Exploring Factors Associated With the Stalled Implementation of a Ground-Up Electronic Health Record System in South Africa: Qualitative Insights From the E-Tick Case Study Using the Consolidated Framework for Implementation Research (CFIR)

Although successful implementation of EHRs can be facilitated by strong user engagement and co-design, outer setting factors such as governance, funding, and policy alignment can pose significant threats to sustainability. This underscores the importance of effective synergy between top-down and bottom-up processes for successful implementation.