Designing interoperable health information systems using Enterprise Architecture approach in resource-limited countries: A literature review

Background: Enterprise Architecture (EA) integrates business and technical processes in health information systems (HIS). Low-income and middle-income countries (LMIC) use EA to combine management components with disease tracking and health care service monitoring. Using an EA approach differs by country, addressing specific needs. Methods: Articles in this review referenced EA, were peer-reviewed or gray literature reports published in 2010 to 2016 in English, and were identified using PubMed, Scopus, Web of Science, and Google Scholar. Results: Fourteen articles described EA use in LMICs. India, Sierra Leone, South Africa, Mozambique, and Rwanda reported building the system to meet country needs and implement a cohesive HIS framework. Jordan and Taiwan focused on specific HIS aspects, ie, disease surveillance and electronic medical records. Five studies informed the context. The Millennium Villages Project employed a “uniform but contextualized” approach to guide systems in 10 countries; Malaysia, Indonesia, and Tanzania used interviews and mapping of existing components to improve HIS, and Namibia used of Activity Theory to identify technology-associated activities to better understand EA frameworks. South Africa, Burundi, Kenya, and Democratic Republic of Congo used EA to move from paper-based to electronic systems. Conclusions: Four themes emerged: the importance of multiple sectors and data sources, the need for interoperability, the ability to incorporate system flexibility, and the desirability of open group models, data standards, and software. Themes mapped to EA frameworks and operational components and to health system building blocks and goals. Most articles focused on processes rather than outcomes, as countries are engaged in implementation.