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A TOGAF based interoperable health information system needs assessment for practitioner-patient interaction

July 2023
The Electronic Journal of Information Systems in Developing Countries 89(8)

July 2023
89(8)

DOI:10.1002/isd2.12284

Authors:

Prosper Tafadzwa Denhere

Manicaland State University of Applied Sciences

Ephias Ruhode

University of the West of Scotland

eHealth systems have been created in most developing countries to facilitate the functioning of healthcare operations and as such various healthcare applications are existing as fragmented silo systems. Such autonomous standalone systems do not communicate through a network thereby making it a challenge to share healthcare data. Therefore, to re‐engineer health information systems (HISs) to develop interoperable adaptive enterprise architecture (EA) systems for healthcare, the study aimed to discover and capture healthcare interoperability functional imperatives through understanding the expectations of healthcare practitioners and patients on post‐development of an interoperable HIS. Therefore, the study's aim was to determine the HISs interoperability perceived functional expectations by both patients and practitioners in fulfilling their healthcare receipt and provision needs in an integrated healthcare environment, respectively. The Open Group Architecture Framework (TOGAF) was used as the main study framework to guide the classification of the expectations from the HIS by patients and practitioners deriving the needs from the four domains which are, business architecture (BA), application architecture (AA), data architecture (DA), and technical architecture. The study used interviews and questionnaire surveys to collect qualitative and quantitative data respectively. The study used purposive sampling to select interview participants. A total of 19 interviews were conducted with healthcare practitioners. Questionnaires were collected from 71 healthcare practitioners and 143 patients and analyzed quantitatively respectively to understand the most significant needs anticipated in an interoperable HIS. The research targeted age groups of at least 20 years and above. The study discovered that patients and practitioners expect the interoperable healthcare environment to support the acquisition of disease knowledge through healthcare surveillance synergies; create healthcare awareness through coordinated digital interactions; augmentation of healthcare intelligence for patient‐care through the healthcare knowledgebase; allow treatment collaboration by various healthcare practitioners in the healthcare ecosystem and mostly achieving a guaranteed healthcare system security and assurance environment.

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RESEARCH ARTICLE

A TOGAF based interoperable health information system

needs assessment for practitioner–patient interaction

Prosper Tafadzwa Denhere

| Ephias Ruhode

| Munyaradzi Zhou

Faculty of Applied Science and Technology,

Manicaland State University of Applied

Sciences, Mutare, Zimbabwe

School of Computing, Engineering and

Physical Sciences, University of the West of

Scotland, London, UK

Faculty Commerce, Midlands State

University, Gweru, Zimbabwe

Correspondence

Prosper Tafadzwa Denhere, Faculty of Applied

Science and Technology, Manicaland State

University of Applied Sciences, P. Bag 7001,

Mutare, Zimbabwe.

Email: prosper.denhere@staff.msuas.ac.zw

Abstract

eHealth systems have been created in most developing countries to facilitate the

functioning of healthcare operations and as such various healthcare applications are

existing as fragmented silo systems. Such autonomous standalone systems do not

communicate through a network thereby making it a challenge to share healthcare

data. Therefore, to re-engineer health information systems (HISs) to develop interop-

erable adaptive enterprise architecture (EA) systems for healthcare, the study aimed

to discover and capture healthcare interoperability functional imperatives through

understanding the expectations of healthcare practitioners and patients on post-

development of an interoperable HIS. Therefore, the study's aim was to determine

the HISs interoperability perceived functional expectations by both patients and

practitioners in fulfilling their healthcare receipt and provision needs in an integrated

healthcare environment, respectively. The Open Group Architecture Framework

(TOGAF) was used as the main study framework to guide the classification of the

expectations from the HIS by patients and practitioners deriving the needs from the

four domains which are, business architecture (BA), application architecture (AA),

data architecture (DA), and technical architecture. The study used interviews and

questionnaire surveys to collect qualitative and quantitative data respectively. The

study used purposive sampling to select interview participants. A total of 19 inter-

views were conducted with healthcare practitioners. Questionnaires were collected

from 71 healthcare practitioners and 143 patients and analyzed quantitatively

respectively to understand the most significant needs anticipated in an interoperable

HIS. The research targeted age groups of at least 20 years and above. The study

discovered that patients and practitioners expect the interoperable healthcare

environment to support the acquisition of disease knowledge through healthcare

surveillance synergies; create healthcare awareness through coordinated digital

interactions; augmentation of healthcare intelligence for patient-care through the

healthcare knowledgebase; allow treatment collaboration by various healthcare

practitioners in the healthcare ecosystem and mostly achieving a guaranteed

healthcare system security and assurance environment.

KEYWORDS

eHealth needs, health information system, healthcare interaction, interoperability, TOGAF

Received: 16 March 2022 Revised: 7 May 2023 Accepted: 19 May 2023

DOI: 10.1002/isd2.12284

https://doi.org/10.1002/isd2.12284

1|INTRODUCTION

Interoperability refers to the creation of systems that can communicate and interact through a seamlessly integrated architecture to allow entities

to relate to each other (Katehakis et al., 2018; Zelm et al., 2018). Such a unified architecture allows for the provision of quality-controlled and per-

sonalized collaborated healthcare services from remote locations by practitioners. Lack of interoperability among eHealth care systems hinders

the exchange of information between and among systems which is a challenge in most developing countries like Zimbabwe (Mwogosi

et al., 2022). Therefore, the interoperability challenge among healthcare systems in turn poses information exchange challenges among healthcare

practitioners and patients alike. The motivation to develop an interoperable health information system (HIS) requires an understanding of the sys-

tem user needs to inform a better design procedure (Wang & Zhao, 2019). As a matter of information systems development strategy, the process

of needs assessment goes in line with healthcare system functional requirements engineering (Ware et al., 2017). Functional metrics which should

prevail in interoperable HISs, need to be understood and addressed to create a practitioner–patient enriched healthcare interaction in an interop-

erable healthcare ecosystem.

As a global trend, eHealth systems are being created in most developing countries to facilitate the functioning of healthcare operations in

areas such as patient care, drug administration, and medical examinations thereby creating an environment infested with various healthcare appli-

cations that are fragmented and existing as silo systems. Such independent healthcare systems exist as autonomous standalone systems that do

not communicate through a network thereby making it a challenge to share healthcare data among systems.

To that effect, federal governments are appreciating the need to address such challenges, and therefore, appreciating the need for collabora-

tion and integration of such healthcare systems among healthcare service providers to plan, strategize, implement programs, and share data which

is pivotal to the growth and efficiency of modern-day HISs. Progressively, the trend of HIS evolution around the world is now to re-engineer HISs

to develop adaptive enterprise architecture (EA) systems for healthcare that are interoperable (Yamamoto et al., 2018). HISs interoperability refers

to the creation of a relational distributed database which is a repository of information concerning the integrated systems of care in a computer-

based environment, to record, transform and safely allow sharing of data to privileged users (Hovenga, 2008).

Studies have been conducted on understanding factors that influence eHealth implementation by healthcare professionals (Furusa &

Coleman, 2018; Moxham et al., 2012; Svedberg et al., 2019). However, it is essential to understand the functional healthcare systems' interopera-

bility and societal needs from a patient and practitioner perspective to improve health information coordination quality through capacity building

and redesigning the information collection and dissemination tools in an integrated healthcare participatory ecosystem. Therefore, efforts toward

HISs reforms should be articulated in line with healthcare systems strengthening through interoperability. The study comes in to provide an

understanding of the critical stakeholder needs in creating a practitioner–patient-centric interoperable HIS along the entire vertical healthcare

value chain.

The main aim of the study was to understand the needs and expectations from the creation of an interoperable healthcare ecosystem for

practitioner and patient interaction for the reinforcement of the reengineering efforts of an interoperable Zimbabwean HIS. The research appetite

is, therefore, to understand the functional needs imperative to a sound and efficient healthcare system where healthcare systems, practitioners,

and patients can smoothly interact.

2|THEORETICAL INSIGHTS

2.1 |Related research on HISs interoperability needs

Studies forming the existing literature regarding HIS interoperability from the review findings were targeted at HIS interoperability architecture

designs and deployment strategies. As such, this includes studies targeted at developing system architectures or frameworks for fostering interop-

erability in electronic health record systems (Kouroubali & Katehakis, 2019; Qehaja et al., 2019; Tsegaye & Flowerday, 2021). Many studies reveal

that interoperability study efforts have been carried out but mainly with a focus on system data exchange, practitioner to practitioner interaction

let leaving a gap in practitioner-to-patient or patient-to-patient interaction within an interoperable healthcare system (Bugnon et al., 2021;

Chali, 2019). A study was also conducted to develop a digital information and consultation platform to strengthen HISs but the study did not scru-

tinize the various specific needs of both patients and practitioners interacting in an interoperable environment of healthcare (Chawurura

et al., 2022). Marufu and Van der Merwe (2019) carried out a closely related study that focused on how some healthcare delivery challenges can

be addressed by technology although their study specifically focused on anti-natal care of mothers and their interaction with the healthcare sys-

tem while ignoring the other healthcare patients and service provider needs for a holistic healthcare sector perspective. The creation of an inter-

operable healthcare environment may present challenges that emanate from the healthcare data interactions which should consider various

stakeholder (system users) needs. HIS interoperability allows fragmented eHealth care technologies to integrate electronic records from various

mobile health applications in most developing countries. Sayeed et al. (2020) concurs with the development of HISs Interoperable environments

when they examined how mobile device software applications could be developed by coming up with a framework for functionality encapsulating

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use case scenarios for patients. Their study focused on developers' efforts to develop applications that are compliant with interoperability stan-

dards in collecting patient healthcare data. This study, therefore, makes focus on the patient and device interaction needs; practitioner and device

interaction needs; patient practitioner interaction needs and practitioner and eHealth system interaction needs.

