Introduction
National electronic health records (EHRs) are widely seen as engines for stronger health systems, enabling seamless data flow across primary, secondary, and tertiary care while informing policy and clinical decision-making. In the Pacific Island context, where populations are geographically dispersed and infrastructure can be uneven, achieving a national, scalable EHR is particularly challenging yet increasingly essential. This environmental scan synthesizes what is known about national EHR coverage in 14 Pacific Island countries and territories (PICTs) within the WHO Western Pacific region, highlighting where progress has occurred, where gaps remain, and what this means for future digital health planning.
Methods
To map the status of national EHRs in PICTs, the study triangulated publicly available government documents, development partner repositories, and peer-reviewed sources. A three-stage approach screened government portals, systematic Google searches, and partner organizations for documents published since 2015. Documents were included if they described national eHealth or EHR status, national coverage by facility type, and any policy or strategy context. Data were extracted into a predefined table focusing on policy наличие, EHR presence, and facility-level coverage. Where possible, findings were validated with senior health or ICT officials in the respective countries.
Key Findings
National presence of EHRs in PICTs
Among the 14 assessed PICTs, 12 have an EHR implemented in at least part of the public health system (86%). In several countries, a single national system spans more than one facility, indicating scale beyond pilot projects. This rate surpasses earlier global estimates, suggesting that Pacific nations are advancing their national EHR journeys, sometimes leapfrogging stages seen in higher-income regions.
Coverage by facility type
Across the region, EHR coverage was highest in tertiary facilities, with many countries reporting full coverage in hospitals or specialized centers. By contrast, primary care facilities show much more limited adoption, with substantial variability by country. The overall picture is that national EHRs are more common in higher tiers of health services, but a robust, nationwide footprint in rural and community settings remains a work in progress.
Systems in use and interoperability
Several systems are in operation across PICTs, including Tamanu, Medtech, Vesalius, and PATIS Plus, plus country-specific, custom-built solutions. Tamanu stands out as the only system recognized as a Global Digital Good for Health, underscoring its potential for scalable, open-source deployment in LMIC contexts. Nevertheless, the breadth of different systems across the region raises concerns about interoperability, data sharing, and long-term sustainability in a region with recurring connectivity challenges.
Policy landscape and digital health strategy
Policy clarity varies markedly. Only one country—Fiji—had a publicly available in-date national eHealth or health information system policy or strategy during the time of the scan. Several other nations had relevant policies that were outdated or not publicly accessible. The mismatch between EHR rollout and policy readiness suggests that technology adoption in PICTs is often driven by programmatic needs rather than a unified national strategy, potentially complicating coordination and sustainability.
Regional and Global context
The findings in PICTs reveal a positive relationship between EHR coverage and national income status, echoing broader global patterns observed in prior GOeH data. However, unlike some high-income countries with broad, uniform EHR use across care settings, many PICTs are still expanding coverage in primary care. This dynamic highlights the importance of tailoring EHRs to fit geographic realities—offline functionality, low-bandwidth operation, and offline data capture are critical in remote islands and outer regions.
Implications for Practice and Policy
To ensure sustainable national EHRs in the Pacific, policymakers and partners should prioritize fit-for-purpose, interoperable, and open-source solutions with offline capabilities. Coordinated reporting, standardized metrics, and a regional mechanism to track digital health progress would reduce fragmentation and unintended duplication of efforts. A centralized regional framework—potentially led by regional bodies such as the Pacific Health Information Network or AeHIN—could harmonize data on EHR presence, coverage, and policy status, feeding into national dialogues and donor planning.
Recommendations for the Road Ahead
– Accelerate the rollout of national EHRs in primary care settings by prioritizing offline and low-bandwidth technologies.
– Promote open-source, scalable EHR platforms with interoperability built in from the start.
– Develop and publish current in-date digital health policies or strategies to align governance with implementation.
– Foster regional coordination to maintain a single source of truth on EHR status, reducing silos from program-based systems.
– Invest in monitoring and evaluation to quantify EHR impact on service delivery and health outcomes, informing ongoing refinements.
Conclusion
This environmental scan demonstrates that national EHR coverage is present in most PICTs, with meaningful adoption in tertiary settings and growing momentum across the region. However, the path to a truly unified national digital health ecosystem remains incomplete, underscoring the need for coordinated policy, interoperable technology, and robust data governance. By prioritizing open, scalable solutions and regional collaboration, Pacific Island countries can advance toward sustainable, high-quality, data-informed health systems.
