## 2 The TASIPPS Conceptual Framework
### The TASIPPS Framework Components
#### 2.1.2 The Semantic Interoperability Module  
The semantic interoperability module is a subsection of the TASIPPS framework. It is positioned as an intermediary between disparate EHR systems, avoiding a central point of access that would be vulnerable to attacks. This placement ensures that data flow securely between systems without creating a single point of failure, enhancing both security and reliability. The various subcomponents of the module are explained below. Adaptation of FHIR: The proposed solution to achieving interoperability does not utilize common technical interoperability standards such as openEHR or FHIR due to the need for participating hospitals to obtain new systems and other implementation costs to conform to these standards. It was also noted by [43] that the associated cost of  
Figure 2: The Middleware server module’s components. implementation, inconsistencies in the various versions, and variations in vendors during their implementation, amongst other factors, do not allow for common standards (such as openEHR or FHIR), which would provide the final answer to the interoperability challenge. Figure 3 captures the flow of traffic and how the EHR systems connect to the central database and the semantic interface. The diagram in Figure 3 captures the two EHR systems that connect to the central database and the semantic interoperability interface. Both EHR systems connect to the central database and share basic patient information with the center, as depicted above. The EHR systems then connect to the semantic interface through API calls to fetch and push data. The proposed framework represents an advancement in interoperability through the forging of seamless connections between two distinct EHR systems--EHR1 and EHR2. At its core lies a sophisticated central database, designed to transcend traditional data silos and cultivate a holistic repository of patient information. By systematically populating this central database with essential but limited details, such as patient names, contact information, affiliated hospitals, and attending physicians, the framework sets the stage for a paradigm shift in healthcare data management. A pivotal feature of this framework is its bilateral connectivity, facilitated through the robust Application Programming Interfaces (APIs) between EHR1 and EHR2. This strategic interoperability not only allows for the exchange of data but also provides a novel approach to semantic interoperability. The mechanics of the bidirectional data flow between EHR1 and EHR2 are orchestrated through a dedicated Semantic Interoperability Interface, which is integrated into the framework's architecture. This interface acts as a gatekeeper, regulating access to patient data between the two EHR systems. When a physician from EHR1 seeks patient information from EHR2, they engage with the Semantic Interoperability Interface, necessitating the input of secure login credentials. This process ensures a stringent verification of the user's identity and authorization status, fortifying the overall security of the interoperability ecosystem. The same process is replicated when a physician from EHR2 seeks data from EHR1, cementing the bidirectional nature of the interoperability framework. Security is a paramount consideration in the implementation of this framework, with a robust array of access control mechanisms forming the vanguard. Users, whether from EHR1 or EHR2, are assigned predefined access rights contingent on their roles and responsibilities. This meticulous access control architecture ensures that sensitive  
Figure 3: The semantic interoperability module and traffic flow. patient information is exclusively accessible to authorized personnel, mitigating the risk of unauthorized data exposure. Additionally, encryption protocols are systematically deployed to ensure data security during transmission, adding a layer of protection against potential data breaches. Furthermore, the framework prioritizes the security of the interconnected EHR systems.