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American Journal of  Medical 
Science and Innovation (AJMSI) 

Enhancing Interoperability and Response Coordination in Disaster Settings: A Review 
of  Methodological Frameworks and Technique

Alina Petrica1, Mohammed Isa Lawan2*, Amakama Nimisingha Jacob2, Gilles Dusserre2

Volume 3 Issue 2, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i2.3612
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: August 12, 2024
Accepted: September 09, 2024
Published: November 14, 2024

When mobile field hospitals are deployed for disaster response missions, they face several 
challenges. Notable among the challenges is the lack of  interoperability with the regional 
hospitals which is essential for patient information sharing and transfer when the need arises. 
Several healthcare systems around the globe have interoperability platforms that are well in 
place. However, due to different standards and system design they cannot easily interoperate 
with one another. This is even more apparent when interoperability during disaster response 
is desired between a mobile field hospital and regional hospital. The several interoperability 
frameworks designed by vendors are mainly designed for usage in large stationary hospitals, 
hence there is need to consider frameworks that can enhance interoperability between a 
mobile field hospital and regional hospital to facilitate coordinated disaster response. In 
this article we argue that an effective disaster response interoperability framework should 
be adaptable, affordable, simple to use, and capable of  being employed in isolated, harsh 
environments such as occurs during disaster response. An analysis of  several healthcare 
interoperability frameworks is conducted in this article with the aim of  proposing a suitable 
framework for possible adoption by mobile field hospital’s interoperability with regionals 
hospitals during sudden onset disasters.

Keywords
Disaster Response, Electronic 
Medical Records, Emergency 
Medical Operating System, 
Interoperability, Mobile Field 
Hospital, Regional Hospital, 
Telemedicine

1 University of  Medicine, Timisoara, Timis, Romania
2 IMT Mines Alès, France
* Corresponding author’s e-mail: mohadamagum71@yahoo.com

INTRODUCTION
Background and Significance
Disasters as defined by United State office for Disaster 
Risk Reduction (UNDRR) is a serious disruption of  the 
functioning of  a community or a society at any scale 
due to hazardous events interacting with conditions of  
exposure, vulnerability, and capacity, leading to one or 
more of  the following: human, material, economic and 
environmental losses and impacts. The effect of  the 
disaster can be immediate and localized but is often 
widespread and could last for a long period of  time. The 
effect may test or exceed the capacity of  a community 
or society to cope using its own resources, and therefore 
may require assistance from external sources, which 
could include neighbouring jurisdictions, or those at the 
national or international levels necessitating request for 
mobile field hospital deployment (UNDRR, 2020).
A mobile field hospital is defined as mobile, self-contained, 
self-sufficient medical facility that is capable of  rapid 
deployment, expansion or contraction to meet immediate 
emergency requirement for a specified period of  time 
(Rossodivita, 2011).The conditions involved before a 
field hospital can be dispatched  include: (a) a written 
request by health authorities of  the affected country, 
(b) be Integrated into the local healthcare systems, and 
(c) a Clear definition of  their roles, responsibilities, and 
operational attainment. The main purpose of  a field 
hospital is to compliment or substitute local hospitals in 
advent of  sudden impact events that produce a disaster. 
When mobile field hospitals are deployed for disaster 
response, they are faced with myriads of  challenges, 

notable amongst is the lack of  interoperability with other 
regional healthcare systems (Hamis et al., 2023; Anyam 
Gift et al., 2020; Olalekan & Gift, 2020; Raimi & Raimi., 
2020)  
Interoperability plays a role in emergency situation, 
especially in emergency departments, where it can be 
both essential and insufficient, at times, especially during 
large scale disasters (Migliorini, 2019). The concept of  
interoperability refers to the capacity of  information 
systems, devices, and applications to access, exchange, 
integrate and collaborate through sharing data across 
organizational boundaries. This coordination aims to 
ensure access to information and optimize the well-
being of  individuals and populations (Li et al., 2022). 
When health information systems lack interoperability, 
it compromises the quality of  patient care, and leads 
to unnecessary resource wastage (Torab-Miandoab et 
al., 2023).This brings about the importance to have a 
compatible healthcare interoperability frameworks.
In disaster situations the importance of  interoperability 
frameworks has been growing. It is crucial for organizations 
involved in disaster response to communicate effectively 
and coordinate their efforts. Interoperability challenges 
can make information sharing and coordination, among 
organizations a daunting task, especially during a disaster 
(Migliorini, 2019; Matshaba et al., 2023). Interoperability 
frameworks play a role in facilitating the exchange and 
sharing of  data across diverse systems and services. These 
frameworks encompass a range of  standards, guidelines 
and policies that outline the agreements for organizations 
to establish connections between their systems using 



