A Cross-Sectional Study about a Health Information

></A Cross-Sectional Study about a Health Information
System (HIS) in the United مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab Emirates Federal
Healthcare Organization (UAE FHO)
دراسة عرضیة حول نظام المعلومات الصحیة في مؤسسة الرعایة الصحیة
الاتحادیة بدولة الإمارات العربیة المتحدة
By
Shaikha Abdulkarim Abdool
Student ID: 100066
Write my thesis – Dissertation submitted in partial fulfillment of
MSc Information Technology Management
Faculty of Engineering & Information Technology
Write my thesis – Dissertation Supervisor
Dr. Sherief Abdallah
March-2014
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Table of Contents
List of Illustrations………………………………………………………………………….5
Figures……………………………………………………………………………5
Tables…………………………………………………………………………….9
Abbreviation List…………………………………………………………………………10
Acknowledgment…………………………………………………………………………11
Abstract…………………………………………………………………………………..12
Chapter 1: Introduction …………………….…….………………………………………14
1.1.General Introduction………..……………………………………………………14
1.2 Problems and Objectives…………………………………….……………….….16
1.3 Setting of Interest……………………………………………..………………….16
1.4 The Implemented Health Information System Background………..……….…..17
1.5 Rational for the Study……………………………………………………………18
1.6 Research Questions………………………………………………….……………..19
Chapter 2: Review of Literatures……………………………………………………….20
2.1 Perceptions of HIS Users………………………………………………………20
2.2 Implementation Puzzles in Health Information Exchange Projects……………21
2.3 Information Technology Adoption in Emergency Departments………………24
2.4 Physicians’ Perceptions about Health Information Technology……………….25
2.5 Health Information Systems Progress………………………………………….26
2.6 Progress and Challenges of IT Healthcare…………………………………….28
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2.7 Health Information Exchange to Improve HIV Patients’ Care and Outcomes..29
2.8 Evaluation of Health Information Systems……………………………………30
2.9 Health Information System to Reduce Mortality Rate…………………………31
2.10 Aspects of Health Information Technologies…………………………..32
2.11 Cerner Health Information System……………………………………..33
2.12 Health Information System to Improve HIV/AIDS Patients Health……34
2.13 Process of Evaluating Health Information Systems…………………….35
2.14 Clinical Information Technology………………………………………36
2.15 Oracle-based Medical Information System…………………………….37
2.16 Information Quality based on Nursing Information System……………38
2.17 Barriers in Implementing Health Information Systems………………..39
2.18 Critical Issues in an Oncology Information System……………………41
2.19 Nurses Perceptions about Hospital Information Systems……………..42
2.20 Consumers Perceptions about Health Information Exchange………….42
2.21 Health Informatics and Future Plans………………………………..…43
Chapter 3: Methodology…………………….…………………………………………44
3.1 Study Design………………………………………………………………….44
3.2 Subjects for Study………………………………………………………….…44
3.3 Measurements…………………………………………………………………46
3.4 Data Collection……………………………………………………………….46
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Chapter 4: Analysis………………………………………………………………….50
4.1 Results………………………………………………………………………..50
4.1.1 Ajman Hospital………………………………………………………51
4.1.2 Al-Fujairah Hospital………………………………………………….61
4.1.3 Dubai Hospital……………………………………………………….65
4.1.4 Ras Al-Khaimah (RAK) Hospital……………………………………68
4.1.5 Sharjah Hospital……………………………………………………..72
4.1.6 Um Al-Qwain (UAQ) Hospital……………………………………..75
4.1.7 Project Management Office (HIS PMO)………… …………………79
4.2 Evaluation of the Study Participants………………………………………..83
4.3 Hypotheses Testing………………………………………………………….85
4.3.1 HIS for Re-designing Patients’ Care Pathway………………………86
4.3.2 HIS for Improving Patients’ Health Outcomes…………………..…87
4.4 Overall……………………………………………………………………….89
4.5 Actual Data………………………………………………………………….94
Chapter 5: Homework help – Discussion…………………………………………………………………….97
5.1 Pre-Testing…………………………………………………………………97
5.2 Response Rate …………………………………………………………….98
5.3 General Homework help – Discussion………………………………………………………..100
5.4 Data Validation……………………………………………………………107
5.5 Recommendations…………………………………………………….…..110
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5.6 Study Limitations…………………………………………………………111
5.7 Future Work………………………………………………………………111
5.8 Ethical Considerations……………………………………………………112
Chapter 6: Conclusion………………………………………………………………….113
References…………………………………………………………………………115
Bibliography……………………………………………………………………….120
Appendices…………………………………………………………………………125
Appendix (A): HIS Survey Sample…………………………………………125
Appendix (B): Al-Fujairah Hospital Figures………………………………133
Appendix (C): Dubai Hospital Figures………………………….…………141
Appendix (D): Ras Al-Khaimah (RAK) Hospital Figures………………….148
Appendix (E): Sharjah Hospital Figures……………………………………156
Appendix (F): Um Al-Qwain (UAQ) Hospital Figures…………..………..162
Appendix (G): HIS Project Management Office (PMO) Figures……….…168
Appendix (H): Results Validity…………………………………………….176
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List of Illustrations
Figures
Figure 1: Outline of the study stages………………………………………………19
Figure 2: Ajman Hospital HIS current status………………………………..……52
Figure 3: Ajman Hospital system satisfactory…………………………………….52
Figure 4: Ajman Hospital HIS for re-designing patients’ care pathway…….…….54
Figure 5: Ajman Hospital HIS helped in re-designing patients’ care pathway……55
Figure 6: Ajman Hospital HIS for diagnosis and medical care……………….…..56
Figure 7: Ajman Hospital HIS helped in diagnosis at earlier stage………………..56
Figure 8: Ajman Hospital discern alerts……………………………….………….57
Figure 9: Ajman Hospital HIS for improving patients’ health outcomes…………58
Figure 10: Ajman Hospital HIS helped in improving patients’ health outcomes…59
Figure 11: Ajman Hospital HIS challenges………………………………………60
Figure 12: Ajman Hospital HIS solutions for challenges…………………………61
Figure 79: Gender distribution for HIS users…………………………………….83
Figure 80: Age range for HIS users…………………………………………..…..83
Figure 81: Majors of HIS users……………………………………………..……84
Figure 82: HIS users’ participation level…………………………………..……..85
Figure 83: Overall satisfaction level. …………………………………………….90
Figure 84: Overall response level about re-designing patients’ care pathway……91
Figure 85: Overall response level about improving patients’ health outcomes…..92
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Figure 86: Overall challenges faced in the HIS…………………………………..93
Figure 87: Overall possible solutions to overcome the challenges faced in the
HIS………………………………………………………………………………94
Figure 88: Response rate………………………………………………………..99
Figure 13: Al-Fujairah Hospital HIS current status……………………………133
Figure 14: Al-Fujairah Hospital system satisfactory. …………………………133
Figure 15: Al-Fujairah Hospital HIS for re-designing patients’ care pathway…134
Figure 16: Al-Fujairah Hospital HIS helped in re-designing patients’ care
pathway.……………………………………………………………………….135
Figure 17: Al-Fujairah Hospital HIS for diagnosis and medical care. ………..136
Figure 18: Al-Fujairah Hospital HIS for diagnosis and medical care at earlier
stage…………………………………………………………………………….137
Figure 19: Al-Fujairah Hospital discern alerts. ………………………….……137
Figure 20: Al-Fujairah Hospital HIS for improving patients’ health
outcomes……………………………………………………………………….138
Figure 21: Al-Fujairah Hospital HIS helped in improving patients’ health
outcomes……………………………………………………………………….139
Figure 22: Al-Fujairah Hospital HIS challenges……………………….……..139
Figure 23: Al-Fujairah Hospital HIS solutions for challenges………………..140
Figure 24: Dubai Hospital HIS current status………………………………….141
Figure 25: Dubai Hospital system satisfactory……………..…………………141
Figure 26: Dubai Hospital HIS for re-designing patients’ care pathway……….142
Figure 27: Dubai Hospital HIS helped in re-designing patients’ care pathway…143
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Figure 28: Dubai Hospital HIS for diagnosis and medical care…………….…..144
Figure 29: Dubai Hospital HIS for diagnosis and medical care at earlier stage…144
Figure 30: Dubai Hospital discern alerts…………………………………………145
Figure 31: Dubai Hospital HIS for improving patients’ health outcomes…..…..145
Figure 32: Dubai Hospital HIS helped in improving patients’ health outcomes…146
Figure 33: Dubai Hospital HIS challenges………………………………………146
Figure 34: Dubai Hospital HIS solutions for challenges…………………………147
Figure 35: RAK Hospital HIS current status……………………………………..148
Figure 36: RAK Hospital system satisfactory………………………..………….148
Figure 37: RAK Hospital HIS for re-designing patients’ care pathway…………..149
Figure 38: RAK Hospital HIS helped in re-designing patients’ care pathway……150
Figure 39: RAK Hospital HIS for diagnosis and medical care……………….….151
Figure 40: RAK Hospital HIS for diagnosis and medical care at earlier stage…..152
Figure 41: RAK Hospital discern alerts………………………………………….152
Figure 42: RAK Hospital HIS for improving patients’ health outcomes…………153
Figure 43: RAK Hospital HIS helped in improving patients’ health outcomes….154
Figure 44: RAK Hospital HIS challenges…………………………………………154
Figure 45: RAK Hospital HIS solutions for challenges……………………..……155
Figure 46: Sharjah Hospital HIS current status……………………………….…..156
Figure 47: Sharjah Hospital system satisfactory………………………………….156
Figure 48: Sharjah Hospital HIS for re-designing patients’ care pathway………..157
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Figure 49: Sharjah Hospital HIS helped in re-designing patients’ care pathway…..157
Figure 50: Sharjah Hospital HIS for diagnosis and medical care…………………158
Figure 51: Sharjah Hospital HIS helped in diagnosis at earlier stage…………….159
Figure 52: Sharjah Hospital discern alerts…………………………………………159
Figure 53: Sharjah Hospital HIS for improving patients’ health outcomes……….160
Figure 54: Sharjah Hospital HIS helped in improving patients’ health outcomes…160
Figure 55: Sharjah Hospital HIS challenges……………………………………….161
Figure 56: Sharjah Hospital HIS solutions for challenges…………………………161
Figure 57: UAQ Hospital HIS current status………………………………………162
Figure 58: UAQ Hospital system satisfactory………………………………………162
Figure 59: UAQ Hospital HIS for re-designing patients’ care pathway…………….163
Figure 60: UAQ Hospital HIS in re-designing patients’ care pathway………………163
Figure 61: UAQ Hospital HIS for diagnosis and medical care………………………164
Figure 62: UAQ Hospital HIS for diagnosis and medical care at earlier stage………164
Figure 63: UAQ Hospital discern alerts………………………………………………165
Figure 64: UAQ Hospital HIS for improving patients’ health outcomes……………166
Figure 65: UAQ Hospital HIS helped in improving patients’ health outcomes……..166
Figure 66: UAQ Hospital HIS challenges…………………………………………….167
Figure 67: UAQ Hospital HIS solutions for challenges……………………………..167
Figure 68: PMO HIS current status………………………………………………….168
Figure 69: PMO HIS satisfactory……………………………………………………168
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Figure 70: PMO HIS for re-designing patients’ care pathway………………………169
Figure 71: PMO HIS helped in re-designing patients’ care pathway……………….170
Figure 72: PMO HIS for diagnosis and medical care………………………………171
Figure 73: PMO HIS for diagnosis and medical care at earlier stage………………172
Figure 74: PMO HIS discern alerts…………………………………………………172
Figure 75: PMO HIS for improving patients’ health outcomes…………………….173
Figure 76: PMO HIS helped in improving patients’ health outcomes………………174
Figure 77: PMO HIS challenges…………………………………………………….174
Figure 78: PMO HIS solutions for challenges………………………………………175
Tables
Table 1: Health information systems barriers and solutions…………………….….39
Table 2: Hospitals involved in the study…………………………………………….50
Table 3: Response rate per facility……………………………………………….…86
Table 4: HIS for re-designing patients’ care pathway…………………………….…87Table 5: HIS for improving patients’ health outcomes……………………….….…88Table 6: Performance of the system’s users…………………………………….….94Table 8: Statistical analysis of the study participants based on age factor………….108Table 9: Mean for grouped data (age factor)………………………………………109Table 7: Sample size……………………………………………………………….17610Abbreviations ListUAE FHO: United مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab Emirates Federal Healthcare OrganizationHIS: Health Information SystemAJ: AjmanFUJ: Al-FujairahDB: DubaiRAK: Ras Al-KhaimahSJ: ShrajahUAQ: Um Al-QwainPMO: Project Management OfficeIT: Information Technology11AcknowledgementI would like to acknowledge my sincere thanks to all people who helped during thisacademic journey and had influences on completing this journey and especial thanks forthe following parties:- My father and oldest sister who are the main reason for perusing my academicstudy and being patience. Also, my two youngest sisters who spent weeks to enterthe collected data for this research.- The UAE Federal Healthcare Organization for the study sponsorship and allowingconducting this research as well as the Health Information System (HIS) ProjectManagement Office who helped in collecting the required data. Also, theInformation Technology (IT) Departments in the targeted hospitals that helped indistributing the survey.- The British University in Dubai (BUID) for their academic support during theseyears 2010-2014.- The study subjects for their valuable participations.- My friend Alya Harbi who joined me in this academic journey and supported eachother.- Again, to each person who helped and been a cause in the completion of thisjourney.All are gratefully acknowledged for all types of support they provided.12AbstractAs healthcare organizations world-wide competing to provide the ultimate care as easy aspossible to its customers, IT technologies have been embraced in delivering healthcare invarious ways, such as: in diagnosing diseases, treatment and for research and planningpurposes. Health information system (HIS) is part of IT technologies that most if not allhealthcare organizations globally are moving toward implement it. Because of that across-sectional study was conducted about health information system (HIS) in the Unitedمساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab Emirates (UAE) Federal Health Organization.The aims of this research were to identify the current status of the health informationsystem (HIS) in the UAE Federal Health Organization (UAE FHO) and how healthinformation system (HIS) can help in re-designing patients’ care pathway as well asimproving health outcomes. Another aim of this research was to identify the challengesfaced in this system with possible solutions to overcome these challenges. Mainly,quantitative method was utilized to conduct the study.The response rate in this study was high and the results were overall positive. The studymet its aims and covered the targeted research questions related to HIS. Two hypotheseswere tested related to patients’ care pathway and health outcomes.Keywords: the United مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab Emirates Federal healthcare Organization (UAE FHO),Health Information System (HIS), patients’ care pathway, health care, health outcomes,HIS challenges and solutions.13الملخصلأن منظمات الرعایة الصحیة حول العالم تتنافس لتزوید العنایة الفائقة إلى زبائنھا بالسھولة المستطاعة، تكنولوجیاالمعلومات أصبحت متضمنة في تسلیم الرعایة الصحیة بطرق المختلفة، مثل: في تشخیص الأمراض، المعالجاتولأھداف البحث والتخطیط . نظام المعلومات الصحیة جزء من تكنولوجیا المعلومات ، حیث أن معظم إن لم یكن ك ّ لمنظمات الرعایة الصحیة عالمیاً تتح ّ رك نحو تطبیقھا. بسبب ذلك ، دراسة عرضیة أجریت حول نظام المعلوماتالصحیة في مؤسسة الرعایة الصحیة الإتحادیة الإماراتیة.أھداف ھذا البحث كانت لتعریف الوضع الحالي لنظام المعلومات الصحیة في مؤسسة الرعایة الصحیة الإتحادیةالإماراتیة وكیف لنظام المعلومات الصحیة أن یساعد في إعادة تصمیم سیرعنایة المرضى ، بالإضافة إلى تحسینالنتائج الصحیة. الھدف الآخر لھذا البحث، تعریف التحدیات التي واجھت في ھذا النظام مع الحلول المحتملة للتغلّبعلى ھذه التحدیات. طریقة إجراء الدراسة كانت بشكل رئیسي كمیاً.لبحثنسبة الر ّ د في ھذه الدراسة كانت عالیة والنتائج كانت إیجابیة بشكل عام. قابلت الدراسة أھدافھا وغطّت أسئلة االمتعلقة بنظام المعلومات الصحیة. فرضیتان تم اختبارھما متعلقتان بسیرعنایة المرضى ونتائج الصحة.كلمات دلیلیة: مؤسسة الرعایة الصحیة الإتحادیة الإماراتیة، نظام المعلومات الصحیة، سیر عنایة المرضى، رعایةصحیة، نتائج الصحة، تحدیات و حلول نظام المعلومات الصحیة.14Chapter 1: Introduction1.1General IntroductionHealthcare organizations exist in uncertain time that requires from time to timeimmediate and right decisions to be taken and in order to achieve that, information mustbe adequate and available at all times for decision-makers, such as: healthcare providers,top management, patients…etc. So, this led healthcare organizations world-wide todevelop systems that assist in taking the right decision at the right time and maintaining ahigh quality of care.Also, these organizations are complex in its nature as it involves various departments andnumbers of human resources that must work as teams and interchangeably to providehigh quality of services to their customers. How to connect these various places andsystems together under one platform in the healthcare field The possible answer thatmany healthcare organizations are moving toward is health information system (HIS).Information Technology (IT) systems is one of the main solutions that most organizationsare moving to implement. Years ago, medical care provided to customers required thathealthcare providers to go through paper charts. This involved handwritten prescriptions,ordering tests, referrals…etc. There were potential risks of paper-charts, such as:misunderstanding medications instructions, unavailability of allergy alerts and no accessto patients’ history information, particularly if the patient went to a private clinic.However, all these can be avoided or at least minimized by implementing healthinformation systemsInformation is important for health care professionals to take decisions. For instance, theprocess of ordering medical tests depends on availability of reliable information, such as:history of medical conditions and vital signs. Unavailability of these essential informationwhen are required; makes health information systems useless. Also, these systems mustbe well-integrated with existing processes and systems to prevent negative consequences,such as: double works.15With rapid developments in healthcare field, healthcare providers have to deal with morecomplex tasks and provide services to customers in a timely and comprehensive manner,which are becoming more challengeable. In order to achieve that, world-wideorganizations are moving toward a significant solution that is becoming almost theconcern of all organizations regardless of the services they provide. This solution isinformation technology (IT). Health information systems are being considered as avaluable strategy to replace traditional systems and processes that are based
on papers.Despite of many attempts to implement health information systems, failure rates are highdue to various reasons, such as: inadequate trainings, eliminating users to involve in theseprojects and poor implementation strategies.Advanced information technologies and its applications are playing significant roles inhealthcare field these days. The advantages of it outweigh the disadvantages. Forinstance, these technologies and applications send reminders to healthcare providers andtheir customers (e.g. patients), allow to e-prescribe medications and refill, order andreview different clinical tests as well as other tasks. However, IT investments are hugeand expensive as well as risks and issues are yet elevating that keep affecting thesuccessfulness of these projects, so proper evaluations and reliable studies are importantto ensure effectiveness adoption and positive outcomes.This paper starts with an introduction about the problems and objectives of the study aswell as a brief introduction about the setting of interest which is the United مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, ArabEmirates Federal Healthcare Organization (UAE FHO). Also, it introduces briefly thetargeted project in this organization which is health information system (HIS) and statesthe rational for this study as well as an overview about the study stages, such as:identification, research, methodology, analysis, discussion and closure. Then, it presents4 research questions for this study that are related to the current status of the implementedHIS, patients’ care pathway, health outcomes, challenges and solutions in this system.After that, it demonstrates some of previous studies about health information systems. Inaddition, the study methodology and related aspects, such as: study design, targetedsubjects, measurements and data collection method are illustrated.16Furthermore, analysis of the results obtained in this study are demonstrated for eachfacility involved as well as the hypotheses generated that are related to patients’ carepathway and patients’ health outcomes. Homework help – Discussion section is followed by demonstratingthe response rates, data validation and possible recommendations for the UAE FHO inparticular and for organizations moving toward HIS, in general. Limitations of this studyand possible future work are presented as well. The study ends with overall conclusionabout the study and HIS.1.2Problems and ObjectivesThe study was targeted to cover the current status of health information system (HIS) inthe UAE Federal Health Organization (UAE FHO). In addition, to cover how suchsystem can assist in re-designing patients’ care pathway and improve health outcomes forpatients. Along with that, the challenges faced in this HIS were addressed, too. Theinformation obtained from this study will be helpful for future implementation of HIS forother organizations as well as for taking remedies actions by the UAE FHO to improvethe current HIS and provide high quality of services. Also, the study is valuable as thenumber of studies conducted regarding HIS in the Middle East is limited.1.3Setting of InterestThe UAE Federal Healthcare Organization (UAE FHO) is one of the criticalorganizations in the country that deals with different agencies, such as: Ministry ofInterior, Ministry of Education, Federal Statistics Department…etc. In order to assurereliable shared information, technologies need to take place that facilitate centralizedaccess to information. UAE FHO provides different types of services to its customers,such as: curative, preventive and rehabilitation.The organization consists of a Minister, Undersecretary and four undersecretaryassistants. Each assistant is responsible for a sector: support services, public health andlicensing, health clinics and centers as well as hospitals. Under each sector, differentdepartments are there. The headquarter is located in Dubai (MOH 2011a, MOH 2011b &MOH 2014).17Under the UAE FHO, there are 15 hospitals, 68 primary healthcare centers and 18 otherfacilities, such as: rehabilitation and diabetes centers. The number of manpower under theUAE FHO is more than 9000 staff distributed across the country. There are 6 medicaldistricts in each Emirate (Dubai to Al-Fujairah) that manage these facilities (MOH 2013a& MOH 2013b).1.4The Implemented Health Information System (HIS) BackgroundHealth information systems and technologies consist of tremendously variouscomponents and tools to convey, handle and manage health information that servesdifferent type of consumers, such as: healthcare providers, patients and insurers(Blumenthal & Glaser 2007, p. 2527).The country is facing growing population that requires more services to be provided. Inorder to facilitate providing services that reach this population, proper methods need totake place. HIS was one of the methods that the country is currently moving toward. Themain reasons that led to implement this HIS were to create paperless environment asmuch as possible, reduces errors, attain centralized electronic patients records, improveprocesses and save time for healthcare professionals as well as customers. Also, toenhance care cooperation between healthcare professionals in urban and rural areas andreduce redundancy of exams (tests) orders, especially those with chronic diseases, forexample, cardio-vascular diseases.The covered health information system (HIS) is targeted to be implemented in 15hospitals and 68 clinics and 18 other facilities under the UAE FHO. The system wasdesigned based on Cerner Millennium Platform that serves various services, such as:nursing, surgery, pharmacy…etc. The project cost was about AED 350 millions. Thesoftware cost about AED 119,142,681. The project started in 2008 and was planned to beended in 2011. However, the deadline was not meet.Different parties are involved in this project, such as: Cerner Corporation to provide thesoftware, iCapital as the vendor and Etisalat for network. The UAE FHO assigned a teamto handle this project that consists of a project manager and members. At the beginning,18the project team was located in a separate office outside the organization, in Sharjah andlater on, they were re-located in the UAE FHO, Dubai.1.5Rational for the StudyIn order to meet the Smart Government Initiative that was launched by His HighnessSheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of theUAE and Ruler of Dubai, the UAE Federal Healthcare Organization is in the process oftransforming its services to electronic formats and smartly that can be reached frommultiple types of devices, such as: mobile applications. As a result, 80% of healthcareservices were transformed electronically after implementing the HIS (Abdul Hamid 2013,p.19 & Al-Awadhi 2013).This study will contribute positively to healthcare filed, specifically in health informaticsas nowadays HIS is one of the main concerns for most healthcare organizations andparties, such as: companies, the public and decisions makers. So, there is a need toconduct comprehensive studies and researches in this field to serve those people.Although, many studies have been conducted, most of them were conducted in Europeand USA, but, this study will maximize the number of studies conducted in this field inthe Middle East in general and in the UAE in specific. This study will also contribute tofill-in gaps in health informatics filed due to low number of studies in this field,particularly in the UAE and Gulf Region. This study covered most of the healthcareservices provided; not only one area.In addition, as mentioned above, this study will be helpful for the UAE FHO to takecorrection actions in order to improve the current HIS. Also, most of the previous studiesfocused on HIS users and administrative staff to evaluate it, but in this study hospitals’management staff and the HIS project team will be involved, too. The HIS in this studyhas just been implemented without being properly evaluated, so this study will assist toevaluate the system and provide proper analysis on the system’s status for themanagement level in the UAE FHO.This study will enable professionals and decision-makers in healthcare f
