Challenges of Implementing Hospital Information

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Technical and Human Challenges of Implementing Hospital Information
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Mohamed Khalifa
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Submitted: February 17, 2014 Accepted: February 27, 2014
Journal of Health Informatics in Developing Countries
Vol. 8 No. 1, 2014
Technical and Human Challenges of
Implementing Hospital Information
Systems in Saudi Arabia
Mohamed KHALIFAa,1
Consultant, Medical & Clinical Informatics, King Faisal Specialist Hospital and
Research Center, Jeddah, Saudi Arabia
Abstract. Hospital information systems (HIS) have been in use for decades
worldwide and for many years now in the area of the Middle East. Many hospitals
in Saudi Arabia started to adopt HIS, where this adoption process is still facing
challenges from different aspects. On top of these come the technical and the
human challenges which might complicate the implementation of HIS as well as
the training of healthcare professionals on using such systems. The main objective
of this study was to identify, analyze and evaluate technical and human challenges
perceived by healthcare professionals to the adoption of HIS in order to provide
system implementers with suggestions on proper actions. The study used a
questionnaire to collect data from a random sample of different healthcare
professionals at two Saudi hospitals known for their experience implementing
HIS; one private and the other is governmental, and then analyzed the results to
identify, describe and evaluate various challenges. The study identified more than
50 challenges; 18 technical and 17 human challenges were validated and selected
then used in the questionnaire to collect data about the participants experiences
regarding each item of these challenges. The study sorted challenges from the most
to the least important. The governmental hospital users had more complains and
concerns than the private hospital regarding the human challenges, related to
awareness, training and usability of systems as well as the technical challenges,
related to hardware and software of HIS. The study recommended increasing the
awareness, training resources and adding hospital information system training to
the undergraduate and postgraduate medical and nursing education. The study also
recommended improving the condition of hardware and software used through
more frequent updating of the devices, computers and their installed systems in
addition to enhancing the usability of systems through different approaches.
Keywords. Hospital Information Systems, Technical Challenges, Human
Challenges, Saudi Arabia, Hospitals.
1. Introduction
Hospital information systems are currently considered a major part of the
healthcare system, on which the processes of care delivery – in hospitals and different
types of healthcare organizations – depend [1]. The importance of these systems
emerges from the importance of their role in managing all patient data and information
including key personal data about the patient and other comprehensive medical data;
1 Email: [email protected]
documenting all medical services that have been provided to the patient such as
investigations, diagnoses, treatments, follow up reports and important medical
decisions [2]. Despite all the described advantages and potential benefits, the
implementation of hospital information systems in most developing countries is still
facing many challenges and barriers that are completely different than challenges faced
in developed countries [3]. Despite the evidence that hospital information systems can
improve quality, safety and reduce costs; implementation of hospital information
systems in developing countries is still not as successful as planned [4]. The level and
extent of usage of hospital information systems in Saudi Arabia is still poor and far less
than expected [5, 6]. The delay in adopting and implementing hospital information
systems in Saudi Arabia hospitals in addition to the lack of a national health
information system actually represents a major challenge for the whole Saudi health
care system [7] and despite the potential benefits that hospital information systems
offer to the healthcare industry, the failure rates in health IT-related projects are
extremely high in Saudi Arabia [8]. Together, these factors were the main motivation
for conducting a research study that addresses the challenges in implementing hospital
information systems in Saudi Arabia.
Many published studies considered even highly regarded, industry-leading hospital
information systems implemented in Saudi Arabia and different world countries to be
challenging to use because of the multiplicity of screens, options, and navigational aids.
Problems with hospital information systems usability especially when physicians
have inadequate computer skills as the case in Saudi Arabia and many other developing
countries caused physicians to spend extra work time to learn effective ways to use
the hospital information systems [5,9]. These substantial initial time costs are
considered an important barrier to obtaining benefits, as greater burdens on physicians
time decrease their use of hospital information systems and increase their resistance,
which lowers the potential for achieving quality improvement [10].
