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'''Keywords''': electronic health record, evaluation, hospital information systems, information system success model, ISSM
 
'''Keywords''': electronic health record, evaluation, hospital information systems, information system success model, ISSM
  
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==Introduction==
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[[Hospital]]s have implemented health information systems to provide timely and accurate [[information]], thus fulfilling managerial needs and improving healthcare effectiveness and efficiency at a reasonable cost.<ref name="ChenAnInvest12">{{cite journal |title=An investigation on physicians' acceptance of hospital information systems: A case study |journal=International Journal of Medical Informatics |author=Chen, R.F.; Hsiao, J.L. |volume=81 |issue=12 |pages=810–20 |year=2012 |doi=10.1016/j.ijmedinf.2012.05.003 |pmid=22652011}}</ref>
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The [[hospital information system]] (HIS) is one of the health information systems which has been extensively utilized. There are major concerns regarding the quality of these systems; therefore, it is vital to continuously evaluate the HIS. As well, HIS implementation requires a great deal of investment. For example, the [[Health Information Technology for Economic and Clinical Health Act]] (HITECH) of 2009 mandates about $10 million for each hospital in the United States.<ref name="IqbalTheRelat13">{{cite journal |title=The relationship between usage intention and adoption of electronic health records at primary care clinics |journal=Computer Methods and Programs in Biomedicine |author=Iqbal, U.; Ho, C.H.; Li, Y.C. et al. |volume=112 |issue=3 |pages=731–7 |year=2013 |doi=10.1016/j.cmpb.2013.09.001 |pmid=24091088}}</ref> Therefore, post-implementation evaluation of HIS success is of critical importance. Determining HIS success rate is an ongoing area of research since its implications are of interest not only for researchers but also to physicians and managers. The results of the evaluation can reveal the value of a HIS and provide essential information for subsequent decisions.<ref name="OjoValid17">{{cite journal |title=Validation of the DeLone and McLean Information Systems Success Model |journal=Healthcare Informatics Research |author=Ojo, A.I. |volume=23 |issue=1 |pages=60–66 |year=2017 |doi=10.4258/hir.2017.23.1.60 |pmid=28261532 |pmc=PMC5334133}}</ref>
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There are many existing frameworks to evaluate health information systems. The information systems success model (ISSM) is one of the most well-known and valid frameworks to assess these systems.<ref name="TilahunModel15">{{cite journal |title=Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals |journal=BMC Medical Informatics and Decision Making |author=Tilahun, B.; Fritz, F. |volume=15 |pages=61 |year=2015 |doi=10.1186/s12911-015-0192-0 |pmid=26231051 |pmc=PMC4522063}}</ref> ISSM was developed by DeLone and Mclean in 1990<ref name="DeLoneInfo92">{{cite journal |title=Information Systems Success: The Quest for the Dependent Variable |journal=Information Systems Research |author=DeLone, W.H.; McLean, E.R. |volume=3 |issue=1 |pages=1–95 |year=1992 |doi=10.1287/isre.3.1.60}}</ref> and was subsequently updated in 2003.<ref name="DeLoneTheDeLone03">{{cite journal |title=The DeLone and McLean Model of Information Systems Success: A Ten-Year Update |journal=Journal of Management Information Systems |author=DeLone, W.H.; McLean, E.R. |volume=19 |issue=4 |pages=9–30 |year=2003 |doi=10.1080/07421222.2003.11045748}}</ref> ISSM is comprised of seven dimensions, including system quality, information quality, service quality, system use, usefulness, satisfaction, and net benefits.<ref name="DeLoneTheDeLone03" /> ISSM focuses on the assessment of technological aspects of information systems based on users’ viewpoints and explains the influence of technology on system use as well as users’ satisfaction. The success of information systems depends on the interaction of different ISSM dimensions.<ref name="OtienoMeasur08">{{cite journal |title=Measuring effectiveness of electronic medical records systems: Towards building a composite index for benchmarking hospitals |journal=International Journal of Medical Informatics |author=Otieno, G.O.; Hinako, T.; Motohiro, A. et al. |volume=77 |issue=10 |pages=657–69 |year=2008 |doi=10.1016/j.ijmedinf.2008.01.002 |pmid=18313352}}</ref> Some of the studies which have deployed this framework to assess HIS include works by Tilahun and Fritz<ref name="TilahunModel15" />, Sicotte ''et al.''