Critical Competencies for Digital Transformation: Aligning Vision, Systems, and Reality Across Regional Health Systems

Digital transformation is no longer a distant ambition—it’s a necessity for achieving more resilient, efficient, and equitable healthcare across the Caribbean region. But while investments in technology are growing, success remains uneven. After participating in more than a dozen health software implementations over the past 15 years, one reality stands out: technology does not transform systems—people do.

To realize the full value of digital health, leaders and implementers in the Caribbean region must develop a set of critical competencies—not just technical skills, but strategic capabilities that ensure lasting impact and equity.

Technology does not transform systems—people do.

System Clarity: HIS, Hospital Systems, and Practice Management Tools

A recurring challenge in digital health projects is the lack of clarity around what kind of system is being implemented—and for what purpose. Terminology matters, especially when systems are mismatched with goals or introduced without aligning expectations.

1. Health Information Systems (HIS)

These refer to broad, system-wide platforms designed to support public health functions such as disease surveillance, policy reporting, research, and population health management. They are crucial for governments and ministries seeking a unified, data-driven overview of national health trends.

✅ Ideal for strategic, system-level use
🚫 Not built for managing hospital operations or front-line workflows

2. Hospital Information Systems

These systems operate within individual hospitals or health institutions, integrating clinical, administrative, and operational functions—such as inpatient management, diagnostics, pharmacy, and financials. They support both operational needs and institutional performance goals.

✅ Supports end-to-end hospital workflows
🚫 Limited use beyond a single facility or site without intentional design

3. Practice Management Systems (PMS)

These are often used in private practices and outpatient clinics to manage appointments, billing, and electronic health records (EHRs). While streamlined and cost-effective, they are not designed for the complexities of inpatient care or national data aggregation.

✅ Efficient for outpatient settings
🚫 Lacks depth and interoperability for broader health systems

Why These Distinctions Matter

Whether you’re selecting a new platform, maintaining an existing one, or planning a system replacement, recognizing the differences between tools and aligning them with appropriate goals is a foundational competency.

Too often, blurred lines between system administration and daily clinical operations lead to confusion, inefficiencies, and underutilization. A hospital team may be handed the responsibility for national reporting without the tools or capacity to do so, while system architects may overlook facility-level realities like staffing shortages or unreliable infrastructure.

To avoid misalignment, leaders must evaluate each layer of the health system—national, institutional, and community-based—separately, then integrate them intentionally.

Lessons from the Field

Lesson 1: Vendors Sell Software—Not Solutions

Software providers deliver functionality, not contextual adaptation. No matter how advanced the platform, it will underperform if it’s not tailored to the structural, cultural, and operational characteristics of the region’s health institutions.

Lesson 2: Digital Transformation Demands Recurrent Investment

A critical yet overlooked factor is sustainable funding. Based on past implementations, I advocate for three distinct budget lines in any serious digital health initiative:

• Licensing and subscription costs (with multi-year planning)
  
• Hardware lifecycle (replacement, scaling, and integration support)
  
• Human resources and optimization (to maintain, troubleshoot, and continuously improve usability)

Without these, systems deteriorate—becoming outdated, underutilized, or altogether abandoned.

Without sustainable funding, systems deteriorate—becoming outdated, underutilized, or altogether abandoned.

Competencies That Matter Most

Effective digital transformation requires more than procurement and rollout. It demands capabilities across several strategic domains:

• System Alignment Literacy: Matching the right platform with the right level (national vs. institutional)
  
• Change Management: Leading people through adaptation, not just installing systems
  
• Operational Insight: Understanding daily workflows and institutional constraints
  
• Financial Stewardship: Ensuring long-term support and avoiding dependency on short-term grants
  
• Interoperability Planning: Enabling systems to speak to each other across facilities and programs
  
• Ethics and Governance: Ensuring data privacy, accountability, and community trust

Building a Connected Future for Health in the Caribbean

For digital transformation to succeed across the Caribbean region, leaders must approach it not as a technical project but as a strategic, people-centered shift. This requires the humility to question assumptions, the discipline to align systems with goals, and the foresight to build for long-term sustainability.

Caribbean Currents remains committed to elevating this conversation—sharing real-world insights and supporting capacity-building across the region’s diverse health systems. By focusing on what truly matters, we can transform not just technology—but the outcomes and experiences of care for millions.