Proposed framework improves data integration and compliance in resource-limited healthcare settings, highlighting interoperability and EHR challenges.
For smaller healthcare organisations, it is typically an arduous task to realise continuous EHR-system interoperability. Barriers to adoption include budget constraints, lack of technical experts, aged legacy systems, and considerations around compliance with changing healthcare regulations, including the 21st Century Cures Act. The lack of data integration leads to inefficiencies in clinical practice workflows, higher operational costs, and, in extreme cases, medical risks for patients. To overcome these challenges, we present a general-purpose, API-first interoperability framework designed for use in resource-limited healthcare facilities. The framework is built on a five-layer modular architecture, which highlights its support for the Fast Healthcare Interoperability Resources (FHIR) R4 standard and end-to-end HIPAA compliance. The architecture is formed by: (1) an API Gateway Layer performing centralized request routing and protocol mediation; an FHIR Resource Management Layer, providing services for data normalization, terminology, validation; a Security and Compliance Framework providing RBAC, audit logging, and consent management; EHR Integration Adapters to connect with legacy and new APIs; and a Data Governance & Quality Management Layer enforcing data consistency, MDM, and real-time conformance checking.
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Arjun Warrier (2025) studied this question.
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