EHR Adoption Across the Caribbean: What the Differences Actually Tell Us

Electronic health records are often framed as a technical milestone. A system goes live, paper charts disappear, and a country is described as digitally transformed.

But across the Caribbean, EHR adoption has become something more revealing than a software deployment. It is a governance choice. The speed at which countries move — and the models they adopt — reflect institutional risk tolerance, fiscal strategy, and accountability culture more than they reflect bandwidth or vendor selection.

Progress is real. It is also uneven. And the unevenness is instructive.

The regional backdrop

The foundation for Caribbean digital health was laid in 2016, when Jamaica hosted the launch of PAHO’s Information Systems for Health (IS4H) initiative — making it the first Caribbean country to formally commit to a structured digital health transformation strategy. That launch set off a slow but widening wave of activity across the sub-region.

By 2024, the momentum had shifted decisively. In that year alone, 20 countries across Latin America and the Caribbean participated in IDB-supported initiatives, backed by over US$900 million in loans for transforming health systems. Altogether, IS4H investments across the IDB, World Bank, and the Development Bank of Latin America and the Caribbean reached US$1.3 billion. These are not marginal investments. They represent a structural bet that digitising health information is foundational to system performance.

US$900M+

IDB loans supported health system
transformation across 20 countries
in 2024

Despite the scale of investment, a comprehensive PAHO maturity assessment told a sobering story about where countries actually stand. Using over 240 standardised indicators, the assessment found that 42.8% of countries in the Americas are at the initial maturity level, 34.7% are implementing best practices, 18.4% are standardising and continuously improving, and only 4.1% have highly integrated systems. No country has reached the maximum maturity level. The Caribbean broadly sits at the lower end of that spectrum — not because of indifference, but because the region’s smaller fiscal bases, dispersed populations, and fragmented legacy systems make the climb steeper.

What individual country trajectories reveal

Jamaica is the region’s most advanced active deployment and, more importantly, its most documented. As of June 2025, thirteen of Jamaica’s health facilities have the eCare EHR system live, implemented under the US$148-million Health Systems Strengthening Programme jointly financed by the Government of Jamaica, the Inter-American Development Bank, and the European Union. The programme’s philosophy — “one patient, one record” — centres on real-time cross-facility data sharing. The system is built on TPP’s SystmOne platform, the same technology backbone used extensively by the UK’s NHS. Early clinical feedback has been substantive: doctors at May Pen Hospital reported that during the August 2024 Cherry Tree Lane mass casualty incident, the EHR system allowed them to create virtual patient groups for each incident, tracking arrivals, treatment stages, and injuries in real time.

Jamaica’s approach has limits worth noting. The current 13-facility programme is concentrated in central Jamaica — three hospitals and ten primary care centres. Expansion to the full public system remains a subsequent phase, and the programme’s 2029 completion timeline means significant portions of the public estate will remain on paper for years. There are also equity concerns: Jamaica’s roughly 60% mobile web traffic rate means a meaningful share of the population, particularly low-income and rural patients, may not easily access patient-facing digital record features.

€60M

EIB-backed financing for hospital modernisation and health information system integration at Barbados’ Queen Elizabeth Hospital

Barbados is at an earlier but increasingly concrete stage. The Queen Elizabeth Hospital — the island’s sole public general hospital — has received the first shipment of new ICT and medical equipment as part of a €60 million loan agreement with the European Investment Bank, implemented through UNOPS, to modernise hospital operations and launch a fully integrated health information system. Separately, Barbados has formed an official IS4H Advisory Committee following a 2022 national health information systems assessment conducted with PAHO support, with the Ministry of Health preparing a Cabinet Paper to formalise its mandate. Barbados is not behind so much as deliberate — its governance-first posture, now backed by concrete EIB capital, puts it closer to execution than observers who tracked only the strategy phase would expect.

Guyana is in active procurement and early deployment. The Ministry of Health awarded a US$3.3 million EHR contract to RioMed Limited following a public tender that attracted 14 expressions of interest, with Phase 1 targeting the Georgetown Public Hospital and satellite clinics. As of late 2025, the Ministry confirmed the project remains on track for 2026 rollout, with servers being configured and software customised for a Guyana-specific context. Guyana’s trajectory is notable for two reasons: the IDB loan structure that underpins it mirrors Jamaica’s, and Guyana’s rapid economic expansion — driven by offshore oil revenues — gives its public health investment a different fiscal context than most of its neighbours.

US$3.3M

EHR contract awarded by Barbados Ministry of Health to RioMed Limited for Phase 1 rollout at Georgetown Public Hospital and satellite clinics

Barbados, Belize, Suriname, Trinidad and Tobago, and The Bahamas are all engaged in the regional digital health agenda at the strategy and planning level. All seven of these countries, alongside Jamaica and Guyana, participated in the July 2024 Caribbean Connect meeting in Kingston — hosted by the IDB and PAHO — to formally align with the Pan-American Highway for Digital Health and advance national digital health strategies. Their varying speeds of execution reflect different fiscal capacities, procurement cycles, and governance structures — not absence of intent.

