Abstract
Interoperability in healthcare is a long-standing and addressed phenomenon. In the literature, it is discussed as both the cause of an insufficiently perceived digitalization and in context with an inadequate IT-based integration in healthcare. In particular, technical and organizational aspects are highlighted from the perspective of the different involved actors to achieve sufficient interoperability. Depending on the individual case, various established international industry standards in healthcare (e. g. DICOM, HL7 or FHIR) promise simple adaptation and various application advantages. In addition to the technical view, this article assumes economic challenges as the main causes for the lack of interoperability not discussed in the forefront. The economic challenges were mentioned and sparingly discussed in few cases in the literature. This article aims to fill this gap by offering a first characterization of identified and discussed economic challenges in the literature with respect to the lack of interoperability in healthcare. Based on a systematic literature search, 14 of the original 330 articles can be identified as relevant, allowing a more economic perspective on interoperability. In this context, different economic effects will be described; this includes cost-benefit decisions by individual stakeholders under different kinds of uncertainty or balancing of known individual costs for interoperability against uncertain and skewed distributed benefits within an ecosystem. Furthermore, more sophisticated cost-benefit approaches regarding interoperability challenges can be identified, including cost-benefit ratios that shift over time, or lock-in effects resulting from CRM-motivated measures that turn (non)interoperability decisions into cost considerations for single actors. Also, self-reinforcing effects through path dependencies, including direct and indirect network effects, have an impact on single and linked interoperability decisions.
About the authors
Lars Stegemann is PhD student at the Department of Information Systems at Freie Universität Berlin. In the time between finishing his master’s degree and starting his PhD, he worked on the German telematics project and encouraged his interest to research in the field of electronic health. His research interests focus in particular on the challenges of interoperability in digital health.
Prof. Dr. Martin Gersch is Professor of Business Administration at the Department of Information Systems at Freie Universität Berlin. He is Principal Investigator for Digital Transformation at the Einstein Center Digital Future and was responsible researcher e. g. at the DFG Pfadkolleg and the Focus Area “DynAge” (Excellence Initiative). His main research areas are technology-driven change, eHealth, entrepreneurship, economic theory and business model analysis.
Literature
1. S. Y. Lim and E. G. Anderson. Institutional Barriers Against Innovation Diffusion: From the Perspective of Digital Health Startups, pp. 3328–3337, 2016.10.1109/HICSS.2016.415Search in Google Scholar
2. M. Gersch, L. Wessel. E-Health und Health-IT. In: Gronau, N. et al. (Editors), Enzyklopädie der Wirtschaftsinformatik. 11. ed., GITO publisher, Berlin (Germany), 2019. [Online] Available: http://www.enzyklopaedie-der-wirtschaftsinformatik.de. Accessed on: 22.4.2019.Search in Google Scholar
3. R. Thiel, L. Deimel, D. Schmidtmann, K. Piesche, T. Hüsing, J. Rennoch, V. Stroetmann. #Smart HealthSystems: Digitalisierungsstrategien im internationalen Vergleich. 1. Auflage, Bertelsmann Stiftung, 2018. [Online] Available: https://www.bertelsmann-stiftung.de/de/publikationen/publikation/did/smarthealthsystems/. Accessed on: 24.04.2019.Search in Google Scholar
4. P. Nohl-Deryk, J. K. Brinkmann, F. M. Gerlach, J. Schreyögg, D. Achelrod. Hürden bei der Digitalisierung der Medizin in Deutschland – eine Expertenbefragung: Barriers to Digitalisation of Healthcare in Germany: A Survey of Experts Hintergrund Ergebnisse. Das Gesundheitswesen 2018, 80 (11), pp. 939–945, 2018.10.1055/s-0043-121010Search in Google Scholar