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interfaces and protocols. By implementing interoperability 
frameworks at levels, such as syntactic, semantic, 
organizational and legal aspects, seamless connectivity 
can be achieved (Ndlovu et al., 2021). The European 
Interoperability Framework (EIF) serves as an illustration 
of  an accepted method, for providing public services 
with seamless compatibility. Interoperability frameworks 
depend on public service governance that encompasses 
aspects like usability, security, privacy, and performance. 
When creating an interoperability framework, it is crucial 
to define four layers; legal, technical, semantic, and 
organizational. However, these layers are seldom defined 
in disaster settings, where inter-operability is required in 
the interaction between existing Regional Hospitals (RH) 
and Mobile Field Hospitals (MFH). The objectives of  this 
study are to provide answers to two research questions; 

(1) What are the healthcare interoperability challenges 
in disaster settings? 

(2) Which of  the current interoperability frameworks 
can improve the interoperability between a mobile field 
hospital and the regional hospitals during a disaster 
response?

Interoperability Challenges in Healthcare  
For a time, the healthcare industry has recognized the 
issue of  interoperability. Interoperability challenges in 
healthcare arise from the obstacles faced when trying to 
exchange and share data seamlessly among systems and 
services. These challenges encompass issues such, as.

• Lack of  coordination among different facilities/health 
systems participating in or facilitating health information 
exchange (HIE) (Mitigating Barriers to Interoperability in 
Health Care | HIMSS, 2019).

• Resistance to data sharing and lack of  skill (Top 
Healthcare Interoperability Challenges - Excellarate, 2023).

• Constraints in budget (‘Interoperability in Healthcare 
Tech, 2022; Top Healthcare Interoperability Challenges - 
Excellarate, 2023).

• Lack of  standardization of  terminology and 
normalization of  data(Healthcare Interoperability: 
Barriers and Solutions, 2020).

• Inconsistent information across multiple sources 
(Ali, 2022; Top 5 Challenges with Interoperability in 
Healthcare, 2021).

• Poorly enforced standards that can obstruct seamless 
health data exchange by complicating transactions and 
posing additional barriers to the flow of  information 
(EHRIntelligence, 2017).

• Inability to identify patients consistently 
(EHRIntelligence, 2017).

• Legal system issues: Systems implemented before 
the establishment of  common national standards are 
known as legacy systems, which typically have restricted 
interoperability capabilities (Barbarito et al., 2012).

• Lack of  interoperability standards or poorly enforced 
standards(EHRIntelligence, 2017).

• Complexity of  healthcare domain (Barbarito et al., 2012). 
These difficulties can lead to negative health outcomes, 

increased expenses and a decrease in the quality of  
patient care (Iroju et al., 2013; sadeghi et al., 2023; Top 
Healthcare Interoperability Challenges - Excellarate, 
2023). To address these issues, stakeholders are adopting 
healthcare technologies and approaches that promote 
interoperability. This includes utilizing intelligence 
empowering patients to engage with their health data 
and strengthening health information exchanges (3 Ways 
to Enhance Healthcare Interoperability with Health IT, 
2020). Additionally, enhancing interoperability requires 
a combination of  strategies like realigning incentives 
and overcoming barriers that hinder the exchange of  
electronic health information (Mitigating Barriers to 
Interoperability in Health Care, HIMSS, 2019) (Sadeghi 
et al., 2023)

LITERATURE REVIEW
In this part, we’ll look at several interoperability 
frameworks and extensively study each framework to 
evaluate its strengths, flaws, and applicability to diverse 
scenarios. The main aim is to find a suitable framework 
for mobile field hospital’s interoperability with regional 
hospitals for patient information sharing and transfer 
during disaster response.

Electronic Medical Record (EMR) 
An EMR has the potential to significantly enhance 
the quality, usability, security, and interoperability of  
documentation with other systems and teams (Schreiber 
et al., 2022). According to Gaynor et al. (2014), EMRs 
that adhere to the US Office of  National Coordinator’s 
(ONC) meaningful use criteria will: 

• Enhance clinical decision-making, 
• Minimize redundancy, 
• Improve compliance with documentation and 

treatment standards, 
• Enable context-specific information presentation, 
• Integrate clinical documentation and billing functions, 
• Support clinical research and quality improvement. 

The interoperability of  health care applications becomes 
complex due to the components of  an EMR. A typical 
hospital EMR consists of  systems, clinical documentation, 
laboratory, radiology, pharmacy and physician order 
entry modules. When clinical data is recorded using data 
elements (HL7v3 CDA) encoded in a manner (XML) 
with accepted terminology (SNOMED) and stored in 
a manner that enables the use of  standardized retrieval 
methods these benefits are more likely to be realized 
(Gaynor et al., 2014).Hence sharing of  electronic medical 
records will go a long way in improving interoperability 
across various healthcare systems.

