Interoperability – Technical or economic challenge?

Abstract

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.