Compliance with Interoperability Standards in Implementing Digital Health in Low and Middle-Income Countries

Résumé

Background and Purpose: Low and Middle-Income Countries (LMICs) bear over 70% of global mortality and morbidity due to systemic healthcare challenges. In response, many LMICs have adopted Digital Health (DH) to transform patient management and overall care. However, the transformative potential of DH is constrained by poor interoperability among diverse systems, which undermines effective data sharing and informed decision-making. This study explores the factors that hinder compliance with interoperability standards in DH implementations in LMICs.

Methods: A Systematic Literature Review (SLR) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with peer-reviewed articles retrieved from PubMed, Scopus, and ScienceDirect. The search, covering the literature from January 1, 2015, to January 30, 2025, was refined using relevant keywords. Out of 865 screened articles, 38 underwent full-text assessment, and 22 met the quality criteria for analysis.

Results: The analysis, structured using the Technology-Organisation-Environment (TOE) framework, identified key barriers. Technological challenges include inadequate IT infrastructure, limited standardisation, fragmented systems, and adaptation difficulties. Organisational barriers involve weak leadership, poor governance, limited technical capacity, and resistance to change. Environmental obstacles include outdated regulations, weak compliance monitoring, data security concerns, and financial constraints.

Conclusions: These findings underscore the need for a coordinated, multi-level approach to enhance interoperability compliance in DH, thereby improving healthcare outcomes in LMICs. Targeted interventions are essential to drive sustainable DH implementation in LMICs.