Digitizing a healthcare system can improve access, continuity, and quality of care. At first glance, doing so might seem like a matter of technology, but a new study of four Latin American countries, published in Nature’s npj Digital Medicine, shows that achieving this transformation involves much more than simply using the best and newest tools.

An international network of researchers analyzed how digital transformation policies have been implemented in Uruguay, Argentina, Chile, and Mexico, and found that factors such as institutional leadership, funding, work organization, and political continuity can be as important as the technology itself.

And although there are various frameworks and recommendations on how to implement digital transformation in health systems, there is still little evidence on what happens during the actual implementation of these policies.

“There is a lot of talk about the potential of digitization, but we have not seen the results of it working,” says Paola Abril Campos, research professor at the School of Government and Public Transformation (EGobiernoyTP) and the Institute for Obesity Research (IOR) of Tec de Monterrey.

Campos and a group of researchers from EGobiernoyTP, IOR, the Faculty of Medicine and Health Sciences of Universidad Mayor, Chile, the Center for Implementation and Innovation in Health Policies (CIIPS), Argentina, the National Center for Health Information Systems (CENS), Chile, and the Harvard School of Public Health, sought to understand what happens when one of these public policies goes from paper to practice.

The study is part of the Reimagining Latin American Health Systems in the Digital Era initiative, promoted by the Elcano Royal Institute for International and Strategic Studies. Two products resulted from its research: a policy brief aimed at decision-makers and the academic article.

The Digital Transformation of Healthcare in Four Countries and Four Different Dtrategies

To understand what happens in practice, the researchers conducted a qualitative multiple case study in which they analyzed four national initiatives to digitize their health systems: My Digital Clinical History (Mi HCD) in Uruguay, the National Digital Health Strategy (ENSD) in Argentina, Information Systems of the Healthcare Network (SIDRA) in Chile, and the National System of Basic Health Information (SINBA) in Mexico.

These countries were selected because they have different government structures, income levels, and degrees of progress in digital transformation.

In total, they conducted 32 interviews between 2024 and 2025 with public officials, health system administrators, technical specialists, civil society representatives, and academics. They also analyzed documents related to the policies implemented.

The interviews were organized into seven dimensions: policy objectives, technical factors, financial factors, organizational culture and structure, political factors, implementation teams, and implementation strategies.

“I was surprised to find so much evidence that, often, policies to digitize health systems focus on the means and not on the ultimate goal,” Campos explains.

What they found is that technology and infrastructure alone do not determine whether a digital transformation policy works. The factors that appeared most consistently across the four countries were the quality of institutional leadership, the ability to manage the various stakeholders involved, financing strategies, and the capacity of the teams to manage the transition between the existing system and the system they want to build.

They also found that while funding is essential, it’s not the only factor. “Chile was an example where they had the budget and still couldn’t achieve it,” Campos explains. Resources need to arrive in a timely manner and be used flexibly enough to address problems that arise during the process.

A Transformation Beyond a Digital One

One of the most important findings was the need to clearly define the health problem to be solved before choosing a technology. In some cases, digitization could become an end in itself, rather than a tool to improve healthcare system outcomes.

“I believe it is a mistake in the design of public policies on this matter,” says Campos.

The researchers also found that workers may experience digitization as a change in their routines, autonomy, responsibilities, and even their professional identity.

In this way, resistance to a new technology doesn’t necessarily mean rejection; it can reflect concerns about how it will change daily work. Communication and the participation of various stakeholders are particularly important.

In the cases studied, when users and workers were not sufficiently involved, problems of appropriation and legitimacy of the initiatives arose.

Furthermore, digital transformations typically extend over several years, while governments and their priorities can change. This can jeopardize the continuity of projects that require time to become established.

Therefore, the authors highlight strategies such as carrying out pilot projects, advancing gradually, and establishing governance mechanisms that allow initiatives to be maintained beyond administrative changes.

The Future of Digitalization of Health Systems in Latin America

Thus, based on the four cases, the researchers conclude that there is no single factor that can explain why a digital transformation policy succeeds or fails. Technical, financial, political, organizational, and cultural aspects interact with each other.

The main lesson is that digitizing a healthcare system should not be an end in itself. Technology can be a tool to improve the efficiency, equity, and responsiveness of health services, but its impact depends on the institutional conditions under which it is implemented.

They also call on citizens to get more involved. “Don’t be fooled by an announcement of a new public policy; let’s be critical,” Campos urges.

In Latin America, where health systems can be fragmented and there are significant inequalities between territories, digital transformation needs to begin with the question of what health system problem we want to solve and what conditions we need for that technology to produce a real and sustainable improvement.

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