ield to makebetter use and take proper decisions based on the information available in these systems,19in a timely manner. The analysis in this study will allow opening eyes on areas that needmore attention while implementing such projects.The below diagram (1) depicts the stages of conducting this study. Mainly, five stageswere involved here: identification, research, methodology, analysis, discussion andclosure. Each stage consisted of tasks.Figure 1: Outline of the study stages.1.6Research QuestionsThe aim of conducting this study is to cover the following areas:1- What is the current status of the health information system (HIS) in the UAEFederal Health Organization (UAE FHO)2- How health information system (HIS) can help in re-designing patients’ carepathway3- How health information system (HIS) can improve health outcomes for patients4- What are the challenges faced in this (HIS) and possible solutions to overcomethese challengesIdentificationStudypurposes.Setting ofinterest.Researchquestions.ResearchReview ofliteratures.MethodologyStudy design.Datacollection:Questionnaire.Targetpopulation.AnalysisResults.Hypothesetesting.Homework help – DiscussionResponserate.Validation.Recommendations.Limitations.Future Works.Ethicalconsiderations.ClosureConclusion.Support20Chapter 2: Review of Literatures2.1Perceptions of HIS UsersA study was conducted by Myers et al. (2012) about the perceptions of care teams inusing health information systems to deal with HIV patients. The number of involved sitesin this study was 5 located in the following States of USA: Louisiana, New Jersey,California, North Carolina and New York. Two approaches were utilized to collect therequired data; interview and survey. Face-to-face and telephone interviews wereconducted during the period of July 2008 and December 2010 to collect the required data.From these 5 sites, 60 users were interviewed. Each interview session lasted from 20 to60 minutes. All sessions were audio-recorded and transcribed. Also, web-based surveywas distributed to evaluate the perceptions of the users. Likert scale was used indesigning the survey; ranging from 1=strongly disagree to 5= strongly agree. Theresponse rate for the survey distributed in this study was 61%. The participants were fromdifferent occupational roles: 21 medical providers, 24 case managers and 17 non-clinicalstaff. Out of 102 survey invitations sent, 62 responses were received.The results obtained from the interviews were variant from the actual use of thesesystems. Because of that, data were analyzed as well quantitatively. Stratified designbased on occupational roles was followed. These roles were: medical providers, casemanagers and non-clinical staff which included administrative staff and billing.In addition, the collected quantitative data varied by these roles. Medical providers wereconcerned about extra workload that these systems might bring. Also, they were lesslikely to use these systems if it could not be integrated with existed procedures and foundto be less efficient. In contrast, some medical providers reported high accuracy and fewerrors when using these technologies. One of the medical providers stated that thesetechnologies made it easier to focus and pay more attention on priority tasks. Overall,within these 5 sites, medical providers reported usefulness access to accurate data.On the other hand, case managers reported that these technologies enabled them to easilyaccess clinical information, check patients’ clinical visits, medical care appointments and21other care tasks provided. Also, they can obtain the required information from theimplemented systems instead of relying on patients to self-report. However, there weresome skepticisms among this group about these systems. One of the case managersreported that sometimes traditional style of communication is more efficient than thesesystems to obtain patients’ information due to these systems’ updating ability in realtime. Overall, case managers reported positive perceptions about these systems as itallowed more access to information and provided extra time to provide care than togather information.Furthermore, non-clinical staff reported that these systems allowed administrators todirectly access data and generate reports effectively. One of the staff stated that withusing these systems more time were saved when consulting clinical staff about patients’information.Despite that this study covered different occupational roles; patients’ perceptions of thesenew technologies were not covered. Also, the study did not clearly illustrated how theimplemented systems helped in reducing errors and improve quality. Additionally, therewas not elucidating description of the implemented systems in these 5 sites.2.2Implementation Puzzles in Health Information ExchangeProjectsAnother study was conducted by Sicotte and Pare (2010) to investigate the success orfailure of two large health information exchange projects in Write my essay for me – CA Essay writer Canada. These two projectswere considered as the largest initiatives at that time due to their political and strategicimportance as well as big budget. The first project consisted of a pediatric network andcost almost CAN$ 11.0 million, while the second project consisted of a primary carenetwork and cost almost CAN$ 14.8 million. Both projects shared similar goals andutilized same technologies. The two main goals were exchanging health informationbetween network partners and adopting medical information systems by the targetedphysicians.22Data were collected via face-to-face semi-structured interviews and following in-realtime the implementation of these two projects in 2001. The interview sessions lasted 45-90 minutes and all sessions were tape-recorded and transcribed. The number ofinterviews for project one was 27 and for project two was 25. These two projects wereanalyzed and divided into 4 stages. For the first project, the stages were:- Stage 1: setting the project’s agenda. The main challenge identified during thisstage was technical feasibility. The project team consisted of only 3 people onpart-time basis and with no prior experience in large IT projects. Anotherchallenge was political risks. The Department of Health there had a major concernabout managing patients’ consent to transfer data to the new project datawarehouse, which acquired a new management system for patients consent.- Stage 2: system design. Technical interfaces were required to transfer data to thenew system data warehouse, which added more risks in terms of timeline andbudget.- Stage 3: testing and installation. Due to the new patients’ consent managementsystem that was decided to be built which also fell behind the schedule as well asreducing the number of interfaces and inability to transfer the required data to thenew system data warehouse; all these compromised the usefulness of the project.- Stage 4: experimenting with the new project. To achieve this, 39 volunteeredphysicians conducted this experiment. However, the results were dissatisfying asthe new system was unable to refresh data automatically. The users needed tologout and login every-time to obtain refreshed data. Despite that the usersrequested to modify refresh option, the request was rejected to prevent anotherdelay in completing the project. Eventually, the project team responded to therequest, but this added 4 months delay.Overall, only 25% of the targeted users in this project used the new system and theproject failed in terms of meeting its goals, deadline and budget.In contrast, the second project consisted of the following stages:23- Stage 1: project planning. The project team consisted of experienced and full-timemembers. Also, two general practitioners were recruited to handle users’relationships and to avoid technical risks. A contract was signed with a consultingfirm to guide and advice strategically and operationally.- Stage 2: ensuring realistic project vision. The involved general practitioners addedmore value as they helped more to understand physicians’ constraints and type ofinformation required. Also, views of all parties were considered instead of onlyconsidering the project team vision.
– Stage 3: system customization and testing. A selected physician at each clinic inthis project acted as a project champion. The main responsibilities were toparticipate in experimental system testing, assist other users by acting as a superuser and conducting thorough analysis related to clinical information as well asbeing part of the system configuration process.- Stage 4: system experimentation. Although many risk mitigation measures tookplace, the project faced a technological threat that jeopardized the projectsuccessfulness. The threat was poor response time of the new system whichaffected patients’ waiting time. To handle this threat, different solutions weretested; however, replacing the network server was the solution.Overall, this project succeeded to meet its goal and was completed on time and withinbudget. After 11 months of implementing the new system, the majority of the targetedphysicians were using the system regularly.The study found that risks identified at the projects’ early stages had also influencedthose risks in the later stages. In addition, there was a direct relationship betweenimplementation strategies quality and projects’ outcomes. Furthermore, there were somesimilar situations that both projects faced, but responding strategies to it were differentwhich affected the projects’ outcomes. For instance, both projects faced with obtainingpatients’ consent challenge, however, the second project identify a solution which wasimproving the existed functionalities related to patients’ consent management systeminstead of developing a new system as in the first project. This saved the second projectfrom extra time and costs. The study demonstrated two large projects with different24outcomes and illustrated how implementation strategies had relationships with theprojects’ outcomes, but did not clearly discussed the technologies used in these twoprojects. Also, the study focused on physicians, but what about other users’ perceptionsand roles in these projects On the other hand, the study collected data in real-time, bythis, participants’ responses are easily observed and evaluated compared to other datacollection technique, such as: survey that may not present real perceptions and attitudes.2.3Information Technology Adoption in Emergency DepartmentsA study was conducted by Pallin et al. (2010) about adopting information technology inMassachusetts Emergency Departments (USA) and to determine whether theimplementation of information systems in Massachusetts had improved and progressed in2006 since early 2000s. A cross-sectional study was adapted in this research withdistributing a survey across 74 federal EDs in Massachusetts. The response rate was 82%.Those who did not respond to the survey via e-mail, structured telephone interviews wereconducted. STATA 10.0 software was used to analyze the collected data. Participation inthe study was optional.The results obtained in this study were as the following. Only 15% of Massachusetts EDsfully implemented electronic medications ordering and 41% reported fully electronicimplementation for capturing patients’ current visits. Furthermore, only 10% of theseEDs fully implemented the electronic clinical decisions support tool. Overall, the studyconfirmed that there had been progress in the implementation of information technologiesin Massachusetts EDs since the early of 2000s (Pallin 2010, pp. 241-242). The study alsopredicted that health information systems and applications, such as: medications’ errorschecking, electronic lab results and medications’ ordering may play a role in improvinghealth outcomes.The study followed quantitative and qualitative measurements to assess the progress ofimplementing information technologies in Massachusetts as sometimes one approachmight not be helpful to collect the required data. However, the study only coveredMassachusetts EDs. Covering other departments, such as: outpatients clinics and alliedhealth services will be more valuable to address the impact of health information25technologies on healthcare services and quality of care as the case in UAE FHO study.Finally, the EDs in the study were only those located in Massachusetts. It would be muchreliable if other EDs from different States were involved too; as by this, it will be moreaccurate to generalize the study’s outcomes outside Massachusetts.2.4Physicians’ Perceptions about Health Information TechnologyA study was conducted by Davis et al. (2009) about health information technology andphysicians’ perceptions. The study’s aims were to evaluate the relationship betweeninformation system and quality of care from physicians’ perspectives. Seven countrieswere involved in this study: Australia, Germany, Netherlands, Write my essay for me – CA Essay writer Canada, United States(US), New Zealand and United Kingdom (UK).Cross-sectional study design was appliedwith 2006 random survey from these seven countries were collected. Variousmethodologies were used to collect the required data, such as: mails, fax and telephones.The response rates from these seven countries were variant. For instance, the number ofparticipants from Australia was 1003, Write my essay for me – CA Essay writer Canada 578, Germany 1006, Netherlands 931,New Zealand 503, UK1063 and US 1004. The response rate for US was 51%, whileWrite my essay for me – CA Essay writer Canada and Netherlands had the response rate of 43% and the survey was sent via e-mailto these countries. On the other hand, New Zealand had the response rate of 32%, whileAustralia had 20%. For these countries, the survey was sent by e-mail and fax. For UK,the data were collected mainly by telephone, but also mail was used and the response ratew20%. However, for Germany, the data were collected by telephone only and that hadthe response rate of18%.The study found that using health information technologies among primary carephysicians allowed better monitoring of patients with chronic diseases as well asaddressing safety issues. These led to attain primary care physicians’ satisfactions. Also,different aspects were evaluated. For instance, accessing to patients’ medical recordremotely was rated low by those seven countries. The rating ranged between 12% and36%. In addition, e-tests ordering and e-prescription were rated high in some countries,such as: Australia and New Zealand, while in other countries, such as: Write my essay for me – CA Essay writer Canada and US,the rating was low.Furthermore, receiving alerts about drugs and sending reminders whether to physicians or26patients were rated high in some countries, such as: Australia and low in other countries,such as: US. Regarding generating reports about patients’ diagnosis, overdue tests andstatistics; the response rate was high and acceptable for all these countries, except US andWrite my essay for me – CA Essay writer Canada who had low response rates in terms of using these technologies; between 13%and 37%. Overall, the study found that using IT is associated with physicians being wellprepared to deal with these technologies, which leads to better quality of care and moreadherences to guidelines. Finally, comparing UK to US, the first country had 90% of itsphysicians with electronic medical records and 83% stated high IT functionalities. On theother hand, US was behind all these countries involved in this study regarding adoptingIT technologies and being committed to it along with Write my essay for me – CA Essay writer Canada. One of the reasons that UKhad this positive perception and high percentage was the government support toinformation technologies and putting standards in place, while US was slow to do suchthings.Although the study attempted to investigate the relationships between physiciansautomated systems, quality of care and satisfaction, the applied study design did notallowed to create a causal relationships between these variables. There are other studydesigns that may allow drawing a relationship between variables that might be moresuitable to this study, such as: cohort study as it allows studying the relationship betweenphysicians and using automated systems and the outcomes of using these systems.2.5Health Information Systems ProgressA study was conducted by Haux (2006a) regarding past, present and future of healthinformation systems (HIS) in Europe. The main aim of the study was to cover thef
ollowing two aspects: lines of HIS development from past until today and theconsequences for HIS in the future.Regarding the first aspect, 7 lines were discussed:1- Toward computer-based processing tools and how HIS while utilizingtechnologies might have advantages and disadvantages. For instance, one of thedisadvantages of shifting toward computerized processing tools is complexity ofthese technologies, but it has a benefit in providing more functionality forutilizing patients’ data and for medical knowledge. Despite that computer-based27form is becoming dominance in healthcare field, paper-based form still exists forvarious reasons, such as: easiness of using it and for medico-legal purposes. Thisis causing double works for healthcare professionals in obtaining and using data.2- Shifting from local to global information system architectures. Years ago, HISfocused on specific specialties, such as: laboratory and radiology. However,almost in the last 15 years, there has been major shifting toward implementingHIS to cover other areas, such as: electronic medical records.3- Providing support to other parties, such as: patients, not only physicians as it wasin the past.4- Using data for other purposes beside patients’ care, such as: research and planningas this change will also have impact on medical statistics and epidemiology.5- Moving from technical to strategic information management priorities which isbecoming part of many healthcare organizations’ business plans. Before, technicalproblems of these systems were the main concerns.6- Including other types of data rather than images and alphanumeric data, such as:molecular data (DNA).7- Including new technologies to monitor patients’ health status. For instance, microsensors can be embedded in patients’ clothes to monitor those with criticalmedical conditions.Regarding the second aspect:1- There is a need for institutional and international HIS strategies to maintainprivacy and confidentiality. HIS, systems’ users, using HIS data and types of dataneed to be considered in strategic information management.2- There is a need to search and find new HIS architectures styles to preventredundancy and downtimes.3- There is a need for trainings and educational courses about health informatics forhealthcare professionals.4- Thorough and comprehensive research to answer unsolved questions related tosystems’ architectures, functionalities, communication tools and management isrequired due to these systems’ complexities and challenges.28The study covered the progress of HIS from past to present and what might happen in thefuture. This is helpful for healthcare organizations that are planning to implement HIS.Although the study aimed to discuss the consequences for HIS in the future, but theselisted consequences are more requirements or recommendations than to be consequences.Finally, the study discussed the past, present and future of HIS in the Europe region. Itwould be much reliable if there was a real-life HIS implemented in Europe covered inthis study.2.6Progress and Challenges of IT HealthcareOn the other hand, a study was conducted by Adler-Milstein and Bates (2010) to evaluatethe progress and challenges of IT healthcare in the United States of America. The studydivided the progress and challenges based on: inpatient system and outpatients system.The challenges and benefits related to these two categories were divided as the following.For challenges, high expenses related to hospitals’ systems. Hospitals must determine towhat level they want to customize their systems, but this will cause additional costs andmore changes. Although this might add extra time for the users during the first period ofimplementation, but at later time, they will be more efficient (Adler-Milstein & Bates2010, p. 123).Another challenge discussed was physicians’ resistance, which was also discussed inUrda et al. (2013). In Cedars-Sinai, in Los Angeles, one of the physicians’ systems fororder entry was abandoned as a result of resistance to use; claiming that it added extratime to their work (Adler-Milstein & Bates 2010, p. 123).Furthermore, lack of trained resources to provide support for the implemented systems.On the other hand, there were several recommendations discussed in this study. Forinstance, technical support from specialized trainers in the medical informatics field isrequired. Those people must be aware of technical and clinical aspects. Also, usersshould be rewarded for providing high quality of care. In addition, the number of vendorsin the region is to be identified as per policies and regulations. This means thatcertification process to be carried out for those vendors and their systems to ensure thatthese systems work as required.As noticed from this study, the location of it was not specified. It was mentioned that the29study took place in the United States of America, but did not specify the targetedhospitals and whether these hospitals are private or public as well as the targeted studysample. Also, the study relied more on previous studies conducted in this field with noclear indications of whether the outcomes obtained where based on these previous studiesor the study itself.2.7Health Information Exchange to Improve HIV Patients’ Careand OutcomesA study was conducted by Messer et al. (2012) about the development of a healthinformation exchange to improve HIV patients’ care and outcomes in Rural NorthCarolina.In order to improve patients’ care and provide reliable healthcare services, the RegionalHealth Integration Project (RHIP) developed the Carolina HIV Information CooperativeRegional Health Information Organization (CHIC RHIO). The CHIC RHIO consists ofone medical clinic and five AIDS Service Organizations (ASOs) that provide services toeight rural counties. CAREWare software was implemented to create an electronicnetwork system between these facilities. To evaluate CHIC RHIO satisfaction on theelectronic system, three qualitative and quantitative approaches were followed. Firstapproach was to evaluate organizations’ readiness to adopt the system. OrganizationalReadiness for Change (ORC) measurement was applied. This measurement covers themotivation for change, resources, organizational climate and staff attributes, such as:growth, influence and adaptability. The results indicated that CHIC RHIO was ready toadopt the new system.Second approach was interviewing CHIC RHIO members. Open-ended questions wereused about health information exchange. The results were largely positive. Theparticipants reported that the system assisted them to easily access clinical data, such as:lab results and making referrals, which helped in improving case management outcomes.In addition, it helped to monitor patients’ medical progress. On the other hand, the usershad a few number of concerns. For example, one of the users had a concern related toconfidentiality when accessing patients’ electronic data, but this was not a major issue as30protocols and security measurements were setup and followed to maintain security andconfidentiality.Third approach was survey. The survey was used to assess the satisfaction level about thesystem. The response options to the questions ranged from scale (1) unsatisfied to (5)very satisfied, or (1) very negative to (5) very positive. The participants reportedincreased ease of data exchange and improved patients’ care that led to retain clients.However, there were some challenges in this project. For instance, interfacingCAREWare with existed electronic health records in the clinics was difficult, whichcaused double work and more data entry errors. In addition, the funding process neededto be amended due to implementing this system.The study did not state whether patients’ satisfaction level was measured or not.Although it measured users’ satisfaction level regarding CAREWare software, patientsare also an important party that should be considered while evaluating such a system. Incontrast, the study covered rural counties, which many previous studies did not cover andpay attention to these sites. Furthermore, the study covered how IT facilitate
s providinghealthcare services in rural areas and improving patients’ care by reducing workloads onhealthcare professionals, enhancing communication with other agencies and reducing thefeeling of isolation.2.8Evaluation of Health Information SystemsAccording to J. Wyatt & S. Wyatt (2003), health information system (HIS) involvesvarious aspects, such as: entering orders, reporting, decision support tools and patientsmedical records to serve different parties, such as: patients, professionals and the public.In this study, when and what methods to evaluate health information systems as well asdifferent challenges were identified related to HIS. For instance, health informationsystems cover multi-functional tasks and processes that may require complex changes inan organization and re-design of processes. Also, such a system has many impacts thatneed to be weighted carefully as it deals with human lives.31There are two evaluations methods in order to assess HIS; objective/quantitative methodsthat are used to gather data, such as: patients’ waiting time and number of tests ordered.The second type is subjective/qualitative methods that are used to analyze and create richdescriptions of data, such as: interviews and meetings.Although one of the study’s aims was to discuss when to evaluate HIS, it did not clearlydiscuss that. The focus was on the evaluation methods. Also, the study did not vividlymention how evaluating HIS can be beneficial to healthcare organizations, decisionmakers, system’s users and customers, such as: patients. Finally, the study would bemuch reliable if there were cases on how to apply the mentioned evolution methods forHIS.2.9Health Information System to Reduce Mortality RateA study was conducted by Graven et al. (2013) about Belize Health Information System(BHIS) to reduce mortality rates. The system was developed by including 8 diseasesmanagement algorithms, such as: maternal health, essential hypertension and seriousadverse drug reactions. All these 8 domains were developed by various professionalorganizations, but were adjusted and approved according to Belize rules and regulations.For this study, data were collected by comparing BHIS data and the Belize Ministry ofHealth reports. Also, mortality data were obtained from the Epidemiology Unit at theBelize Ministry of Health. SAS was used to carry out the analysis of the obtained data.The results obtained from this study were that infants’ mortality rates, mother to childHIV transmission and maternal mortality declined sharply after deploying BHIS. Inaddition, there were some areas that declined steadily after implementing BHIS, such as:mortality rates for children aged 1 to less than 5 years and hypertension. Mortality due toadverse drug reactions declined almost 90% when BHIS was deployed as the new systemrequires that two to three caregivers to override adverse drug warnings with justifying thereasons before a patient receives that drug again. Furthermore, expenditure increased in2009, but started to decline for the following three years. Hospital stays due tohypertension decreased by over 60% which saved 1% of the budget during the period of2006-2007 and 2010-2011.However, there were some medical conditions that did not change consistently after32implementing BHIS, such as: diabetes and transport accidents as these conditions werenot embedded in the BHIS algorithms. One of the reasons that BHIS succeeded wasusers’ involvement in the project stages.The study discussed how BHIS helped in decreasing mortality rates based on the 8embedded algorithms, but what about these not embedded medical conditions, such as:diabetes Also, the study did not discuss the users’ perceptions as those people are themain factor to determine a new system’s successfulness.2.10 Aspects of Health Information TechnologiesA study was conducted by Haux (2006b) regarding the aspects of health informationtechnologies with possible consequences for the aim of medical informatics. Healthinformation systems HIS deal with processing healthcare data, information andknowledge using various methodologies and technologies. One of the main aims of HISis to provide a high quality of services to patients and healthcare professionals. The studypresented the evolution of HIS and how it changed from 1960 to 2000s in differentaspects of HIS. For instance, HIS architectures range from local to regional, national andglobal architectures. Also, the users of HIS have changed since 1960, from focusing onlyon healthcare professionals to focus as well on patients and customers. Thefunctionalities of HIS changed from using data only for patients’ care to qualitymanagement, planning and research purposes. The changes as well included types of datathat are processed by HIS, from alpha-numeric to molecules data. Haux also describedsuch changes in another study conducted by the same author Haux (2006a) about past,present and future of health information systems HIS.HIS allows for global access to healthcare services and medical knowledge, minimizeserrors and facilitates continuous quality management; however, the study revealed thatthere are some challenges in HIS. For instance, users’ acceptance of such a complexsystem that consists of several applications. Also, healthcare professionals, such as:physicians may face workload with such a system as the documentation process might betoo long. In addition, technical problems, such as: downtime of one application in HIS ormore may negatively impact the workflow of the entire system if not handled well.33In this study, few points were noticed. Firstly, one of the study’s aims was about medicalinformatics and the consequences of it. The study did not analyze this aim in depth. Also,it would be much valuable if the study analyzed a real HIS system while describing HISaspects theoretically. Finally, the information in this study are nearly the same as whatwas published in another study conducted by the same author about past, present andfuture of HIS (Haux 2006a), so some information in this study were redundant.2.11 Cerner Health Information SystemThe conference (Cerner 2013) demonstrated about the Children’s Cancer Hospital inEgypt that was opened in 2007. The hospital implemented Cerner Health InformationSystem. Since the implementation of this system, the adoption rate was high particularlyby nurses, which led to the successfulness of the implemented system. The hospital has itowns IT Nurse Unit that consists of nurses with IT skills to conduct training, providesystem orientation and assist in upgrading. Cerner System enhanced the workflow ofnurses there from different aspects. For instance, the quality of nursing documentationincreased after implementing the system as before that, the vital signs for patients werenot always recorded, but after the implementation of Cerner System, the vital signs areentered in the system for all patients.In terms of patients safety, the number of medications errors decreased as the nurses haveto double check the medication order placed by doctors and use bar code to entermedications ordered in the system to avoid handwritten errors. The errors decreased by80% since the implementation of the system. Also, the system includes allergy alerts,which helped in reducing the number of allergy reactions.In terms of infection control, the implemented system helped in following-up tests resultsand analyses in a timely manner and how to handle infections for each patient;individually.For nursing performance, the system helped to evaluate nursing documentations on daily,monthly and yearly basis. Also, allowed at anytime to evaluate nurses’ practices as wellas promote nursing educations by discovering errors through continuous assessments.In terms of technology evaluation, before implementing the system, a white board andmarker were used for the nurses to follow their patients, however, after implementing34Cerner, a plasma screen was utilized for triaging and day care.Despite of all these enhancements, there were no indications of barriers faced during andafter the implementation of the new system. Also, it was not mentioned how th
