ABSTRACT This study aims to analyze research papers related to Hospital Information Systems (HIS), including Electronic Health Record and Electronic Medical Record (EMR), in South Korea over three decades. The research explores frequently used terms and concepts in HIS research, examines how these reflect key focus areas, and investigates the evolution of research trends. This study employed text preprocessing, text network analysis, and a large language model (LLM)-based topic modeling approach. Network analysis identified the most connected keywords in the research corpus, highlighting their central importance across diverse studies. Through LLM-based topic modeling, seven distinct research topics were identified. Intertopic distance mapping revealed significant conceptual overlap between system performance and digital transformation research, while Security and Privacy Management and Health Information Exchange emerged as more distinct areas. Temporal analysis demonstrated evolution in research focus, beginning with system performance in the 1990s, shifting toward EMR adoption and nursing applications, then emphasizing digitalization and security concerns. Recent trends continue to emphasize security alongside digital integration of hospital information infrastructure. These findings reveal that future research should prioritize security in complex healthcare ecosystems, address the underdeveloped area of documentation standardization, and investigate user experience across diverse clinical settings to understand HIS implementation barriers.

Health care is of great importance to individuals and those funding health care. The academic community is interested in how health care can be delivered and the role of health information. This study uses bibliometrics to identify novel research subjects, highly cited literature, worldwide cooperation relationships, author distribution and cooperative network, journal distribution, and research hotspots in the field of health information. Data were collected from the Web of Science database, and the 3525 items of literature retrieved were analysed with word frequency, social network, and cluster analysis methods. The findings indicate that the Internet, Health Information, Health Information Technology, Health Literacy, and Health Information Exchange are the top five health information research topics. There is a close relationship between the research themes of COVID-19, Mental Health, Public Health, and Health Information Seeking. The main co-operative network is centred around the United States and the United Kingdom. College students (health information), young people (health information), and privacy issues (concerning health information) are the recent areas of research. This study can provide some insights for practitioners in libraries and health information institutions, for topic selection in health journals, and for international cooperation among educators.

Uninterrupted health insurance coverage among Medicaid, CHIP, and ACA Marketplaces is still grappling with administrative complications and the barriers to transition eligibility resulting in coverage divide among vulnerable groups. Transformative solutions to be applied to automate eligibility determination and reduce churn in the coverage process can be found in the intelligent workflow systems that combine artificial intelligence and machine learning algorithms with Business Process Management platforms. Health information exchange infrastructure is used to support the flow of data among organizationally varied systems to enable coordinated care delivery. Modern AI-enhanced eligibility engines will add automated data verification features, which significantly lower the disenrolling procedures by ex parte renewals. Predictive analytics software can be used to detect beneficiaries with a high likelihood of coverage loss, so that proactive intervention mechanisms can be put in place. Business Process Management systems coordinate intricate work-flows across multi-systems which include eligibility engines, document management systems, and external data. Comprehensive assessment systems involving coverage churn rates, renewal success measures, transition efficiency measures, and health outcome measures offer multidimensional performance transparency. This has significant technical issues, such as integration of the old system, data quality control, and standards-based interoperability specifications. The implementation will require close consideration of organizational change management, human resources development, and long-term stakeholder involvement. The combination of both cutting-edge automation solutions and the principles of the person-centered design makes intelligent workflow systems the key to the continuity of coverage goals in healthcare safety net programs.

Health information exchanges (HIEs) are generally underutilized as data sources for public health surveillance, potentially decreasing the ability of public health practitioners to leverage the rich, real-time, clinical, and public health data therewith contained. To systematize the process of implementing an academic-nonprofit partnership (ANPP) designed to leverage multijurisdictional HIE data for public health surveillance of Long COVID by Systematizing the ANPP's. Implementation, with a focus on its operational strengths, opportunities, challenges, and strategies for its sustained growth. Document review and analysis informed by the Centers for Disease Control and Prevention's Surveillance System Evaluation framework. We employed a systematic approach to the collection and interpretation of 5 types of documents to describe the experience of implementing a multistakeholder, multijurisdictional, HIE-based ANPP for public health surveillance from 2022 to 2025. Multijurisdictional settings in the US. The ANPP and its constituent organizations. Implementation of the ANPP. Identification of critical lessons learned including key partnership elements, encountered challenges, surveillance framework application, and strategies for implementing a multistakeholder, multijurisdictional ANPP for public health surveillance. A participatory, iterative approach was used to engage stakeholders on ANPP implementation. Foundational strengths included complementary partner expertise and robust data environments, which created unique opportunities for comprehensive Long COVID surveillance. Challenges involved navigating varied institutional, legal, and regulatory requirements, complex data permission structures, and coordinating teams across different time zones. Key lessons learned highlighted that extensive initial investment in legal frameworks, data environments, and communication protocols, though time-consuming, significantly improves surveillance capabilities. Strategies to ensure success included replacing large meetings with focused working groups, fostering frequent communication, and implementing rigorous inter-team data quality control. Implementing multistakeholder, multijurisdictional, HIE-based surveillance necessitates substantial upfront investment. Continuous refinement and strategic efforts are vital for overcoming operational complexities and maximizing HIE potential for robust public health surveillance.

