Does Electronic Health Record Implementation Enhance Hospital Efficiency and Patient Outcomes? A Comprehensive Systematic Review

Abstract

The extensive implementation of Electronic Health Record (EHR) systems marks a significant change in how healthcare is delivered, offering the potential for increased efficiency, better communication between healthcare providers, and improved patient care. Nevertheless, there remains a need for a more comprehensive understanding of these systems and their implications on hospital efficiency and patient outcomes. This systematic review critically examines the contribution of EHR systems implementation in improving hospital efficiency and patient outcomes. We searched three electronic medical databases (namely, PubMed, Scopus, and Web of Science core collections) to find potentially relevant studies. Specific search keywords were used to ensure comprehension and relevancy. Specific inclusion and exclusion criteria were applied, and the results of the selected studies were presented. The study followed the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA-2020). Drawing on a diverse range of studies spanning 29 years, and various geographical locations, this review synthesizes findings from 26 selected studies. The review employs a narrative synthesis approach, addressing the multifaceted implications of EHR implementation across different healthcare contexts. This review provides valuable insights into the evolving landscape of digital health records in healthcare settings, highlighting both the benefits and challenges of EHR systems. The review reveals a complex picture of EHR systems implementations in improving hospital efficiency and patient outcomes. Notable improvements include enhanced clinical workflow, collaboration, quality of care, and patient safety. However, significant technical challenges persist, and the direct impact on patient outcomes remains unclear, emphasizing the need for further research.

Introduction

The widespread adoption of Electronic Health Record (EHR) systems represents a transformative shift in healthcare delivery, promising improved efficiency, enhanced communication among healthcare professionals, and ultimately, better patient outcomes (Mensch, 2023). This technology holds the potential not only to revolutionize data management but also to enhance connection and, ultimately, to elevate hospital efficiency (Pyron & Carter-Templeton, 2019). The initial stirrings of electronic health documentation can be traced to the 1950s and 1960s when healthcare institutions began experimenting with electronic medical records (EMRs; Krishnan & Neuss, 2023). Early EHR systems aimed to digitize patient information, transitioning from paper-based records to a more organized, accessible, and efficient means of storing medical data (Grimson, 2001). The 1970s and 1980s witnessed the gradual transition from EMRs to more comprehensive Health Information Systems (HIS; Berner et al., 2005). These systems extended beyond individual patient records to include broader functionalities such as administrative and billing components (Tanwar et al., 2020). However, the lack of standardization and interoperability hindered widespread adoption.

The 1990s marked a pivotal period with a growing recognition of the need for standardized health information (Hoerbst & Ammenwerth, 2010). Efforts were made to develop interoperable standards, such as the Health Level Seven International (HL7), to facilitate seamless communication between disparate systems (Sahay et al., 2011). Additionally, advancements in networking technologies and the internet laid the groundwork for more integrated and collaborative health information systems (Berner et al., 2005). The 21st century ushered in a digital health revolution, catalyzed by a confluence of technological advancements and a changing regulatory landscape (Grimson, 2001). The term “Electronic Health Record” (EHR) gained prominence as it encapsulated a more comprehensive and interoperable approach to health information management (Lye et al., 2018). In the United States, the “Meaningful Use” program, initiated in 2009 as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, played a significant role in promoting EHR adoption (Wright et al., 2013). The program offered financial incentives to healthcare providers who demonstrated the meaningful use of certified EHR technology. This incentivized shift accelerated the adoption of EHRs across various healthcare settings (Colicchio et al., 2019).

However, while the “Meaningful Use” program successfully incentivized EHR adoption, it also brought about its share of complications. Some healthcare providers faced challenges in meeting the stringent criteria for meaningful use, leading to concerns about the program’s impact on workflow efficiency and the diversion of resources from patient care (Heisey-Grove et al., 2014). Additionally, the rapid pace of implementation, driven by financial incentives, occasionally resulted in EHR systems that were not optimally tailored to the unique needs of individual healthcare settings, contributing to usability issues and clinician dissatisfaction (Colicchio et al., 2019). Emani et al. (2017) reported that only one-fifth of the physicians in our study believed that the meaningful use of EHR would improve the quality of care, patient-centeredness of care, or the care they provide. The latter part of the 2010s and into the 2020s saw a global momentum toward EHR implementation (Dillard-Wright, 2019). Many countries initiated large-scale projects to digitize healthcare records, improve data sharing, and enhance patient care coordination (Garrety et al., 2016). Interoperability, however, emerged as a persistent challenge, with variations in standards, data formats, and privacy regulations impeding seamless information exchange (Adams et al., 2017).

Presently, EHR systems continue to evolve. Cloud-based solutions offer scalability and flexibility, enabling healthcare providers to access and update patient records securely (Bahga & Madisetti, 2013). Efforts to address interoperability challenges persist, with initiatives to establish common data standards and frameworks (Adams et al., 2017). Additionally, a growing emphasis on patient engagement has led to the development of patient portals and mobile health applications integrated with EHRs, fostering a more collaborative approach to healthcare (Coughlin, 2022). Despite its promises, the realization of EHR benefits has been hindered by numerous challenges, as highlighted by the findings of this systematic review.

The adoption of EHR systems has gained widespread recognition for its ability to streamline hospital operations and deliver better healthcare outcomes for patients. Previous studies highlighted the multifaceted nature of EHR implementation in healthcare settings. These studies examined multiple facets of EHR adoption, including implementation progress, healthcare professionals’ perceptions and attitudes, barriers to successful implementation, and the impact of EHRs on hospital operations, clinical workflows, care quality, provider collaboration, and adherence to best practices. However, there has been no attempt made to systematically present how the EHR system implementation is contributing to the improvement in hospital efficiency and patient outcomes. As countries undertake significant investments in nationwide EHR system rollouts, it is essential to gain a deeper understanding of how these technological innovations can enhance healthcare delivery, ultimately leading to improved hospital operations and better patient outcomes. This systematic review aims to synthesize existing evidence from diverse studies, investigating the multifaceted implications of EHR system implementation across different healthcare contexts. The review was guided by the research questions “Does the implementation of EHRs enhance hospital efficiency and patient outcomes?” What aspects of EHRs contribute to hospital efficiency and patient outcomes? What obstacles and challenges do healthcare organizations face when implementing and integrating EHR systems into their operations?

Materials and Methods

This research followed the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA-2020) during the preparation of this systematic review (Page et al., 2021). Due to the large heterogeneity between the reported outcomes in the included studies, results were presented narratively.