e systemwas evaluated whether quantitatively or qualitatively to address users’ perceptions. Theenhancements described were all related to nursing side, but it did not cover otherhealthcare providers, such as: physicians.2.12 Health Information System to Improve HIV/AIDS PatientsHealthA study was conducted by Virga et al. (2012) about health information system HIS as atool to improve quality of care and health outcomes for patients with HIV/AIDS. Thestudy was conducted in the City of Paterson, New Jersey. A second version of onlineelectronic health information system known as e2 was implemented. Three HIV/AIDSclinics were involved in this study form year 2008 to 2012. To improve the quality ofactivities in the system, the developers worked closely with the users to determine theneeds of the users.Qualitative and quantitative measurements were applied in this study to evaluate e2.Interviewing the quality management team who was as well representatives of these threeclinics along with the clinical staff and administrators was carried out to measure thequality improvements in the system. In addition, serial cross-section design was used tomeasure the health outcomes from e2 data as well as to measure quality improvementinterventions. To analyze data, 263 records of HIV patients were pulled out.To determine whether health outcomes had improved while using e2 system, twoindicators were selected; the first indicator was CD4-T Cell counts, while the secondindicator was Viral Load Suppression (VL) as those two indicators are commonly relatedto the health status of patients with HIV/AIDS. The study revealed the following results.First of all, e2 system users stated that the system improved their ability to provide healthcare for patients by saving time as information are available at their fingertips.Furthermore, the system facilitated monitoring tests results, screening and identifyingmissing clinical data. Also, it allowed the users to easily access to reports and being35updated about patients’ health status and staffs’ works. One of the significant options ine2 system was introduction of [alert] option. This option sends reminders to healthcareproviders. For instance, the alert reminds the healthcare provider about medical visitswithin six months for a HIV/AIDS patient as well as ordering CD4-T Cell counts. Thisoption helped to maintain a high quality of care provided to patients.A few points were noticed in this study. Firstly, the study sample involved in the studywas the system’s users. It would be much beneficial if patients’ satisfaction level werealso measured regarding e2. Also, incorporating other healthcare centers specialized inother types of care not only for HIV/AIDS in the study as by this, it would help otherparties to take proper decisions regarding implementing such systems. Although the studylisted the improvements of applying e2 system, it did not clearly discuss the challengesand issues of it. One of this study’s aims is almost the same as in the UAE FHO study interms of improving health outcomes.2.13 Process of Evaluating Health Information SystemsA study was conducted by Al-Yaseen et al. (2010) about health information systemsevaluation processes in Jordan private hospitals. Two evaluation processes were covered:Prior Operational Use evaluation (POUe) that is used to predict the impact of a project aswell as before a system becomes operational. The second process covered wasOperational Use evaluation (OUe) that is used when the system is in operational use.Data were gathered from government websites, such as: Ministry of Health andadministered questionnaires to these 60 targeted private hospitals. Out of 60questionnaires sent, only 19 were completed with 31.6% response rate.The results were as the following. In order to improve efficiency and effectiveness,73.7%of these hospitals adopted technologies, while only 26.3% adopted technologies to handleproblems. The reasons for adopting POUe were various, such as: meeting requirements,system effectiveness and security, while for OUe, the reasons were as well various, suchas: risks, tangible benefits and estimating systems’ life. In addition, about two thirds(68.5%) of these private hospitals showed that they do not collect evidences to determinethe successfulness of their information systems. which means that they can not benefit36from OUe’s information to enhance their evaluation techniques and outcomes.Furthermore, based on the results obtained, decision makers tend to believe in OUe as aformality instead of an evaluation process.This study focused on private hospitals without covering public hospitals. Also, it did notpresent the types of information systems implemented in these hospitals. The responserate was low 31.6%, which is not reliable to generalize the findings.2.14 Clinical Information TechnologyA study was conducted by McAlearney et al. (2007) to evaluate physicians’ views in theUnited States of America (US) about clinical information technology (CIT) in reducingmedical errors, benefits of CIT and issues.Ten focus groups were held during the period of April 2002 and February 2005. Theduration of these sessions was about 60 to 90 minutes and each session was recorded ontape and transcribed for data analysis purposes. The number of physicians was 71 fromdifferent specialties. Two themes were covered in this study, which were: appropriatenessof CIT to reduce medical errors and impact of CIT on physicians’ work. The resultsobtained regarding these two themes were as the following. For theme one, thephysicians had their concerns about appropriateness of CIT to reduce medical errors andintroducing new errors. Also, they criticized the capability of CIT hardware and software,such as: battery life of handled computers. Furthermore, about new errors, the physicianswere skepticism about CIT in introducing new errors, such as: systems designs tounderstand entered orders. For instance, number 7 will be read by the system as 70, so thephysician has to enter 07 in order for the system to understand it as 7.On the other hand, physicians had concerns related to theme two in terms of time andworkload. Many of them were concerned that new technology means more time to useand accept than manual processes. Also, technical support availability on timely mannerwas considered as a threat to physicians. Furthermore, physicians were skepticism thatsuch systems add more responsibilities in entering data as before they were relying onothers, such as: clerks and nurses, but this helps to define the roles and responsibilities ofindividuals.The study suggested to distinct physicians who have positive pre-conceptions from37negative physicians as a strategy during the implementation of these technologies.The study focused on physicians only without taking into consideration other caregivers,such as: nurses. Although the study used focus group to collect data and is one of theleast applied methodology compared to other methodologies, such as: interview andsurvey, this might affect the participants’ perceptions as they might be influenced by eachother and feel uncomfortable to share opinions and thoughts during the sessions. Incontrast, the study covered users and non-users of CIT, which allowed evaluatingdifferent parties’ perspectives about CIT regardless of their interactions with thesetechnologies.2.15 Oracle-based Medical Information SystemA study was conducted by Elmetwaly (2011) about a proposed medical informationsystem that had been developed years ago in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia. The study covered how to useavailable technologies and use Oracle databases in order to save medical information.The study covered the benefits of Oracle databases, such as: easiness of delivering reportsrequested to different parties and supporting all professionals in the healthcare field.Also, covered the stages of developing medical information systems, such as: datacollection, converting information to meet Oracle databases requirements and trainingusers. Oracle-based system allows rectifying work flaws by activating tasks easier andfaster. For example, extracting charts from existed information syst
ems, generatingreports that show work flaws and following-up individuals, such as: physicians andnurses.Although the study aimed to cover a medical information system in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia as wellas utilizing Oracle databases, it only focused on Oracle without a clear illustration onthose existed systems. Also, it did not demonstrate the exact targeted organizationswhether public or private or both types as well as did not clearly explained the flaws inthe existed systems. As in the UAE FHO study, the targeted hospitals were identifiedwith evaluating the current status of the implemented health information system.382.16 Information Quality based on Nursing Information SystemA study was conducted by Michel-Verkerke (2012) about information quality based onNursing Information System (NIS) that is part of hospital information system in a Dutchteaching hospital at Netherlands. Paper questionnaire distributed across 195 nurses with48% respondents (93 nurses), while 12 nurses were interviewed. The main aim of thestudy was to determine whether NIS met the requirements of information quality of thesystem’s users and the aspects to determine that.The study results were as the following. The majority agreed that the information in thesystem is accurate, but there are possibilities for further improvements. Despite that 70%agreed that there were not contradictions between oral and written information, a highnumber of the system users agreed that patients’ data were entered in the wrong records.In addition, some of the information was considered necessary to be available. Forexample, patients’ history, care plans, treatments, planned investigations, medicationsand actual nursing interventions. However, the respondents found it difficult to specifythe type of information needed. A possible reason could be that information depends onpatients and situations.Furthermore, the respondents had some information quality requirements, such as:completeness, accessibility and correctness. Accessibility apparently improved due toeasy retrieval of data in the NIS, but technical problems sometimes impacted negativelythe accessibility in patients’ rooms. Overall, information quality depends on the system’susers and re-designing of the NIS is required in order to increase quality of theinformation.The study utilized two research methods: quantitative and qualitative which helped tosupport the findings and provide reliable results. The developed questionnaire was paperbased, which is the same as in the UAE FHO study. Also, the study provided a briefintroduction about the utilized system. However, the response rate was low (48%), belowthe half, which may affect the study’s findings’ reliability. Additionally, the study did notclearly cover the quality of the information inputs and the impact on the outputs. Due tothe small number of interviews (12 nurses), frequencies were not demonstrated.392.17 Barriers in Implementing Health Information SystemsA study was conducted by Khalifa (2013) about barriers in implementing healthinformation systems and electronic medical records at the Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabian Hospitals. Datawere collected via questionnaire distributed across two Saudi Hospitals; one private andone public. The number of participants was 158.The results obtained were as following. Six categories of barriers were listed: human,professional, technical, organizational, financial and legal barriers. For these six types ofbarriers, solutions were also suggested. The following table illustrates examples of thesebarriers and possible solutions:Barrier SolutionHuman:- Lack of experience andknowledge about thesesystems.- Negative attitudes towardsthese new systems.- Unavailability of healthinformatics professionals.- Conduct formal training sessions.- Provide continuous medical educationprograms related to these newtechnologies.- On-site orientations for staff.- Develop undergraduate and postgraduate programs in this field.Professional:- Lack of support.- More responsibilities.- Lack of motivation.- Increase users’ involvement inprojects’ phases.- Motivate users by providing thembonuses and rewards.- Educate users on how to understandtheir parts when using these systemsto prevent workloads.Technical:- No user manuals.- Interface design issues.- Vendors to provide the requireddocumentations.40- Old communication networks. – These systems need to be designed ina simple way and less complicated fordaily uses.- Upgrade networks and operatingsystems for better performance.Organizational:- Old workflows.- No system prototype.- Insufficient training courses.- Re-designing workflows.- Demonstrate existed live systems tothe targeted hospitals that are not yetlive with such projects.- Continuous trainings for best use ofhealth information systems andelectronic medical records.Financial:- Lack of capital resources forthese projects.- High maintenance costs.- High implementation andadoption resourcesconsumption compared to thebenefits.- Allocate proper funding resources.- Allocate annual budgets for theseprojects’ maintenance instead of beingburden on hospitals’ resources.- Proper planning of resources duringdifferent phases of such projects.Legal:- Confidentiality issues.- Lack of policies andprocedures that control thesesystems.- Ensure users’ commitment andsigning confidentiality agreements.- Develop regulations on nation-widelevel about these systems.Table 1: Health information systems barriers and solutions.(Adapted from Khalifa 2013, pp. 338-341).Overall, human and financial were the two main barriers in the implementation of healthinformation systems and electronic medical records. In addition, public hospitals had41more concerns and complains compared to private hospitals, particularly to those relatedto organizational and technical aspects, such as: no experiences to deal with thesesystems.Although the study covered the barriers in implementing health information systems andelectronic medical records, it did not clearly indicate the outcomes for each sectorinvolved in this study: private and public in order to evaluate the outcomes of thesesectors. Also, the study did not thoroughly explain the sample size and the design appliedto conduct this research as well as data collection methodology.2.18 Critical Issues in an Oncology Information SystemA study was conducted by Urda et al. (2013) about critical issues in an OncologyInformation System at one of Spain hospitals. To address these issues, two approacheswere utilized. First approach was identifying the percentage of medical consultations andnotes enabled in the oncology system during the first three months of implementing thesystem, then after one year, the same approach was carried out. The second approach wasdistributing a survey to evaluate physicians’ perceptions about the system.A pilot trail of the system was conducted by physicians to evaluate and adjust minoraspects of the system. Once the system was verified of its usability and integration withother workflows; official implementation was carried out.The number of participants was 14 physicians and the results obtained from this studywere that the system improved the access to patients’ information and status. Althoughabove 70% of the physicians indicated that the system added more workload to their dailyjob, only about 43% believed this view after one year of conducting the evaluation. Also,half of the users believed that the system improved the quality of care provided topatients; however, this was shared almost by all users one year later.The study revealed some of the barriers that affected the implementation of such asystem. For instance, users’ resistance to change, particularly those who do not havecomputer skills (Urda et al. 2013, p. 404). Another barrier was training period. This isimportant for users to be familiar with new systems which require more time to learn andabsorb new information (Urda et al. 2013, p. 404). However, with continuous using of the42implemented system, physicians can be more aware of the system’s benefits.Although the study used two different approaches to evaluate the implemented system inSpain, it covered only phy
sicians’ views without evaluating other healthcare providers’perspectives. Also, the study did not clearly explain how the implemented systemimproved patients care from different aspects, such as: tests orders and results, diagnosesand medications prescriptions.2.19 Nurses Perceptions about Hospital Information SystemsA study was conducted by Oroviogoicoechea and Watson (2009) to evaluate nurses’perceptions in North Spain about using hospital information systems and how thesesystems impact clinical practices. Cross-sectional analysis design was applied withdistributing a questionnaire across 227 nurses, however, 179 nurses participatedwith78.8% response rate. SPSS 13.0 was used to analyze the obtained data. Likert scalewas applied in the designed questionnaire (1=strongly agree to 5=strongly disagree). Theresults obtained were as the following. The implemented system is easy to use. Theywere asked about returning to paper-based records; 79.8% of the nurses said “no”.The areas covered in this study were categorized into three areas: context (e.g. Userscharacteristics), mechanisms (e.g. IT support) and outcomes (e.g. impact on patientscare). Users’ characteristics had direct and indirect impact on the outcomes. Nurses withpositive attitudes about the system, had better perceptions about the system’s impact ontheir routine works. Overall, the results obtained about the perception of nurses werepositive.This study only covered nurses, which might be valuable for nursing practice, but otherareas, such as: allied health services need to be covered as well.2.20 Consumers Perceptions about Health InformationExchangeA study was conducted by Ancker et al. (2012) to evaluate consumers’ perceptions aboutelectronic Health Information Exchange (HIE) in New York. Random digital dialtelephone survey that conducts annually by the Survey Research Institute at CornellUniversity in 2011 was utilized in this study as a data collection tool. The surveyconsisted of 77 questions. Pre-testing of the questions was done with 25 respondents thatresulted in making changes on the wording for clarity purposes. The number of43respondents was 800 with 71% response rate.Overall, results were that 68% of the respondents agreed that HIE improves quality ofcare and 90% agreed that in emergency situations, HIE allows to access data withoutconsent. In terms of privacy and security, 68% of the respondents expressed theirconcerns.Despite that the study covered 800 respondents in New York State, this does not allowgeneralizing the findings as New York was only covered and 800 compared to the totalnumber of the targeted population and the country is very small. Also, telephoneconversations may prevent evaluating respondents’ attitudes and impressions as it doesnot directly allow observing their body language.2.21 Health Informatics and Future PlansA study was conducted by Zhang et al. (2007) to address the current status of 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – Chinahealth informatics as well as future plans. Data were collected by utilizing variousmethods, such as: interviews and regulations documents in 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China. The results obtained inthis study were as the following. About 35%-40% of hospitals have developed hospitalinformation systems. The percentages of healthcare organizations that can transmit realtime data and reports were above 80% of medical organizations above the country/districtlevel, all Chinese Centers for Disease Control and Prevention (CDC) abovecountry/district level and 27% of town level hospitals. Despite that 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China has embracedsome coding classifications, vocabularies and messages standards; there are some barriersin health informatics standardizations related to financial, cultural, technical, legal,ethical…etc.The study utilized different data collections methodologies, such as: interviews andexisted law documents in 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China instead of utilizing one methodology compared to someof previous studies. However, it did not clearly state the targeted healthcare organizationsas 论文帮助/论文写作服务/负担得起我及时提交我最好的质量 – China is one of the biggest countries. Also, there was not clear illustration of the studydesign and if there was any evaluation process of the current status of health informaticstargeted in this study.44Chapter 3: Methodology3.1Study DesignMixed study design between descriptive and analytical design was conducted.Descriptive study design aims to collect information about a situation or subject withoutlooking to the reasons and causes. However, analytical study design is used when thereare hypotheses or theories that to be tested and evaluated. It answers how and why asituation happened (NIHR 2010). As this study is composed of four research questions asmentioned above, two questions, the first and the last questions are descriptive type andthe other two, the second and third questions are analytical type. The second and thirdresearch questions were tested as hypotheses. The reasons for choosing this design aredue to its easiness to conduct, quicker than other types of study and easy to obtainprevalence of outcomes.Statistical measurements were estimated in this research, such as: central tendency thatincludes the mean, median and percentages of how HIS improved and re-designedpatients’ care pathway and outcomes. In addition, p-value was calculated for the secondand third research questions. Mainly, bar charts and pie graphs with tables were used todemonstrate the findings.Because descriptive studies are usually used to generate hypotheses, analytical studydesign was also applied here to test two hypotheses:1- Hypothesis One: HIS helped in re-designing patients’ care pathway positively.2- Hypothesis Two: HIS helped in improving patients’ health outcomes.So, mixed study designs of descriptive and analytical were applied.3.2Subjects for StudyThis study was conducted to cover 6 hospitals and the project management office. As sixEmirates in the country implemented this HIS, the main hospitals under UAE FHO inthese six Emirates were selected. For example, in Ras Al-Khaimah, there are threehospitals under UAE FHO, but only the main hospital was included. This saved times tocollect data and prevented complexity in analyzing data. The selected hospitals were only45those which implemented HIS. Other facilities that did not implement the system wereexcluded. The reasons for not implementing the system in these hospitals are due to siteinfrastructure issues, such as: electricity and demolishing one of the hospitals which willbe re-built.The targeted populations are healthcare providers, IT/HIS, the project management teamand hospitals’ management staff. The sample size was 25% of the total staff at eachfacility. The reasons for selecting these facilities and populations are that this HIS is aone of its kind in the region and just been implemented without being evaluated properly.Also, selecting random population from a public will consume more time. Furthermore, itwould not be practical as one of the aims of this study is to cover HIS from users’perspectives who interact with the system.Many sampling methods are available, such as: simple random sampling, cluster randomsampling, stratified sampling…etc. In this study, cluster random sampling method wasused for several reasons. First of all, as the study covered healthcare field, it would bemuch practical when grouping the sample population according to their commoncharacteristics. For instance, here, there were different groups based on roles, then theparticipants were selected randomly, so, not necessary that all the groups contain thesame number of participants, such as: healthcare providers (physicians and nurses) whoare using the system were grouped together, while radiologists, lab staff and pharmacistswere merged in one group. Also, IT/HIS, project management team and hospitals’management staff who use the system and make decisions based on the system’ data forplanning and quality management purposes. In addition, it is more organized compared tosimple random sampling as the study’s samples are grouped together that have the samecharacteristics or interests. Cluster and stratified sampling almost are the same except incluster sampling is not necessary that all
