We systematically investigated digital determinants of pharmacists’ readiness for technology-oriented practice change and interoperability. Key factors identified were digital literacy and technology-oriented tailored training, technical system features, technology operations, pharmacy digital infrastructure, digital privacy and technical support. The overall readiness level for technology-related practice change was mainly intermediate followed by high and low level of readiness. The review also highlighted end-user, organizational, policymaking, legal, governmental, and financial factors and provided several recommendations to address these challenges.

This review is the first systematic analysis of digital determinants influencing pharmacists' technology-oriented practice change and interoperability. It comprehensively examines technical and technology-related challenges, providing individual, organizational, and legislative recommendations for improvements. Key areas include training for skills and digital literacy development. Key strengths also include using comprehensive quality assessment tools to evaluate the diverse study designs in the review, enhancing the robustness of the obtained results. In addition, comprehensive inclusion criteria allowed for a nuanced exploration of the study's aim. Limitations include the specific nature of interviews, potential survey biases, and language bias from excluding non-English studies, restricting generalizability. While this review did not include randomized control trials (RCTs), this was not a limitation given the research objectives and the nature of the topic, which primarily involves survey-based and interview studies. Still, the included studies were assessed for quality using assessment tools that reflected the high quality of the included studies. We also excluded non-original research publications, such as reviews, for a more accurate interpretation and representation of results due to the specific inclusion criteria of the current study. Therefore, the quality and bias assessment tools presented were slightly modified, considering the nature of the collected data, which is an acknowledged deviation in assessing the included studies adequately. Obtaining direct data on pharmacists' readiness was challenging for some studies [40,41,42, 45, 46]. Therefore, regarding readiness evaluation, we clarified and indicated this matter in the results (Table 4). Efforts were made to contact the authors of the included studies for additional details.

Effective communication between healthcare providers is crucial for optimal patient care. Interoperability enhances medication safety and provides numerous benefits, including error reduction [3, 6, 9, 10]. Factors like the practice environment, societal expectations, motivation, healthcare system communication, and country-specific legislation are important factors that can influence the practice change [68]. For pharmacists to adapt, improvements in skills, knowledge, values, and attitudes are necessary [68].

None of the included studies was eliminated based on low quality, as all included studies were of high quality. Across the observed studies, pharmacists' digital literacy was consistently addressed, emphasizing its importance in contemporary pharmacy practice. Of the seven studies that indicated the setting, most discussed specifically the community pharmacy setting (n = 3, 23.1%), followed by studies that specifically examined the hospital pharmacy setting (n = 1, 7.6%) and those that discussed both settings (n = 3, 23.1%) (Table 1).

However, while community pharmacies were well-represented in the literature [42, 47, 50,51,52,53], hospital pharmacy settings were comparatively underexplored [44, 50,51,52], indicating a need for further research. This can be attributed to the general availability of basic technological infrastructure in hospitals compared to community pharmacies, necessitating more focus and thorough investigation in the community pharmacy setting. The review also extracted other important influencing factors as additional input that can be used by policymakers planning for a technology-oriented practice change in the pharmaceutical field (See Supplementary File 2).

Considering that any practice change encompasses several factors and is not limited solely to technology-related factors, the current review also extracted some critical factors, such as end-user factors, which included resistance to change [42, 46, 47, 52, 53], perceived beliefs [41, 43, 48, 52], user processing factors [41,42,43, 51,52,53], and sociodemographic factors and outside work technological personal skills [43, 46, 51, 52]. Organizational factors include human resources and organizational support [40, 41, 43, 45, 47, 48, 51,52,53] and engaging technology users during the implementation [40, 53]. Policymaking, legal, and governmental factors include healthcare policies [40, 51, 53] and jurisdiction factors [40, 53]. Financial factors were also extracted [40, 42, 47, 53]. The most reported technology-related influencing factors were related to digital literacy and technology-oriented tailored training (70.58%) [40, 42,43,44,45,46, 50, 52, 53], followed by technical system features influencing factors (52.94%) [40,41,42,43, 52, 53], the technology operations factors (47.05%) [40, 42, 47, 49, 52, 53], pharmacy digital infrastructure factors (29.41%) [49,50,51,52,53], digital privacy factors (11.76%) [41, 53] and technical support (11.76%) [48].

Several studies highlighted the need for digital literacy and related training, including upgrading general computer skills and access to internet-related education, particularly for community pharmacists. Furthermore, software vendors' lack of training and technical support was highlighted [40, 42,43,44,45,46, 50, 52, 53]. The current review provides in-depth observations and suggestions to improve the quality of provided training and make it more efficient and technology-oriented (Table 3). Interoperability was identified as an influencing factor by over 58% of included studies that discussed it generally [40,41,42, 47, 48, 52, 53]. Still, it was discussed clearly by a few studies [40, 52, 53].

Previous systematic and qualitative reviews discussed only specific technology-related outcomes or individual health technologies [59, 63, 65,