The integration of the Internet of Things (IoT) and edge computing is transforming healthcare by enabling real-time acquisition, processing, and exchange of sensitive patient data close to the data source. However, the distributed nature of IoT-enabled smart healthcare systems exposes them to severe security and privacy risks during health information exchange (HIE). This study proposes an edge-enabled hybrid encryption framework that combines elliptic curve cryptography (ECC), HMAC-SHA256, and the Advanced Encryption Standard (AES) to ensure data confidentiality, integrity, and efficient computation in healthcare communication networks. The proposed model minimizes latency and reduces cloud dependency by executing encryption and verification at the network edge. It provides the first systematic comparison of hybrid encryption configurations for edge-based HIE, evaluating CPU usage, memory consumption, and scalability across varying data volumes. Experimental results demonstrate that the ECC + HMAC-SHA256 + AES configuration achieves high encryption efficiency and strong resistance to attacks while maintaining lightweight processing suitable for edge devices. This approach provides a scalable and secure solution for protecting sensitive health data in next-generation IoT-enabled smart healthcare systems.

Racial disparities in maternal health outcomes are a public health crisis in the U.S. Adequate connection to pregnancy-related resources is a strategy for improving maternal outcomes (Trost et al., in Pregnancy-related deaths: Data from maternal mortality review committees in 36 States, 2017-2019. Centers for disease control and prevention. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html , 2022), yet patients receive little support navigating complex systems. We tested the feasibility of a transition-of-care program that identifies individuals in early pregnancy who visit the emergency department (ED) and facilitates connections to needed healthcare and supportive resources. This pilot used a regional Health Information Exchange (HIE) to identify people from EDs across four counties in South Jersey with evidence of a current or recent pregnancy and limited connection to care. Eligible patients were assigned to a partner site who contacted them to offer scheduling support for pregnancy-related care and connection to supportive resources. The pilot initially focused on prenatal care but expanded to include other supports based on patient needs. Of the 2073 eligible patients, 896 were contacted, and 379 accepted one or more types of support. Support was accepted across racial, ethnic, age, and insurance groups. This pilot illustrated that a perinatal transition of care program from the ED to appropriate pregnancy-related services and resources is feasible. The ED provides a unique opportunity to identify and engage people early in pregnancy who might face barriers to accessing timely care. The model reduced reliance on self-navigation and addressed common access challenges.

The aims of this study were to (1) understand the interactions between system-level factors and key leverage points impacting the implementation of shared care models in Australia and (2) develop strategies and actions targeting these leverage points. A systems thinking approach was applied through two facilitated workshops (online and face-to-face) using group model building and the nominal group technique to guide discussions. Twenty-four stakeholders participated in either one or both workshops (18 in workshop one and 15 in workshop two), including patient advocates (n = 4), oncology specialists (n = 3), primary care providers (i.e., general practitioners (GPs) and practice nurses) (n = 5), oncology nursing professionals (n = 6), cancer care researchers (n = 3), and policymakers (n = 3). A causal loop diagram was developed following workshop one, informed by stakeholder discussions and existing literature. In workshop two, stakeholders prioritised 10 key leverage points in terms of importance, with the top three being (i) funding and resource allocation; (ii) healthcare interoperability, health information exchange, and information technology; and (iii) collaborative relationships. In response to these prioritised leverage points, stakeholders identified 12 potential strategies and 55 corresponding actions to address the challenges. A systems thinking lens enabled stakeholders to prioritise key leverage points and develop targeted strategies to enhance shared care implementation. These strategies can be used to address key areas for change in policy planning and practice in Australia. This study highlights key areas in the health system where targeted changes can improve follow-up and survivorship care for cancer survivors.

