Integrating Information Systems Success, Institutional, and Resource Dependence Theories for Blockchain-Based Health Interoperability in LMICs
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Abstract
Digital health interoperability in devolved public health systems is constrained by technical, organisational, and systemic factors that current research treats as competing rather than complementary diagnoses. This paper asks which theoretical lens should govern a given readiness question, and answers through a four-step theoretical conceptual synthesis: selecting five established lenses, the DeLone and McLean Information Systems Success Model, the Blockchain Trilemma, the Parkerian Hexad, Institutional Theory, and Resource Dependence Theory; constructing an integrating structure; analysing tension and complementarity between lenses; and illustrating the resulting framework against a real governance context. Readiness is defined as the joint sufficiency of a health system's technical capacity, organisational legitimacy, and source-system quality to support a blockchain interoperability layer. The five lenses are organised along three readiness dimensions: technical, organisational, and systemic and applied to Kenya's devolved health system, including county-level evidence from Kisumu, drawing on the Constitution of Kenya (2010), the Digital Health Act (2023), the Kenya Health Information Systems Interoperability Framework (2020), the Data Protection Act (2019), and published accounts of electronic medical record fragmentation. Benchmarked against the WHO-ITU National eHealth Strategy Toolkit, the framework is shown to add diagnostic precision that a single-lens or purely strategic instrument does not supply. We conclude that treating readiness as one undifferentiated construct risks misdiagnosing which intervention a context actually needs, and recommend that certification regimes, research instruments, and technical-assistance programmes test technical, organisational, and systemic readiness separately rather than assuming the three co-vary.
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References
Balasubramanian, S., Shukla, V., Sethi, J. S., Islam, N., & Saloum, R. (2021). A readiness assessment framework for Blockchain adoption: A healthcare case study. Technological Forecasting and Social Change, 165, 120536. https://doi.org/10.1016/j.techfore.2020.120536 DOI: https://doi.org/10.1016/j.techfore.2020.120536
Chimbo, B., & Motsi, L. (2024). The effects of electronic health records on medical error reduction: Extension of the DeLone and McLean information system success model. JMIR Medical Informatics, 12, e54572. https://doi.org/10.2196/54572 DOI: https://doi.org/10.2196/54572
Constitution of Kenya. (2010). National Council for Law Reporting. http://www.kenyalaw.org/kl/index.php?id=398
Data Protection Act, No. 24 of 2019 (Kenya). http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/2019/TheDataProtectionAct__No24of2019.pdf
DeLone, W. H., & McLean, E. R. (2003). The DeLone and McLean model of information systems success: A ten-year update. Journal of Management Information Systems, 19(4), 9–30. https://doi.org/10.1080/07421222.2003.11045748 DOI: https://doi.org/10.1080/07421222.2003.11045748
Digital Health Act, No. 15 of 2023 (Kenya). http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/2023/TheDigitalHealthAct_No.15of2023.pdf
Digital Health (Health Information Management Procedures) Regulations, 2025 (Kenya). https://new.kenyalaw.org/akn/ke/act/ln/2025/76/eng@2025-04-11
DiMaggio, P. J., & Powell, W. W. (1983). The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. American Sociological Review, 48(2), 147–160. https://doi.org/10.2307/2095101 DOI: https://doi.org/10.2307/2095101
Halwenge, P. M. (2026). A blockchain-based interoperability framework for Kenya's integrated health records [Unpublished doctoral dissertation]. Technical University of Kenya.
Health Act, No. 21 of 2017 (Kenya). https://new.kenyalaw.org/akn/ke/act/2017/21/eng@2022-12-31/source
Ireri, S., Waiganjo, P., Ochieng, D. O., Kagiri, M., Anindo, M., Adoyo, M., Wanjiru, R., Kirui, J., Pundo, R., Kimani, M., & Wanyungu, J. (2025). An exploration of the successful scale-up of the electronic community health information system in Kenya. Oxford Open Digital Health, 3, oqaf020. https://doi.org/10.1093/oodh/oqaf020 DOI: https://doi.org/10.1093/oodh/oqaf020
Isemeck, C. S., Ngure, K., Kariuki, J., & Muchene, O. (2019). Factors influencing the adoption of electronic health records in public health facilities in Kisumu County, Kenya. Journal of Health, Medicine and Nursing, 4(1), 74–101. https://iprjb.org/journals/JHMN/article/view/826
Joshi, S., & Sharma, M. (2023). Assessment of implementation barriers of blockchain technology in public healthcare: Evidences from developing countries. Health Systems, 12(2), 223–242. https://doi.org/10.1080/20476965.2023.2206446 DOI: https://doi.org/10.1080/20476965.2023.2206446
Juma, R., Abila, J., & Oluoch, J. (2020). Electronic medical records software types in use within Kisumu County. International Journal of Innovative Science and Research Technology, 5(5), 1989–1992. https://doi.org/10.38124/ijisrt20may395 DOI: https://doi.org/10.38124/IJISRT20MAY395
Kenya Ministry of Health. (2016). National eHealth policy 2016–2030. Government of Kenya. https://www.health.go.ke/wp-content/uploads/2016/04/Kenya-National-ehealth-Policy-final-1.pdf
Kenya Ministry of Health. (2020). Kenya health information systems interoperability framework. Government of Kenya. https://www.data4sdgs.org/sites/default/files/services_files/Kenya%20Health%20Information%20Systems%20Interoperability%20Framework.pdf
Kore, T., Rorissa, A., & Mamo, G. (2026). Healthcare institutions readiness towards blockchain technology adoption: A case study of hospitals in Ethiopia. Discover Health Systems, 5, 34. https://doi.org/10.1007/s44250-026-00367-2 DOI: https://doi.org/10.1007/s44250-026-00367-2
Meyer, J. W., & Rowan, B. (1977). Institutionalized organizations: Formal structure as myth and ceremony. American Journal of Sociology, 83(2), 340–363. https://doi.org/10.1086/226550 DOI: https://doi.org/10.1086/226550
Olufadewa, I. I., Iyiola, O. P., Nnatus, J., Fatola, K., Oladele, R., Olufadewa, T., Adesina, M., & Udofia, J. (2024). National eHealth strategy frameworks in Africa: A comprehensive assessment using the WHO-ITU eHealth strategy toolkit and FAIR guidelines. Oxford Open Digital Health, 2, oqae047. https://doi.org/10.1093/oodh/oqae047 DOI: https://doi.org/10.1093/oodh/oqae047
Parker, D. B. (2014). Toward a new framework for information security. In S. Bosworth, M. E. Kabay, & E. Whyne (Eds.), Computer security handbook (6th ed., pp. 3.1–3.23). Wiley. https://doi.org/10.1002/9781118820650.ch3
Pfeffer, J., & Salancik, G. R. (1978). The external control of organizations: A resource dependence perspective. Harper & Row.
World Health Organization & International Telecommunication Union. (2012). National eHealth strategy toolkit. International Telecommunication Union. https://apps.who.int/iris/handle/10665/75211
Zhou, Q., Huang, H., Zheng, Z., & Bian, J. (2020). Solutions to scalability of blockchain: A survey. IEEE Access, 8, 16440–16455. https://doi.org/10.1109/ACCESS.2020.2967218 DOI: https://doi.org/10.1109/ACCESS.2020.2967218