{"id":"https://openalex.org/W7139973891","doi":"https://doi.org/10.1016/j.jbi.2026.105022","title":"Challenges of health data standard adoption and usage: a systematic review","display_name":"Challenges of health data standard adoption and usage: a systematic review","publication_year":2026,"publication_date":"2026-03-21","ids":{"openalex":"https://openalex.org/W7139973891","doi":"https://doi.org/10.1016/j.jbi.2026.105022","pmid":"https://pubmed.ncbi.nlm.nih.gov/41871756"},"language":"en","primary_location":{"id":"doi:10.1016/j.jbi.2026.105022","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jbi.2026.105022","pdf_url":null,"source":{"id":"https://openalex.org/S11622463","display_name":"Journal of Biomedical Informatics","issn_l":"1532-0464","issn":["1532-0464","1532-0480"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Biomedical Informatics","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://doi.org/10.1016/j.jbi.2026.105022","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5102941031","display_name":"Alberto Marfoglia","orcid":"https://orcid.org/0009-0000-5857-2376"},"institutions":[{"id":"https://openalex.org/I9360294","display_name":"University of Bologna","ror":"https://ror.org/01111rn36","country_code":"IT","type":"education","lineage":["https://openalex.org/I9360294"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Alberto Marfoglia","raw_affiliation_strings":["Department of Computer Science and Engineering - DISI, University of Bologna, Via dell'Universit\u00e0 50, 47521 Cesena, Italy"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Computer Science and Engineering - DISI, University of Bologna, Via dell'Universit\u00e0 50, 47521 Cesena, Italy","institution_ids":["https://openalex.org/I9360294"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5087378246","display_name":"Valerio Antonio Arcobelli","orcid":"https://orcid.org/0000-0002-1262-9899"},"institutions":[{"id":"https://openalex.org/I4210098188","display_name":"Laboratori Guglielmo Marconi (Italy)","ror":"https://ror.org/01r3vad87","country_code":"IT","type":"company","lineage":["https://openalex.org/I4210098188"]},{"id":"https://openalex.org/I9360294","display_name":"University of Bologna","ror":"https://ror.org/01111rn36","country_code":"IT","type":"education","lineage":["https://openalex.org/I9360294"]}],"countries":["IT"],"is_corresponding":true,"raw_author_name":"Valerio Antonio Arcobelli","raw_affiliation_strings":["Department of Electrical, Electronic and Information Engineering \"Guglielmo Marconi\" - DEI, University of Bologna, Viale del Risorgimento 2, 40136 Bologna, Italy. Electronic address: valerio.arcobelli2@unibo.it"],"raw_orcid":"https://orcid.org/0000-0002-1262-9899","affiliations":[{"raw_affiliation_string":"Department of Electrical, Electronic and Information Engineering \"Guglielmo Marconi\" - DEI, University of Bologna, Viale del Risorgimento 2, 40136 Bologna, Italy. Electronic address: valerio.arcobelli2@unibo.it","institution_ids":["https://openalex.org/I4210098188","https://openalex.org/I9360294"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5087324655","display_name":"Serena Moscato","orcid":"https://orcid.org/0000-0002-0538-650X"},"institutions":[{"id":"https://openalex.org/I4210098188","display_name":"Laboratori Guglielmo Marconi (Italy)","ror":"https://ror.org/01r3vad87","country_code":"IT","type":"company","lineage":["https://openalex.org/I4210098188"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Serena Moscato","raw_affiliation_strings":["Department of Electrical, Electronic and Information Engineering \"Guglielmo Marconi\" - DEI, University of Bologna, Viale del Risorgimento 2, 40136 Bologna, Italy"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Electrical, Electronic and Information Engineering \"Guglielmo Marconi\" - DEI, University of Bologna, Viale del Risorgimento 2, 40136 Bologna, Italy","institution_ids":["https://openalex.org/I4210098188"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5003371321","display_name":"Antonino A. La Mattina","orcid":"https://orcid.org/0000-0002-9927-2393"},"institutions":[{"id":"https://openalex.org/I4210121742","display_name":"Istituto Ortopedico Rizzoli","ror":"https://ror.org/02ycyys66","country_code":"IT","type":"healthcare","lineage":["https://openalex.org/I4210121742","https://openalex.org/I4210153126"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Antonino Amedeo La Mattina","raw_affiliation_strings":["Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy","institution_ids":["https://openalex.org/I4210121742"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5039380849","display_name":"Sabato Mellone","orcid":"https://orcid.org/0000-0001-7688-0188"},"institutions":[{"id":"https://openalex.org/I4210098188","display_name":"Laboratori