clusters are included, while in the stratified, allstrata to be included in the sampling.Despite that cluster random sampling method has higher standard error and is lessprecise, for this study it would be more appropriate for the reasons mentioned above(Bowling 2009, pp. 205-206). In any study there is a chance for selection bias and inorder to avoid that or at least minimize it, the participants were reminded to complete the46survey. This was done via e-mail, telephone or face-to-face conversation in order to savetime especially that some of these hospitals are located far geographically.3.3MeasurementsIn order to cover the research questions listed above, a survey was distributed among theparticipants. Interview was put as a contingency plan in case there are missing answers.The interview was planned to be either face-to-face or via telephone.The survey mainly covered the research questions which are about how HIS helped in redesigning patients’ care pathway and improving health outcomes. The questions were inform of closed-needed questions. The design of the questionnaire was mainly close-endedquestions, but there was a space for open answers where the participants may write theircomments or write other answers instead of selecting the options available.3.4Data CollectionQuantitative method (survey) was used in this study. Participants in the survey were toanswer most of the questions by ticking answers (Refer to appendix A: HIS SurveySample).The participants to follow the instructions provided in the survey. This type of datacollection method was used as it is much easier to conduct, less expensive and timeconsuming. One more thing is that by applying this method, interviewer bias can bereduced as the participants will not be interacting directly with a human being. However,there is no interaction with participants to observe their feelings regarding the topic understudy. Also, the questions might not be clear enough to the participants. In addition, theanswers might not be reliable as it is not possible to know if the participants are truthfulwith their inputs.To achieve the goal of this study and collect data appropriately and within the scheduledtimeframe, assistance from Information Technology (IT) Departments across the selectedhospitals were obtained. Also, the HIS Project Management Team assisted in distributingthe questionnaire. As the research covered 6 hospitals in different Emirates as well as the47project management office, the time spent to collect the required date was about 4months.The survey mainly covered the research questions which are about how HIS helped in redesigning patients’ care pathway and improving health outcomes. The questions were inform of closed-needed questions and the answers were based on Likert Scale (range fromstrongly agree to not applicable) and the participants had the space to write theircomments beside each question. The options were as following:- Strongly Agree- Agree- Neutral- Disagree- Strongly Disagree- Not Applicable: this option was provided as may not all participants use thequestioned service in the studied HIS. For instance, lab technicians do notprescribe medications for patients.The data collection tool [survey] was designed in way that allows gathering as much asrelated information. Before answering the questions, the participants had to provide somedemographical information, such as: name, gender, age, major, employee IDorganization’s name, contact number and e-mail address. The name was optional toprovide in order to maintain confidentiality and avoid sensitivity. Gender was included inthe survey to measure the distribution level of the system users based on the gender. Agerange was included starting from 20s and ending in 60s. The maximum age range was 60-69 as the retirement age in the UAE Federal Organizations is in 60s. The targeted majorsfor this study were listed and an option titled as “other” was provided for those who arenot within the listed majors and the participant has to specify the major. However, all ofthe participants were from the listed majors. Medical services also include allied healthservices, such as: medical records personnel. As different facilities were involved in thisstudy, organization’s name and employees ID were added in the survey to cluster thecollected data based on the facility and other criteria. Contact number and e-mail addresswere to be provided in order to contact the participants in case of missed data. After48implementing the system, e-mail addresses were created for them under the UAE FHOdomain, which means that all the participants have e-mails.The survey lay out and format was as following (Refer to appendix A: HIS SurveySample).- First page was general information about the survey and confidentiality statement.Also, there was a box for participants who do not want to be part of this study andthey have to tick the box and write their names or employee ID, so they will notbe reached regarding this study.- The following pages started with demographical questions and then the researchquestions. Each research question was sectioned separately. As there was fourresearch questions in this study, the sections were titled according to the researchquestions as following:o Part One: The current status of the health information system. This partconsisted of 8 questions and the participants to select from availableoptions.o Part Two: The current health information system (HIS) can help in redesigning patients’ care pathway. This part consisted of 12 questions andthe participants to select from available options.o Part Three: The current health information system (HIS) can improvehealth outcomes for patients. This part consisted of 3 sub-divisions. Firstsub-division was titled as “Diagnosis and Medical Care” and it contained9 questions. The second sub-division was titled as “Discern Alerts” and itcontained 4 questions. The third sub-division was titled as “Other” and itcontained 11 questions. The participants to select from available optionso Part Four, this section was divided into two sub-sections: (a): Thechallenges faced in this (HIS) and the participants may select more thanone option if needed and (b): Possible solutions to overcome thechallenges in this (HIS) and the participants may select more than oneanswer if needed. In this part, the participants had the space to add otheranswers, not only selecting from the list available.49A space for further comments and recommendations was provided and at the end of thesurvey, contact details of the researcher were provided for clarifications and enquiries.One call received by a physician from Al-Fujairah Hospital about making this studyobligatory as it will serve the healthcare filed in the UAE by improving the implementedHIS and enhance the quality of the system by adding more useful options and rectifyissues. However, the reply to this recommendation was that the study is voluntary sonumber of participants would be higher and to open a door for expressing thoughts andopinions about the system without any fears and hesitations. Also, that the study ismainly a research paper about HIS in the UAE Federal Healthcare Organization.At the end of the survey, a thank statement was given as well contact details regardingthe survey.The survey was designed in English despite that the targeted organization is the UAEFHO and مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabic is the official language. However, as the evaluated information systemis in English, the survey was designed as well in English. Also, the system’s users areمساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabians and non-مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabians and they deal with a system that is only available in English.50Chapter 4: Analysis4.1 ResultsAlthough the HIS is implemented in most of the hospitals under UAE FHO, the selectedone in this study are the main hospitals in each Emirates and that fully implemented thesystem. The target percentage of the study sample was 25% out of the total number ofstaff who use the system in each hospital.In order to maintain confidentiality, the hospitals’ names in this study are not real andeach name was selected based on the emirates they are located in.The below table (Table 2) illu
strates the hospitals involved in the study with the totalnumber of staff in each hospital and the total number of participants as well as the totalnumber of staff who refused to participate. The accepted percentage of participants in thisstudy was 25% of the total number of staff. Also, the Project Management Office (PMO)was involved in the study.FacilityTotal numberof staffTargeted number ofparticipants(Total number of staff X 0.25)TotalparticipantsTotal refusedto participateAjman 350 350 X 0.25 = 87.5 100 15Al-Fujairah 600 150 175 30Dubai 500 125 125 13Ras Al-Khaimah 300 75 75 15Sharjah 500 125 125 9Um Al- Qwain 300 75 75 8PMO 12 3 9 3Total 2,562 640.5 rounded to the nearestwhole number = 641684 93Total number of staff who participated and rejected 777Table 2: Hospitals involved in the study.51The results obtained in this study were grouped according to the facilities involved aswell as providing overall comparison between these facilities. The results obtained fromthis questionnaire were merged as:- Strongly agree and agree were merged together.- Disagree and strongly disagree were merged as well.4.1.1 Ajman HospitalThe results obtained from Ajman Hospital are as following. The total number ofparticipants in this study from this hospital was 100, while 15 refused to participate dueto different reasons, such as: they do not have enough time to complete the questionnaire.To evaluate the current status of the implemented Health Information System (HIS), asdemonstrated in figure (2), most of the participants about 95 agreed that the systemenhances the quality of the work and services provided to customers (e.g. patients).Almost the same for the ability of the system to provide the required information whenneeded, 90 agreed, while only 1 disagreed. For the system reliability, 93 participantsagreed that the system is reliable with 5 disagreed and the easiness and flexibility of thesystem, more than half of the participants agreed about that with only 2 disagreed. Inaddition, above half of the participants agreed that the system was implementedsuccessfully, while about quarter of them disagreed. Almost, the same applied for thesystem friendliness. On the other hand, the system comprehensiveness, which means thatall services (e.g. laboratory and billing) are available in the system, only 51 participantsagreed with 37 disagreed.52Figure 2: Ajman Hospital HIS current status..Figure 3: Ajman Hospital system satisfactory.The below figure (3) depicts the overallrating of the system. More than half ofthe participants, about 86% agreed thatthe system is satisfactory with 6%disagreement.For re-designing patients care pathway,the below figure (4) demonstrates theresults. More than half of theparticipants agreed that the implemented HIS facilitates a patient’s journey in thehospital; once the patient enters the facility till leaving it with 5 disagreeing. Forreviewing patients’ progress notes, more than the half agreed about this and 9 disagreed.Almost the same is applied for documenting patients’ care with only 7 disagreed.However, acquiring and analyzing laboratory, radiology and other results, the participants01020304050607080# of Participants Research Topics – CriteriaAjman Hospital: HIS Current StatusStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable16%70%8%6%0% 0%Ajman Hospital: SystemSatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable53agreed about this with a few disagreeing. About 81 participants agreed that the systemsimplified the processes with 10 disagreed. More than the half agreed that the systemallows for taking decisions by communicating remotely with only 4 disagreed. Most ofthe participants agreed that the security and confidentiality are promoted in the system.Furthermore, patients satisfaction from the HIS users perspectives was positive. Also, theparticipants agreed that the system facilitates unifying healthcare processes across allhospitals under the UAE Federal Healthcare Organization.54Figure 4: Ajman Hospital HIS for re-designing patients’ care pathway..010203040506070# of ParticipantsResearch Topics – CriteriaAjman Hospital: HIS for Re-designing Patients’ CarePathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable55Figure 5: Ajman Hospital HIS helped in re-designing patients’ care pathway..The below figure (5)depicts the overallrating of the system.More than half of theparticipants agreedthat the system helpedin re-designingpatient’s care pathwaywith only 4%disagreement.The below figure (6) illustrates the results obtained from Ajman Hospital aboutimproving patients’ health outcomes while using the implemented HIS. This area wassub-divided into three areas: diagnosis and medical care, discern alerts and other areasthat includes general criteria. Regarding diagnosis and medical care, almost more thanhalf of the participants agreed that the process of generating reports via the system is easy(e.g. statistics about a specific disease) with a few disagreeing. Just about the same forhaving a comprehensive picture about a patient that helps in diagnosing problems sooner.In addition, more than the half agreed that the system allows gathering all informationrelated to a patient in one place (e.g. lab results and radiology reports) that helps inmaking therapeutic decisions. In contrast, tracking patients’ care progress and reliabilityof tests results for healthcare providers to take decisions about patients’ conditions werealmost average. Allow viewing drug formulary information and easy access to patients’assessments was selected by more than half of the participants. About quarter of theparticipants disagreed that the system has the option to send reminders to healthcareproviders (e.g. surgeries appointments and nurses to give medications to inpatients).37%55%4% 4% 0% 0%Ajman Hospital: HIS Re-designedPatients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable56Figure 6: Ajman Hospital HIS for diagnosis and medical care.Figure 7: Ajman Hospital HIS helped in diagnosis at earlier stage.However, the implementation ofsuch systems helped indiagnosing medical conditions atearlier stage as depicted in figure(7). More than half of theparticipants agreed by 93% andonly 3% disagreed.010203040506070# of ParticipantsResearch Topics – CriteriaAjman Hospital: Improving Health Outcomes -Diagnosis and Medical CareStrongly AgreeAgreeNeutralDisagreeStronglyDisagree33%60%4% 3% 0% 0%Ajman Hospital: HIS Helped inDiagnosis at Earlier StageStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable57Figure 8: Ajman Hospital discern alerts.The below figure (8) depicts how discern alerts helped in improving patients’ healthoutcome in Ajman hospital while using the system. As noticed that most of theparticipants agreed and strongly agreed that the system sends alerts about incompletetasks and information as well as to obtain patients’ allergy history, drugs interaction anddrug allergy when prescribing medications. Only a very small number of participantsdisagreed.The below figure (9) demonstrates how other areas in the implemented HIS improvedpatients’ health outcomes for Ajman Hospital’s patients. As noticed most the participantsagreed and strongly agreed about the following: patients’ registration and schedulingappointments processes take maximum 5 minutes per patient, but 5 participants selectedthis feature as not applicable. The reason could be that those people do not deal directlywith scheduling appointments. However, more than the quarter disagreed that test resultsare transferred correctly from devices to the HIS and there is a need for double work toenter data from devices to the HIS. The same is almost applied with the successfulintegration of the system with other devices (e.g. lab machines). In contrast, more thanthe half agreed that the number of errors is decreased compared to the manual system andthe system generates reports for planning and research.010203040506070Sends alertsaboutincompletetasks andinformationAlerts aboutobtainingpatients’ allergyhistoryAlerts aboutdrugsinteractionsAlerts aboutdrug allergywhenprescribingmedications# of ParticipantsResearch Topics – CriteriaAjman Hospital: Imp
roving Health Outcomes -Discern AlertsStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable58Figure 9: Ajman Hospital HIS for improving patients’ health outcomes.On the other hand, there were a number of participants who disagreed that the systemimproves documentation process and coding system as well as patients waiting time isreduced and the ability of the system to send reminders to patients about theirappointments.Another area covered was the ability of the system to analyze the performance ofdifferent sections at the facility and simply obtain required data for various reasons, suchas: diagnosis and planning. The participants mostly agreed about these two options in thesystem.010203040506070# of ParticipantsResearch Topics – CriteriaAjman Hospital: Improving Health Outcomes – OtherAreasStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable59Figure 10: Ajman Hospital HIS helped in improving patients’ health outcomes.Overall, the system helped in improving patients’ health outcomes as illustrated in thebelow figure (10). More than half of the participants agreed on that with small percentageof disagreement.The below figure (11) depicts the challenges faced in the implemented HIS. Theparticipants had the option to select more than one answer and add other challenges thatwere not listed in the questionnaire. However, the most selected challenges wasinadequacy of training and support during the implementation of the system, thendifficulty of the system layout and format (e.g. terminologies)and after that, the selectedchallenge was technical problems (e.g. unscheduled system downtime). The followingwas time consumption while using the system compared to the manual system (paperbased form). Only 5 participants selected user acceptance of the new system as achallenge. No participants provided other challenges.23%59%9%4%5%0%Ajman Hospital: HIS Helped in ImprovingHealth OutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable60Figure 11: Ajman Hospital HIS challenges.The below figure (12) depicts the possible solutions to overcome the challenges faced inthe implemented HIS. The participants had the option to select more than one answer andadd solutions that were not listed in the questionnaire. However, the most selectedsolution was providing more training courses, then extending support period and afterthat, the selected solution was simplifying the system and last solution was rewards andpenalty strategy. No participants provided additional solution.4535158 5 050101520253035404550Inadequatetraining andsupportingLayout andformattingdifficulty ofthe systemTechnicalproblemsTimeconsumptioncompared tothe paperbased formUserAcceptanceOther# of ParticipantsResearch Topics – CriteriaAjman Hospital: Challenges in the HIS61Figure 12: Ajman Hospital HIS solutions for challenges.4.1.2 Al-Fujairah HospitalThe results obtained from Al-Fujairah Hospital are as following. The total number ofparticipants in this study from this hospital was 175, while 30 refused to participate dueto different reasons, such as: no enough time to complete the questionnaire and fear ofsharing feedbacks and opinions.To evaluate the current status of the implemented Health Information System (HIS), asdemonstrated in figure (13) (Refer to appendix B: Al-Fujairah Hospital Figures), themajority of the participants agreed that the system enhances the quality of the work andservices provided to customers (e.g. patients). Almost the same applied for the ability ofthe system to provide the required information when needed. However, there were a fewof them who disagreed. For the system reliability, above the half agreed that the system isreliable with 45 were neutral and about the easiness and flexibility of the system, half ofthe participants agreed about that with nearly 61 participants had the oppositeperspective. In addition, about 80 participants agreed that the system was implementedsuccessfully, while about 62 disagreed with 33 were neutral. More than the half indicatedthat the system is friendly with only 29 out of 175 disagreed. The number of participants483016 7 00102030405060More training Extendingsupport periodSimplifying thesystem layout,format anddesignReward andpenalty strategyOther# of ParticipantsSolutionsAjman Hospital: Solutions for theChallenges62who were neutral regarding the system friendliness was 33 which is higher than thenumber of disagreed participants. On the other hand, the system comprehensiveness,which means that all services (e.g. laboratory and billing) are available in the system wasrated the lowest compared to other criteria here.Figure (14) (Refer to appendix “B”: Al-Fujairah Hospital Figures) depicts the overallrating of the system. More than half of the participants, about 65% agreed that the systemis satisfactory with 16% dissatisfaction.For re-designing patients care pathway, figure (15) (Refer to appendix B: Al-FujairahHospital Figures) demonstrates the results. More than half of the participants agreed thatthe implemented HIS facilitates a patient’s journey in the hospital; the minute the patiententers the facility till leaving it with more than 30 disagreeing and 34 were neutral. Forreviewing patients’ progress notes, the majority agreed about this and a few disagreed.Almost the same is applied for documenting patients’ care with a few disagreed.However, acquiring and analyzing laboratory, radiology and other results, the participantsagreed about this with some disagreements. About 100 participants agreed that thesystem simplified the processes with 40 disagreements. About 86 agreed that the systemallows for taking decisions by communicating remotely, while 37 were neutral and 47disagreed. Most the participants agreed that the security and confidentiality are promotedin the system.In contrast, patients satisfaction from the HIS users perspectives was positive. Also, theparticipants agreed that the system facilitates unifying healthcare processes across allhospitals under the UAE Federal Healthcare Organization.Figure (16) (Refer to appendix B: Al-Fujairah Hospital Figures) depicts the overall ratingof the system. More than half of the participants agreed that the system helped in redesigning patient’s care pathway with only 6% disagreement.Figure (17) (Refer to appendix B: Al-Fujairah Hospital Figures) illustrates the resultsobtained from Al-Fujairah Hospital about improving patients’ health outcomes whileusing the implemented HIS. This area was sub-divided into three areas: diagnosis andmedical care, discern alerts and other areas that includes general criteria.63Regarding diagnosis and medical care, nearly half of the participants agreed that theprocess of generating reports via the system is easy (e.g. statistics about a specificdisease) with some disagreements. For having a comprehensive picture about a patientthat helps in diagnosing problems sooner, more than 110 participants agreed with 26disagreed. In addition, more than the half agreed that the system allows gathering allinformation related to a patient in one place (e.g. lab results and radiology reports) thathelps in making therapeutic decisions. Also, tracking patients’ care progress andreliability of tests results for healthcare providers to take decisions about patients’conditions were positive. Viewing drugs formulary information and easy access topatients’ assessments was selected by more than half of the participants. About less thanthe half agreed that the system has the option to send reminders to healthcare providers(e.g. surgeries appointments and nurses to give medications to inpatients). However, theimplementation of such system helped in diagnosing medical conditions at earlier stageas depicted in figure (18) (Refer to appendix B: Al-Fujairah Hospital Figures). More thanhalf of the participants agreed by 69% and 13% disagreed.Figure (19) (Refer to appendix B: Al-Fujairah Hospital Figures) depicts how discernalerts helped in improving patients’ health outcome in Al-Fujairah Hospital while usingthe system. As noticed that most of the participants agreed that the system sends alertsabout incomplete tasks and information as well as to obtain
