Abstract

In this paper an insight on various e-health interoperable systems was reviewed to discover strengths and challenges faced during sustainable implementation. It covered local, national and regional coverage of integrated systems towards implementation of a single unified e-health system. Peer reviewed and grey literatures were consulted to discover global and local trend and efforts towards implementations of e-health interoperable systems. The available systems and frameworks from the European Union, Asia, America, Oceania and Africa were analyzed for their strengths and challenges. Various policies, guides as well as free and proprietary standards associated with e-health interoperability was reviewed to understand the common standards adopted by the majority of existing systems. The findings of the analysis are useful for policy makers on the best ways to implement interoperable systems in developing countries by focusing on the existing infrastructures and the environment. Similarly, the strengths and challenges encountered by interoperable systems were also examined to provide recommendations for future studies.

Keyword

Interoperability, Electronic health records, Interoperable frameworks, Big data, Security, Tanzania.

Cite this article

Mtey MM, Dida MA

Refference

[1][1]Owais ST, Khanna S, Mani RS. Building multi-channel e-service delivery platform: opportunities and challenges. In proceedings of the special collection on eGovernment innovations in India 2017 (pp. 58-63). ACM.

[2][2]Munyoka W, Maharaj M. Towards the harmonisation of information and communication technology policy frameworks in the Southern African development community. In international conference on information technology systems and innovation 2017 (pp. 1-8). IEEE.

[3][3]Simon E, Mushi A. eHealth as the trigger initiative that may foster development in health care delivery in Tanzania. In international conference on sustainable ICT, education, and learning 2019 (pp. 39-44). Springer, Cham.

[4][4]Sylva P, Abeysinghe B, James C, Jayatilake A, Lunuwila S, Sanath D, et al. A review of eHealth policies that underpin global health care digitization. Sri Lanka Journal of Bio-Medical Informatics. 2011; 2(4):118-29.

[5][5]Ouhbi S, Fernández-Alemán JL, Carrillo-de-Gea JM, Toval A, Idri A. E-health internationalization requirements for audit purposes. Computer Methods and Programs in Biomedicine. 2017; 144:49-60.

[6][6]Tuna G, Kogias DG, Gungor VC, Gezer C, Taşkın E, Ayday E. A survey on information security threats and solutions for machine to machine (M2M) communications. Journal of Parallel and Distributed Computing. 2017; 109:142-54.

[7][7]Borgia E. The internet of things vision: key features, applications and open issues. Computer Communications. 2014; 54:1-31.

[8][8]Vernadat FB. Technical, semantic and organizational issues of enterprise interoperability and networking. Annual Reviews in Control. 2010; 34(1):139-44.

[9][9]Boateng R, Acheampong B, Bedi I. Preliminary insights into dominant issues, theories and methodologies in platform interoperability research. Twenty-fifth americas conference on information systems, cancun, 2019 (pp. 1-10).

[10][10]Margariti V, Stamati T. Organizational interoperability in e-government: α case study from the Greek public sector. EGOV-CeDEM-ePart 2018.

[11][11]Rac-Albu EM, Ciobanu V, Rac-Albu M, Popescu N. Interoperability of medical data through e-Health service in Romania. In international conference on exploring services science 2016 (pp. 683-92). Springer, Cham.

[12][12]Chokshi A, Patel S. Internet of things (IoT), IoT architecture, security challenges in IoT & Role of IoT in healthcare industry. International Journal of Engineering Technology Science and Research. 2017; 4(10):822-5.

[13][13]Bandyopadhyay D, Sen J. Internet of things: applications and challenges in technology and standardization. Wireless Personal Communications. 2011; 58(1):49-69.

[14][14]Lee I, Lee K. The internet of things (IoT): applications, investments, and challenges for enterprises. Business Horizons. 2015; 58(4):431-40.

[15][15]Rahmani AM, Gia TN, Negash B, Anzanpour A, Azimi I, Jiang M, et al. Exploiting smart e-Health gateways at the edge of healthcare internet-of-things: a fog computing approach. Future Generation Computer Systems. 2018; 78:641-58.

