Abstract
This study aimed to conduct an integrated review and synthesize research studies on the effects of the health system interoperability challenge on healthcare quality. Electronic records are replacing paper records in the worldwide healthcare system’s data storage and documentation processes. Due to the lack of standards and the ongoing development of new technologies, the transformation has posed considerable issues. This poses an argument that healthcare companies are having trouble interoperating because of the complexity and variety of the digital infrastructure. Data for this study was obtained by recruiting 100 volunteer hospital specialists who utilize electronic health records to help clarify how interoperability concerns affect the system’s problems and the meaningful use of information. The study took two months, and the capital city served as the study’s location because it is the busiest and home to hospitals with the most cutting-edge medical equipment. The methodology strongly emphasized observation and experimentation on how the EHR systems function. Six peer-reviewed papers were also used during the study, confirming that interoperability challenges result in the offering of poor-quality services to patients with severe clinical conditions.
Introduction
Electronic records are replacing paper records in the worldwide healthcare system’s data storage and documentation processes. In healthcare, interoperability refers to the prompt and secure integration and use of electronic health data to improve individual and population health outcomes (Ayaz et al., 2021). Healthcare delivery and provision will be substantially impacted by interoperability. This is because healthcare providers can have access to medical data, comprehensive prescription lists, discharges, hospital admissions, lab test results, and healthcare plans thanks to the healthcare system’s interoperability. Healthcare professionals will be able to make the best healthcare decisions with access to this data.
This study aims to explore the challenges that affect the effective utilization of system interoperability in the healthcare sector as well as how challenges in system interoperability affect the quality of hospital services (Gupta et al., 2021). The Health system interoperability challenge has resulted in poor quality healthcare service providers in the US. By making patient information easily accessible upon request, interoperability technologies increase service delivery by enabling practitioners to communicate data in real time.
However, the operational effectiveness of technological systems in the healthcare setting has suffered significantly due to systemic issues. Given the dearth of data on system interoperability problems, research exposing these obstacles is scarce (Gohar et al., 2021). Furthermore, jargonized ideas, such as the one about regulatory restraints that support secrecy and autonomy, are presented in the majority of the literature examining the barriers to system interoperability (Ayaz et al., 2021). These results show that there is still much to be learned about the basic problems influencing the interoperability of sustainable systems. Therefore, this study will benefit healthcare industry stakeholders and interested parties in healthcare delivery issues.
Research Questions
- What challenges affect the effective utilization of system interoperability in the healthcare sector?
- How does the challenge in system interoperability affect the quality of hospital services?
Hypothesis
H0: Challenges in system interoperability affect the quality of hospital services negatively.
Variables and Definitions
The study utilizes dependent and independent variables to explain how each affects the other. In this case, the dependent variable is the system interoperability considering that manipulations of the independent variables can change it. Additionally, the state of system interoperability affects the outcome of this research, considering that the challenge is measured when dependent variables are altered (Younas et al., 2018). The independent variables in this study include all the glitches that affect system interoperability, making it not function properly. Such variables include restricted large data sharing, syntactic web synchronization, and evolving semantic heterogeneity (Younas et al., 2018. These challenges are the independent variables considering that they determine whether system interoperability is functional in the absence or non-functional in their presence.
Independent and dependent variables were selected for this study since the connection on the affective consequence of each variable is easily identified. This process enables the researcher to identify the outcome of their research by simply analyzing the cause-and-effect relationship between the present variable (Younas et al., 2018). For instance, if there is a challenge in accessing information in an EHR system, the probability that system interoperability is affected by either syntactic web synchronization error or change in the system is guaranteed. This factor will enable the research to determine individual issues clogging the system.
