A semantic interoperability framework for contextualising common standards supporting health information exchange in Uganda's healthcare ecosystem

Abstract

Introduction: Uganda’s healthcare system faces challenges of fragmented data systems, inadequate infrastructure, and limited resources, hindering effective information exchange and care coordination. More than 50 digital health solutions have been piloted in the last decade but have not scaled up, forming fragmented Electronic Health Information Systems. Recommendations including the need for Semantic interoperability standards, and adapting the international standards to the national context have been advanced. This research provides a framework that would provide a structured approach to data exchange, ensuring accurate interpretation and understanding across different systems and settings. Objectives: The study aimed to document semantic interoperability standards and common elements in Uganda's Health Information System (HIS) for Health Information Exchange (HIE) and develop a semantic interoperability framework for contextualizing common standards supporting health HIE in Uganda’s Digital e-health ecosystem. Methods: This research was a case study that used qualitative and quantitative research approaches, with gap analysis to develop a Semantic interoperability framework for contextualizing common standards for health information exchange. A purposive sampling procedure was used, and data collection was done using semi-structured key informant interviews, document analysis, and gap analysis. Data management involved transcription, cleaning, and thematic analysis using Atlas ti software for qualitative data and Excel for quantitative data analysis. Key Findings: The ICD10 and ICD11 are the most adopted semantic standards, other semantic standards adopted vary from system to system, and yet many lack key semantic standards. Notably, developers are adapting to include terminology, ontology, and vocabulary standards. The developers’ and regulators’ ignorance of semantic interoperability standards is making it difficult to develop HIS with semantic interoperability to support data sharing. Conclusion and recommendations: Uganda's digital health sector is making initial progress towards HIE, but interoperability remains limited. Ministry of Health is working on a cohesive multi-electronic medical record systems’ using proprietary and open-source solutions approach. A semantic interoperability framework, data-sharing policies, and stakeholder engagement could enhance Uganda's digital ecosystem, address key issues, and optimize healthcare outcomes.