Purpose: This paper seeks to carry out a critical study of health data standards and adoption process with a focus on Saudi Arabia. Design/methodology/approach: Many developed nations have initiated programs to develop, promote, adopt and customise international health data standards to the local needs. The current status of, and future plans for, health data and related standards in developing countries are still questionable due to the absence of government actions, plans and related studies. However, the development of interoperable standards not only technically defines a method of interoperation between the different systems in a network but most importantly represents a proposal for the future of complex socio-technical systems that is the shape of a national health information network and therefore a complex balance between different types of requirements including organisational, social and managerial aspects must be managed. This reaffirms the need for a more in-depth study to evaluate the adoption of health information technology-related standards at the decision-making stage in developing countries. Based on diffusion of innovation theory and the theories surrounding the economics of standards, a case study method was applied in Saudi Arabia to study the adoption process of health data standards. Findings: The preliminary analysis findings revealed that there are 18 factors influencing the decision-making adoption process of acquiring certain standards. Research limitations/implications: Qualitative study methods have been employed in the present study that have shed light on the many issues that need to be addressed in this field. Studies involving other countries including advanced nations should be done for which the present results have economic, social and educational implications. Practical implications: The present study and findings should help inform policy and decision makers in developing health systems with the potential creation of information and structure that can sustain future and improved systems. Originality/value: This paper makes a novel contribution at both academic and practical levels since both the academics and practitioners, who are devoted to the ongoing use of health data standards, still lack a significant body of evidence with regard to the factors that influence their adoption.