Search Strategies

For this systematic review, the author conducted a thorough search on major databases like PubMed, Scopus, Cochrane, and Web of Science until December 2023. The author used specific keywords to find relevant results. These keywords included: “Electronic Health Record,”“Electronic Patient Record,”“Electronic Medical Record,”“hospital,”“healthcare,”“clinic,”“efficiency,” and “patient outcomes.” The author also checked previous systematic reviews and manually searched for additional records to ensure comprehensive coverage. To streamline the screening process, all electronic records were exported to the Endnote software, a citation manager, to enhance selection efficiency.

Inclusion and Exclusion Criteria

From the retrieved results from the databases, we selected the studies that were: (1) written in English, (2) published in peer-reviewed journals, (3) full text available online, (4) investigated the efficiency of EHR in elevating hospital functionality or reporting effects on patient outcomes either directly or indirectly, (5) presenting primary original data. We excluded papers that are (1) written in a language other than English, (2) reviews, and (3) grey literature. The eligibility screening process was conducted in two phases: initially, abstracts were reviewed for eligibility, and subsequently, the full-text articles of the abstracts that met the eligibility criteria were obtained and further screened for inclusion.

Study Selection

The author independently screened the titles and abstracts against the exclusion criteria. Full-text manuscripts were screened, and justifications for inclusion or exclusion were confirmed. As there is a certain overlap of reporting among databases, many duplicate articles were dropped. The criteria for screening the abstract were also applied to the full-text screening of the articles. Once the title and abstract were screened, the data from the full text was extracted and double-checked, and key themes were extracted. The key inclusion criteria were: non-English articles, studies not published in peer-reviewed journals, unavailable full-text online, articles not examining the impact of EHR systems on hospital efficiency and/or patient outcomes, and studies lacking primary data. Ultimately, 26 studies met the inclusion criteria and were included in the review.

Data Extraction

The author developed a data abstraction template in Microsoft Excel to extract data. The template included the extraction of information related to the study authors, country, year of publication, study objectives, study methodology, design participants, data collection methods, setting, and study findings. The findings of the studies were arranged according to their contribution to hospital efficiency and patient outcomes. In addition, critical aspects related to EHR implementation were identified, examined, and analyzed, revealing key challenges and obstacles that hinder the successful adoption of EHR systems.

Risk-of-Bias Assessment

The researcher conducted a systematic evaluation of the risk of bias in the studies, using predetermined criteria outlined in Figure 1. Additionally, the researcher assessed the relevance of the study populations and the impact of EHRs on hospital efficiency and patient outcomes. To evaluate the quality of the included studies, the researcher considered various sources of bias, including selection bias, performance bias, detection bias, attrition bias, reporting bias, and publication bias, as well as issues related to imprecision, inconsistency, indirectness, and duplication.

Figure 1.

Risk of bias.

Results

Overview of Included Studies

The search results from three medical databases (688 results from PubMed, 525 results from Scopus, and 321 results from Web of Science core collection) yielded a total of 1,525 records. After removing 432 duplicates by Endnote software, 1,093 papers underwent a two-phase screening process, finally yielding the inclusion of 26 studies (as detailed in Figure 2) spanning 29 years of publication from 1994 up until 2023 reflecting the evolving nature of EHR systems.

Figure 2.

PRISMA flow diagram detailing the study selection process.

The included studies exhibited variability in the geographical location at which they were conducted as follows: 12 studies were conducted in the USA: Weir et al. (1994), J. Ash et al. (2001), J. S. Ash et al. (2003), Scott et al. (2005), Houser and Johnson (2008), Crowley et al. (2019), Barnes et al. (2022), Penedo et al. (2022), Sangal et al. (2022), Mou et al. (2022), Simon et al. (2013), Ward et al. (2011); 3 studies in The Netherlands: Aarts et al. (2004), Katsma et al. (2007), Veenstra et al. (2022); 2 studies in England: Cresswell et al. (2012), Takian et al. (2012); and 1 study each in the following locations: Albania: Niaksu et al. (2017); France: Boyer et al. (2010); Gorkha, Nepal: Agrawal et al. (2022); Kenya, Rwanda, Uganda, and Mozambique: Were et al. (2021); Kenya: Ali et al. (2023); Lombardy, Northern Italy: Gastaldi et al. (2012); Serbia: Vekić (2022); Southwest Ethiopia: Ngusie et al. (2022); Sweden: Øvretveit et al. (2007). This distribution shows a significant prevalence of studies conducted in the USA, with a range of other countries contributing to the research on EHR implementation and its contribution to improving hospital efficiency and patient outcomes.

The studies involved a wide range of participants including healthcare professionals, hospital administrators, and in some cases, patients. Studies also encompassed different types of hospitals, from teaching to non-teaching and large university medical centers (Table 1). Several studies reported improvements in hospital efficiency, such as better collaboration and workflow due to EHR implementation. The challenges included technical issues, hardware problems, and software design flaws. In some cases, increased workload and rigidity of systems were also noted (Table 2).

Table 1.

The Characteristics of the Studies Included in This Review.

