PURPOSE: To systematically review evidence of the benefits, barriers, and key factors for success in implementing Electronic Health Record (EHR) systems in physical therapist practice settings. BACKGROUNDS/SIGNIFICANCE: Clinicians are struggling to make sound decisions in the face of information that is often ambiguous, incomplete, or poorly organized. The demands to effectively manage health information have sharpened the focus on information technology solutions such as EHRs. SUBJECTS: Not applicable. METHODS AND MATERIALS: We systematically reviewed the literature to identify refereed articles of EHRs with physical therapist participants. We searched for English-language articles in the electronic databases of MEDLINE, CINAHL, and Ovid's All EBM Reviews (ACP, CENTRAL, COCH, and DARE) from 1969 to present. We also searched conference proceedings and contacted authors and experts to identify potential articles. 776 citations were examined, and potentially relevant articles were independently evaluated for inclusion by three authors (κ=.66; 95%CI .48,.85). For each selected study, three authors independently extracted study data using a structured form. Discussion resolved any disagreements. ANALYSES: Three authors independently reviewed each study and rated it according to the levels of evidence criteria published by the Oxford Centre for Evidence-based Medicine (rated from 1a-5). Inter-rater reliability on rating evidence level was analyzed by the level of chance-corrected agreement. Formal meta-analytic methods were precluded because of the heterogeneity in study attributes. We performed a qualitative analysis by synthesizing the literature and forming recommendations from identified themes in benefits, barriers, and success factors. We graded our recommendations by the Oxford Centre's standardized criteria for strength of supporting evidence RESULTS: Seventeen studies met our eligibility criteria. Sixteen of 17 studies were rated evidence level 4 (case study), and 1 was rated evidence level 5 (expert opinion). The level of chance-corrected agreement on evidence level between the three reviewers was .73 (κ=.73; 95%CI .45,1). Six of the 17 articles reported results for study of the same EHR, and thus results from these articles were aggregated and analyzed as one unit. This yielded a total of 12 study units in the analysis. All 12 studies reported benefits of EHR implementation, with 10 citing an improvement in reporting capabilities, 6 citing an improvement in interdepartmental communication, and 4 citing that the EHR would provide data for future research. Six of 12 studies reported barriers to EHR implementation, with 4 citing challenges in behavior or workflow modification, 2 citing software or equipment inadequacy, 2 citing training demands, and 2 citing resource demands. All 12 studies reported key factors for success in implementing an EHR, with 6 citing end-user participation in development, 5 citing adequate staff training, 4 citing incorporation of workflow analysis in system design, and 4 citing standardization of data. Four studies provided quantified results of process improvements after EHR implementation. CONCLUSIONS: There is a paucity of high quality evidence on EHRs in physical therapist practice; however, current literature suggests that they may have significant benefits. We recommend that EHR implementations include end-users in development activities, devote significant resources for training, incorporate workflow analysis into their design, and commit to data standards (grade of recommendations = C). FUNDING SOURCE: This work was supported in part by the National Library of Medicine (T15 LM-7117-7). KEYWORDS: Informatics, Medical Records Systems, Computerized, Physical Therapy Administration & Management, Physical Therapy, Electronic Patient Record System