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Architectural patterns for health information systems: a systematic review.

Rene Casanova1, Fernan A Villa-Garzon1, John W Branch-Bedoya1

  • 1Departamento de Ciencias de la Computación y la Decisión, Universidad Nacional de Colombia, Medellín, Colombia.

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Summary

Health information systems (HIS) face fragmentation challenges. This review highlights service-based and decentralized architectures, but achieving interoperable ecosystems needs more diversity and collaboration.

Keywords:
HL7 FHIRblockchaindigital health ecosystemsinteroperabilitymicroservicessoftware architecturesystematic review

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Area of Science:

  • Digital Health
  • Health Informatics
  • Healthcare Systems Engineering

Background:

  • Health Information Systems (HIS) are crucial for digital health transformation.
  • System fragmentation and poor interoperability hinder HIS adoption and effectiveness.
  • Addressing these challenges is vital for advancing healthcare.

Purpose of the Study:

  • To systematically review architectural patterns in HIS.
  • To evaluate these patterns against ecosystem-level requirements.
  • To identify current trends and future directions in HIS architecture.

Main Methods:

  • Systematic literature review adhering to PRISMA 2020 guidelines.
  • Searches conducted across Scopus, IEEE Xplore, PubMed, and Web of Science (2020-2025).
  • Inclusion of studies describing, evaluating, or proposing HIS solutions.

Main Results:

  • 89 studies met inclusion criteria from 304 initial records.
  • Service-based and decentralized/distributed ledger architectures are predominant.
  • Emerging trends include edge computing, modular design, and FHIR-based interfaces.
  • Gaps identified in cross-border care, sustainability, and AI integration.

Conclusions:

  • Microservices currently dominate HIS architectures.
  • Achieving resilient, interoperable health ecosystems requires greater architectural diversity.
  • Intersectoral collaboration is essential for future HIS development.