The health sector is complex [1]; while it must inevitably respond to treatment advances, it can be slow to adopt other types of innovation and has lagged behind other sectors in its use of information and communications technology (ICT) [2]. Health organizations are characterized by a dual structure: one for clinical functions and the other for business and support functions [3], which is reflected in their ICT. Despite the importance of business and support systems in health organizations, very little research on their adoption or impacts exists, compared with other areas in health informatics and eHealth [4]. Like clinical information systems, business and support systems vary depending on the department in which they are used (eg, finance, human resources [HR], or procurement) and may be implemented either as standalone systems (eg, integrated procurement system, or inventory management module) or as a part of generic health information or enterprise resource planning (ERP) systems.

This review focuses on one such functional system, human resource information systems (HRISs), either implemented as a standalone system (eg, a payroll module, or as a dedicated multifaceted HR system), or embedded within a broader generic health information system (eg, as an HR module within an ERP system). Although HRIS are vital for the effective operation of health organizations and address many of the information, communication, and training issues of health professionals [2], they are underrepresented within the health, information systems, and management literature. This is despite the fact that “people costs” can account for 65-80% of health organizations’ total operating budgets [3] and successful implementation of HRIS in HR departments has been linked to improvements in patient care [2].

The importance of HRIS, and the data that they can generate, has also been highlighted by various global health initiatives [5-15]. For example, the World Health Organization (WHO), in their 2006 World Health report stated that “systems for recording and updating health worker numbers often do not exist, which presents a major obstacle to developing evidence-based policies on human resource development” [16]. Six years later, despite the importance of HRIS for underpinning strong health systems, a 2012 review ([17] cited in [18]), concluded that “universal understanding of the HRIS used in monitoring human resources for health is minimal and baseline information regarding their scope and capability is practically non-existent...[there is a need] for more descriptive research of HRIS globally, including the documentation of impact so as to advance the science and evidence-based practice in this area” [18]. Some researchers have already responded to this request and made their contributions to the international peer-reviewed literature [18,19]. However, because this topic lies at the intersection of informatics, management, and health, most of the existing HRIS studies in health care are spread across several discipline-specific bodies of knowledge, making it difficult to obtain a complete picture of the evidence base.

To verify the aforementioned claim, we first searched for and examined existing reviews of HRIS literature, and indeed, as can be seen in Figure 1, these tend to be discipline specific, typically coming either from a business, social science, or ICT perspective.

Reviews were classified as systematic if they were either labeled as such, or used a structured search strategy to interrogate named online databases, and clear methods for filtering, summarizing, and synthesizing results. Only a few used a systematic approach [17,20-22], and none encompassed the ICT, social science, business, and health literatures in combination. Only 2 reviews looked specifically at HRIS in health care [17,20], both of which prioritized medical and social science databases, and were limited in scope. The first, published in 2012, was aimed at uncovering baseline information on the use and capability of HRIS in different countries, as a means of understanding the challenges this presents for global health workforce monitoring and development. The second, published in 2013, examined the role of different types of ICTs as a means of enabling continuing professional development to strengthen human resource capacity in health care.

Other nonsystematic literature reviews [23-29] were classified according to their references and the journals in which these references were published. The 6 literature reviews included in Figure 1 [21,22,24,26,28,29] were adopted from “Orchestrating the e-HRM symphony” [30], an inaugural lecture given by Professor T Bondarouk at the University of Twente in December 2014. The other 5 [17, 20, 23, 25, 27] were already known to the authors, based on their background reading.

Our scoping searches, using different keywords, revealed a wide variety of terms and definitions that have been used in the literature to describe information systems aimed at supporting human resource management (HRM) [21], echoing previous scholars’ observations on the lack of consistency and agreement in this area [26]. Such systems may be explicitly referred to as HRIS (eg, defined as “the composite of databases, computer applications, and hardware and software necessary to collect/record, store, manage, deliver, present, and manipulate data for human resources” [31]), as an electronic human resource or E-HR system (eg, described as a “created real-time, information-based, self-service, interactive work environment” [32]) or, more recently, as an electronic human resource management or e-HRM system (eg, defined as “a way of implementing HR strategies, policies, and practices in organizations through conscious and directed support of and/or with the full use of web-technology-based channels” [33]). These terms are often used to refer to standalone information systems for HR, whereas, in complex organizations, HR functions may be embedded within wider ERP systems [34] or health information systems [35]. Because the proposed systematic review is designed to be interdisciplinary, comprehensive, and inclusive, it will encompass any study referring to ICT aimed at supporting the administration, management, and development practices of HR in the health sector [36], whether used solely by HR professionals or jointly by HR and health professionals and leaders. This may include such HRM practices as staffing, training and development, compensation and rewards, communication, employee engagement, and performance management [36]. Such systems are not directly related to patient care, although their use in HRM has the potential to indirectly influence care quality and outcomes [37].