<ref name="SicotteVirtual10">{{cite journal |title=Virtual organization of hospital medical imaging: A user satisfaction survey |journal=Journal of Digital Imaging |author=Sicotte, C.; Paré, G.; Bini, K.K. et al. |volume=23 |issue=6 |pages=689–700 |year=2010 |doi=10.1007/s10278-009-9220-x |pmid=19588196 |pmc=PMC3046687}}</ref>, Otieno ''et al.''<ref name="OtienoNurses07">{{cite journal |title=Nurses' views on the use, quality and user satisfaction with electronic medical records: Questionnaire development |journal=Journal of Advanced Nursing |author=Otieno, O.G.; Toyama, H.; Asonuma, M. et al. |volume=60 |issue=2 |pages=209–19 |year=2007 |doi=10.1111/j.1365-2648.2007.04384.x |pmid=17877568}}</ref>, Ojo<ref name="OjoValid17" />, Messeri ''et al.''<ref name="MesseriAnInfo13">{{cite journal |title=An information systems model of the determinants of electronic health record use |journal=Applied Clinical Informatics |author=Messeri, P.; Khan, S.; Millery, M. et al. |volume=4 |issue=2 |pages=185–200 |year=2013 |doi=10.4338/ACI-2013-01-RA-0005 |pmid=23874357 |pmc=PMC3716425}}</ref>, and Aggelidis ''et al.''<ref name="AggelidisHosp12">{{cite journal |title=Hospital information systems: Measuring end user computing satisfaction (EUCS) |journal=Journal of Biomedical Informatics |author=Aggelidis, V.P.; Chatzoglou, P.D. |volume=45 |issue=3 |pages=566–79 |year=2012 |doi=10.1016/j.jbi.2012.02.009 |pmid=22426283}}</ref>
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In 2014, the Iranian Ministry of Health and Medical Education mandated that public hospitals transfer patients’ medical records to SEPAS (Iran’s [[electronic health record]] [EHR] project). This led to a rapid growth in the implementation of a HIS in hospitals across the country. Following the implementation of EHRs and HISs in Saudi Arabia<ref name="AlharthiPhys14">{{cite journal |title=Physician satisfaction with electronic medical records in a major Saudi Government hospital |journal=Journal of Taibah University Medical Sciences |author=Alharthi, H.; Youssef, A.; Radwan, S. et al. |volume=9 |issue=3 |pages=213–18 |year=2014 |doi=10.1016/j.jtumed.2014.01.004}}</ref>, Korea<ref name="IqbalTheRelat13" />, and Taiwan<ref name="WangAttitudes15">{{cite journal |title=Attitudes toward inter-hospital electronic patient record exchange: Discrepancies among physicians, medical record staff, and patients |journal=BMC Health Services Research |author=Wang, J.Y.; Ho, H.Y.; Chen, J.D. et al. |volume=15 |pages=264 |year=2015 |doi=10.1186/s12913-015-0896-y |pmid=26162748 |pmc=PMC4499194}}</ref><ref name="LuFactors12">{{cite journal |title=Factors determining nurse acceptance of hospital information systems |journal=Computers, Informatics, Nursing |author=Lu, C.H.; Hsiao, J.L.; Chen, R.F. |volume=30 |issue=5 |pages=257–64 |year=2012 |doi=10.1097/NCN.0b013e318224b4cf |pmid= 22228251}}</ref>, the success of these systems was evaluated. In the case of Iran, a developing country, to the best of our knowledge there have been very few studies which have evaluated the success of a HIS. The studies by Tavakoli ''et al.''<ref name="TavakoliElectro13">{{cite journal |title=Electronic medical record in central polyclinic of isfahan oil industry: a case study based on technology acceptance model |journal=Acta Informatica Medica |author=Tavakoli, N.; Jahanbakhsh, M.; Shahin, A. et al. |volume=21 |issue=1 |pages=23–5 |year=2013 |doi=10.5455/AIM.2012.21.23-25 |pmid=23572857 |pmc=PMC3610586}}</ref>, Abdekhoda ''et al.''<ref name="AbdekhodaTheEff15">{{cite journal |title=The effects of organizational contextual factors on physicians' attitude toward adoption of Electronic Medical Records |journal=Journal of Biomedical Informatics |author=Abdekhoda, M.; Ahmadi, M.; Gohari, M. et al. |volume=53 |pages=174–9 |year=2015 |doi=10.1016/j.jbi.2014.10.008 |pmid=25445481}}</ref>, and Saghaeiannejad-Isfahani ''et al.''<ref name="Saghaeiannejad-IsfahaniASurv14">{{cite journal |title=A Survey on the Users' Satisfaction with the Hospital Information Systems (HISs) based on DeLone and McLean's Model in the Medical-Teaching Hospitals in Isfahan City |journal=Acta Informatica Medica |author=Saghaeiannejad-Isfahani, S.; Jahanbakhsh, M.; Habibi, M. et al. |volume=22 |issue=3 |pages=179-82 |year=2014 |doi=10.5455/aim.2014.22.179-182 |pmid=25132711 |pmc=PMC4130683}}</ref> offer some examples to this end. Nevertheless, these studies did not collectively provide conclusive evidence on the success of HISs. As such, there is a need for additional studies to gather further evidence on the effectiveness and efficiency of the HIS in Iran.
  