2.1.1 | Security needs

Most e-healthcare data in enterprises is concerned with technical data security issues in utilizing software and ICT hardware and therefore, efforts

should be made in limiting the risk of information security violations in smart healthcare systems (Kobis, 2019; Lu & Sinnott, 2020). In this context,

the security of interoperable e-health systems should be mainly centered on confidentiality, integrity, and availability (CIA) enforcement at the

database engine layer of an EA (Cherdantseva & Hilton, 2013). Figure 1, shows the security needs in a system.

Integrity needs

Integrity is critical in distributed ledger systems since they are characterized by changes and modifications of databases in the health internet of

things (IoT) and hence threaten modifications of patients' records by unauthorized parties (Williams & McCauley, 2016). Integrity ensures that

such changes to the records are done by authorized parties and that their actions do not lead to data loss. Therefore, data integrity in an interop-

erable healthcare ecosystem entails the accuracy and completeness of data without any malicious alterations or modifications (Olaronke &

Rhoda, 2013; Shave, 2018). However, in a distributed healthcare information system, any malicious changes to historical transactions are identi-

fied by honest peers in the distributed ledger databases (Elayaraja, 2020). Moreover, integrity needs in the interoperable HIS are fostered by,

a distributed database, maintained by a consensus protocol run by nodes in a peer-to-peer network. This consensus protocol

replaces a central administrator since all peers contribute to maintaining the integrity of the database (Elayaraja, 2020, p. 21).

Availability needs

Availability of information is mainly threatened by communication network reliability. Denial of service (DoS) attacks due to network conflicts and

other vulnerabilities render service unavailable to seemingly connected applications sharing access to database servers (Bhartiya &

Mehrotra, 2014; Shave, 2018).

Confidentiality needs

Confidentiality entails permitting subsets of participants or organizations to access and handle data while preserving their privacy within their

channels through being part of the great collaborative ecosystem in the Blockchain (AL-mawee, 2012; Androulaki et al., 2018). In healthcare, it is

mandatory to always preserve the confidentiality and privacy of patient data.

On the other hand, “Privacy”refers to the right of patients to prevent their information from being revealed to unintended stakeholders or

fostering individual ownership of data thereby explicitly protecting it from unauthorized access and disclosure (Olaronke & Rhoda, 2013;

Shave, 2018). Therefore, the integration of e-healthcare systems should be implemented in such a way that does not compromise on data

Availability

Assuring the

authorised use of

data in an

case

Integrity

Security

Integrity preventing

malicious or

unauthorised data

modication

Condentiality

preventing

unuauthorised

data access

FIGURE 1 The confidentiality, integrity, and availability (CIA) of security and access model (Shave, 2018).

DENHERE ET AL.3of24

privacy and confidentiality of patient data thereby making it mandatory to preserve and prohibit access to data without the patient's consent

(Bhartiya & Mehrotra, 2014). In as much as security protocols and rules are developed in HISs, confidentiality breaches will always be a threat

in interoperable healthcare systems, and as such adequate authentication measures must be developed and enforced (Tipton et al., 2016).

2.1.2 | Access to information needs

Access to information refers to the anticipated utility of the information that drives someone to retrieve information using ICTs (Shneiderman

et al., 1997). The intent to retrieve information is not only about perceived utility but may also be transactional or navigational procedures

(Barns, 2019). According to Drozdowicz et al. (2016), e-Health data interoperability requires controlled access to health data resources through

autonomously facilitated. Therefore, access to health data, requires policies to be crafted to allow heterogeneous entities to interact through

(Human Computer Interaction) while coming up with semantically enriched policy systems to access control (Jayabalan & O'Daniel, 2016).

Moreover, health patients require unhindered access to their health-related data needs. Different patients have got varying health informa-

tion needs and therefore mechanisms should be put in place to manage the availability and access to both confidential and sensitive health data

for patients. Drozdowicz et al. (2016), identified standard levels of confidentiality and information sensitivity categories to relate to information

about substance abuse; genetic disease; pandemic ailments; psychiatry; gender-based violence; sexual and reproductive health; sickle cell; sexually

transmitted diseases and taboo illness. This further entails the creation of health information libraries to categorize data according to intended

sensitive health inquiries (Riahi et al., 2017). Hence, such sensitive health information should not be accessed by anyone in the health system

but parameters should be crafted in line with access needs identified for privileges to be granted to both patients and healthcare practitioners.

However, some information relating to body parameters like blood pressure and temperature should be made accessible to multiple healthcare

practitioners like nurses, physiotherapists, and many others.

In the same thought complementary to access to patient health records, access authentication needs should be addressed by giving access to

a specific user who claims the right to be recognized by the system (Manikis et al., 2019). Moreover, Rose and Levinson (2004) highlighted that in

some cases the motive for information access may not be to get information but rather to get access to resources. This in turn requires users to

be granted access keys which can be enforced by biometric or other security authentication access tools to meet the needs to access ownership

within interoperable e-health systems. This can be achieved in the healthcare Blockchain which is characterized by sensitive data (Biswas

et al., 2020). Moreover, this can be reinforced through the use of various layers of encryption and the decryption process to protect sensitive data

along the healthcare Blockchain (Maseleno et al., 2020).

2.1.3 | Health information sharing needs

The reality that health systems generate and store large amounts of e-health data emanating from each healthcare encounter creates confined

data silos within the isolated e-health systems which limit information interoperability, hence not meeting the information sharing needs among

healthcare practitioners (Kouroubali & Katehakis, 2019). However, healthcare should exist as an ecosystem and therefore, needs some reorganiza-

tion based on information sharing of citizens in the fast-paced digital world of the IoT.

Resultantly, the sharing ecosystem demands the development of new workflows of information among healthcare organizations necessitated

by the symbiotic and interoperability of the healthcare information systems (Oliveira et al., 2021). Such new workflows require the creation and

operationalization of interoperability standards and legal and regulatory fundamental instruments in which the e-health systems should be devel-

oped (Bourquard & Berler, 2021). These will in turn allow easy e-health systems integration to create a mature HIS model to meet the health

information sharing needs (Gomes & Rom˜ao, 2018).

2.1.4 | Summary of patient/practitioner perspectives

As a way to guarantee the best user experience of the HIS by both patients and practitioners, it is therefore imperative that the user is in a posi-

tion to access or provide access to secondary beneficiaries of his healthcare information as a procedure for medical inquiry for action. Patients

prefer that the healthcare record access ownership lies within the patient who through secondary authentication should grant access to a

healthcare practitioner. Moreover, patients are willing to share their medical data and biospecimens for various healthcare efforts with the assur-

ance that their consent takes precedence above any access right (Chang et al., 2018; Kim et al., 2019). In the same perspective, healthcare pro-

viders appreciate the idea of complimenting each other in medical records creation and thus ensuring successful care coordination of healthcare

service provision (Chang et al., 2018). However, caregivers need to possess standardized eHealth systems with structured medical information

exchange capabilities which allow for smooth interoperability from different vendor-driven HISs and prevent the existence of data heterogeneity

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(Xiao et al., 2021). Overall, both patients and practitioners perceive healthcare interoperability as a facilitator of coordinated healthcare over inte-

grated electronic health records to support reliable and secure medical information access; short time access; reduced costs; transparency, and

better quality of service (Kouroubali & Katehakis, 2019; Simblett et al., 2019). Practitioner consultations by patients are made convenient since

they can now access their health records at any time through web portals thereby improving patient/ practitioner healthcare engagements

(Azarm & Peyton, 2018; De et al., 2021).

2.2 |Conceptual framework

The Open Group Architecture Framework (TOGAF) was in turn used in determining the functional needs of the stakeholders in question to exist

in line with resource needs, business process needs, and hardware and software infrastructure needs that should be looked into to understand

the architectural needs requirements before the commencement of the interoperable HIS design.

TOGAF is an EA approach that was introduced in 1995 based on the United States Department of Technical Architecture Framework. TOGAF

exists as a method that splits the EA of an entity into four domains which are, business architecture (BA), application architecture (AA), data architec-

ture (DA), and technical architecture (TA) (Sajid & Ahsan, 2016). TOGAF is the most used EA framework in designing HISs having been used in coun-

tries like Indonesia, Japan, Iran, Malaysia, Netherlands, and Poland in coming up with EA projects. Accordingly, the researcher adopted the TOGAF

framework for EA design to guide the building of EA theoretical themes since it consists of the TOGAF Architecture Development Method (ADM)

consisting of several phases to follow in building EA (Mei & Andry, 2019; Nugraha, Aknuranda, Andarini, & Roebijoso, 2017). The step-by-step

approach in building EA through TOGAF provides a clear understanding of the business and ICT requirements in the design of EA (Eldein, Ammar, &

Dzielski, 2017). TOGAF has been used as the main approach to the research as it best informs the development of Knowledge-Based HISs by con-

sidering a layered approach to architecture formulation (Bhupesh, 2016). TOGAF was used as the main EA framework to assist as a model that

shaped the research study through its themes. This is because TOGAF assists to shape the study framing on the EA functional themes to derive the

HISs functional expectations from healthcare patients and practitioners alike from the layered approach to architecture existence (Bhupesh, 2016).

TOGAF as a method helped to split the study focus into four domains which are, BA, AA, DA, and TA (Haren, 2011;Sajid&Ahsan,2016). BA of the

interoperable HIS sub-architecture entails a closer look into the practitioner and patient business needs.