Use of  iPhone Application iChat 
Electronic medical records are extensively utilized in 
both developed and some developing countries, playing 
a role in addressing challenges within the healthcare 
industry. Interestingly their significance becomes more 
pronounced during short medical service trips to areas 



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despite their limited implementation in such regions 
(Dainton & Chu, 2017). The research underscores the 
value of  two technologies; the iPhone application called 
iChart and traditional satellite communication. The 
study highlights how EMR greatly benefits low resource 
settings and challenging environments. Specifically, it 
improves care coordination and information retrieval by 
enabling devices to access data thereby replacing the old 
paper chart system with longitudinal patient records and 
a centralized repository for essential patient information. 
However, it is worth mentioning that some limitations 
exist; for instance, the current version of  iChart has been 
criticized for its time-consuming nature as it takes around 
two to five minutes to input patient data. Additionally, one 
of  the authors noted that their EMR system becomes less 
usable on days when there could be up to 500 encounters 
(Dainton & Chu, 2017). According to the study, EMR 
has gained popularity while other EMRs-like systems 
are still in the pilot phase and mainly used internally by 
non-governmental organizations (NGOs). Based on 
this finding smaller rival EMR systems should consider 
enhancing their technology to facilitate communication 
and data manipulation, between physicians, patients, other 
clinicians and larger EMR platforms. This suggestion 
aims to enhance interoperability among these systems.

Intelligent Agent Technology (AIDA)
Researchers, from the University of  Minho collaborated 
with one of  Portugals leading hospitals Centro Hospitalar 
do Porto (CHP) to develop the Agency for Integration, 
Diffusion and Archive of  Medical Information (AIDA). 
AIDA is a platform that facilitates the integration 
and sharing of  data generated in healthcare settings. 
By utilizing tools like Service Oriented Architectures 
(SOA) and Multi Agent Simulation (MAS) which 
ensure interoperability in diverse contexts, AIDA offers 
ways to integrate information. What sets AIDA apart 
from systems are its programs functioning as proactive 
software agents and intelligent workers. These agents 
handle tasks such as managing information, sending, 
and receiving medical reports, photos, data collection, 
prescriptions, communicating with systems and providing 
accurate and timely responses to requests. As the volume 
and complexity of  data generated in healthcare facilities 
continues to grow so does the need for a system to 
manage these agents effectively.
To address this need, Cardoso et al. (2014), proposed a 
module for AIDA that allows administrators to create 
agents to schedule their actions and monitor their activities 
closely. The primary goal of  AIDA is to distribute and store 
datasets from various sources, like services, departments, 
units, computers, and medical devices. Additionally, 
it provides tools to make human connections easier. 
Ensuring that AIDA functions optimally and satisfies 
its stakeholders (such as administrators, physicians, 
nurses, patients) is crucial because the AIDA platform 
has become indispensable for operations in healthcare 
institutions where it’s implemented. Given that the agents 

form the foundation of  the AIDA platform (even a small 
anomaly during their execution) can lead to issues for a 
healthcare facility. These issues can directly or indirectly 
impact treatment. Thus, AIDA administrators need to be 
aware of  an agent’s tasks and their duration along with 
details. Consequently, it became necessary to develop 
a module for managing AIDA agents to identify agent 
failures.

Social and Healthcare Information Sharing System (SISS)
Barbarito et al. (2012) present the application of  
interoperability standards in the Lombardy Regional 
Healthcare Information System in Italy. The method 
included implementing the Health Level 7 (HL7) standard 
within individual institutions as well as establishing a 
technology infrastructure for data sharing based on 
regionally recognized interoperability protocols. This 
enables the integration of  various healthcare organizations 
in the region, resulting in large-scale integration among 
healthcare providers while also serving patients. Also, it 
facilitates communication and message exchange across 
many actors in the healthcare system, including hospitals, 
general practitioners, specialists, nurses, and pharmacists, 
by utilizing standardized web services and integration 
profiles.