Although vendors in Saudi Arabia are slowly improving hospital information
systems usability, most vendor analysis studies doubted that any newly innovated
technology, such as voice recognition, tablet computers, or mobile hand-held devices,
will dramatically simplify hospital information systems usage. Designing user friendly
software for information and knowledge professionals is a challenge that spans the
software industry beyond health care [11]. Inadequate electronic data exchange and
weak integration between different Saudi hospital information systems modules and
between hospital information systems and other electronic systems were defined as
another barrier to hospital information systems implementation and use, such as the
lack of integration between the hospital information systems and other clinical data
systems as lab, radiology or referral systems. Working with both electronic and paper
based systems in parallel, usually forces healthcare professionals to switch during their
work tasks between these systems, thereby slowing workflow, requiring more time to
manually enter data from external systems, and increasing healthcare professionals
resistance to hospital information systems use [12].
Saudi hospital information systems usually need a lot of difficult complementary
changes and support during the process of customization and final tuning. Hospital
information systems hardware and software cannot simply be used “out of the box”.
Instead, physicians and other healthcare professionals must carry out many complex
and time consuming activities to customize, adjust and complement the hospital
information systems product before being able to generate benefits from this new
technology [13]. Hospital information systems need a lot of technical support from the
various software, hardware, networking, and service vendors when technical problems
appear, such as poor user software interfaces, slow computer machines or networks or
difficult data entry and retrieval especially when the hardware is old. Moreover,
physicians had to redesign their workflow (how they worked in the exam room) and
office workflow (who did what tasks; such as data entry). As a general rule, larger
hospitals could implement complementary changes and request better support from
vendors more easily than smaller hospitals because they tend to have stronger
organizational resources such as management experience with past process changes,
financial resources, leadership, and information systems support staff [14].
Active research on hospital information systems development and implementation
in Saudi Arabia and in many developing countries has been trying to explain the delay
or unsuccessful implementation of such systems and link this problem to the
acceptance or resistance of healthcare professionals’ towards these systems [15]. The
effect of information technology knowledge, experience and skills of healthcare
professionals, current status and level of automation in hospitals, and professionals’
attitudes, in terms of their positive or negative beliefs about computerized systems and
information systems in the healthcare environment are considered among the major
human challenges to the successful implementation and use of such systems. This is
why planned training of healthcare professionals is needed to foster positive attitudes
about hospital information systems, and build confidence in the benefits of these
systems [16].
Strategies for the successful management of hospital information systems
implementation should include engaging physicians and other healthcare professionals
and providing strong organizational support to them before and during the
implementation activities. These two factors could eliminate major resistance and
negative attitudes frequently reported and in the same time increase level of acceptance
of hospital information systems by physicians and healthcare professionals [17].
Saudi studies also reported that physicians using hospital information systems
spent more time per patient for a period of months after successful systems
implementation [18]. The increased time and effort consumed resulted in longer
workdays or fewer patients seen, or both, especially during that initial period of
hospital information systems implementation. This is adding more work load,
decreasing productivity and slowing down performance [19]. Hospital information
systems use could be encouraged through financial rewards for quality improvement
and for achievement of quality performance. Yet few studies reported any financial
incentives for quality improvement or achievement of quality performance [10].
Effective physician-patient communication and interaction is associated with
improved health outcomes, treatment adherence and patient satisfaction. Some studies
tried to measure the quality of verbal and nonverbal physician-patient communication
during hospital information systems based consultation visits. One study measured the
level of keyboarding, doctor’s computer screen gaze, and doctors eye contact with
patient and doctor’s body lean. Researchers concluded that hospital information
systems use during office visits adds to the complexity of the physician-patient
interaction and might negatively affect patient-centered communication. Consequently,
hospital information systems use can undermine patient-centered care and result in
poor patient and physician satisfaction [20].
While the majority of research focus is related to the enhancement and
modernization of electronic medical records in developed countries which already have
gone long path into implementing hospital information systems, many developing
countries are still progressing from paper-based systems to electronic systems. The
requirements and challenges of their hospital information systems are totally different
from those of the developed world [21]. The developing world faces a series of health
crises that threaten the lives of millions of people, where lack of technical infrastructure
and trained, experienced healthcare professional staffs are considered important
challenges to scaling up treatment for diseases and improve healthcare, this is why it is
very crucial to identify and manage such challenges according to their priorities [22].