Moreover, the motivation toward the usage of TOGAF as an EA approach is that it allows for optimization of data sharing in various situa-

tions and improves overall interoperability of eHealthcare systems as it focuses on various levels of interoperability while solving various integra-

tion challenges such as integrity of information organization, a collaboration of major stakeholders and ensuring integration of healthcare systems

through standards and policies (Lu et al., 2020).

The TOGAF layers mentioned before look at the BA needs, AA needs, DA needs, and TA needs. BA looked into the methods in which the HIS

achieves its objectives thereby taking into account the mission and vision of the healthcare enterprise in meeting patients' and practitioners'

healthcare needs. The needs theory was fused into the analysis of the BA to have a broad understanding of the HIS business environment functional

expectations from the patient and practitioner perspectives. On the other hand, the AA domain is aimed at identifying the user application needs in

the interoperable architecture environment as anticipated by healthcare providers and patients to allow interaction. This sub-architecture dealt with

the kind of data to be shared in the HIS among and between practitioners and patients. This stratum allows for data storage and retrieval by actors

in the interoperable system context, Moreover, the DA was concerned with the data models, metadata dictionaries, standards, and procedures for

healthcare data communication (Neittaanmaki, 2017; Yamamoto et al., 2018). In the end, the technology architecture (TA) was concerned with iden-

tifying the ideal technologies to be used for practitioners' and patients' healthcare interaction and in managing healthcare information. Therefore, the

hardware, software, and network infrastructure that support the different applications is imperative for the proper functioning of an interoperable

HIS (Sajid & Ahsan, 2016). However, more technology infrastructure was viewed as an infrastructure service provider concern to implement interop-

erability standards and protocols to support tertiary expectations of users rather than a user-level operational activity concern.

The adoption of TOGAF as an EA framework however presents its challenges such as the limited availability of evidence on the benefits, chal-

lenges, and primary objectives associated with the usage of EA for developing countries. Moreover, the TOGAF framework in this study was used

in the context of discovering the needs of both practitioners and patients in a layered approach constituting the EA layers within the healthcare

domain which made it a challenge since the literature around its usage in needs assessment was scarce.

Through the framework, practitioner and patients' functional resource needs, healthcare business functional data or process needs, functional

hardware needs, functional infrastructure software, and hardware needs relating to HIS development were investigated through the survey.

2.3 |Summary

The study was therefore carried out to understand the needs using the TOGAF as conceptual framework to derive the various needs which were

then classified according to the themes in the conceptual framework and guide the collection of data; its analysis and results presentation.

DENHERE ET AL.5of24

3|MATERIALS AND METHODS

The study aimed to investigate the HIS interoperability needs of healthcare practitioners and patients alike for the effective functioning of

the parties in a unified healthcare environment. The study was undertaken to determine the HISs interoperability needs and how patients

and practitioners use their digital devices in carrying out healthcare activities in an interoperable environment. The research formed a pre-

liminary study to provide an estimation of the functional conditions and resources that inform the development of interoperable EA for

healthcare in Zimbabwe. The research findings were aimed at addressing various expectations which are pertinent to HIS architecture

development.

A total of 100 and 200 questionnaires were dispatched to both practitioners and patients respectively. The response rate was 71% and

71.5% for practitioners and patients respectively. The research instruments employed in the study included Interviews and questionnaire surveys.

Therefore, questionnaires were collected from 71 healthcare practitioners and 143 patients and analyzed qualitatively and quantitatively to

understand the most significant needs that should be met by an interoperable HIS design. The interviews were used to qualitatively collect data

from healthcare practitioners and analyzed qualitatively while some quantitative questionnaires were analyzed quantitatively. The study used a

mini-Delphi technique whereby it allows rounds of data gathering from a selected sample of participants in a study domain to improve the results

(Pan et al., 1996). Hence the second round of soliciting feedback from the 143 participants who had earlier responded was administered a second

survey to qualify the initial themes quantitatively.

The study used purposive sampling to select interview participants. In this sampling technique, a nonprobability sample of healthcare practi-

tioners was selected based on some special characteristics such as occupation, age, level of education, and experience. Also, each participant was

strictly selected on the condition that he or she is 20 years and above and also attached to a particular healthcare organization or sector. There-

fore, the researchers' judgments shaped the selection criteria on who to include in the population according to relevancy. To that effect, from the

purposeful study population of healthcare practitioners selected, a total of 19 interviews were conducted with healthcare practitioners. The

healthcare practitioners interviewed involved medical doctors, nurses, healthcare administrators, pharmacists, ambulatory technicians, lab scien-

tists, and radiologists. However, the interviewed group included non-healthcare practitioners who directly are involved in the healthcare value

chain such as the IT infrastructure personnel, healthcare ministry personnel, and medical insurance underwriters. The interviews were scheduled

and conducted over Skype and telephone calls due to Covid-19 restrictions. The research targeted age groups of at least 20 years and above

formed the sample.

4|QUALITATIVE RESULTS FROM THE HEALTHCARE PRACTITIONER INTERVIEW SURVEY

Most of the respondents were ready to fully function in an interoperable HIS. However, from the interview analysis, seven operational needs

were identified as enabling factors to the evolution of an interoperable healthcare ecosystem for healthcare practitioners. These needs include

education and training, technical ICT support, motivation, management facilitation support, resource conscientization, confidentiality, and integrity

as depicted in Figure 2and variables discussed in the sections that follow.

4.1 |Business architecture

4.1.1 | Functional resource needs

Functional resource needs were identified to be education, training, and resource conscientization.

Education, training, and resource conscientization

The respondents indicated not to be ready to function and provide services to healthcare patients through interoperable ICT systems and

therefore needed to be trained. The respondents indicated that technical training was needed to equip practitioners with skills of working collabo-

ratively on online interoperable healthcare systems to provide healthcare services. More to this, respondent R5 said,

It is best that the users are trained to understand the systems together with making efficient use of their smart devices. (R5)

However, the respondents R2, R3, R4, R7, and R11 converged to acknowledge that given the skills gap, if systems are developed to be inter-

operable, the government of Zimbabwe through its ministries of Health and Child Care and ICT and Courier Services could facilitate delivery of

training tangent to the technology evolution of online healthcare collaboration in an interoperable healthcare service architecture and provide the

digital devices to various practitioners who may not be able to afford to replenish such devices for work purposes.

6of24 DENHERE ET AL.

4.1.2 | The business functional process needs

The functional business process needs were identified to be access to data resources and motivation together with management facilitation

support.

Access to data resources and motivation

Respondents R6, R9, R11, and R13 highlighted that not everyone is privileged to have access to internet access and hence the praises of ICT in

healthcare service provision should be hinged upon provision of uninterrupted internet connectivity. Practitioners are motivated by the existence

of critical essential devices and consumables to have effective healthcare practice.

Moreover, respondents R10 and R12 indicated that their motivation for practicing using ICT was due to their acceptance of the emerging

technologies and having been established to afford various gadgets and internet connectivity together with their established advanced interna-

tional networks and partnerships which who primarily collaborate through video conferencing and email. Respondents R10 said,

It is enriching to have an environment where you can reach out to your patient, colleagues and strategic partners together with

the ability to access healthcare records in a seamlessly connected world where patients can also be actively engaged by service

providers. (R10)

Respondents R1, R3, and R5 were conserved in showing motivation to use ICT to collaborate in patient care. Mainly this was due to

contributory factors such as doing real-time remote services thereby making them always in working mode even during vacations and the fact

that some patients will not afford to be virtually attended to due to their failure to afford broadband connectivity. Respondent R3 said,

The idea of online services in healthcare does not seem to be always positive to us since it will always be spamming your device

with messages and puts you in a work environment mode even when you prefer to be on vacation. (R3)

Another factor was that some respondents were of the view that the government has no policies that guarantee support of an interoperable

healthcare ecosystem and therefore felt that their working domain was not protected since the terms of practice were not spelled out from a

policy perspective. Respondent R1 said,

Let the government come in first to lead the initiative through policy and then level the practicing field through a framework that

governs every player in the sector. (R1)

In this section, it was established that some respondents were motivated and willing to collaboratively provide healthcare services through

ICT to patients. Motivational factors were noted as being the ability to collaborate as healthcare practitioners in providing services to patients

Educaon &

Training

Technical ICT

support Movaon

Management

Facilitaon

Support

Resource

Consienzaon Conﬁdenality Integrity

FIGURE 2 Underlying functional needs necessary for practitioner–patient healthcare smart digital interaction. Source: Author.

DENHERE ET AL.7of24

who actively can afford to exist as the healthcare-centric unifier. Another motivational factor was the ability to afford gadgets and internet con-

nectivity. Conversely, respondents were demotivated by the lack of policy to protect their operational domain and fear carrying the service provi-

sion prowess everywhere they go since the service will be linked to the mobile device in some instances.

Management facilitation support

The respondents concurred on the need for line ministry and management support to the efforts to collaboratively co-practice in ensuring seam-

less patient care through ICT. The respondents consider the government as the prime enabler in the championing of an interoperable healthcare

architecture where various healthcare service providers can be unified for the primary cause of patient cares through ICT. Therefore, the govern-

ment should take a pivotal role in supporting the creation of a National HIS by motivating various stakeholders who are major entities in the HIS

model by providing a policy framework, financial and technical resources, infrastructure, and the strategy for operational implementation.

Healthcare Practitioner R11 said,

Doctors should be given incentives for working collaboratively on digital healthcare platforms and also avail them with resources

to access those e-health systems. It is not fair that you would expect me to use my funds to buy internet bundles and use my

devices which can be very expensive not to conservatively use since healthcare services do not require shortcuts. (R11)

4.2 |Application architecture

Questions were asked to practitioners on whether their systems interact with other systems to collaborate their medical roles in the country.

