• Adoption of electronic health records (EHRs) is shaped by misaligned incentives, limited purchasing power, cost burdens, and workflow concerns, producing slower uptake in smaller practices despite planned implementations [2], [7], [1], [3], [4].

• Policy-level strategies, interoperability initiatives, and national programs influence diffusion of EHRs, ranging from national interoperable EHR solutions to local pilots and data-protection concerns [9], [17], [6], [18].

• Patient empowerment and user engagement shape EHR acceptance, with research on patient access controls, nursing documentation experiences, and patient-facing information interfaces guiding design choices [12], [16], [19].

• Architectural work emphasizes security, ontology-driven design, and cross-border/interoperable standards, alongside visualization tools for navigating EHR data and archetypes [10], [20], [14].

• Empirical evaluations of EHR/CDSS deployments report mixed effects on clinician workflow, performance, and costs, highlighting financial tradeoffs, workflow disruption, and potential productivity gains depending on context [5], [4], [16].