The New Mexico P5 (Physician-Pharmacist-Patient-Payor Partnerships) Summit, held May 13-15, 2024, in Albuquerque, NM, sought to bring physicians, pharmacists, patients, and payors together to address the state's healthcare access crisis by advancing integration of advanced practice pharmacists (APPh) into team-based care. The summit sought to identify gaps in healthcare delivery, optimize pharmacists' clinical roles, and develop sustainable collaborative care models to improve outcomes, particularly in rural and underserved areas. New Mexico has a long history of progressive pharmacy practice legislation, including the Pharmacist Prescriptive Authority Act (1993) and reimbursement parity for pharmacist-provided services (2020). The New Mexico P5 Summit convened 119 stakeholders-healthcare providers, payors, policymakers, employers, and patient advocates-to address primary care shortages, workforce gaps, and socioeconomic determinants of health. Keynote and panel sessions examined APPh models in New Mexico and other states, payment reform initiatives, and expanded pharmacist roles in chronic disease management, preventive care, and point-of-care testing. Breakout sessions identified 5 priority areas: (1) legislative and regulatory reform, (2) pharmacy workforce development, (3) health information exchange, (4) reimbursement/business models for clinical services, and (5) employer-based pharmacist demonstration projects. Workgroups were formed and are working to address these priorities. The New Mexico P5 Summit underscored the potential of APPh to mitigate primary care shortages and improve healthcare quality, access, and equity. The collaborative strategies and workgroup initiatives developed provide a framework for legislative, workforce, and payment reforms that leverage pharmacists' expertise. Ongoing stakeholder engagement will be essential to achieving sustainable innovations and transforming New Mexico's healthcare delivery system.

The maternal health crisis in the United States continues to affect some communities more severely than others, often due to historic and systemic barriers to care. Addressing these challenges requirehs solutions that are built with, and trusted by, the communities they serve. This supplement highlights the Safer Childbirth Cities initiative, a multi-year investment by Merck for Mothers and philanthropic partners that supported twenty community-based organizations across the country. These organizations implemented a wide range of approaches-including community-based doula care, storytelling initiatives, health information exchange systems, and new ways of defining and measuring evidence-to improve maternal health outcomes in their cities. By elevating local leadership, building trust through collaboration, and tailoring care to reflect the knowledge and needs of patients, the efforts featured here provide valuable lessons on how maternal health systems can be reshaped to deliver high quality, accessible, and culturally responsive care.

This study is to explore information synthesis on research topics and emerging trends in privacy within the context of technology adoption. A search for the terms privacy and technology adoption in the Web of Science database yielded information on 2910 publications from 2005 to 2025. The analysis was conducted using CiteSpace, incorporating cluster analysis, timeline analysis, and burst detection to identify key patterns and developments. Fifteen sub-areas of privacy related to technology adoption were identified, including health information exchange, blockchain adoption, artificial intelligence, Internet banking, smart home devices, location-based services, mobile commerce, ubiquitous commerce adoption, tracing apps, metaverse adoption, and facial recognition payment. Timeline analysis provided insights into the growth or decline of these research clusters over time. Based on the findings, a framework was developed to illustrate key insights and their interconnections, offering guidance for future research. The study concludes by discussing its implications, limitations, and recommendations for further research.

