Organizational factors influencing electronic health record adoption in Philippine public hospitals: A systematic review.

Abstract

Electronic Health Record (EHR) systems are vital in realizing universal health coverage in Low- and Middle-Income Countries. The Philippines' Universal Health Care Act mandates nationwide EHR adoption; however, implementation remains inconsistent across the devolved health system. To systematically review the role of organizations in implementing EHRs in Philippine public hospitals, using the Consolidated Framework for Implementation Research (CFIR). A systematic review protocol was developed according to the PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251247527). Eight databases were searched: PubMed, Scopus, Web of Science, CINAHL, IEEE Xplore, ACM Digital Library, Google Scholar, and HERDIN from January 2010 to November 2025. Quality was assessed using Joanna Briggs Institute checklists; evidence certainty was evaluated using GRADE and GRADE-CERQual frameworks. A total of seven studies (2016-2024) qualified for inclusion. The quality assessment of the included studies showed that 57 % (4/7) had high quality (≥80 %), 43 % (3/7) had moderate quality (60-79 %), and the average quality was 80 %. The CFIR-informed thematic synthesis identified twenty-three contextual organizational variables underpinning five domains. Self-efficacy emerged as the sole significant predictor of EHR acceptance, with acceptance rates of 96 %-98 % across urban, rural, and remote areas. The most thoroughly investigated domains among inner-setting factors were leadership engagement (100 %), implementation climate (86 %), organizational readiness (86 %), and infrastructure constraints (100 %). Notably, the domains of infrastructure (100 %), information technology support (100 %), training (86 %), and software-workflow fit, including system complexity (86 %), emerged as critical sociotechnical challenges rather than user-side deficits. Key facilitators included leadership (86 %), high-quality training support (86 %), user involvement (86 %), and phased implementation (57 %). Organizational change management factors and inner setting constructs have been identified as the critical determinants of EHR adoption success in resource-limited hospitals. The findings also challenge technology-deterministic approaches and emphasize leadership commitment, readiness assessment, authentic user engagement, and sustainability planning.