Implementation faced resistance to change among health workers transitioning from paper-based to digital records, driven by concerns about workload, workflow disruption, and varying digital literacy levels. High clinical workload and staff turnover limited training coverage and consistency. Technical challenges included uneven ICT infrastructure, particularly connectivity and power reliability in remote facilities, limited availability of devices, and early-stage data duplication due to the absence of standardized data definitions and unique identifiers. System performance and usability required continuous optimization as the scale of deployment increased. Contextual Factors - Implementation occurred amid institutional and regulatory changes, including evolving governance arrangements for digital health systems and increasing requirements related to data protection and data sharing.

While these shifts required mid-course adjustments, they also reinforced the importance of standardized digital health systems. Enabling Factors - Strong leadership from the Ministry of Health, close collaboration with GovTech, and active engagement of clinicians and administrators supported adoption. Policy developments and emerging legal requirements for electronic records and reporting further legitimized ePIS use. A phased rollout approach allowed iterative improvements based on user feedback. Best Practices - Key best practices included user-centered system design, Training-of-Trainers and blended learning approaches, standardized data elements and workflows, and the use of open standards and APIs to support interoperability. Clear governance structures and regular stakeholder coordination strengthened alignment and accountability. Implications for Scalability and Sustainability - For sustainability, clear business ownership, data stewardship, and financing mechanisms are essential. Scalable digital health systems require robust architecture, open standards, and continuous capacity building. Routine ePIS data also presents opportunities for operational research and evidence-based planning, reinforcing the system’s long-term value.