  Our scoping review aims to assess what legal, ethical, and socio-technical
factors contribute or inhibit the success of national eHealth system
implementations. In addition, our review seeks to describe the characteristics
and benefits of eHealth systems. We conducted a scoping review of literature
published in English between January 2000 and 2020 using a keyword search on
five databases; PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After
removal of duplicates, abstract screening and full-text filtering, 86 articles
were included from 8276 search results. We identified 17 stakeholder groups, 6
eHealth Systems areas, and 15 types of legal regimes and standards. In-depth
textual analysis revealed challenges mainly in implementation, followed by
ethico-legal and data related aspects. Key factors influencing success include
promoting trust of the system, ensuring wider acceptance amongst users,
reconciling the system with legal requirements and ensuring an adaptable
technical platform. Results revealed support for decentralised implementations
because they carry less implementation and engagement challenges than
centralised ones. Simultaneously, due to decentralised systems interoperability
issues, federated implementations (with a set of national standards) might be
preferable. This study identifies the primary socio-technical, legal and
ethical factors that challenge and contribute to the success of eHealth system
implementations. This study also describes the complexities and characteristics
of existing eHealth implementation programs, and surmises suggested guidance
for resolving the identified challenges.