Telemedicine 
Telemedicine refers to the use of  information and 
communication technologies to deliver healthcare 
services and support when physical distance separates 
the people involved (Jamal et al., 2007). In the study, 
telemedicine was utilized to enhance interoperability, 
between healthcare providers and tertiary healthcare 
facilities during an earthquake that occurred in Pakistan 
on October 8, 2005. Furthermore, telemedicine has the 
potential to address the issue of  staff  shortages, which 
was an observed challenge at COVID 19 field hospitals 
(Alpert et al., 2018). An example of  this success can be 
seen during the FMT type 3 Nepal mission in 2015, where 
a consultant pediatric cardiologist was not physically 
present to treat a child with difficulty breathing and an 
abnormal ECG. By utilizing telemedicine, images and 
videos were transmitted to the specialist who provided 
lifesaving advice. This intervention has not only resolved 
staffing shortages but also improved collaboration 
between healthcare systems when expertise from limited 
specialists is required.

Emergency Medical Operating System (EOS)
Emergency medical teams (EMTs) are dispatched 
immediately in response to sudden onset disasters to 
provide care for the injured. However, coordinating and 
communicating with regional hospitals can be challenging 
for EMTs due to the lack of  information systems and 
standards (Schreiber et al., 2022). To tackle these challenges 
the Emergency Medical Team Operating System (EOS) 
was specifically developed for EMTs. The European 
Modular Field Hospital (EUMFH) which is a Project 



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of  the European Directorate General for European 
Civil Protection and Humanitarian Aid Operations 
(DG ECHO) supported by the General Directorate, 
for Civil Protection and Humanitarian Aid Operations 
of  the European Commission aimed to conceptualize a 
European EMT3 and ultimately led to the creation of  the 
Emergency Medical Team Operating System (EOS).
Sharing data with systems is crucial in situations where 
an EMT may collaborate with responders and nearby 
hospitals. To facilitate integration into an information 
processing chain an interface called HL7 FHIR was 
developed. Additionally, each information card can be 
linked to scanned or downloaded documents allowing 
for the inclusion of  data and complementing EOS data 
forms while ensuring continuity of  care. This feature 
would enable the use of  preprinted EOS forms during 
prolonged power outages and enable the addition of  
completed forms scanned to their cards once power is 
restored. EOS can be accessed through a web browser that 
is compatible with any device ranging from smartphones 
to PCs making it user friendly and intuitive. The patient 
care user interface has been specifically designed for tablet 
PCs providing flexibility for staff  members to move 
around the field hospital as needed (Schreiber et al., 2022).
To effectively communicate with teams, the EMR 
language can be easily switched at any time. The system 
is designed to strike a balance between openness and 
necessary restrictions. Its aim is to minimize the number 
of  clicks required for users to quickly respond in 
emergency situations. To ensure traceability, quality and 
safety standards are met, EOS maintains a comprehensive 
audit log that tracks all user added or modified data. 
Moreover, it allows flexible role allocation for healthcare 
professionals such as doctors, nurses, and technicians 
with system permissions for each role. EOS offers an 
EMR solution tailored specifically to meet the needs 
of  EMTs. It addresses the standing need in the market 
for a portable digital tool that facilitates organized and 
transparent documentation—an essential aspect of  
managing, coordinating, and evaluating disaster relief  
operations. Initial assessments conducted during a field 
exercise demonstrated implementation of  the system 
while receiving positive feedback from users (Schreiber 
et al., 2022). 

The Hermes Semantic Model
Vergeti et al. (2018) developed the HERMES model 
which is an ontological representation of  the conceptual 
model of  the Health Emergency Management domain 
that makes up the HERMES Semantic Model, which 
aims to: (a) provide an integral conceptual model of  
Health Emergency Management covering all relevant 
knowledge domains; and (b) address the previously 
mentioned interoperability and integration issues. 
HERMES reuses existing ontologies to produce a new 
upper model, a set of  vertical models, and a data facet. A 
specific method imports data from the various resources 
using the model to give an integrated and consistent view 

of  the data. The final standardized data may be used by 
different event management platforms to assist in making 
decisions during an emergency. Lastly, open data from 
open data sources is used to assess the model and the data 
harmonization process. The evaluation’s findings confirm 
that the strategy is appropriate. Even though there are 
many ontologies accessible, the HERMES approach is 
unique since it establishes a general higher model for 
emergency response that can be used for any incident, 
including mass emergencies and everyday occurrences. 
Additionally, HERMES adheres to interoperability 
requirements that the Emergency Management Ontology 
does not anticipate.

Complete And Resilient Documentation (Card) For 
Operational Medical Environments
Clemson University United States sponsored the research 
by Woo et al. (2019) on interoperability framework 
known as the complete and resilient documentation for 
operational medical environment (CARD). This system-
oriented approach aimed at enabling resilient handsfree 
data collection, preserve complete documentation and 
provide timely information for medical operations. It is a 
highly flexible and evolvable framework which addresses 
challenges of  handsfree electronic health record data 
entry in noisy operational environments, preventing 
disruption of  care for documentation and avoiding loss 
of  documentation.

