JMIR Publications

ABSTRACT

Background:

Despite the clinical and administrative benefits of Electronic Health Records (EHRs), comprehensive evidence regarding the specific barriers to their implementation within the unique socio-political context of public health systems remain scarce.

Objective:

To identify barriers to the implementation of electronic health records (EHRs) in public health facilities by reviewing previous publications

Methods:

A systematic review of peer-reviewed articles was conducted. The search was conducted in PubMed, Scopus and Embase for articles published in English or Spanish between 2005 and 2025. Qualitative and quantitative studies were included that reported barriers from the perspective of health authorities and professionals, excluding incomplete implementations or systems that did not conform to the characteristics of an EHR. Study selection and data extraction were conducted independently by two reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Barriers were classified according to the PRISM framework: technical, behavioral, and organizational

Results:

The search included 161 articles, from which 10 studies published between 2012 and 2023 were selected, representing both high-income and low-to-middle-income countries. Technical difficulties include the need for investment and improvements in infrastructure. Behaviorally, lack of training and resistance to change make adoption difficult. At the organizational level, lack of leadership and funding issues are key obstacles. For successful implementation, it is essential to address these challenges through adequate investment, staff training, and strengthened policies and coordination

Conclusions:

Barriers have been identified in the process of implementing the EHR within the public sector, which can be considered by governments to speed up the process of adopting this tool