Barriers and Facilitators to the Implementation of Electronic Prescribing Systems in Healthcare: A Systematic Review Using a Sociotechnical Framework
DOI:
https://doi.org/10.35451/jfm.v9i1.3942Keywords:
Electronic Prescribing, Medical Informatics, Patient Safety, Diffusion of Innovation, Medication Systems, HospitalAbstract
Background: Electronic prescribing (e-prescribing) and computerized provider order entry (CPOE) are increasingly used in medication management, but successful implementation depends on more than technology. How systems fit workflows, user practices, organizational conditions, and the policy environment can influence their use in routine care. Objective: To synthesize empirical evidence on barriers, facilitators, and other factors influencing e-prescribing/CPOE implementation in clinical practice. Methods: This systematic review followed PRISMA 2020. PubMed and Scopus were searched for empirical studies published from January 2000 through December 2025. Eligible studies directly examined barriers, facilitators, determinants, or implementation processes involving e-prescribing, CPOE, EPMA, or EMMS in clinical settings. Methodological quality was assessed at criterion level using MMAT 2018 without an overall numerical score. Results: The review included 49 reports representing 48 unique studies. Workflow disruption and workload were most frequent (46/48; 95.8%). Technical infrastructure/usability, perceived usefulness/safety/efficiency/time, acceptance/resistance/self-efficacy/trust, and leadership/organizational readiness/user engagement were each identified in 45/48 studies (93.8%). Training and implementation support occurred in 43/48 (89.6%), communication/interoperability/prescription processing in 38/48 (79.2%), and policy/financial/external-environment factors in 21/48 (43.8%). Conclusion: E-prescribing/CPOE implementation involves interconnected technical, workflow, human, organizational, and external factors. Workflow fit, organizational readiness, user involvement, implementation support, and policy and resource conditions require attention when systems are introduced or optimized. Theme frequencies indicate study-level presence rather than effect estimates.
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