Background: Process analysis and expert consultation help streamline and optimise processes, but these are underutilised. The World Health Organisation (WHO) recommends migration to electronic data collection by 2015, partly in response to multidrug-resistant tuberculosis (MDR-TB). We explore the influence of process analysis and iterative expert consultation, on shaping health information solutions to MDR-TB programmes. Methods: The study employs a two phase design. Phase one involves a process analysis of the South African National Tuberculosis Programme and an electronic medical records (EMR) solution and the generation of a detailed process model grounded in the fit between individual task and technology (FITT) theoretical framework using ‘business process modelling notation’. Phase two involves a two round Delphi study in the clinical management of tuberculosis and implementers of EMR solutions. Expert opinion is analysed according to emergent thematic content. Analyses and graphical model representation are performed using Microsoft Excel® and Visio® software. Results: A detailed process model is constructed which reveals 54 break points, 12 gaps, 3 risks, 5 wastes. Five participants are included in the Delphi study which support the findings of the process analysis. Thematic analysis identifies five themes: the individual, the process, technology, capacity, and collaboration. The opportunity to include synergistic relations across programmes emerges as a strong theme. Conclusions: Overall, the findings highlight inefficiencies, risk and gaps in the current process and the need for an operational excellence intervention. The study demonstrated the value of process engineering with iterative expert consultation toward developing a meaningful EMR solution consultation in a resource constrained, developing world context.