Generally, the interoperable health information exchange is very paramount for clinicians to have access to the timely and relevant patient health records. However, the progress of interoperability frameworks has been left unanswered while there has been significant investment into these frameworks. Thus, this study seeks to compare the progress of interoperability frameworks in seamless data exchange across healthcare systems in the US and Australia. The study adopts the systematic review design, which involves the use of structured and scientific approach to the review of literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The study showed that the US, in comparison to Australia, has a fragmented healthcare system with varying levels of interoperability across states and institutions. While the interoperability system in Australia is centralized, it is still faced with some challenges. Some of these challenges include underutilization of existing resources due to administrative burdens and privacy laws. It was revealed that healthcare centres in the US rely on multiple proprietary systems as their interoperability frameworks. Meanwhile, interoperability in healthcare centers in Australia is often faced with the challenge of fragmentation as a result of clinical decision support systems (CDSS). The study concludes that both countries – the US and Australia – are faced with significant interoperability challenges. While the US struggles with regulatory fragmentation, Australia contends with policy misalignment and vendor control. Thus, it is recommended that future frameworks should concentrate on regulatory consistency, national alignment, and leveraging emerging technologies like blockchain technology for enhanced healthcare data exchange

Keywords: Interoperability, data exchange, Australia, the United States, blockchain technology.

