Table 3.
Barriers identified in the literature.
| Barriers | Occurrences by article reference number | Total occurrences |
| Cost | 5,8,12,13,16,17,19,25,28,30,32, 33,34,37,38 | 16 |
| Time consuming | 5,19,20,32,34,39 | 6 |
| User perception/perceived lack of usefulness | 5,8,13,17,19,34 | 6 |
| Transition of data | 13,19,20,22,28,34 | 6 |
| Facility location (rural areas)/characteristicsa | 2,7,14,21,28 | 6 |
| Implementation issues | 8,13,19,20,25 | 5 |
| User/patient resistance | 7,9,13,19,20 | 5 |
| Lack of tech assistance/experience | 13,16,29,33,38 | 5 |
| Interoperability/no standard protocols for data exchange | 12,21,25,39 | 4 |
| Medical error | 15,20,23,40 | 4 |
| Training, maintenance, upgrades | 8,12,20,23 | 4 |
| Lack of agility to make changes | 20,32,39 | 3 |
| Staff shortages/overworked | 2,26,39 | 3 |
| Privacy and/or security | 13,35,36 | 3 |
| Missing data | 15,20,40 | 3 |
| External factorsa | 8,26,38 | 3 |
| Competiveness | 12,10,27 | 3 |
| Provider or patient agea | 7,29 | 2 |
| Race & income disparitiesa | 2,15 | 2 |
| Lack of infrastructure and/or space for systems | 17,19 | 2 |
| Need organizational cultural change | 8,38 | 2 |
| Lack of incentives | 12 | 1 |
| IMGs less likely to adapt | 26 | 1 |
aStatistical association identified through retrospective studies, rather than answers to “why” in a survey or interview.