Evaluating the impact of security techniques on semantic interoperability in Kenya’s Distributed Health Information Systems

The rise of distributed health information systems in Kenya has brought significant opportunities for enhancing clinical efficiency and patient outcomes through electronic data exchange. However, semantic interoperability, the ability of systems to exchange data with shared, unambiguous meaning, remains severely constrained by inconsistent adoption of security techniques such as access control and encryption. Weak security measures not only compromise data integrity and confidentiality but also hinder healthcare professionals' trust and willingness to engage in interoperable data exchange. This study aimed to evaluate the impact of security techniques on semantic interoperability in Kenya’s distributed healthcare systems. The central research question guiding this inquiry was: What is the impact of security techniques on semantic interoperability in healthcare data exchange? The target population consisted of healthcare professionals, system administrators, developers, and records officers in four Level 5 hospitals across Kenya: Kisii, Nyeri, Nakuru, and Coast General Teaching and Referral Hospital. A sample of 301 respondents was determined using Yamane’s formula, with participants selected through purposive and stratified random sampling techniques. Data collection employed structured questionnaires, complemented by interviews and focus group discussions for triangulation. Descriptive statistics (frequencies, percentages, means) were used to summarize respondent characteristics and perceptions. Inferential analysis included Spearman’s correlation, Mann-Whitney U test, and bootstrapped mediation analysis, conducted using SPSS to explore the relationship between security techniques and semantic interoperability, as well as the mediating role of system usability. Ethical approval was obtained from the National Commission for Science, Technology and Innovation (NACOSTI) and respective hospital boards. Informed consent was secured from all participants, and data confidentiality was strictly maintained. Findings revealed a significant but weak positive correlation between security techniques and semantic interoperability (ρ = .053, p = .002). Descriptively, institutions that reported higher levels of access control and encryption practices showed increased semantic data exchange effectiveness. The Mann-Whitney U test confirmed statistically significant differences in semantic interoperability scores between institutions with robust and weak security practices (U = 7425, p = .005). Moreover, system usability was found to significantly mediate the relationship between security techniques and semantic interoperability (β = .400, p < .001), underscoring the importance of user-centered design in leveraging security for interoperability gains. The study concludes that while security techniques positively influence semantic interoperability, their impact is contingent upon the usability of health information systems. It recommends the national enforcement of security protocols such as role-based access control (RBAC) and encryption standards, alongside targeted training programs to enhance system usability among healthcare staff. Strengthening both technical safeguards and human-centered design will be critical in advancing trustworthy and interoperable healthcare data exchange in Kenya’s distributed environments.