25 Years of Electronic Health Record Implementation Processes: Scoping Review

Electronic health record (EHR) systems have undergone substantial evolution over the past 25 years, transitioning from rudimentary digital repositories to sophisticated tools that are integral to modern health care delivery. These systems have the potential to increase efficiency and improve patient care. However, for these systems to reach their potential, we need to understand how the process of EHR implementation works.

This scoping review aimed to examine the implementation process of EHRs from 1999 to 2024 and to articulate process-focused recommendations for future EHR implementations that build on this history of EHR research.

We conducted a scoping literature review following a systematic methodological framework. A total of 5 databases were selected from the disciplines of medicine and business: EBSCO, PubMed, Embase, IEEE Explore, and Scopus. The search included studies published from 1999 to 2024 that addressed the process of implementing an EHR. Keywords included "EHR," "EHRS," "Electronic Health Record*," "EMR," "EMRS," "Electronic Medical Record*," "implemen*," and "process." The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The selected literature was thematically coded using NVivo qualitative analysis software, with the results reported qualitatively.

This review included 90 studies that described the process of EHR implementation in different settings. The studies identified key elements, such as the role of the government and vendors, the importance of communication and relationships, the provision of training and support, and the implementation approach and cost. Four process-related categories emerged from these results: compliance processes, collaboration processes, competence-development processes, and process costs.

Although EHRs hold immense promise in improving patient care, enhancing research capabilities, and optimizing health care efficiency, there is a pressing need to examine the actual implementation process to understand how to approach implementation. Our findings offer 7 process-focused recommendations for EHR implementation formed from analysis of the selected literature.