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[Lessons learned in the implementation of interoperable National Health Information Systems: a systematic review].

OBJECTIVE
Identify shared criteria used throughout the world in the implementation of interoperable National Health Information Systems (NHIS) and provide validated scientific information on the dimensions affecting interoperability.


METHODS
This systematic review sought to identify primary articles on the implementation of interoperable NHIS published in scientific journals in English, Portuguese, or Spanish between 1990 and 2011 through a search of eight databases of electronic journals in the health sciences and informatics: MEDLINE (PubMed), Proquest, Ovid, EBSCO, MD Consult, Virtual Health Library, Metapress, and SciELO. The full texts of the articles were reviewed, and those that focused on technical computer aspects or on normative issues were excluded, as well as those that did not meet the quality criteria for systematic reviews of interventions.


RESULTS
Of 291 studies found and reviewed, only five met the inclusion criteria. These articles reported on the process of implementing an interoperable NHIS in Brazil, China, the United States, Turkey, and the Semiautonomous Region of Zanzíbar, respectively. Five common basic criteria affecting implementation of the NHIS were identified: standards in place to govern the process, availability of trained human talent, financial and structural constraints, definition of standards, and assurance that the information is secure. Four dimensions affecting interoperability were defined: technical, semantic, legal, and organizational.


CONCLUSIONS
The criteria identified have to be adapted to the actual situation in each country and a proactive approach should be used to ensure that implementation of the interoperable NHIS is strategic, simple, and reliable.