Interoperability as a Catalyst for Digital Health and Therapeutics: A Scoping Review of Emerging Technologies and...

Interoperability is fundamental for advancing digital health and digital therapeutics, particularly with the integration of technologies such as artificial intelligence (AI), blockchain, and federated learning. Low- and middle-income countries (LMICs), where digital infrastructure remains fragmented, face specific challenges in implementing standardized and scalable systems.

This scoping review was conducted using the Arksey and O'Malley framework, refined by Levac et al., and the Joanna Briggs Institute guidelines. Five databases (PubMed, Scopus, IEEE Xplore, ACM Digital Library, and Google Scholar) were searched for peer-reviewed English language studies published between 2015 and 2025. We identified 255 potentially eligible articles and selected a 10% random sample (n = 26) using Stata 18 by StataCorp LLC, College Station, TX, USA, for in-depth data charting and thematic synthesis.

The selected studies spanned over 15 countries and addressed priority technologies, including mobile health (mHealth), the use of Health Level Seven (HL7)'s Fast Healthcare Interoperability Resources (FHIR) for data exchange, and blockchain. Interoperability enablers include standards (e.g., HL7 FHIR), data governance frameworks, and policy interventions. Low- and Middle-Income Countries (LMICs) face common issues related to digital capacity shortages, legacy systems, and governance fragmentation. Five thematic areas were identified: (1) policy and governance; (2) standards-based integration; (3) infrastructure and platforms; (4) emerging technologies; and (5) LMIC implementation issues.

Emerging digital health technologies increasingly rely on interoperability standards to scale their operation. Although global standards such as FHIR and the Trusted Exchange Framework and Common Agreement (TEFCA) are gaining momentum, LMICs require dedicated governance, infrastructure, and capacity investments to make equitable use feasible. Future initiatives can benefit from using science- and equity-informed frameworks.