People living with HIV (PLWH) are at increased risk for cardiovascular disease (CVD), which includes both cardiac and cerebrovascular outcomes. Current CVD prediction models underestimate risk in this population, highlighting the need for improved risk stratification tools. To assess whether adding neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), emerging biomarkers of systemic inflammation derived from routine complete blood counts to the Atherosclerotic Cardiovascular Disease (ASCVD) risk score improves 10-year CVD prediction in PLWH. Retrospective cohort study from 2009 to 2019 using electronic health records from the Bronx Regional Health Information Organization. Regional public health information exchange (Bronx, New York). Adults aged ≥18 years, including 11,334 PLWH and 31,276 demographically matched people without HIV (1:3 ratio). Individuals with pre-existing CVD were excluded. Mean age was 49 years, 45% female, 67% Black/African American, 39% Hispanic/Latino. HIV status, ASCVD risk scores, and inflammatory markers (NLR, PLR quartiles) derived from routine complete blood count parameters. Incident CVD identified via ICD-9/10 diagnostic codes over 10-year follow-up. Multivariable logistic regression models assessed associations between HIV status, ASCVD risk, and inflammatory marker quartiles with outcomes. Model performance was compared using likelihood ratio tests. PLWH were younger (47 vs. 49 years), more likely to be current smokers (53% vs. 33%), and had lower total cholesterol levels (173 vs. 187 mg/dL) (all p<0.001). PLWH had higher incident CVD rates (26% vs. 22%, p<0.001), including cerebrovascular disease (9.6% vs. 6.5%, p<0.001). In the fully adjusted model, HIV-positive status was associated with 32% higher odds of CVD (OR 1.316; 95% CI: 1.249-1.386). The highest NLR quartile was strongly associated with increased disease odds (OR 1.540; 95% CI: 1.430-1.658), while higher PLR quartiles showed protective effects. The full model achieved an AUC of 0.70, with likelihood ratio tests confirming significant improvements in predictive power (all p≤0.0004). Adding NLR and PLR quartiles to ASCVD risk scores significantly improves 10-year CVD prediction in PLWH. These routine, low-cost, readily available biomarkers could enhance cardiovascular risk stratification for this high-risk population.

Despite well-established connections between oral and systemic health, electronic health records (EHRs) and electronic dental records (EDRs) remain largely siloed due to infrastructural and interoperability challenges. This separation limits interdisciplinary care and data-driven research to generate practice-based evidence. We developed and validated 4 algorithmic frameworks specifically designed to link EHR with EDR across nonintegrated systems. Using data from more than 1.7 million medical records and 222,480 dental records spanning a 10-y period at Temple University, we evaluated 4 linkage strategies: (1) direct Social Security number matching, (2) unweighted similarity scoring, (3) weighted average similarity scoring, and (4) a probabilistic expectation-conditional maximization classification model. We compared these approaches using expert-reviewed validation of 1,000 candidate record pairs and selected optimal similarity thresholds for high-fidelity linkages. Our weighted average similarity algorithm demonstrated the best performance with 100% specificity (correctly avoiding false matches), 99% sensitivity (correctly identifying all true matches), and 99% accuracy (proportion of all correct linkages out of total comparisons) at the threshold of 0.82 for successfully linking 121,771 unique patients and 144,229 patients’ linkage with 96% sensitivity, 78% specificity, and 89% accuracy. After linking the datasets, the completeness of key patient demographic information significantly improved, with missing race data reduced from 79% to 11% and missing ethnicity data from 82% to 17%. We designed the algorithm to be transparent and vendor neutral, making it potentially adaptable to any institution or practice regardless of their existing EHR/EDR systems. This provides a foundation for developing a clinical decision support systems that facilitate real-time health information exchange, supporting safer dental procedures, timely medical referrals, and integrative research. Our findings provide a critical bridge between medicine and dentistry, which have remained largely divorced from each other. Future work will focus on multi-institutional validation, implementation, and integration into routine clinical workflows.

Health Information Exchange (HIE) aims to provide healthcare practitioners with a comprehensive, real-time overview of a patient's medical history, connecting patient records across healthcare facilities. Despite the potential advantages and despite ongoing efforts to promote HIE, challenges have often outweighed successes. In this article, the authors outline the process of establishing an HIE in Dubai (Nabidh HIE), emphasizing the obstacles, significant moments, and successes. This article examines the difficulties and achievements faced throughout the implementation phase and their effects on upcoming HIE initiatives. We think that our experience can act as a useful point of reference for other countries in the area as they strive to implement HIE.

