Maturity Assessment of the Health Information System Using Stages of Continuous Improvement Methodology: Results From Serbia

The Prime Minister’s Office recognized the need to define and adopt the eHealth Strategy.

In January 2021, an eHealth Steering Committee was formed that was in charge of developing the eHealth Strategy and Action Plan.

HIS policies and legislations are available to guide decisions and achievements of HIS outcomes in most areas/programs.³

The last strategy was announced in 2009, with activities from 2009–2015, so it has expired.

Some key activities from that strategy have not yet been implemented, such as defining an organization/institution in charge of coordinating all aspects of eHealth.

Lack of regularity in overseeing the function and implementation of the HIS and weak established process for sharing and reviewing HIS information with all HIS stakeholders.

There are qualified personnel within Serbia, but they may not currently work in the public health system.

For some positions and roles, requirements for IT staff are well defined in the national policy documents.¹⁵

National financing of HIS development within the last 10+ years has wisely used available international funds and credits, and almost all public health facilities currently have been equipped with HISs.

Clearly defined rules for public financing.^16,17

A lack of mechanisms for keeping and retaining qualified IT staff within the public health care system.

There is no standard definition of the HR needs (the number and qualifications) for IT staff in health care facilities.

A clear legislative framework for outsourcing IT services (i.e., regulations of the relationships between vendors [owners of operating IT systems] and health care facilities) is missing.

There is no consolidated resource mobilization plan for further development and capital investments in HIS.

Operations and maintenance of the IT systems are provided by vendors and their call centers. For centralized systems, support has been provided by MOH and IT Office.

The majority of infrastructural components are in place, but operations, maintenance, redundancy, and security have to be improved.

At the national level, there are robust Business Continuity Plans at the Office of IT and eGovernment and the National Data Center, which could support key system functions, such as data hosting and system developments.²⁵

An overall and comprehensive system for technical monitoring of infrastructure, services, and central systems is missing.

Central systems are not sufficiently resilient to respond to the temporary unavailability of local systems. Currently, local IT systems are not projected to provide a high level of targeted operability and availability (for example, 99% of the time) that is required for an integrated HIS.

Monitoring and supervision of local IT systems is not provided.

There is a lack of procedures to assure continuity in the work of local systems and disaster recovery.

Use of already existing standards and guidelines have been established by normative regulations (legislation), primarily those related to infrastructure, public health, health insurance, and connecting subsystems in institutions.^14,18,19,21

Existence of the portal eZdravlje (eHealth) for patients’ own monitoring of their health-related data and also scheduling appointments.²⁷

Existence of the digital platform Servis javnog zdravlja (public health service) for official communication and data sets collection between institutes of public health and health care services.²⁶

Interoperability between primary health care services and pharmacies is achieved through paperless, electronic prescription system eRecept (E-prescription), which is integrated into local HISs.⁴

Standards and guidelines for the HIS interoperability are not established yet; there is no centralized and coordinated system of their setting, application, localization, and control.

Health care facilities at different levels are not able to exchange patient health records to provide a better quality of health care.

Interoperability is low due to the lack of data exchange standards and common software solutions.

The Institute of Public Health of Serbia defines and implements procedures for data collection, processing, analysis, and use at all levels of health care services in accordance with the national legislative obligations.¹⁸

Data might be available upon request, according to the Law on Free Access to Information of Public Importance.²⁸

Working groups for developing and using HIS consist of representatives of all relevant stakeholders annual statistical yearbook is produced by the Institute of Public Health of Serbia.

Current data collection is not standardized, and data are not in a machine-readable format that allows for their synthesis and communication.

There is no common, standardized format of data collection in a machine-readable format that would allow further data synthesis, report, and analysis, as well as quality assurance and control.

There are no clear guidelines or procedures for access to depersonalized health data and their availability for further analysis.

There is a lack of decision-making support tools based on updated and readily available registers of different kinds of machine-readable health-related data.