Overview: The state of national EHRs in Pacific Island Countries and Territories
National electronic health records (EHRs) promise to improve care continuity, coordinate services across community, primary, secondary, and tertiary levels, and generate data to guide policy decisions. In the Pacific Island region, geographic dispersion, limited infrastructure, and workforce constraints present unique challenges for national EHR scale-up. This environmental scan examines 14 Pacific Island Countries and Territories (PICTs) in the WHO Western Pacific Region to map current national EHR coverage, identify the software in use, and assess the presence of digital health strategies that support or hinder widespread adoption.
Key findings from the environmental scan
How widespread is national EHR coverage?
Among the 14 PICTs assessed, 12 countries (86%) have some form of EHR in the public health system. Eight countries (57%) report a single national system implemented across more than one facility, indicating progress toward national coverage even in geographically challenging settings. However, national coverage varies widely: the average across all 14 countries is about 33% (median 10%), and among the 12 countries using EHRs, the average national coverage is 39% (median 16%). Small numbers of facilities in some nations can yield high percentages, while larger countries with thousands of health facilities show much lower proportional coverage. Notably, four PICTs introduced EHRs after 2020, reflecting a post-COVID acceleration in digital health activity.
Which EHR solutions are in use?
Regional systems include Tamanu, Medtech, Vesalius, and PATIS Plus, alongside country-specific or locally developed solutions. Tamanu is the only system among these that has achieved recognition as a Global Digital Good for Health (an open-source, scalable option suitable for LMICs), highlighting the region’s potential to leverage open, interoperable tools for sustainability.
Where are EHRs most and least mature within facilities?
Across the region, EHR coverage in tertiary care settings tends to be higher, with several countries achieving full or near-full coverage in hospitals and specialized centers. In contrast, coverage at primary care facilities remains strikingly low, averaging around 1–2% in most PICTs and concentrated in a few early-adopter countries. This gap underscores the need for offline-capable, scalable, interoperable solutions to support frontline care in remote communities and to ensure data flows back to national systems.
Policy and strategy status
Despite the growing use of EHRs, public availability of up-to-date national eHealth or health information system (HIS) policies is limited. In this scan, only Fiji had a current national eHealth or HIS policy publicly accessible online. Several countries had policies or strategies that were out of date or not publicly available, including Cook Islands, Kiribati, Papua New Guinea, Samoa, and Vanuatu. For countries introducing EHRs since 2020 (Palau, Nauru, Samoa, Tonga), only Samoa had a relevant in-date policy during rollout. This mismatch between EHR deployment and policy readiness may impede sustainability and scale-up unless governance and regulatory frameworks catch up with implementation.
Regional and global context
Globally, the WHO Global Observatory for eHealth (GOeH) tracked national EHR presence in 2015, but responses from LMICs in many regions were limited. A 2023 Global Digital Health Monitor indicated widespread development of national digital health strategies but again had limited representation from Pacific Island states. The Pacific findings suggest that PICTs may be “leapfrogging” in some aspects of EHR deployment, achieving higher than anticipated coverage levels in certain tertiary settings and among some mid-income economies, while still grappling with primary-care data capture, connectivity, and long-term governance. The disconnect between national scale and day-to-day usage highlights the need for robust, offline-capable, interoperable systems and for clear, up-to-date policy environments to guide adoption and sustainment.
Implications for policy, practice, and sustainability
Effective national EHR rollout in PICTs requires fit-for-purpose technology that works offline when internet access is intermittent, scales to thousands of facilities, and interoperates with other digital health components. Open-source options such as Tamanu offer potential pathways for sustainable, low-cost adoption, but regional coordination remains critical to avoid fragmentation and duplication of effort. The limited availability of up-to-date policies or blueprints undermines long-term governance, funding alignment, and evaluation of EHR impact on health outcomes.
Recommendations for advancing national EHRs in PICTs
- Adopt a regional standard for digital health metrics to streamline reporting, improve comparability, and guide investments. A single framework could reduce duplication and enhance visibility of national EHR progress across development partners.
- Prioritize open-source, scalable, offline-capable EHR solutions that can operate across remote primary facilities and urban centers, enabling real-time data exchange when connectivity allows.
- Develop or update in-date national eHealth/HIS policies in tandem with EHR rollouts to anchor governance, data sharing, privacy, and interoperability.
- Strengthen regional collaboration through networks such as the Pacific Health Information Network (PHIN) and AeHIN to share lessons, harmonize standards, and track progress.
- Improve data quality and facility-level data collection to ensure accurate measurement of national coverage and to support evaluation of health outcomes linked to EHR use.
Limitations and conclusion
The environmental scan relies on publicly available gray literature and may miss rapidly evolving developments. Data quality and facility enumerations vary across countries, which can affect coverage calculations. Nevertheless, the study provides a baseline view of national EHR status in 14 PICTs, reveals promising regional momentum, and emphasizes the need for coordinated policy, interoperable technology, and transparent reporting to achieve sustainable digital health gains in the Pacific.