Background and Significance of the Study
Effective semantic interoperability enhance the exchange of properly interpreted information within a system. Restrictions on information exchange can be due to limited large data sharing, syntactic web synchronization error, and evolving semantic heterogeneity, affecting operational balance. Healthcare systems experiencing interoperability challenges fail to secure timely access to information, electronic data integration, and poor health outcomes optimization, affecting the quality of care. For instance, delayed access to a patient’s current diagnosis results or medical history could lead to repetitive processes that derail health processes and cause issues such as misdiagnosis to occur. All these flaws indicate that poor interoperability systems can affect the quality of care by delaying health processes.
The study purports that system interoperability is a game changer in enhancing efficiency in healthcare systems. The advantages of effective system interoperability include adaptability, data unity, information security, and few errors (Gohar et al., 2021). Therefore, restrictions on achieving system interoperability indicate that these benefits will be restricted, resulting in delayed processes. For instance, adaptability is whereby systems are automated to share information faster with relevant parties. Adaptability is hindered when the system is affected, affecting the overall functions.
Literature Search
The next stage was to look for papers to get the necessary data after developing the research questions. An adequate search is necessary to determine the scope and search keywords, which are the main ideas of our research questions for getting precise results, to carry out a comprehensive systematic literature evaluation. This study employed several keywords that effectively answered the research questions (Ayaz et al., 2021). This included system interoperability, challenges, effective utilization, and healthcare. System interoperability and challenges were the most effective keyword during the study as they were crucial in matching the target audience’s needs with the material on the website. This, in turn, provided the study with the most accurate data to justify the need to focus on the selected title.
ACM, IEEE Explorer, Springer, Google Scholar, PubMed, and Science Direct were just a few of the main digital health care and computer science databases we searched for publications published between January 2017 and September 2022 (Ayaz et al., 2021). Of the numerous scientific articles we found on this topic that was published, six met our inclusion criteria and were taken for further review. During the selection process, the scope and domains of the papers and where and when they were published were the major factors we considered. Relevant articles from the literature were searched through the named databases and selected data based on the search string. Filtering was then done to remove duplicate articles.
The inclusion criteria were complete system interoperability-related works written in English and published between 2017 and 2022 in peer-reviewed journals. Books, theses (doctoral and master’s), notes, chapters, press reports, informal literature surveys, literature surveys, papers without full-text availability, and articles that discuss topics outside the purview of health care without mentioning system interoperability were among the articles that did not meet the inclusion criteria. All articles that were published in non-English journals or proceedings were removed.
Methodology
The problem’s scope indicates that the research should concentrate on the challenges of the interoperability system and how it impacts quality health. Because each person’s experience with healthcare is unique, the challenges of the interoperability system are distinct for people who work in this field (Svacina and Zvarova, 2021). The frank evaluations of research participants determined how this challenge affects the standard of care. Utilizing a qualitative research approach helped to fully explore and comprehend the topic for the study to be successful. The “why” and “how” of a situation are the main topics of the qualitative method (Renjith et al., 2021), which is the primary purpose of this research. While research should focus on understanding patterns, exploring healthcare theories’ needs, and designing interventions, this analysis will explain why the qualitative research approach is a favorable approach to use in this research.
Qualitative research selects dense description to employ in the study that provides transferable findings which can be used in similar individuals and settings. This description dives into the respondents’ opinions and experiences which are significant for the study. The qualitative approach works best when trying to understand thoughts, feelings, or experiences, which is the main concern of this study (Braunstein, M. L. 2018). It provides a better understanding of improving the problem and not just identifying it. This research approach can illuminate factors in healthcare delivery that impact the quality of care.
The qualitative research design has a flexible structure that can be reconstructed to accommodate the variety of responses from participants. Qualitative research offers a wide range of methods that assist in identifying obstacles and explaining reasons for the lack of improvement. This provides openness through engaging with the respondents since there is no extent or hindrance to the thoughts and views provided. Therefore, the elements of the qualitative research approach focused on how these challenges of interoperability systems impact the quality of health care. This methodology, however could be improved to maximize on reliability and validity of the obtained data. This could be achieved by prolonging the study time and increasing the number of articles used as samples.