5. B. Kadry, I. C. Sanderson, and A. Macario. Challenges that limit meaningful use of health information technology. Current Opinion in Anesthesiology, 23 (2), pp. 184–192, 2010.10.1097/ACO.0b013e328336ea0eSearch in Google Scholar
6. S. Dünnbeil, H. Krcmar, A. Sunyeav, J. M. Leimeister. Modular Architecture of Value-Added Applications for German Healthcare Telematics. Business & Information Systems Engineering, 5 (1), pp. 3–16, 2013.10.1007/s12599-012-0243-3Search in Google Scholar
7. C. Yang, T.-C. Chou, Y.-H. Chen. Bridging Digital boundary in Healthcare Systems – An Interoperability Enactment Perspective. Computer Standards & Interfaces, 62, pp. 43–52, 2019.10.1016/j.csi.2018.08.001Search in Google Scholar
8. S. Thun, H. Dewenter. Syntaktische und semantische Interoperabilität. In: Müller-Mielitz, S. & Lux, T. (Editors), E-Health-Ökonomie. Springer Fachmedien Wiesbaden, Wiesbaden (Germany), pp. 669–682, 2017.Search in Google Scholar
9. C. Kops, L. Wessel, M. Gersch. Innovation Barricades in German Health Care: Balancing Resource-based and Institutional Perspectives. In: 29th EGOS Colloquium 2013, July 4–6 2013, Montreal (Canada), 2013.Search in Google Scholar
10. M. Gersch, T. Rüsike. Diffusionshemmnisse innovativer E-Health Anwendungen im deutschen Gesundheitswesen. Arbeitsbericht, Berlin (Germany), 2011.Search in Google Scholar
11. A. Alkraiji, T. Jackson, and I. Murray. Health data standards and adoption process. Preliminary findings of a qualitative study in Saudi Arabia. Campus-Wide Information Systems, 28 (5), pp. 345–359, 2011.10.1108/10650741111181616Search in Google Scholar
12. A. Alkraiji, T. Jackson, and I. Murray. Barriers to the widespread adoption of health data standards: an exploratory qualitative study in tertiary healthcare organizations in Saudi Arabia. J Med Syst, 37 (2), 9895, 2013.10.1007/s10916-012-9895-2Search in Google Scholar
13. D. Buhalisa, R. Leungb. Smart hospitality – Interconnectivity and interoperability towards an ecosystem. International Journal of Hospitality Management, 71, pp. 41–50, 2018.10.1016/j.ijhm.2017.11.011Search in Google Scholar
14. K. D. Mandl, J. C. Mandel, I. S. Kohane. Driving Innovation in Health Systems through an Apps-Based Information Economy. Cell Systems, 1 (1), pp. 8–13, 2015.10.1016/j.cels.2015.05.001Search in Google Scholar
15. A. Marsh. The establishment of a pilot telemedical information society. Future Generation Computer Systems – The International Journal of Grid Computing and Escience, 15 (2), pp. 133–156, 1999.10.1016/S0167-739X(98)00059-4Search in Google Scholar
16. B. H. Gray, T. Bowden, I. Johansen, and S. Koch. Electronic health records: an international perspective on “meaningful use”. Commonwealth Fund, 28, pp. 1–18, 2011.Search in Google Scholar
17. M. Kautsch, M. Lichoń, and N. Matuszak. eHealth Development in Selected EU Countries: Barriers and Opportunities. International Journal of Integrated Care (IJIC), 16 (6), pp. 1–2, 2016.10.5334/ijic.2645Search in Google Scholar
18. G. C. Lamprinakos, A. S. Mousas, A. P. Kapsalis, D. I. Kaklamani, I. S. Venieris, A. D. Boufis, P. D. Karmiris and S. G. Mantzouratos (eds.). Using FHIR to develop a healthcare mobile application. 2014 4th International Conference on Wireless Mobile Communication and Healthcare – Transforming Healthcare Through Innovations in Mobile and Wireless Technologies (MOBIHEALTH), pp. 132–135, 2014.Search in Google Scholar
19. G. Doelfs. Gematik: „Wir müssen jetzt handeln“. kma, 24 (04), pp. 46–47, 2019.10.1055/s-0036-1595780Search in Google Scholar
20. B. Blobel. Introduction into Advanced eHealth – The Personal Health Challenge. In: Blobel, B., Pharow, P., Nerlich, M. (Editors), E-Health: Combining Health Telematics, Telemedicine, Biomedical Engineering and Bio-informatics to the Edge – Global Experts Summit Textbook, Series Studies in Health Technology and Informatics, vol. 134, IOS Press, Amsterdam (Netherlands), pp. 3–14, 2008.Search in Google Scholar
21. T. Benson and G. Grieve (eds.). Principles of Health Interoperability. Springer International Publishing, Cham (Switzerland), 2016.10.1007/978-3-319-30370-3_2Search in Google Scholar