Guglielmo Marconi (Italy)","ror":"https://ror.org/01r3vad87","country_code":"IT","type":"company","lineage":["https://openalex.org/I4210098188"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Sabato Mellone","raw_affiliation_strings":["Department of Electrical, Electronic and Information Engineering \"Guglielmo Marconi\" - DEI, University of Bologna, Viale del Risorgimento 2, 40136 Bologna, Italy"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Electrical, Electronic and Information Engineering \"Guglielmo Marconi\" - DEI, University of Bologna, Viale del Risorgimento 2, 40136 Bologna, Italy","institution_ids":["https://openalex.org/I4210098188"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5080851662","display_name":"Antonella Carbonaro","orcid":"https://orcid.org/0000-0002-3890-4852"},"institutions":[{"id":"https://openalex.org/I9360294","display_name":"University of Bologna","ror":"https://ror.org/01111rn36","country_code":"IT","type":"education","lineage":["https://openalex.org/I9360294"]}],"countries":["IT"],"is_corresponding":false,"raw_author_name":"Antonella Carbonaro","raw_affiliation_strings":["Department of Computer Science and Engineering - DISI, University of Bologna, Via dell'Universit\u00e0 50, 47521 Cesena, Italy"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Computer Science and Engineering - DISI, University of Bologna, Via dell'Universit\u00e0 50, 47521 Cesena, Italy","institution_ids":["https://openalex.org/I9360294"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":6,"corresponding_author_ids":["https://openalex.org/A5087378246"],"corresponding_institution_ids":["https://openalex.org/I4210098188","https://openalex.org/I9360294"],"apc_list":{"value":2980,"currency":"USD","value_usd":2980},"apc_paid":{"value":2980,"currency":"USD","value_usd":2980},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.35381952,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"178","issue":null,"first_page":"105022","last_page":"105022"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.3181000053882599,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.3181000053882599,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T14400","display_name":"Medical Coding and Health Information","score":0.11620000004768372,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12790","display_name":"Nursing Diagnosis and Documentation","score":0.04780000075697899,"subfield":{"id":"https://openalex.org/subfields/2910","display_name":"Issues, ethics and legal aspects"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/health-data","display_name":"Health data","score":0.47609999775886536},{"id":"https://openalex.org/keywords/systematic-review","display_name":"Systematic review","score":0.36160001158714294},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.3522000014781952},{"id":"https://openalex.org/keywords/medline","display_name":"MEDLINE","score":0.3472999930381775},{"id":"https://openalex.org/keywords/health-records","display_name":"Health records","score":0.33480000495910645}],"concepts":[{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.4860999882221222},{"id":"https://openalex.org/C3017977704","wikidata":"https://www.wikidata.org/wiki/Q18745135","display_name":"Health data","level":3,"score":0.47609999775886536},{"id":"https://openalex.org/C2522767166","wikidata":"https://www.wikidata.org/wiki/Q2374463","display_name":"Data science","level":1,"score":0.43140000104904175},{"id":"https://openalex.org/C56739046","wikidata":"https://www.wikidata.org/wiki/Q192060","display_name":"Knowledge management","level":1,"score":0.40389999747276306},{"id":"https://openalex.org/C189708586","wikidata":"https://www.wikidata.org/wiki/Q1504425","display_name":"Systematic review","level":3,"score":0.36160001158714294},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.3522000014781952},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.3472999930381775},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.3366999924182892},{"id":"https://openalex.org/C3019952477","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Health records","level":3,"score":0.33480000495910645},{"id":"https://openalex.org/C145642194","wikidata":"https://www.wikidata.org/wiki/Q870895","display_name":"Health informatics","level":3,"score":0.29190000891685486},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.2752000093460083},{"id":"https://openalex.org/C2780433410","wikidata":"https://www.wikidata.org/wiki/Q5276090","display_name":"Digital health","level":3,"score":0.262800008058548},{"id":"https://openalex.org/C71745522","wikidata":"https://www.wikidata.org/wiki/Q2476929","display_name":"Confidentiality","level":2,"score":0.2517000138759613}],"mesh":[{"descriptor_ui":"D000097103","descriptor_name":"Digital Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008490","descriptor_name":"Medical