[16][16]Li J, Zhang Y, Chen X, Xiang Y. Secure attribute-based data sharing for resource-limited users in cloud computing. Computers & Security. 2018; 72:1-12.

[17][17]Fernandez F, Pallis GC. Opportunities and challenges of the internet of things for healthcare: systems engineering perspective. In 4th international conference on wireless mobile communication and healthcare-transforming healthcare through innovations in mobile and wireless technologies (MOBIHEALTH) 2014 (pp. 263-6). IEEE.

[18][18]Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, et al. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Medicine. 2011; 8(1):1-16.

[19][19]Stephanie FL, Sharma RS. Health on a cloud: modeling digital flows in an e-health ecosystem. Journal of Advances in Management Sciences & Information Systems. 2016; 2:1-20.

[20][20]Yadav P, Steinbach M, Kumar V, Simon G. Mining electronic health records: a survey. arXiv preprint arXiv:1702.03222. 2017.

[21][21]Pasupuleti SK, Ramalingam S, Buyya R. An efficient and secure privacy-preserving approach for outsourced data of resource constrained mobile devices in cloud computing. Journal of Network and Computer Applications. 2016; 64:12-22.

[22][22]Kumar P, Lee HJ. Security issues in healthcare applications using wireless medical sensor networks: a survey. Sensors. 2012; 12(1):55-91.

[23][23]Juma K, Nahason M, Apollo W, Gregory W, Patrick O. Current status of e-health in Kenya and emerging global research trends 1. International Journal of Information and Communication Technology Research. 2012; 2(1):50-4.

[24][24]Chituc CM. XML interoperability standards for seamless communication: an analysis of industry-neutral and domain-specific initiatives. Computers in Industry. 2017; 92:118-36.

[25][25]Reis ZS, Maia TA, Marcolino MS, Becerra-Posada F, Novillo-Ortiz D, Ribeiro AL. Is there evidence of cost benefits of electronic medical records, standards, or interoperability in hospital information systems? overview of systematic reviews. JMIR Medical Informatics. 2017; 5(3):1-13.

[26][26]Rezaei R, Chiew TK, Lee SP, Aliee ZS. Interoperability evaluation models: a systematic review. Computers in Industry. 2014; 65(1):1-23.

[27][27]Nijeweme-d Hollosy WO, Van Velsen L, Huygens M, Hermens H. Requirements for and barriers towards interoperable eHealth technology in primary care. IEEE Internet Computing. 2015; 19(4):10-9.

[28][28]Huser V, Sastry C, Breymaier M, Idriss A, Cimino JJ. Standardizing data exchange for clinical research protocols and case report forms: an assessment of the suitability of the clinical data interchange standards consortium (CDISC) operational data model (ODM). Journal of Biomedical Informatics. 2015; 57:88-99.

[29][29]Evans L. Protecting information assets using ISO/IEC security standards. Information Management. 2016; 50(6):28-33.

[30][30]https://www.iso.org/obp/ui/#iso:std:iso-iec:27000:ed-5:v1:en:en. Accessed 15 March 2018.

[31][31]Dolin RH, Rogers B, Jaffe C. Health level seven interoperability strategy: big data, incrementally structured. Methods of Information in Medicine. 2015; 54(01):75-82.

[32][32]http://www.hl7.org/ . Accessed 15 March 2018.

[33][33]Bhalla S, Sachdeva S, Batra S. Semantic interoperability in electronic health record databases: standards, architecture and e-Health systems. In international conference on big data analytics 2017 (pp. 235-42). Springer, Cham.

[34][34]Nalin M, Baroni I, Faiella G, Romano M, Matrisciano F, Gelenbe E, et al. The European cross-border health data exchange roadmap: case study in the Italian setting. Journal of Biomedical Informatics. 2019.

[35][35]Mondorf A, Wimmer M. Contextual components of an enterprise architecture framework for pan-European egovernment services. Proceedings of the 50th hawaii international conference on system sciences. 2017 (pp. 2933-42).

[36][36]Kouroubali A, Katehakis DG. The new European interoperability framework as a facilitator of digital transformation for citizen empowerment. Journal of Biomedical Informatics. 2019.

