Authors:
(1) Prabath Jayatissa, University of Colombo
(2) Roshan Hewapathirane, University of Colombo Table of Links Abstract & Introduction Methodology Results Conclusion & References 2. METHODOLOGY The review article focuses on the issue of interoperability among health information systems in low and middle-income countries (LMICs). The methodology employed involves a rigorous process that includes several key steps. First, a comprehensive literature review encompasses relevant research articles, reports, and publications from reputable sources. The findings from the literature review are then synthesised to identify common challenges faced by LMICs in achieving interoperability in their health information systems. The challenges identified include a lack of standardisation, fragmented systems, limited resources, and data privacy concerns. These challenges hinder the seamless exchange of health information among different health information systems, leading to inefficiencies and suboptimal health outcomes.Next, the review article proposes strategies to enhance interoperability in LMICs. These strategies are derived from the analysis and interpretation of the literature findings. Proposed strategies include standardisation of data formats and protocols, consolidation of health information systems, investment in health IT infrastructure, and capacity building of health IT professionals in LMICs.Once the strategies are identified, the review article is organised and written, providing a concise and coherent overview of the current state of interoperability among health information systems in LMICs and potential strategies for improvement. The article is then revised and finalised for submission, taking into account feedback from peers and experts in the field. In summary, the methodology for the review article involves conducting a comprehensive literature review, synthesising findings, identifying challenges and strategies, analysing and interpreting results, and writing and finalising the article. The article provides insights into the current state and potential strategies for enhancing interoperability among health information systems in LMICs, to improve healthcare delivery and outcomes in these regions. 2.1. Literature Review Interoperability has been recognised as a critical factor for effective health information exchange and care coordination at the national and international levels1 . In LMICs, achieving interoperability among health information systems is particularly challenging due to various factors. Several studies have identified challenges to interoperability in LMICs, including: Lack of standardisation: LMICs often need morestandardised data formats, coding systems, and terminologies, which hinder the accurate and seamless exchange of health information (AdlerMilstein et al., 2013; Kamadjeu, 2019). This lack of standardisation makes integrating data from different sources challenging, resulting in fragmented and incomplete health information2 Fragmented health information systems: Many LMICs have fragmented health information systems, where different systems are used for different healthcare functions, such as patient registration, electronic health records (EHRs), and laboratory systems, leading to data silos3 . This fragmentation hampers the exchange of data across different systems, hindering interoperability. Limited resources: LMICs often need more resources, including limited funding, technical expertise, and infrastructure, which can pose challenges in implementing and maintaining interoperable health information systems4 .The high cost of health IT infrastructure, such as servers, software, and networking, can hinder achieving interoperability in LMICs. Data privacy and security concerns: Data privacy, security, and consent are critical concerns in health information exchange, and LMICs often lack robust policies, regulations, and safeguards to address these issues effectively5 . This can hinder the sharing of health information among different systems due to concerns about data breaches and misuse. Despite these challenges, several strategies have been proposed to enhance interoperability among health information systems in LMICs. Standardisation: Adoption of internationally recognised health IT standards, such as HL7 and SNOMED CT, can facilitate data standardisation and ensure consistency and accuracy of data exchange6 . Standardisation of data formats, coding systems, and terminologies can enable seamless data exchange and promote interoperability. Consolidation and integration: The integration of fragmented health information systems into a unified health information exchange (HIE) platform can facilitate data exchange and coordination of care7 . Developing national HIE policies and governance frameworks can support the establishment and sustainability of HIEs in LMICs. Investment in health IT infrastructure: Investment in health IT infrastructure, including hardware, software, and networking, is crucial for supporting interoperable health information systems8 .Partnerships and collaborations with governments, non-profit organisations, and the private sector can help overcome resource constraints and facilitate the development of robust health IT infrastructure. Capacity building and training: Capacity building and training programs for the health IT workforce can enhance technical expertise and knowledge in LMICs9 . Training programs can focus on building skills in health IT standards, data management, and interoperability concepts, Interoperability, the ability of different health information systems to exchange and use data seamlessly, is a critical factor for effective health information exchange and coordination of care at the national and international levels10. In LMICs, achieving interoperability among health information systems is