Architectural patterns for health information systems: a systematic review

Abstract

Background: Health information systems (HIS) are critical for digital health transformation, yet fragmentation and poor interoperability adoption remains a major challenge. Objectives: This study systematically reviews architectural patterns used in HIS and evaluates their alignment with ecosystem-level requirements. Methods: Following PRISMA 2020 guidelines, a systematic literature review was conducted across Scopus, IEEE Xplore, PubMed, and Web of Science (2020–2025). Eligible studies described, evaluated, or proposed HIS solutions. Results: From an initial set of 304 records, 89 met the inclusion criteria. Service-based and decentralized/distributed ledger architectures were predominant, with emerging models integrating edge computing and modular design. FHIR-based contracts are found as stabilizers of interfaces, enabling validation and reducing integration costs. However, gaps persist in cross-border care, sustainability, and artificial intelligence integration. Conclusion: While microservices dominate current HIS architectures, achieving resilient, interoperable ecosystems requires greater architectural diversity and intersectoral collaboration.