## 3 Smart and Secure HIE Systems: SSHES
### Challenges of HIE Systems  
HIE systems face many difficulties that affect their utility and efficiency. These difficulties can be categorized into technical, organizational, and legal barriers [19; 20; 21; 22; 23].  
* Technical Challenges
* Interoperability: healthcare organizations usually use different EHR mechanisms, and each has its unique data structures, standards, and protocols. The different techniques lead to many challenges, for example, variability in data formats and coding systems across different healthcare providers, e.g., one hospital may use ICD-10 coding for diagnoses, while another uses SNOMED CT, causing mismatches in interpreting patient data. The absence of standardization poses challenges in seamlessly exchanging patient information between various systems, resulting in data fragmentation and incomplete records.
* Data Security and Privacy: healthcare organizations are obliged to safeguard patient information from illegal access, breaches, or misuse during both transmission and storage. The challenges in terms of data security and privacy can be summarized as follows: One challenge is data encryption, ensuring that all health data are encrypted both in transit and at rest. Another challenge is access control and authentication, implementing robust access management strategies to guarantee that only allowed users can access certain data. To preserve the confidentiality and integrity of health information, it becomes essential to implement strong security procedures such as cryptography, access controls, and audit tracking.
* Data Quality and Integrity: ensuring that the health information being exchanged is accurate, complete, and consistent is essential in health systems. Errors or omissions in data can result in medical mistakes, incorrect diagnoses, or unsuitable treatments.
* Organizational Challenges
* Lack of Standardization: different organizations often have unique workflows, terminology, and documentation methods, making it challenging to synchronize these diverse systems for seamless data sharing.
* Costs and Resource Constraints: establishing a successful HIE system demands substantial financial investments and technical proficiency. Smaller healthcare institutions or those with constrained budgets may encounter challenges in allocating resources towards acquiring the essential infrastructure, software, and skilled personnel needed for effective implementation.
* Resistance to Change: resistance within healthcare institutions can hinder the implementation and use of HIE systems. Healthcare professionals, including physi
cians, may be hesitant to embrace new technologies or workflows due to concerns about disrupting established practices or increasing administrative burdens.
* Change Management and User Adoption: implementing new technologies and workflows in healthcare requires proficient change management strategies. Resistance to change, insufficient user training, and limited engagement from healthcare professionals can impede the successful integration of HIE systems.
* Legal and Regulatory Barriers: organizations must navigate through various regulations related to patient consent, data sharing agreements, data retention periods, and breach notification requirements. These legal complexities can slow down the implementation process and create uncertainties around liability and accountability.
* Consent Management: obtaining patient consent for sharing their health information is a critical aspect of HIE systems. Balancing patient autonomy with the need for timely access to information by healthcare providers requires clear policies, standardized consent forms, and robust consent management systems.
* Data Governance and Ownership: determining ownership rights and responsibilities regarding health data exchanged through HIE systems is a complex issue. Establishing clear data governance frameworks that address these concerns while promoting transparency, accountability, and trust is essential for successful HIE implementation.