1. Adeyemi, I. O., & Issa, A. O. (2020). Perceived usefulness and ease of use as predictors of early-year lawyers satisfaction with Law Pavilion Electronic Law Reports. Buletin Al-Turas, 26(2), 239-252.
2. Abbasi, A. B., Layden, J., Gordon, W., Gregurick, S., DeLew, N., Grossman, J., ... & Tripathi, M. (2025). A Unified Approach to Health Data Exchange: A Report From the US DHHS. JAMA.
3. Adegoke, K., Adegoke, A., Dawodu, D., Bayowa, A., & Adekoya, A. (2025). Interoperability in Digital Healthcare: Enhancing Consumer Health and Transforming Care Systems.
4. Ait Gacem, S., Huri, H. Z., Wahab, I. A., & Abduelkarem, A. R. (2025). Investigating digital determinants shaping pharmacists’ preparedness for interoperability and health informatics practice evolution: a systematic review. International Journal of Clinical Pharmacy, 1-11.
5. Amar, F., April, A., & Abran, A. (2024). Electronic health record and semantic issues using fast healthcare interoperability resources: systematic mapping review. Journal of Medical Internet Research, 26, e45209.
6. Andreas, A., Mavromoustakis, C. X., Mastorakis, G., Do, D. T., Batalla, J. M., Pallis, E., & Markakis, E. K. (2021). Towards an optimized security approach to IoT devices with confidential healthcare data exchange. Multimedia Tools and Applications, 80, 31435-31449.
7. Atkinson, L. Z., & Cipriani, A. (2018). How to carry out a literature search for a systematic review: A practical guide. BJPsych Advances, 24(2), 74-82.
8. Carlos-Ferreira, J., Elvas, L. B., Correia, R., & Mascarenhas, M. (2024). Enhancing EHR interoperability and security through distributed ledger technology: A review. Healthcare,12(19), 1-11.
9. Chen, M., & Esmaeilzadeh, P. (2023). Adoption and use of various health information exchange methods for sending inside health information in US hospitals. International Journal of Medical Informatics, 177, 105156.
10. Costin, A., & Eastman, C. (2019). Need for interoperability to enable seamless information exchanges in smart and sustainable urban systems. Journal of Computing in Civil Engineering, 33(3), 1-19.
11. Das, L. (2017). Role of data in improving care within a health system: A case study of the australian health system. The Pardee RAND Graduate School.
12. de Mello, B. H., Rigo, S. J., da Costa, C. A., da Rosa Righi, R., Donida, B., Bez, M. R., & Schunke, L. C. (2022). Semantic interoperability in health records standards: a systematic literature review. Health and Technology, 12(2), 255-272.
13. Djinevski, L., & Arsenovski, S. (2024). Comparative overview of interoperability in distributed medical systems through data exchange standards in Macedonia, USA and Australia regarding health providers and insurance agencies. UTMS Journal of Economics, 15(1), 64-70.
14. Esmaeilzadeh, P. (2020). Patients' perceptions of different information exchange mechanisms: an exploratory study in the United States. Methods of Information in Medicine, 59(04/05), 162-178.
15. Gabriel, M. H., Richwine, C., Strawley, C., Barker, W., & Everson, J. (2024). Interoperable Exchange of Patient Health Information among US Hospitals: 2023. ASTP Health IT Data Brief.
16. Gordon, W. J., & Catalini, C. (2018). Blockchain technology for healthcare: facilitating the transition to patient-driven interoperability. Computational and Structural Biotechnology Journal, 16, 224-230.
17. Hammarberg, K., Kirkman, M., & de Lacey, S. (2016). Qualitative research methods: When to use them and how to judge them. Human Reproduction, 31(3), 498-501.
18. Holmgren, A. J., Esdar, M., Hüsers, J., & Coutinho-Almeida, J. (2023). Health information exchange: understanding the policy landscape and future of data interoperability. Yearbook of Medical Informatics, 32(1), 184-194.
19. Jendle, J., Adolfsson, P., Choudhary, P., Dovc, K., Fleming, A., Klonoff, D. C., ... & Heinemann, L. (2024). A narrative commentary about interoperability in medical devices and data used in diabetes therapy from an academic EU/UK/US perspective. Diabetologia, 67(2), 236-245.
20. Johnston, R., Phunthasu, B., Wang, Y., Nguyen, H. N., Li, M., & Dilnutt, R (2024). How integrating healthcare information systems and enterprise architecture optimises patient flow in Australian Hospitals? Enterprise Architecture Professional Journal, 1-13.
21. Kennedy, K. (2023). The Relationship Between Clinical Integration, Interoperability, and Patient Engagement in Electronic Health Capacities in the United States: A Socio-Economic Health Study(Doctoral dissertation, Northcentral University).
22. Kwon, A., Lee, H. Y., Shin, S. Y., Yang, K., Sung, Y., Lee, K., ... & Lee, J. H. (2024). Current health data standardization project and future directions to ensure interoperability in Korea. Healthcare Informatics Research, 30(2), 93-102.
23. Laka, M., Carter, D., Milazzo, A., & Merlin, T. (2022). Challenges and opportunities in implementing clinical decision support systems (CDSS) at scale: Interviews with Australian policymakers. Health Policy and Technology, 11(3), 100652.
24. Oemig, F., Snelick, R., Oemig, F., & Snelick, R. (2016). Healthcare Data Exchange Standards. Healthcare Interoperability Standards Compliance Handbook: Conformance and Testing of Healthcare Data Exchange Standards, 105-156.
25. Palojoki, S., Lehtonen, L., & Vuokko, R. (2024). Semantic interoperability of electronic health records: Systematic review of alternative approaches for enhancing patient information availability. JMIR Medical Informatics, 12(1), e53535.
26. Perlin, J. B., Baker, D. B., Brailer, D. J., Fridsma, D. B., Frisse, M. E., Halamka, J. D., ... & Tang, P. C. (2016). Information technology interoperability and use for better care and evidence: a vital direction for health and health care. NAM Perspectives.
27. Perugu, B., Wadhwa, V., Kim, J., Cai, J., Shin, A., & Gupta, A. (2023). Pragmatic approaches to interoperability–surmounting barriers to healthcare data and information across organizations and political boundaries. Telehealth and Medicine Today, 8(4), 1-20.
28. Pimentel, J. C., Pimentel, E. C., & Dao, S. (2021, April). A comparison of modern frameworks for the development of interoperable healthcare information systems. In Frontiers in Biomedical Devices(Vol. 84812, p. V001T12A017). American Society of Mechanical Engineers.
29. Sarkar, I. N. (2022). Transforming Health data to actionable information: Recent progress and future opportunities in health information exchange. Yearbook of Medical Informatics, 31(01), 203-214.
30. Saripalle, R. K. (2019). Fast Health Interoperability Resources (FHIR): current status in the healthcare system. International Journal of E-Health and Medical Communications (IJEHMC), 10(1), 76-93.
31. Schut, M., Adeyemi, I., Kumpf, B., Proud, E., Dror, I., Barrett, C. B., ... & Leeuwis, C. (2024). Innovation portfolio management for the public non-profit research and development sector: What can we learn from the private sector? Innovation and Development, 1-19.
32. Tejani, A. S., Bialecki, B., O’Donnell, K., Sippel Schmidt, T., Kohli, M. D., & Alkasab, T. (2024). Standardizing imaging findings representation: Harnessing common data elements semantics and Fast Healthcare Interoperability Resources structures. Journal of the American Medical Informatics Association, 31(8), 1735-1742.
33. Wang, Q., & Qin, S. (2021). A hyperledger fabric-based system framework for healthcare data management. Applied Sciences, 11(24), 11693.
34. Woods, L., Eden, R., Pearce, A., Wong, Y. C. I., Jayan, L., Green, D., ... & Sullivan, C. (2022). Evaluating digital health capability at scale using the digital health indicator. Applied Clinical Informatics, 13(05), 991-1001.
35. Woods, L., Eden, R., Macklin, S., Krivit, J., Duncan, R., Murray, H., ... & Sullivan, C. (2024). Strengthening rural healthcare outcomes through digital health: qualitative multi-site case study. BMC Health Services Research, 24(1), 1096.

Qazeem Faniran