### Existing Interoperability Frameworks
The authors of [13] presented an interoperability framework that utilizes blockchain technology to ensure the privacy and security of patients' medical records in an interoperable environment. They proposed a blockchain-based framework named Ancile to facilitate secure, interoperable, and efficient access to medical records by patients, providers, and third parties while safeguarding patients' sensitive information. Ancile utilizes smart contracts in an Ethereum-based blockchain to enhance access control and data obfuscation, incorporating advanced cryptographic techniques for heightened security. While successful in achieving its intended objectives, the framework faces fundamental challenges related to scalability and the cost of storing data on blockchain platforms, rendering it unsuitable for nationwide deployment. Scalability issues and the associated costs of using blockchain technology make it impractical to implement on large-scale interoperable platforms, as has been noted by several authors, such as [14; 15; 16; 17]. The current study proposes an alternative framework, addressing these challenges and emphasizing scalability and higher security measures. An innovative access control framework was proposed by [18]. It focused on safeguarding the privacy of Personal Health Record (PHR) data during emergencies. This framework was built on permissioned blockchain technology, specifically utilizing the Hyperledger Fabric and Hyperledger Composer playground for evaluation. Through their experiments, the researchers demonstrated that the proposed framework ensures the secure sharing of PHR data, incorporating important features such as auditing, immutability, and emergency access control policies. This framework has limitations regarding latency and performance traits (related to scalability) that are inherent in the Hyperledger-based (blockchain) approach. The current research aims to overcome these limitations through the use of scalable technologies and therefore provide a more efficient and effective solution for handling PHR data within a healthcare ecosystem. A conceptual framework was proposed by [19], aimed at enhancing decision-making processes within healthcare facilities in Tanzania through the implementation of EHRs. The paper establishes six propositions that underscore the role of EHRs' interoperability in supporting effective decision-making. It addresses the existing inconsistencies in EHR implementation and emphasizes the potential of interoperability to bridge these gaps and improve decision-making outcomes. The framework proposed in the paper emphasizes the collaborative potential of interoperable EHRs among healthcare professionals, facility managers, and policymakers, enabling shared decision-making. Furthermore, the framework highlights the importance of information exchange between policymakers and healthcare facility managers to create an environment conducive to efficient healthcare delivery. Despite its promising potential, the proposed interoperability conceptual framework for Tanzanian healthcare facilities exhibits certain limitations. It lacks applicability beyond the Tanzanian context, and the practical challenges associated with its implementation, encompassing technical, financial, and regulatory aspects, are not thoroughly addressed. Also, data security and privacy concerns, which are critical, are inadequately addressed. The current research seeks to propose an alternative framework that addresses the limitations discussed above. In the study by [20], an interoperability framework was proposed to address the privacy challenges in sharing and storing EHRs. The study focused on introducing a framework named PbDinEHR, which focused on Privacy by Design (PbD) mechanisms, distributed data storage, and sharing in the context of EHRs. To showcase the framework's capabilities, the researchers developed a Patient Record Management System (PRMS), providing user interfaces for patients and healthcare providers.