Electronic Health Records: Adoption and Implications for Health Data Interoperability and Digital Transformation: A Systematic Review

Abstract

Background: Saudi Arabia has made nationwide electronic health record (EHR) deployment a pillar of Vision 2030, connecting more than 2,000 primary care centers to a unified national system. Adoption and clinical impact remain uneven across settings. This review synthesizes evidence on EHR effectiveness and barriers and appraises its quality.  Methods: Umbrella-informed mixed-evidence synthesis following PRISMA 2020; PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched (January 2015-December 2025; English; final search, February 15, 2026). Eligible records reported empirical evidence on EHR adoption, effectiveness, or barriers in Saudi facilities. The risk of bias was appraised using design-appropriate tools (NOS, AMSTAR-2, MMAT, CASP); heterogeneity precluded meta-analysis, so we synthesized findings narratively.  Results: Twenty-one studies (12 primary, 9 secondary; 4,672 healthcare professionals) were included, mostly from urban tertiary hospitals and Ministry of Health primary care centers. User-perceived effectiveness was moderate: more than 70% endorsed care-quality benefits; efficiency agreement rose from ~80% to 96% in two pre/post cohorts; satisfaction medians ranged from 53 to 62/80. No study reported objective hard outcomes. Barriers spanned five domains: technical, organizational, human, financial, and regulatory; use concentrated in administrative and documentation functions, with advanced clinical decision support being rare.  Discussion: EHR adoption delivers moderate user-perceived effectiveness in defined operational domains, constrained by persistent multidomain barriers. The evidence base is predominantly cross-sectional and perception-based, limiting causal and clinical claims. Longitudinal studies with objective outcomes are needed to substantiate clinical impact and guide Vision 2030 priorities.