Electronic health record adaptation and innovation among healthcare professionals in hospitals: an integrative framework based on a systematic review

BACKGROUND: Worldwide, many hospitals have adopted an Electronic Health Record (EHR) and are currently in the post-implementation phase. To exploit EHRs to their full potential, healthcare professionals must continuously engage in adaptive behaviors to cope with (changes and updates in) EHR systems, and explore existing and novel EHR functionalities. This systematic review aimed to (a) identify factors related to EHR adaptation and innovation among healthcare professionals in hospitals, and (b) develop a multidisciplinary integrative framework. METHODS: A PRISMA-compliant systematic review was conducted. We searched the databases PubMed, Embase, Scopus, and PsycInfo for the period from 2019 to 2023. After validation of the eligibility criteria by two independent reviewers, the first reviewer performed title and abstract screening, followed by full-text screening. Data extraction was carried out by the first reviewer and risk of bias assessment by two independent reviewers. Subsequently, the first reviewer summarized the collected data using a narrative synthesis approach in collaboration with the other reviewers. RESULTS: Out of the 3,585 studies emerging from databases and citation searching, 14 studies were included in this study. Regarding EHR adaptation, psychological, work design, technological, and organizational factors were identified. Regarding EHR innovation, predominantly psychological and work design factors were found. Healthcare professionals' knowledge and proficiency, task prioritization, recognition of EHR benefits, and their mindset towards change were relevant psychological/individual factors. Important work design factors were time and information availability, workflow impact, task dynamism, technostress, role clarity, and autonomy. Well-designed and functioning EHR modifications or novel EHR tools were significant technological factors. Identified organizational factors were available resources, an organizational climate of innovation and change, and comprehensive change and human resource management practices accompanying EHR changes. CONCLUSIONS: Most of the eligible studies dealt with EHR adaptation, and a few with EHR innovation. Based on the review findings, an integrative framework was developed that entails key factors for EHR adaptation and innovation among healthcare professionals in the post-implementation phase of EHRs. Thereby, this review provides first directions for healthcare organizations to exploit the EHR's full potential. REGISTRATION: The study was registered in Prospero on March 16, 2024 (CRD42024520547; last update: June 30, 2025).