patients’ allergy history,drugs interaction and drug allergy when prescribing medications. Only a very smallnumber of participants disagreed. However, the noticeable is that the number of neutralresponses is high compared to other hospitals rated this criteria, such as Ajman Hospital.Figures (20) (Refer to appendix B: Al-Fujairah Hospital Figures) demonstrates otherareas in the implemented HIS improved patients’ health outcomes for Al-FujairahHospital’s patients. The number of participants who agreed about patients’ registrationand scheduling appointments processes that take maximum 5 minutes per patient wasabout 83 with 42 disagreed. Nearly the same applies for no double work is required toenter data. There were a few numbers of participants who selected these two features asnot applicable. The reason could be that those people do not directly deal with schedulingappointments or are not technicians. However, more than the quarter agreed that the64system is well integrated with other devices (e.g. lab machines). In contrast, more thanthe half agreed that the number of errors is decreased compared to the manual system andthe system generates reports for planning and research.On the other hand, there were a number of participants who disagreed that the systemimproves documentation process and coding system as well as patients waiting time isreduced and the ability of the system to send reminders to patients about theirappointments.Another area covered was the ability of the system to analyze the performance ofdifferent sections at the facility and simply obtain required data for various reasons, suchas: diagnosis and planning. Most of the participants agreed about these two options in thesystem.Overall, the system helped in improving patients’ health outcomes as illustrated in figure(21) (Refer to appendix B: Al-Fujairah Hospital Figures). More than half of theparticipants agreed on that about 81% with only small percentage disagreed, about 9%and only 1% of the participants were not applicable to decide whether the system helpedin improving health outcomes or not.Figure (22) (Refer to appendix B: Al-Fujairah Hospital Figures) depicts the challengesfaced in the implemented HIS. The participants had the option to select more than oneanswer and add other challenges that were not listed in the questionnaire. However, themost selected challenges was inadequacy of training and support during theimplementation of the system, then difficulty of the system layout and format (e.g.terminologies)and after that, the selected challenge was time consumption while using thesystem compared to the manual system (paper-based form). The following was technicalproblems (e.g. unscheduled system downtime). Last challenge selected was useracceptance of the new system as a challenge. No participants provided other challenges.Figure (23) (Refer to appendix B: Al-Fujairah Hospital Figures) depicts the possiblesolutions to overcome the challenges faced in the implemented HIS. The participants hadthe option to select more than one answer and add solutions that were not listed in thequestionnaire. However, the most selected solution was extending support period, then65providing more training courses and after that, the selected solution was simplifying thesystem and last solution was rewards and penalty strategy. No participants providedadditional solution.4.1.3 Dubai HospitalThe results obtained from Dubai Hospital are as following. The total number ofparticipants in this study from this hospital was 125, while 13 refused to participate dueto different reasons, such as: fear to share feedbacks and opinions.To evaluate the current status of the implemented Health Information System (HIS), asdemonstrated in figure (24) (Refer to appendix C: Dubai Hospital Figures), the majorityof the participants agreed that the system enhances the quality of the work and servicesprovided to customers (e.g. patients). Almost the same applied for the ability of thesystem to provide the required information when needed with zero disagreeing. For thesystem reliability, above the half agreed that the system is reliable and about the easinessand flexibility of the system, more than half of the participants agreed about that withnearly 14 participants had the opposite response. In addition, about 90 participants agreedand that the system was implemented successfully, while about 16 disagreed and 19 wereneutral. More than the half indicated that the system is friendly with 16 out of 125disagreed. On the other hand, the system comprehensiveness, which means that allservices (e.g. laboratory and billing) are available in the system, was agreed by 86participants with 6 not applicable.Figure (25) (Refer to appendix C: Dubai Hospital Figures) depicts the overall rating ofthe system. More than half of the participants, about 81% agreed that the system issatisfactory with only 4% dissatisfaction.For re-designing patients care pathway, figure (26) (Refer to appendix C: Dubai HospitalFigures) demonstrates the results. More than half of the participants agreed that theimplemented HIS facilitates a patient’s journey in the hospital; the minute the patiententers the facility till leaving it with 8 disagreeing and 16 were neutral. For reviewingpatients’ progress notes, the majority agreed about this and a few disagreed. Almost thesame is applied for documenting patients’ care. However, acquiring and analyzing66laboratory, radiology and other results, the participants agreed about this, but the numberof neutral participants was higher than disagreed participants. About 99 participantsagreed that the system simplified the processes with 6 disagreements. Also, 96 agreedthat the system allows for taking decisions by communicating remotely. Most theparticipants agreed that the security and confidentiality are promoted in the system.In contrast, patients satisfaction from the HIS users perspectives was positive. Also, theparticipants agreed that the system facilitates unifying healthcare processes across allhospitals under the UAE Federal Healthcare Organization.Figure (27) (Refer to appendix C: Dubai Hospital Figures) depicts the overall rating ofthe system. More than half of the participants 85% agreed that the system helped in redesigning patient’s care pathway with 0% disagreement. As noticed, the percentage ofneutral participants is 15%, which is higher than the percentage of disagreed participants.Figure (28) (Refer to appendix C: Dubai Hospital Figures) illustrates the results obtainedfrom Dubai Hospital about improving patients’ health outcomes while using theimplemented HIS. This area was sub-divided into three areas: diagnosis and medical care,discern alerts and other areas that includes general criteria.Regarding diagnosis and medical care, more than half of the participants agreed that theprocess of generating reports via the system is easy (e.g. statistics about a specificdisease) with some disagreements. For having a comprehensive picture about a patientthat helps in diagnosing problems sooner, about 88 participants agreed with 6 disagreed.In addition, more than the half agreed that the system allows gathering all informationrelated to a patient in one place (e.g. lab results and radiology reports) that helps inmaking therapeutic decisions. Also, tracking patients’ care progress and reliability oftests results for healthcare providers to take decisions about patients’ conditions werepositive. Viewing drugs formulary information and easy access to patients’ assessmentswere selected by more than half of the participants. The number of participants whoagreed that the system has the option to send reminders to healthcare providers (e.g.surgeries appointments and nurses to give medications to inpatients) is 78 with 24disagreeing.67However, the implementation of such system helped in diagnosing medical conditions atearlier stage as depicted in figure (29) (Refer to appendix C: Dubai Hospital Figures).More than half of the participants agreed by 82%, 0% disagreed with 15% neutral and 3%not applicable. The neutral and not applicable could be due to not willingness to declaretho
ughts.Figure (30) (Refer to appendix C: Dubai Hospital Figures) depicts how discern alertshelped in improving patients’ health outcome in Dubai Hospital while using the system.As noticed that most of the participants agreed that the system sends alerts aboutincomplete tasks and information as well as to obtain patients’ allergy history, drugsinteraction and drug allergy when prescribing medications. Only a small number ofparticipants disagreed. However, the noticeable is that the number of neutral responses ishigh compared to the disagreed responses.Figure (31) (Refer to appendix C: Dubai Hospital Figures) demonstrates how other areasin the implemented HIS improved patients’ health outcomes for Dubai Hospital’spatients. The number of participants who agreed about patients’ registration andscheduling appointments processes that take maximum 5 minutes per patient was about73 with 19 disagreed. Nearly the same applied for no double work is required to enterdata. There were a few number of participants selected these two feature as notapplicable. The reason could be that those people do not directly deal with schedulingappointments or are not technicians. However, more than the quarter agreed that thesystem is well integrated with other devices (e.g. lab machines). In addition, more thanthe half agreed that the number of errors is decreased compared to the manual system andthe system generates reports for planning and research.On the other hand, there were a number of participants who agreed that the systemimproves documentation process and coding system as well as patients waiting time isreduced and the system ability to send reminders to patients about their appointments.Another area covered was the ability of the system to analyze the performance ofdifferent sections at the facility and simply obtain required data for various reasons, such68as: diagnosis and planning. Most of the participants agreed about these two options in thesystem.Overall, the system helped in improving patients’ health outcomes as illustrated in figure(32) (Refer to appendix C: Dubai Hospital Figures). More than half of the participantsagreed on that about 76% with only small percentage strongly disagreed, about 2% andthe same percentage of the participants were not applicable to decide whether the systemhelped in improving health outcomes or not. The obvious is that the percentage of neutralparticipants was higher than those disagreed.Figure (33) (Refer to appendix C: Dubai Hospital Figures) depicts the challenges faced inthe implemented HIS. The participants had the option to select more than one answer andadd other challenges that were not listed in the questionnaire. However, the most selectedchallenges was inadequacy of training and supporting, then time consumption whileusing the system compared to the manual system (paper-based form) and after that,difficulty of the system layout and format (e.g. terminologies). The number ofparticipants who selected user acceptance of the new system as a challenge is 20. Theleast selected challenge was Technical problems (e.g. unscheduled system downtime). Noadditional challenges were added.Figure (34) (Refer to appendix C: Dubai Hospital Figures) depicts the possible solutionsto overcome the challenges faced in the implemented HIS. The participants had theoption to select more than one answer and add solutions that were not listed in thequestionnaire. However, the most selected solution was extending support period duringthe go-live period of the system. Then, providing more training courses and after that, theselected solution was simplifying the system and last solution was rewards and penaltystrategy. This is the same order of selecting solutions made compared to Al-FujairahHospital. No participants provided additional solution.4.1.4 Ras Al-Khaimah (RAK) HospitalThe results obtained from Ras Al-Khaimah (RAK) Hospital are as following. The totalnumber of participants in this study from this hospital was 75, while 15 refused toparticipate due to different reasons, such as: time consumption.69To evaluate the current status of the implemented Health Information System (HIS), asdemonstrated in figure (35) (Refer to appendix D: Ras Al-Khaimah (RAK) HospitalFigures), most of the participants about 65 agreed that the system enhances the quality ofthe work and services provided to customers (e.g. patients). Almost the same for theability of the system to provide the required information when needed, 64 agreed, whileonly 6 disagreed. For the system reliability, also 64 participants agreed that the system isreliable with 8 disagreed and the easiness and flexibility of the system, more than half ofthe participants agreed about that with only 7 disagreed. Nearly the same applied forsuccessfulness of the system implementation while more than quarter of them agreed thatthe system is friendly. On the other hand, the system comprehensiveness, which meansthat all services (e.g. laboratory and billing) are available, was selected by most of theparticipants. Compared to other hospitals, this criterion was selected by the majority fromRAK hospital.Figure (36) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures) depicts theoverall rating of the system. More than half of the participants, about 87% agreed that thesystem is satisfactory with 8% dissatisfaction.For re-designing patients care pathway, figure (37) (Refer to appendix D: Ras AlKhaimah (RAK) Hospital Figures) demonstrates the results. More than half of theparticipants agreed that the implemented HIS facilitates a patient’s journey in thehospital; once the patient enters the facility till leaving it with 4 disagreeing. Forreviewing patients’ progress notes, more than the half agreed about this and only 2disagreed. Almost the same is applied for documenting patients’ care with only 1 stronglydisagreed. However, acquiring and analyzing laboratory, radiology and other results, theparticipants agreed about this with a few disagreeing. About 57 participants agreed thatthe system simplified the processes with 13 disagreed. More than the half agreed that thesystem allows for taking decisions by communicating remotely with only 4 disagreed.The participants agreed that the security and confidentiality are promoted in the system.In addition, patients satisfaction from the HIS users perspectives was positive. Also, theparticipants agreed that the system facilitates unifying healthcare processes across allhospitals under the UAE Federal Healthcare Organization.70Figure (38) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures) depicts theoverall rating of the system. More than half of the participants agreed that the systemhelped in re-designing patient’s care pathway with only 7% dissatisfaction.Figure (39) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures) illustratesthe results obtained from RAK Hospital about improving patients’ health outcomes whileusing the implemented HIS. This area was sub-divided into three areas: diagnosis andmedical care, discern alerts and other areas that includes general criteria.Regarding diagnosis and medical care, more than half of the participants agreed that theprocess of generating reports via the system is easy (e.g. statistics about a specificdisease) with 4 disagreeing. Just about the same for having a comprehensive pictureabout a patient that helps in diagnosing problems sooner. In addition, more than the halfagreed that the system allows gathering all information related to a patient in one place(e.g. lab results and radiology reports) that helps in making therapeutic decisions. Almostthe same applied for tracking patients’ care progress and reliability of tests results forhealthcare providers to take decisions about patients’ conditions. Allow viewing drugsformulary information, easy access to patients’ assessments and send reminders tohealthcare providers were selected by more than half of the participants.The implementation of such systems helped in diagnosing medical conditions at earlierstage as depicted in figure (40) (Refer to appendix D: Ras Al-Khaimah (RAK) HospitalFigures). More than half of
the participants agreed by 88% and only 4% disagreed.Figure (41) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures) depicts howdiscern alerts helped in improving patients’ health outcome in RAK Hospital while usingthe system. As noticed that most of the participants agreed that the system sends alertsabout incomplete tasks and information as well as to obtain patients’ allergy history,drugs interaction and drugs allergy when prescribing medications. Only a very smallnumber of participants disagreed with numbers of neutral responses.Figure (42) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures)demonstrates how other areas in the implemented HIS improved patients’ healthoutcomes for RAK Hospital’s patients. As noticed most the participants agreed about the71following: patients’ registration and scheduling appointments processes take maximum 5minutes per patient, but 5 participants selected this feature as not applicable. Also, morethan the half agreed that test results are transferred correctly from devices to the HIS andthere is no need for double work to enter data from devices to the HIS. Almost the sameapplied for the successful integration of the system with other devices (e.g. labmachines). In addition, more than the half agreed that the number of errors is decreasedcompared to the manual system and the system generates reports for planning andresearch.Improving documentation process, coding system as well as reducing patients’ waitingtime and the system ability to send reminders to patients about their appointments wereselected by more than half of the participants. Another area covered was the ability of thesystem to analyze the performance of different sections at the facility and simply obtainrequired data for various reasons, such as: diagnosis and planning. The participantsmostly agreed about these two options in the system.Overall, the system helped in improving patients’ health outcomes as illustrated in figure(43) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures). More than half ofthe participants agreed on that with 11% disagreed.Figure (44) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures) depicts thechallenges faced in the implemented HIS. The participants had the option to select morethan one answer and add other challenges that were not listed in the questionnaire.However, the most selected challenges was inadequacy of training and support during theimplementation of the system, then, technical problems (e.g. unscheduled systemdowntime) and after that, the selected challenge was difficulty of the system layout andformat (e.g. terminologies).The following was time consumption while using the systemcompared to the manual system (paper-based form). Only 7 participants selected useracceptance of the new system as a challenge and 1participant added an extra challengewhich is increasing in the number of patients compared to the number of staff.Figure (45) (Refer to appendix D: Ras Al-Khaimah (RAK) Hospital Figures) depicts thepossible solutions to overcome the challenges faced in the implemented HIS. The72participants had the option to select more than one answer and add solutions that were notlisted in the questionnaire. However, the most selected solution was providing moretraining courses, then extending support period and after that, the selected solution wassimplifying the system and last solution was rewards and penalty strategy. Noparticipants provided additional solution. The same order of the solutions was alsoselected by Ajman Hospital.4.1.5 Sharjah HospitalThe results obtained from Sharjah Hospital are as following. The total number ofparticipants in this study from this hospital was 125, while 9 refused to participate due todifferent reasons, such as: not interested in being part of the study.To evaluate the current status of the implemented Health Information System (HIS), asdemonstrated in figure (46) (Refer to appendix E: Sharjah Hospital Figures), most of theparticipants about 100 agreed that the system enhances the quality of the work andservices provided to customers (e.g. patients). Almost the same for the ability of thesystem to provide the required information when needed, 96 agreed, while 16 disagreed.For the system reliability, 97 participants agreed that the system is reliable with 11disagreed and for the easiness and flexibility of the system, more than half of theparticipants agreed about that with 17 disagreed. More than half of the participants agreedthat the system was implemented successfully and that the system is friendly.Furthermore, more than the half agreed that the system is comprehensive, which meansthat all services (e.g. laboratory and billing) are available with 13 disagreed and 6indicated as not applicable as these participants might be medical records clerks so onlyknow about their part of the system.Figure (47) (Refer to appendix E: Sharjah Hospital Figures) depicts the overall rating ofthe system. More than half of the participants, about 76% agreed that the system issatisfactory with 8% dissatisfaction.73For re-designing patients care pathway, figure (48) (Refer to appendix E: SharjahHospital Figures) demonstrates the results. More than half of the participants agreed thatthe implemented HIS facilitates a patient’s journey in the hospital; once the patient entersthe facility till leaving it with 6 disagreeing. For reviewing patients’ progress notes, morethan the half agreed about this and 10 disagreed. Almost the same is applied fordocumenting patients’ care with 10 disagreed. Also, acquiring and analyzing laboratory,radiology and other results, the participants agreed about this with a few disagreeing.About 93 participants agreed that the system simplified the processes with 1 stronglydisagreed. More than the half agreed that the system allows for taking decisions bycommunicating remotely with only 6 strongly disagreed. The participants agreed that thesecurity and confidentiality are promoted in the system.In contrast, patients satisfaction from the HIS users perspectives was positive with 6participants selected this criterion as not applicable. Also, the participants agreed that thesystem facilitates unifying healthcare processes across all hospitals under the UAEFederal Healthcare Organization.Figure (49) (Refer to appendix E: Sharjah Hospital Figures) depicts the overall rating ofthe system. More than half of the participants agreed that the system helped in redesigning patient’s care pathway with 5% disagreeing and 2% not applicable.Figure (50) (Refer to appendix E: Sharjah Hospital Figures) illustrates the resultsobtained from Sharjah Hospital about improving patients’ health outcomes while usingthe implemented HIS. This area was sub-divided into three areas: diagnosis and medicalcare, discern alerts and other areas that includes general criteria. Regarding diagnosis andmedical care, more than half of the participants agreed that the process of generatingreports via the system is easy (e.g. statistics about a specific disease) with 4 disagreeing.Almost the same for having a comprehensive picture about a patient that helps indiagnosing problems sooner. In addition, more than the half agreed that the system allowsgathering all information related to a patient in one place (e.g. lab results and radiologyreports) that helps in making therapeutic decisions. Almost the same applied for trackingpatients’ care progress and reliability of tests results for healthcare providers to takedecisions about patients’ conditions. Viewing drugs formulary information, easy access74to patients’ assessments and sending reminders to healthcare providers were selected bymore than half of the participants.However, about 86% agreed that the implementation of such systems helped indiagnosing medical conditions at earlier stage and 3% disagreed as depicted in figure (51)(Refer to appendix E: Sharjah Hospital Figures).Figure (52) (Refer to appendix E: Sharjah Hospital Figures) depicts how discern alertshelped in improving patients’ health outcome in Sharjah Hospital while using the system.As noticed that most of the participants
agreed that the system sends alerts aboutincomplete tasks and information as well as to obtain patients’ allergy history, drugsinteraction and drug allergy when prescribing medications. Only a very small number ofparticipants disagreed with numbers of neutral responses.Figure (53) (Refer to appendix E: Sharjah Hospital Figures) demonstrates how otherareas in the implemented HIS improved patients’ health outcomes for Sharjah Hospital’spatients. As noticed most the participants agreed about the following: patients’registration and scheduling appointments processes take maximum 5 minutes per patient,but 9 participants selected this feature as not applicable. Also, more than the half agreedthat test results are transferred correctly from devices to the HIS and there is no need fordouble work to enter data from devices to the HIS. Almost the same applied for thesuccessful integration of the system with other devices (e.g. lab machines). In addition,more than the half agreed that the number of errors is decreased compared to the manualsystem and the system generates reports for planning and research.Improving documentation process, coding system as well as reducing patients’ waitingtime and the system ability to send reminders to patients about their appointments wereselected by more than half of the participants. Another area covered was the ability of thesystem to analyze the performance of different sections at the facility and simply obtainrequired data for various reasons, such as: diagnosis and planning. The participantsmostly agreed about these two options in the system.75Overall, the system helped in improving patients’ health outcomes as illustrated in figure(54) (Refer to appendix E: Sharjah Hospital Figures). More than half of the participantsagreed on that with 4% disagreed.Figure (55) (Refer to appendix E: Sharjah Hospital Figures) depicts the challenges facedin the implemented HIS. The participants had the option to select more than one answerand add other challenges that were not listed in the questionnaire. However, the mostselected challenges was inadequacy of training and support during the implementation ofthe system, then difficulty of the system layout and format (e.g. terminologies) and afterthat, the selected challenge was technical problems (e.g. unscheduled system downtime).The following was time consumption while using the system compared to the manualsystem (paper-based form). The number of participants who selected user acceptance ofthe new system as a challenge is 16. No participants provided other challenges. The sameorder of challenges was selected by Ajman and UAQ Hospitals.Figure (56) (Refer to appendix E: Sharjah Hospital Figures) depicts the possible solutionsto overcome the challenges faced in the implemented HIS. The participants had theoption to select more than one answer and add solutions that were not listed in thequestionnaire. However, the most selected solution was extending support period duringthe go-live of the system. Then providing more training courses and after that, theselected solution was rewards and penalty strategy and least selected solution wassimplifying the system layout and format which includes using simple terminologies. Noparticipants provided additional solution. The order of the selected solutions here is thesame as for UAQ Hospital.4.1.6 Um Al-Qwain (UAQ) HospitalThe results obtained from Um Al-Qwain (UAQ) Hospital are as following. The totalnumber of participants in this study from this hospital was 75, while 8 refused toparticipate due to different reasons, such as: time consumption. In some ways, the resultsobtained from UAQ and RAK Hospitals have some commonality.To evaluate the current status of the implemented Health Information System (HIS), asdemonstrated in figure (57) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital76Figures), most of the participants about 63 agreed that the system enhances the quality ofthe work and services provided to customers (e.g. patients). The same for the ability ofthe system to provide the required information when needed, 64 agreed, but only 6disagreed. For the system reliability, 56 participants agreed that the system is reliablewith 9 disagreed and the easiness and flexibility of the system, more than half of theparticipants agreed about that with only 5 disagreed. Nearly the same applied forsuccessfulness of the system implementation while more than half of them agreed that thesystem is friendly. On the other hand, the system comprehensiveness, which means thatall services (e.g. laboratory and billing) are available, was selected by most of theparticipants.Figure (58) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures) depicts theoverall rating of the system. More than half of the participants, about 84% agreed that thesystem is satisfactory with 9% dissatisfaction.For re-designing patients care pathway, figure (59) (Refer to appendix F: Um Al-Qwain(UAQ) Hospital Figures) demonstrates the results. More than half of the participantsagreed that the implemented HIS facilitates a patient’s journey in the hospital; when thepatient enters the facility till leaving it with 8 disagreeing. For reviewing patients’progress notes, more than the half agreed about this and only 3 disagreed. Nearly thesame is applied for documenting patients’ care with only 1 strongly disagreed. However,acquiring and analyzing laboratory, radiology and other results, the participants agreedabout this with a few disagreeing. About 56 participants agreed that the system simplifiedthe processes with 11 disagreed. More than the half agreed that the system allows fortaking decisions by communicating remotely with only 3 disagreed. The participantsagreed that the security and confidentiality are promoted in the system. In addition,patients satisfaction from the HIS users perspectives was positive. Also, the participantsagreed that the system facilitates unifying healthcare processes across all hospitals underthe UAE Federal Healthcare Organization.Figure (60) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures) depicts theoverall rating of the system. More than half of the participants 89% agreed that thesystem helped in re-designing patient’s care pathway with only 4% disagreeing.77Figure (61) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures) illustrates theresults obtained from UAQ Hospital about improving patients’ health outcomes whileusing the implemented HIS. This area was sub-divided into three areas: diagnosis andmedical care, discern alerts and other areas that includes general criteria.Regarding diagnosis and medical care, more than half of the participants agreed that theprocess of generating reports via the system is easy (e.g. statistics about a specificdisease) with 7 disagreeing. Almost the same for having a comprehensive picture about apatient that helps in diagnosing problems sooner. In addition, more than the half agreedthat the system allows gathering all information related to a patient in one place (e.g. labresults and radiology reports) that helps in making therapeutic decisions. Almost thesame applied for tracking patients’ care progress, while for reliable tests results sohealthcare providers can take decisions about patients’ conditions, the number ofparticipants who agreed was 53 with 13 disagreeing. Allow viewing drugs formularyinformation, easy access to patients’ assessments and send reminders to healthcareproviders were selected by more than half of the participants.The implementation of such systems helped in diagnosing medical conditions at earlierstage as depicted in figure (62) (Refer to appendix F: Um Al-Qwain (UAQ) HospitalFigures). More than half of the participants agreed by 82% and 10% disagreed.Figure (63) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures) depicts howdiscern alerts helped in improving patients’ health outcome in UAQ Hospital while usingthe system. As noticed that most of the participants agreed that the system sends alertsabout incomplete tasks and information as well as to obtain patients’ allergy history,drugs interaction and drug allergy when prescribing