Systems, Methods, and Techniques for Interoperable 
Emergency Communication
Ma et al. (2020) proposes the use of  systems methods and 
techniques for interoperable emergency communication. 
This proposes a framework for triggering and releasing 
emergency communication escalation events which 
enhances emergency communication systems. The 
framework suggests the use of  notifications to inform 
specific individuals or groups involved in escalation, 
ensuring timely communication during emergency 
situations. Even though the framework was aimed 
for military emergency response, the concept of  
emergency communication escalation can be applied 
within organizations or across multiple organizations, 
facilitating coordinated responses to emergency. Hence 
such approach can be applied to filed hospitals and 
enable interoperability with other regional hospital during 
disaster response.

Interoperability Framework for Integrated E-Health 
Services
This framework, which is built using Web Service 
technology and the service-oriented architecture (SOA) 
paradigm, is proposed (Amin et al., 2020). During the 
analysis and design phases of  system development, a 
technique called service-oriented analysis and design 
(SOAD) is employed to create a service portfolio that is 
divided into three levels: conceptual, logical, and physical 
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The Service Oriented Architecture (SOA) paradigm 
in system development is demonstrated by the service 
portfolio, which was created because of  the architecture 
of  the interoperability framework for the e-health service 
utilized in this study. 
An array of  computer-based information systems, 
including emergency department, inpatient, laboratory, 
financial, and other services, are integrated into the 
e-health service to satisfy stakeholder information 
needs and patient demands. The goal of  the project was 
to develop an interoperability mechanism model for 
sharing information and data between multiple databases, 
including the National Population Database, the Health 
Insurance Database, and e-health services run by hospitals 
or other health data providers. 

Automatic Ambulance System Using Internet of  Things
Saha et al. (2020) suggested this model in which The 
Raspberry Pi serves as the foundation for the architecture, 
with sensor units connected to it. Sensors are used 

to measure the patient’s physiological characteristics. 
Parameters include heart rate, temperature, blood 
pressure, glucose, cholesterol levels, and more. The 
machine also has a camera module for capturing patient 
images at regular intervals. 
After completing the ambulance module, upload the 
data to the cloud. The Cloud module includes two 
cloud services. They’re ThinkSpeak and Dropbox. The 
ThinkSpeak cloud platform allows numerical data to 
be submitted. ThinkSpeak cloud provides graphical 
representation of  uploaded data. The images are uploaded 
to DropboxCloud.In the hospital module, the doctor 
monitors the data that has been uploaded to the cloud. 
The red detected image aids clinicians in determining the 
severity of  wounds. The hospital module includes a basic 
application that downloads data from the cloud. With the 
data collected, the doctors plan for an immediate medical 
response. This, however, is best suited for interoperability 
between emergency medical ambulance and regional 
hospitals within a given metropolitan.

Table 1: Comparative analysis of  selected interoperability frameworks
Author (s) Methodology Advantages Disadvantages Applicability 
Cardoso et 
al., 2014. 

Service Oriented 
Architecture (SOA) and 
MAS. Uses intelligent 
agent-based technology 
AIDA 

Enhance communication 
with various systems and 
provide accurate and prompt 
responses to requests. Flexible 
and can be applied to different 
healthcare environments. 

Expensive and 
complex 

More useful in 
larger healthcare 
systems. 

Barbarito 
et al., 2012. 

Social and healthcare 
information sharing 
system (SISS): Adoption 
of  HL7, using a 
conceptual framework 
with technological 
infrastructure for data 
sharing

Provides interoperable social 
healthcare system that, by 
putting international health 
standards into practice, 
connects patients, healthcare 
providers, healthcare 
organizations, and healthcare 
professionals in a vast and 
diverse territory 

Expensive and 
complex, may not 
be easily used in 
areas with low 
connectivity and 
power supply.

Suitable for 
stationary 
healthcare facilities. 
Some aspects, 
such as EHR, 
appointment 
scheduling and 
reporting tools 
could be useful 
with mobile field 
hospital  

Dainton et 
al., 2012. 

Highlighted two most 
popular EMR systems 
technology (proprietary 
iPhone application 
called iChat to create a 
patient log and custom-
built clinical database 
constructed for the Palm 
operating system (OS) 
using the Smart List 
to Go program, and 5 
personal digital assistants 
(PDAs)

Used by mobile field hospitals 
during Haiti earthquake. 
Shows importance of  the 
creation of  longitudinal 
patient records and a 
centralized repository of  
basic patient information 
resulted in improved provider 
handoffs and continuity of  
care. Data could be accessed 
from multiple devices, 
rather than one fixed central 
location in the case of  paper 
charts, resulting in improved 
interoperability

The current 
version of  iChart 
was reported 
to be too 
cumbersome, as 
it took 2-5 and 
a half  minutes 
to input a single 
patient encounter. 
Researchers 
reported their 
EMR system to 
be impractical 
during busier 
days when there 
could be upwards 
of  500 patient 
encounters. 