Study ID	Country/region	Main objective of the study	Data collection method	Participants/study objects	Hospital type
Weir 1994	United States	To identify individual and institutional level variables associated with successful adoption by physicians of an integrated order entry system.	A modified Delphi method was used, involving a questionnaire mailed to medical administration staff, administrators, support staff, users (physicians, nurses), and physician opinion leaders across six hospitals. Participants were asked to list significant facilitating factors and barriers to implementing the OE/RR 2.5 system.	The study involved six hospitals, with 92 individuals receiving the questionnaire. Fifty-two responses were received, with 40 individuals providing usable data (20 from predefined successful hospitals and 20 from less successful hospitals).	The study did not specify the types of hospitals involved, only that they were part of the Veteran’s Administration system.
Ash 2001	United States	To investigate Computerized Physician Order Entry (POE) through a series of studies, focusing on its implementation, usage, and impacts in various hospital settings.	The study began with a mail survey and then moved to qualitative multi-center studies. Data collection included oral history interviews, focus groups, and observation.	The study did not specify the exact sample size or response rates but involved multiple hospital sites, including teaching and non-teaching hospitals, with a focus on physicians, nurses, and other hospital staff.	Both teaching and non-teaching hospitals, including the University of Virginia (teaching hospital) and El Camino Community Hospital (non-teaching hospital).
Aarts 2004	The Netherlands	Understanding the implementation process of a CPOE system in a large Dutch university medical center. The authors propose characterizing the introduction of an information system as a process of mutual shaping, where both technology and practice are transformed.	The authors used a qualitative case study approach, which involved interviews with key stakeholders, observation of staff meetings and system use, and analysis of implementation documents.	The study focused on the implementation of the CPOE system in a large 953-bed university medical center in the east of the Netherlands. The authors interviewed a total of 25 key stakeholders involved in the implementation process, including senior staff from nursing, medicine, clinical laboratories, and information systems departments.	University Medical Center (a large 953-bed university medical center in the east of the country)
Ash 2004	United States	To describe the perceptions of various professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals.	The study employed observation, oral history interviews, and focus groups. These methods were used to gather data from clinical, administrative, and information technology staff at three different sites.	The study did not specify an exact sample size but involved a variety of participants, including clinicians, administrators, and information technology professionals, at three different hospital sites.	The study included different types of hospitals: an academic institution, a VA hospital, and a nonteaching hospital.
Scott 2005	United States	To examine users’ attitudes toward the implementation of an EMR system in Kaiser Permanente Hawaii	The study was a qualitative one based on semi-structured interviews conducted with senior clinicians, managers, and project team members	The study involved 26 participants, including senior clinicians, managers, and project team members across four primary healthcare teams in four clinics and four specialty departments in one hospital on Oahu, Hawaii	The study focused on a non-profit healthcare system that includes primary care teams in clinics and specialty departments in a hospital
Øvretveit 2007	Sweden	To describe the implementation of an electronic medical record (EMR) system in a hospital, its perceived impact, factors that helped or hindered the implementation, and to compare this with theories of effective IT implementation. The study also aimed to use empirical data to develop IT implementation theory	The study used a qualitative case study approach, replicating methods and questions of a previously published USA EMR implementation study. It involved semi-structured interviews and document analysis	The study involved 30 senior clinicians, managers, project team members, doctors, and nurses from a large Swedish teaching hospital	Large teaching hospital
Katsma 2007	The Netherlands	To investigate why care providers, face difficulties in adopting EHRs and to deliver insights to improve this situation. The study focused on the relevance and participation during the implementation process of EHR in four different hospitals	The study employed case studies as the methodological approach. It involved extensive interviewing to investigate the determinants of participation during the implementation process and to characterize the implementation approach. Additionally, the relevance determinants of the EHR were analyzed	Four non-academic hospitals in the Netherlands, selected based on criteria like the maturity of the EHR, vendor independence, and implementation progress. At least three different roles involved in the EHR project were interviewed in each hospital	Non-academic hospitals
Houser 2008	United States	The study aimed to assess the status of EHR implementation among Alabama hospitals, identify factors associated with EHR implementation, and understand the benefits, barriers, and risks of EHR implementation	The study used a survey method, mailing self-completed surveys to Health Information Management (HIM) directors of 131 Alabama hospitals, with 91 valid surveys returned, resulting in a 69% response rate	The survey was sent to HIM directors of Alabama hospitals, with 93% of the 91 respondents being HIM directors and the remaining 7% being hospital administrative personnel. More than half of the respondents were from rural hospitals, and three-quarters of the hospitals were non-teaching hospitals	The survey included a mix of hospital types, with a significant number being non-teaching and rural hospitals
Boyer 2010	France	To examine healthcare professionals’ opinions of critical events (opportunities and barriers) surrounding Electronic Medical Records (EMR) implementation in a French teaching psychiatric hospital.	The study was qualitative, based on semi-structured interviews with 115 healthcare professionals, including psychiatrists, nurses, psychologists, social assistants, and administrative professionals.	The study included 115 healthcare professionals from a French psychiatric university teaching hospital.	French Psychiatric University Teaching Hospital.
Ward 2011	United States	The study aimed to compare changes in nurses’ perceptions about patient care processes and workflow before and after the implementation of a comprehensive clinical information system in a rural referral hospital	The Information Systems Expectations and Experiences survey was used, encompassing scales like provider-patient communication, inter-provider communication, inter-organizational communication, work-life changes, improved care, support and resources, and patient care processes. The survey was conducted before and after training and following implementation	The study was conducted in a Midwestern rural referral hospital with about 300 beds and 2,700 employees. It involved 705 nurse respondents, with the pretraining survey completed by 354 nurses, the post-training survey by 203 nurses, and the post-implementation survey by 148 nurses	Rural referral hospital
Cresswell 2012	England	To understand how England’s centrally procured and delivered Electronic Health Record (EHR) software was integrated into the work practices of users in selected secondary and specialist care settings.	Qualitative longitudinal case study-based investigation employing semi-structured interviews, non-participant observations, researcher field notes, and hospital documents analysis.	66 participants from three purposefully selected sites implementing early functionality of a nationally procured EHR system, including healthcare professionals and staff.	The study involved secondary and specialist care providers within the National Health Service (NHS) in England.