medications. Only a very smallnumber of participants disagreed with numbers of neutral responses.Figure (64) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures) demonstrateshow other areas in the implemented HIS improved patients’ health outcomes for UAQHospital’s patients. As noticed, most the participants agreed about the following:patients’ registration and scheduling appointments processes take maximum 5 minutesper patient, but 14 participants disagreed. Also, more than the half agreed that test results78are transferred correctly from devices to the HIS and there is no need for double work toenter data from devices to the HIS. Almost the same applied for the successful integrationof the system with other devices (e.g. lab machines). In addition, more than the halfagreed that the number of errors is decreased compared to the manual system and thesystem generates reports for planning and research.Improving documentation process, coding system as well as reducing patients’ waitingtime and the system ability to send reminders to patients about their appointments wereselected by more than half of the participants, but 7 participants indicated coding criterionas not applicable. This could be that those participants are not involves in coding task.Another area covered was the ability of the system to analyze the performance ofdifferent sections at the facility and simply obtain required data for various reasons, suchas: diagnosis and planning. The participants mostly agreed about these two options in thesystem.Overall, the system helped in improving patients’ health outcomes as illustrated in figure(65) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures). The percentage ofparticipants who agreed that the system helped in improving health outcomes was 80%with 11% disagreed. The disagreeing percentage here is the same as for RAK Hospital.Figure (66) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures) depicts thechallenges faced in the implemented HIS. The participants had the option to select morethan one answer and add other challenges that were not listed in the questionnaire.However, the most selected challenges was inadequacy of training and support during theimplementation of the system, then difficulty of the system layout and format (e.g.terminologies) and after that, the selected challenge was technical problems (e.g.unscheduled system downtime).The following was time consumption while using thesystem compared to the manual system (paper-based form). Only 9 participants selecteduser acceptance of the new system as a challenge. This is the same order of selectingchallenges made compared to Ajman and Sharjah Hospitals. No additional challengeswere added.79Figure (67) (Refer to appendix F: Um Al-Qwain (UAQ) Hospital Figures) depicts thepossible solutions to overcome the challenges faced in the implemented HIS. Theparticipants had the option to select more than one answer and add solutions that were notlisted in the questionnaire. However, the most selected solution was extending supportperiod during the go-live of the system. The second solution was providing more trainingsessions and after that, the selected solution was reward and penalty strategy and leastselected solution was simplifying the system layout, format and design which includesusing simple terminologies. No additional solutions were added.4.1.7 Project Management Office (PMO)The results obtained from the Project Management Office (PMO) of the implementedHIS are as following. The total number of participants in this study from PMO was 9,while 3 were excluded as two of the individuals are recently joined the office and thethird one is the author of the study, so to avoid any biases.To evaluate the current status of the implemented Health Information System (HIS), asdemonstrated in figure (68) (Refer to appendix G: HIS Project Management Office(PMO) Figures), all of the participants agreed that the system enhances the quality of thework and services provided to customers (e.g. patients). Almost the same applied for theability of the system to provide the required information when needed. For the systemreliability, above the half agreed that the system is reliable with 2 disagreed and theeasiness and flexibility of the system, all of the participants agreed. In addition, forsuccessfulness of the system implementation, 7 agreed, while 2 of the participants hadneutral point of view. On the other hand, the system comprehensiveness, which meansthat all services (e.g. laboratory and billing) are available and was selected by most of theparticipants with 2 disagreeing.Figure (69) (Refer to appendix G: HIS Project Management Office (PMO) Figures)depicts the overall rating of the system. All the participants agreed that the system issatisfactory.For re-designing patients care pathway, figure (70) (Refer to appendix G: HIS ProjectManagement Office (PMO) Figures) demonstrates the results. Almost all of the80participants agreed that the implemented HIS facilitates a patient’s journey in thehospital; once the patient enters the facility till leaving it except 1 participant who hadneutral perspective. For reviewing patients’ progress notes, all of them agreed. Almostthe same is applied for documenting patients’ care with only 1 neutral perspective.However, acquiring and analyzing laboratory, radiology and other results, the participantsagreed about this with a few disagreeing. About 5 participants agreed that the systemsimplified the processes with 1 disagreed. More than the half agreed that the systemallows for taking decisions by communicating remotely. The participants agreed that thesecurity and confidentiality are promoted in the system. In addition, patients satisfactionfrom the HIS users perspectives was positive. Also, the participants agreed that thesystem facilitates unifying healthcare processes across all hospitals under the UAEFederal Healthcare Organization.Figure (71) (Refer to appendix G: HIS Project Management Office (PMO) Figures)depicts the overall rating of the system. All the participants agreed that the system helpedin re-designing patient’s care pathway.Figure (72) (Refer to appendix G: HIS Project Management Office (PMO) Figures)illustrates the results obtained from PMO about improving patients’ health outcomeswhile using the implemented HIS. This area was sub-divided into three areas: diagnosisand medical care, discern alerts and other areas that includes general criteria.Regarding diagnosis and medical care, about half of the participants strongly agreed thatthe process of generating reports via the system is easy (e.g. statistics about a specificdisease) with 4 disagreeing. While, for having a comprehensive picture about a patientthat helps in diagnosing problems sooner, 5 agreed and 2 disagreed. In addition, about thehalf agreed that the system allows gathering all information related to a patient in oneplace (e.g. lab results and radiology reports) that helps in making therapeutic decisions,but 2 disagreed. On the other hand, all of the participants agreed about the system abilityto track patients’ care progress. For reliability of tests results for healthcare providers totake decisions about patients’ conditions, almost all of them agreed with 1 disagreeing.Allow viewing drugs formulary information and easy access to patients’ assessments, the81participants agreed about that, while sending reminders to healthcare providers wereselected by less than half of the participants and almost above the have disagreed.The implementation of such systems helped in diagnosing medical conditions at earlierstage as depicted in figure (73) (Refer to appendix G: HIS Project Management Office(PMO) Figures). More than half of the participants agreed with a noticeable percentage ofdisagreeing. The PMO was the only facility had this percentage of disagreeing. Thereason could be their perspective of the system from IT point of view, not like otherfacilities that see the system most likely from medical point of view.Figure (74) (Refer to appendix G: HIS Project Management Office (PMO) Figures)depicts how discern alerts helped in improvin
g patients’ health outcome while using thesystem. As noticed that most of the participants agreed that the system sends alerts aboutincomplete tasks and information as well as to obtain patients’ allergy history, drugsinteraction and drug allergy when prescribing medications. Only 2 participants stronglydisagreed about sending alerts for incomplete tasks and information with a few number ofneutral responses.Figure (75) (Refer to appendix G: HIS Project Management Office (PMO) Figures)demonstrates how other areas in the implemented HIS improved patients’ healthoutcomes. As noticed, above the half, agreed that patients’ registration and schedulingappointments processes take maximum 5 minutes per patient, but 4 participantsdisagreed. Also, more than the half agreed that test results are transferred correctly fromdevices to the HIS and there is no need for double work to enter data from devices to theHIS. Almost the same applied for the successful integration of the system with otherdevices (e.g. lab machines). In addition, all of them agreed that the number of errors isdecreased compared to the manual system. However, about the ability of the system togenerate reports for planning and research, less than the half strongly agreed with 3disagreeing and 2 had neutral perspective.Improving documentation process and coding system as well as reducing patients’waiting time and the system ability to send reminders to patients about their appointmentswere selected by more than half of the participants. Another area covered was the ability82of the system to analyze the performance of different sections at the facility and simplyobtain required data for various reasons, such as: diagnosis and planning. The participantsmostly agreed about these two options in the system. Overall, the system helped inimproving patients’ health outcomes as illustrated in figure (76) (Refer to appendix G:HIS Project Management Office (PMO) Figures). All the participants agreed on that.Figure (77) (Refer to appendix G: HIS Project Management Office (PMO) Figures)depicts the challenges faced in the implemented HIS. The participants had the option toselect more than one answer and add other challenges that were not listed in thequestionnaire. However, the most selected challenge was inadequacy of training andsupport during the implementation of the system, then, user acceptance and after that,technical problems (e.g. unscheduled system downtime). Nevertheless, none of theparticipants selected difficulty of the system layout and format (e.g. terminologies) andtime consumption while using the system compared to the manual system (paper-basedform) as challenges. Only 1 participant added an extra challenge which is languagebarrier as the system in only in English version and there are some users who are notgood in English.Figure (78) (Refer to appendix G: HIS Project Management Office (PMO) Figures)depicts the possible solutions to overcome the challenges faced in the implemented HIS.The participants had the option to select more than one answer and add solutions thatwere not listed in the questionnaire. However, the most selected solution was providingmore training courses, then extending support period and after that, the selected solutionwas rewards and penalty strategy. Neither of the participants selected simplifying thesystem as a possible solution nor provided additional solution.83Figure 79: Gender distribution for HIS users.Figure 80: Age range for HIS users.4.2 Evaluation of the Study ParticipantsTo evaluate the HIS users from different angles; gender, age and major of the users basedon the geographical distribution of the users were used as criteria. As seen from thesethree figures (79, 80 and 81), thenumber of females users ishigher in all areas. However, thisvariation is only for the samplesize involved in the study. Asnoticed that Dubai, Ras AlKhaimah, Um Al-Qwain and theProject Management Office(PMO) has the remarkablevariation in the number of malesand females users. The variationis almost the double, except forthe PMO; it was more than thedouble. For instance, the number of HIS males users involved in this study from DubaiHospital was 40, while the number of HIS females users was 85.On the other hand, the age distribution of the HIS users involved in this study was as thefollowing. As noticed, mostof the HIS users involved inthis study were in theirthirties, in another word,the most age rangeinvolved here was 30 to 39except for the PMO; themajority of them fall in theage range of 20-29. While,the least age range of the020406080100AJ FUJ DB RAK SJ UAQ PMOCountGeographical Area / FacilityGender Distribution for HIS UsersMaleFemale010203040506070AJ FUJ DB RAK SJ UAQ PMOCountGeographical Area / FacilitiesAge Range for HIS Users20-2930-3940-4950-5960-6984Figure 81: Majors of HIS users.HIS users involved in this study was between 60 and 69. However, the users had to selectthe age range from the available options in the questionnaire distributed and the age rangeof sixties was the last option as the average age of retirement in the UAE publicorganizations falls in sixties. All of the facilities had users with different age ranges; intwenties, thirties, forties, fifties and sixties, except the PMO that only had the age rangeof twenties and thirties.Another criteria was the HIS users’ majors. Five majors/categories were provided for theparticipants to select thatrepresent their specialties. Asnoticed, most of the participantswere physicians and nurses about482 participants despite of theirbusy schedules. The secondmajor was medical services (e.g.radiologists, laboratorytechnicians, pharmacists…etc)about 124 participants.Information Technology (IT)personnel/ HealthInformation System (HIS) specialists and Hospitals’ Management Staff were the involvedin this study, but the number of participants was low compared to specificities(physicians, nurses…etc). The PMO staffs as shown in this figure (80) are onlyspecialized in IT/HIS field. Also, there were no participants from other specialty notlisted in the study.The below figure (82) illustrates the participation level for all facilitates involved in thisstudy. As obvious, the participation level is higher than the rejection level. The numberinside each column indicates the number of participants and number of individuals whorefused to participate. Those numbers were also represented in percentage for eachfacility. As stated above, the minimum requirement of participants in this study is 25% of020406080100120140160AJ FUJ DB RAK SJ UAQPMOCountGeographical Area / FacilitiesMajor / Category DistributionPhysician / NurseMedical ServicesIT/HISHospital’sManagementOther85the total numbers of staffs for each facility that use the implemented HIS. Because ofthat, the number of participation is different for each facility. The reasons that there wereparticipants who refused to be part of this study are various. For example, some of themwere afraid to share thoughts about the implemented HIS despite of explaining that thestudy is for research purposes. Another reason was that there is no enough time tocomplete the questionnaire, although physicians and nurses were the most participatedparties. Also, a few of them were not interested in this study. However, for the PMOstaff, the three individuals who refused to be part of the study were actually excluded asone of them is the author of this study and the remaining two just recently joined theoffice and still not involved in the HIS tasks.4.3 Hypotheses TestingIn order to analyze the collected data, Microsoft Office Excel was used. The below table(3) depicts the statistical analysis based on the mean and standard deviation (SD) forparticipation response per each facility. A mean can be defined as the average number ofa dataset, while standard deviation is about how the values of a dataset are related to themean. Small SD might mean that the values of a dataset are close to the mean, whilelarge SD might mean that the values of the dataset are spread-out.100 175 125 75 125 75915 30 13 15 9 830%10%20%30%40%50%60%70%80%90%100%AJ FUJ DB RAK SJ UAQ PMOPercentageGeographical A
rea / FacilitiesParticipation LevelTotal RefusedTotal ParticipatedFigure 82: HIS users’ participation level.86Since in this study, there were different numbers of population samples, the means andSDs for each population were calculated separately. As noticed from the table below thatthere is a variation between the mean and SD for each facility. Some of these facilitieshave small variation, such as: the PMO and UAQ Hospital, while other facilities havelarge variation, such as: Dubai and Sharjah Hospitals. The PMO has the smallest SD, butthis could be due to the fact that the office has the lowest number of population comparedto other facilities in this study. So, the data points/values are more centered toward themean.Facility Mean StandardDeviation (SD)AJ 50.5 29.01FUJ 88 50.66DB 63 36.23RAK 38 21.79SJ 63 36.23UAQ 38 21.79PMO 5 2.74In this study, two hypotheses were generated. The first hypothesis was how healthinformation system helped in re-designing patients care pathway and the secondhypothesis was how the implemented HIS helped in improving patients’ health outcomes.To test and evaluate these two hypotheses, a questionnaire was administered across sevenfacilities. The results were rounded to two decimals places.4.3.1 HIS for Re-designing Patients’ Care PathwayFor each facility the responses to whether the implemented HIS helped in re-designingpatients’ care pathway or not were categorized as positive and negative response. As theparticipants had to select the response based on Likert Scale (Strongly Agree, Agree,Table 3: Response rate per facility.87Neutral, Disagree, Strongly Disagree and Not Applicable), these scales were merged asthe following:- Strongly Agree and Agree = Positive Response- Disagree and Strongly Disagree a = Negative Response- Neutral and Not Applicable were excluded as they do not state a clear responseThe below table (4) shows the total number of participants with positive and negativeresponse for each facility:HIS for re-designing patients’ care pathwayTwo-sample assuming unequal variancesFacility Observations Mean Df P(T<=t)two-tailt CriticalPositive Negative Positive Negative two-tailAJ 92 4 46.5 2.5 93 2.55 1.99FUJ 135 11 68 6 144 7.62 1.98DB 107 0 54 0 106 5.20 1.98RAK 61 5 31 3 63 1.53 2.00SJ 106 7 53.5 4 110 1.83 1.98UAQ 67 3 34 2 66 5.72 2.00PMO 9 0 5 0 8 0.00059 2.31Total p-value 2.714.3.2 HIS for Improving Patients’ Health OutcomesFor each facility the responses to whether the implemented HIS helped in improvingpatients’ health outcomes or not were also categorized as positive and negative response.The below table (5) shows the total number of participants with positive and negativeresponse for each facility:Table 4: HIS for re-designing patients’ care pathway.88HIS for improving patients’ health outcomesTwo-sample assuming unequal variancesFacility Observations Mean Df P(T<=t)two-tailt CriticalPositive Negative Positive Negative two-tailAJ 82 9 41.5 5 89 1.70 1.99FUJ 142 15 71.5 8 155 2.14 1.98DB 96 2 48.5 1.5 93 5.68 1.99RAK 61 8 31 4.5 67 1.78 2.00SJ 111 6 56 3.5 114 2.37 1.98UAQ 60 8 30.5 4.5 66 3.60 2.00PMO 9 0 5 0 8 0.00059 2.31Total p-value 1.80In this study, the probability value (p-value) = 0.05 was used to support the stated nullhypotheses. Null hypothesis (H0) is based on chance and when testing it, there is a chanceto make wrong conclusion. There are two types of errors, which are:Type 1 errors: this occurs when the null hypothesis is rejected although it is true. Alsoknown as false positive. For this type of errors, the acceptable level is alpha (α=0.05 and0.01). It means that type 1 errors can be accepted up to 5%.Type 2 errors: this occurs when the null hypothesis is rejected although it is false. Alsoknown as false negative. For this type of errors beta (β) is used as an acceptable level.Here, to test the null hypotheses, p-value was used as: p < α (p smaller than or equals α),in that case, the null hypothesis is rejected (Real statistics using Excel n.d.).Null hypothesis 1: the implemented HIS helped in re-designing patients’ care pathway.Based on the results obtained, the null hypothesis is not rejected as the overall p-valueTable 5: HIS for improving patients’ health outcomes.89obtained = 2.71 is greater than 0.05. This means that there is no statistic significance atthe level of 5%.Null hypothesis 2: the implemented HIS helped in improving patients’ health outcomes.Based on the results obtained, the null hypothesis is not rejected as the overall p-valueobtained = 1.80 is greater than 0.05. This means that there is no statistic significance atthe level of 5%.What noticed is that the project management office (PMO) had low results. This could bedue to the small population size of it compared to other facilities that were involved inthis study. for this facility, the obtained p-values for both hypotheses 1 and 2 was thesame 0.00059 which is smaller than 0.05 and the means are equal, in that case, the statednull hypotheses are rejected.4.4 OverallThe below figure (83) depicts the overall satisfaction level about the implemented HIS inthese 6 facilities under UAE FHO along with the HIS project management office. Ingeneral, most of the participants agreed that the system is satisfactory with number ofdisagreements. Al-Fujairah and Sharjah Hospitals had the highest agreement levelcompared to the remaining hospitals. The noticeable is that PMO had none disagreementsabout the satisfactory level of the system, while the 6 hospitals had some. This could bedue to the fact that the hospitals are interacting daily with the system, while PMO teamdeal and handle the system from management aspects. Also, the number of neutralresponses was higher compared to disagreed responses.90The below figure (84) illustrates the overall response level about re-designing patients’care pathway while using the implemented HIS. In general, the agreement level was highin these facilities despite of being distributed across different geographical areas whichmeans different types of patients and services provided. Al-Fujairah Hospital had thehighest agreement response that the implemented HIS helped in re-designing patients’care pathway, while the disagreement level was also high in Al-Fujairah and SharjahHospitals. PMO had no disagreements about re-designing patients’ care pathway. Therewere only 2 participants from Sharjah Hospital who selected “Not Applicable” option forthis aspect. This could be due to uncertainty or unwillingness to share thoughts…etc.Also, the number of neutral responses was higher compared to disagreed responses.0102030405060708090AJ FUJ DB RAK SJ UAQ PMOCountGeographical Area / FacilitiesHIS SatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot ApplicableFigure 83: Overall satisfaction level.91The below figure (85) illustrates the overall response level about improving patients’health outcomes while using the implemented HIS. In general, the agreement level washigh in these facilities despite of being distributed across different geographical areaswhich means different types of patients and services provided. Al-Fujairah Hospital hadthe highest agreement response that the implemented HIS helped in improving patient’health outcomes, while the disagreement level was high in Ajman and Al-FujairahHospitals. Ras Al-Khaimah and Um Al-Qwain Hospitals had the same number ofdisagreements. PMO had no disagreements about this aspect. There were only 4participants from Al-Fujairah and Dubai Hospitals who selected “Not Applicable” optionfor this aspect. This could be due to uncertainty or unwillingness to share thoughts, fearof adding inputs…etc. Also, the number of neutral responses was almost highercompared to disagreed responses.0102030405060708090100AJ FUJ DB RAK SJ UAQ PMOCountGeographical Area / FacilitiesHIS for Re-designing Patients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot ApplicableFigure 84: Overall response level about re-designing patients’ care pathway.92Health information systems can help physicians in achieving best practices by providingimportant information related to clinical protocols, such as: su
