Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 12, 2025
Date Accepted: Apr 29, 2025
National Electronic Health Record (EHR) coverage in Pacific Island Countries and Territories (PICTs): An environmental scan
ABSTRACT
Background:
Pacific Island Countries and Territories (PICTs) face unique challenges in delivering healthcare and sustaining digital health systems, including geographically dispersed populations and service delivery points, workforce shortages, and poor infrastructure. National Electronic Health Records (EHRs) can strengthen health systems by facilitating continuity of care but are only available in 47% of countries worldwide. The status of national EHRs in PICTs has not been previously described in published literature.
Objective:
This study aimed to map the status of national EHRs in 14 PICTs of the World Health Organization (WHO) Western Pacific Region classified as Small Island Developing States (SIDS) and compare findings to known global metrics.
Methods:
We conducted a three-stage environmental scan to systematically search publicly available websites across government, bilateral, multilateral, and philanthropic organizations for documents describing the status of national EHR implementations in 14 PICTs of the WHO Western Pacific Region classified as SIDS.
Results:
Of the 14 PICTs assessed, 12 countries (85.7%) have an EHR implemented at some level of the public health system, and eight countries (57.1%) have a single national system implemented at more than one facility. We identified a positive relationship between EHR coverage and country income status, and generally high EHR coverage across tertiary hospitals (46.3%, n = 19/41) but low implementation at primary care facilities (1.5%, n = 61/4158).
Conclusions:
Our findings demonstrate, for the first time, that EHRs are being implemented in PICTs, including at scale in some settings. Despite high apparent coverage in some PICTs, the success of implementation and in-practice usage by health workers remains unclear. Grey literature indicates that some EHRs currently available are failing or incapable of scaling to a national rollout. To support sustainability of national EHRs in PICTs, governments should prioritize the implementation of fit-for-purpose, open-source, and scalable EHRs, and future studies should assess the success of EHR adoption and impact in the region. Clinical Trial: N/A
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