Respondents R31 and R32 argued that different healthcare organizations have got different service provision needs and therefore have created or

developed their own eHealth systems (software applications) with different interfaces and that will present a challenge in trying to integrate the dif-

ferent applications' databases emanating from different records and record fields of software applications. Respondent R31 mentioned that,

Many healthcare service providers are using software applications that are not standardize and therefore, capture information dif-

ferent with different interfaces offering unique fields to capture healthcare data which creates heterogeneous medical records

among practitioners' systems. (R31)

4.3 |Data architecture

HIS Interoperability elements, enterprise data, and technology are discussed in this section analyses to discover the interoperability elements of

the healthcare sector. The respondents were asked the following questions in the interview sessions,

1. Do you record any medical data or patient data on any electronic platform for collaborative healthcare or integrated healthcare information-

building purposes?

2. When diagnosing, collecting, and recording patients' healthcare data, do you consider any information recording standards mechanisms or uni-

versal protocols?

a. Which other content formats would you consider?

b. Which resources or tools would you require for you to achieve that?

86.5% of the respondents highlighted that they were potential sources of primary healthcare data except for respondents R16, R17, R31, and

R32 who existed as supporting units of the tertiary healthcare services such as ICT support and healthcare policy administration. However, the

respondents who are involved in primary healthcare coincided to say that they only record patient healthcare data in paper files except for phar-

macists who are respondents R10, R11, R12, R13, R14, and R15. Respondent R14 said

At this pharmacy, once you come in as a new patient to buy your drugs with a prescription using your medical aid card we capture

your details in our computer system. Actually, before that, we register all your fingerprints for our biometric security scanning

which in turn are linked to your medical aid service provider system for authentication. (R14)

On the other hand, most medical doctors are not using any computer systems to build electronic data for future systems interoperability. The

actions of laboratory practitioners, radiographers, and nurses are fragmented and enshrined in paper files which can only be accessed by the same

practitioners within the organization unless when referrals occur. Respondent R20 said,

8of24 DENHERE ET AL.

When we attend to a patient here at a ward clinic, we may refer a patient to a district hospital at that is when we can provide clini-

cal notes to the district hospital but not through the internet. (R20)

4.4 |Technology architecture

The reality that the healthcare business environment is mainly reliant on intensive information from big data sets compounding from various

medical domains like diagnostics, medical exam results, medical insurance, imaging, and other patient records renders e-health standardiza-

tion an essential phenomenon in healthcare. The possibilities of sharing data across the entire healthcare value chain within and among

healthcare entities to provide a patient-centric healthcare ecosystem. Standardization becomes imperative as it allows for quick, timely

access and information which is reliable in aiding patient care. Interoperability technology elements included, Electronic Data Interchange;

the HL7 v-3; COBRA; Distributed healthcare environment; Web-services; DICOM; Statistical Data and Metadata Exchange Health Domain

(SDMX-HD); SNOMED-CT; ISO 21090:2011 (Harmonized data types for information interchange). The healthcare supply chain shares simi-

lar business-to-business integration of processes with other industries such as the manufacturing and distribution industries though contex-

tual differences may exist.

4.4.1 | Functional software and hardware infrastructure needs

The software and hardware infrastructure needs suggested were discovered to be technical ICT interaction support, confidentiality, and integrity.

Technical ICT interaction support

Respondents R2, R4, R6, R7, R8, R10, and R11 showed consensus in sharing sentiments that the evolution and usage of ICT are essential in the

provision of effective healthcare. However, the respondents concurred that induction and training on the usage of new technology was critical.

Respondents R4 and R10 indicated that service provision through technology would be very effective if practitioners would work as teams in pro-

viding healthcare services. The respondents further argued that medical specialists such as surgeons and physicians should work along with medi-

cal technologists and ICT systems engineers to ensure flawless service provision.

Confidentiality

Generally, all respondents came to zero in on security issues relating to gaining confidence in the interoperable HIS for both service providers and

patients alike. Privacy of healthcare data needed to be the overall security issue since patient data should be treated as sensitive information that

requires maximum security and only be accessed by authorized participants in the architecture. Respondents R1, R2, R5, R6, R7, R8, R10, R11,

R13, R16, R17, and R19 all mentioned privileges and granting of access rights controls for the collaboration to earn confidence from various

players in the ecosystem.

Particularly, respondent R19 had this to say,

That looks to be a good initiative for healthcare practitioners to collaborate on patient data, but there is a need to make sure mea-

sures are put in place to ensure that there is trust in the system, especially about who can access, who grants access permission

and how is data accessed in the system. (R19)

Integrity

As part of systems data security in line with integrity, respondents R10 and R17 emphasized the need for data records to be safeguarded from

malicious alterations and for alterations to be tracked and attributed to specific actors. Respondent R17 said,

Audit trails can help achieve transparency in the activities of all practitioners active on a certain record, therefore, all players are at

least accountable for their actions in the collaborative workmanship centered on trustworthiness and accountability of individual

actions. (R17)

Resultantly, this implies that the operational model of healthcare service collaboration should be hinged upon the provision of secure

and trustworthy procedures that foster privacy while guaranteeing the protection of patient data coupled with ensuring that it is not

accessed or changed by any malicious intent. Security, therefore, remains one of the major enablers to successful eHealth systems imple-

mentation lest the whole intentions fail from lack of a robust security strategy. To conclude the interview findings are summarized in

Figure 2, which follows.

DENHERE ET AL.9of24

4.5 |Summary

The data was gathered reported under four domains of TOGAF and underlying functional needs identified as applications needs, business needs,

technology needs and data/information needs. Such included education and training, technical support, security, and motivation.

5|QUANTITATIVE RESULTS FROM QUESTIONNAIRE SURVEY

The questionnaire results were obtained from 143 patients for patient surveys and 71 healthcare practitioners for practitioner surveys. The

results are presented in Sections 5.1 and 5.2.

5.1 |Patient survey results

The gathering of the data was guided by the following research question which is, “What are the patient and healthcare practitioner needs regard-

ing HIS EA interoperability?”Qualitative data was collected through a survey of patients.

The study ascertained the general healthcare needs of patients which are displayed in Figure 3.

The most prevalent general healthcare needs of patients were observed and withdrawn from those who answered strongly agree to needs

that formed the highest frequencies. These included medical center facilities list (68%), medical time alert (60%), medical review alert (55%), out-

break awareness alert (54%), drug administration instructions (48%), medical aid payment alert (46%), and medical exam results (42%) and these

topped the list.

Patients were asked the first question relating to their general digital information needs and responses were derived from the question,

“In your day-to-day life, what general healthcare information-sharing activities you would carry out on your device?”Responses were obtained

from a total of 143 patients and the data obtained from the questionnaire scripts were analyzed qualitatively and 16 themes of patient digital

healthcare information-sharing needs were withdrawn. The patient (activities) needs are displayed in Table 1.

The 16 themes derived from the initial qualitative analysis were then used to develop a closed ended questionnaire which was then

dispatched to withdraw responses from the 143 patients on the question, “How often would you engage in the following healthcare digital device

activities on a Likert scale ranging from 1 to 5 where 1 represents not applicable and 5 represents very often?”The questionnaires responses

were then analyzed quantitatively to derive the digital activities frequency results displayed as a percentage of (N) responses representing the

population per Likert scale.

0 20406080100120

Medicaon me alert

Medical review alerts

Medical aid payment alert

Outbreak awareness alerts

Medical exam results

Medical social discussions

Occupaonal healthcare alerts

An-natal care advice

Neo-natal care advice

Drug administraon instrucons

Medical images

Medical videos

Medical centre facilies list

Medical aid statement/ report

Paent Needs

Strongly disagree Disagree Undecided Agree Strongly Agree % of Paents

FIGURE 3 Patient general healthcare information needs. Source: Author.

10 of 24 DENHERE ET AL.

Figure 4shows the frequency results on the importance of patients' information-sharing activities (needs) on a graph. The results in Figure 4

represent the perceived importance of the healthcare information needs based on the Likert scale measurements. The information-sharing activi-

ties that scored the most responses on the Strongly Agree category were then considered to be the most important needs and are therefore priori-

tized on the list. The inverse is true for the needs that shed the least importance.

The results displayed in Figure 4, show that the leading five activity needs that patients view to be important for healthcare communication

relate to medication information access. The five most prevalent information-sharing activities represented by “Strongly Agree”were medical cen-

ter facilities list (68.31%), medication time alerts (60.49%), medical review alerts (55.14%), outbreak awareness alerts (53.91%), and drug administration

instructions (48.15%). Four of the top five information-sharing activities have frequencies above 50% while the fifth one is close to 50% with a

48.15%. The perceptions of patients in accessing the healthcare information needed on the Likert scale are distributed across the scale but with

more scores toward viewing them as important. Hence, patients viewed healthcare digital information sharing access as important.

Looking at the results displayed in Figure 4, the perceived frequency of accessing the needs is directly related to the perceived importance of

the healthcare digital information communication activity. For example, all the top five frequency results from the two comparisons are greater

than 50% except for Drug administration instructions with 48.15%. Drug administration instructions had a less than 50% because it is the only activ-

ity that can be tied to a drug dispensary at a pharmacy which cannot be an online activity. Since the drug dispensary has to be purely physical,

TABLE 1 General patient needs.

General patients' digital activities

1. Search the internet for healthcare news or medical information

on emerging events

2. Search the internet to approve or disapprove of certain viral

perceptions or suggestions check the mail

3. Search the internet for medical diagnosis 4. Search the internet for special and epidemiological data

5. Use the internet to inquire about medical financial cover 6. Use the Internet to communicate with a healthcare provider/

patient

7. Go to TV websites and watch medical videos online 8. Check mails

9. Reply to your emails 10. Record a video or audio file

11. Download documents 12. Chat with colleagues or medical care providers or patient

13. Create awareness through online campaigns 14. Marketing and brand promotion

15. Articulate research activities 16. Online collaboration and engagement

Source: Author.

