Digital health policy to innovation: health system maturity and AI readiness in Serbia

@article{djikanovic2026digital,
  title = {{Digital health policy to innovation: health system maturity and AI readiness in Serbia}},
  author = {B Djikanovic and M Kovacevic and I Smigic and M Cvejic and E Nicic and C Madevu-Matson and S Ollis and V Curcin and A Barry and S Watson-Grant},
  journal = {The European Journal of Public Health},
  year = {2026},
  month = oct,
  doi = {10.1093/eurpub/ckag169.1221},
  url = {https://doi.org/10.1093/eurpub/ckag169.1221},
  note = {CC BY-NC 4.0},
}

TY  - JOUR
TI  - Digital health policy to innovation: health system maturity and AI readiness in Serbia
AU  - B Djikanovic
AU  - M Kovacevic
AU  - I Smigic
AU  - M Cvejic
AU  - E Nicic
AU  - C Madevu-Matson
AU  - S Ollis
AU  - V Curcin
AU  - A Barry
AU  - S Watson-Grant
PY  - 2026
DA  - 2026/10/01
JO  - The European Journal of Public Health
DO  - 10.1093/eurpub/ckag169.1221
UR  - https://doi.org/10.1093/eurpub/ckag169.1221
AB  - Issue/problem: Strengthening health information systems is a key priority of digital health policy, yet evidence linking policy interventions to measurable system improvements remains limited. In Serbia, a baseline assessment in 2021 revealed low system maturity, fragmentation, and limited data use. Addressing these gaps is essential for enabling data-driven decision-making and readiness for artificial intelligence applications, with relevance for other middle-income settings.  Description of the problem: Following the 2021 assessment, Serbia adopted a national digital health strategy and action plan (2022–2026). This study evaluates whether policy implementation led to measurable improvements in system maturity and readiness for AI-supported systems. Maturity was assessed using the Stages of Continuous Improvement (SOCI) framework across five domains. A baseline consensus-based assessment (2021) was followed by reassessment in 2024 using desk review and expert validation, enabling longitudinal comparison on a five-point scale.  Results: Overall maturity increased from 1.6 (2021) to 2.5 (2024). The largest gains occurred in leadership and governance and ICT infrastructure, reflecting strengthened institutional frameworks and system resilience. Progress in machine-readable data supports prerequisites for AI-driven analytics. However, slower progress in interoperability and data use indicates persistent barriers to full implementation of AI-enabled decision support.  Lessons: Digital health policy can drive measurable improvements in system maturity when supported by strong governance and coordinated implementation. Structured assessment tools enable monitoring of policy impact. However, interoperability, data quality, and workforce capacity remain critical for achieving AI-enabled, data-driven health systems, and these lessons might be transferable to similar settings.  Key messages: • Digital health policy can improve HIS maturity when supported by strong governance and coordination. Tools like SOCI link policy actions to system performance and enable progress monitoring.  • AI-ready health systems require more than infrastructure: interoperability, high-quality data, and workforce capacity remain key challenges. Addressing them is essential for data-driven decisions.
SN  - 1101-1262
SN  - 1464-360X
ER  -