## 3 Challenges in Healthcare Management Systems  
The healthcare sector suffers from many challenges, loopholes, and issues in various domains [36]. Based on related research work, this study identifies the various challenges in existing HMS depicted in Figure 4.  
* **Manual Record Handling:** There has been no patient data sharing among different healthcare providers, even though there have been many advancements in medical record management in the healthcare sector [40]. Medical records are still primarily managed in the form of handwritten forms or reports in most hospitals. Paper-based medical records are created with several healthcare providers as patients see various specialists, change healthcare plans, or move to a new city. The records are often housed in distinct, independent data silos, each with its storage configuration, security system, and descriptive semantics. Because of manual record systems, data sharing has been more challenging for patients, providers, and payers;
* **Lack of Data Integrity:** Data modification and duplication are major issues in data management. Data integrity is always tampered with by a chance of error while maintaining health records, as different persons are involved at different locations. Errors such as mismatched records, incomplete information, data duplication, missing lab reports, and no historical data make health records less integral. In addition, medical records are central to a healthcare institution and cannot be accessed outside; critical healthcare cannot be granted in such cases as up-to-date information is not available [41];
* **Data Availability Issues:** Manual record keeping has many limitations, including the need for large storage areas and difficulties with data retrieval. Data availability issues still exist with current EHRs because the data are housed in a centralized database that is only accessible within the hospital or healthcare facility, even though the switch  
Figure 4: Challenges in the existing HMS [37; 38; 39]. to EMR and EHRs made data retrieval slightly easier. Data are also lost permanently in the current systems in the event of server latency and failure;
* **Privacy and Authentication Errors:** Keeping health data private has been another challenge for HMS. Health records are the most pertinent for every patient for which the access must be patient-centric. There must be a provision for patient control over health information sharing and confidentiality. HMS suffers from privacy breaches where records are less private and can be modified [39]. Authentication issues such as access control and eavesdropping are also having a bad effect on private health information;
* **Delay in Record Access:** Most healthcare systems now allow patients to examine some of their medical records online. However, these portals provide information that needs to be finished in terms of timing and integrity. Medical records are an important part of managing a patient. It is essential that medical professionals and facilities can quickly access patient records. A delay in record access could endanger a patient who is experiencing major health issues;
* **High Rise in Security Breaches:** The biggest challenge in HMS is security. Several attempts of security breaches have led to the loss of critical health data. Many disastrous situations have occurred due to threats such as insider attacks, Wi-Fi attacks, data stealing, hacking, and many more. No robust, secure mechanism can avoid these attacks, as there is a central server for data storage. Even cloud storage is also vulnerable to these threats [39];
* **No provisions for Interoperability of Data:** Varying information standards across different healthcare providers is another challenge that hampers health record quality. Interoperability has been an issue in HMS as different stakeholders, complex cycles, and clinical guidelines are involved. These factors create enormous hindrances in conveying improved patient care.