BackgroundPatients with Inflammatory Bowel Disease (IBD) are at an increased risk of developing colorectal cancer (CRC). While numerous studies have explored chemoprevention strategies in the general population, the specific roles of statins and aspirin in reducing CRC risk among IBD patients remain inconclusive.AimThis study aims to evaluate the effect of statins on CRC risk and investigates whether combining statins and aspirin further reduces CRC risk in this high-risk population.MethodsWe included 11,325 IBD patients from the Northwell Health Information Exchange (HIE) database (2008–2023). Demographic and clinical variables were collected. The primary endpoint was CRC development, while the secondary endpoint was the occurrence of any cancer. Multivariable logistic regression assessed the association between cancer development and statin use, adjusted for confounders. Subgroup analyses evaluated the combined effect of statins and aspirin compared to non-users and aspirin-only users. Statistical significance was defined as a p-value <0.05.ResultsAmong 11,325 patients (mean age 65.1± 20.4 years, 54.5% females, 68% white), 2,809 (24.8%) used statins. Logistic regression analysis revealed that statin use was associated with lower odds of CRC, although it did not reach statistical significance (OR: 0.647, p = 0.0564). It was, however, significantly associated with a reduced risk of any cancer (OR: 0.630, p<0.0001). Furthermore, combining statins and aspirin significantly reduced the risk of CRC (OR: 0.163, p=0.0028) and any cancer (OR: 0.367, p<0.0001) compared to non-users. When compared to aspirin-only users, the statin-aspirin combination was associated with significantly lower odds of CRC (OR: 0.235, p=0.0289) and any cancer (OR: 0.522, p=0.0087).ConclusionStatins are associated with a reduced risk of any cancer and a potential reduction in CRC in patients with IBD. The combination of statin-aspirin demonstrates a significant and synergistic protective effect, supporting its potential role in chemoprevention strategies for this high-risk population.

Background/Objectives: We wished to determine whether patients of providers subscribing to Health Information Exchange (HIE) services experience a reduction in emergency room visits and inpatient admissions compared to those who do not subscribe and whether the type of HIE service (online access to records via an HIE portal and/or integration with their electronic health record (EHR) and push notifications) a provider uses further impacts utilization. Methods: The research team utilized the Colorado All-Payer Claims Database (CO APCD) from 2017 to 2019, intentionally excluding the impact of COVID-19 on HIE services. A pre–post analysis was conducted 15 months before and after the provider subscribed to HIE solutions to quantify the effects when compared to control clinics. Results: Subscription to HIE solutions was associated with lower inpatient (IP) admissions than those in a control group for all insurance payer types (p = 0.001). The reduction in Medicaid patients was more pronounced when their providers subscribed to either service alone or in combination and was associated with significantly fewer ED and IP admissions than those for control clinics (p = 0.003, p < 0.05 for HIE portal alone and p < 0.0001, p = 0.002 for both HIE portal and integrated EHR solutions). HIEs enable providers to coordinate care and access patients’ previous test results and clinical histories, potentially reducing the need for high-cost emergency department and inpatient services. This, in turn, appears to substantially impact low-resource individuals, who have historically been the highest users of these services. Conclusions: HIE provider subscription is associated with a reduction in patients’ use of inpatient care after enrolling in HIE products across all insurance types. Medicaid patients experienced the most significant decrease in both emergency room (ED) visits and inpatient admissions when compared to control clinics.

To use more precise measures of which hospitals are electronically connected to determine whether health information exchange (HIE) is associated with lower emergency department (ED)-related utilization. We combined 2018 Medicare fee-for-service claims to identify beneficiaries with 2 ED encounters within 30days, and Definitive Healthcare and AHA IT Supplement data to identify hospital participation in HIE networks (HIOs and EHR vendor networks). We determined whether the 2 encounters for the same beneficiary occurred at: the same organization, different organizations connected by HIE, or different organizations not connected by HIE. Outcomes were: (1) whether any repeat imaging occurred during the second ED visit; (2) for beneficiaries with a treat-and-release ED visit followed by a second ED visit, whether they were admitted to the hospital after the second visit; (3) for beneficiaries discharged from the hospital followed by an ED visit, whether they were admitted to the hospital. In adjusted mixed effects models, for the first two outcomes, beneficiaries returning to the same organization had significantly lower utilization compared to those going to different organizations; for the third outcome, those returning had higher utilization. Comparing only those going to different organizations, HIE was not associated with lower levels of repeat imaging or likelihood of admission following hospital discharge. HIE was associated with lower likelihood of hospital admission following a treat-and-release ED visit (1.83 percentage points [-3.44 to 0.21]). Differing utilization for beneficiaries returning to the same organization could reflect better access to information or other factors such as aligned incentives. HIE is not consistently associated with utilization outcomes reflecting more coordinated care in the ED setting.

Using a statewide health information exchange to enhance COVID research and surveillance: The impact of information fragmentation.

