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The widespread use of electronic health records (EHRs) and healthcare information systems (HISs) has led to isolated data silos across healthcare providers, and current interoperability standards like FHIR cannot address some scenarios. For instance, it cannot retrieve patients’ health records if they are stored by multiple healthcare providers with diverse interoperability standards or the same standard but different implementation guides. FHIR and similar standards prioritize institutional interoperability rather than patient-centered interoperability. We explored the challenges in transforming fragmented data silos into patient-centered data interoperability. This research comprehensively reviewed 56 notable studies to analyze the challenges and approaches in patient-centered interoperability through qualitative and quantitative analyses. We classified the challenges into four domains and categorized common features of the propositions to patient-centered interoperability into six categories: EMR integration, EHR usage, FHIR adaptation, blockchain application, semantic interoperability, and personal data retrieval. Our results indicated that “using blockchain” (48%) and “personal data retrieval” (41%) emerged as the most cited features. The Jaccard similarity analysis revealed a strong synergy between blockchain and personal data retrieval (0.47) and recommends their integration as a robust approach to achieving patient-centered interoperability. Conversely, gaps exist between semantic interoperability and personal data retrieval (0.06) and between FHIR adaptation and personal data retrieval (0.08), depicting research opportunities to develop unique contributions for both combinations. Our data-driven insights provide a roadmap for future research and innovation.

eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.

Health information technology (health IT) has revolutionized health care in the United States through interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and electronic patient access to health information. This study aims to examine progress in health IT adoption and its alignment with the Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP's) mission to enhance health care through data access and exchange. This study leverages data on end users of health IT to capture trends in engagement in interoperable clinical care data exchange (ability to find, send, receive, and integrate information from outside organizations), e-prescribing, electronic public health reporting, and capabilities to enable patient access to electronic health information. Data were primarily sourced from the American Hospital Association Annual Survey IT Supplement (2008 to 2023), Surescripts e-prescribing use data (2008 to 2023), the National Cancer Institute's Health Information National Trends Survey (2014 to 2022), and the National Center for Health Statistics' National Electronic Health Records Survey (2009 to 2023). Since 2009, there has been a 10-fold increase in electronic health record (EHR) use among hospitals and a 5-fold increase among physicians. This enabled the interoperable exchange of electronic health information, e- prescribing, electronic public health data exchange, and the means for patients and their caregivers to access crucial personal health information digitally. As of 2023, 70% of hospitals are interoperable, with many providers integrated within EHR systems. Nearly all pharmacies and 92% of prescribers possess e-prescribing capabilities, an 85%-point increase since 2008. In 2013, 40% of hospitals and one-third of physicians allowed patients to view their online medical records. Patient access has improved, with 97% of hospitals and 65% of physicians possessing EHRs that enable patients to access their online medical records. As of 2022, three-fourths of individuals report being offered access to patient portals, and over half (57%) report engaging with their health information through their patient portal. Electronic public health reporting has also seen an increase, with most hospitals and physicians actively engaged in key reporting types. Federal incentives have contributed to the widespread adoption of EHRs and broad digitization in health care, while efforts to promote interoperability have encouraged collaboration across health care entities. As a result, interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and patient access to health information have grown substantially over the past quarter century and have been shown to improve health care outcomes. However, interoperability hurdles, usability issues, data security concerns, and inequitable patient access persist. Addressing these issues will require collaborative efforts among stakeholders to promote data standardization, implement governance structures, and establish robust health information exchange networks.

The International Patient Summary (IPS) is a minimal data standard enabling rapid access to essential health information across institutions and borders. Korea provides Fast Healthcare Interoperability Resources (FHIR) data through the “My Health Record” application, which utilizes an implementation guide (IG) inheriting from the KR Core FHIR profiles.  However, a standardized workflow for transforming these domestic FHIR resources into IPS-compliant data has not yet been established. This study aimed to assess the feasibility of implementing an IPS-compliant patient summary in Korea using existing FHIR-based resources and national profiles. First, a literature review confirmed IPS as a global standard supporting interoperability and patient-centered care. Second, a gap analysis revealed that six of the seven IPS-required and recommended components successfully mapped to ten KR Core profiles. However, the Device component and the MedicationStatement profile remained unmapped due to the lack of corresponding definitions in the KR Core. Third, real-world FHIR data from three individuals were transformed using ChatGPT-4o into IPS-compatible formats and validated via HAPI FHIR and SMART FRED tools. Fourth, user requirements were identified through personas and expert consultations, highlighting the need for summary and timeline-based UI elements. Fifth, a user interface was developed using Figma based on these requirements. Overall, approximately 86% of required IPS data elements were represented using existing Korean FHIR-based resources. These findings demonstrate the technical feasibility of IPS implementation in Korea, while also highlighting current gaps in terminology coverage and profile alignment. Future work should focus on multi-site validation, increased automation of mapping processes, and governance frameworks to support scalable and reproducible IPS deployment.