Suitable for use 
in a low resource 
setting and mobile 
medical facility 
such as the mobile 
field hospital 



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Jamal et al., 
2007 

Telemedicine mobile 
device connected to a 
base unit via a customized 
software which enables 
seamless exchange of  
data between the two 
units 

Speeds up diagnosis and 
therapeutic interventions by 
allowing primary healthcare 
providers to receive 
continuous assistance from 
specialized centers. It is has 
the advantage of  being cost 
effective

Require 
technology and 
communication 
infrastructure. 
Data privacy and 
security are not 
guaranteed. 

This can be applied 
to areas where 
specialized care is 
absent or lacking 
and can address 
the issue of  staff  
shortage. Suitable 
for mobile field 
hospital

Schreiber 
et al., 2022. 

Emergency medical team 
operating system. Uses 
EMR, FHIRHL7. 

Data sharing with other 
systems is essential since an 
EMT might work alongside 
first responders and nearby 
hospitals. HL7-FHIR interface 
promote standard information 
transmission and make it easier 
to be incorporated into a larger 
information processing chain

Staff  may require 
training regarding 
its usage. 

Specifically 
designed for use 
by deployable 
emergency medical 
teams such as 
the mobile field 
hospital

Amin et al., 
2019. 

Utilized system-oriented 
architecture (SOA) and 
implemented using web 
service technology. 
This is developed using 
service-oriented analysis 
and design (SOAD). 

Materialize data 
interoperability and 
information exchange among 
several e-health systems. 

Cannot be used 
on multiple 
platforms e.g., 
laptop, desktop, 
and mobile 
phones. 

Designed for data 
exchange between 
multiple databases. 

Vergeti et 
al, 2018  

Developed a semantic 
model called HERME 
which reuses an existing 
ontological model to 
provide an upper model 
which imports data from 
various sources hence 
providing an integrated 
and harmonized view of  
the data.

The model can be applied 
to any incident (every day or 
mass emergency). Also aligned 
with interoperability standard 
not foreseen in emergency 
management ontology

Maily focusses 
on semantic 
interoperability

Flexible and can 
be applied to any 
incident

Woo et al., 
2021

Complete and Resilient 
Documentation (CARD) 
for Operational Medical 
Environments is a 
system-oriented approach 
aimed at enabling 
resilient handsfree data 
collection, preserve 
complete documentation 
and provide timely 
information for medical 
operations

Addresses challenges of  
handsfree electronic health 
record data entry in noisy 
operational environments, 
preventing disruption of  
care for documentation 
and avoiding loss of  
documentation

Limited or 
unreliable 
network coverage 
in disaster-
stricken areas 
may hinder 
effectiveness of  
CARD

Highly flexible and 
evolvable system 
which is applicable 
in variety of  
scenarios including 
harsh austere 
disaster settings

Ma et al., 
2020

Proposes a framework 
for triggering and 
releasing emergency 
communication escalation 
events

Improves response times 
and enhance emergency 
communication systems

May require 
personnel training 
and internet 
connections

Flexible and 
can be applied 
to healthcare 
emergency 
response such as 
deployed mobile 
field hospitals



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Amin et 
al.,2020 

This framework uses 
web service technology 
and service-oriented 
architecture to build an 
interoperability model 
for information sharing 
between several data 
bases

Serve as a guide for creation 
of  e-health systems across a 
range of  medical applications

Further research 
is needed for 
developing 
e-health systems 
using multi 
platforms 
environments 

Flexible and can be 
used for variety of  
healthcare system 
interoperability 

MATERIALS AND METHODS
We conducted searches in credible databases including 
Web of  Science, PubMed, and Google Scholar. Google 
search of  websites was also included. The keywords 
used include “disaster response”, “mobile field hospital”, 
“regional hospital”, “emergency medical operating 
system”, “telemedicine”, and “electronic medical 
records”.
For inclusion, we targeted articles published in English 
within the previous 20 years and focussing on the state-
of-the-art on several healthcare related interoperability 
standards, frameworks, and applications. While for 
exclusion, we removed opinion pieces and studies with 
insufficient data.
By using the search, 400 articles were found at first. Upon 
examining abstracts and titles, we narrowed the field 
down to 86. After carrying out a full-text examination, 
we included 46 articles that satisfied the predetermined 
standards and chosen for in-depth analysis. Finally, 28 
articles were selected with additional 16 website obtained 
Via google search containing relevant information 
as per the criteria. Thus, assisting in gaining valuable 
understanding about several interoperability frameworks, 
their limitations, strengths and opportunities for 
improvement and application in disaster settings. These 
reviews were critical in the proposal of  an appropriate 
methodological framework with features and capabilities 
that is anticipated to address the challenges that are 
usually associated with interoperability, vis-à-vis the 
improvement of  healthcare delivery and subsequent 
patient outcomes in disaster settings.

