Currently submitted to: JMIR Medical Informatics
Date Submitted: Sep 10, 2025
Open Peer Review Period: Oct 23, 2025 - Dec 18, 2025
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital Health Interoperability: Stakeholder Insights on Affinity Domains from the Czech Republic
ABSTRACT
Background:
Health-data interoperability in post-transition systems depends on enforceable standards and clear governance. Affinity domains, as defined in the IHE XDS framework, offer a combined organisational-technical model for cross-enterprise data exchange. Evidence from Central Europe remains scarce.
Objective:
This study aimed to examine stakeholder perceptions of prerequisites, opportunities, and barriers to implementing affinity domains in the Czech healthcare system, and to contextualise these findings in relation to international experiences to inform policy development.
Methods:
We conducted 18 semi-structured interviews (January–April 2025) with policymakers, regional authorities, providers, insurers, IT vendors, and consultants. Participants were selected through purposive and snowball sampling to capture diverse perspectives. Data were analysed inductively using thematic analysis in MAXQDA24, with dual coding, consensus resolution, and reflexive memos to ensure rigour.
Results:
Thematic analysis yielded five categories: (A) roles and responsibilities, characterised by ambiguous mandates, regional fragmentation, vendor dominance, and exclusion of clinicians; (B) perceived risks, including institutional distrust from past failures, legal uncertainty regarding liability, technical inconsistency, and vendor lock-in; (C) system-level prerequisites, such as the need for an empowered governance body, sustainable funding, adoption of common standards, and adequate human resources; (D) perceived benefits and opportunities, notably improved continuity of care, reduced diagnostic redundancy, and enhanced accountability; and (E) implementation barriers, including legal ambiguity, political discontinuity, vendor resistance, and limited stakeholder engagement. Stakeholders also emphasised the need for an independent governance body, binding interoperability standards (IHE XDS, HL7 FHIR), and pilot affinity domains with certification mechanisms.
Conclusions:
To advance affinity domain implementation in Czechia, we recommend establishing an empowered coordinating authority, launching pilot projects with contractual enforcement and audit trails, and aligning national efforts with EHDS requirements (metadata catalogues, access bodies). These steps can reduce duplication, improve continuity of care, and strengthen cross-sectoral trust. Clinical Trial: n/a
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