Implementation of Healthcare Information System: Management Issues and Recommendations

ABDULLA SHUHOOD
STUDENT ID: 00493872 2018

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DISSERTATION
Contents
1. Introduction.........................................................................................................................................3
Background and Context of the study.....................................................................................................3
Rationale.................................................................................................................................................4
Aim..........................................................................................................................................................5
Objectives................................................................................................................................................5
Research Question...................................................................................................................................6
2. Literature review.....................................................................................................................................7
Overview.................................................................................................................................................7
Definition and purpose of Healthcare Information System (HIS).............................................................7
Types of Healthcare Information System..............................................................................................10
Implementation of Healthcare Information System..............................................................................10
Benefits of implementing Healthcare Information System....................................................................11
Challenges in implementing Healthcare Information System................................................................12
Gap in literature....................................................................................................................................14
3. Methodology.....................................................................................................................................15
Type of investigation.............................................................................................................................15
Research design.....................................................................................................................................15
Data collection process..........................................................................................................................16
Research setting:...................................................................................................................................17
Sample group:.......................................................................................................................................17
Data analysis process.............................................................................................................................18
Ethical considerations............................................................................................................................18
4. DATA ANALYSIS AND FINDINGS.........................................................................................................19
Introduction...........................................................................................................................................19
Data and findings...................................................................................................................................19
Demographic factors.........................................................................................................................19
Non demographic factors..................................................................................................................20
Interview analysis..................................................................................................................................22
Regression analysis................................................................................................................................22

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Regression 1......................................................................................................................................23
Regression 2......................................................................................................................................24
Secondary data analysis:.......................................................................................................................25
Importance of implementing HIS system in health care:...................................................................25
Challenges faced in the implementation of HIS:................................................................................26
Possible solutions to address challenges in implementing EHR:........................................................27
5. Discussion..........................................................................................................................................29
6. Conclusion and recommendation:.....................................................................................................31
Recommendation:.................................................................................................................................32
Evaluation of study and scope for further research:.............................................................................33
References.................................................................................................................................................34
7. Appendices........................................................................................................................................39
I. Survey and Interview questionnaire for Manchester Institute of Health & Performance (MIHP). 39
SURVEY QUESTIONNAIRE..................................................................................................................39
INTERVIEW QUESTIONS.....................................................................................................................42
II. Survey and interview questionnaire for North Manchester General Hospital (NMGH).................43
SURVEY QUESTIONNAIRE..................................................................................................................43
INTERVIEW QUESTIONS.....................................................................................................................45
III. Interview response obtained from four staffs working in MIHP and NMGH:............................47
Interview response for MIHP:............................................................................................................47
Interview response for NMGH:..........................................................................................................49
IV. Gender wise distribution of samples in survey:.........................................................................51
V. Details regarding age group in survey:..........................................................................................51
VI. Benefits of implementing Healthcare Information System (Murthy B. K., 2014).......................53
VII. Demographic factors.................................................................................................................54
VIII. Demographic Factors.................................................................................................................55
IX. Non Demographic Factors.........................................................................................................56
X. Ranking of Factors affecting efficiency of HIS................................................................................58
XI. Opinion on the impact of management issued in the hospital affecting the HIS.......................59
XII. Most influence factors...............................................................................................................60
XIII. Potential Data Security Issues....................................................................................................61

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Statement of Originality:
I declare that the dissertation is my own piece of work and has been developed on my own
knowledge and research skills. No information has been directly copied from any sources. All
arguments provided has been cited with appropriate reference and citations to indicate originality of
the work.

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Abstract:
Background: The implementation of healthcare technology had brought about a significant
transformation in the healthcare system over the past few years. There is a need to understand the
challenges and concerns arising related to the implementation and utilization of HIS for optimizing its
use across the health care organization.
Aim: The main aim of the mixed method study is to understand the management issues that are faced
during the implementation of HIS and find out the ways to deal with the same.
Methods: Primary and secondary data was collected to gain answer to the research question. Survey
and interview method was used to collected response from health care staffs working in two hospitals.
Survey was done with fifty staffs and interview was done with four technicians. Secondary data was
collected by review of research literature on the topic.
Findings: The study revealed that more than one HIS technology is being used by health care staffs and
this has lead to improvement in care. However, challenges has been experienced by staffs during the
implementation process because of lack of training, lack of accountability, infrastructural issues and lack
of master database affect efficiency of HIS. The solutions presented by technicians needs to be analyzed
by IT leaders so that effectiveness and utility of HIS is further improved.

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Chapter 1: Introduction
Background and Context of the study
It is well recognized that the healthcare sector is rapidly undergoing transformation, posing key
challenges to healthcare practitioners, healthcare systems, governments and healthcare entities. This is
more evident for the countries where the economic burden of healthcare costs is increasingly high
owing to an aging population and high prevalence of chronic diseases. The complexity of delivering
adapted and modified care services that meet the person-centered concerns is well reported across
research. Health researchers have time and again sought answer for the increasing cost of proliferation
of treatments that can address the concern of catering to the needs of a large patient population. It is
critical for health care systems to optimize the nature of services provided and re-design different
aspects of care provision (Callen, 2016).Constant efforts are being given to entrench innovation into the
technologies used for articulating healthcare services at the present time (Paul, Ezz, & Kuljis, 2012). The
researchers further state that healthcare authorities are have given their best efforts to integrate latest
technologies into the healthcare system for advancement of services, starting from planning of care to
evaluation of outcomes. The focus is on improving health through valuable contributions from different
levels of healthcare system. A culture change has therefore been witnessed that promotes a shift
towards optimal use of superior and highly developed technologies.
The implementation of healthcare technology had brought about a significant transformation in the
healthcare system over the past few years. Key insights from research into the healthcare domain have
led to a better understanding of how patient information can be managed, analyzed, shared and used
for better outcomes. Various technologies are in use at present for augmenting the level of care
provided and making it easier for service providers to do so. The purpose of integration of technology
into healthcare system is to provide better care for patients and help them achieve health equality (Lau,
Kuziemsky, Price, & Gardner, 2010). Further, technology has helped care professionals to increase
patient safety, decreases rate of medical errors and strengthens the active interaction between
healthcare providers and patients.
Healthcare Information System (HIS) refers to the wide range of technology based applications that are
useful for capturing, storing, managing and transmitting health related information across the care
continuum. This definition includes different systems such as routine information system, laboratory
information system, hospital administration system, and human resource management system. Overall,
HIS is an integrated effort for collecting, processing, reporting, and using health information and
advanced knowledge for influencing decision-making and policy at different levels (Awang Kalong &
Yusof, 2017). (Jardim, 2013) suggests reliable and sound information is the key to appropriate decision