[37][37]https://www.eesc.europa.eu/en/our-work/opinions-information-reports/opinions/european-interoperability-framework-implementation-strategy-communication. Accessed 15 March 2018.

[38][38]Kalogirou V, Charalabidis Y. The european union landscape on interoperability standardisation: status of european and national interoperability frameworks. In enterprise interoperability VIII 2019 (pp. 359-68). Springer, Cham.

[39][39]Voutsidou S, Moraitis E, Sissouras A, Jelastopulu E, Charalampous G. E-Health and primary health care: telemedicine in the greek national health system. International Journal of Recent Scientific Research. 2019; 10(8):34320-5.

[40][40]Høstgaard AM, Bertelsen P, Nøhr C. Constructive eHealth evaluation: lessons from evaluation of EHR development in 4 danish hospitals. BMC Medical Informatics and Decision Making. 2017; 17(45):1-15.

[41][41]Paide K, Pappel I, Vainsalu H, Draheim D. On the systematic exploitation of the Estonian data exchange layer X-road for strengthening public-private partnerships. In proceedings of the 11th international conference on theory and practice of electronic governance 2018 (pp. 34-41). ACM.

[42][42]http://julkaisut.valtioneuvosto.fi/handle/10024/74459. Accessed 15 March 2018.

[43][43]Domenichiello M. State of the art in adoption of e-health services in Italy in the context of European union e-government strategies. Procedia Economics and Finance. 2015; 23:1110-8.

[44][44]Waterson P. Health information technology and sociotechnical systems: a progress report on recent developments within the UK national health service (NHS). Applied Ergonomics. 2014; 45(2):150-61.

[45][45]Gibson D, Smith L. How to use the summary care record in community pharmacy. Pharmaceutical-Journal. 2016.

[46][46]Adewunmi A. A critical appraisal of the summary care record (SRC) scheme in England: medway maritime hospital case study. University of Sheffield South Yorkshire. 2014.

[47][47]Hayward-Giles S, Millar J. UK approach to developing SNOMED CT subsets for physiotherapists to use as part of the electronic health record. Physiotherapy. 2015; 101(1):550-1.

[48][48]Bodenreider O, Cornet R, Vreeman DJ. Recent developments in clinical terminologies—SNOMED CT, LOINC, and RxNorm. Yearbook of Medical Informatics. 2018; 27(01):129-39.

[49][49]Schiza EC, Kyprianou TC, Petkov N, Schizas CN. Proposal for an e health based ecosystem serving national healthcare. IEEE Journal of Biomedical and Health Informatics. 2018; 23(3):1346-57.

[50][50]Nøhr C, Parv L, Kink P, Cummings E, Almond H, Nørgaard JR, et al. Nationwide citizen access to their health data: analysing and comparing experiences in Denmark, Estonia and Australia. BMC Health Services Research. 2017; 17(1):534-44.

[51][51]Efendi S, Siregar B, Pranoto H. Concept designs of patient information security using e-health sensor shield platform on blockchain infrastructure. In proceedings of MICoMS 2018 (pp. 641-6). Emerald Publishing Limited.

[52][52]Quaglio G, Dario C, Stafylas P, Tiik M, McCormack S, Zilgalvis P, et al. E-health in Europe: current situation and challenges ahead. Health Policy and Technology.2016; 5(4):314-7.

[53][53]Kanter AS, Borland R, Barasa M, Iiams-Hauser C, Velez O, Nina Kaonga N, et al. The importance of using open source technologies and common standards for interoperability within e-health: perspectives from the millennium villages project. In health information technology in the international context 2012 (pp. 189-204). Emerald Group Publishing Limited.

[54][54]Choudhury NR. Framework for development of information technology infrastructure for health (ITIH) care in india–a critical study. Qualitative and Quantitative Methods in Libraries. 2017; 5(4):787-96.

[55][55]Kavitha R, Kannan E, Kotteswaran S. Implementation of cloud based electronic health record (EHR) for Indian healthcare needs. Indian Journal of Science and Technology. 2016; 9(3):1-5.

