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This paper is based on experience with the design and implementation of the patient information system (patient based) (PATIS) that is being implemented across medical facilities in Fiji with the financial assistance of the Australian Government Overseas Aid Agency (AusAID) and the Government of Fiji. The paper initially outlines the scope and technical infrastructure of the PATIS in Fiji before focusing on two fundamental areas of the system. The implementation of a National Health Number (NHN) is discussed in detail outlining the objectives, production, implementation strategies, problems encountered and solutions applied. To implement an NHN it was necessary to design a reliable, but affordable, methodology to synchronize the medical information across multiple facilities on a nightly basis. The paper discusses the innovative use of "off the shelf products to effectively synchronize multiple databases, how the system is structured and monitored and various issues that have arisen since implementation.