The regional architecture taking shape

The most significant development of early 2026 is the formalisation of a genuine cross-border framework. In February 2026, the ONE Caribbean Connect dialogue brought together digital health experts from the IDB, CARICOM, CARPHA, and PAHO alongside representatives from The Bahamas, Barbados, Belize, Guyana, Jamaica, Suriname, and Trinidad and Tobago to advance a shared plan for interoperable health information exchange, with the goal of beginning cross-border health data exchange by 2028.

The ONE Caribbean Digital Health Roadmap is structured around three pillars: harmonised governance, technical interoperability, and resilient systems — moving participating countries toward a unified, secure system for health information exchange. The 2028 target is ambitious but specific, which matters. Regional health roadmaps in the Caribbean have historically struggled with vague timelines and voluntary standards. This one has named countries, named pillars, and a named year.

The cybersecurity dimension deserves attention that the roadmap itself acknowledges. According to the IDB’s latest cybersecurity report, the region’s cybersecurity posture and frameworks are still immature, though improving. As more patient data moves into connected digital systems — and eventually across national borders — the risk surface expands in ways that Caribbean health ministries, with limited dedicated security capacity, are only beginning to plan for.

The most significant development of early 2026 is the formalisation of a genuine cross-border framework.

The structural tensions that recur across every market

Reading across all of these trajectories, several patterns repeat in ways that no individual country has fully resolved.

The first is the interoperability deferral. Every country profiled above is building national systems at varying speeds, but the question of how those systems will eventually talk to each other — and to regional exchange infrastructure — is treated as a later problem. It is not a later problem. Vendor selection decisions made now will either constrain or enable exchange capability for a decade. PAHO’s IS4H framework is explicit: the IS4H Plan of Action 2024–2030, adopted by PAHO’s 61st Directing Council in October 2024, aims to facilitate adoption of cost-effective digital health solutions and improve standards, legislation, and human competencies for the digital transformation of the health sector. Standards mandated early are cheap. Standards retrofitted later are expensive.

The second is clinician burden. Implementation failures in the Caribbean and globally are rarely about technology aversion. They occur when digital tools increase documentation workload, duplicate existing workflows, or shift administrative tasks onto already stretched clinical staff. Jamaica’s early feedback from eCare is positive specifically because the system was designed around clinical utility — virtual triage groups, real-time imaging access, cross-facility record sharing. That design discipline is not automatic. It requires deliberate workflow redesign before go-live, not after.

The third is the overseas care blind spot. Few EHR strategies in the region explicitly incorporate cross-border referral pathways, despite the structural reality that tertiary care for serious conditions in smaller territories frequently occurs abroad — in Miami, London, Barbados, or Trinidad, depending on the origin country. Systems designed as if care ends at national borders are misaligned with how Caribbean patients actually receive treatment.

The fourth is sustainability after the initial loan. The IDB and EU-financed programmes in Jamaica, Barbados, and Guyana carry 15-year vendor support obligations and multi-year implementation timelines. But the history of technology projects in the region — and globally — shows that systems procured under grant or concessional funding often deteriorate when that funding cycles out and domestic maintenance budgets have not been built. Sustainability planning needs to be embedded in procurement, not appended to it.

What the differences tell us

Different speeds are not inherently signs of failure. Jamaica took a facility-by-facility approach because starting broad would have exceeded both fiscal and institutional absorptive capacity. Barbados took a governance-first approach because building an advisory structure before committing capital reduces procurement risk. Guyana contracted a single vendor with a phased rollout to manage complexity while moving quickly given expanding fiscal headroom.

These are rational choices. What separates them from dysfunction is whether they convert into outcomes — clinical records accessible to patients, data flowing between facilities, systems able to eventually connect to regional exchange infrastructure.

The Caribbean does not need a single EHR model. It needs clarity about trade-offs. Phased rollouts must enforce interoperability from the first contract, not the last. Governance-first approaches must set deployment milestones with teeth. And all of it must account for where Caribbean patients actually go when they are seriously ill — which is rarely just within a single island’s health system.

The ONE Caribbean framework, the PAHO Plan of Action 2024–2030, the IDB investments, and the active deployments in Jamaica and Guyana collectively represent the most coordinated moment Caribbean digital health has seen. Whether that coordination holds through the harder work of procurement, implementation, and maintenance is a governance question, not a technical one.

Key sources:

•  PAHO IS4H Programme Budget Assessment 2022–2023;
• 2. Jamaica Ministry of Health & Wellness official releases and HSSP programme documentation (June 2025);
• 3. IDB Caribbean Development Trends blog, “Connecting the Caribbean to the Pan-American Highway for Digital Health” (July 2024);
• 4. CARPHA/HTS News 4orce reporting on ONE Caribbean Connect (February 2026);
• 5. Barbados Today and QEH Connect coverage of Queen Elizabeth Hospital digitalisation (2024–2025);
• 6. Guyana Chronicle and HTN Health Tech News on Guyana EHR procurement (2024–2025);
• 7. PAHO Executive Committee Report CE174/15 on IS4H maturity assessment (June 2024);
• 8. ICT Pulse, “The healthcare revolution: Why digital records are the Caribbean’s next big leap” (March 2026).