 
==References==
 
==References==

Revision as of 23:52, 10 June 2019

Full article title Determining the hospital information system (HIS) success rate: Development of a new instrument and case study
Journal Open Access Macedonian Journal of Medical Sciences
Author(s) Ebnehoseini, Zahara; Tabesh, Hamed; Deldar, Kolsoum; Mostafavi, Sayyed M.; Tara, Mahmood
Author affiliation(s) Mashhad University of Medical Sciences, Shahroud University of Medical Sciences
Primary contact Email: TaraM at mums dot ac dot ir
Year published 2019
Volume and issue 7(9)
Page(s) 1407–14
DOI 10.3889/oamjms.2019.294
ISSN 1857-9655
Distribution license Creative Commons Attribution-NonCommercial 4.0 International
Website https://www.id-press.eu/mjms/article/view/2647
Download https://www.id-press.eu/mjms/article/view/oamjms.2019.294/3327 (PDF)

Abstract

Background: A hospital information system (HIS) is a type of health information system which is widely used in clinical settings. Determining the success rate of a HIS is an ongoing area of research since its implications are of interest for researchers, physicians, and managers.

Aim: In the present study, we develop a novel instrument to measure HIS success rate based on users’ viewpoints in a teaching hospital.

Methods: The study was conducted in Ibn-e Sina and Dr. Hejazi Psychiatry Hospital and education center in Mashhad, Iran. The instrument for data collection was a self-administered structured questionnaire based on the information systems success model (ISSM), covering seven dimensions, which includes system quality, information quality, service quality, system use, usefulness, satisfaction, and net benefits. The verification of content validity was carried out by an expert panel. The internal consistency of dimensions was measured by Cronbach’s alpha. Pearson’s correlation coefficient was calculated to evaluate the significance of associations between dimensions. The HIS success rate on users’ viewpoints was determined.

Results: A total of 125 users participated in the study. The instrument was validated by an expert panel with the content validity index (CVI) at 0.85 and content validity ratio (CVR) at 0.86. The overall Cronbach’s alpha value of the instrument was 0.93. The Pearson correlation coefficient showed significant positive relationships among the investigated dimensions. On average, HIS success rate in the hospital under study was 65% (CI: 64%, 67%). The dimensions of “usefulness,” “system quality,” and “net benefits” showed the highest rates of success, respectively.