0 20406080100120

Medicaon me alert

Medical review alerts

Medical aid payment alert

Outbreak awareness alerts

Medical exam results

Medical social discussions

Occupaonal healthcare alerts

An-natal care advice

Neo-natal care advice

Drug administraon instrucons

Medical images

Medical videos

Medical centre facilies list

Medical aid statement/ report

Importance of informaon sharing acvity frequency

Strongly disagree Disagree Undecided Agree Strongly Agree

% of paents

Informaon sharing acvity

FIGURE 4 Frequency of information sharing activity (needs) importance by patients. Source: Author.

DENHERE ET AL.11 of 24

patients find no need of accessing Drug administration instructions online which are usually prescribed on the drug's packaging at the dispensary.

Therefore, the need does not achieve a high frequency of access.

In summary, the patient survey conducted ranked digital device needs according to the frequency of access and their importance. The

results from data analysis revealed that the perceived frequency of access is directly related to the importance of the need perceived. In that

context, the needs that score high frequencies are imperative in addressing information-sharing challenges, collaboration, and interoperabil-

ity of healthcare functions in a HIS. Patients who require remote medical attention outside the premises of a healthcare facility would

require efficient and reliable access to medical attention and resources. Such resources include medical facilities information, outbreak

awareness, medical diagnosis, medical exam results, and medical coverage information. Patients also indicated the need to receive medical

alerts on their digital devices such as medication time alerts, medical review alerts, occupational healthcare alerts, and medical aid payment

alerts. In times such as a pandemic outbreak, medical practitioners may be physically distant from patients and or overwhelmed such that

digital resources may replace their absence or reinforce their presence through a collaborative digital environment that is seamlessly an

abstract of the real environment but rather a virtual reality.

The study went on to find out about the activities conducted by patients on their digital devices shown in Table 2.

The digital activities that patients carry very often include chat with colleagues (50%), record video or audio (37%), download documents

(33%), medical research (31%), check emails (26%), and replying emails (26%) results which represent a 20% and above frequency.

5.2 |Practitioner survey results

Practitioners were asked to rank the needs according to their importance on a scale ranging from 1 to 5, where 5 represented Very important and

1 represented Not important. The question was presented as, “Consider the following healthcare interoperability needs of practitioners as shown

in the table below. You are required to rank the needs variables according to the importance of each on a scale range of 1 to 5 regarding the crea-

tion of an interoperable environment for the ZHIS.”Table 3displays the results of practitioners' responses to the questions asked. Results are

shown as a percentage of total responses (N) of the population per Likert scale.

The analysis results display the perceived importance from the views of practitioners in terms of their needs measured on a Likert scale.

The needs which scored the highest frequency responses indicating the Very Important option suggested the needs to be considered the

most important. The inverse is true to suggest the least important needs. The results are displayed in Table 3.

TABLE 2 Frequency of use by patients' digital device activities.

Healthcare activity

Not applicable Never Seldom Often Very often

% of Total N% of Total N% of Total N% of Total N% of Total N

Healthcare news 26% 63 7% 18 47% 113 16% 38 5% 11

Validate viral perceptions 24% 59 5% 11 15% 37 41% 99 15% 37

Medical diagnosis 22% 53 6% 14 49% 119 16% 38 8% 19

Epidemiology 26% 63 63% 154 7% 18 2% 5 1% 3

Inquire about medical cover financial cover 25% 60 11% 27 30% 74 23% 56 10% 23

Provider/patient liaison 26% 63 38% 93 34% 83 1% 3 0.00% 0

Medical videos 26% 63 20% 48 38% 92 11% 27 5% 13

Collaborate on surgical procedure 26% 63 74% 180 0% 0 0.00% 0 0.00% 0

Send medical notes 26% 67 72% 176 0% 0 0.00% 0 0.00% 0

Radiological\laboratory results 26% 63 74% 180 0% 0 0.00% 0 0.00% 0

Check mails 26% 62 15% 36 9% 23 24% 58 26% 63

Reply to your emails 26% 63 16% 38 9% 21 24% 58 26% 63

Record a video or audio file 7% 16 6% 15 5% 11 46% 112 37% 89

Download documents 20% 49 2% 6 4% 9 40% 97 33% 81

Chat with colleagues 26% 63 3% 8 12% 29 15% 36 50% 121

Healthcare campaigns 26% 62 44% 108 20% 49 7% 16 3% 7

Brand promotion 25% 60 48% 116 14% 34 8% 19 5% 11

Medical research 26% 63 4% 10 12% 29 27% 65 31% 76

Collaboration 26% 63 47% 114 10% 24 11% 26 7% 16

12 of 24 DENHERE ET AL.

From the results, it can be noted that the five most important needs that practitioners consider to be important for healthcare interoperability

relate to healthcare information security needs which are availability and Access assurance (96%), real-time service assurance (93%), identifying and

sharing medical resources (87%), integrity validity and reliability of healthcare data (69%) and confidentiality assurance (61%). However, even though

the need to identify and share medical resources (87%), is not related to information security, the need scored high enough to be among the most

important needs perceived by healthcare practitioners as being more important than some other security needs. This can be attributed to the fact

that practitioners perceive the identification and sharing of medical resources as a critical activity that needs to exist as a prerequisite activity that

allows the other security functions to become and exist as needs.

Furthermore, Table 3, also shows the least important needs for healthcare interoperability to be, Finding support or work groups/ partnerships

(11%), Knowledge management (13%), and Book appointments (17%). Storing information (21%) and Sharing X-rays,Radiology or Lab results,clinical

notes, etc. (23%).

Considering some of the needs perceived to be least important such as Book appointments and finding support work groups it can be assumed

that such resources do not provide much medical information support for patient care and healthcare practitioners may have discovered that

some of the needs could still be met outside an interoperable HIS in their isolated conventional healthcare service systems.

For the “Importance of Interoperability Needs”theme, variables were tested for internal consistency and the Cronbach's alpha coefficient

was α=0.872, which indicates a very high level of internal consistency for the scale in this specific theme. The reliability statistics to display the

Cronbach's alpha is shown in Table 4.

TABLE 3 Practitioner interoperability needs metrics for eHealth care.

System interoperability practitioner functional

metrics

Not important 2 3 4 Very important

N1 % of Total N2 % of Total N3 % of Total N4 % of Total N5 % of Total

1. Sharing x-rays, radiology, or lab results, clinical

notes, etc.)

0 0% 0 0% 2 3% 53 75% 16 22%

2. Storing information 0 0% 0 0% 18 25% 38 54% 15 21%

3. Expert advice and decision support 0 0% 1 1% 6 8% 45 63% 19 27%

4. Collaborate on a patient record 0 0% 0 0% 2 3% 33 46% 36 51%

5. Contacting, tracing, and communication 0 0% 2 3% 15 21% 22 50% 32 45%

6. Education and training 1 1% 0 0% 4 7% 38 53% 28 39%

7. Collect and monitor case information 0 0% 3 4% 13 18% 36 51% 19 27%

8. Finding support or work groups/partnerships 1 1% 2 3% 28 39% 32 45% 8 11%

9. Monitor healthcare conditions 2 3% 1 1% 13 18% 34 48% 21 30%

10. Monitoring and evaluation of pandemic and

epidemiology (spatial dynamics in GIS)

0 0% 1 1% 14 20% 31 44% 25 35%

11. Track health funding and performance 1 1% 3 4% 19 27% 28 39% 20 28%

12. Book appointments 0 0% 0 0% 14 20% 45 63% 12 17%

13. Prescription and drug administration 2 3% 5 7% 16 23% 21 30% 27 38%

14. Crowdsourcing and data aggregation 1 1% 4 6% 18 25% 21 30% 27 38%

15. Create awareness 0 0% 0 0% 13 18% 31 44% 27 38%

16. Handle referrals 0 0% 1 1% 5 7% 31 44% 34 48%

17. Mortality statistics 4 6% 9 13% 17 24% 21 30% 20 28%

18. Identifying and sharing medical resources 0 0% 0 0% 0 0% 9 13% 62 87%

19. Augment patient self-care 0 0% 0 0% 12 17% 27 38% 32 45%

20. Knowledge management 6 8% 13 18% 16 23% 27 38% 9 13%

21. Healthcare intelligence and indicators 0 0% 3 4% 16 23% 22 31% 30 42%

22. Aiding data analytics 1 1% 2 3% 18 25% 20 28% 30 42%

23. Confidentiality assurance 0 0% 0 0% 0 0% 27 38% 44 62%

24. Integrity validity and reliability of

healthcare data

0 0% 0 0% 3 4% 19 27% 49 69%

25. Availability and access assurance 0 0% 0 0% 1 1% 2 3% 68 96%

26. Real-time service assurance 0 0% 0 0% 2 3% 3 4% 66 93%

DENHERE ET AL.13 of 24

5.2.1 | Importance of interoperability needs by practitioners

The tables below show labels that were used in place of actual variable names to run the analysis. The analysis tables will display the labels in

place of the actual variables and the variable key is shown in Table 5.

The item-total statistics is shown in Table 6.

Observations from Table 6suggest that the removal of variables INP_12 and INP_25 would result in a higher Cronbach's alpha. Therefore,

the removal of the above-mentioned variables would lead to an improvement in Cronbach's alpha. We, therefore, considered removing these two

variables in subsequent analysis.

The variance explained is shown in Table 7.

Table 7shows a selection of six components whose Eigenvalue was at least 1. It, therefore, suggested that the 23 variables under the

“Importance of Interoperability Need”question measure 6 factors encapsulated in this question. The six variables selection was made since their

Eigenvalues were greater or equal to 1. However, the other factor components with low-quality scores failed to portray real traits to our

questions. The components are shown in the screen chart in Figure 5.