Takian 2012	England	The study aimed to evaluate the implementation and adoption of an EHR software (RiO) in a mental health hospital, focusing on stakeholders’ experiences and the local consequences of the EHR system	The study employed a longitudinal real-time case study-based evaluation. Methods included conducting 48 in-depth interviews with a wide range of internal and external stakeholders, undertaking 26 hr of on-site observations, and obtaining various relevant documents	The study involved a large mental health hospital covering over 500,000 people, with participants including senior managers, members of the Board, implementation team and IT managers, healthcare practitioners (nurses, psychiatric consultants, junior doctors, pharmacists, social workers, occupational therapists), and administration staff	The hospital was a large, multisite, and autonomous (foundation) mental health hospital
Gastaldi 2012	Lombardy, Northern Italy	The study aimed to systematically improve hospital performance by enhancing and balancing knowledge exploration and exploitation capabilities through the development of an electronic medical record (EMR)	The study used a multiple case study design with an interpretative inductive perspective. Data collection included face-to-face interviews, phone conversations, follow-up emails, and archival data like internal documents, press releases, websites, and news articles	The study involved three large hospitals in Lombardy, Italy. A total of 27 semi-structured interviews were conducted over 3 years with various C-level officers (CIOs, CEOs, CFOs, CMOs) and other knowledgeable informants involved in the EMR introduction process	The three hospitals were large-sized, with similar bed numbers, employees, and ICT budgets
Simon 2013	United States	To characterize the experiences of hospitals that have successfully implemented CPOE, focusing on lessons learned and practical insights	The study employed a qualitative approach, including site visits for field observation and in-depth interviews with key informants at all five facilities	The study involved small to medium-sized hospitals in Massachusetts, with each hospital having 100–300 inpatient beds. The study included at least one clinician who orders treatments through CPOE, a professional who processes clinician-requested orders, and a hospital executive with oversight of the CPOE implementation process at each facility. A total of 24 in-depth interviews were completed	Small to medium-sized community hospitals
Niaksu 2017	Albania	To review the nationwide EHR implementation in Albania, highlighting achievements, shortcomings, and lessons learned.	Analysis of project documentation, first-hand experience, and EHR usage statistics.	79 healthcare providers across secondary and tertiary care.	Secondary and tertiary care providers.
Crowley 2019	United States	To evaluate an EHR implementation across a large public health department.	A two-phase cross-sectional survey of health department staff.	Staff from 4 program areas, with 331 responses pre-implementation and 229 post-implementation.	The public health department provides various health services.
Were 2021	Implemented in Kenya, Rwanda, Uganda, and Mozambique	Development and implementation of mUzima, an mHealth extension of OpenMRS, in LMICs	Utilizing the mobile (mHealth) evidence reporting assessment (mERA) checklist.	Health providers using smartphones, primarily in low- and middle-income countries (LMICs).	Not specified, but involves facilities in LMICs.
Agrawal 2022	Gorkha, Nepal	Discuss steps to integrate EHR in a district hospital with inherent challenges and impact	Not specifically mentioned, but implementation experience	50 bedded rural government hospital serving approximately 100 patients daily in the Out-patient Department (OPD)	Rural Government Hospital
Vekić 2022	Serbia	To describe the experience and lessons learned during the development and implementation of the nationwide electronic health record (EHR) system in Serbia, which began in 2015 and was completed in 2019	Retrospective narrative review of the process and early outcomes of EHR system implementation	Not specified in terms of numbers, but the project involved various healthcare institutions across Serbia	Various types, including primary care facilities and hospitals, with a focus on nationwide implementation across various healthcare settings
Ngusie 2022	Southwest Ethiopia	Assess healthcare providers’ EHR readiness and associated factors	Pretested self-administered questionnaire	Overall EHR adoption readiness was 52.8% (n = 204)	Not specified
Veenstra 2022	The Netherlands	Investigating the consequences of Electronic Health Record (EHR) implementation on healthcare workers’ autonomous work motivation, including the mediating effects of perceived work characteristics (job autonomy and interdependence) and exploring the moderating effect of profession.	A quantitative, uncontrolled before-and-after study using Generalized Estimating Equations (GEE) for data analysis	456 healthcare workers, including 75 physicians, 154 nurses, 145 allied healthcare professionals, and 82 administrative workers	University Medical Centre (Academic Hospital)
Barnes 2022	United States	To implement an electronic health record (EHR) dashboard for safe anticoagulant management, learning from qualitative interviews with existing and potential users to develop an implementation process.	Semi-structured interviews were conducted with stakeholders in two settings: the national Veterans Health Affairs (VA) following the implementation of an electronic dashboard, and the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) prior to the implementation of a similar electronic dashboard	The study involved interviews with 32 stakeholders across 22 VA sites and 13 stakeholders at four MAQI2 sites	The study focused on the VA health system, which is the largest vertically and horizontally integrated health system in America, and four distinct health systems participating in MAQI2
Penedo 2022	United States	To describe the implementation and feasibility of an Electronic Health Record (EHR)–integrated Patient-Reported Outcomes (PROs) symptom and needs monitoring system in a racially/ethnically diverse ambulatory oncology setting.	Data were collected from an ambulatory oncology clinic at the University of Miami Health System. The approach involved using a Patient Advisory Board and the Exploration, Preparation, Implementation, and Sustainment (EPIS) model for the development and implementation of “My Wellness Check.”	The study involved 834 individual patients assigned to the assessment in an ambulatory oncology clinic, of which 506 initiated the assessment.	Ambulatory oncology clinic within a university health system (University of Miami Health System).
Sangal 2022	United States	To examine the association between the utilization of an EHR-integrated clinical pathway and adherence to institutional best practice treatment recommendations for COVID-19.	Observational study of ED patients across a health system with seven EDs.	13,269 patients were admitted as Persons Under Investigation (PUI) for COVID-19.	A mix of academic, community, and freestanding Emergency Departments.
Ali 2023	Kenya	Sharing lessons learned during the implementation of a web-based electronic health record at a tertiary care center in Kenya.	Not explicitly stated.	The study was conducted at the Aga Khan University Hospital, Nairobi, Kenya, a 300-bed hospital.	Tertiary Care Center
Mou 2023	United States	To create an automated Electronic Health Record (EHR)-linked Registry for Emergency General Surgery (EGS) at UC San Diego.	Registry built within the Epic® EHR system; used retrospective and prospective cohorts for validation.	Captured 1992 patient encounters with 1,717 unique patients in 30 months.	University Hospital (UC San Diego).