ggesting antibiotics. Also,such systems alert physicians of medications interactions and allergies as well as sharingmedical information with authorized parties and other healthcare systems. Furthermore,these systems aid in identifying possible epidemics by listing uncommon symptomsduring a specific period of time (Farley et al. 2013, p. 400). In contrast, as indicated byFarley et al. (2013) there are some shortcoming of such systems, such as: human errorsdue to lack of trainings and experiences in dealing with these technologies (Farley et al.2013, p. 400). In addition, such systems minimize the interaction between healthcareproviders and patients which may cause patients dissatisfaction. Also, in the EmergencyDepartments, it is difficult to use computers 24/7 as these departments are usuallycongested with critical cases that require urgent response not like other department, suchas: outpatients clinics where physicians have their own offices. In EmergencyDepartments physicians may give orders verbally and later on they enter these orders inthe patients’ charts which sometimes are done by nurses who might misunderstand thehandwriting and this could lead to issues affecting quality of care and patients safety(Farley et al. 2013, p. 401).0102030405060708090AJ FUJ DB RAK SJ UAQ PMOCountGeographical Area / FacilitiesHIS for Improving Patients’ Health OutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot ApplicableFigure 85: Overall response level about improving patients’ health outcomes.93The below figure (86) depicts the challenges faced in this HIS. As noticed, the mostselected challenge was inadequacy of training and support during the implementation ofthe system with 220 participants selected this challenge. The second selected challengewas difficulty of the system layout and format (e.g. terminologies) and the total numberof participants was 157. However, the least selected challenge was user acceptance of thenew system with only 84 participants selected it. Two other challenges that were notincorporated in this study were added by the participants, which were: increasing numberof patients compared to the number of staff and language barrier as the system in only inEnglish version and there are some users who are not good in English.The below figure (87) depicts the possible solutions to overcome the above listedchallenges faced in this HIS. As noticed, the most selected solution was extendingsupport period. From these targeted facilities, 239 participants selected this solution as astrategy to overcome the challenges. The second selected solution was providingadditional trainings and total number of participants was 232. However, the least selectedsolution was rewards and penalties strategy for the system’s users with only 91respondetsselected it. No other solutions were added by the participants.0102030405060AJ FUJ DB RAK SJ UAQ PMOCountGeographical Area / FacilitiesChallenges Faced in the HISInadequate training andsupportingLayout and formatting difficultyof the systemTechnical problemsTime consumption compared tothe paper-based formUser AcceptanceOtherFigure 86: Overall challenges faced in the HIS.944.5 Actual DataThe below data (Table 6) are the actual data retrieved from the implemented HISdatabase for the period of September 2013 related to these 6 hospitals that illustrate theperformance of the system’s users based on the following criteria:Research Topics – Criteria / Hospital Ajman AlFujairahDubai Ras AlKhaimahSharjah Um AlQwainTotalLogin transactions. 51,936 56,898 29,985 19,961 69,539 30,836 259,155Patients’ assessmentssigned.92,747 69,777 17,388 28,245 45,571 19,157 272,885Total medicationsadministered.37,313 31,905 21,557 55,707 78,178 18,588 243,248Orders approved. 19,323 15,883 30,259 17,528 18,733 12,658 114,384All laboratory orders. 40,903 38,940 24,535 23,941 110,264 18,413 256,99601020304050607080AJ FUJ DB RAK SJ UAQ PMOCountGeographical Area / FacilitiesSolutions to Overcome the ChallengesMore trainingExtending support periodSimplifying the system layout,format and designReward and penalty strategyOtherFigure 87: Overall possible solutions to overcome the challenges faced in the HIS.95Clinical notesdocumented.27,465 19,785 14,325 11,762 17,386 20,080 110,803All pharmacy orders. 124,80267,538 54,011 76,927 180,611 54,793 558,682Results viewed. 7,940 33,916 28,104 31,380 33,159 16,897 151,396Total discern alertsfired.10,620 15,442 6,643 19,608 25,872 24,428 102,613Total discern alertsoverridden.0 0 0 0 0 3 3Diagnosis created. 4,767 6,752 3,928 1,380 4,276 3,540 24,643Allergiesdocumented.2,730 1,925 2,711 585 3,271 1,089 12,311Table 6: Performance of the system’s users.(Adapted from Cerner 2010).As noticed, there were not any discern alerts overridden for all these hospitals during thismonth, except for Um Al-Qwain that had 3 overridden alerts. Also, Ras Al-KhaimahHospital had the lowest number of allergies documented during this period compared toremaining hospitals that had more than 1,000 documented allergies. Sharjah Hospital hadthe highest number of laboratory and pharmacy orders, but the total number of approvedorders was low = 18,733 compared to the number of laboratory and pharmacy orders.There are some discrepancies in the data above. For instance, in some areas for the largehospitals, the numbers are low compared to the small hospitals. For example, the totalnumber of discern alerts fired for Um Al-Qwain Hospital was 24,428, while for AlFujairah Hospital, it was 15,442 despite that Al-Fujairah Hospital has more patientsattending than Um Al-Qwain Hospital. In addition, total medications administered in Ras96Al-Khaimah Hospital were 55,707, while for Al-Fujairah and Dubai Hospitals were31,905 and 21,557, respectively. This could mean different things, such as: number ofacute and chronic medical conditions, easiness of prescribing medications…etc. Theseactual data are important for the UAE FHO to evaluate their facilities performances,needs and quality of care.97Chapter 5: Homework help – Discussion5.1Pre-TestingTo design an ideal survey is almost impossible, but designing effective survey is possibleand to evaluate the effectiveness of a survey, pre-testing is an essential step before theactual use of the developed survey (CSU n.d). Pilot study is another term for pre-testing,which can be defined as a preliminary test designed and used to measure the effectivenessof the survey planned to use in full-scale study. One of the main aims of pre-testing is toensure that the designed survey and the actual study are related and harmonious to attainthe targeted information. Also, pre-testing helps researchers to evaluate the survey fromdifferent perspectives, such as: survey’s layout and format, terminology, questions’ order,there is a need to add/remove questions, the instructions in the survey areunderstandable…etc (CSU n.d.; FAO n.d. & Rigney & Associates n.d.).In order to cover the research questions listed above, a survey was prepared anddistributed among the participants, but before that, the developed survey was testedamong 30 people from different backgrounds, such as: IT, Health Information SystemSpecialists and Healthcare Providers. Although the sample size for pre-testing is smallcompared to the study sample size, but the participants are from the same backgroundsand within the same organization.In this study, the participants in the pre-testing were informed about this step sothey will provide their feedback freely and will a give a chance for discussion, althoughthere is another type of pre-testing where participants are not aware of pre-testing stepand are involved blindly. For pre-testing, the designed survey was sent to the participantsvia e-mail and out of 50, only 30 responded and provided their comments which wereabout the survey format, terminologies and adding space to write comments beside eachquestion. Examples of their feedbacks are as following:- Overall, the survey is understandable, but it would be much better if thenumbers of questions are reduced. However, this could not be done as the98research questions require to cover these areas in order to obtain the aimedresults.- Another parti
cipant responded that to provide the survey in two versions,مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabic and English as for the distributed survey was only in English, but thisdid not take place as the research topic is about health information system inthe UAE and the evaluated system is in English version, so the users of thesystem are familiar with basics English Language.- Another feedback was that the instructions and questions in the survey areclear and understandable as well the questions were divided in sections.- Also, the terminologies are easy to understand.The participants’ responds were taking into consideration and there was a channel fordiscussing with them via e-mail and phone. Some of the suggestions were added to thesurvey, such as: adding space to write comments beside each question.5.2Response RateThe sample size in the study represents the study population due to its validity. By this, itis possible to say that 95% of the opinion and thoughts shared in the distributed surveyand received are the same as for those who did not respond to the survey (“Howstatistically valid are your survey results” n.d.). In this study, the targeted populationconsisted of almost 2,562 staff, the minimum requirement of response was 25% and thenumber of participants was 684. For instance, Ajman Hospital consists of 350 staff, theminimum requirement for this study is 25%, so the result would be (350 X 25% = 87.5).However, the number of participants was more than this; about 100. According to table(7) (Refer to appendix H: Results Validity), for this study, the target sample should bearound 332 and 334. However, the number of participants was 684, which is more than330s. Also, the response rates for these 7 facilities were higher than rejection rates asillustrated in the figure (88) below. The response rate in this study was 86%, while therejection rate was 14%. These two rates represent the response from the 7 facilitiestargeted in this study. To obtain high participation rates, there are some factors that needto be considered:99- Data collection methodology: for instance, in this study, the distributed surveyconsisted of direct and clear questions and the participants have to select from theavailable options along with a space to add their comments (optional) instead ofwriting sentences which takes time. Also, the layout and format of the survey tobe friendly not complicated.- Time and location: the time and location to gather the required data is essential. Inthis study, the designed survey was administered to each facility at their location.Participants were visited at their work locations. In addition, during the workinghours, the survey was distributed in order to ensure the completion of the surveyand prevent as much as possible of missing surveys.- Study objectives: stating clear objectives and aims of the study is important asparticipants will not be interested in being part of a study if it is not clear. In thisstudy, the aim was indicated and explained in the distributed survey’s cover pageas well as verbally.On the other hand, low response rates result due to several reasons, such as: unclearpurposes of the study, long data collection methodology, unclear instructions andselecting the wrong time to gather the required data, for example, during holidays, butthis factor depends on the study’s type.Figure 88: Response rate.86%14%Response Rate for theUAE FHO StudyParticipationRejection1005.3General Homework help – DiscussionThe study aimed to cover several questions, which were about the current status of theimplemented HIS, how such a system may help in re-designing patients care pathway andimproving health outcomes as well as the challenges faced during the implementation ofthe system and how to overcome these challenges.Because descriptive studies are usually used to generate hypotheses, analytical studydesign was also applied here to test two hypotheses:1- Hypothesis One: HIS helped in re-designing patients’ care pathway positively.2- Hypothesis Two: HIS helped in improving patients’ health outcomes.So, mixed study designs of descriptive and analytical were applied.The answers to these questions were discussed in the “Analysis Section” above.However, in terms of the current status of the implemented HIS, the followings werecovered:- Quality of work and services.- Providing required information.- System reliability.- System easiness and flexibility.- Successfulness implementation of the system.- System friendliness.- System comprehensiveness.- Overall, system satisfaction.In terms of re-designing patients’ care pathway, the followings were covered:- Patients’ journey in the hospital.- Patients’ progress notes.- Patients’ care documentation- Radiology, laboratory and other tests’ results.- Simplifying supporting processes.- Remote decisions making.- Security and confidentiality101- Patients’ satisfaction.- Unifying healthcare processes across hospitals.- Overall, re-designing patients’ care pathway.The implemented HIS helped in re-designing patients’ care pathway positively byfacilitating patients journey in the hospitals and related care activities in terms of caredocumentation, viewing and analyzing tests’ results, taking decisions remotely, unifyinghealthcare processes across all hospitals under the UAE FHO and promoting patients’satisfaction as well as maintaining confidentiality and security of the implemented systemby designing the system in a way that is protected based on password-driven style.In terms of improving patients’ health outcomes, this part was divided into three subcategories as the following:1- Diagnosis and Medical Care:- Process of generating reports.- Comprehensive picture of a patient.- Information is gathered in one place for therapeutic decisions.- Patients’ care progress.- Reliable tests results.- Drugs formulary information.- Patients’ assessments.- Sending reminders to healthcare providers.- Diagnosing medical conditions at early stages.2- Discern Alerts:- Alerts about incomplete tasks and information.- Alerts of patients’ allergy history.- Drugs interactions.- Drugs allergy when prescribing medications.3- Other:- Patients’ registration or scheduling appointments processes duration.- Correct transferring of tests’ results.- System integration.102- Decreased number of errors compared to the manual system.- Generating reports.- Documentation process and coding system.- Patients’ waiting time.- Reminder for patients.- Departments’ performance analysis.- Obtaining required data.- Overall, improving health outcomes.The implemented HIS helped in improving patients’ health outcomes positively byfacilitating the process of generating reports for various reasons, such as: statistics,research and planning as well as evaluating the performance of other departments inhospitals and managing resources as the system helps in measuring the number ofpatients in each facility, prescriptions issued and tests ordered. Also, after implementingthe system, patients’ information are gathered in one place and healthcare users canaccess to these clinical information from anywhere based on their access privileges. Thishelps in viewing patients’ care progress, history, assessments, results and medications.Furthermore, after implementing this system, patients’ waiting time has been reduced thatis considered as a factor to obtain patients’ satisfaction. Patients health outcomes havebeen improved as the implemented system has the functionality of sending discern alertsto the users regarding incomplete tasks, information, allergy alerts, drugs interactions andallergies when prescribing medications. Furthermore, the implemented systems is wellintegrated with other devices that aids in providing correct results analysis and transferthese results to the HIS.In terms of challenges and solutions, the followings aspects were covered:- Training and support.- System layout and format (e.g. terminologies).- Technical problems (e.g. unscheduled system downtime).- Time consumption compared to the manual system (paper-based form).- User acceptance of the new system.- Rewards and penalties strategy.103- Other challenges and solutions
to be specified by the participant.In many of previous studies, the above challenges and solutions were the most discussedalong with other challenges and solutions. Because of that, in this study those challengesand solutions were listed. However, the participants had the option to add other unlistedchallenges and solutions which only counted participants did, such as: language barrier.For each facility in this study, the obtained results were analyzed separately and overallfindings based on the research questions were demonstrated. Cluster random samplingtechnique was utilized as it is more practical when the study population is scattered,which is the same as in this study. Also, it is useful when the study sample will beselected randomly from different classes, such as: healthcare providers, hospitals’management staff and IT/HIS specialists as well as the project management team of thecurrent HIS project in the UAE Federal Healthcare Organization (UAE FHO).A previous study was conducted by Al Rae (n.d.) regarding centralized health recordssystem in the UAE. The aims of the study were to address the status of electronic healthrecord (EHR) in the country and the challenges in developing such system as well ascovering the methods to manage EHR project in order to control change.The author mainly applied qualitative methods, such as: interview and structured casestudy. Data were collected by interviewing different people with different specialties,such as healthcare providers, hospital director and information technology specialists.The study revealed about the challenges in EHR system. For example, users resistance touse the system. Also, lack of interaction between healthcare providers who use thesystem and patients as the users spend more time in front of machines thancommunicating with patients. Furthermore, technical challenges, such as: more effortsand time were required to create such system, security issues and data integration todatabase servers. Some of the proposed solutions by the interviewees were: enrichingtechnical training for EHR users, arrange social meetings with users to share experiencesand provide educational sessions to the users about the advantages of the EHR.104In order to adopt EHR, change management concept and actions was addressed in thisstudy. For instance, apply leadership concept properly by improving the relationships inthe organization and increasing employees’ satisfaction rate.In this study, the author applied qualitative methods, such as: interview to cover theresearch questions, which were related to the electronic health record (EHR) mainly inAbu Dhabi and one private hospital in Dubai. However, in the UAE FHO study differentresearch questions related to the implementation of health information system (HIS) insix emirates were covered, from Dubai to Al-Fujairah, excluding Abu Dhabi as it is notincluded in the project scope of the HIS. The research paper covered the followingpoints: the current status of HIS in the UAE Federal Healthcare Organization (UAEFHO). Also, how HIS helped in re-designing patients’ care pathway and improvinghealth outcomes as well as the challenges faced while implementing this HIS and how toovercome these challenges. In contrast, Al Rae covered the following points in his study:the current status of electronic health records in the UAE, the challenges of developingsuch system and how EHR can be managed to control change. Furthermore, the datacollection method was mainly quantitative method, which was survey.Some of previous studies, such as: Myers et al. (2012) and Davis et al. (2009) were insomehow similar to the UAE FHO study in terms of several sites involved. However,data collection methods were different as in Myers et al. (2012) survey and interviewwere utilized, while in the UAE FHO study, only survey was utilized. Another differencewas the mode of administering the survey. In the UAE FHO study, the survey wasadministered by hand during working hours to ensure as much as possible highresponding rate. Web-based survey as what in Myers et al. (2012) was not design for theUAE FHO study as the participants have limited access to Internet in the facilities andnot all of them will be able to open the survey online. Yet, Likert scale was used in mostprevious studies, such as: Myers et al. (2012) and Oroviogoicoechea and Watson (2009)as well in this UAE FHO study. Likert scale based on (1=strongly agree to 5=stronglydisagree) was applied in Oroviogoicoechea and Watson study (2009). In the UAE FHOstudy Likert scale was also applied, from strongly agree to strongly disagree, but twoadditional options were added: Not Applicable and Comments. The last option was added105for the participants if they want to elaborate more than just selecting options.In the UAE FHO study participants were categorized based on their occupational rolesand geographical distributions. These roles were: healthcare provider (Physician orNurse), medical services (e.g. Allied Health Personnel, Pharmacy, Laboratory andRadiology Specialist or Technician), IT / health information system (HIS) specialist,hospital’s management staff, which were more specific than in Myers et al. (2012) study:medical providers, case managers and non-clinical staff).The response rate for the survey distributed in this study was 86%, while for Myers et al.(2012) was 61%. In Davis et al. (2009): The response rates from the seven countries werevariant. For instance, the response rate for US was 51%, while Write my essay for me – CA Essay writer Canada and Netherlandshad the response rate of 43% and the survey was sent via e-mail to these countries. Onthe other hand, New Zealand had the response rate of 32%, while Australia had 20%. Forthese countries, the survey was sent by e-mail and fax. For UK, the data were collectedmainly by telephone, but also mail was used and the response rate was 20%. However,for Germany, the data were collected by telephone only and that had the response rate of18%. In UAE FHO 7 facilities located at different areas were involved and the responserate was also variant as the following: Ajman 87%, Al-Fujairah 85%, Dubai 91%, RasAl-Khaimah 83%, Sharjah 93%, Um Al-Qwain 90% and the HIS Project ManagementOffice 75%). The high response rates in the UAE FHO study could be due to the fact thatall these sites are located in one country, which means more and easy control on thesubjects.Regarding the implemented system, in the Myers et al. (2012), medical providers hadtheir own concerns about these systems, which contradict the findings in the UAE FHOstudy that healthcare providers were the most satisfied users of the implemented system.In terms of patients’ safety, the number of medications errors decreased as indicated inthe conference Cerner (2013), the nurses at the Children’s Cancer Hospital in Egypt haveto double check the medication order placed by doctors and use bar code to entermedications ordered in the system to avoid handwritten errors. The errors decreased by80% since the implementation of the system. Also, the system includes allergy alerts,which helped in reducing the number of allergy reactions. This was agreed by the106majority of the participants in this study that the system sends alerts to healthcareproviders about allergy, drugs interactions, incomplete tasks…etc as well as the numberof errors decreased compared to the manual system.). For nursing performance, thesystem implemented in the Children’s Cancer Hospital in Egypt helped to evaluatenursing documentations on daily, monthly and yearly basis. Also, allowed at anytime toevaluate nurses’ practices as well as promote nursing educations by discovering errorsthrough continuous assessments. Most of the participants in this study agreed that theimplemented system allowed evaluating the performance of other sections at a specificfacility.Regarding the easiness of the implemented system, the majority of the nurses as well asother healthcare specialists in the UAE FHO agreed that the implemented HIS is easy touse and friendly which is what was indicated by the nurses in Oroviogoicoechea andWatson study (2009).In addition, many previous studies covered the possible chal
lenges and solutions for thesesystems. In Khalifa (2013): lack of motivation was one of the professional barriersdiscussed. To overcome this barrier in the UAE FHO study reward and penalty strategywas suggested for the new system users. However, a few number of the participantsselected this solution as a strategy to overcome challenges in the HIS. In addition,McAlearney et al. (2007) suggested to distinct physicians who have positive preconceptions from negative physicians as a strategy during the implementation of thesetechnologies. This supports the suggested solution of applying rewards and penaltystrategy, however, it was selected by a few number of participants, although this strategymight be useful to overcome challenges in health information systems.Another technical barrier was discussed in Khalifa (2013) related to interface designissues which is almost the same as difficulty of the system layout and format (e.g.terminologies) that was listed as a challenge in the UAE FHO study. This was selected asthe second challenge in the implemented HIS; about 157 participants selected thischallenge. However, simplifying the implemented system was selected as a third strategyand about 122 participants agreed on that.107Sicotte and Pare (2010) discussed [super users] concept. In UAE FHO, super userconcept was considered. Although names of users from different specialties and hospitalswho want to be part of this strategy were collected, till this time, the strategy is notapplied despite of its many advantages, such as: provide continuous trainings for usersinstead of waiting for the vendor to provide training plan and costs of trainings will bereduced.One of the reasons that BHIS succeeded was users’ involvement in the project stages(Graven et al. 2013). Although users’ involvement was done in the UAE FHO, still usersacquiring for modifications despite that the system is almost deployed in all hospitalsunder UAEFHO, except for 3 hospitals.Another challenge discussed by Adler-Milstein and Bates (2010), p. 123 was lack oftrained resources to provide support for the implemented systems. In the UAE FHOstudy, inadequacy of training and support during the implementation of the system wasselected as a main challenge, by 220 participants. The same barrier was discussed byUrda et al. (2013) related to training period. This is important for users to be familiar withnew systems which require more time to learn and absorb new information. In the UAEFHO study, providing more training courses was selected as a second solution for thechallenges faced in the implemented HIS. The number of participants who selected thissolution was 232. 5.4 Data ValidationDespite that the sample size met the requirements set in this study as described above, thedata can not be said 100% accurate due to several reasons, such as: study design that wasonly survey which prevents observing the real behavior and thoughts of the participantsand time consumption to analyze large set of data.Since this study is quantitative research, the validity of it can be assessed internally andexternally. Internal validation is assessed based on the study structure and how it is done.Here, the stated theories were measured statistically and tested according to the nullhypothesis in terms of rejecting or accepting it. Also, the external validation is donebased on results generalization and this can be done in this study for several reasons. For108instance, the study covered several facilities under UAE FHO, not only one facility aswell as the participants were selected from different specialties; clinical and non-clinicalstaff. Also, the study covered most of the healthcare services provided in the UAE as wellas 6 out of 7 emirates were involved along with the HIS Project Management Office,except for Abu Dhabi. The participants in the study were from different geographicalareas and backgrounds.In addition, the results were analyzed statistically, such as: p-value and confidenceinterval. Another reason is that participation in the study was voluntary and individual inthe targeted population had the chance to participate.Furthermore, despite that there were some rejections to participate in this study, all datawere completed as the survey was designed by indicating that all questions must beanswered unless stated optional. All surveys were checked for completion.The below table (8) depicts the statistical analysis of the study participants based on agefactor. The total number of participants from these 7 facilities was 684 from different agegroups; starting from age group of 20-29 to 60-69. The average age distribution (mean) inthis study was 39.5, which is slightly close to the median 34.5. The standard deviationwas 11.71. The confidence interval (CI) of 95% was +0.88. So, the 95% CI around themean equaled between 38.62 and 40.38.This means that the study participants’ age liesbetween 38.62 and 40.38. In another word, if the same number of this study sample weretaken from the same population, the expected age range would be someplace between38.62 and 40.38.Analysis (Age)Mean 39.5Standard Error 0.447848777Median 34.5Mode 34.5Standard Deviation 11.71276537Sample Variance 137.1888726Kurtosis -0.610373565109Skewness 0.529116441Range 40Minimum 24.5Maximum 64.5Sum 27018Count 684Largest(1) 64.5Smallest(1) 24.5Confidence Level(95.0%)0.879325687Table 8: Statistical analysis of the study participants based on age factor.The below table (9) illustrates the mean for grouped data (age factor).Age Range Midpoint Frequency Frequency XMidpoint20-29 24.5 141 3,454.530-39 34.5 256 8,83240-49 44.5 137 6,096.550-59 54.5 104 5,66860-69 64.5 46 2,967Total 684 27,018Table 9: Mean for grouped data (age factor).Mean from grouped data = Total of all frequencies X Interval Midpoints / Totalfrequencies= 27,018 / 684= 39.5Average mean age of 685 individuals in this study = 39.5, rounded to the nearest wholenumber, which will be 40 (Koch 2000).1105.5 RecommendationsThe following recommendations may aid in attaining potential benefits from theimplemented health information system (HIS) as well as in dealing with healthinformation system projects in order to have successful implementation and highadoption rate:- The UAE FHO should have a clear and comprehensive policy and regulationsrelated to health informatics that identify roles and responsibilities of parties, statethe aims of these HIS projects, terms and conditions, security measurements…etc.- Users need to be involved in all stages of these projects and advance trainings tobe provided that are not related only to using these systems, but as well sometechnical aspects, such as: data cleaning in order to minimize external supports.- Provide continuous training courses and to be accredited.- In order to avoid or minimize employees turnover consequences, proper andcomprehensive manuals and continuous trainings to be provided, particularly thatthese technologies are upgraded from time to time.- Demonstrate success stories of implemented health information systems topotential users.- Make adjustments to the implemented systems, but with caution in order to notcause overwhelming costs and workloads.- The implemented system was purchased from USA, which means the design of itis based on America’s healthcare style. This caused a lot of issues in customizingthe system to fit UAE healthcare style. If the system was self-developed, whichmeans that IT professionals from the UAE FHO with healthcare providers wereinvolved in developing the system would help more to reduce the number ofissues faced in the system as those people are more aware of the workflows. Also,number of customizations will be less, which means less time, efforts and costsfor modifications.- As part of HIS improvements, “patient portal” would be a positive tool forpatients to access their own electronic health records which is useful for111communication, completing tasks, viewing their medical conditions…etc ratherthan visiting healthcare facilitates when it is not critical that save time, resourcesand efforts for both healthcare professionals and patients themselves.5.6 Study LimitationsThe study is q