Data Analysis
The data obtained during the study was in the form of texts on peoples’ comments as well as observations. Therefore, the narrative type of data analysis was applied in analyzing the obtained data. First, the data was organized and explored to check on patterns and repeated ideas that may emerge. Based on the developing patterns, a set of codes was applied to the data to give it meaning. The codes were then combined and refined into themes identifying recurrent ideas, expressions, viewpoints, and beliefs (Ayaz et al., 2021). The collected themes were gathered and used to answer the research question for the review in a cohesive presentation. Finally, inferences were drawn from the data, and a report summarizing the results was written. The methods used in data analysis were appropriate for the study as the data obtained helped in answering the developed research questions and were in line with the employed methodology.
During the systematic research, a research gap was spotted in one of the articles. There is no sufficient literature focusing on commercial or more technological approaches or solutions to the problem concerning the effects of interoperability challenges on healthcare quality (Braunstein, M. L. 2018). This problem was underexplored due to the short duration of time assigned for the project; hence it could not be addressed in depth. The study was also limited to a small geographical area which limited the views from hospitals in the bigger world which could have probably contributed handsomely to the issue. There were no inconsistencies observed during the study as they all amounted to the same conclusion.
Results
Synthesis and Interpretation
The findings of Ayaz et al., (2021) reveal that even though there are many semantic interoperability concerns in its implementation, the FHIR is an important development. The article recognizes that the heterogeneity of modern technology makes standardization difficult. The conclusion is that it may be needful for multi-sectorial leadership in healthcare to consider selecting one type of technology for use in patient data. The findings of both Gohar et al., (2021) and Braunstein, M. L. (2018) are relevant in providing statistical evidence on the negative impact of interoperability challenges on patients. The papers recognize the negative impact of lack of interoperability on the quality of medical care. The healthcare system needs to adopt a patient-centered health model yet the interoperability issues make it difficult to offer fast and quality care.
In their study, Gupta et al., (2021) indicate that there is pragmatic evidence for using blockchains to alleviate the interoperability challenges. Gohar et al. (2021) found that the challenges of interoperability in healthcare can be resolved by correctly applying the blockchain. The paper is useful as it offers a business perspective on how computer systems used in hospitals can be improved to enable clear, secure, and reliable data. Moreover, the paper shows how to achieve patient-centered interoperability. Therefore, the article provides significant insights into some practical implementation strategies for EHR within an ecosystem. The studies of both Svacina and Zvarova (2021) and Ullah et al., (2017) recognize the use of a recyclable semantic web framework and communicate the same information in three different sentences with the same meaning.
All six studies used qualitative methods of research to analyze the data obtained from the systematic literature review. The method was similarly used for the primary data obtained through interviews and subsequent observations. Ethics in medical research deals with conflicts of interest across various levels. The protection of research participants’ rights, safety, and well-being are at the forefront of ethical concerns in clinical research. In any study, ethical issues govern the research strategy to be used. Qualitative methods are usually preferred since they largely depend on secondary data that does not violate ethical issues. During the study, it is noted that all the articles went for secondary data since it was easily accessible and fast as no ethical issues clearance was required. However, in cases where clearance was needed, compliance with current national and international ethical standards was employed.
Throughout the study, trends in the importance of system interoperability were observed. The six articles aimed at emphasizing the adoption of FHIR and blockchains in healthcare to improve the quality of service provision. During the entire study, secondary data was used and the selection of sources was purely objective. This is because the selection of articles was based on the inclusion criteria where complete system interoperability-related works written in English and published between 2017 and 2022 in peer-reviewed journals were selected.
Findings of the conclusive search reveal that even though there are many semantic interoperability concerns in its implementation, the FHIR and blockchains are an important development. They also point to the fact that lack of interoperability in healthcare affects the provision of healthcare services cumulatively. Adopting interoperability is useful in enhancing adaptability, data unity, information security, and minimizing errors in healthcare recording systems. The main purpose of these studies was to explore and perform a systematic review of the literature related to interoperability, including the challenges, implementation, opportunities, and future applications in improving healthcare services.
This research contributes highly to the healthcare industry and involved stakeholders at large as its adoption results in an effective, reliable, and efficient recording of data in the entire industry. Utilization of secondary data during the process was a feasible option as it was fast, as no ethical clearance was required. However, depending on the source, objectives, and methods, secondary data might show limitations such as a lack of relevance and accuracy. This results in obtaining data that does not answer the developed research questions or objectives. For the six reviewed articles, research involving people and/or animals was done in full compliance with current national and international ethical standards. There were no conflicts of interest declared throughout the studies.
Conclusion
This study provides a systematic literature review regarding the effects of the health system interoperability challenge on healthcare quality. We have explored interoperability-related literature and investigated articles associated with the challenges facing interoperability in healthcare. The thorough literature search confirms that healthcare institutions can enjoy benefits such as adaptability, data unity, information security, and few errors if this study’s findings are considered (Ayaz et al., 2021). The reviewed articles demonstrated clear patterns in the importance of FHIR and EHR, which were borrowed during this study to emphasize the need for adoption to improve healthcare quality.
The study was limited to FHIR-specific issues, not health care as a whole. In this regard, the literature review was limited to works that addressed FHIR and EHR topics. Without particularly evaluating any computer system that mentions EHR in FHIR use, this effort aimed to respond to research questions that were provided for presenting an overview of the current literature connected to the two. Additionally, we narrowed down our search to publications about system interoperability that were published in a range of scholarly journals during a specific time window (Gohar et al., 2021). The scope of this inquiry was restricted to papers chosen from journals and conferences using the systematic literature review methodology’s standard procedures.
The findings obtained at the end of the research were reliable and valid. This is evidenced by their ability to answer the research questions developed before the study. The study review shows that healthcare organizations are facing interoperability challenges due to the complexity and multiplicity of the digital framework. This research employed a systematic review to explore the opportunity, implementation, challenges, and future of Fast Health Interoperability Resources
(FHIR) using electronic health records (EHR). Findings revealed that even though there are many semantic interoperability concerns in its implementation, the FHIR is an important development. It will be useful in enabling organizations to increase their efficiency and minimize administrative costs for manual and faxing operations. The study will also enhance the available knowledge on system interoperability and provide solutions to the challenges facing this field.
References
Ayaz, M., Pasha, M. F., Alzahrani, M. Y., Budiarto, R., & Stiawan, D. (2021). The fast health interoperability resources (FHIR) standard: Systematic literature review of implementations, applications, challenges and opportunities. JMIR Medical Informatics, 9(7), 1-44.
Braunstein, M. L. (2018). Health care in the age of interoperability: the potential and challenges. IEEE pulse, 9(5), 34-36. Web.
Gohar, A., AbdelGaber, S., & Salah, M. (2021). A proposed patient-centric healthcare framework for better semantic interoperability using blockchain. International Journal of Computer Science and Information Security (IJCSIS), 19(11), 26-36.
Gupta, P., Hudnurkar, M., & Ambekar, S. (2021). Effectiveness of Blockchain to solve the interoperability challenges in Healthcare. Cardiometry, 20, 80–88. Web.
Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative methods in health care research. International journal of preventive medicine, 12. Web.
Svacina, S., & Zvarova, J. (2021). Semantic Interoperability in Medicine and Healthcare III. European Journal for Biomedical Informatics, 1 (1), 119-122.
Ullah, F., Habib, M. A., Farhan, M., Khalid, S., Durrani, M. Y., & Jabbar, S. (2017). Semantic interoperability for big-data in heterogeneous IoT infrastructure for healthcare. Sustainable Cities and Society, 34, 90-96.
Younas, M., Jawawi, D. N., Ghani, I., Fries, T., & Kazmi, R. (2018). Agile development in the cloud computing environment: A systematic review. Information and Software Technology, 103, 142-158.