Electronic health record (EHR) systems are a popular mechanism for accessing health records in the developed world and have contributed towards improved and cost-effective health care management. However, the development of appropriate and scalable EHR systems in developing countries has been difficult to achieve because of certain limitations inherent in the technological infrastructure. For instance, bandwidth limitations and power outages make it difficult to guarantee dependability in terms of accessibility to the data. This paper presents a comparative study of 19 EHR systems in terms of the security and usability of these systems within the context of the developing world. The evaluation is based on a number of dimensions such as development environment, system platform, type and access control standards found in the National Institute for Standard and Technology (NIST) and Certification Commission for Health Information Technology (CCHIT). Our research indicates that all the systems evaluated require online access control decisions. Access to data on a central server is controlled by a mechanism that verifies/authenticates users or parties wanting to view/modify/edit patient records. However, solely relying on an online access control system is limiting, particularly in developing countries where access to the server can be disrupted by a number of disastrous events. Additionally, literature also reveals that all the evaluated tools were developed with the user contexts in the developed World and therefore do not represent the needs of the patients and medical practitioners in the developing countries.