particularly challenging due to various factors. Several studies have identified challenges to interoperability in LMICs, including lack of standardisation, fragmented health information systems, limited resources, and data privacy and security concerns11 . Lack of standardisation is a major challenge in LMICs, as they often needstandardised data formats, coding systems, and terminologies, which hinder the accurate and seamless exchange of health information12. Fragmented health information systems, which are used for different healthcare functions, such as patient registration, electronic health records (EHRs), and laboratory systems, must also be improved for interoperability12,21. This fragmentation leads to data silos, hindering data exchange across different systems. Limited resources, including funding, technical expertise, and infrastructure, are often faced by LMICs, which can pose challenges in implementing and maintaining interoperable health information systems13. The high cost of health IT infrastructure, such as servers, software, and networking, can hinder achieving interoperability in LMICs. Data privacy and security concerns are also critical challenges, as LMICs often lack robust policies, regulations, and safeguards to address these issues effectively9,10,11. This can hinder the sharing of health information among different systems due to concerns about data breaches and misuse. Despite these challenges, several strategies have been proposed to enhance interoperability among health information systems in LMICs. Standardisation, such as adopting internationally recognised health IT standards like HL7 and SNOMED CT, can facilitate data standardisation and ensure data exchange consistency and accuracy of data exchange9,21 . Consolidating and integrating fragmented health information systems into a unified health information exchange (HIE) platform can facilitate data exchange and coordination of care10,12,15. Investment in health IT infrastructure, including hardware, software, and networking, is crucial for supporting interoperable health information systems in LMICs7,9,11. Capacity building and training programs for the health IT workforce can enhance technical expertise and knowledge in LMICs, focusing on health IT standards, data management, and interoperability concepts13,14,16,20 Further research is needed to evaluate the impact of these strategies on improving interoperability, identifying novel approaches specific to LMICs, and addressing the unique challenges faced by different regions and contexts within LMICs. Additionally, research on the cost-effectiveness and sustainability of interoperable health information systems17,18,19. This paper is available on arxiv under CC 4.0 license. Authors: (1) Prabath Jayatissa, University of Colombo (2) Roshan Hewapathirane, University of Colombo Authors: Authors: (1) Prabath Jayatissa, University of Colombo (2) Roshan Hewapathirane, University of Colombo Table of Links Abstract & Introduction Abstract & Introduction Methodology Methodology Results Results Conclusion & References Conclusion & References 2. METHODOLOGY The review article focuses on the issue of interoperability among health information systems in low and middle-income countries (LMICs). The methodology employed involves a rigorous process that includes several key steps. First, a comprehensive literature review encompasses relevant research articles, reports, and publications from reputable sources. The findings from the literature review are then synthesised to identify common challenges faced by LMICs in achieving interoperability in their health information systems. The challenges identified include a lack of standardisation, fragmented systems, limited resources, and data privacy concerns. These challenges hinder the seamless exchange of health information among different health information systems, leading to inefficiencies and suboptimal health outcomes.Next, the review article proposes strategies to enhance interoperability in LMICs. These strategies are derived from the analysis and interpretation of the literature findings. Proposed strategies include standardisation of data formats and protocols, consolidation of health information systems, investment in health IT infrastructure, and capacity building of health IT professionals in LMICs.Once the strategies are identified, the review article is organised and written, providing a concise and coherent overview of the current state of interoperability among health information systems in LMICs and potential strategies for improvement. The article is then revised and finalised for submission, taking into account feedback from peers and experts in the field. In summary, the methodology for the review article involves conducting a comprehensive literature review, synthesising findings, identifying challenges and strategies, analysing and interpreting results, and writing and finalising the article. The article provides insights into the current state and potential strategies for enhancing interoperability among health information systems in LMICs, to improve healthcare delivery and outcomes in these regions. 