RESULTS AND DISCUSSION
Result
Table 1 is a summary of  the analysis done on selected 
healthcare interoperability frameworks. As the main aim 
of  this research is to device a suitable framework that 
can be adopted during disaster response to enhance 
interoperability between mobile field hospital and 
regional hospital, we hold that the framework should 
meet some criteria: it should be cost effective, has ease of  
usage, is feasible in low connectivity or resource area, its 
practicality during emergency and it has data and security 
privacy. Categorizing these frameworks based on these 
requirements we obtain the following results:

Cost Effectiveness
This must be considered when deciding which 
frameworks to use for mobile field hospital as a cheaper 

framework will be easy to implement in disaster and low 
resource settings. Some of  the frameworks that fits into 
this criterion include:

1. Use of  iphone applications e.g ichart
2. Telemedicine
3. Emergency medical team operating system

Ease of  Understanding
For it to be adopted in emergency response, the framework 
should be easy to understand by the healthcare personnel. 
Among the reviewed frameworks, it is obvious that the 
ones having easy mode of  operation or requiring less 
training include:

1. Use of  iphone applications e.g ichart
2. Telemedicine
3. Emergency medical team operating system

Feasibility In Low Connectivity Areas (REMOTE 
LOCATIONS)
Based on the analysis, the frameworks that are feasible in 
remote and low resource settings include:

1. Use of  iphone applications e.g ichart
2. Telemedicine
3. Emergency medical team operating system

Practicality During Emergency Situations
Among the reviewed frameworks, those that are best 
designed and suited in emergency situations include:

1. Use of  iphone applications e.g ichart
2. Telemedicine
3. Emergency medical team operating system
4. framework for triggering and releasing emergency 

communication escalation events by ma et al. (2020).
5. Complete and Resilient Documentation (CARD) for 

Operational Medical Environments

Privacy And Security Concerns
Privacy is an important challenge in interoperability 
and any framework must have data privacy and security 
protection even in emergency response situations. Some 
of  the frameworks that have more data privacy based on 
the information provided include the following:

1. Uses intelligent agent-based technology AIDA. 
2. Social and healthcare information sharing system (SISS)
3. Complete and Resilient Documentation (CARD) for 

Operational Medical
4. Framework for triggering and releasing emergency 

communication escalation events by ma et al. (2020).



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Discussion
Table 1 summarizes the weaknesses, strengths, and 
opportunities of  the selected frameworks. Some 
frameworks are better suited for a larger stationary 
healthcare system while others can be suitable for use in 
austere settings such as during disaster response. We hold 
that the suitable framework should have specific features 
applicable to a low resource disaster setting, they include 
adaptability, flexibility, cost effectiveness and privacy. 
The emergency medical team operating system was one 
that fits well because it has almost all the attributes. It 
was designed specifically for mobile field hospitals and 
was tested during a full-scale European union module 
exercise and proven to be effective by 21 team members 
from 9 different countries. Its resource management 
feature enhances interoperability and coordination. The 
second one in line is the Telemedicine. Even though it 
lacked some qualities such as data privacy, it has excellent 
features which can easily be adopted for interoperability 
during disaster. The most prominent feature is the 
ability to allow medical consultations remotely. This is 
extremely important in situations of  staff  shortage or 
when a specialist intervention from a different location 
is required. The third is the iChat which is also very 
similar to the first two as it is suitable for use in low 
resource settings. Another similarity is it also can be used 
on several platforms e.g. phones, laptops, and tablets. 
Other frameworks that are very specific for emergency 
response include: the Hermes semantic model, complete 
and resilient documentation (card) for operational 
medical environments, and interoperability framework 
for integrated e-health services. These frameworks can 
also be considered due to their specificity for emergency 
response, data security and flexibility to several conditions. 
However, they maybe be costly and may also require 
some operator skills. Furthermore, they have not been 
tested for usage in a mobile field hospitals or emergency 
medical teams as in the case of  the Emergency medical 
team operating system. Other frameworks have better 
data security and privacy and are better suited for 
larger stationary hospital e.g. Uses intelligent agent-
based technology AIDA and The Social and healthcare 
information sharing system (SISS).In view of  this, it 
can be seen that the best suitable framework is not the 
one with the greatest quality in one aspect but the one 
that is more flexible to accommodate a whole different 
attributes. This is to make disaster response easier in an 
environment where the resources are lacking, and more 
technical and sophisticated expertise is not available. 
We therefore suggest that choosing a framework that 
satisfy the conditions proposed by the authors will greatly 
enhance interoperability between mobile field hospitals 
and regional hospitals in disaster response.