Conclusion: The instrument used in this study can be adopted for HIS evaluation in future studies. In the current study, a method was developed to determine the HIS success rate based on users’ viewpoints. This method allows for the comparison of HIS success rates in various hospitals. As well, our findings underscore the viewpoints of HIS users in a developing country.

Keywords: electronic health record, evaluation, hospital information systems, information system success model, ISSM

Introduction

Hospitals have implemented health information systems to provide timely and accurate information, thus fulfilling managerial needs and improving healthcare effectiveness and efficiency at a reasonable cost.[1]

The hospital information system (HIS) is one of the health information systems which has been extensively utilized. There are major concerns regarding the quality of these systems; therefore, it is vital to continuously evaluate the HIS. As well, HIS implementation requires a great deal of investment. For example, the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 mandates about $10 million for each hospital in the United States.[2] Therefore, post-implementation evaluation of HIS success is of critical importance. Determining HIS success rate is an ongoing area of research since its implications are of interest not only for researchers but also to physicians and managers. The results of the evaluation can reveal the value of a HIS and provide essential information for subsequent decisions.[3]

There are many existing frameworks to evaluate health information systems. The information systems success model (ISSM) is one of the most well-known and valid frameworks to assess these systems.[4] ISSM was developed by DeLone and Mclean in 1990[5] and was subsequently updated in 2003.[6] ISSM is comprised of seven dimensions, including system quality, information quality, service quality, system use, usefulness, satisfaction, and net benefits.[6] ISSM focuses on the assessment of technological aspects of information systems based on users’ viewpoints and explains the influence of technology on system use as well as users’ satisfaction. The success of information systems depends on the interaction of different ISSM dimensions.[7] Some of the studies which have deployed this framework to assess HIS include works by Tilahun and Fritz[4], Sicotte et al.[8], Otieno et al.[9], Ojo[3], Messeri et al.[10], and Aggelidis et al.[11]

In 2014, the Iranian Ministry of Health and Medical Education mandated that public hospitals transfer patients’ medical records to SEPAS (Iran’s electronic health record [EHR] project). This led to a rapid growth in the implementation of a HIS in hospitals across the country. Following the implementation of EHRs and HISs in Saudi Arabia[12], Korea[2], and Taiwan[13][14], the success of these systems was evaluated. In the case of Iran, a developing country, to the best of our knowledge there have been very few studies which have evaluated the success of a HIS. The studies by Tavakoli et al.[15], Abdekhoda et al.[16], and Saghaeiannejad-Isfahani et al.[17] offer some examples to this end. Nevertheless, these studies did not collectively provide conclusive evidence on the success of HISs. As such, there is a need for additional studies to gather further evidence on the effectiveness and efficiency of the HIS in Iran.

