Assessing the role of electronic health records standards in advancing semantic interoperability in distributed health systems in Kenya

Achieving semantic interoperability in distributed healthcare systems is a global challenge, especially in low-resource settings such as Kenya. Inconsistent implementation of electronic health record (EHR) standards hinders semantic interoperability by limiting the ability of distributed healthcare systems to exchange and interpret data with shared, unambiguous meaning. This study evaluates the influence of EHR standards on semantic interoperability in distributed health systems in Kenya. A mixed-method approach using descriptive and correlational research design was adopted, targeting four Level 5 public hospitals with 301 sampled respondents including system developers, health practitioners, and administrators. Statistical analyses confirmed a very weak but statistically significant correlation between EHR standards and semantic interoperability (Spearman’s ρ = 0.007, p = 0.04, N = 268). Additionally, the Kruskal-Walli’s test revealed significant differences in semantic interoperability across low, medium, and high EHR adoption groups (H-Statistic = 6.52, p = 0.038), with high adopters demonstrating the highest mean rank (148.92). However, mediation analysis indicated that system usability does not significantly mediate the relationship between EHR standards and semantic interoperability (Indirect effect = -0.0004, 95% CI [-0.0125, 0.0097]). Findings highlight that EHR standards alone have limited impact, and greater interoperability gains depend on integrated approaches combining standards with usability, governance, and technical alignment.