The main objective of this study is to identify, analyze and evaluate the most
important technical and human challenges perceived by healthcare professionals to the
successful adoption of hospital information systems in Saudi Arabia and in developing
countries generally in order to provide system implementers and policy makers with
suggestions on proper plans and actions to overcome implementation problems.
2. Research Methodologies
2.1. Developing the Research Questionnaire
This research study depended on the use of survey methods, through the
development and application of a questionnaire to collect data and information directly
from different categories of healthcare professionals including doctors, nurses,
technicians and administrative staff of Saudi hospitals, mainly two selected hospitals as
mentioned above; one private and the other one is governmental and then analyze the
results of these answered questionnaires using the statistical analysis functions of the
SPSS software to determine the statistical relevance of the various factors mentioned
with the challenges of the implementation of hospital information systems and
determine the order and rank of these challenges.
The research questionnaire was designed to include four sections of questions. The
first section was about the participant, with some demographic information so as to
discover any possible relation of these factors to the experience about technical and
human challenges of implementing hospital information systems. The second section
was designed to collect some data about the type and extent of the implemented
hospital information system. The third section of the questionnaire was designed to
collect data about the technical challenges related to the information technology and
computers hardware and software that might contribute to the delay or unsuccessful
implementation of hospital information systems such as poor interfaces or usability,
difficult data entry or retrieval, insufficient hardware in terms of numbers or old and
slow machines in addition to lack of support and training [23]. The fourth section of the
questionnaire was designed to collect data about the human challenges.
It is common for user resistance to challenge implementation efforts. Enhancing
the acceptance of hospital information systems is necessary to get the benefits of
medical error reduction, improved quality of care, and decreased healthcare costs.
Physician satisfaction and increased usability can increase the chances of success for
hospital information systems implementation [24]. Human factors includes; awareness
of the importance and benefits of using HIS, knowledge and experience of using
computer applications in general and HIS specifically, beliefs and impressions about
HIS and the ability to use them. In one study, researchers could identify three main
human challenges facing the adoption of hospital information systems which include
shortage of health professional faculty who are familiar with hospital information
systems and related technologies, shortage of health informatics specialists who can
implement these technologies, and poor acceptance of hospital information systems
software [25]. The nature of the healthcare professions could also contribute to the
delay or unsuccessful implementation of hospital information systems. The lack of time
allowed learning and training on using hospital information systems is one of the major
problems, this is why educating healthcare professionals about hospital information
systems could help a lot in removing the barriers to adoption [25]. The lack of
motivation, lack of healthcare professionals support also is a problem. Studies show
that hospital information systems adds more work, needs more time and effort, they
may slow down work or decrease productivity in other times, may also add more
responsibilities [26].
2.2. Research Population and Research Sample
The research study population included four categories of healthcare professionals;
physicians, nurses, technicians and administrators, who are working in two of the major
Saudi hospitals and are in contact with some type of hospital information systems fully
or partially implemented in their hospitals and departments. For the purpose of
studying this large population, a representative sample was planned; a group of
participating healthcare professionals were recruited to answer the questionnaire. The
researcher selected these two hospitals based on their history in developing and
implementing hospital information systems.
The researcher approached the hospitals selected for the study through formal
channels, meeting with seniors in the hospitals management, to get the approval for
accessing and contacting healthcare professionals at the hospital during their working
hours. Research ethics forms and related committees were consulted for their consents
and the researcher got their approval before starting data collection.
The challenge was in the process of selecting and recruiting healthcare
professionals as participants in the study. The researcher started with studying the two
hospitals in terms of working staff and decided to take participation from the major
four categories of professionals; doctors, nurses, technicians as well as administrators.
The researcher aimed to include 5% of the professionals population in the two
hospitals as a sample for the research. The researcher used systemic random methods
for the selection of participating healthcare professionals. The researcher tried to make
sure that each category of professionals is proportionally represented in the sample of
the study.