Patients and clinicians are equally frustrated by the slow pace of changeThe international movement pushing to increase transparency by giving patients easy access to their health information parallels a broader shift in healthcare towards increased patient empowerment and participation. In the United States, the philanthropic OpenNotes initiative works to increase transparency by encouraging healthcare organisations to provide patients with access to notes in their electronic health record. It began in 2010 as a pilot that included 105 volunteer primary care providers and their 19 000 patients and has since spread throughout the US, with more than 200 organisations offering roughly 41 million patients access to their clinical notes. In Sweden, the first region-wide implementation of patient access to electronic health records was in 2012, more than 10 years after the first pilot study. All 21 Swedish regions have now offered this e-service through a national patient portal that integrates with all electronic health record systems currently used in Sweden. More than 3 million people (>30% of the population) had accessed their records online by August 2019, and more than 2 million logins occur each month. Similar patient accessible electronic record systems are implemented in other countries, though different strategies and approaches have influenced uptake and impact. Progress has been slow because of legal constraints, technical challenges, and concerns or resistance among healthcare professionals. Low rates of adoption among patients have also been a problem in some areas. Nonetheless, research evidence reports positive outcomes among patients accessing their records, and the concerns expressed by healthcare professionals have not been realised. Patients who read their notes report understanding their care plans better, feeling more in control of their care, doing a better job taking their medications, improved communication with and trust in their clinicians, and improved patient safety.

Fast Healthcare Interoperability Resources (FHIR) is an open interoperability standard that allows external software to quickly search for and access clinical information from the electronic medical record (EMR) in a method that is developer-friendly, using current internet technology standards. In this article, we highlight the new FHIR standard and illustrate how FHIR can be used to offer the field of radiology a more clinically integrated and patient-centered system, opening the EMR to external radiology software in ways unfeasible with traditional standards. We explain how to construct FHIR queries relevant to medical imaging using the Society for Imaging Informatics in Medicine (SIIM) Hackathon application programming interface (API), provide sample queries for use, and suggest solutions to offer a patient-centered, rather than an image-centered, workflow that remains clinically relevant.

Correspondence to Dr Alec Petersen, Internal Medicine Residency Program, Brigham and Women's Hospital, Boston, MA 02115, USA; AWPETERSEN@BWH.HARVARD.EDU Introduction Every patient admitted to the hospital, scheduled for a procedure or facing a life-limiting illness potentially confronts a decision about cardiopulmonary resuscitation (CPR). Despite their importance and frequency, resuscitation or code status discussions (CSD) are often not included in broader serious illness conversations (SIC) or ignored altogether.1 CSDs for patients with serious, life-limiting illness should be incorporated into comprehensive serious illness care delivery, which includes discussions about advance care planning and goals of care at every stage of illness; ideally, for most patients, this will occur early in the disease trajectory.1 Yet, even when conversations occur, health systems frequently do not capture code status in an accurate, retrievable, timely and consistent manner.2 Failing to understand, document and act on patients’ preferences may lead to harm, like other medical errors. CPR, cardiopulmonary resuscitation; CSD, code status discussion; EHR, electronic health record; ICU, intensive care unit; MOLST, Medical Orders for Life-Sustaining Treatment. Only one in four patients with incurable metastatic cancer were found to have SICs in the outpatient setting.11 Delayed SICs in patients have significant consequences: unwanted CPR, increased hospital length of stay and unnecessary health costs.3 Of course, inpatient clinicians must revisit patients’ goals and preferences at admission and other key transition points.