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making in a healthcare system, and is crucial for policy implementation, regulation and governance,
human resource development, health research, health education and service financing. The health
information system enables the underpinnings for decision making in healthcare sector and comprises
of four distinct functions; data generation, compilation, analysis and synthesis, and communication and
use. The distinct feature is that the HIS is responsible for collecting data from relevant healthcare sector,
analyzing the same and ensuring overall quality, timeliness and relevance, and converting the data into
valuable information that can aid in health related decision making.
Health information systems function to serve a broader end, supporting health facility management,
ensuring accurate planning and stimulating research, enabling trends analysis and underpinning
effective communication. Health related information is not of much value when the same is not
available in a format that is of use of multiple users such as managers, planners, individuals and
communities. Communication and dissemination are important attributes of the health information
system (Lovelace & Shah, 2016). It is opined that a suitable HIS is elementary for enabling professionals
gain access to authoritative, useable, reliable, comprehensive and understandable data. HIS aims to
manage the paperless workflow of a patient and it is to be noted that this process is less complex and
easier than the volatile medical records previously used. Healthcare providers benefit at large as
accurate information is present on time for informed decision making. HIS is to be considered as an
independent as well as self-contained system that runs in a seamless integrated process, covering a
wide array of functionalities (Than, 2017).
The benefits of implementing HIS to the patient as well as to the healthcare setting are copious and have
been well established across literature. Some of the key advantages for the patients include reduction in
waiting times for admission, registration and examination; increased quality time for clinical
examinations, improved treatment quality, and regular treatment monitoring. The advantages for the
healthcare system are more profound and implies to professionals at different levels of practice.
Reduction in manual data entry at multiple locations within the same system for the same patient is the
most striking benefit. Secondly, HIS ensures that professionals can incorporate standards treatment
guidelines for treating patients with diverse needs. Further, reduction in retrieval time of patient data is
also highly appreciated. Faster referral of patients within a particular care setting is also an advantage
(Lovelace & Shah, 2016).
As pointed out by healthcare experts there is a need to understand the challenges and concerns arising
related to the implementation and utilization of HIS for optimizing its use across the care gamut. The
rationale would be to understand the strategies through which transformation can be brought about in
the improvement of quality of services provided at different levels (Weaver et al. 2016). New
approaches in the HIS are emerging at the present time, increasing the complexity of implementing the
same in a suitable manner. Professionals have been looking for solutions to problems arising due to the
speedy change in practice (Kisekka & Giboney, 2018).

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Rationale
A deep look into the research carried out on the implementation of HIS in the recent years would
indicate that a number of challenges have been faced in achieving desired outcomes. Successful
implementation of the system has been restricted to certain countries, while the others are still
struggling to accomplish the same. A key issue that has been acknowledged in this regard is the set of
challenges at the management level. Such challenges include lack of skill and competency of the
healthcare professionals and lack of awareness regarding the best application of the same. Though the
use of HIS in the form of electronic medical record system has increased from 21% in 2005 to 86% in
2015, the risks of faulty treatment processes has increases as a result of the lack of adaptation
capability. This concern has been found to be due to poor healthcare management system (Kaur & Rani,
2015). There is therefore a need to carry out a thorough analysis of the structural processes of
implementation of HIS that are aimed at providing advanced forms of medical care.
The present research was carried out with the agenda of coming up with key recommendation for HIS
implementation practice at management level. A key insight into the challenges faced at management
level to implement HIS would help in coming up with recommendations that guide future use of HIS in a
more effective manner. The healthcare industry would be highly benefited from such form of research in
that they can consider policy changes within the healthcare settings. Concerned stakeholders would be
armed with proper recommendations that would support the need of process changes across settings. It
is also to be mentioned that leadership and accountability would be essential for promoting the changes
based on a rich pool of evidences (Kisekka & Giboney, 2018).
Aim
Research aims are the broad statement regarding the outcomes of the study that outlines the expected
accomplishments to be made. The aims give a clear picture of the overall purpose of the research
(Chatburn, 2011). The aim of the present research was to identify the management issues that lead to
poor implementation of HIS. Simultaneously, the research also aimed at providing recommendations for
enhancement of skills and development of awareness among the respective stakeholders.
Objectives
Research objectives are subsidiary to the research aims and are highly focused on the purpose of the
research. It is crucial that the research objectives are precisely outlined (Chatburn, 2011). For the
present research the objectives of the study were as follows-
 To identify the management issues that are encountered by HIS
 To identify the cause of medical errors that occur due to poor implementation of HIS