Informatics","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D008490","descriptor_name":"Medical Informatics","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D057286","descriptor_name":"Electronic Health Records","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D057286","descriptor_name":"Electronic Health Records","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true}],"locations_count":3,"locations":[{"id":"doi:10.1016/j.jbi.2026.105022","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jbi.2026.105022","pdf_url":null,"source":{"id":"https://openalex.org/S11622463","display_name":"Journal of Biomedical Informatics","issn_l":"1532-0464","issn":["1532-0464","1532-0480"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Biomedical Informatics","raw_type":"journal-article"},{"id":"pmid:41871756","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41871756","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of biomedical informatics","raw_type":null},{"id":"pmh:oai:cris.unibo.it:11585/1055931","is_oa":true,"landing_page_url":"https://www.sciencedirect.com/science/article/pii/S1532046426000468?via=ihub","pdf_url":null,"source":{"id":"https://openalex.org/S4306402579","display_name":"Archivio istituzionale della ricerca (Alma Mater Studiorum Universit\u00e0 di Bologna)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I4210117483","host_organization_name":"Istituto di Ematologia di Bologna","host_organization_lineage":["https://openalex.org/I4210117483"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"info:eu-repo/semantics/article"}],"best_oa_location":{"id":"doi:10.1016/j.jbi.2026.105022","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jbi.2026.105022","pdf_url":null,"source":{"id":"https://openalex.org/S11622463","display_name":"Journal of Biomedical Informatics","issn_l":"1532-0464","issn":["1532-0464","1532-0480"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Biomedical Informatics","raw_type":"journal-article"},"sustainable_development_goals":[],"awards":[],"funders":[{"id":"https://openalex.org/F5497039910","display_name":"Ministero dell'Istruzione e del Merito","ror":"https://ror.org/01ehyh486"}],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":108,"referenced_works":["https://openalex.org/W1585721025","https://openalex.org/W2057193449","https://openalex.org/W2266982813","https://openalex.org/W2560438049","https://openalex.org/W2799331768","https://openalex.org/W2901924397","https://openalex.org/W3003735349","https://openalex.org/W3093979768","https://openalex.org/W3110452186","https://openalex.org/W3111868183","https://openalex.org/W3112504521","https://openalex.org/W3114967472","https://openalex.org/W3126541242","https://openalex.org/W3134300625","https://openalex.org/W3134942993","https://openalex.org/W3142471904","https://openalex.org/W3143295419","https://openalex.org/W3145356118","https://openalex.org/W3156855582","https://openalex.org/W3160152776","https://openalex.org/W3162045605","https://openalex.org/W3162919713","https://openalex.org/W3171628577","https://openalex.org/W3173644676","https://openalex.org/W3175011949","https://openalex.org/W3175934966","https://openalex.org/W3185101488","https://openalex.org/W3189109866","https://openalex.org/W3198379981","https://openalex.org/W3202649559","https://openalex.org/W3203951545","https://openalex.org/W3204593612","https://openalex.org/W3208139312","https://openalex.org/W3210129127","https://openalex.org/W3213141383","https://openalex.org/W3214708599","https://openalex.org/W4200366967","https://openalex.org/W4205235067","https://openalex.org/W4206907874","https://openalex.org/W4210761086","https://openalex.org/W4211144876","https://openalex.org/W4213303680","https://openalex.org/W4220804872","https://openalex.org/W4220839621","https://openalex.org/W4220915814","https://openalex.org/W4220961567","https://openalex.org/W4223655014","https://openalex.org/W4225003357","https://openalex.org/W4233255714","https://openalex.org/W4234370987","https://openalex.org/W4280489245","https://openalex.org/W4280550674","https://openalex.org/W4280590415","https://openalex.org/W4282839071","https://openalex.org/W4285315819","https://openalex.org/W4289861031","https://openalex.org/W4295905516","https://openalex.org/W4300817810","https://openalex.org/W4303699900","https://openalex.org/W4304974837","https://openalex.org/W4304991627","https://openalex.org/W4306898397","https://openalex.org/W4308139572","https://openalex.org/W4308772318","https://openalex.org/W4309035108","https://openalex.org/W4312114715","https://openalex.org/W4315479549","https://openalex.org/W4317749998","https