LIMITATION
The disadvantage of  this study is that various alternative 
frameworks may have been overlooked due to a lack 
of  access to non-open-source literature focusing on 
interoperability. Furthermore, most of  the information 

presented about each framework was based on the 
information provided in the article, and thus it may 
contain some characteristics that were not recorded in 
this article.

Future Directions
The several frameworks and systems shows potential for 
exploration and advancement. Here are a few aspects that 
can be explored further.

Resource Allocation Algorithms
Create algorithms that enhance the distribution of  
resources by utilizing up-to-date patient information and 
facility capacities. Research could delve into AI powered 
models to forecast patient requirements and adjust 
resource allocation strategies accordingly, in line with the 
frameworks highlighted.

Scalability and Adaptability
Discover the potential of  each framework to effectively 
respond to types of  disasters whether they are small 
scale incidents or major emergencies. The research could 
concentrate on developing a structure that can adjust to 
patient volumes and resource requirements.

Remote Training and Education
Explore the possibilities of  the frameworks in facilitating 
training and education for healthcare professionals during 
disaster response situations. This may involve utilizing 
simulations training modules and platforms for sharing 
knowledge.

Regulatory and Legal Frameworks
It is important to study the regulatory aspects related to 
using the frameworks. This includes exploring licensing, 
liability and cross-border healthcare regulations. Creating 
a framework that complies with requirements is vital for 
ensuring its widespread adoption.

Ethical Guidelines
Create a set of  guidelines to govern the use of  the 
frameworks. These guidelines should cover aspects like 
ensuring consent for remote consultations, maintaining 
patient confidentiality, and promoting equal access to 
healthcare services.

Implementation and Adoption Strategies
Explore approaches for implementing the frameworks 
within established healthcare systems. This involves 
addressing change management, designing training 
programs, and devising strategies to overcome any 
resistance to the adopting technologies.

Human Factors and Psychology
Investigate the effects of  consultations on healthcare 
professionals and patients in times of  disasters. Gaining 
insights into the emotional aspects can aid in enhancing 
the design and implementation of  the framework.



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CONCLUSION
As the world is experiencing increasing incidents of  
disasters, mobile field hospitals serve as the beacon of  
hope among chaos especially when the local capacity is at 
stake. However, to achieve a better patient outcome, these 
deployed mobile field hospitals will need to interoperate 
with the regional hospital to facilitate patients transfer 
and information sharing whenever required. Most of  the 
healthcare interoperability frameworks focus on creating 
frameworks that are more suitable for stationary healthcare 
facilities. To solve this problem, this article investigated 
various healthcare interoperability frameworks with the 
aim of  finding a suitable framework between mobile field 
hospitals and regional hospitals during disaster response 
scenarios. The frameworks were selected based on their 
focus on interoperability of  healthcare systems. Their 
strengths, weaknesses, and applicability to mobile field 
hospital were analyzed. To find the best framework for 
adoption, we hold that the framework should be cost-
effective, easy to use, feasible, and practical in disaster and 
austere settings. Patient data and security must also be 
considered. The result of  the comparative analysis shows 
that some frameworks are less cost effective than others, 
have more feasibility in low resource settings, and have 
better ease of  understanding. They include Use of  iPhone 
applications iChat, Telemedicine, and Emergency medical 
team operating system. Other frameworks have better 
practicality during disaster situations. They include framework 
for triggering and releasing emergency communication 
escalation events, Complete and Resilient Documentation 
(CARD) for Operational Medical Environments, Use of  
iPhone applications iChat, Telemedicine, and Emergency 
medical team operating system. While others have more 
privacy and data security. They include Intelligent agent-based 
technology AIDA, Social and healthcare information sharing 
system (SISS), Complete and Resilient Documentation 
(CARD) for Operational Medical, framework for triggering 
and releasing emergency communication escalation events 
by ma et al. (2020).

Acknowledgments
We would like to express our gratitude to IMT Mines Alès 
for providing us with a conducive research environment. 
Additionally, we extend our thanks to the Petroleum 
Technology Development Funds for their support, in the 
form of  scholarship, for authors 1.

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