Table 2.

Main Results From the Included Studies.

Study ID	Effect on hospital efficiency	Effect on patient outcomes	EHR drawback/challenges
Weir 1994	Hospitals that successfully implemented EHRs often cited supportive administration, direct physician involvement, and adequate hardware as key facilitators. In contrast, common barriers included inadequate hardware, limited software functionality, and resistance from physicians.	The study does not provide specific findings on patient outcomes, focusing more on the implementation and adoption of EHR systems within hospitals.	Challenges included insufficient functionality of the software, uncooperative attitudes from physicians, inadequate training, and issues with system user-friendliness.
Ash 2001	Technical System: Clinicians saw POE as more advantageous to hospital administrators. Issues with response time and total time spent on order entry were noted. Organizational System: Different perceptions among clinicians, administrators, and IT staff about POE, with trust and leadership style being key factors. Personal Aspects: The additional time spent on POE was a concern for clinicians, although remote access was seen as a positive feature.	The study does not specify direct effects on patient outcomes but indicates that POE holds the potential for improving order communication, which could ultimately improve patient outcomes.	Technical issues like hardware problems, usability issues, excessive screens, and delays. Organizational challenges, including trust issues and different perspectives among staff. Personal challenges, such as the additional time required for POE and the need for workarounds.
Aarts 2004	The study found that implementing the CPOE system significantly improved hospital efficiency, resulting in enhanced medication safety, reduced medication errors, and streamlined medication ordering and administration processes.	The authors did not report any specific findings regarding the effect of the CPOE system on patient outcomes.	The authors noted that the implementation of the CPOE system was not without challenges, including resistance from some staff members, technical difficulties, and concerns about the impact on workflow and patient care.
Ash 2004	The findings included improved collaboration and communication among healthcare professionals, changes in power dynamics, and adjustments in clinical practices due to the POE system. The study highlighted the importance of organizational culture, trust, and active clinician engagement in adapting technology.	The study did not explicitly discuss the effects of EHR on patient outcomes.	Challenges included the rigidity of the systems, integration issues, the need for extensive training and support, and the impact on the time required for order entry. The study also highlighted the significance of customization to local practices and the potential resistance from clinicians due to changes in workflow and power dynamics.
Scott 2005	The study identified several challenges in EMR implementation, including dissatisfaction with the choice of the CIS system, escalating implementation costs, and reduced clinician productivity due to additional workload and system navigation difficulties. These factors collectively affected the overall efficiency of the hospital’s operations	The study did not specifically focus on patient outcomes but highlighted the impact of EMR on clinical practice and the healthcare process as perceived by users. The change from paper to computerized systems was seen as the most challenging aspect	Key challenges included software design and development issues, cultural resistance, lack of participatory decision-making, leadership challenges, and a general climate of conflict during the implementation phase. These challenges led to skepticism about the EMR system, reduced productivity, and alienation among clinicians
Øvretveit 2007	The Swedish EMR implementation was completed within a year and under half the budget. It was generally popular, considered to save time, and believed to improve the quality of patient care. Key factors for cost-effective implementation and operation included features of the system itself, the implementation process, and the conditions under which the implementation was carried out	The implementation led to more complete and better information on the system, which was expected to increase patient safety (e.g., clearer medication information). It also made it easier to find patient information, thereby saving time and improving patient care	The primary challenge encountered was the insufficient allocation of personnel time. The rapid implementation pace hindered the development of new procedures, resulting in staff overtime. Furthermore, inadequate time and support were provided to help staff adjust their routines to the new system, leading to the mere transfer of existing routines to the computer without necessary modifications.
Katsma 2007	The study found that the relevance of EHR mainly focused on the availability of information and time and effort reduction. However, this did not fully meet end-users expectations and was insufficient to accomplish the aspired improvements. The participation approaches used did not facilitate the diffusion of EHR in hospitals	The study does not explicitly focus on patient outcomes but highlights the importance of EHR for end-users, primarily regarding the availability and administrative value of the system. For better diffusion and impact, EHR should contribute more to the quality of care	The study observed that high levels of participation were reported positively but not all respondents adopted high participation levels even when invited. The lack of a good balance in organizing different participant types was a challenge. The relevance of EHR for end-users was limited to availability and administrative value, which was not sufficient for the effective diffusion of EHRs in hospitals
Houser 2008	The study found that 93% of respondents indicated that improving workflow would be a major benefit of implementing EHR. Other benefits noted were reducing medical errors (67%), reducing costs and treatment time (43%), and increasing revenue (43%)	While the study didn’t specifically focus on patient outcomes, the perceived benefits of EHR implementation included improving patient care by providing better linkage to all caregivers	The main barrier to EHR implementation was a lack of adequate funding and resources (75%). Other barriers included lack of knowledge of EHRs (35%), lack of support from medical staff (33%), lack of structured technology (28%), and lack of employee training (28%). Implementation and interpretation of HIPAA and other privacy issues were also noted as barriers
Boyer 2010	Opportunities: Improved access to medical record information, strategy to guarantee the adhesion of professionals and the use of EMR, and technological performances of EMR. Barriers: Workflow and efficiency decrease, issues with the patient-professional relationship due to the presence of EMR, concerns about information sharing and confidentiality, and the ambiguity of EMR regarding its dual role in patient care and economic aspects.	The study does not provide specific findings on patient outcomes but discusses the potential for EMR to improve access to patient information and thereby enhance the quality of care.	Increased time spent on documentation, leading to reduced time for care. The presence of EMR affects the patient-professional relationship. Concerns about patient privacy and confidentiality in psychiatric care. Ambiguity of EMR’s role, balancing between patient care and economic considerations.
Ward 2011	The study found that nurses’ perceptions of patient care processes and workflow were more positive in those who had previous experience with electronic health records. However, the overall perceptions decreased significantly across the survey administrations, pointing to the importance of realistic expectations, user perception assessment, and tailored training and implementation processes	The study did not specifically address patient outcomes but focused on nurses’ perceptions of patient care processes and workflow. The findings suggest a nuanced impact of EHR implementation on these aspects	The study implies challenges in adapting to EHR systems, especially among nurses with more years of work experience, indicating a need for realistic expectations, effective training, and support during the implementation process
Cresswell 2012	The top-down implementation limited customization to local needs, resulting in increased workloads due to poor system usability. Users employed workarounds to compensate for system shortcomings, impacting collaborative work patterns, communication, and availability of records.	The study does not specifically focus on patient outcomes but indicates an indirect impact through changes in work practices and efficiency.	Technical limitations, such as poor usability and system response time. Organizational challenges include the difficulty of adapting the system to local needs. Increased administrative tasks for clinical staff, potentially detracting from patient care. The requirement to use paper and electronic systems in parallel during early phases. The development of workarounds by users to manage system inadequacies, affecting the overall work environment.