uite large as it covered 7 facilities distributed across the country whichrequires a long period of time to conduct and cover more aspects; particularly that it isaimed to cover several facilities that consist of many parties. Due to the limited timeframe, only four aspects were covered: current status of HIS, how HIS helped in redesigning patients care pathway, how HIS helped in improving health outcomes,challenges and solutions.In this study, patients’ perception about health information systems was not covered. Thestudy only covered the users of the implemented health information system and excludedthose who are not yet live with the system. Including both users and non-users will helpto evaluate different types of individuals. Also, only one data collection method wasutilized.5.7 Future WorksFurther researches to cover the following areas are required. First of all, conducting acomparison study between hospitals that are live with health information systems andthose are not yet live in order to evaluate the perceptions of staff and patients. In addition,covering both HIS users and non-users to evaluate these systems from various angelsneeds to be considered.Furthermore, there is a need to determine which type of diseases; chronic or acute aremore probable to mange and reduce its impacts when using health information systems aswell as how HIS helps in reducing healthcare costs, making decisions and reduceredundancy when ordering clinical tests and medications.Further research is needed to cover how health information systems may impactmorbidity and mortality in the region and world-wide. Also, how these systems may helpin resources management as most of the previous studies in this field focused on users’112perceptions, benefits and challenges, so resources management based on healthinformation systems is a new concept that need to be covered as well.Using other data collection methodologies, such as: focus group to study HISs andmonitor participants’ behaviors and body languages instead of utilizing the commonmethodologies, such as: interview and questionnaire.5.8 Ethical ConsiderationsThe study was conducted with no disclosure of real names of organizations, participantsand identifications. The participants’ responses were treated with respect andconfidentiality. Appropriate questions were asked to avoid participants’ resistance toanswer the questions and pre-testing step was accomplished to ensure that the questionsare appropriate and not offensive. Consent from the UAE Federal HealthcareOrganization (UAE FHO): HIS Project Management Office was obtained to conduct thisstudy. Participation in this study was optional and no one was forced to complete thesurvey. Also, to ensure confidentiality; participants’ names were optional to provide.Supervision during the survey distribution was done by the author herself with assistanceof IT Departments in the targeted facilities, so the participants may ask questions forclarifications and to make sure that no participant was forced to complete the survey.Furthermore, a letter of “To whom it may concern” was obtained from the BritishUniversity in Dubai (BUID) for the targeted organization to grant the permission forcollecting the required data. Homework help – Discussion of the study nature with the concerned parties inthe targeted organization took place to grant the permission of carrying out the study.113Chapter 6: ConclusionIn conclusion, this study covered one of the significant IT projects in the Middle East thatserves healthcare field. The project is a health information system (HIS). Data weregathered from 7 facilities distributed geographically under the UAE FHO and the numberof the study subjects who participated was 684. Current status of the implementedinformation system was evaluated. Also, two hypotheses were tested in this study relatedto patients care pathway and health outcomes as well as evaluating possible challengesand solutions to overcome these challenges. Different statistical analyses were used, suchas: p-value and confidence interval. Overall results obtained were positive andsatisfactory.Health information systems can be considered as possible improvement approaches thatassist health care providers, clinicians and non-clinical staff to provide better services inorder to add more values to healthcare field in terms of productivity, security,management…etc. However, these projects are still considered challenging and difficultto predict its outcomes as threats may suddenly appear that jeopardize projects’successfulness. No matter where, the aims of health information systems remain thesame. The aims could be different terminologically, but share the same meanings, suchas: easy access to patients’ clinical information. These new technologies hold the promiseto effectively handle unexpected situations.Organizations, decision makers and healthcare providers depending on health informationsystems to improve the quality of services provided to customers by utilizing variousinformation technologies, but they must be aware of these technologies’ limitations as itmight limit the usage and benefits of the implemented systems.Developing and implementing health information systems requires prior analysis ofvarious aspects, such as: the target organization, clinical activities, potential users, ITinfrastructure and workflows. Collaboration between concerned parties is crucial to thesuccess of the implemented system.114Hopefully, the findings of this study will help healthcare settings to manage and handlesuch projects appropriately and pay attention to essential areas.115References‘How statistically valid are your survey results’. (n.d.). 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International Journal of Medical Informatics, vol. 76 (8),August, pp. 614-620, (online ScienceDirect).125AppendicesAppendix (A): HIS Survey SampleUnited مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab EmiratesHealth Information System (HIS) Survey(All information will be kept strictly confidential)I would be very grateful if you would complete this questionnaire, which should onlytake about 15 minutes, and is concerned with studying the current implemented healthinformation system (HIS) in the United مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab Emirates Federal Healthcare Organization(UAE FHO) and how this system helped in redesigning patients’ care and improvinghealth outcomes with the challenges faced in this HIS. Your feedback is essential to usand to the success of this study.Please read through the covering letter before answering the questions in this survey.Participation in this survey in completely voluntary and all responses will be kept strictlyconfidential and treated with full respect. No real names or identifications will bedisclosed in the final report.126If you do not want to participate in this study, then please indicate that by ticking the boxto ensure that you will not be approached again regarding this study.Instructions: Put (3) in the following boxes and write your answer when it is required.All questions to be a
nswered unless it is stated “Optional”.™ Name (Optional):………………………………………………………………………™ Gender: F Male FFemale™ Age:F 20-29F 30-39F 40-49F 50-59F 60-69™ Major / Category:F Healthcare Provider (Physician or Nurse).F Medical Services (e.g. Allied Health Personnel, Pharmacy, Laboratory and RadiologySpecialist or Technician).F IT / Health Information System (HIS) Specialist.F Hospital’s Management Staff.F Other (Please Specify):………………………………………….……™ Employee ID:……………………………………………………………………..™ Organization’s Name:…………………………………………………………….™ Contact Number:………………………………………………………………….™ E-mail Address:………..…………………………………………………………..Part One: The current status of the health information system (HIS):Research Topics – CriteriaStronglyAgreeAgreeNeutralDisagreeStronglyDisagreeNotApplicableComments(Optional)1271- The implemented HIS enhancesthe quality of the work andservices provided to customers(e.g. patients).2- The system provides the requiredinformation when needed.3- The system is reliable.4- The system is easy to use andflexible.5- The implementation of thesystem was successful.6- The system is user-friendly.7- The system includes almost allthe services provided to patientswithin the facility (e.g.laboratory, radiology, surgeryand billing).8- Overall, the system issatisfactory.Part Two: The current health information system (HIS) can help inre-designing patients’ care pathway:Research Topics – CriteriaStronglyAgreeAgreeNeutralDisagreeStronglyDisagreeNotApplicableComments(Optional)1- This HIS facilitates a patient’sjourney in the hospital; since thepatient enters the facility till128leaving it.2- Allows reviewing patients’progress notes.3- Facilitates documenting patients’care.4- Acquires and analyzes radiologyresults.5- Acquires and analyzes lab tests’results.6- Acquires and analyzes otherresults.7- This HIS helps in simplifyingsupporting processes, such asbilling.8- Allows taking decisions bycommunicating with specialistsremotely.9- Promoting security andconfidentiality.10- Promoting patients’ satisfaction.11- The system facilitates unifyinghealthcare processes across allhospitals under the UAE FederalHealthcare Organization.12- Overall, the system helped inredesigning patients’ carepathway.129Part Three: The current health information system (HIS) can improvehealth outcomes for patients:Research Topics – Criteria ScaleDiagnosis and Medical Care:StronglyAgreeAgreeNeutralDisagreeStronglyDisagreeNotApplicableComments(Optional)1- The process of generatingreports via the system is easy(e.g. statistics about a specificdisease).2- The system allows having acomprehensive picture about apatient that helps in diagnosingproblems sooner.3- The system allows gathering allinformation related to a patientin one place (e.g. lab results andradiology reports) that helps inmaking therapeutic decisions.4- This HIS helps to track patients’care progress.5- The tests results are reliable forhealthcare providers to takedecisions about patients’conditions.6- The system allows viewing drugformulary information.7- This HIS allows to access and130view patients’ assessments easilyand quickly.8- The system has the option tosend reminders to healthcareproviders (e.g. surgeriesappointments and nurses to givemedications to inpatients).9- The implementation of suchsystems helped in diagnosingmedical conditions at earlierstage.Discern Alerts:StronglyAgreeAgreeNeutralDisagreeStronglyDisagreeNotApplicableComments(Optional)1- The system sends alerts aboutincomplete tasks andinformation.2- Receiving patients’ allergyhistory alerts.3- Receive drugs interactions alertswhen prescribing medications.4- Receiving drugs allergy alertswhen prescribing medications.Other:StronglyAgreeAgreeNeutralDisagreeStronglyDisagreeNotApplicableComments(Optional)1- Patients’ registration orscheduling appointmentprocesses take maximum1315 minutes per patient.2- Tests’ results are transferredcorrectly from devices to theHIS. This means that there is noneed for double work to enterdata from devices to the HIS.3- The system is integratedsuccessfully with other devices(e.g. lab machines).4- The number of errors isdecreased compared to themanual system.5- The system generates reports forplanning and research.6- The system improvesdocumentation process andcoding system.7- The system reduces the waitingtime for patients.8- The system has the option tosend reminders to patients abouttheir appointments.9- Ability to analyze theperformance of different sectionsat the facility.10- Simply obtaining required datafor various reasons, such as:diagnosis and planning.11- Overall, the system helped inimproving patients’ healthoutcomes.132Part Four (a): The challenges faced in this (HIS) ( You may select more than oneanswer if needed):… Inadequacy of training and support during the implementation of the system.… Difficulty of the system layout and format (e.g. terminologies).… Technical problems (e.g. unscheduled system downtime).… Time consumption while using the system compared to the manual system (paper-based form).… User acceptance of the new system.… Other (Please Specify):…………………………………………………………………………………..Part Four (b): Possible solutions to overcome the challenges in this (HIS)(You may select more than one answer if needed):… Additional training to be provided.… Extending support period.… Simplifying the system layout, format and design which include using simple terminologies.… Rewards and penalties strategy for the system’s users.… Other (Please Specify):………………………………………………………………………………Further comments and recommendations (Optional):End of the surveyThank you for your time and cooperation.___________________________________________________For any enquires regarding this questionnaire, please contact: Shaikha Abdool, E-mail:shaikha.abdool@hotmail.com, Contact #: 050-3071177133Figure 14: Al-Fujairah Hospital system satisfactory.Figure 13: Al-Fujairah Hospital HIS current status..Appendix (B): Al-Fujairah Hospital Figures0102030405060708090# of ParticipantsResearch Topics – CriteriaAl-Fujairah Hospital: HIS Current StatusStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable20%45%19%9%7%0%Al-Fujairah Hospital: SystemSatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable134Figure 15: Al-Fujairah Hospital HIS for re-designing patients’ care pathway..0102030405060708090100# of ParticipantsResearch Topics – CriteriaAl-Fujairah Hospital: HIS for Re-designing Patients CarePathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable135Figure 16: Al-Fujairah Hospital HIS helped in re-designing patients’ care pathway..28%49%17%3% 3% 0%Al-Fujairah Hospital: HIS Re-designedPatients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable136Figure 17: Al-Fujairah Hospital HIS for diagnosis and medical care.0102030405060708090# of ParticipantsResearch Topics – CriteriaAl-Fujairah Hospital: Improving Health Outcomes -Diagnosis and Medical CareStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable137Figure 18: Al-Fujairah Hospital HIS for diagnosis and medical care at earlier stage.Figure 19: Al-Fujairah Hospital discern alerts.23%46%15%7%6%3%Al-Fujairah Hospital: HIS Helped inDiagnosis at Earlier StageStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable0102030405060708090Sends alertsabout incompletetasks andinformationAlerts aboutobtainingpatients’ allergyhistoryAlerts aboutdrugsinteractionsAlerts about drugallergy whenprescribingmedications# of ParticipantsResearch Topics – CriteriaAl-Fujairah Hospital: Improving HealthOutcomes – Discern AlertsStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable138Figure 20: Al-Fujairah Hospital HIS for improving patients’ health outcomes.0102030405060708090# of ParticipantsResearch Topics – CriteriaAl-Fujairah Hospital: Improving Health Outcomes -Other AreasStrongly AgreeAgreeNeutra
lDisagreeStrongly DisagreeNot Applicable139Figure 21: Al-Fujairah Hospital HIS helped in improving patients’ health outcomes.Figure 22: Al-Fujairah Hospital HIS challenges.504329 30 27 00102030405060Inadequatetraining andsupportingLayout andformattingdifficulty ofthe systemTechnicalproblemsTimeconsumptioncompared tothe paperbased formUserAcceptanceOther# of ParticipantsResearch Topics – CriteriaAl-Fujairah Hospital: Challenges in theHIS34%47%9%6%3%1%Al-Fujairah Hospital: HIS Helped inImproving Health OutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable140Figure 23: Al-Fujairah Hospital HIS solutions for challenges.59 6833 27 001020304050607080More training Extendingsupport periodSimplifying thesystem layout,format anddesignReward andpenalty strategyOther# of ParticipantsResearch Topics – CriteriaAl-Fujairah Hospital: Solutions for theChallenges141Figure 24: Dubai Hospital HIS current status..Figure 25: Dubai Hospital system satisfactory..Appendix (C): Dubai Hospital Figures01020304050607080# of ParticipantsResearch Topics – CriteriaDubai Hospital: HIS Current StatusStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable34%47%15%4%0% 0%Dubai Hospital: System SatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable142Figure 26: Dubai Hospital HIS for re-designing patients’ care pathway..01020304050607080# of ParticipantsResearch Topics – CriteriaDubai Hospital: HIS for Re-designing Patients CarePathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable143Figure 27: Dubai Hospital HIS helped in re-designing patients’ care pathway..31%54%15%0% 0% 0%Dubai Hospital: HIS Re-designedPatients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable144Figure 28: Dubai Hospital HIS for diagnosis and medical care.Figure 29: Dubai Hospital HIS for diagnosis and medical care at earlier stage.01020304050607080# of ParticipantsResearch Topics – CriteriaDubai Hospital: Improving Health Outcomes – Diagnosisand Medical CareStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable30%52%15%0% 0% 3%Dubai Hospital: HIS Helped in Diagnosis atEarlier StageStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable145Figure 30: Dubai Hospital discern alerts.Figure 31: Dubai Hospital HIS for improving patients’ health outcomes.010203040506070Sends alertsabout incompletetasks andinformationAlerts aboutobtainingpatients’ allergyhistoryAlerts aboutdrugsinteractionsAlerts about drugallergy whenprescribingmedications# of ParticipantsResearch Topics – CriteriaDubai Hospital: Improving Health Outcomes -Discern AlertsStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable010203040506070# of ParticipantsResearch Topics – CriteriaDubai Hospital: Improving Health Outcomes – Other AreasStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable146Figure 32: Dubai Hospital HIS helped in improving patients’ health outcomes.Figure 33: Dubai Hospital HIS challenges.26%50%20%0% 2%2%Dubai Hospital: HIS Helped in ImprovingHealth OutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable39251926200501015202530354045Inadequatetraining andsupportingLayout andformattingdifficulty ofthe systemTechnicalproblemsTimeconsumptioncompared tothe paperbased formUserAcceptanceOther# of ParticipantsResearch Topics – CriteriaDubai Hospital: Challenges in the HIS147Figure 34: Dubai Hospital HIS solutions for challenges.35 40 33220501015202530354045More training Extendingsupport periodSimplifying thesystem layout,format anddesignReward andpenalty strategyOther# of ParticipantsResearch Topics – CriteriaDubai Hospital: Solutions for the Challenges148Figure 35: RAK Hospital HIS current status..Figure 36: RAK Hospital system satisfactory..Appendix (D): Ras Al-Khaimah (RAK) Hospital Figures0102030405060# of ParticipantsResearch Topics – CriteriaRas Al-Khaimah Hospital: HIS Current StatusStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable35%52%5%4% 4% 0%Ras Al-Khaimah Hospital: SystemSatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable149Figure 37: RAK Hospital HIS for re-designing patients’ care pathway..0102030405060# of ParticipantsResearch Topics – CriteriaRas Al-Khaimah Hospital: HIS for Re-designing PatientsCare PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable150Figure 38: RAK Hospital HIS helped in re-designing patients’ care pathway..44% 37%12%7%0% 0%Ras Al-Khaimah Hospital: HIS Redesigned Patients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable151Figure 39: RAK Hospital HIS for diagnosis and medical care.50101520253035404550# of ParticipantsResearch Topics – CriteriaRas Al-Khaimah Hospital: Improving HealthOutcomes – Diagnosis and Medical CareStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable15231%57%8%4% 0% 0%Ras Al-Khaimah Hospital: HIS Helpedin Diagnosis at Earlier StageStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot ApplicableFigure 40: RAK Hospital HIS for diagnosis and medical care at earlier stage.Figure 41: RAK Hospital discern alerts.0102030405060Sends alertsaboutincompletetasks andinformationAlerts aboutobtainingpatients’ allergyhistoryAlerts aboutdrugsinteractionsAlerts aboutdrug allergywhenprescribingmedications# of ParticipantsResearch Topics – CriteriaRas Al-Khaimah Hospital: Improving HealthOutcomes – Discern AlertsStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable153Figure 42: RAK Hospital HIS for improving patients’ health outcomes.0102030405060# of ParticipantsResearch Topics – CriteriaRas Al-Khaimah Hospital: Improving Health Outcomes -Other AreasStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable154Figure 43: RAK Hospital HIS helped in improving patients’ health outcomes.Figure 44: RAK Hospital HIS challenges.31%50%8%11%0%0%Ras Al-Khaimah Hospital: HISHelped in Improving HealthOutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable3017 18 12 7 150101520253035Inadequatetraining andsupportingLayout andformattingdifficulty ofthe systemTechnicalproblemsTimeconsumptioncompared tothe paperbased formUserAcceptanceOther# of ParticipantsResearch Topics – CriteriaRas Al-Khaimah Hospital: Challenges in theHIS155Figure 45: RAK Hospital HIS solutions for challenges.3630167 05010152025303540More training Extendingsupport periodSimplifying thesystem layout,format anddesignReward andpenalty strategyOther# of ParticipantsResearch Topics – CriteriaRas Al-Khaimah Hospital: Solutions for theChallenges156Figure 46: Sharjah Hospital HIS current status..Figure 47: Sharjah Hospital system satisfactory..Appendix (E): Sharjah Hospital Figures.01020304050607080# of ParticipantsResearch Topics – CriteriaSharjah Hospital: HIS Current StatusStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable34%42%16%3% 5% 0%Sharjah Hospital: SystemSatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable157Figure 48: Sharjah Hospital HIS for re-designing patients’ care pathway..Figure 49: Sharjah Hospital HIS helped in re-designing patients’ care pathway…01020304050607080# of ParticipantsResearch Topics – CriteriaSharjah Hospital: HIS for Re-designing Patients’ CarePathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable30%55%8%3% 2% 2%Sharjah Hospital: HIS Re-designedPatients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable158Figure 50: Sharjah Hospital HIS for diagnosis and medical care.010203040506070# of ParticipantsResearch Topics – CriteriaSharjah Hospital: Improving Health Outcomes -Diagnosis and Medical CareStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable159Figure 51: Sharjah Hospital HIS helped in diagnosis at earlier stage.Figure 52: Sharjah Hospital discern alerts.38%48%9%1%2% 2%Sharjah Hospital: HIS Helped in diagnosisat earlier stageStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable01020304050607080Sends alertsabout incompletetasks andinformationAlerts aboutobtainingpatients’ allergyhistoryAlerts aboutdrugsinteractionsAlerts about drugallergy whenprescribingmedications# of ParticipantsResearch Topics – CriteriaSharjah Hospital: Improving Health Outcomes -Discern AlertsStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable160Figure 53: Sharjah Hospital HIS for improving patients’ health outcomes.Figure 54: Sharjah Hospital HIS helped inimproving patients’ health outcomes.01020304050607080# of ParticipantsResearch Topics – CriteriaSharjah Hospital: Improv
ing Health Outcomes – OtherAreasStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable38%51%7%2% 2% 0%Sharjah Hospital: HIS Helped inImproving Health OutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable161Figure 55: Sharjah Hospital HIS challenges.Figure 56: Sharjah Hospital HIS solutions for challenges.40332118 160501015202530354045Inadequatetraining andsupportingLayout andformattingdifficulty ofthe systemTechnicalproblemsTimeconsumptioncompared tothe paperbased formUserAcceptanceOther# of ParticipantsResearch Topics – CriteriaSharjah Hospital: Challenges in the HIS435613 15 00102030405060More training Extendingsupport periodSimplifying thesystem layout,format anddesignReward andpenalty strategyOther# of ParticipantsResearch Topics – CriteriaSharjah Hospital: Solutions for theChallenges162Figure 57: UAQ Hospital HIS current status..Figure 58: UAQ Hospital system satisfactory..Appendix (F): Um Al-Qwain (UAQ) Hospital Figures50101520253035404550# of ParticipantsResearch Topics – CriteriaUm Al-Qwain Hospital: HIS Current StatusStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable27%57%7%5% 4% 0%Um Al-Qwain Hospital:System SatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable163Figure 59: UAQ Hospital HIS for re-designing patients’ care pathway..Figure 60: UAQ Hospital HIS in re-designing patients’ care pathway..0102030405060# of ParticipantsResearch Topics – CriteriaUm Al-Qwain Hospital: HIS for Re-designing Patients’ CarePathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable52%37%7%4% 0% 0%Um Al-Qwain Hospital: HIS Redesigned Patients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable164Figure 61: UAQ Hospital HIS for diagnosis and medical care.Figure 62: UAQ Hospital HIS for diagnosis and medical care at earlier stage.5 01015202530354045# of ParticipantsResearch Topics – CriteriaUm Al-Qwain Hospital: Improving HealthOuctomes – Diagnosis and Medical CareStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable44%38%8%7% 3% 0%Um Al-Qwain Hospital: HIS Helped in Diagnosisat Earlier StageStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable165Figure 63: UAQ Hospital discern alerts.0102030405060Sends alertsabout incompletetasks andinformationAlerts aboutobtainingpatients’ allergyhistoryAlerts aboutdrugsinteractionsAlerts about drugallergy whenprescribingmedications# of ParticipantsResearch Topics – CriteriaUm Al-Qwain Hospital: Improving HealthOuctomes – Discern AlertsStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable166Figure 64: UAQ Hospital HIS for improving patients’ health outcomes.Figure 65: UAQ Hospital HIS helped in improving patients’ health outcomes.0102030405060# of ParticipantsResearch Topics – CriteriaUm Al-Qwain Hospital: Improving HealthOuctomes – Other AreasStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable33%47%9%11% 0% 0%Um Al-Qwain: HIS Helped inImproving Health OutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable167Figure 66: UAQ Hospital HIS challenges.Figure 67: UAQ Hospital HIS solutions for challenges.302012 10 9 050101520253035Inadequatetraining andsupportingLayout andformattingdifficulty ofthe systemTechnicalproblemsTimeconsumptioncompared tothe paperbased formUserAcceptanceOther# of ParticipantsResearch Topics – CriteriaUm Al-Qwain Hospital: Challenges in theHIS25 2713 150501015202530More training Extendingsupport periodSimplifying thesystem layout,format anddesignReward andpenalty strategyOther# of ParticipantsResearch Topics – CriteriaUm Al-Qwain Hospital: Solutions for theChallenges168Figure 68: PMO HIS current status..Figure 69: PMO HIS satisfactory..Appendix (G): HIS Project Management Office (PMO) Figures876543210# of ParticipantsResearch Topics – CriteriaProject Management Office (PMO): HIS CurrentStatusStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable33%67%0%0% 0%0%Project Management Office(PMO): System SatisfactoryStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable169Figure 70: PMO HIS for re-designing patients’ care pathway..9 8 7 6 5 4 3 2 1 0# of ParticipantsResearch Topics – CriteriaProject Management Office (PMO): HIS for Re-designingPatients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable170Figure 71: PMO HIS helped in re-designing patients’ care pathway..33%67%0%0% 0% 0%Project Management Office (PMO): HISRe-designed Patients’ Care PathwayStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable171Figure 72: PMO HIS for diagnosis and medical care.8 7 6 5 4 3 2 1 0# of ParticipantsResearch Topics – CriteriaProject Management Office (PMO): ImprovingHealth Ouctomes – Diagnosis and Medical CareStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable172