Conclusions: Complex systemic problems often derail ICT projects. The case study of an isolated region provides a number of lessons and insights to improve electronic records adoption projects. The limited resources and limited choices faced by the region lead to the development of a number of key approaches that revolved around aiming for a workable system rather than a high-end flawless solution. This ethos pervaded the electronic health records project and was underpinned by a patient centred approach and a strong desire to improve the service given to patients. (Source: International Journal of Medical Informatics).