2.3. Data Collection Process
A pilot study was conducted using the preliminary research questionnaire on a
limited number of different healthcare professionals, from both hospitals, to get their
feedback on the questions used and to help the researcher in developing better formulae
for the questions and clearer sentences, eliminate irrelevant or repeated questions and
rearrange some questions to fit better in the sequence. The final questionnaire was used
to collect data directly from the selected healthcare professionals. The questionnaire
was administrated in two versions; English and Arabic. Study data were collected over
six months; from March, 2012 to September 2012 and included 153 valid responses
from both hospitals. The whole study was completed and results reported by the end of
October 2012.
3. Research Results
The researcher used the SPSS software to conduct a multi-level statistical analysis
and started by calculating the reliability coefficient for the eighteen technical
challenges and the seventeen human challenges before conducting more descriptive or
inferential statistical analysis. A very high Cronbachs Alpha coefficient (0.924) for
technical challenges and (0.853) for human challenges resulted from this reliability
testing, which was a good sign for the reliability of the results.
Descriptive statistics were conducted and reported for the general variables, these
are the demographic data of the study participants, as well as for the data about the
implemented health information system in the hospital. Technical and human
challenges data were also analyzed using both descriptive as well as inferential
statistics to detect the possible relations or associations between demographic data as
well as data on hospital information systems implemented with different technical and
human challenges perceived by different healthcare professionals. Frequency analysis
for technical and human barriers sorted them according to the answers of the
participants from the most important to the least.
Both males and females were equally represented in the research sample and
respondents, the study had nearly the same percentage for both of them and this is a
good sign for the participation of females in the healthcare field in a country such as
Saudi Arabia. This is not unexpected, because the healthcare field in general is one of
the most mature business fields in Saudi Arabia and it is very balanced in terms of
hiring males and females with no gender discrimination which is consistent and proved
by the results of a local research study [7].
Table 1. Gender Distribution of Respondents
Value Frequency Percentage
Male 75 49.0
Female 78 51.0
Total 153 100.0
Regarding the age groups with the most participation, most of the participants
(about 85%) were from the two middle groups, between 26 and 50 years of age and this
is also expected, because people who are younger than 25 years and those who are
older than 50 years are already less in the healthcare field in Saudi Arabia. Another
point is that people over 50 years might have less interest in research participation,
especially when it comes to sophisticated information technology.
Table 2. Age Group Distribution of Respondents
Value Frequency Percentage
Less than 25 years 11 7.2
26 – 35 years 68 44.4
36 – 50 years 62 40.5
Over 50 years 12 7.8
Total 153 100.0
Regarding qualification of participants, and as a general concept, most of the
healthcare professionals are either college graduates or post graduate qualified with
Masters and PhD degrees; this is why these two categories were the largest among the
participants. While total years of experience varied.
Table 3. Qualifications Distribution of Respondents
Value Frequency Percentage
Higher education 75 49.0
College degree 71 46.4
Associate degree 4 2.6
High school 3 2.0
Regarding the profession distribution, it was expected that nurses would be the
largest group participating in the research because, by nature, they are the largest
working force in hospitals, but it seems that they were always busy and overloaded
with much work tasks, so they simply have limited time to spend participating in such
research as long as it is a voluntary participation. Doctors were more responsive and
they took the largest portion of participation, this could be explained by the physicians
nature of resistance, such as conclusions presented by some researchers in their study
about barriers to the acceptance of electronic medical records by physicians [27].
Table 4. Profession Distribution of Respondents
Value Frequency Percentage
Doctor staff 93 60.8
Nursing staff 12 7.8
Technician Staff 27 17.6
Employee/Administrator 21 13.7
Total 153 100.0
There were twice as many participants from the private hospital as from the
government hospital. Private hospitals working healthcare professionals might be more
motivated to participate in healthcare research. They feel that their voice is heard and
that they can change things around them easily. In Saudi Arabia, and in most Middle
East countries, the private healthcare section is usually more advanced than the
government, except for the very specialized or independent government hospitals.
Private hospitals and healthcare organizations are selecting professionals usually in a
more effective way and despite professionals are working for longer hours and with
bigger load of tasks, they are still more motivated by the competitive nature of work.
These assumptions and explanations are still consistent with a local research study [7].