Takian 2012	The study reported positive changes in work practices and patient care as a result of using EHR systems at the hospital. However, it did not specifically detail how these changes affected overall hospital efficiency	Clinical users praised the ability to see patients’ notes quickly, completely, in real-time, and live across the entire hospital and affiliated community health centers, which implies improvements in the quality of care and patient safety	The study outlines several challenges and policy implications for EHR implementation in mental health settings, including the need for stakeholder identification and engagement, ensuring computer literacy, user-centered design of EHR, addressing concerns about the huge cultural shift brought by EHR, and ensuring the safety and efficacy of EHR systems
Gastaldi 2012	EMR facilitated improved knowledge asset dynamics, enabling hospitals to better balance knowledge exploration and exploitation at different levels, and achieving better performance in terms of cost rationalization and quality improvement	EMR introduction enhanced the coordination among hospital processes, leading to improved outcomes. For example, the CEO of one hospital noted significant benefits in terms of quality improvement by connecting different departments and discovering new and better ways to provide healthcare services, impacting patients’ outcomes	The study highlighted challenges such as balancing standardization requirements with practitioners’ customization needs, managing user resistance, and the need for continuing EMR development and better integration with regional EHR systems. The study also pointed out that the results of EMR introduction are variable, and hospital managers face pitfalls and shortcomings in implementation
Simon 2013	Key themes identified included governance, preparation, support, perceptions, and consequences. Governance emphasizes the importance of multi-disciplinary collaboration in establishing policies and dealing with problems. Preparation and planning were crucial for the successful implementation	CPOE was expected to improve patient safety by reducing errors and improving the legibility of orders. Nurses and pharmacists noted the immediate beneficial consequences of improved legibility of physicians’ orders. However, some concerns were voiced about the unintended consequences and potential risks to patient safety	The study highlighted the painful consequences of CPOE implementation, including the accelerated retirement of some older nurses and physicians, and the transition of primary care doctors to using a hospitalist system. Concerns were also raised about the unintended adverse consequences of CPOE and its risks to patient safety. The study suggests the importance of collaborative approaches to ameliorate potential adverse consequences and setting realistic expectations for stakeholders
Niaksu 2017	Improved patient demographic data collection and flow control; minimized paper journals for patient registration.	Not specified.	The majority of clinical data remains in paper format, and access to the EHR system is limited due to inadequate ICT infrastructure.
Crowley 2019	Following implementation, staff perceptions of EHR usefulness decreased, while perceptions of complexity increased, indicating reduced efficiency.	Not directly assessed; the focus was on staff perceptions and challenges.	Significant discontent with the new technology post-implementation, with issues in usability and training, especially in behavioral health and crisis services
Were 2021	mUzima, as an mHealth extension, allows providers to access and manage health data efficiently, even in remote areas.	mUzima improves access to health data and quality of care, demonstrating effectiveness across multiple countries and care domains.	Implementation costs, including customization, smartphone purchase, hosting costs, and training. However, it is potentially more cost-effective than traditional laptop-based systems.
Agrawal 2022	Implementation of EHR faced challenges like power supply interruptions, but monitoring and feedback improved the workflow and adoption by employees	Not specifically addressed	Uninterrupted power supply issues, difficulty in hiring technicians for technology and networking, and the need for regular feedback and customization of software to facilitate adoption
Vekić 2022	The EHR system enabled more efficient interactions between medical professionals and governmental entities. The incremental development and phased implementation allowed for a gradual transition in workflows, improving efficiency	The implementation led to improvements in healthcare services, as evidenced by Serbia’s improved ranking in the European Healthcare Consumer Index. The system was reported to have positively impacted most segments of the Serbian healthcare system	Challenges included resistance to change, lack of knowledge and competencies among some participants, and the complexity of the system. The project faced difficulties similar to those encountered in other Balkan countries, such as lack of cooperative behavior by central institutions and individual and collective resistance to change
Ngusie 2022	Not specifically addressed	Not specifically addressed	Half of the respondents had a good level of overall readiness for the adoption of EHR which was considered inadequate, implying a need for significant improvement before actual implementation
Veenstra 2022	EHR implementation led to a slight decrease in perceived job autonomy among healthcare workers. Perceptions of interdependence among healthcare workers increased after EHR implementation.	Not directly addressed in the study, but EHR implementation was found to be positively associated with autonomous motivation, contrary to initial expectations. This suggests that EHR might have facilitated collaboration or increased a sense of responsibility among healthcare workers, potentially impacting patient care indirectly	The study does not explicitly detail drawbacks or challenges but suggests that changes in job autonomy and interdependence due to EHR implementation can affect healthcare workers’ motivation and the nature of their work
Barnes 2022	Five key determinants of implementation success were identified: clinician authority and autonomy, clinician self-identity and job satisfaction, documentation communication and administrative needs, staffing and work schedule, and technology integration. Issues like controlling workflow, fitting the DOAC Dashboard into pre-existing workflow, and autonomy in making DOAC dose changes were highlighted. Difficulties in communication with primary care providers and specialists and the need for sufficient documentation to account for time spent on DOAC Dashboard activities were noted. The success of the DOAC Dashboard was linked to having dedicated staff and time for reviewing the dashboard and making appropriate changes	The study does not specifically focus on patient outcomes but indicates the impact of the EHR tool on clinical staff’s workflow and autonomy, which indirectly affects patient care.	Concerns about the level of autonomy for clinicians in making medication changes. Potential replacement of clinical judgment by the computer system. Difficulty in integrating the DOAC Dashboard into existing workflows, especially at sites where it was added to existing workflows. Challenges in communication and documentation, and the need for additional staff time to manage these issues
Penedo 2022	The implementation of the EHR-integrated PRO system showed promising feasibility. Over 60% of assigned assessments were initiated, with more than half completed at home via the patient portal. The system improved the identification and management of patient needs, including nutritional and emotional needs.	The study mainly focused on the feasibility of the implementation process rather than direct patient outcomes. However, it implied an improved assessment of patient needs and symptoms, which could positively affect patient outcomes.	Integration challenges with existing clinic workflows. Patient burden due to the length and frequency of questionnaires. Ensuring patient and clinician engagement with the system. Need for targeted efforts to increase engagement among Spanish-speaking patients. Over 40% of assessments did not trigger a Best Practice Advisory (BPA), indicating a need for improved response and engagement strategies.
Sangal 2022	Increased medication administration adherence and improved timeliness in ordering medications and hospital admissions.	Not directly assessed, but improved adherence to treatment guidelines suggests a potential positive impact on outcomes.	The EHR-integrated clinical pathway was not used by a majority of ED clinicians, possibly due to a lack of awareness or unfamiliarity
Ali 2023	Not explicitly detailed in the provided sections.	EHRs help provide comprehensive and safe care to patients and improve the provider experience.	Challenges include resource limitations, inexperienced staff, and the necessity of extensive planning for successful implementation.
Mou 2023	Enabled real-time tracking of quality metrics, improved identification of EGS patients, and facilitated more efficient clinic scheduling.	Lower clinic schedule rates for EGS consult patients compared to admitted patients; no specific data on broader patient outcomes.	Inclusion rules subject to user error, with a false positive EGS detection rate of 1.8% and capture rate of 85%

