Serbian Health Information System (HIS) improvements 2021-2024: comparison study using stages of continuous improvement (SOCI) methodology.

Background: The Health Information System (HIS) in public healthcare services in Serbia was introduced in 2008, with the first comprehensive evaluation of its maturity conducted in 2021. Since then, several improvement initiatives have been implemented. This study aimed to assess the extent of HIS advancement between 2021 and 2024 and to identify both the desirable and realistic future maturity status.

Methods: The maturity assessment of the Serbian HIS in 2024 was conducted using the same tool as in 2021: The Health Information Systems Stages of Continuous Improvement (SOCI), enabling direct comparison between the two periods. Progress was measured across five domains: Leadership and Governance, Management and Workforce, Information and Communication Technologies (ICT), Standards and Interoperability, and Data Quality and Use. These domains covered 13 components and 39 single subcomponents, with their maturity stages being assessed on a 5-point Likert scale on the basis of the opinions of key informants and documented through a desk review. Higher scores indicate a higher level of development. Along with a current assessment of maturity, key informants identified desired maturity levels for the future, using the same scale. Data were presented as comparisons in total scores per domain in 2024 versus 2021, for both current and projected statuses.

Results: Between 2021 and 2024, the overall maturity of the Serbian HIS improved by nearly 1 point (from 1.6/5 to 2.5/5). The same difference of 0.9 was observed between the current 2024 status and the future desired status (2.5 versus 3.4). The most notable improvements were observed in the HIS Strategic Plan under Leadership and Governance (2.5-point increase) and Business Continuity under ICT Infrastructure (2-point increase). The primary driver of progress over the past 3 years was the adoption of the national Program for Digitalization in the Health System of Serbia (eHealth Strategy) and its corresponding Action Plan, which served as a development blueprint.

Conclusions: Substantial progress in HIS maturity was achieved between 2021 and 2024, driven by strong governmental commitment, international donor support, and the engagement of dedicated national professionals. If current momentum and resourcing are sustained, the projected maturity levels are likely to be attainable in the near future.