{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T11:48:27Z","timestamp":1763380107507,"version":"3.45.0"},"reference-count":234,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Health information systems (HIS) are critical for digital health transformation, yet fragmentation and poor interoperability adoption remains a major challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study systematically reviews architectural patterns used in HIS and evaluates their alignment with ecosystem-level requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA 2020 guidelines, a systematic literature review was conducted across Scopus, IEEE Xplore, PubMed, and Web of Science (2020\u20132025). Eligible studies described, evaluated, or proposed HIS solutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From an initial set of 304 records, 89 met the inclusion criteria. Service-based and decentralized\/distributed ledger architectures were predominant, with emerging models integrating edge computing and modular design. FHIR-based contracts are found as stabilizers of interfaces, enabling validation and reducing integration costs. However, gaps persist in cross-border care, sustainability, and artificial intelligence integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While microservices dominate current HIS architectures, achieving resilient, interoperable ecosystems requires greater architectural diversity and intersectoral collaboration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdgth.2025.1694839","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T11:45:23Z","timestamp":1763379923000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Architectural patterns for health information systems: a systematic review"],"prefix":"10.3389","volume":"7","author":[{"given":"Rene","family":"Casanova","sequence":"first","affiliation":[]},{"given":"Fernan A.","family":"Villa-Garzon","sequence":"additional","affiliation":[]},{"given":"John W.","family":"Branch-Bedoya","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.1109\/CBI.2017.55","article-title":"Towards adaptive pathways: reference architecture for personalized dynamic pathways","author":"Schlieter","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"e42615","DOI":"10.2196\/42615","article-title":"Digital health data quality issues: systematic review","volume":"25","author":"Syed","year":"2023","journal-title":"J Med Internet Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"105780","DOI":"10.1016\/j.ijmedinf.2024.105780","article-title":"Towards secure and trusted AI in healthcare: a systematic review of emerging innovations and ethical challenges","volume":"195","author":"Mohsin Khan","year":"2025","journal-title":"Int J Med Inform"},{"key":"B4","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B5","volume-title":"Guidance on the Conduct of Narrative Synthesis in Systematic Reviews: A Product from the ESRC Methods Programme","author":"Popay","year":"2006"},{"key":"B6","volume-title":"White Paper\u2014Overview and Insight: Performance of Digital Health Systems during the COVID-19 Pandemic","author":"Abbasi","year":"2023"},{"key":"B7","volume-title":"Development of an Interoperability Platform for Information Systems in the e-Health Domain, for the Portuguese Health System","author":"Pereira","year":"2023"},{"key":"B8","doi-asserted-by":"publisher","first-page":"163","DOI":"10.3233\/SHTI210065","article-title":"The process of modeling information system architectures with IHE","volume":"278","author":"Merzweiler","year":"2021","journal-title":"Stud Health Technol Inform"},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.1109\/RTEICT52294.2021.9573996","article-title":"Comparative analysis of edge computing and edge devices: key technology in IoT and computer vision applications","author":"Rohith","year":""},{"key":"B10","doi-asserted-by":"publisher","first-page":"363","DOI":"10.3233\/SHTI250345.","article-title":"Barriers and opportunities in developing health information system (HIS) architectures to support universal health coverage in resource-limited settings","volume":"327","author":"Haddad","year":"2025","journal-title":"Stud Health Technol Inform"},{"key":"B11","doi-asserted-by":"crossref","DOI":"10.3233\/SHTI220945","article-title":"Health information systems: past, present, future-revisited","author":"Haux","year":""},{"key":"B12","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1109\/EMR.2021.3100418","article-title":"Using requirements for health data organization and management","volume":"49","author":"Condry","year":"2021","journal-title":"IEEE Eng Manage Rev"},{"key":"B13","article-title":"Cybersecurity in healthcare industry","author":"Ali","year":""},{"key":"B14","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1109\/TCSS.2021.3122807","article-title":"Medical cyber-physical systems: a solution to smart health and the state of the art","volume":"9","author":"Chen","year":"2022","journal-title":"IEEE Trans Comput Soc Syst"},{"key":"B15","doi-asserted-by":"crossref","DOI":"10.1109\/INCET54531.2022.9824500","article-title":"Blockchain-enabled immunization system: a novel idea to leverage reliability and traceability","author":"Arsheen","year":""},{"key":"B16","article-title":"In: 2023 10th International Conference on Computing for Sustainable Global Development. 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