[56][56]Kumar S, Kumar S, Mishra A, Yadav M. Developing a pro-people health policy: documenting the participatory processes involved in drafting and revision of national health policy. Journal of Health Management. 2017; 19(3):369-76.

[57][57]https://mohfw.gov.in/documents/policy. Accessed 13 March 2018.

[58][58]https://www.snomed.org/member/india. Accessed 13 March 2018.

[59][59]https://mohfw.gov.in/basicpage/electronic-health-record-ehr-standards-india-2016. Accessed 15 March 2018.

[60][60]Mudaly T, Moodley D, Pillay A, Seebregts CJ. Architectural frameworks for developing national health information systems in low and middle income countries. In proceedings of the first international conference on enterprise systems: ES 2013 (pp. 1-9). IEEE.

[61][61]Foster J. Case study 1: nursing informatics and e-health in Australia. In introduction to nursing informatics 2015 (pp. 305-22). Springer, London.

[62][62]Khoshafian S. Service oriented enterprises. Auerbach Publications; 2016.

[63][63]Milosevic Z, Bond A. Digital health interoperability frameworks: use of RM-ODP standards. In 20th international enterprise distributed object computing workshop 2016 (pp. 1-10). IEEE.

[64][64]Walsh L, Hemsley B, Allan M, Adams N, Balandin S, Georgiou A, et al. The e-health literacy demands of Australia s my health record: a heuristic evaluation of usability. Perspectives in Health Information Management. 2017.

[65][65]Mather C, Cummings E, Gale F. Nurses as stakeholders in the adoption of mobile technology in Australian health care environments: interview study. JMIR Nursing. 2019; 2(1).

[66][66]Black AS. E-health-as-a-service: a service based design approach for large scale e-health architecture (Doctoral Dissertation, Queensland University of Technology).2018.

[67][67]Baskaya M, Yuksel M, Erturkmen GL, Cunningham M, Cunningham P. Health4Afrika-implementing HL7 FHIR based interoperability. In proceedings of world congress of medical and health informatics, MEDINFO. 2019:20-4.

[68][68]Huang F, Blaschke S, Lucas H. Beyond pilotitis: taking digital health interventions to the national level in China and Uganda. Globalization and Health. 2017; 13(49):1-11.

[69][69]Higman S, Dwivedi V, Nsaghurwe A, Busiga M, Sotter Rulagirwa H, Smith D, et al. Designing interoperable health information systems using Enterprise Architecture approach in resource‐limited countries: A literature review. The International Journal of Health Planning and Management. 2019; 34(1): e85-99.

[70][70]Adebesin F, Kotzé P, Ritz D, Foster R, Van Greunen D. Method for selecting e-health standards to support interoperability of healthcare information systems. IST-Africa Conference Proceedings. 2014.

[71][71]Roa JH. Designing mobile instant messaging for collaborative health data management in Rwanda (Masters thesis). 2017.

[72][72]Jain S, Zorzi N. Investing for impact: the global fund approach to measurement of AIDS response. AIDS and Behavior. 2017; 21(1):91-100.

[73][73]Bholah LA, Beharee K. Mauritius e-health-trust in the healthcare revolution. In ITU kaleidoscope: trust in the information society (K-2015) 2015 (pp. 1-8). IEEE.

[74][74]Fox S, Duggan M. Mobile health 2010. Washington, DC: Pew Internet & American Life Project; 2010.

[75][75]Cheerkoot-Jalim S, Gopal K. Design of an architectural framework for the implementation of ehealth in mauritius. In information and communication technology for sustainable development 2020 (pp. 547-58). Springer, Singapore.

[76][76]Katuu S. Health information systems, e-health strategy, and the management of health records: the quest to transform south africa s public health sector. In Healthcare Policy and Reform: Concepts, Methodologies, Tools, and Applications 2019:493-517. IGI Global.

[77][77]http://policyresearch.limpopo.gov.za/bitstream/handle/123456789/873/e-Health%20Strategy%20South% 20Africa.pdf? sequence=1. Accessed 13 March2018.

[78][78]Agostinho C, Ducq Y, Zacharewicz G, Sarraipa J, Lampathaki F, Poler R, et al. Towards a sustainable interoperability in networked enterprise information systems: trends of knowledge and model-driven technology. Computers in Industry. 2016; 79:64-76.

