JMIR Publications

ABSTRACT

Background:

Interoperability of Electronic Health Records (EHRs) is essential for ensuring continuity of care, particularly at the interface between primary and specialised services. In Spain, the decentralised structure of the healthcare system has historically led to fragmentation of digital infrastructures, limiting effective information exchange between care levels.

Objective:

To examine how EHR interoperability between primary (PC) and specialised care (SC) in Spain has evolved, and to identify current barriers, clinical implications, and alignment with emerging national and European initiatives.

Methods:

A systematic narrative review was conducted in accordance with PRISMA principles. A structured search strategy was applied in PubMed/MEDLINE and complementary sources, combining terms related to EHRs, interoperability, and Spain. Studies addressing technical, clinical, or organisational aspects of interoperability were included. Data were extracted and analysed using a narrative synthesis approach.

Results:

A total of 9 studies were included. The evidence reviewed here shows meaningful progress, especially in national interoperability frameworks. These improvements were most evident in interregional data exchange, notably in enabling access to shared clinical information across autonomous communities. National initiatives such as the Historia Clínica Digital del Spanish National Health System (HCDSNS) have played a key role in enabling the exchange of patient data across regions. Despite these advances, PC–SC integration across regions remains variable, often limited to document-based exchange rather than fully integrated healthcare workflows. Important regional differences remain, and some autonomous communities appear to have achieved more mature interoperability models than others. More recent studies increasingly describe a transition toward Application Programming Interface (API)-based architectures and standards, such as HL7 FHIR, which reflects an ongoing but uneven adoption process. Clinically, persistent integration gaps continue to affect care transitions, coordination between professionals, and longitudinal patient management across care levels.

Conclusions:

The available evidence indicates progressive improvement in addressing EHR fragmentation at the national level, but full interoperability between primary and specialised care has not yet been achieved. Future efforts should focus on integrating interoperability into healthcare workflows, advancing semantic standardisation, and aligning national infrastructures with European initiatives such as MyHealth@EU.