BackgroundTimely surveillance of diabetes mellitus remains a challenge for public health agencies. In this study, researchers compared type 2 diabetes (T2D) prevalence estimates using electronic health record (EHR) data and computable phenotypes (CPs) as defined and applied by 2 independent networks. One network, Diabetes in Children, Adolescents, and Young Adults, was a research consortium, and the other, the Multi-State EHR-Based Network for Disease Surveillance, is a practice-based public health surveillance network.ObjectiveThis study sought to determine the equivalence of T2D prevalence estimates generated by 2 distinct, yet conceptually related, CPs using EHR data.MethodsEach network used diagnostic, laboratory, and medication data for young adults (aged 18-44 years) extracted from the Indiana Network for Patient Care (INPC) to independently calculate prevalence of T2D using distinct CPs for the year 2022. The INPC is a statewide health information exchange that receives EHR data from multiple health care systems and supports public health use cases such as surveillance. The two one-sided tests method for independence with a predefined margin of –2.5 to +2.5 percentage points was used to compare the estimated prevalence as previously derived from the Multi-State EHR-Based Network for Disease Surveillance and Diabetes in Children, Adolescents, and Young Adults networks. The two one-sided tests for equivalence show that any observed difference between 2 estimates is small and practically insignificant. Results at the overall level, and stratified by sex, age, and race or ethnicity, were examined.ResultsOverall prevalence estimates for 2022 were 4.1% for CP 1 and 2.4% for CP 2. Although prevalence estimates for CP 1 were consistently higher than those for CP 2, absolute differences were generally less than 2.5 percentage points, which did not result in a statistically significant (P<.001) difference between estimates. The only exception was for Hispanic individuals, where prevalence was significantly different (P=0.2) for CP 1 (5.4%) versus CP 2 (3.0%), yielding a margin of 2.4 (95% CI 2.2-2.6) percentage points. Other groups that had relatively higher but statistically nonsignificant prevalence included male individuals (4.6% for CP 1 vs 2.3% for CP 2), individuals aged 35-44 years (6.9% for CP 1 vs 4.9% for CP 2), and African American individuals (5.5% for CP 1 vs 3.7% for CP 2). Therefore, we concluded that the 2 CPs largely produced equivalent estimates of T2D prevalence.ConclusionsThe 2 independent CPs demonstrated equivalent T2D prevalence estimates, except in Hispanic individuals. Although the CPs can be considered statistically equivalent, the data driving each CP may impact accuracy and completeness. CP 1 was broader, incorporating clinical diagnoses, laboratory data, and medication, whereas CP 2 used clinical diagnostic codes alone. These results have implications for improving harmonization of CPs for public health surveillance.

Referral systems represent the structural link between different tiers of health care, ensuring patients receive appropriate, timely, and continuous management. Effective referral mechanisms prevent fragmentation, duplication, and inequity while optimizing limited specialist resources. In the Gulf and Middle East, fast-growing populations, epidemiologic transitions, and significant digital-health investments have reshaped how referrals operate. This review synthesizes evidence from Saudi Arabia, the United Arab Emirates (UAE), Qatar, Oman, Bahrain, Jordan, and Lebanon, examining referral models, common bottlenecks, and emerging innovations. Across the region, digital transformation through national health information exchanges (HIEs) has advanced rapidly, yet persistent challenges remain, particularly in gatekeeping, interoperability, workforce training, and governance. The review concludes with policy and research recommendations aligned with the World Health Organization (WHO) Eastern Mediterranean Region (EMRO) strategy for people-centered integrated health services.

Referral systems represent the structural link between different tiers of health care, ensuring patients receive appropriate, timely, and continuous management. Effective referral mechanisms prevent fragmentation, duplication, and inequity while optimizing limited specialist resources. In the Gulf and Middle East, fast-growing populations, epidemiologic transitions, and significant digital-health investments have reshaped how referrals operate. This review synthesizes evidence from Saudi Arabia, the United Arab Emirates (UAE), Qatar, Oman, Bahrain, Jordan, and Lebanon, examining referral models, common bottlenecks, and emerging innovations. Across the region, digital transformation through national health information exchanges (HIEs) has advanced rapidly, yet persistent challenges remain, particularly in gatekeeping, interoperability, workforce training, and governance. The review concludes with policy and research recommendations aligned with the World Health Organization (WHO) Eastern Mediterranean Region (EMRO) strategy for people-centered integrated health services.