References

  1. Chen, R.F.; Hsiao, J.L. (2012). "An investigation on physicians' acceptance of hospital information systems: A case study". International Journal of Medical Informatics 81 (12): 810–20. doi:10.1016/j.ijmedinf.2012.05.003. PMID 22652011. 
  2. 2.0 2.1 Iqbal, U.; Ho, C.H.; Li, Y.C. et al. (2013). "The relationship between usage intention and adoption of electronic health records at primary care clinics". Computer Methods and Programs in Biomedicine 112 (3): 731–7. doi:10.1016/j.cmpb.2013.09.001. PMID 24091088. 
  3. 3.0 3.1 Ojo, A.I. (2017). "Validation of the DeLone and McLean Information Systems Success Model". Healthcare Informatics Research 23 (1): 60–66. doi:10.4258/hir.2017.23.1.60. PMC PMC5334133. PMID 28261532. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=PMC5334133. 
  4. 4.0 4.1 Tilahun, B.; Fritz, F. (2015). "Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals". BMC Medical Informatics and Decision Making 15: 61. doi:10.1186/s12911-015-0192-0. PMC PMC4522063. PMID 26231051. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=PMC4522063. 
  5. DeLone, W.H.; McLean, E.R. (1992). "Information Systems Success: The Quest for the Dependent Variable". Information Systems Research 3 (1): 1–95. doi:10.1287/isre.3.1.60. 
  6. 6.0 6.1 DeLone, W.H.; McLean, E.R. (2003). "The DeLone and McLean Model of Information Systems Success: A Ten-Year Update". Journal of Management Information Systems 19 (4): 9–30. doi:10.1080/07421222.2003.11045748. 
  7. Otieno, G.O.; Hinako, T.; Motohiro, A. et al. (2008). "Measuring effectiveness of electronic medical records systems: Towards building a composite index for benchmarking hospitals". International Journal of Medical Informatics 77 (10): 657–69. doi:10.1016/j.ijmedinf.2008.01.002. PMID 18313352. 
  8. Sicotte, C.; Paré, G.; Bini, K.K. et al. (2010). "Virtual organization of hospital medical imaging: A user satisfaction survey". Journal of Digital Imaging 23 (6): 689–700. doi:10.1007/s10278-009-9220-x. PMC PMC3046687. PMID 19588196. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=PMC3046687. 
  9. Otieno, O.G.; Toyama, H.; Asonuma, M. et al. (2007). "Nurses' views on the use, quality and user satisfaction with electronic medical records: Questionnaire development". Journal of Advanced Nursing 60 (2): 209–19. doi:10.1111/j.1365-2648.2007.04384.x. PMID 17877568. 
  10. Messeri, P.; Khan, S.; Millery, M. et al. (2013). "An information systems model of the determinants of electronic health record use". Applied Clinical Informatics 4 (2): 185–200. doi:10.4338/ACI-2013-01-RA-0005. PMC PMC3716425. PMID 23874357. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=PMC3716425. 
  11. Aggelidis, V.P.; Chatzoglou, P.D. (2012). "Hospital information systems: Measuring end user computing satisfaction (EUCS)". Journal of Biomedical Informatics 45 (3): 566–79. doi:10.1016/j.jbi.2012.02.009. PMID 22426283. 
  12. Alharthi, H.; Youssef, A.; Radwan, S. et al. (2014). "Physician satisfaction with electronic medical records in a major Saudi Government hospital". Journal of Taibah University Medical Sciences 9 (3): 213–18. doi:10.1016/j.jtumed.2014.01.004. 
  13. Wang, J.Y.; Ho, H.Y.; Chen, J.D. et al. (2015). "Attitudes toward inter-hospital electronic patient record exchange: Discrepancies among physicians, medical record staff, and patients". BMC Health Services Research 15: 264. doi:10.1186/s12913-015-0896-y. PMC PMC4499194. PMID 26162748. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=PMC4499194. 
  14. Lu, C.H.; Hsiao, J.L.; Chen, R.F. (2012). "Factors determining nurse acceptance of hospital information systems". Computers, Informatics, Nursing 30 (5): 257–64. doi:10.1097/NCN.0b013e318224b4cf. PMID 22228251. 
  15. Tavakoli, N.; Jahanbakhsh, M.; Shahin, A. et al. (2013). "Electronic medical record in central polyclinic of isfahan oil industry: a case study based on technology acceptance model". Acta Informatica Medica 21 (1): 23–5. doi:10.5455/AIM.2012.21.23-25. PMC PMC3610586. PMID 23572857. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=PMC3610586. 
  16. Abdekhoda, M.; Ahmadi, M.; Gohari, M. et al. (2015). "The effects of organizational contextual factors on physicians' attitude toward adoption of Electronic Medical Records". Journal of Biomedical Informatics 53: 174–9. doi:10.1016/j.jbi.2014.10.008. PMID 25445481. 
  17. Saghaeiannejad-Isfahani, S.; Jahanbakhsh, M.; Habibi, M. et al. (2014). "A Survey on the Users' Satisfaction with the Hospital Information Systems (HISs) based on DeLone and McLean's Model in the Medical-Teaching Hospitals in Isfahan City". Acta Informatica Medica 22 (3): 179-82. doi:10.5455/aim.2014.22.179-182. PMC PMC4130683. PMID 25132711. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=PMC4130683. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation, spelling, and grammar. We also added PMCID and DOI when they were missing from the original reference.