Semantic Interoperability of Electronic Health Records: Systematic Review of Alternative Approaches for Enhancing Patient Information Availability

Abstract

Background: Semantic interoperability facilitates the exchange of and access to health data that are being documented in Electronic Health Records (EHRs) with various semantic features. The main goals of semantic interoperability development entails patient data availability and use in diverse EHRs without loss of meaning. Internationally, there are current initiatives that aim to enhance semantic development of EHR data, and consequently, availability of patient data. Interoperability between health information systems is among the core goals of proposal for a regulation on the European Health Data Space and the WHO Global strategy on digital health. Objective: To achieve integrated health data ecosystems, stakeholders need to overcome challenges of implementing semantic interoperability elements. To research the available scientific evidence on the development of semantic interoperability, we defined the following research questions: What are the key elements of and approaches for building semantic interoperability integrated in EHRs? What kinds of goals are driving the development? What kinds of clinical benefits are perceived following this development? Methods: Our research questions focused on key aspects and approaches for semantic interoperability and on possible clinical and semantic benefits in EHR context of these choices. For that purpose, we performed a systematic literature review in PubMed by defining our study framework based on previous research. Results: Our analysis consisted of 14 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. All articles reported clinical benefits of the selected approach to enhancing semantic interoperability. We identified three main categories for this purpose: increasing availability of data for clinicians (n = 6), increasing quality of care (n = 4) and enhancing clinical data use and re-use for varied purposes (n = 4). Regarding semantic development goals, data harmonization and developing semantic interoperability between different EHRs was the largest category (n = 8). Enhancing health data quality through standardization (n = 5) and developing EHR integrated tools based on interoperable data (n = 1) were the other identified categories. The results were closely coupled with the need to build usable and computable data out of heterogeneous medical information that is accessible through various EHRs and databases, e.g., registers. Conclusions: When heading towards semantic harmonization of clinical data, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of health care data. Instead of promoting a single approach, semantic interoperability should be assessed through several levels of semantic requirements A dual- or multi-model approach is possibly usable to address different semantic interoperability issues during development. The objectives of semantic interoperability are to be achieved in diffuse and disconnected clinical care environments. Therefore, approaches for enhancing clinical data availability should be well prepared, thought out, and justified to meet economically sustainable and long-term outcomes. Clinical Trial: N.a.