Abstract
BACKGROUND: Adopting electronic health records (EHR) is critical for improving healthcare efficiency, yet implementation remains inconsistent, particularly in developing countries. This study applies a scoping review approach to evaluate the macro-environmental factors influencing EHR adoption in Tanzania using the PEST (Political, Economic, Social, and Technological) analysis framework. OBJECTIVES: This study explores the adoption of EHR systems in Tanzanian healthcare using the PEST analysis framework to identify macro-environmental factors influencing implementation. METHODS: A scoping review methodology was employed, examining 35 studies published between 2010 and 2024. A comprehensive search was conducted in Scopus, PubMed, JSTOR, and Emerald. Reference lists of relevant studies were also reviewed for additional sources. Data were systematically extracted using a standardised framework categorising studies under political, economic, social, and technological domains. Thematic synthesis was applied to identify key patterns. RESULTS: The review included 35 studies, highlighting that political inconsistencies, economic constraints, social resistance, and technological limitations hinder EHR adoption. Key barriers include weak policy enforcement, unsustainable funding, workforce resistance, and poor ICT infrastructure. However, potential solutions such as strengthening governance frameworks, leveraging public-private partnerships, targeted digital literacy training, and improving ICT infrastructure were identified. CONCLUSION: This study provides valuable insights into the macro-environmental challenges affecting the adoption of EHR systems in Tanzania. Addressing these barriers through a comprehensive policy and infrastructure development strategy is critical to ensuring successful digital health transformation.