title: Health Informatics in Developing Countries: Going beyond Pilot Practices to Sustainable Implementations: A Review of the Current Challenges.
abstract: OBJECTIVE
  Information technology is an essential tool to improve patient safety and the quality of care, and to reduce healthcare costs. There is a scarcity of large sustainable implementations in developing countries. The objective of this paper is to review the challenges faced by developing countries to achieve sustainable implementations in health informatics and possible ways to address them.
  
  
  METHODS
  In this non-systematic review of the literature, articles were searched using the keywords medical informatics, developing countries, implementation, and challenges in PubMed, LILACS, CINAHL, Scopus, and EMBASE. The authors, after reading the literature, reached a consensus to classify the challenges into six broad categories.
  
  
  RESULTS
  The authors describe the problems faced by developing countries arising from the lack of adequate infrastructure and the ways these can be bypassed; the fundamental need to develop nationwide e-Health agendas to achieve sustainable implementations; ways to overcome public uncertainty with respect to privacy and security; the difficulties shared with developed countries in achieving interoperability; the need for a trained workforce in health informatics and existing initiatives for its development; and strategies to achieve regional integration.
  
  
  CONCLUSIONS
  Central to the success of any implementation in health informatics is knowledge of the challenges to be faced. This is even more important in developing countries, where uncertainty and instability are common. The authors hope this article will assist policy makers, healthcare managers, and project leaders to successfully plan their implementations and make them sustainable, avoiding unexpected barriers and making better use of their resources.
authors.affiliation: Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Luna
authors.affiliation: Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Almerares
authors.affiliation: Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: John Charles
authors.initials: JC
authors.lastname: Mayan
authors.affiliation: Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Fernán
authors.initials: F
authors.lastname: González Bernaldo de Quirós
authors.affiliation: Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Otero
keywords: Developing Countries; Health Manpower; Health Planning; Medical Informatics; Public Health Informatics