INFORMATION SYSTEMS HETEROGENEITY AND INTEROPERABILITY INSIDE HOSPITALS A Survey Lucas Ribeiro 1,2 , João Paulo Cunha 3 and Ricardo Cruz-Correia 1,4 1 Center for Research in Health Technologies and Information Systems (CINTESIS) Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal 2 Centro Hospitalar de Trás-os-Montes e Alto Douro, Portugal 3 Instituto de Engenharia Electrónica e Telemática de Aveiro (IEETA), Universidade de Aveiro, Aveiro, Portugal 4 Serviço de Bioestatística e Informática Médica da FMUP, Porto, Portugal lucas@chtmad.min-saude.pt Keywords: Electronic Health Record, Integration, Information System Interoperability, Heterogeneity. Abstract: This paper presents a study of the heterogeneity and interoperability of Information Systems (IS) that exist in Northern Portuguese Hospitals. Structured interviews to each Hospital CIO were performed regarding their opinions, existing IS and integrations. The number of IS is exponentially related of the dimension of the hospital (number of beds), and the relation between the number of IS and the number of integrations follows an exponential model. The ratio between the number of effective integrations and the total possibilities is very low and follows a quadratic model, indicating that the energy spent grows rapidly with the increase of IS number and with poor results. Admission/discharge/transfer and drug related IS are installed more often, and therefore are better candidates for a regional network. Despite numerous efforts to develop standards, it seems that there is a large gap between their development and their applicability. Interoperability inside organizations is a crucial first step, looking for the goal of achieving regional and national EHR. Standardization is vital considering the number of IS and multitude of organizations involved. 1 INTRODUCTION It is currently agreed that interoperability in healthcare is a matter of great importance, but also of great complexity. The major challenge is to find a way to allow interoperability between different Information Systems (IS) in order to share information and resources. Interoperability promises a positive effect in the quality of care and also economic advantages (Maldonado et al., 2003, Lenz and Reichert, 2005, Walker et al., 2005, Uslu and Stausberg, 2008). Several solutions coexist with the aim of facilitating the integration of a growing volume of data, using different standards and technologies. After many years of development in IS, the majority of the healthcare organizations unfortunately are still far beyond achieving open architectures that would allow harmonious integration of computer applications. The creation of a cohesive and integrated Electronic Healthcare Record (EHR) is a more complicated task than initially expected with several obstacles (Zviran et al., 1998, Kitsiou et al., 2006). Consistently combining data from different sources takes a great deal of effort because the individual systems usually differ in several aspects, such as semantics, data representation, functionality, presentation and terminology (Lenz, Blaser et al. 1999; Lenz and Kuhn 2002; Kitsiou, Manthou et al. 2006). In addition, several architectural mismatches exists in the majority of the organizations, bringing additional problems (Land and Crnkovic, 2003). Interoperability of EHR is on the agenda of the European Union (e.g. EPSOS and Calliope), of many national governments (e.g. MedCom at Denmark, RSEpt at Portugal) and regional initiatives (e.g. RTS at the region of Aveiro in Portugal (Cunha, 2007)). A summary of relevant patient data has been seen as the most appropriate approach for establishing EHR interoperability (Shabtai et al., 2007). Nevertheless, to obtain the full advantages of information sharing (either for patient care, 337