The systems barrier for clinical information interoperability and standards has now evolved from a technology barrier to a semantic barrier. The processes to gather clinical data and to build clinical information and knowledge cannot be fully implemented, owing to semantic dissonances and limited data normalization. According to [1], "Just over a half of entered codes were appropriate for a given scenario and about a quarter were omitted." This is a significant data and financial gap for healthcare provision. Huge amount of addition to the financial cost, lack of data integration and loss of information affects the ability to maintain standards in clinical care delivery and patient outcomes.This paper proposes that the solution to these issues is an augmented network of clinical note taking, where coding is automatically generated by an AI system as clinicians write their clinical notes. The system (AI-KEN) offers enhanced web support that is integrated to local clinical systems, whereby clinical notes are prompted by suggested predictive text options in real time. The anticipated benefits include reducing financial loss for acute services, support for clinical standard maintenance and enhanced advancements for clinical practice and research in real time.

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While efforts are underway to create a sound system of electronic health records in Palestinian health institutions, there remain obstacles and challenges. Given modern day demands on health systems, we propose a federated electronic health system based on the clinical document architecture (CDA) that is compliant within the Palestine context. This architecture also brings a normalized electronic health record and a structure of blockchain to enhance interoperability with scalability, fault tolerance, privacy, and security. The new architecture and technologies will enhance services by allowing health care players, patients, and others to have the opportunity to obtain improved access and control of their health services. This may also serve as a useful model for other low-middle income countries.

Objectives Due to the diversity, volume, and distribution of ingested data, the majority of current healthcare entities operate independently, increasing the problem of data processing and interchange. The goal of this research is to design, implement, and evaluate an electronic health record (EHR) interoperability solution – prototype – among healthcare organizations, whether these organizations do not have systems that are prepared for data sharing, or organizations that have such systems. Methods We established an EHR interoperability prototype model named interoperability smart lane for electronic health record (islEHR), which comprises of three modules: 1) a data fetching APIs for external sharing of patients’ information from participant hospitals; 2) a data integration service, which is the heart of the islEHR that is responsible for extracting, standardizing, and normalizing EHRs data leveraging the fast healthcare interoperability resources (FHIR) and artificial intelligence techniques; 3) a RESTful API that represents the gateway sits between clients and the data integration services. Results The prototype of the islEHR was evaluated on a set of unstructured discharge reports. The performance achieved a total time of execution ranging from 0.04 to 84.49 s. While the accuracy reached an F-Score ranging from 1.0 to 0.89. Conclusions According to the results achieved, the islEHR prototype can be implemented among different heterogeneous systems regardless of their ability to share data. The prototype was built based on international standards and machine learning techniques that are adopted worldwide. Performance and correctness results showed that islEHR outperforms existing models in its diversity as well as correctness and performance.