Critical Analysis of e-Health Interoperability Frameworks – A Review of Reviews (Preprint)
Authors: Ndlovu Kagiso , Scott Richard Ernest , Mars Maurice 
Published: December 2018

BACKGROUND

Major challenges in today’s healthcare setting are fragmentation of data systems, duplicate functionality, large data sets in various locations, and non-uniform formats. These impair accurate reporting and decision making needed to address key healthcare challenges. Although difficult to attain, interoperability of e-Health systems presents numerous opportunities including better patient management, improved quality of care, better decision making and reduced healthcare costs. Several e-Health interoperability frameworks have been published under various circumstances and geographical regions of the world. However, the extent to which e-Health systems are interoperable and the degree to which existing e-Health interoperability frameworks address each interoperability layer is unknown.

OBJECTIVE

This study aims to provide an informed context for the e-Health systems’ interoperability landscape, detailing how each interoperability framework addresses the technical, syntactical, semantic and organizational layers, as well as relevance to developing countries.

METHODS

A literature review and analysis of published reviews of e-Health interoperability frameworks or models was performed to determine interoperability layers covered under each and to establish if any were appropriate for broad application in developing countries.

RESULTS

Seventeen (17) review papers described e-Health interoperability frameworks in various settings. They addressed either one or two of the four identified layers; technical, syntactical, semantic, and organizational interoperability, and only four addressed them all. The frameworks were based upon varying standards and perspectives and mostly addressed technical, syntactic and semantic e-Health interoperability layers, all of which are important especially since interoperability is an emerging field. While the shortcomings of existing frameworks have been highlighted, most contain aspects that are relevant and can be drawn on when developing an e-Health interoperability framework for developing countries where little has been achieved as yet. In particular, the study showed a need to identify, based on domestic needs and circumstances, the most locally relevant and specific layer of interoperability appropriate for the task, and to determine how technology could be leveraged to attain interoperable solutions within a specific domain(s) for that layer. Thereafter the alignment of technology solutions with workplace realities, medical protocols and human preferences will be necessary. These areas need further research before attempting to develop a more generic e-Health interoperability framework.

CONCLUSIONS

The need for interoperable e-Health systems is critical. While some e-Health interoperability frameworks exist, each one addresses certain layers of the interoperability stack. Each framework presents unique implementation lessons and opportunities which are important for countries seeking to develop an e-Health interoperability framework.