An umbrella review of behavioral factors influencing the efficiency and effectiveness of EHR

Abstract Background This umbrella review aims to identify a parsimonious and comprehensive list of factors - mainly inspired by behavioral science evidence - that make electronic health records efficient and effective in aiding professionals’ decision-making. In other words, it seeks to understand what works and what doesn't work in the design and implementation of electronic health records. It does so by systematizing knowledge from existing literature reviews and meta-analyses to benefit the Tuscany Health Ecosystem (THE). Methods We conducted, following the PRISMA guidelines, an umbrella review of literature reviews and meta-analyses using PubMed, Scopus, and Web of Science databases. Inclusion criteria focused on studies identifying factors, rooted in behavioral science, that enhance the efficiency and effectiveness of EHRs in supporting professional decision-making. This review is registered in PROSPERO (CRD420251000239). Results A total of 1.175 papers were found; after removing duplicates, 568 remained. Our primary results from 183 reviews (2022-2025) identified key factors to enhance EHR efficiency and effectiveness: guidelines integration; data-related characteristics such as quality, entry, and quantity; integration of artificial intelligence (e.g., natural language processing); blockchain technologies; access to relevant stakeholders; user interface design; teamwork support and interprofessional collaboration; specific EHR training; EHR interoperability and access; shared decision-making process; predictive analysis and risk assessment, and nudging interventions (e.g., alert systems, treatment suggestions). Findings are preliminary. Conclusions ThE aims to implement tools that aid the decision-making process of healthcare professionals and the governance judgment of administrative counterparts and policymakers. In this context, it seems pivotal to develop evidence-based guidelines for implementing digital health records based on behavioral science findings. Key messages • The findings will inform behaviorally based EHR guidelines. • The findings will contribute to shaping a shared and global framework for EHRs development and implementation.