://openalex.org/W4317904523","https://openalex.org/W4317932413","https://openalex.org/W4318933528","https://openalex.org/W4323532087","https://openalex.org/W4361305356","https://openalex.org/W4366149809","https://openalex.org/W4366551404","https://openalex.org/W4366772879","https://openalex.org/W4380077406","https://openalex.org/W4383531879","https://openalex.org/W4383895266","https://openalex.org/W4384205827","https://openalex.org/W4384932964","https://openalex.org/W4385189906","https://openalex.org/W4385760103","https://openalex.org/W4386319349","https://openalex.org/W4386579961","https://openalex.org/W4386714604","https://openalex.org/W4386981309","https://openalex.org/W4387041314","https://openalex.org/W4387341807","https://openalex.org/W4388153184","https://openalex.org/W4388651350","https://openalex.org/W4389121351","https://openalex.org/W4389359264","https://openalex.org/W4391320577","https://openalex.org/W4391462928","https://openalex.org/W4391543224","https://openalex.org/W4392157835","https://openalex.org/W4392565343","https://openalex.org/W4392753127","https://openalex.org/W4393408029","https://openalex.org/W4394688673","https://openalex.org/W4394731592","https://openalex.org/W4394909904","https://openalex.org/W4400842408","https://openalex.org/W4401264707","https://openalex.org/W4401561850","https://openalex.org/W4407085172","https://openalex.org/W4408488651"],"related_works":[],"abstract_inverted_index":{"OBJECTIVE:":[0],"To":[1],"explore":[2],"the":[3,9,98,102,105,117,120,136,178,192,195],"adoption":[4,241],"and":[5,18,34,39,66,75,84,92,126,145,155,182,214,232,255,263],"practical":[6],"implementation":[7,111,265],"of":[8,27,64,101,116,122,189,194],"three":[10],"major":[11],"health":[12,89,180,273],"data":[13,158,185,215,258,274],"standards":[14,128],"(i.e.,":[15,119],"FHIR,":[16,144,230],"OMOP-CDM,":[17,142,231],"openEHR),":[19],"to":[20,71,87,237,269],"evaluate":[21],"their":[22,240],"maturity":[23],"level":[24],"in":[25,49,104,151,177],"terms":[26],"how":[28],"extensively":[29],"they":[30],"have":[31],"been":[32],"applied":[33],"integrated":[35],"into":[36],"everyday":[37],"clinical":[38,162],"research":[40,152],"practice.":[41],"METHODS:":[42],"We":[43],"conducted":[44],"a":[45],"systematic":[46],"review":[47],"registered":[48],"PROSPERO":[50],"(CRD42024623398)":[51],"following":[52],"PRISMA":[53],"guidelines.":[54],"Literature":[55],"searches":[56],"were":[57,79,108,129],"performed":[58],"through":[59],"PubMed,":[60],"Cochrane,":[61],"Scopus,":[62],"Web":[63],"Science,":[65],"IEEE":[67],"Xplore":[68],"from":[69],"2021":[70],"2024.":[72],"After":[73],"de-duplication":[74],"screening,":[76],"99":[77,137],"studies":[78,190,218],"included.":[80],"Data":[81],"was":[82,167,175],"extracted":[83],"classified":[85],"according":[86],"five":[88,93],"application":[90],"domains":[91],"use":[94],"cases":[95],"based":[96],"on":[97,157],"intended":[99],"purpose":[100],"standard":[103,118,245],"work.":[106],"Studies":[107],"assessed":[109],"for":[110,169,183,212,250,253,257],"scale,":[112],"ETL":[113],"tools,":[114],"coverage":[115,193],"number":[121],"mapped":[123],"source":[124],"variables),":[125],"whether":[127],"adapted":[130],"or":[131,161],"used":[132,141],"as-is.":[133],"RESULTS:":[134],"Of":[135],"included":[138],"studies,":[139],"57%":[140],"39%":[143],"8%":[146],"openEHR.":[147],"Most":[148],"applications":[149],"occurred":[150],"settings":[153],"(87%)":[154],"focused":[156],"reuse":[159],"(47%)":[160],"decision":[163],"support":[164,270],"(23%).":[165],"OMOP-CDM":[166,204,252],"preferred":[168],"large-scale,":[170],"longitudinal":[171],"research,":[172],"while":[173],"FHIR":[174,197,249],"dominant":[176],"public":[179],"domain":[181],"real-time":[184],"exchange.":[186],"Only":[187],"27%":[188],"reported":[191,221],"standard.":[196],"implementations":[198],"often":[199],"require":[200],"customization,":[201],"complicating":[202],"interoperability.":[203],"offered":[205],"strong":[206],"analytical":[207],"tooling":[208],"but":[209],"posed":[210],"challenges":[211],"mapping":[213],"loss.":[216],"Few":[217],"using":[219],"openEHR":[220,233,256],"limitations,":[222],"with":[223],"its":[224],"uptake":[225],"remaining":[226],"limited.":[227],"CONCLUSION:":[228],"Although":[229],"hold":[234],"significant":[235],"potential":[236],"enhance":[238],"interoperability,":[239],"remains":[242],"fragmented.":[243],"Each":[244],"shows":[246],"specific":[247],"strengths:":[248],"exchange,":[251],"analytics,":[254],"persistence.":[259],"A":[260],"hybrid":[261],"approach":[262],"clearer":[264],"practices":[266],"are":[267],"essential":[268],"scalable,":[271],"interoperable":[272],"ecosystems.":[275]},"counts_by_year":[],"updated_date":"2026-06-22T08:00:12.763002","created_date":"2026-03-22T00:00:00"}
