Electronic health records: managerial insights from an umbrella review

Healthcare systems are increasingly implementing tools that aid the decision-making process of professionals. There is a clear need to develop evidence-based managerial guidelines for implementing electronic health records. This umbrella review aims to identify a parsimonious yet comprehensive set of factors that enhance the efficiency and effectiveness of electronic health records in supporting professionals' decision-making.

We analysed 199 literature reviews and meta-analyses to classify key factors influencing electronic health records' performance into technological, human, and institutional domains. For each domain, we systematized implications and recommendations relevant to healthcare management.

Technological factors account for the largest share of existing research, with data management, artificial intelligence, and usability emerging as the most frequently studied areas, while barriers related to ICT infrastructure and software receive comparatively less attention. Human factors are also widely examined, particularly user familiarity, nudges, and system use, whereas collaboration, ethics, and enforced actions are less frequently addressed. Institutional factors primarily concern adoption processes and acceptance, followed by access and workflow optimization; privacy and guidelines are discussed to a lesser extent, while customization and evaluation remain relatively underexplored.

Healthcare managers should prioritize cognitive usability, workflow integration, user familiarity, and alignment with organizational strategy when designing and implementing electronic health records. Their development should be guided by robust evidence and continuous, iterative refinement. By placing behavioural considerations at the centre, this review supports the development of systems that not only meet technical standards but also actively enhance clinical reasoning, without duplicating prior efforts.

Prospero CRD420251000239.