Regarding the extent of implementing HIS in hospitals, 40% of participants said
they are working on a fully implemented HIS system and 60% reported that they are
working on a partially implemented system. These figures are very similar to what has
been reported by one local study in Saudi Arabia [6], describing the Saudi healthcare
sector, which witnessed significant progress in the recent decades without equivalent
advancement of the electronic health field. A noticeable fact is that 100% of the
participants are already using HIS and most of them are using the systems in all or
most of their job tasks. This clears out the generally good experience of most of the
participants in using hospital information systems and consequently their ability to
judge and evaluate the challenges of implementing and using such systems.
75% of the participants already used hospital information systems even before they
joined their current job, and only 25% of the research participants were using the
hospital information systems for the first time at their current job. But maybe some of
them have been here in the current job for years, so they still have good experience.
The most commonly used IT tools were communication, email & voice mail in
addition to the hospital information systems applications. This is also similar to the
findings of the referred study [6].
Table 5. Technical challenges sorted from the most to the least, according to participants experience
Item Mean Opinion
There are no manuals or guidelines for using HIS 4.08 Agree
Computers and networks have a lot of maintenance problems 4.01 Agree
Communication networks are slow 3.95 Agree
The computer terminals are slow 3.94 Agree
HIS modules are not fully integrated 3.93 Agree
HIS are not satisfying different users needs 3.80 Agree
The main difficulty with HIS is data entry 3.77 Agree
Communication networks are old 3.70 Agree
The computer terminals are old 3.65 Agree
There are not enough computer terminals 3.63 Agree
The systems interface design is not user friendly/understandable 3.61 Agree
There is no maintenance/technical support for hardware/software 3.53 Agree
There are no standards for data entry and/or retrieval 3.50 Agree
The main difficulty with HIS is data retrieval 3.38 Neutral
The user interface language is difficult or not clear 3.29 Neutral
It is difficult to train users to use HIS 3.28 Neutral
HIS are difficult to use because they are very complicated 3.22 Neutral
HIS are difficult to access 2.50 Disagree
Table 6. Human challenges sorted from the most to the least, according to participants experience
Item Mean Opinion
Lack of awareness of the importance and benefits of using HIS 4.11 Agree
Lack of knowledge of using HIS 4.09 Agree
Lack of healthcare professionals support to HIS 4.08 Agree
Lack of experience using HIS 4.07 Agree
Lack of motivation to learn and train on using HIS 4.06 Agree
Lack of time allowed to learn and train on using HIS 4.00 Agree
HIS add more professional responsibilities 3.98 Agree
Low numbers of health informatics specialists 3.88 Agree
Lack of experience of computer applications 3.85 Agree
HIS add more work/need more time/effort 3.50 Agree
Negative beliefs about their ability to use HIS 3.42 Agree
Negative beliefs and impressions about HIS 3.35 Neutral
HIS decrease interaction between doctors and patients 3.34 Neutral
Using HIS creates legal problems for users 3.12 Neutral
Using HIS creates administrative problems for users 3.07 Neutral
Using HIS creates clinical problems for users 2.98 Neutral
HIS slow down work/decreases productivity 2.91 Neutral
The analysis of the challenges shows the ranking of these challenges according to their
importance from the perspective and experience of the healthcare professionals. This
part of the analysis should help hospital information systems developers and
implementers to address important challenges first, which would support successful
implementation of such systems in Saudi Arabia and other developing countries.