The scree plot shows the Eigenvalues and from the plot, six components have Eigenvalues greater than 1. These then represent the “strong

factors”considered for analysis. From component 6 and beyond, the Eigenvalues significantly fell thereby dropping.

The components were analyzed using Varimax rotation and the results are displayed in Table 8. The components that are greater than 0.5

represent strong factors and therefore are selected to derive the underlying factor within them.

Our rotated component matrix in Table 8shows that our first interaction need component is measured by the following needs variables:

1. IINP_6―Training

2. IINP_5―Contact tracing

3. IINP_9―Monitor conditions

4. IINP_10―Epidemiology

5. IINP_7―Monitoring cases

6. IINP_8―Partnerships

7. IINP_11―Track funding

8. IINP_4―Collaboration.

The initial component variables all relate to training, disease surveillance, funding, and partnership collaborations. Therefore, we interpret compo-

nent 1 as “Disease knowledge and surveillance Synergies.”This is the underlying trait measured by IINP_6, IINP_5, IINP_9, IINP_10, IINP_7, IINP_8,

IINP_11, and IINP_4. The argument for encapsulating all the components under the underlying trait is that knowledge of diseases and surveillance

involves proper training to identify diseases from contact tracings to monitor cases and conditions through healthcare partnerships and collaborations

for epidemiological purposes supported by proper funding and accounting structures. Disease knowledge is achieved through training, epidemiology,

and partnerships collaboration. Moreover, surveillance synergies emanate from contact tracing, monitoring conditions/cases, and funding.

Our rotated component matrix is shown in Table 8also suggests that our second interaction need component is measured by the following

variables:

1. IINP_15―Create awareness

2. IINP_16―Handle referrals

3. IINP_17―Mortality statistics

4. IINP_14―Crowd sourcing

5. IINP_20―Knowledge management

6. IINP_18―Sharing resources.

From the analysis, we figure out that all these variables relate to awareness, handling referrals, statistics, crowdsourcing, and resource sharing.

Therefore, we interpret component 2 as “Healthcare Awareness and Coordination”. This is the underlying trait measured by IINP_15, IINP_16,

TABLE 4 Reliability statistics.

Reliability statistics

Cronbach's alpha Cronbach's alpha based on standardized items Nof items

0.872 0.877 25

14 of 24 DENHERE ET AL.

IINP_17, IINP_14, IINP_20, and IINP_18. The argument for encapsulating all the components under the underlying trait “Healthcare Collaboration

and Coordination”involves communicating healthcare information and harnessing information for healthcare knowledge.

Moreover, our rotated component matrix displays that our third interaction need component is measured by the following variables:

1. IINP_21―Healthcare indicators

2. IINP_22―Data analytics

3. IINP_19―Patient self-care.

The observation is that these variables all relate to healthcare indicators, data analytics, and patient self-care. deductively, we can interpret

component 3 as “Healthcare intelligence for patient care”. This is the underlying trait measured by IINP_21, IINP_22, and IINP_19. The three vari-

ables converge to process various healthcare parameters to allow for patient self-care to support self-care decision support.

Concerning our rotated component matrix in Table 8, we observe that our fourth interaction need component is measured by the following

variables:

1. IINP_2―Storing

2. IINP_3―Advice

We observe that these variables all relate to storing and advice. Therefore, we interpret component 4 as “Healthcare knowledgebase.”This is

the underlying trait measured by IINP_2 and IINP_3 which point toward building a knowledgebase for advice by storing various cases for inference

to give ideal advice to patients' self-service portal.

TABLE 5 Variables key.

Importance of eHealth system interoperability needs (practitioner)

Sharing IINP_1

Storing IINP_2

Advice IINP_3

Collaboration IINP_4

ContactTracing IINP_5

Training IINP_6

MonitoringCases IINP_7

Partnerships IINP_8

MonitorConditons IINP_9

Epidemiology IINP_10

BookAppointments IINP_11

TrackFunding IINP_12

Prescriptions IINP_13

CrowdSourcing IINP_14

CreateAareness IINP_15

HandleReferrals IINP_16

MotalityStatistics IINP_17

SharingResources IINP_18

PatientSelfCare IINP_19

KnowledgeManagement IINP_20

HealthcareIndicators IINP_21

DataAnalytics IINP_22

ConfidentialityAssurance IINP_23

IntegrityReliability IINP_24

AccessAssurance IINP_25

RealtimeService IINP_26

DENHERE ET AL.15 of 24

We can also pick our fifth interaction need component from the rotated component matrix in table which is measured by the following variables:

1. IINP_1―Sharing

2. IINP_13―Prescriptions

The variables shown relate to sharing and prescriptions. Therefore, we interpret interaction need component 5 as “Treatment collaboration.”

This is the underlying trait measured by IINP_1 and IINP_13 which compound to build cases of shared prescriptions from various practitioners'

cases to build a knowledgebase for e-prescriptions for patients This entails the derivation of common traits from the shared prescriptions to

abstract a collaborated patient treatment scenario.

Our rotated component matrix in Table 8shows that our sixth interaction need component is measured by the following variables:

1. IINP_26―Real-time service

2. IINP_24―Integrity reliability

We further observe that the variables shown relate to real-time service and integrity reliability. Therefore, we interpret component 5 as

“System security and assurance.”This is the underlying trait measured by IINP_26 and IINP_24 which point to real-time patient/practitioner

consultations without breaching any security protocols in patient care. Patients are assured of promptly reliable healthcare service while

observing their privacy and confidential concerns.

TABLE 6 Item-total statistics.

Item-total statistics

Variable

Scale mean

if item deleted

Scale variance

if item deleted

Corrected item-total

correlation

Squared multiple

correlation

Cronbach's alpha

if item deleted

IINP_1 99.8451 92.047 0.329 –0.870

IINP_2 100.0704 90.638 0.309 –0.870

IINP_3 99.9296 88.695 0.485 –0.866

IINP_4 99.5352 89.424 0.513 –0.866

IINP_5 99.8592 84.723 0.610 –0.861

IINP_6 99.7183 87.777 0.574 –0.864

IINP_7 100.0141 86.614 0.528 –0.864

IINP_8 100.4085 85.759 0.606 –0.862

IINP_9 100.0282 87.113 0.433 –0.867

IINP_10 99.8732 88.455 0.422 –0.867

IINP_11 100.1549 85.876 0.501 –0.865

IINP_12 100.0563 93.168 0.136 –0.874

IINP_13 100.0986 86.604 0.370 –0.870

IINP_14 100.0563 85.882 0.446 –0.867

IINP_15 99.8169 88.695 0.427 –0.867

IINP_16 99.6479 88.774 0.458 –0.866

IINP_17 100.3944 82.357 0.522 –0.865

IINP_18 99.1690 91.771 0.484 –0.868

IINP_19 99.7465 87.592 0.505 –0.865

IINP_20 100.7465 81.449 0.589 –0.862

IINP_21 99.9155 87.678 0.393 –0.868

IINP_22 99.9577 86.441 0.435 –0.867

IINP_24 99.3662 90.864 0.372 –0.869

IINP_25 99.1408 93.008 0.173 –0.873

IINP_26 99.1268 92.398 0.352 –0.870

16 of 24 DENHERE ET AL.

TABLE 7 Total variance explained.

Total variance explained

Component

Initial eigenvalues

Extraction sums of

squared loadings

Extraction sums

of squared loadings Rotation sums of squared loadings

Total % of Variance Cumulative % Total % of Variance Cumulative % Total % of Variance Cumulative %

1 6.628 28.816 28.816 6.628 28.816 28.816 4.374 19.018 19.018

2 3.693 16.058 44.874 3.693 16.058 44.874 3.854 16.757 35.776

3 1.769 7.692 52.566 1.769 7.692 52.566 2.41 10.478 46.254

4 1.378 5.989 58.556 1.378 5.989 58.556 2.056 8.938 55.192

5 1.349 5.867 64.422 1.349 5.867 64.422 1.607 6.986 62.177

6 1.081 4.698 69.12 1.081 4.698 69.12 1.597 6.943 69.12

7 0.94 4.087 73.207

8 0.688 2.991 76.198

9 0.662 2.878 79.077

10 0.628 2.73 81.807

11 0.581 2.528 84.335

12 0.519 2.257 86.592

13 0.471 2.05 88.642

14 0.437 1.9 90.541

15 0.398 1.729 92.27

16 0.351 1.527 93.797

17 0.326 1.419 95.216

18 0.299 1.298 96.514

19 0.248 1.077 97.591

20 0.184 0.798 98.389

21 0.16 0.697 99.086

22 0.135 0.589 99.674

23 0.075 0.326 100

FIGURE 5 Scree plot.

DENHERE ET AL.17 of 24

5.3 |Summary

After interpreting all components from the analysis, we arrived at the following descriptions:

Component 1―“Disease Knowledge and Surveillance Synergies”―BA with organizational interoperability.

Component 2―“Healthcare Awareness and Coordination”―DA with semantic interoperability.

Component 3―“Healthcare intelligence for patient-care”―AA with syntactic interoperability.

Component 4―“Healthcare knowledgebase”―DA with syntactic interoperability.

Component 5―“Treatment collaboration”―BA with organizational interoperability.

Component 6―“Healthcare system security and assurance”―TA with technical interoperability.

6|DISCUSSION

The study contributions culminated from the efforts to identify in particular the healthcare information needs of both patients and practitioners which

thereby addresses the issues surrounding patient satisfaction obtaining from an EA domain perspective. This helped to bridge the study gap where the

focus was only on patient satisfaction from enterprise domains aligned to Industrial Revolution 4.0 Big Data technology. The study focused on the core

needs in general that the EA should meet for both patients and healthcare practitioners.

