Jeddah, Sharia Primary Healthcare Clinic in Makkah, and King Khalid Residential City Clinic in Taif. 377 participants	physician's attention to the patient during the consultation improved from 77% (n = 291) to 82.3% (n = 314) with the implementation of EMR and the physician's explanation of the reasons for ordering tests and medication improved from 80.7% (n = 302) to 85.8% (n = 325). The time spent with the patient during the consultation also improved from 73.8% (n = 279) to 80.4% (n = 303) and active listening improved from 73.5% (n = 278) to 77.3% (n = 289). Patients feeling that the physician is more interested in the medical records improved from 44.1% (n = 166) to 57.5% (n = 218) majority agreed that the implementation of the EMR improved the physician-patient relationship in general and reduced the waiting time (63.9%, n = 242). The majority (81.6%) also agreed that the services provided by the PHC im- proved with the implementation of EMR; specifically, more efficient prescription dispensing (80%, n = 304), improved appointment booking (80.6%, n = 304) and an improved referral system (76.1%, n = 287)	This study showed positive participant's perception about primary health care services after implementation of the EMR in all of the aspects; it improved information access, health care professional productivity, quality of provided health care, and overall patient satisfaction, overall physician-patient relationship improved with the implementation of EMR, as well as the total waiting time and the overall quality of services, the appointment booking time, and referral system.
16-Karim Jabali (21)	Predictors Of Anaesthesiologists’ Attitude Toward Ehrs in Saudi Arabia For Clinical Practice	Cross-sectional study, carried out in Saudi Arabia during March–June 2020 comprehensive questionnaire about the adoption and perception of EHRs. 67 anaesthesiologists/physician responses	About 88% of respondents strongly agree or agree that EHRs positively changed their working clinical experience. EHRs are positively affecting healthcare cost, quality of care, communication, patient satisfaction, efficiency of practice and occurrence of medical errors. However, the respondents are about evenly divided regarding the burnout because of the use of EHRs. More than 75%– 100% agree that the given features are either very easy or at least easy to use. The small deviation from the ‘near consensus’ is seen in the answers about the continuity of care (67%) and analysis of care results (69%) which is not a bad result in general at least 67% agreement regarding the consistency of monitored and recorded clinical details and suitability of documentation features, while the screens and layouts of pages and other web-based tools found an agreement of 69%.	The above results show that the young generations of specialists (86%) are more adaptable to change and accept the EHRs even if the experience they have is less than three years. the need for integrating some EHRs related training in the curriculum of medical schools is of paramount importance
17-AlSadrah, Sana (22)	Electronic Medical Records and Health Care Promotion in Saudi Arabia	In this literature review, the author focused on the benefits of widespread adoption of EMRs in Saudi Arabia, the perceptions of health care professionals, and the challenges and barriers toward improved implementation of this technology.	The ease of communication is another major advantage when health care professionals can communicate with patients through email, fax, and phone.18 important for clinical investigations, but for evaluating health care policies and informing stakeholders about approaches to improve access to high-quality health care.25 Other advantages related to accessibility and management include management and records of patient referrals, allowing health care professionals, even when out of the hospital, to access patient health records, allowing patients to access parts of their health records and providing data backup and disaster recovery.2	Recommendations are related to improving the communication between different health care personnel as well as between physicians and their patients. Ensuring the possibility of short message service (SMS) or email communication is a must. This can be achieved by providing quality Internet connection to hospitals and other healthcare delivery facilities, improving patients’ awareness about the value of online communication with their health care provider, and increasing physicians’ computer literacy.39 Physicians should also be able to customize their preferred, easy-to-use EMR interface and should be able to select the optimal tools to achieve effective communications with their patients.40 A literature review summarized the barriers of EHRs by physicians and classified them into 8 main categories. These categories included technical, financial, psychological, social, legal, time, organizational, and change processes. In short, the main highlighted barriers across the eight categories were probable security breaches, loss of access to data upon computer crashes or power failures, the time needed to enter data and check their quality, the complexity of the technology (especially among personnel with poor English language and computer skills), the potential to disturb physician-patient communication, and the lack of system customization for all hospital needs. Other barriers were concerned about the lack of continuous support from IT staff in hospitals and poor training of health care personnel in the use of EMR.
18-Koutzampasopoulou Xanthidou (23)	Electronic Medical Records in Greece and Oman: A Professional's Evaluation Of Structure And Value	The study took place in the natural setting of the medical units’ environments. A purposive sample of 40 professionals in Greece and Oman, was interviewed.	Some believe that religion should be included in the patient's record to help understand the patient's habits and, possibly, culture that affect an individual's health condition while others find such an idea highly disputable, to say the least, pointing to the discrimination practices that it might lead to. Likewise, with the cases of a person's nationality, language, and religion; some find the idea of their inclusion to the EMR useful or even essential while others find it unacceptable. Category of ‘eating habits’ or ‘life style’—MD could provide better health care to the patients and avoid mistakes that are related to the elimination of the effects of a medicine because of these behaviors. The race, education level and the language are important because they may assist in communicating with the patient.”	The study suggests that: (1) The demographics of the EMR should be divided in categories, not all of them accessible and/or visible by all; (2) The EMR system should follow an open architecture so that more categories and subcategories can be added as needed and following a possible business plan (ERD is suggested); (3) The EMR should be implemented gradually bearing in mind both medical and financial concerns; (4) Sharing should be a patient's decision as the owner of the record. Reaching a certain level of maturity of its implementation and utilization, it is useful to seek the professionals’ assessment on the structure and value of such a system.