Creating a sustainable, patient-centered health care system necessitates integrated supply chains supported by information technologies. However, achieving interoperability among various devices and systems remains a significant hurdle. Our research highlights the need for systematic reviews that address health care interoperability as a holistic knowledge domain. Notably, we observed a lack of studies that outline its structure or develop a comprehensive, high-order facet-based taxonomy from the perspective of supply or value chains. This study aims to address that gap. The primary aim of this study is to elucidate the knowledge structure within the extensive domain of health care interoperability, with an emphasis on trending topics, critical hot spots, and the categorization of significant issues. Furthermore, we aim to model the higher-order elements of a taxonomy for health care interoperability within the context of the health care value chain framework. We used both quantitative and qualitative methodologies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework guided our selection process. We examined 6 databases-Scopus, Web of Science, IEEE Xplore, Embase, Cochrane, and PubMed-focusing on journal articles and gray literature published from 2011 onward. Articles were screened using predefined eligibility criteria. Quantitative bibliometric techniques-including cluster, factor, and network analyses-were applied to explore the structure of the knowledge. A subset of articles was selected for qualitative synthesis using an iterative coding process to develop a higher-order facet-based taxonomy. We identified 370 articles for quantitative analysis. The bibliometric analysis revealed 2 major clusters. Key terms in the first cluster included interoperability, electronic health record, and eHealth-with betweenness centralities of 70.971, 59.460, and 12.000, respectively, and closeness centralities of 0.047, 0.043, and 0.034, respectively. In the second cluster, the most relevant terms were IoT, blockchain, and health care-with betweenness centralities of 6.765, 2.581, and 1.283, respectively, and closeness centralities of 0.034, 0.030, and 0.030, respectively. Factor analysis explained 59.46% of the variance in a 2-factor model, with the first dimension accounting for 36.78% and the second dimension for 22.68%. The qualitative review of 79 articles yielded a taxonomy with 4 higher-order facets: object (what is shared), source (what mechanism is used), ambit (space covered), and content (technology primarily involved). Each facet extended to a third level of classification. The comprehensive domain of health care interoperability, viewed through the lens of a sustainable value chain, encompasses studies that highlight various facets or attributes. These studies underscore the relevance of eHealth within this knowledge domain and reflect a strong focus on 2 key health information technologies: electronic health records and the Internet of Things.

Background mHealth presents innovative approaches to enhance primary healthcare delivery in developing countries like Botswana. The impact of mHealth solutions can be improved if they are interoperable with eRecord systems such as electronic health records, electronic medical records and patient health records. eHealth interoperability frameworks exist but their availability and utility for linking mHealth solutions to eRecords in developing world settings like Botswana is unknown. The recently adopted eHealth Strategy for Botswana recognises interoperability as an issue and mHealth as a potential solution for some healthcare needs, but does not address linking the two. Aim This study reviewed published reviews of eHealth interoperability frameworks for linking mHealth solutions with eRecords, and assessed their relevance to informing interoperability efforts with respect to Botswana’s eHealth Strategy. Methods A structured literature review and analysis of published reviews of eHealth interoperability frameworks was performed to determine if any are relevant to linking mHealth with eRecords. The Botswanan eHealth Strategy was reviewed. Results Four articles presented and reviewed eHealth interoperability frameworks that support linking of mHealth interventions to eRecords and associated implementation strategies. While the frameworks were developed for specific circumstances and therefore were based upon varying assumptions and perspectives, they entailed aspects that are relevant and could be drawn upon when developing an mHealth interoperability framework for Botswana. Common emerging themes of infrastructure, interoperability standards, data security and usability were identified and discussed; all of which are important in the developing world context such as in Botswana. The Botswana eHealth Strategy recognises interoperability, mHealth, and eRecords as distinct issues, but not linking of mHealth solutions with eRecords. Conclusions Delivery of healthcare is shifting from hospital-based to patient-centered primary healthcare and community-based settings, using mHealth interventions. The impact of mHealth solutions can be improved if data generated from them are converted into digital information ready for transmission and incorporation into eRecord systems. The Botswana eHealth Strategy stresses the need to have interoperable eRecords, but mHealth solutions must not be left out. Literature insight about mHealth interoperability with eRecords can inform implementation strategies for Botswana and elsewhere.

Semantic interoperability establishes intercommunications and enables data sharing across disparate systems. In this study, we propose an ostensive information architecture for healthcare information systems to decrease ambiguity caused by using signs in different contexts for different purposes. The ostensive information architecture adopts a consensus-based approach initiated from the perspective of information systems re-design and can be applied to other domains where information exchange is required between heterogeneous systems. Driven by the issues in FHIR (Fast Health Interoperability Resources) implementation, an ostensive approach that supplements the current lexical approach in semantic exchange is proposed. A Semantic Engine with an FHIR knowledge graph as the core is constructed using Neo4j to provide semantic interpretation and examples. The MIMIC III (Medical Information Mart for Intensive Care) datasets and diabetes datasets have been employed to demonstrate the effectiveness of the proposed information architecture. We further discuss the benefits of the separation of semantic interpretation and data storage from the perspective of information system design, and the semantic reasoning towards patient-centric care underpinned by the Semantic Engine.