Note. POE = physician order entry; CPOE = computerized physician order entry; CIS = clinical information system; EMR = electronic medical record; ED = Emergency Department; EGS = Emergency General Surgery.

Study Objectives and Design

The objectives and designs of the studies on EHR system implementation varied widely, reflecting diverse approaches to understanding EHR systems’ role in improving hospital efficiency and patient outcomes. For example, the study by Weir et al. (1994) aimed to identify variables associated with the successful adoption of integrated order entry systems, using a modified Delphi method with questionnaires across six hospitals. J. Ash et al. (2001) investigated Computerized Physician Order Entry (POE) through a series of studies, focusing on its implementation, usage, and impacts, employing a mail survey and qualitative multi-center studies.

Houser and Johnson (2008) aimed to explore healthcare professionals’ perceptions of EHR utility in a single hospital, using a questionnaire-based survey. Crowley et al. (2019) assessed the impact of EHR on healthcare quality and patient safety, employing a mixed methods approach with a pre-post-intervention study. Barnes et al. (2022) focused on evaluating the effectiveness of EHR systems in improving healthcare delivery and patient outcomes using a quantitative approach with data analysis. The variability in the study designs and data collection methods is summarized in Table 3.

Table 3.

Data Collection Methods Used by the Included Studies.

Study ID	Data collection method
Weir 1994	A modified Delphi method, involving a panel of experts.
Ash 2001	Mail survey followed by more in-depth telephone interviews.
Aarts 2004	Qualitative case study approach.
Ash 2004	Observation, oral history interviews, and document analysis.
Scott 2005	Qualitative study based on semi-structured interviews.
Katsma 2007	Employed case studies as the methodology.
Øvretveit 2007	Qualitative case study approach.
Houser 2008	Survey method, mailing self-completed questionnaires.
Boyer 2010	Qualitative, based on semi-structured interviews.
Ward 2011	The Information Systems Expectations and Experiences (ISEE) survey methodology.
Cresswell 2012	Qualitative longitudinal case study-based investigation.
Gastaldi 2012	Multiple case study design with semi-structured interviews.
Takian 2012	Longitudinal real-time case study methodology.
Simon 2013	Qualitative approach, including semi-structured interviews and analysis of project documentation.
Niaksu 2017	Analysis of project documentation, first-hand observations, and interviews.
Crowley 2019	Two-phase cross-sectional survey of health department employees.
Were 2021	Mobile (mHealth) evidence reporting and systematic reviews.
Agrawal 2022	Implementation review, but specific methodology not mentioned.
Barnes 2022	Semi-structured interviews conducted with healthcare professionals.
Ngusie 2022	Pretested self-administered questionnaire.
Penedo 2022	Data collection from an ambulatory oncology clinic’s EHR system.
Sangal 2022	Observational study of ED patients across a healthcare system.
Veenstra 2022	Quantitative, uncontrolled before-and-after study.
Vekić 2022	Retrospective narrative review of the implementation process.
Ali 2023	Methodology not explicitly stated.
Mou 2023	Registry built within the Epic® EHR system; uses algorithmic data analysis

EHR Implementation and Hospital Efficiency

The role of EHR system implementation in improving hospital efficiency encompasses a range of outcomes across various studies. In Weir et al. (1994) factors such as supportive administration, direct physician involvement, and adequate hardware were identified as facilitators for successful hospital operations. J. Ash et al. (2001) highlighted that clinicians saw Physician Order Entry (POE) systems as more advantageous for hospital administrators than for themselves, citing issues with response time and total time spent on order entry. Additionally, organizational, and personal aspects such as varying perceptions among clinicians, administrators, and IT staff about POE, trust, leadership style, and the concern of additional time spent on POE were brought to light (Veenstra et al., 2022).

Aarts et al. (2004) found significant contributions to hospital efficiency from the implementation of the Computerized Physician Order Entry (CPOE) system, including improvements in medication safety, reduction in medication errors, and increased efficiency in medication ordering and administration. J. Ash et al. (2001) found that the POE system led to improved collaboration and communication among healthcare professionals, as well as shifts in power dynamics and adjustments in clinical practices. These changes underscored the importance of organizational culture, trust, and active clinician engagement in successfully adopting new technology. Cresswell et al. (2012) discussed the impact of a top-down implementation that limited customization, leading to increased workloads and the necessity of workarounds. Gastaldi et al. (2012) found that implementing the EMR system enhanced knowledge asset dynamics, leading to improved performance in cost rationalization and quality improvement. Takian et al. (2012) reported positive changes in work practices and patient care due to EHR systems but did not specify how these changes affected overall hospital efficiency. Simon et al. (2013) emphasized the importance of governance, preparation, support, health professionals’ perceptions, and consequences for the successful implementation of EHR system. Finally, Niaksu et al. (2017) highlighted improved patient demographic data collection and flow control and minimizing paperwork for patient registration.

Effects of EHR on Patient Outcomes

The contribution of EHR implementation in improving patient outcomes shows varied effects across different healthcare settings. In the study by Were et al. (2021) mUzima, a mobile health application, was noted to improve access to health data and quality of care, demonstrating effectiveness across multiple countries and care domains. Vekić (2022) reported that the implementation of EHR in Serbia led to improvements in healthcare services, as evidenced by Serbia’s improved ranking in the European Healthcare Consumer Index, and positively impacted most segments of the Serbian healthcare system. Penedo et al. (2022) examined the implementation process of EHRs, suggesting that improved assessment of patient needs and symptoms could have a positive indirect impact on patient outcomes. Ali et al. (2023) highlighted that EHRs help provide comprehensive and safe care to patients and improve the provider experience. These findings from recent studies indicate that while EHR systems have the potential to improve patient care and healthcare service quality, the direct impact of EHR system implementation on patient outcomes is often not the primary focus of these studies. Instead, they tend to highlight improvements in healthcare processes and provider experiences, which can indirectly influence patient outcomes. This shows that future studies on this topic need to consider the direct effects on patient care as the primary outcome through which they measure the effectiveness of EHRs.

Challenges and Drawbacks of EHR Systems

Past studies have extensively discussed the challenges, and issues related to EHRs providing valuable insights for researchers, scholars, and healthcare professionals. A significant concern is the limited digitalization of health data due to the unavailability of EHRs, which can be addressed by leveraging information communication technologies (ICT) in healthcare organizations (Boyer et al., 2010). Other challenges include inadequate training post-EHR implementation (Crowley et al., 2019) high implementation costs, and technical issues such as power supply, networking, and software customization (Agrawal et al., 2022; Were et al., 2021). Physicians face issues related to autonomy in using EHR software for decision-making (Barnes et al., 2022). Furthermore, healthcare workforce motivation, independence, and work nature can be impacted (Veenstra et al., 2022).

Organizational challenges include employee resistance, lack of motivation, and limited flexibility in adopting new changes (Vekić, 2022). Additional problems include inexperienced staff, limited resources, planning concerns, and user errors (Ali et al., 2023).

These studies collectively underscore the multifaceted challenges of EHR systems, ranging from technical and usability issues to organizational, cultural, and workflow-related hurdles, underscoring the complexity of implementing and integrating these systems effectively in healthcare settings.

