Digital health in Africa is gaining momentum, yet remains fragmented due to gaps in strategic coherence, capacity, and system interoperability. To address these challenges, this study proposes a Reference Goal Model that captures and structures the key goals and means underpinning digitalization and interoperability initiatives across multiple governance levels-national, regional, and continental. We applied the Business Motivation Model (BMM) to systematically analyze strategic content from three key strategic documents: Rwanda's National Digital Health Strategic Plan, the East African Community's (EAC) Digital REACH Initiative Strategic Plan, and the African Union's (AU) Digital Transformation Strategy. Statements from the three documents were decomposed into atomic goals and means, illustrating how digital health and interoperability are conceived. The resulting Reference Goal Model for Digital Health in Africa (RGMDHA) identifies a set of goals and means for both digitalization and interoperability. By making these goals and means explicit and structured, the RGMDHA facilitates the strategic evaluation of national, regional, and continental plans, enables communication and stakeholder alignment in the digital health domain, and can be used as a tool for guiding the design and analysis of digital health and interoperability projects.

Background: The extensive use of ICT in healthcare delivery has become important globally. As a result, patient data in many countries, including Rwanda, are dispersed across different Electronic Health Record (EHR) systems. Often these systems exhibit a lack of interoperability among healthcare organizations, resulting in several silos of isolated patient data.

Methods: In this study, the research strategy employed was a survey, with data collection conducted through semistructured interviews and an examination of documents. The gathered data were then analyzed thematically.

Results: The findings revealed that the existing policies at the national level do not explicitly promote health information exchange (HIE) in Rwanda. Moreover, there is a lack of a common data model supporting interoperability between healthcare facilities, and EHRs are not interoperable because there is no national HIE mediator. Therefore, the caregivers cannot access the transferred patients' complete medical history. Every healthcare facility has its specific EHR system for data storage and some of them also have frequent internet disturbances.

Conclusion: In this study, HIE challenges on different levels of interoperability in the Rwanda EHR systems have been identified. Several of these challenges can be addressed by the new guidelines and standards for HIE released by the African Union: these will greatly contribute to Rwanda and other African countries to address the challenges. Clear strategies for implementing interoperable EHR can supplement the existing HIE guidelines and standards.