© The Author(s) 2019. Pharmacy plays a pivotal role in supporting acute clinical care pathways. However, across hospital environments, pharmacies are often stretched by growing service demands and conflicted by increased medication and service costs. Ultimately, such factors contribute towards process inefficiencies that impact on the provision of healthcare services. Following a literature review, we examined clinical pharmacy services by undertaking three acute hospital pharmacy case studies. We adopted an ethnographic approach, observing and interviewing pharmacists, pharmacy staff and nurses. With a view to improving healthcare information systems (ISs), we identified the enablers and barriers in service efficiency, thus identifying opportunities for pharmacy IS implementation across acute hospital environments. The findings also reveal some of the key enablers and barriers towards the introduction of hospital IS innovation. We present recommendations to overcome such barriers.