Advancing digital health in low-middle-income countries: experiences from Armenia's health system digital transformations.

Background: Digital health systems and the implementation of those systems in low- and middle-income countries (LMICs) can measurably enhance and facilitate systematic healthcare efficiency; though, it is often challenged by infrastructural and socioeconomic limitations. Republic of Armenia has recently fast-tracked healthcare digitalization as part of broader health system reforms. Objective: To describe experience and lessons learned from the implementation of the country-level E-health system, including barriers and solutions relevant to LMIC settings. Methods: A review of National policies, established digital health infrastructure, and existing practices; data were also gathered from country health system reports. Results: The full-scale roll-out of the national-level electronic health network, called ARMED, empowered the extension of digital healthcare services-including all reporting systems, e-prescription workflow, registries, screening programs, and telemedicine. Implementation improved continuity of care and access to services, particularly in rural areas. Major challenges included fragmented health information, limited infrastructure, workforce and digital literacy gaps, and persistent rural-urban inequalities. Addressing these barriers required centralized governance, regulatory reforms, workforce training, and context-specific implementation approaches. Conclusion: The experience of Armenia can serve as an evocative guide, with practical steps for LMIC countries to fill gaps and tackle challenges. Experience in digital health governance can help fill gaps and strengthen the ability to use one's own systems to achieve health equity. The experience of Armenia clearly shows the impact of sustained governance, infrastructure development, and inclusive implementation strategies as critical factors for functional digital health implementation and transformation from paper to e-health in LMICs and can act for other countries pursuing equitable and scalable digital health integration as a well-documented case study.