Leveraging a Terminology Service to Facilitate Semantic Interoperability for Continuity of Care: A Sri Lankan Perspective
Year: 2026
Type: article
Abstract: Sri Lanka’s digital health ecosystem is characterized by multiple heterogeneous Electronic Medical Record (EMR) systems operating in silos, limiting continuity of care. While HL7 FHIR-based data exchange with the National Electronic Health Record (NEHR) is being utilized to achieve syntactic interoperability, semantic interoperability remains constrained due to use of non-standardized clinical terminologies across EMRs. This case study describes the experience of leveraging a terminology service to standardize locally used clinical data and enable semantic interoperability in a low-resource setting. An OpenHIE-aligned architecture was implemented using Open Concept Lab (OCL) online as the terminology service, Open Health Information Mediator (OpenHIM) as the interoperability layer and HapiFHIR as a health data store. Locally defined value-sets for presenting complaints, diagnoses, medications, procedures, and investigations were extracted from multiple national EMRs, consolidated, and mapped to well recognized international terminology standards including SNOMED-GPS and LOINC through a multi-stakeholder process. The implementation resulted in creation of four terminology sources, 17 collections, 3,169 concepts, and 1,247 mappings, validated through national Connectathons. A mapping mediator was used for the transformation of local or free-text inputs into coded terminology prior to persistence in the NEHR, ensuring semantic consistency while preserving original data. The findings demonstrate that terminology mapping using open-source, OpenHIE-aligned technologies is a feasible approach for enabling semantic interoperability in low-resource settings. However, long-term sustainability requires adoption of standardized terminologies at the point of data capture, strengthened governance mechanisms, and continued capacity building.
Source: Oxford Open Digital Health
DOI: 10.1093/oodh/oqag046
Authors: Shakira Irfaan, Chaminda Weerabaddana, Palitha Karunapema, Muditha Hapudeniya, Uditha Perera, Malinda P B Wijeratne, Piyumi Gamage, Chethana Nihathamani, Nadeesha Balasuriya, Christopher Seebregts, Wayne Chelliah Naidoo, Ajeenckya Gadewar, Joshua Kiluba, Adrian Floor, Martin Brocker, Poorna Fernando
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,590
OpenAlex ID: W7225636614
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