22. F. Oemig, R. Snelick. Healthcare Interoperability Standards Compliance Handbook – Conformance and Testing of Healthcare Data Exchange Standards. Springer International Publishing, Cham (Switzerland), 2016.10.1007/978-3-319-44839-8Search in Google Scholar
23. J. vom Brocke, A. Simons, B. Niehaves, K. Riemer, R. Plattlauf, A. Cleven. Reconstructing the Giant: On the Importance of Rigour in Documenting the Literature Search Process. ECIS 2009 Proceedings, pp. 3226–3238, 2009.Search in Google Scholar
24. European Commission. eHealth Network: Refined eHealth European Interoperability Framework. [Online] Available: https://ec.europa.eu/health/sites/health/files/ehealth/docs/ev_20151123_co03_en.pdf. Accessed on: 04.07.2019.Search in Google Scholar
25. D. Chen and F. Vernadat. Standards on enterprise integration and engineering – state of the art. International Journal of Computer Integrated Manufacturing, 17 (3), pp. 235–253, 2004.10.1080/09511920310001607087Search in Google Scholar
26. IEEE Standards Board. IEEE Standard Glossary of Software Engineering Terminology, 1998.Search in Google Scholar
27. H. Krcmar. Information. In: Gronau, N. et al. (Editors), Enzyklopädie der Wirtschaftsinformatik, 11. ed., GITO publisher, Berlin (Germany), [Online] Available: http://www.enzyklopaedie-der-wirtschaftsinformatik.de. Accessed on: 04.07.2019.Search in Google Scholar
28. B. Blobel and F. Oemig. Solving the Modeling Dilemma as a Foundation for Interoperability. EJBI, 14, pp. 3–12, 2018.10.24105/ejbi.2018.14.3.2Search in Google Scholar
29. W. A. Khan et al. Process interoperability in healthcare systems with dynamic semantic web services. COMPUTING, 95 (9), pp. 837–862, 2013.10.1007/s00607-012-0239-3Search in Google Scholar
30. Y. Zhang, Y. Xu, L. Shang, and K. Rao. An investigation into health informatics and related standards in China. International journal of medical informatics, 76 (8), pp. 614–620, 2007.10.1016/j.ijmedinf.2006.05.003Search in Google Scholar PubMed
31. P. Afflerbach. The Business Value of IT in Light of Prospect Theory. Bus Inf Syst Eng, 57 (5), pp. 299–310, 2015.10.1007/s12599-015-0400-6Search in Google Scholar
32. P. Sprivulis et al. The economic benefits of health information exchange interoperability for Australia. Australian Health Review, 31 (4), pp. 531–539, 2007.10.1071/AH070531Search in Google Scholar PubMed
33. H. Dewenter and S. Thun. SNOMED CT und IHTSDO-Mitgliedschaft – Nutzen einer Referenzterminologie für Deutschland aus der Perspektive der Neuen Institutionenökonomik. In: E-Health-Ökonomie, Müller-Mielitz, S. and Lux, T. (Editors), Springer Fachmedien Wiesbaden, Wiesbaden, pp. 239–272, 2017.10.1007/978-3-658-10788-8_14Search in Google Scholar
34. S. Schröder. Ökonomische Analyse und Bewertung integrierter Versorgungssysteme im Gesundheitswesen: Ansätze einer methodischen Erweiterung aus diffusionstheoretischer Perspektive. Dissertation, Freie Universität Berlin, Berlin (Germany), 2015.Search in Google Scholar
35. A. Moumtzoglou. E-Health as the Realm of Healthcare Quality. In: Di Giacomo, P., Moumtzoglou, A., Kastania, A., Moumtzoglou, A., and Kastania, A. (Editors), E-Health Systems Quality and Reliability: Models and Standards, IGI Global Hershey, Hershey (Pa, USA), pp. 291–310, 2011.10.4018/978-1-61692-843-8.ch022Search in Google Scholar
36. J. R. Vest and B. A. Kash. Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems Enterprise Health Information Exchanges. Milbank Q, 94 (1), pp. 77–108, 2016.10.1111/1468-0009.12180Search in Google Scholar PubMed PubMed Central
37. X. Gansel, M. Mary, and A. van Belkum. Semantic data interoperability, digital medicine, and e-health in infectious disease management: a review. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology, 38 (6), pp. 1023–1034, 2019.10.1007/s10096-019-03501-6Search in Google Scholar PubMed
38. W. E. Hammond. The making and adoption of health data standards. Health Affairs, 24 (5), pp. 1205–1213, 2005.10.1377/hlthaff.24.5.1205Search in Google Scholar PubMed
