AI-enhanced health information exchange systems: a systematic review of implementation challenges and opportunities

This systematic review evaluates the integration of Artificial Intelligence (AI) into Health Information Exchange (HIE) systems to improve data utilisation, patient outcomes, and healthcare delivery efficiency. Through a comprehensive analysis of major academic databases from 2015 to 2024, 72 peer-reviewed papers were selected following rigorous screening processes, including duplicate removal, title/abstract screening, and full-text evaluation against predefined criteria. The analysis examined AI implementation across directed exchange, query-based exchange, and consumer-mediated exchange systems. Results demonstrate AI significantly enhances HIE functionality through improved data standardisation, error detection, and system integration. Key benefits include enhanced predictive capabilities for patient outcomes, optimised resource utilisation, and effective automated processing of unstructured clinical data. Critical solutions identified include federated learning techniques to preserve privacy, explainable AI models to support clinical adoption, and robust bias-detection frameworks to ensure equitable outcomes. Future opportunities encompass integrating diverse data sources, exploring federated learning approaches, balancing data utility with privacy concerns, and developing transparent AI models to increase clinical acceptance. The study emphasises ongoing data standardisation efforts and ethical considerations in AI deployment, particularly for real-time, context-aware decision-support systems. AI integration represents a promising advancement that, through strategic development, can transform HIE into more effective and equitable tools for healthcare delivery.