4. Discussion and Conclusions
In the analysis of the technical challenges, participants confirmed that computer
hardware and software needed maintenance and upgrade because of being old and slow,
but they disagreed regarding information accessibility difficulty. In our study, the
slowness of systems in addition to hardware and software recurrent maintenance
problems came on top of the technical challenges which is very similar to the findings
of other research work published in 2004 which found that systems response time is the
parameter most highly valued by clinical users, where healthcare professionals do not
consider suffering of slow or old systems as a part of their job, they dont care as much
about beautiful screen design, features, advice, warnings, or alerts [28]. Since hospital
information systems are high technology systems and include complex hardware and
software, a certain level of computer skills is required for users. There are still some
technical problems with hospital information systems, which lead to complaints from
users, and they need to be improved. These technical challenges that existed are related
to the technical issues of the systems, the technical capabilities of the users and of the
suppliers. This is very much consistent with many published researches [27]
Participants agreed that many human challenges are facing implementation of
hospital information systems. Our study identified knowledge, experience, motivation
and training of healthcare professionals on using hospital information systems as main
challenges while other comparable studies identified the lack of human resource
development in the context of systems use and the problem of convincing individuals
to accept new technologies as major challenges [29]. One similar study about
implementation difficulties of hospital information systems showed that the potential
sources of difficulties were related to poor integration of different systems,
inconsistency among different workflows of different departments and training issues
whereas there was no major implementation problem related to hardware or software
support [30]. The importance of training healthcare professionals on using hospital
information systems and its direct impact on the success of systems implementation has
been focused in many research works [31, 32]
The lack of health informatics specialists and the lack of experienced healthcare
professionals in computer applications were among the human challenges highlighted
by our study and are consistent with the results published by other research work [25]
which, as mentioned above, could identify three major human challenges facing the
adoption of hospital information systems, including shortage of health professional
faculty who are familiar with hospital information systems and related technologies,
shortage of health informatics specialists who can implement these technologies, and
poor acceptance of hospital information systems software. In addition time constraints
and lack of motivation of users were also reported. The physicians use, attitude and
challenges facing implementing hospital information systems in Saudi Arabia were
discussed in some earlier research work and physicians experiences reported were very
similar to our study results [18].
Some research focused on the organizational challenges of implementing hospital
information systems, considering this project as a transformation or a change
management project, where the hospital policies and procedures play an important role
in the success of systems implementation [33]. Another study focusing on the
determinants of hospital information systems successful adoption used a completely
different set of challenges; the researchers associated the successful implementation of
systems to environmental uncertainty, type of system affiliation, size, and urban-ness
of hospitals and considered hospital information systems adoption an organizational
survival strategy for hospitals to improve quality and efficiency. [34]
When we come to the analysis of differences and associations, through the section
of the inferential statistics, we find that female participants considered technical
challenges more important than human challenges, compared to male participants.
When we compare responses from participants in the private hospital to their peers of
participants in the government hospitals we also find many differences that have
statistical significance. Government hospital participants complained of time
constraints and work overload that prevent them from learning how to use the hospital
information systems, in addition to the problem of old, slow and few in number
computer machines and outdated software which were not reported the same level from
the private hospital participants. In some studies conducted on government hospitals,
study participants felt that the existing hospital information systems was old which
resulted in longer time for OPD consultation and delay in investigation results [35].
Previous experience with HIS could also make a difference in the opinions of the
participants. Participants with previous hospital information systems experience could
identify negative beliefs and impressions about hospital information systems as a
challenge, since they do find such wrong beliefs very influential in learning and using
hospital information systems [36]. They complained that using hospital information
systems adds more work and needs more time and effort and might sometimes slow
down work and decreases productivity. This might be due to their negative experience
with legacy systems, outdated software solutions and old computer machines. They
also identified that HIS usually do not satisfy different users needs, which would
necessitate that system designers take this into consideration.
The age factor could affect the participants opinion regarding the allowed time for
training and learning. Some younger participants believe that computer terminals are
old and slow while older participants feel that machines are fine. In one study, which
confirmed similar results, researchers found that younger clinicians reported different
attitudes than senior clinicians, but this might be related more to age and previous
experience with computers [37]. Another study confirmed that younger physicians
tended to consider using computer systems easy when compared to older physicians,
since these young physicians use computers more frequently and are more used to
access the Internet [9]. The profession nature of the participants, being doctors, nurses
or technicians could affect their opinions about many technical factors. Qualification
factor of participants could also affect their opinions regarding many of the technical
challenges. People who use hospital information systems in all and most of their job
tasks reported that there are not enough computer terminals in the hospital. This might
be due to their increased need to use computers more often.
As a conclusion and summary, human challenges; those related to the healthcare
professionals and their beliefs, nature of work and time constraints as well as technical
challenges; those related to software and hardware of hospital information systems are
the major barriers and challenges in the way of successful implementation of these
systems in Saudi Arabia. Government hospitals had more complains and concerns than
private hospitals, where systems are old and not satisfying the increased needs and in
the same time the hospital doesnt have the experience to go with hospital information
systems implementation in terms of technical infrastructure and maintenance. This
study could identify, define and sort the detailed human and technical challenges that
should be managed to achieve successful implementation of hospital information
systems in Saudi Arabia and in developing countries generally.