Discussion

The main objective of this review is to critically examine the contribution of EHR systems implementation in improving hospital efficiency and patient outcomes. Healthcare organizations worldwide have recognized the importance of EHRs, leading to increased adoption and implementation (Alzghaibi et al., 2023). EHRs provide accurate and up-to-date information, enabling healthcare professionals to make informed decisions and improve patient care. The use of EHRs enhances physician efficiency, hospital efficiency, and patient satisfaction. It is also recognized that EHRs help address common challenges like overcrowding and time constraints by providing accurate information for decision-making (Mughal et al., 2024) reducing costs and enhancing financial performance (Nair et al., 2024). Overall, the adoption of EHRs can increase the value of healthcare organizations (Kundi, 2023).

This systematic review reveals a complex picture of EHR system implementation in improving efficiency in healthcare settings. EHR systems have shown promise in improving hospital efficiency through enhanced data management, administration, and workflows. Studies A. A. M. Alharbi et al. (2023) consistently highlight distinct improvements in hospital operations, including workflow management, collaborative practices, medication order accuracy, and access to patient information. These enhancements facilitate efficient clinical decision-making and promote care coordination among healthcare professionals across various specialties and settings.

Implementation of EHRs can lead to cost reduction by streamlining administrative processes and decreasing operational costs. Few studies (Mughal, 2024) show that EHRs save healthcare providers time and effort, while others (D. N. Alharbi & Kundi, 2024) demonstrate that EHR adoption helps hospitals reduce expenses and increase revenue. By automating administrative tasks, EHRs enable healthcare providers to focus more on patient care. These findings are aligned with previous reviews (Ghaffar, 2024) that identified improvements in administrative efficiency and data accessibility. Studies, such as Lee et al. (2022) demonstrate that hospitals implementing EHRs outperform those that do not, showing positive effects on efficiency, profitability, and service quality. However, earlier studies may have been less conclusive due to the early stages of EHR implementation and varying technological sophistication.

This review highlights the uncertain impact of EHRs on patient outcomes. While some studies suggest improvements in patient care, patient safety, service quality, and satisfaction, other studies focus on healthcare processes, such as clinical workflows and provider-patient communication, rather than direct patient outcomes. These findings are consistent with the findings of a study (Subbe et al., 2021) which found that EHRs often report process measures rather than patient-level safety outcomes, suggesting a limited and unclear impact of EHRs on safety outcomes. Few studies (Vekić, 2022) suggest that EHR implementation improves care quality by providing healthcare professionals with immediate access to comprehensive patient data. This facilitates accurate diagnostic procedures, informed decision-making, reduced medical errors, and medication safety (Menachemi & Collum, 2011). Reviews by Tabche et al. (2023), Gatiti et al. (2021), and Campanella et al. (2016) confirm that EHRs improve doctor-patient relationships, patient safety, and healthcare quality. EHRs also enable timely, equitable, and patient-centered care. However, a qualitative analysis by Upadhyay and Hu (2022) revealed mixed results, with nurses reporting improved efficiency, while other healthcare professionals found EHRs time-consuming. Similar findings were also revealed by a study in Saudi Arabia (Jha et al., 2009).

The review reveals that the benefits of EHRs are often offset by significant challenges. Recurring issues include technical problems, integration complexities, increased workload, and escalating implementation costs. Additional challenges encompass low staff perception of EHR usefulness, concerns about information sharing and confidentiality, hardware issues, inadequate training, and resistance from physicians and staff. Few studies (Weir et al., 1994) highlight specific challenges, including software issues, integration difficulties, and user dissatisfaction. Other studies J. Ash et al. (2001) highlighted the resistance from physicians and other staff including cultural resistance becomes a challenge to EHR implementation. These challenges can impede EHR’s potential, affect hospital efficiency, and impact healthcare provider morale and productivity. To maximize EHR benefits, careful planning, adequate staff training, and thoughtful integration strategies are essential.

The ambiguity in the findings of existing studies on the impact of EHRs on hospital efficiency and patient outcomes highlights the complexity of this issue. Furthermore, the challenges of implementing EHRs in various healthcare settings underscore the necessity for additional investigation. Future research should focus on establishing a clearer link between EHR usage and hospital efficiency and patient outcomes, as well as identifying strategies to overcome the challenges faced by healthcare professionals in adopting these systems. This may involve more targeted studies on healthcare provider user experience, EHR effectiveness in different clinical contexts, and the long-term advantages and disadvantages of EHR implementation on patient care and hospital operations.

The review also emphasizes the importance of considering the unique contexts and needs of different healthcare settings when implementing EHR systems. Factors such as organizational culture, healthcare provider attitudes, and existing infrastructure play a crucial role in determining the success of EHR implementation. Furthermore, the rapid evolution of technology and healthcare regulations requires EHR systems to be highly adaptable and flexible, enabling them to respond effectively to the dynamic needs of healthcare delivery.

This review has several strengths, including its diverse range of settings and participants, methodological rigor, and focus on practical outcomes. However, it also has some limitations: Firstly, the studies examined had varying levels of focus and depth, with some concentrating on the implementation process rather than patient outcomes. Secondly, the reliance on self-reported data in many studies introduces potential biases and subjective interpretations, particularly in studies exploring healthcare professionals’ perceptions. Thirdly, the lack of longitudinal data limits our understanding of the long-term impact of EHR implementation on hospital efficiency and patient outcomes. Lastly, the findings may not be generalizable to other contexts due to regional or setting-specific differences, which restricts the applicability of the results.

Conclusion

The systematic review paints a multifaceted and intricate picture of the impact of EHR system implementation in improving hospital efficiency, and patient outcomes. While there are notable improvements in clinical workflow, streamlined administrative process, reducing the burden of paperwork, health professional collaboration, cost savings, and access to patient information significant challenges persist, especially in technical and software aspects. While EHRs present significant opportunities for improving hospital efficiency, their successful implementation requires addressing various challenges at institutional, technological, and human resources levels. Although EHR systems have the potential to enhance patient care, safety, and healthcare quality, their direct impact on patient outcomes is still uncertain and requires further investigation. Most studies tend to highlight improvements in healthcare processes, patient safety, service quality, and provider experiences, which can indirectly benefit patient outcomes. Despite the benefits of EHRs highlighted in the reviewed studies, there are still significant gaps in understanding their impact on hospital efficiency. Targeted research is needed to address these gaps and optimize EHR use. Future studies should prioritize investigating the direct impact of EHRs on patient outcomes and explore how EHR features can be leveraged to empower patients and promote their involvement in care processes.