Investigating Strategies to Improve Health Information Systems for Enhanced Care Delivery in Haiti: A Qualitative Inquiry. (Preprint)

BACKGROUND Robust Health Information Systems (HIS) that generate high-quality data are essential for fostering equitable access to healthcare services in resource-limited settings. Yet, HIS often exhibit significant fragmentation and complexity, which stems from many factors, including inadequate infrastructure, limited and unevenly disbursed financial resources, expertise gaps, and lack of standardized systems. In Haiti, the implementation of an Electronic Medical Record (EMR) system, initially launched as part of the national tuberculosis and HIV program in the early 2000s, was a groundbreaking effort that continues to evolve today. However, limited research around this pioneering experience has been conducted to inform future improvements in HIS in resource-constrained settings. OBJECTIVE This study attempts to fill that gap by integrating insights from Data/IT experts and frontline healthcare providers, who bring both technological and practical perspectives on HIS use and implementation in resource-limited settings, with a particular focus on enhancing EMR performance and adaptability in such contexts. METHODS Using a qualitative research methodology, this investigation of HIS in Haiti employed semi-structured interviews with purposive sampling of key informants, including frontline doctors, nurses, and IT/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 derive key emerging themes. RESULTS The findings of this investigation reveal that optimizing the use of the EMR in public hospitals in Haiti requires a comprehensive strategy. This strategy must account for ecosystemic challenges at the national level, such as internet and power unreliability and socio-political instability, as well as the intrinsic complexities of the existing HIS, including legacy systems, competing stakeholder priorities, and a lack of dedicated financial resources. CONCLUSIONS The results of this study suggest a set of protective strategies that, if effectively implemented, can enhance the resilience and usefulness of EMR. These strategies include prioritizing integration and interoperability between systems, aligning requirements gathering with clinical workflows, strengthening staffing to support system use, ensuring proactive equipment maintenance and replacement, right-sizing the paper footprint (e.g., improving handwriting-to-text scanning and digitization solutions), and embracing technological innovations.