Benefits, challenges, and contributors to success for national eHealth systems implementation: a scoping review

James Scheibner, Joanna Sleigh, Marcello Ienca, Effy Vayena

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)


Objective: Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute to or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. Materials and Methods: We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on 5 databases: PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening, and full-text filtering, 86 articles were included from 8276 search results. Results: We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data-related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance among users, reconciling the system with legal requirements, and ensuring an adaptable technical platform. Discussion: Results revealed support for decentralized implementations because they carry less implementation and engagement challenges than centralized ones. Simultaneously, due to decentralized systems' interoperability issues, federated implementations (with a set of national standards) might be preferable. Conclusion: This study identifies the primary socio-technical, legal, and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and suggests guidance for resolving the identified challenges.

Original languageEnglish
Pages (from-to)2039-2049
Number of pages11
JournalJournal of the American Medical Informatics Association
Issue number9
Publication statusPublished - Sept 2021


  • eHealth
  • Electronic health records
  • Review
  • review
  • electronic health records


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