Challenges and facilitators of electronic health record implementation: a scoping review

The rapid advancement of technology has made eHealth a vital part of modern healthcare. Electronic Health Records (EHRs), as core tools of eHealth, enhance care quality, enable access to medical data, and improve coordination among healthcare providers. Implementing EHRs successfully requires understanding the challenges and facilitators involved to inform effective policymaking and management. This study aimed to identify key factors influencing the successful implementation of EHRs.

A scoping review was conducted in accordance with PRISMA guidelines to explore the challenges and facilitators of EHR implementation. Comprehensive searches were performed in PubMed, Web of Science, Scopus, Embase, and Google Scholar (first 10 pages) using keywords related to EHRs, challenges, and facilitators. Articles published between January 2010 and January 2024 were included. Eligible studies were original quantitative and qualitative research in English. Two reviewers independently screened and selected studies for inclusion.

From an initial yield of 5,358 records, 23 studies were included in the review, demonstrating international scope with data from a wide range of countries including Iran, Germany, the USA, Saudi Arabia, South Africa, and others. Findings showed that EHR implementation faces challenges across governance, policy, leadership, human resources, infrastructure, and operations. Common challenges included lack of clear policies, weak strategic oversight, limited infrastructure, and interoperability issues. Facilitators included strong leadership and political support, infrastructure investment, stakeholder engagement, adherence to standards, and comprehensive training programs.

This scoping review identifies the challenges and facilitators of Electronic Health Record (EHR) implementation using the SURE framework, offering a structured and novel perspective for analysis. The findings demonstrate that successful EHR deployment extends beyond technology, requiring robust governance, capable leadership, skilled personnel, resilient infrastructure, and interoperable systems. To overcome these challenges and realize the full potential of EHRs, the study proposes specific policy recommendations, including the development of clear and actionable national roadmaps with operational guidelines, sustainable funding through adequate budgetary allocations and infrastructure investment, enforcement of standardization and interoperability-particularly through standards like ICD-10, prioritization of continuous staff training, and promotion of active stakeholder engagement through multi-level collaboration. These insights provide practical policy guidance for accelerating EHR adoption and improving health system performance.