Navigating large-scale EHR implementations in public health systems: Lessons learned and recommendations from a rapid review.

Abstract

Objective: This review systematically synthesizes empirical evidence from past NEHR initiatives to identify critical gaps between knowledge and practice and provide actionable insights for policymakers, health IT leaders, and practitioners.Materials and Methods: A rapid review approach was employed, focusing on qualitative content analysis of empirical studies published between 2010 and 2024. The search covered the Scopus, PubMed, Medline, and CINAHL databases. A total of 24 studies met the eligibility criteria and were analyzed across key dimensions.Results: Our analysis reveals that successful NEHR implementation hinges on three interdependent factors: (1) Stakeholder engagement and governance-meaningful clinician involvement and adaptive leadership strategies are crucial for system adoption; (2) Institutional and cultural alignment-the tension between centralized mandates and local adaptation must be carefully managed; and (3) Technological and process standardization-balancing interoperability with customizability remains a persistent challenge. Notably, rigid top-down implementations often face resistance, whereas hybrid "middle-out" approaches tend to facilitate smoother transitions.Conclusions: NEHR deployments require a nuanced approach that integrates strategic decision-making, continuous stakeholder engagement, and flexible governance models. Policymakers and project leaders should prioritize participatory implementation strategies, adaptive standardization, and mechanisms for iterative learning to enhance the sustainability and effectiveness of these systems.