Objective: While health information technology (HIT) offers great potential for supporting healthcare delivery, interoperability issues can be a barrier to effective use of HIT. While technical and semantic interoperability issues have been well studied there is a shortage of research that addresses process interoperability. Methods: This paper uses a two year case study of a Palliative Care Information System (PAL-IS) to study process interoperability and health information technology (HIT). We describe the design of PAL-IS and develop and describe three types of process interoperability issues that arose from its implementation. Results: The implementation of PAL-IS caused care delivery, clinical practice and administrative process interoperability issues. Further, many of these issues emerged over time and a solution to address one type of process interoperability issue often led to a different type of issue. We used our evaluation of PAL-IS to develop a general framework for understanding process interoperability and HIT. Conclusion: Designing HIT to support care delivery is a complex sociotechnical endeavor that can result in different types of process interoperability issues. Evaluating process interoperability takes time and longitudinal studies are necessary to understand the overall ecosystem where technology, processes, and people interact. The framework developed in this paper provides a starting point for the evaluation of process interoperability and HIT.
- Health information technology