The implementation of data interoperability in healthcare relies heavily on policy frameworks. However, many hospitals across South Africa are struggling to integrate data interoperability between systems, due to insufficient policy frameworks. There is a notable awareness that existing policies do not provide clear actionable direction for interoperability implementation in hospitals. This study aims to develop a policy framework for integrating data interoperability in public hospitals in Gauteng Province, South Africa. The study employed a conceptual framework grounded in institutional theory, which provided a lens to understand policies for interoperability. This study employed a convergence mixed method research design. Data were collected through an online questionnaire and semi-structured interviews. The study comprised 144 clinical and administrative personnel and 16 managers. Data were analyzed through descriptive and thematic analysis. The results show evidence of coercive isomorphism that public hospitals lack cohesive policies that facilitate data interoperability. Key barriers to establishing policy framework include inadequate funding, ambiguous guidelines, weak governance, and conflicting interests among stakeholders. The study developed a policy to facilitate the integration of data interoperability in hospitals. This study underscores the critical need for the South African government, legislators, practitioners, and policymakers to consult and involve external stakeholders in the policy-making processes.

Adeniji, O.V., Lala, O.G., Oduwole, O.A., & Morakinyo, A.E. (2022). Healthcare Interoperability in Developing Countries: A Review. Adeleke University Journal of Science, 1(1), 475-487.

Bagyendera, M., Nabende, P., & Nabukenya, J. (2023). Critical factors influencing data use and utilization in health systems: a focus on data and interoperability standards for health information exchange (HIE) in Uganda’s health care system. Oxford Open Digital Health, 1(2), 15.

Bhartiya, S., & Mehrotra, D. (2014). Challenges and recommendations to healthcare data exchange in an interoperable environment. Electronic Journal of Health Informatics, 8(2), 16.

Chetty, M. (2015). Supporting the South African healthcare system with e-health technologies. CSIR Science Scope, 8(2), 34-35.

Creswell, J.W., & Plano Clark, V.L. (2023). Revisiting mixed methods research designs twenty years later. Handbook of mixed methods research designs, pp.21-36.

David, R.J., Tolbert, P.S., & Boghossian, J. (2019). Institutional theory in organization studies. In Oxford research encyclopaedia of business and management.

Department of Health [South Africa] and Council for Scientific and Industrial Research [South Africa]. (2014). "National Health Normative Standards Framework for Interoperability in eHealth in South Africa", Pretoria. http://www.samed.org.za/Filemanager/userfiles/hnsf-complete-version.pdf (Accessed on 16 April 2016).

Department of Health [South Africa]. (2012). eHealth strategy South Africa 2012-2017. Pretoria.www.hst.org.za/sites/default/files/eHealth_Strategy_South_Africa_2012-2016.pdf (Accessed on 23 May 2017).

Department of Health [South Africa]. (2015). mHealth Strategy for South Africa: 2015–2019. The National Department of Health Republic of South Africa; Pretoria, South Africa

Department of Health [South Africa]. (2017). Gauteng Department of Health annual report 2016/17. Johannesburg: Gauteng Department of Health.

Department of Health and Human Services. (2019). HHS proposes new rules to improve interoperability of electronic health information [Press release]. https://www.hhs.gov/about/news/2019/02/11/hhs-proposes-new-rules-improve-interoperability-electronic-health-information.html (Accessed on 12 October 2020).

DiMaggio, J., & Powell, W.W. (1983). The iron cage revisited: institutional isomorphism and collective rationality in organisational fields. America Sociological Review, 48(2), 147-160.

Dlodlo, N., & Hamunyela, S. (2017). The status of integration of health information systems in Namibia. Electronic Journal of Information Systems Evaluation, 20(2), 61-75.

Fishlock, U. (2020). Why is policy important in healthcare? https://askinglot.com/why-is-policy-important-in-healthcare (Accessed on 12 May 2021).

Guerrazzi, C. (2020). An international perspective on health information exchange: adoption in OECD countries with different health care system configurations. Medical Care Research and Review, 77(4), 299-311.

