Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 4, 2021, Pages. 15487 - 15499 Received 05 March 2021; Accepted 01 April 2021. 15487 http://annalsofrscb.ro Interoperability Challenges in Healthcare Blockchain System - A Systematic Review Faheem Reegu 1 , Salwani Mohd Daud 2 , Shadab Alam 3* 1, 2 Razak faculty of technology and Informatics, Universiti Teknologi Malaysia, Malaysia 3 College of Computer Science & IT, Jazan University, Jazan, KSA Email: 1 farfaheem6211@gmail.com , 2 salwani.kl@utm.my , 3* snafis@jazanu.edu.sa ABSTRACT EHR is the digital record of the medical history of the patient. It has solved many issues related to data handling and its security. A detailed study is required to implement this technology under modern technology and standards to minimize errors in integration. Present solutions lack interoperability and blockchain;therefore, theymust undergo further discussion and research related to it. This research aims to examine the interoperability challenges and issues of blockchain EHR frameworks as per the national and international standards of EHR. It will follow the interoperability standards in the EHR framework in terms of medical data distribution, sharing, and data dependability. The research is based on a systematic review of previous researches; 156 articles were excluded as they were based purely on blockchain and had little or no part of EHR, and 11 articles were selected based on the keywords selected in this research. Innovative interoperability framework and blockchain-based framework found to be successful in solving the current challenges in EHR. However, the issues of EHR can be resolved by bringing advancement in EHR. The research has contributed to highlighting the related challenges and solution in EHR implementation and presented a solution that will help to manage the data, security of information related to the patient and the benefits of blockchain and interoperability of EHR Keywords: Healthcare;EHR, blockchain; interoperability; EHR standards 1. Introduction Blockchain technology launched in 2009[1]; it is about storing information into ledgers and decentralized into a way across all computing devices within the company that is part of the blockchain infrastructure[2]. The infrastructure is based on peer-to-peer and operates by two sides; the users of the network and the blockchain miners who facilitate the transactions in a distributed ledger [3]. There are various security issues related to any online system minimized using encryption and authentication techniques, but due to centralized storage and inherent weaknesses cannot be fully resolved [4][5]. The ledger prepared by the blockchain in a decentralized network is created through a cryptographic process that is computed by all the data miners within the network. This technology additionally includes reliable storage capabilities for the data, and because of the advanced features, its services are secure, traceable, and non- repudiate[6]. Furthermore, the data is stored in a decentralized public manner while respecting the privacy of the data so that there is no unauthorized access[7]. However, the use of blockchain proves to be challenging for organizations[8]. The advent of substantial transaction volumes in the healthcare industry has inspired a lot of research into scaling blockchain for healthcare[9]. For example, key management and engagement questions, including anonymity and privacy on a blockchain,