2.1. Literature Review Interoperability has been recognised as a critical factor for effective health information exchange and care coordination at the national and international levels1 . In LMICs, achieving interoperability among health information systems is particularly challenging due to various factors. Several studies have identified challenges to interoperability in LMICs, including: Lack of standardisation: LMICs often need morestandardised data formats, coding systems, and terminologies, which hinder the accurate and seamless exchange of health information (AdlerMilstein et al., 2013; Kamadjeu, 2019). This lack of standardisation makes integrating data from different sources challenging, resulting in fragmented and incomplete health information2 Fragmented health information systems: Many LMICs have fragmented health information systems, where different systems are used for different healthcare functions, such as patient registration, electronic health records (EHRs), and laboratory systems, leading to data silos3 . This fragmentation hampers the exchange of data across different systems, hindering interoperability. Limited resources: LMICs often need more resources, including limited funding, technical expertise, and infrastructure, which can pose challenges in implementing and maintaining interoperable health information systems4 .The high cost of health IT infrastructure, such as servers, software, and networking, can hinder achieving interoperability in LMICs. Data privacy and security concerns: Data privacy, security, and consent are critical concerns in health information exchange, and LMICs often lack robust policies, regulations, and safeguards to address these issues effectively5 . This can hinder the sharing of health information among different systems due to concerns about data breaches and misuse. Despite these challenges, several strategies have been proposed to enhance interoperability among health information systems in LMICs. Standardisation: Adoption of internationally recognised health IT standards, such as HL7 and SNOMED CT, can facilitate data standardisation and ensure consistency and accuracy of data exchange6 . Standardisation of data formats, coding systems, and terminologies can enable seamless data exchange and promote interoperability. Consolidation and integration: The integration of fragmented health information systems into a unified health information exchange (HIE) platform can facilitate data exchange and coordination of care7 . Developing national HIE policies and governance frameworks can support the establishment and sustainability of HIEs in LMICs. Investment in health IT infrastructure: Investment in health IT infrastructure, including hardware, software, and networking, is crucial for supporting interoperable health information systems8 .Partnerships and collaborations with governments, non-profit organisations, and the private sector can help overcome resource constraints and facilitate the development of robust health IT infrastructure. Capacity building and training: Capacity building and training programs for the health IT workforce can enhance technical expertise and knowledge in LMICs9 . Training programs can focus on building skills in health IT standards, data management, and interoperability concepts, Interoperability, the ability of different health information systems to exchange and use data seamlessly, is a critical factor for effective health information exchange and coordination of care at the national and international levels10. In LMICs, achieving interoperability among health information systems is particularly challenging due to various factors. Several studies have identified challenges to interoperability in LMICs, including lack of standardisation, fragmented health information systems, limited resources, and data privacy and security concerns11 . Lack of standardisation is a major challenge in LMICs, as they often needstandardised data formats, coding systems, and terminologies, which hinder the accurate and seamless exchange of health information12. Fragmented health information systems, which are used for different healthcare functions, such as patient registration, electronic health records (EHRs), and laboratory systems, must also be improved for interoperability12,21. This fragmentation leads to data silos, hindering data exchange across different systems. Limited resources, including funding, technical expertise, and infrastructure, are often faced by LMICs, which can pose challenges in implementing and maintaining interoperable health information systems13. The high cost of health IT infrastructure, such as servers, software, and networking, can hinder achieving interoperability in LMICs. Data privacy and security concerns are also critical challenges, as LMICs often lack robust policies, regulations, and safeguards to address these issues effectively9,10,11. This can hinder the sharing of health information among different systems due to concerns about data breaches and misuse. Despite these challenges, several strategies have been proposed to enhance interoperability among health information systems in LMICs. Standardisation, such as adopting internationally recognised health IT standards like HL7 and SNOMED CT, can facilitate data standardisation and ensure data exchange consistency and accuracy of data exchange9,21 . Consolidating and integrating fragmented health information systems into a unified health information exchange (HIE) platform can facilitate data exchange and coordination of care10,12,15. Investment in health IT infrastructure, including hardware, software, and networking, is crucial for supporting interoperable health information systems in LMICs7,9,11. Capacity building and training programs for the health IT workforce can enhance technical expertise and knowledge in LMICs, focusing on health IT standards, data management, and interoperability concepts13,14,16,20 Further research is needed to evaluate the impact of these strategies on improving interoperability, identifying novel approaches specific to LMICs, and addressing the unique challenges faced by different regions and contexts within LMICs. Additionally, research on the cost-effectiveness and sustainability of interoperable health information systems17,18,19. This paper is available on arxiv under CC 4.0 license. 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Unraveling Interoperability Challenges in LMIC Health Information Systems

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