As a predominant need in a HIS, patient-practitioner interaction, disease knowledge, and surveillance synergies are characteristics that need

to be active within a healthcare framework as evidence of meeting the needs and expectations of healthcare stakeholders. Such an outcome

TABLE 8 Rotated component matrix.

Rotated component matrix

Component

123456

IINP_6 0.847 0.14 0.131 0.211 0.105 0.046

IINP_5 0.808 0.036 0.055 0.294 0.199 0.134

IINP_9 0.773 0.034 0.156 0.126 0.204 0.357

IINP_10 0.772 0.031 0.045 0.094 0.061 0.041

IINP_7 0.683 0.11 0.012 0.373 0.14 0.068

IINP_8 0.666 0.055 0.061 0.475 0.099 0.185

IINP_11 0.581 0.007 0.04 0.244 0.376 0.222

IINP_4 0.525 0.365 0.198 0.301 0.268 0.03

IINP_15 0.127 0.838 0.069 0.054 0.108 0.072

IINP_16 0.124 0.784 0.133 0.27 0.086 0.025

IINP_17 0.012 0.78 0.198 0.07 0.141 0.207

IINP_14 0.012 0.709 0.277 0.124 0.249 0.007

IINP_20 0.057 0.708 0.443 0.063 0.062 0.151

IINP_18 0.096 0.572 0.061 0.031 0.096 0.563

IINP_21 0.053 0.181 0.829 0.067 0.083 0.049

IINP_22 0.112 0.097 0.819 0.011 0.187 0.145

IINP_19 0.057 0.525 0.616 0.054 0.061 0.082

IINP_2 0.218 0.013 0.123 0.732 0.123 0.12

IINP_3 0.327 0.06 0.325 0.65 0.02 0.048

IINP_1 0.192 0.042 0.215 0.172 0.712 0.042

IINP_13 0.037 0.297 0.158 0.107 0.65 0.262

IINP_26 0.124 0.047 0.036 0.172 0.156 0.771

IINP_24 0.127 0.115 0.223 0.497 0.373 0.508

Note: Shaded values signifies the components that are greater than 0.5 represent strong factors.

18 of 24 DENHERE ET AL.

emanates from a trained and skilled populace who are the patients and the healthcare practitioners who should perform various eHealth Care

activities such as contact tracing, monitoring and sensing of healthcare conditions, and collaborating through healthcare synergies. These

findings are tangential to the studies of Alshamrani (2022) and Mbunge et al. (2022), which articulate the need for disease surveillance, sensing,

monitoring, and controlling in smart city healthcare services through wireless sensor networks.

Studies by Zegers et al. (2022) also support that the interoperable HIS must satisfy the need for Healthcare information management and

sharing of patient electronic records for quality healthcare systems to be achieved. Certain healthcare metrics are used to measure or assess the

status of healthcare service quality or standards within society. Such metrics include the level at which medical systems are managing referrals,

consolidation of mortality statistics, and healthcare knowledge management in cases of pandemics and other chronic conditions management.

Therefore, there is a need for the development of business applications that facilitate healthcare data accumulation within an integrated

framework fostered by healthcare data standards and policies. Such applications, in turn, tend to make it possible for tertiary healthcare

decision support and intelligence dashboards to be met for better patient care and public health administration activities (Blazek et al., 2022). The

activities may include healthcare indicators dashboards, data analytics platforms, and patient self-care portals which support clinical decisions at

an end-user level offering expert advice from a healthcare expert system, for example, dashboards for electronic medical records and clinical

decision support and other healthcare quality indicators (Xie et al., 2022).

The complexities of healthcare conditions and diseases now require healthcare practitioners to collaborate and coordinate their expertise on

certain emerging ailments which may need research or complementary healthcare procedures to be administered to a patient. Therefore, interop-

erable systems will allow for the sharing of clinical notes, medical results from medical exams among practitioners, prescriptions handling, and to

some extent the possibilities of remote medical diagnosis or collaborated surgical procedures among surgeons and physicians in an integrated

set-up (Holmgren et al., 2022).

However, it should be noted that the need for patient healthcare data security, integrity, privacy, and healthcare assurance be a pledge of the

interoperable HIS since such should not be compromised for the healthcare interaction objectives not to be compromised (d'Aliberti &

Clark, 2022). Patients should be confident that the system is secure and that their rights to privacy and access to healthcare concerns are satisfied.

Healthcare data ownership and custodianship should be with the right parties and custodianship and ownership are two distinct terms in the

interactive healthcare systems. The integrity and reliability of the HIS give a mileage to the enterprise's credibility.

Study results are supporting the study by Amu et al. (2022) which justifies the need for healthcare insurance. In this study, it was evident that HISs

interoperability needed efficient financing mechanisms at both the TA level for systems interaction and at the patient-practitioner interaction BAlayer.

The fulfillment of such in turn help to smoothly allow the transfer of value in return for healthcare service rendered to patients by healthcare practi-

tioners flawlessly. From the study, it was observed that most patients rely on medical aid fund subscriptions for their healthcare welfare, and from the

findings the subscriptions are mostly associated with higher age groups. The subscription to age direct relationship can be attributed to the idea that

most middle-aged to older ages represent the age groups that are the working class cluster of the population that affords payments and also is more

exposed to chronic illnesses. The study also agrees with the research by Adjei-Mantey and Horioka (2022) who puts across that level of income deter-

mines the rate of medical aid subscription adoption. In the study, the medical aid funding distribution observed indicates that most unemployed patients

need medical funding to benefit from the interoperable healthcare system for patient-practitioner interaction. Therefore, if the government is to estab-

lish a national healthcare insurance system that could inclusively cater to the marginalized population it will further reinforce the creation of an efficient

healthcare system that is financially interoperable and functional along the healthcare value chain on access and use.

For an interoperable ecosystem to be effective, practitioners value the extent of management facilitation and support to be crucial together

with the education and training of medical staff in digital working environments. The study, therefore, supports the suggestions by, Umberfield

et al. (2023) and Cuevas-González et al. (2022) which mention the need for the creation of standards and formats in eHealthcare systems

creation. Therefore, practitioners need induction and training on the usage of standardized terminology in the interoperable healthcare library

as it is critical to allow standardized information structures and homogeneity of DA. A skilled labor force is key to the interoperable healthcare

enterprise domain. Therefore, human capacity should be properly addressed.

As part of the functional requirements for a sound interactive environment among patients and practitioners to be achieved, as part of the

enabling framework, these players need to be literate and therefore get trained. Analysis in this study as such, also suggested that patients and

practitioners need to be educated on the scalability and capabilities of some digital devices that they own. This entails creating awareness about

device features and functions that their digital devices possess since it affects how well they will use these devices for healthcare interaction and

collaboration. The study established that most devices owned by both patients and practitioners are smart devices that possess features such as

wireless access protocol, apps download, instant messenger, word and PDF readers, email, internet access, and SMS which are key enabling func-

tions for healthcare interactive communications. Such devices are crucial for the creation and consumption of digital medical resources and

services.

InthesameeffortsassuggestedbyDhatterwaletal.(

2022), this study discovered that sensitive medical data should be treated with

extreme confidence and therefore privacy concerns of patients' healthcare data should be preserved to foster trust and acceptance of the

interoperable healthcare model. Patients should be allowed to take ownership of their data assets within the interoperable architecture.

Authentication and granting of access to patient data should have approval by the patient especially when sharing electronic medical

DENHERE ET AL.19 of 24

records among medical practitioners. Security of medical records is the main expectation of all patients although other healthcare needs

aretobesatisfiedbytheinteroperablehealthcaresystem(Mamuyeetal.,2022). Moreover, to security needs, patients value other system

capabilities such as getting consolidated information on medical facilities list, medical alerts, and drug administration instructions, and

therefore, an intelligent Interoperable system will add so much value to patients' well-being (Granath et al., 2022;Overhage&

Kansky, 2023).

6.1 |Summary

In summary, the study helped discover that healthcare practitioners considered disease knowledge and surveillance synergies for healthcare,

healthcare Information management and sharing, healthcare intelligence for patient care, creation of healthcare knowledgebase, healthcare collab-

oration, and healthcare system security and assurance as the main interoperable HIS needs. The findings are encapsulated and framed into an EA

of patient/practitioner interaction needs in an interoperable HIS as presented in Figure 6.

7|CONTRIBUTION

The study discovered that patients and practitioners expect the interoperable healthcare environment to support the acquisition of disease

knowledge through healthcare surveillance synergies; create healthcare awareness through coordinated digital interactions; augmentation of

Healthcare knowledgebase

•Storage and archiving

•Advice and case mining

Disease knowledge and

surveillance synergies

•eHealth-care

Training

•Contact Tracing

•Monitor Condions

•Epidemiology

•Monitoring cases

•Partnerships

•Track Funding

•Collaboraon and

synergies

Healthcare Informaon

management and sharing

•Healthcare Metrics

Awareness

•Handle Referrals

•Mortality stascs

•Crowd Sourcing

•Knowledge

Management

•Sharing Resources

Treatment

collaboraon

•Sharing clinical

notes/medical

exam results

•Prescripons

administraon

•Remote

diagnoscs

Healthcare System

security and assurance

•Rea-Time

Service

•Integrity

Reliabilit

Healthcare Intelligence

for paent-care

•Healthcare

indicators

dashboards

•Data Analycs

plaorms

•Paent self-care

portals

Application

architecture

Data

architecture

Business

architecture

Technical

architecture

FIGURE 6 The Open Group Architecture Framework (TOGAF) based health information system (HIS) interoperability needs for practitioner/

patient interaction.

