# ‘A tough nut to crack’: inconsistent standards as roadblocks to data interoperability of health information systems in public hospitals in the Gauteng Province of South Africa

## TL;DR

This study explores how inconsistent data standards hinder health data interoperability in South African public hospitals, particularly in Gauteng Province.

## Contribution

The study identifies key factors causing interoperability challenges and emphasizes the need for unified standards and stakeholder collaboration.

## Key findings

- Hospitals in Gauteng follow conflicting standards, complicating data interoperability.
- Legacy systems, weak regulations, and lack of stakeholder collaboration are major barriers.
- There is a notable lack of compliance with interoperability standards among hospitals.

## Abstract

Standards are pivotal in achieving significant levels of data interoperability in the healthcare industry. However, inconsistent data standards and ambiguous guidelines stifle data interoperability in healthcare. Public sector hospitals in South Africa, particularly in Gauteng Province, face challenges in attaining data interoperability due to discrepancies in standards. This study investigates inconsistent standards as roadblocks to data interoperability of health information systems in public hospitals in the Gauteng Province of South Africa. A convergent parallel mixed methods research design was adopted, using an online questionnaire with 144 clinical and administrative personnel and semi-structured interviews with 16 managers. A multi-level sampling was used to select participants possessing the necessary expertise and experience in data interoperability and health information systems. Quantitative data were analyzed using SPSS for descriptive statistics, while qualitative data were thematically analyzed using the ATLAS.ti. The results indicated that hospitals in Gauteng adhere to multiple, conflicting standards, complicating data interoperability. Key factors contributing to this issue included legacy health systems, disparate systems, insufficient knowledge and awareness, weak regulations, and limited stakeholder collaboration. Furthermore, there was a notable lack of compliance with interoperability standards among hospitals. The study underscores the pressing need for coordinated efforts from policymakers, regulatory bodies, and health stakeholders to establish and enforce policies and standardized frameworks mandating uniform standards for interoperability. In conclusion, the cohesive implementation of uniform standards for data interoperability requires a holistic approach, incorporating clear policies, ongoing compliance monitoring, stakeholder collaboration, and continuous training to ensure the efficient exchange of healthcare data.