[79][79]Mgozi T, Weeks R. The impact of cloud computing on the transformation of healthcare system in South Africa. In ITU kaleidoscope: trust in the information society (K-2015) 2015 (pp. 1-7). IEEE.

[80][80]Njoroge M, Zurovac D, Ogara EA, Chuma J, Kirigia D. Assessing the feasibility of e-health and mHealth: a systematic review and analysis of initiatives implemented in Kenya. BMC Research Notes. 2017; 10(90):1-11.

[81][81]Kiberu VM, Mars M, Scott RE. Barriers and opportunities to implementation of sustainable e-health programmes in Uganda: a literature review. African Journal of Primary Health Care & Family Medicine. 2017; 9(1):1-10.

[82][82]Darcy N, Elias M, Swai A, Danford H, Rulagirwa H, Perera S. E-Health strategy development: a case study in Tanzania. Journal of Health Informatics in Africa. 2014; 2(2):36-43.

[83][83]https://www.who.int/goe/policies/countries/tza_ehealth.pdf. 2012. Accessed 13 March 2018.

[84][84]Mashoka RJ, Murray B, George U, Lobue N, Mfinanga J, Sawe H, et al. Implementation of electronic medical records at an emergency medicine department in Tanzania: the information technology perspective. African Journal of Emergency Medicine. 2019; 9(4):165-71.

[85][85]Chali F, Yonah ZO, Kalegele K. Data exchange architecture for the development of mobile applications that support e-health systems interoperability: a case of Tanzania. International Journal of Advanced Computer Research. 2018; 8(34):1-10.

[86][86]https://www.healthcareitnews.com/news/interoperability-3-charts-take-pulse-health-data-sharing-today. Accessed 13 March 2018.

[87][87]Salas-Vega S, Haimann A, Mossialos E. Big data and health care: challenges and opportunities for coordinated policy development in the EU. Health Systems & Reform. 2015; 1(4):285-300.

[88][88]Sukumar SR, Natarajan R, Ferrell RK. Quality of big data in health care. International Journal of Health Care Quality Assurance. 2015; 28(6):621-34.

[89][89]Galetsi P, Katsaliaki K, Kumar S. Big data analytics in health sector: theoretical framework, techniques and prospects. International Journal of Information Management. 2020; 50:206-16.

[90][90]Goldstein BA, Navar AM, Pencina MJ, Ioannidis J. Opportunities and challenges in developing risk prediction models with electronic health records data: a systematic review. Journal of the American Medical Informatics Association. 2017; 24(1):198-208.

[91][91]Cowie MR, Blomster JI, Curtis LH, Duclaux S, Ford I, Fritz F, et al. Electronic health records to facilitate clinical research. Clinical Research in Cardiology. 2017; 106(1):1-9.

[92][92]Union I. Communication from the commission to the European parliament, the council, the European economic and social committee and the committee of the regions. A New Skills Agenda for Europe. Brussels. 2014.

[93][93]Firouzi F, Farahani B, Ibrahim M, Chakrabarty K. Keynote paper: from EDA to IoT e-health: promises, challenges, and solutions. IEEE Transactions on Computer-Aided Design of Integrated Circuits and Systems. 2018; 37(12):2965-78.

[94][94]Eom D, Lee H. A holistic approach to exploring the divided standards landscape in e-health research. In ITU kaleidoscope: challenges for a data-driven society 2017 (pp. 1-7). IEEE.

[95][95]Payne JD. The state of standards and interoperability for m-health. Washington, DC: m-Health Alliance. 2013.

[96][96]Zeinab KA, Elmustafa SA. Internet of things applications, challenges and related future technologies. World Scientific News. 2017; 67(2):126-48.

[97][97]Agostinho C, Ducq Y, Zacharewicz G, Sarraipa J, Lampathaki F, Poler R, et al. Towards a sustainable interoperability in networked enterprise information systems: trends of knowledge and model-driven technology. Computers in Industry. 2016; 79:64-76.

[98]

[99]

[100]

[101]