5. Recommendations
5.1. Overcoming Technical Challenges
To ensure that HIS vendors and commercial providers are supplying hospitals
with the proper system documentations, user manuals and guidelines for using
and troubleshooting HIS.
We have to make sure that computers and networks are working fine in
terms of hardware and that they have less maintenance problems, so that we
can guarantee that the software will consequently work better. Hardware
maintenance and technical support is essential.
We might need to upgrade computer machines and communication networks
for new ones, update their operating systems to enhance their performance.
Technically, HIS should be satisfying different users needs, this can be
achieved as we mentioned above by performing requirements analysis
thoroughly before the design phase is started and much before the
implementation phase starts.
Overcoming data entry difficulties through implementing new innovations in
both software and hardware. For the software innovations, the system should
be designed to support structured data entry rather than unstructured, drop
down list fields more than text fields, dictation and voice recognition
techniques. For the hardware innovations, we can implement touch screens,
hand-held devices and tablet PCs so as to minimize the gap between the
acquisition of data and the process of recording them and provide every user
with a computer device so as to make information accessibility easier.
Outsourcing some electronic processing tasks, such as medical transcription of
the dictated voice files, could also eliminate the overload on the health
information technology and management staff.
It is essential, for the healthcare professionals as users, to make the systems
interface design more friendly and understandable, it is essential to make such
systems less complicated and convenient for the daily use of the regular or
standard user not for the super or knowledgeable users.
Using data standards is an essential step in validating data on the systems and
consequently important for the quality, accuracy and reliability of such source.
Increase the number of computer terminals at the point of care.
5.2. Overcoming Human Challenges
Improving the awareness of the importance and benefits of using HIS by
focusing on the topic through a multi-phase approach. Starting from the level
of medical schools and colleges the undergraduate level and through
different levels of post-graduate medical education. The importance of HIS
and their applications should be an integral part of the medical education
Improving the knowledge of using HIS through formal training during
different levels of medical education and training.
The researcher suggests that teaching and training on HIS should be
developed and implemented as a course or a subject of the formal
undergraduate as well as post graduate medical education programs.
Short courses for healthcare professionals and continuous medical education
programs should be provided on the subjects of HIS and health information
management. These programs should be implemented by the ministry of
health and its formal channels for all healthcare professionals at all types of
hospitals and healthcare organizations. We need also to develop and enhance
our taught computer science courses in medical schools, nursing education
and post-graduate training.
Increasing the numbers of health informatics technicians and specialists
through developing both undergraduate as well as post graduate specialized
programs in Health Informatics, Health Information Management and
Health Information Technology. This way we could establish a new
generation of professionals specialized in this new discipline. Undergraduate
programs would deliver health information technicians and basic level
professionals, while post graduate programs would deliver leaders, consultants
and specialists in the field.
The researcher suggests developing an and
training programs on HIS especially for newly appointed staff to overcome
the negative beliefs and impressions about HIS.
Improving healthcare professionals support to HIS through increasing their
participation and involvement in the stages of systems development, systems
implementation and deployment. Healthcare professionals support would be
much better if developers and implementers of HIS took into account their
different needs during the stages of requirements analysis and before
Improving motivation of healthcare professionals to learn and train on using
HIS by providing them with direct and indirect incentives, including overtime
payments, bonuses and rewards for the hospital sections and departments
successfully implementing HIS. Departments that achieved well should also
be recognized.
We should also provide the enough time suitable and convenient for
healthcare professionals to learn and train on using HIS.
Conducting training programs for healthcare professionals to educate them on
how to take new HIS responsibilities and accountabilities, so they would
better understand their part of the process.
When healthcare professionals are overloaded with HIS tasks and functions,
we should look for workflow redesign of processes so that they could
minimize or completely eliminate some unnecessary processes, provide help
in some complicated tasks and assign more help to super busy users.
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