20 of 24 DENHERE ET AL.

healthcare intelligence for patient-care through a healthcare knowledgebase; allow treatment collaboration by various healthcare practitionersin

the healthcare ecosystem and mostly achieving a guaranteed healthcare system security and assurance environment. Therefore, this research

advocates for the designing of HISs that have the capacity to consolidate and capture digitized information from multiple healthcare sources on

diseases and their symptoms in a unified or integrated system. More so, eHealth systems have to be designed with the ability to communicate

with each other within an ecosystem of patient care. This means that, the systems have to be designed within a concept of homogeneity to allow

them to communicate among each other especially on interfaces that allow the creation of patient records. Such design will allow for the exis-

tence of a unified database schema that smoothen the challenges of differing DAs from various systems. The research also presents the evidence

that systems should be designed with interfaces that allow for collaboration on patient care by a group of expert healthcare practitioners, for

example, collaborating on a surgical procedure while experts are not in the same confined surgical theater. To that end, this research exists as an

informant to eHealth systems developers to capture such needs in the design and creation of contemporary healthcare systems.

8|CONCLUSION

Healthcare systems interoperability is the new evolution of healthcare systems where healthcare service providers and patients should interact

and share healthcare data within a specified framework of healthcare data security. In light of the HIS functional metrics which should prevail in

interoperable HISs, include education and training; access to hardware and software resources; government facilitation and support; medical

funding; broadband infrastructure support, and healthcare data security in line with confidentiality, integrity, and privacy of patient data.

Some countries are quickly appreciating the need for creating interoperable HISs and thereby facilitating and supporting the creation of

such ecosystems through the creation of Blockchain systems that allows the existence of a distributed EA for healthcare databases

(Gordon & Catalini, 2018). Such distributed databases allow every system to have a copy of each transaction that is executed within the

HIS and thereby fostering the security and integrity of healthcare data (Kumar & Chand, 2021). This is imperative since patient cantered

interoperability creates threats and vulnerabilities to the integrity of the interoperable HIS and as such Blockchain Technology comes in to

address privacy concerns of patient data through some authentication procedures which allow the patient to have complete authorization

and custodianship of their data.

The study discovered that patients and practitioners require digital devices that possess smart functions for interactivity in carrying out vari-

ous healthcare activities. However, these devices affordability is a concern since they come expensive to most of the population together with

medical aid and internet subscription. The study reveals that there may be a need of creating national health insurance systems and provision of

affordable broadband connectivity within the country.

Moreover, the interoperable environment to be created requires the standardization of eHealth systems' extreme security, DAs, and informa-

tion libraries. However, extreme data security mechanisms can affect smooth information flow and collaboration, although, to a larger extent, they

also ensure confidentiality in secure information sharing (Shrivastava et al., 2021). Therefore, there will be a need to strike a balance between

security enforcement and access to data within the interoperable HIS.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

ORCID

Prosper Tafadzwa Denhere https://orcid.org/0000-0003-3791-321X

Munyaradzi Zhou https://orcid.org/0000-0002-2184-0290

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DENHERE ET AL.23 of 24

AUTHOR BIOGRAPHIES

Prosper Tafadzwa Denhere has more than 14 years' experience as a University lecturer of Information Systems. He joined the Manicaland

State University of Applied Sciences (MSUAS) in 2017 after being seconded by the Midlands State University to spearhead the establishment

of a Department of Computer Science and Information Systems. Prosper has taught enterprise architecture, information systems governance,

systems analysis and design, E-business, and digital financial services. Prosper is a final year PhD student in Information Systems specializing

in Health. Prosper is a Senate and Council Board member of Manicaland State University of Applied Sciences and also responsible for Univer-

sity Quality Assurance Governance.

Ephias Ruhode has over 28 years' experience in industry and academia. He is currently lecturer and researcher in Digital Business Transfor-

mation in the School of Business and Creative Industries at University of the West of Scotland (UWS). He is an active researcher in UWS'

Centre for African Research on Enterprise and Economic Development (CAREED). He is also adjunct professor of Information Technology at

the Cape Peninsula University of Technology (South Africa). He is External Postgraduate Programs Supervisor at Nelson Mandela University

(South Africa), Management College of Southern Africa and Midlands State University (Zimbabwe). He has previously taught Undergraduate

and Postgraduate Programs (MBA, DBA, DBL, PhD) at various universities in Southern Africa, including University of the Witwatersrand's

Wits Business School, Cape Peninsula University of Technology, Herriot Watt University (Cape Town Campus) and Greenwich University

(Cape Town Campus). His teaching and learning as well as research activities included academic exchange programs to the University of East-

ern Finland, Tsinghua University in China, Riga Technical University in Latvia, Université Nouveaux Horizons in the DR Congo and Neu-Ulm

University of Applied Sciences in Germany. Ephias holds a Doctor of Technology Degree in Information Technology. His research interests

include futures thinking, digital society and social innovation, digital transformation as well as technology for sustainable development. He has

participated in large collaborative transdisciplinary research projects involving several international university partners.

Munyaradzi Zhou is currently a senior lecturer in the Department of Information and Marketing Sciences at the Midlands State University,

Zimbabwe. He instructs data science, advanced databases, and software engineering modules. His current research areas include health infor-

mation systems, big data analytics, artificial intelligence and machine learning, and digital transformation to support sustainability and inclu-

siveness. He participates in different boards in the application of ICTs and is the board member for the Institute of Sustainable Project

Planning, Monitoring, and Evaluation.

How to cite this article: Denhere, P. T., Ruhode, E., & Zhou, M. (2023). A TOGAF based interoperable health information system needs

assessment for practitioner–patient interaction. The Electronic Journal of Information Systems in Developing Countries, e12284. https://doi.

org/10.1002/isd2.12284

24 of 24 DENHERE ET AL.

ResearchGate has not been able to resolve any citations for this publication.

Preserving Patient Privacy During Computation over Shared Electronic Health Record Data

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PLOS ONE

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Interoperability is defined as the ability of a system or device to communicate between different technologies and software applications. This allows the exchange and use of data in an efficient, precise, and robust way. The present article gives researchers and healthcare information systems developers a qualitative and quantitative synthesis of the state of knowledge related to data formats and data standards proposed for mHealth devices interoperability in healthcare information systems that retrieve and store ECG data. We carry out a scoping review to answer to following questions: (1) What digital data formats or data standards have been proposed for the interoperability of electrocardiograph data between traditional healthcare information systems and mobile healthcare information systems? (2) What are the advantages and disadvantages of these data formats or data standards? The scoping review was conducted in four databases in accordance with the JBI methodology for scoping reviews, and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A total of 4018 studies were identified of which 30 studies met the inclusion criteria. Based on our findings, we identify four standards and nine formats for capturing and storing streaming ECG data in mobile health applications. The standards used were HL7, SCP-ECG, x73-PHD, and PDF/A. Formats include CSV, PDF-ECG, and seven XML-based formats. These are ECG-XML, HL7-XML, mPCG-XML, mECGML, JSON, SaECG, and CDA R2.

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This paper analyzes the determinants of health insurance enrollment and health expenditure in Ghana using micro data from wave 7 of the Ghana Living Standards Survey (GLSS 7) with emphasis on the role of risk preferences and the availability of health facilities in one’s own community. It is possible to analyze the determinants of health insurance enrollment in Ghana because its public health insurance system (the National Health Insurance Scheme or NHIS) is, in theory, mandatory, but is, in actual practice, voluntary, with only about 40% of the population enrolled in the scheme. Our empirical findings show that risk preferences have a significant impact on health insurance enrollment, with risk averse individuals being significantly more likely than other households to enroll in health insurance. Moreover, our findings also show that very poor households are significantly more likely to enroll in health insurance than other households, perhaps because they are exempt from paying premiums for health insurance. Finally, our findings also show that the availability of health facilities in one’s own community significantly decreases expenditures on health care.

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When a healthcare system employs the World Wide Web and other connected connections, it is called ‘e-health.’ This article deals with the use of intelligent health approaches and their growth through time, in particular the connection of IoT devices with cloud applications. E-Health is described as ‘the possibility of seeking, identifying, understanding and evaluating the information on health from internet databases and information gained to correctly solve health issues or address them. The web can safeguard consumers from damage and enhancement as a storehouse for health and e-health analyses to fully take part in an educated decision linked to health. Above all, the high level of e-Health connectivity mitigates the risk of inaccurate Internet information. Different views on IoT-cloud-based e-health systems linked to confidentiality and protection are explored with a concentrate on the potential, advantages, and challenges of implementing those systems. A bright alternative trend is the integration of the integrating IoT-based e-health systems with artificial intelligence like cloud technology that gives intelligent goals and implementations.

Syntactic interoperability and the role of syntactic standards in health information exchange

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Jan 2023

The Indiana Health Information Exchange

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Developing a Digital Information and Consultation Platform in Zimbabwe

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This paper presents a narrative on developing a COVID-19 digital information and consultation platform for a province situated in southern Zimbabwe. In response to a WHO prediction and call to prepare for the worst, a team of medical and computer experts worked on a sovereign digital platform facilitating COVID-19 triaging over the phone. Ethnographic assessments revealed that platform developments benefitted from national dialogue, engaged communities and stakeholders, and use of locally available technologies and skills. In this paper, the development of this digital platform is placed in the broader facets of local development, data sovereignty, and growth of local capacity and abilities under the auspices of the Zimbabwe Ministry of Health and Child Care. The paper reflects on the facets involved in developing this digital platform for digital health interventions aligned with local capacity and needs.KeywordsCOVID-19TriageContact centre

A TOGAF based interoperable health information system needs assessment for practitioner-patient interaction

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