We are undertaking an interdisciplinary systematic review to identify and classify existing evidence on development, adoption, implementation, and impacts of HRIS on health organizations. In addition to documenting and classifying the research, we will seek to understand the outcomes and implications of HRIS implementation in health organizations, the theoretical frameworks used to study them, and to identify unexplored areas. This review also aims to support health leaders by summarizing the current evidence base and informing recommendations on HRIS implementation and research.

This review concerns the effective development, implementation, and use of ICT platforms and software for supporting the effective management of HR within health organizations and, in some cases, across health care systems. The specific objectives of this review are the following: (1) to determine the prevalence and scope of existing research and evaluation pertaining to HRIS in health organizations; (2) to analyze, classify, and synthesize existing evidence on the processes and impacts of HRIS development, implementation, and adoption; and (3) to generate recommendations for HRIS research, practice, and policy, with reference to the needs of different stakeholders and communities of practice (eg, eHealth, business ICT systems, and HRM).

This is the protocol for a structured review of scientific and gray literature on HRIS in health care. A PRISMA flow diagram [38] will be followed, to illustrate the study selection process and ensure transparency of the review (Trial Registration: CRD42015023581).

A high-level scoping review was first undertaken to inform a draft search strategy, which was refined through several cycles of piloting and iteration to optimize its sensitivity and specificity. This was used by the first author, with the help of a medical librarian, to search international electronic databases indexing medical (Cochrane Library, Medline, and EMBASE), Business (ABI/Inform, ASSIA, and Sociological abstracts), ICT (IEEE Xplore), and multidisciplinary (Scopus, Web of Science Core Collection, and ScienceDirect) research, as this topic lies at the intersection of informatics, management, and health. There were no restrictions on language or publication year applied to the literature search.

In addition to the electronic databases, various gray literature sources were also reviewed to identify relevant studies, using a subset of the search terms described in the next section. They included, but were not limited to 4 types of sources. First, WHO reports and working papers were searched using WHO’s Institutional Repository for Information Sharing and the following query: HRIS OR eHRM OR e-HRM OR “Human resource information system”. Second, with respect to professional, marketing, and consulting company reports, the resources/publications/web pages of the following organizations were examined individually to identify relevant articles: Chartered Institute of Personnel and Development, Society for Human Resource Management, Deloitte, Ernst & Young, PricewaterhouseCoopers, KPMG, Towers Watson, McKinsey & Company, Boston Consulting Group, and Sierra-Cedar. Third, white papers and publications of the Healthcare Information and Management Systems Society available at their Resource Library (under “Health IT” topics) were included. Finally, academic theses were identified via Google’s search engine using the following query: HRIS OR eHRM OR e-HRM OR "Human resource information system" AND Health AND Thesis. The first 7 pages of the returned results were considered relevant and reviewed. References of qualified articles were “snowballed” to identify other relevant studies. Once data extraction is complete, experts in the field will be consulted to identify any further relevant articles that may have been missed.

A comprehensive list of keywords was created for this systematic review [39] through three steps. First, the following types of HR-related terms were identified: (1) HR terminology that the authors were familiar with based on their background readings; (2) terms that were returned when searching under “Human resource” in the US National Library of Medicine’s Medical Subject Headings (MESH) browser, such as staff and manpower; and (3) terms articulated within a highly cited expert review analyzing theoretical, methodological, and topical aspects of e-HRM, and in the abstracts of the referenced articles [21] (added during the “Search Query 2” development stage). Second, the ICT-related terms “information systems” and “information technology” were selected based on background readings. Third, general health terminology that the authors were already familiar with were identified: health, health care, hospital, clinic*, and medic*. Health care and care were not sufficiently sensitive. Searching the MESH terms database did not reveal any additional relevant results.

Three main search queries (Table 1) for the identified keywords were tested (Tables 2-5) by the first author on June 25-26, 2015. Their results were then shared with the review team to jointly identify the search query most likely to ensure the highest level of inclusion of relevant studies.

The following information will be extracted from each of the eligible studies: authors/institutional affiliation; year; setting (type of organization, country or region in which the study was conducted); innovation stage (eg, design, piloting, implementation); journal discipline; HRIS function/activity; research purpose/questions; theoretical basis (if specified, or if this can be deduced from the author’s description); study design; main findings; and conclusions. Other fields may be added as the analysis progresses.

It is expected that data synthesis will be descriptive, only due to the interdisciplinary nature of the review, variety of study designs, outcomes, and heterogeneity of technology functions and their applications. The data, therefore, will be descriptively summarized and narratively reported.

Two reviewers will independently assess included studies to eliminate the risk of selection bias; the advice of the third reviewer will be sought in cases of disagreement. We anticipate that most studies will be qualitative. In line with other systematic literature reviews of qualitative research [40,41], we will use the Critical Appraisal Skills Programme (CASP) qualitative checklist [42] to assess study quality.