39. D. Voltz and T. Tran. Is middleware the right medicine? Health Management Technology, 36 (5), 2015.Search in Google Scholar
40. J. Adler-Milstein and E. Pfeifer. Information Blocking: Is It Occurring and What Policy Strategies Can Address It? Milbank Q, 95 (1), pp. 117–135, 2017.10.1111/1468-0009.12247Search in Google Scholar PubMed PubMed Central
41. S. J. Liebowitz and S. E. Margolis. Path Dependence, Lock-in, and History. Journal of Law, Economics, & Organization, 11 (1), pp. 205–226, 1995.10.2139/ssrn.1706450Search in Google Scholar
42. L. Dobusch and E. Schüßler. Theorizing path dependence: a review of positive feedback mechanisms in technology markets, regional clusters, and organizations. Ind Corp Change, 22 (3), pp. 617–647, 2013.10.1093/icc/dts029Search in Google Scholar
43. J. Sydow, G. Schreyögg, and J. Koch. Organizational Path Dependence: Opening the Black Box. Academy of Management Review, 34 (4), pp. 689–709, 2009.10.5465/amr.34.4.zok689Search in Google Scholar
44. K. Kunow, M. Gersch, and J. Koch. Temporary incompetence as a path-breaking strategy: two major record companies’ efforts to escape their competence lock-in, Jahrbuch Strategisches Kompetenz Management, vol. 6, 2013.Search in Google Scholar
45. J. van den Ende, G. van de Kaa, S. den Uijl, and H. J. de Vries. The Paradox of Standard Flexibility: The Effects of Co-evolution between Standard and Interorganizational Network. Organization Studies, 33 (5–6), pp. 705–736, 2012.10.1177/0170840612443625Search in Google Scholar
46. J. C. Schwarze et al. A modular electronic health record as an answer to communication problems in health care. Wirtschaftsinformatik, 47 (3), pp. 187–195, 2005.10.1007/BF03254899Search in Google Scholar
47. H. Masum, R. Lackman, and K. Bartleson. Developing global health technology standards: what can other industries teach us? Globalization and Health, vol. 9, 2013.10.1186/1744-8603-9-49Search in Google Scholar
48. J. Sydow, A. Windeler, G. Müller-Seitz, K. Lange. Path Constitution Analysis: A Methodology for Understanding Path Dependence and Path Creation. BuR – Business Research, 5, pp. 155–176, 2012.10.1007/BF03342736Search in Google Scholar
49. M. L. Katz, C. Shapiro. Network Externalities, Competition, and Compatibility. The American Economic Review, 75 (3), pp. 424–440, 1985.Search in Google Scholar
50. C. H. Lin, I. C. Lin, J. S. Roan, and J. S. Yeh. Critical Factors Influencing Hospitals’ Adoption of HL7 Version 2 Standards: An Empirical Investigation. Journal of Medical Systems, 36 (3), pp. 1183–1192, 2012.10.1007/s10916-010-9580-2Search in Google Scholar
51. M. L. Braunstein. Health Informatics on FHIR: How HL7’s New API is Transforming Healthcare, Springer International Publishing, Cham (Switzerland), 2018.10.1007/978-3-319-93414-3Search in Google Scholar
52. J. R. Langabeer and T. Champagne. Exploring Business Strategy in Health Information Exchange. Journal of Healthcare Management, 61 (1), pp. 15–26, 2016.10.1097/00115514-201601000-00005Search in Google Scholar
53. I. P. Chochliouros and A. Spiliopoulou-Chochliourou. European standardisation activities: An enabling factor for the competitive development of the information society technologies market. Journal of the Communications Network, 2, pp. 62–68, 2003.Search in Google Scholar
54. R. Busse, M. Blümel, F. Knieps, T. Bärnighausen. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity self-governance, and competition. The Lancet, 390 (10097), pp. 882–897, 2017.10.1016/S0140-6736(17)31280-1Search in Google Scholar
55. D. Chen. Enterprise Interoperability Framework, EMOI – INTEROP’06, Proceedings of the Open Interop Workshop on Enterprise Modelling and Ontologies for Interoperability, Co-located with CAiSE’06 Conference, Luxembourg (Luxembourg), 2006.Search in Google Scholar
56. O. Noran, H. Panetto. Modelling a Sustainable Cooperative Healthcare: An Interoperability-Driven Approach. TM 2013 Workshops, LNCS, vol. 8186, pp. 238–249, 2013.10.1007/978-3-642-41033-8_32Search in Google Scholar
© 2019 Walter de Gruyter GmbH, Berlin/Boston
