Investigating Strategies for Sustaining Modern Health Information Systems for Enhanced Care Delivery in Fragile Resource-Constrained Settings Through Electronic Medical Record Implementation in Haiti: Qualitative Study.

Background: Robust and reliable health information systems (HISs) are foundational to equitable health care delivery in resource-constrained settings. Yet, HISs often exhibit significant fragmentation and complexity, which stem from many factors, including inadequate infrastructure, limited and unevenly allocated financial resources, expertise gaps, and a lack of integrated systems. At the same time, advances in modern HISs and digital technologies, such as electronic medical records (EMRs), present opportunities for addressing these limitations and supporting evidence-based health systems if well implemented and sustained. However, limited attention has been paid to how modern and resilient HISs can be effectively sustained in fragile, resource-constrained settings. Objective: This empirical study seeks to identify pathways for strengthening the resilience, adaptability, and contextual-fit of EMRs in fragile, resource-constrained settings such as Haiti. Methods: Using a qualitative research methodology, the study used semistructured interviews with purposive sampling of key informants, including frontline doctors, nurses, and IT or data specialists. Interview participants were selected for their expertise and capacity to offer insightful and varied viewpoints on the topic. Transcripts were analyzed using an inductive approach to identify key emerging themes. Results: The findings of this investigation reveal that implementing resilient EMR in limited-resource settings, such as Haiti, requires a comprehensive strategy that accounts for ecosystemic challenges from interdependent systems (electricity, sociopolitical instability, internet connectivity), as well as the intrinsic complexities of legacy systems. Conclusions: Drawing on empirical evidence, the study identifies a set of protective strategies that, if effectively implemented, may enhance the resilience and adaptability of EMRs. These strategies include prioritizing integration and interoperability between systems, building redundancy to mitigate cascading failures derived from other interdependent systems, strengthening staffing to support system use, right-sizing the paper footprint (eg, improving handwriting-to-text scanning and digitization solutions), and embracing technological innovations.