Jaleel, A., Mahmood, T., Hassan, M.A., Bano, G., & Khurshid, S.K. (2020). Towards medical data interoperability through collaboration of healthcare devices. IEEE Access, 8, 132302-132319.

Katehakis, D.G., Kouroubali, A., & Fundulaki, I. (2018). Towards the Development of a National eHealth Interoperability Framework to Address Public Health Challenges in Greece. In SWH@ ISWC.

Kautsch, M., Lichoń, M., & Matuszak, N. (2017). Setting the scene for the future: implications of key legal regulations for the development of e‐health interoperability in the EU. The International journal of health planning and management, 32(4), 637-652.

Lee, E., Seo, Y.D., Oh, S.R., & Kim, Y.G. (2021). A Survey on Standards for Interoperability and Security on the Internet of Things. IEEE Communications Surveys & Tutorials, 23(2), 1020-1047.

Mamuye, A.L., Yilma, T.M., Abdulwahab, A., Broomhead, S., Zondo, P., Kyeng, M., Maeda, J., Abdulaziz, M., Wuhib, T., & Tilahun, B.C. (2022). Health information exchange policy and standards for digital health systems in Africa: a systematic review. PLOS Digital Health, 1(10), pe0000118.

Mueller, D. (2020). Addressing the challenges of implementing a Health Technology Assessment Policy framework in South Africa. International journal of technology assessment in health care, 36(4), 453-458.

Mulukuntla, S. (2015). Interoperability in Electronic Medical Records: Challenges and Solutions for Seamless Healthcare Delivery. EPH-International Journal of Medical and Health Science, 1(1), 31-38.

Mumtaz, H., Riaz, M.H., Wajid, H., Saqib, M., Zeeshan, M.H., Khan, S.E., Chauhan, Y.R., Sohail, H., & Vohra, L.I. (2023). Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review. Frontiers in Digital Health, 5, 1203945.

Musabi, A.G., & Kipkebut, A.K. (2024). Healthcare Services Interoperability in Kenya: Challenges and Opportunities. E-Health Telecommunication Systems and Networks, 13(1), 1-11.

Ntafi, C., Spyrou, S., Bamidis, P., & Theodorou, M. (2022). The legal aspect of interoperability of cross border electronic health services: A study of the European and national legal framework. Health Informatics Journal, 28(3),14604582221128722.

Oemig, F., & Snelick, R. (2017). Healthcare interoperability standards compliance handbook. Springer.

Peters, B.G. (2022). Institutional theory. In Handbook on theories of governance (pp. 323-335). Edward Elgar Publishing.

Raghavan, A., Demircioglu., M.A., & Taeihagh, A. (2021). Public health innovation through cloud adoption: a comparative analysis of drivers and barriers in Japan, South Korea, and Singapore. International Journal of Environmental Research and Public Health, 18(1), 334.

Rajapakshe, W. (2017). Factors affecting human resources management policy implementation in small and medium enterprises (SMEs) in Sri Lanka. International Journal of Academic Research in Business and Social Sciences, 7(12), 1129-1144.

Skrocki, M. (2013). "Standardisation Needs for Effective Interoperability". Transactions of the International Conference on Health Information Technology Advancement. 32. https://scholarworks.wmich.edu/ichita_transactions/32 (Accessed on 12 May 2015).

Subbarao, C., Renukappa, S., Suresh, S., & Menon, S. (2022). Challenges for adoption of smart healthcare strategies: An Indian perspective. British Academy of Management Conference Proceedings. 31st August-2nd September, Alliance Manchester Business School

Tsegaye, T., & Flowerday, S. (2021). A system architecture for ensuring interoperability in a South African national electronic health record system. South African Computer Journal, 33(1), 79-110.

Wilson, D., Sheikh, A., Görgens, M., Ward, K., & Bank, W. (2021). Technology and Universal Health Coverage: Examining the role of digital health. Journal of Global Health,11, 16006

World Health Organisation. (2012). WHO Forum on Health Data Standardisation and Interoperability. https://www.who.int/ehealth/WHO_Forum_on_HDSI_Report.pdf?ua=1 (Accessed on 12 July 2018).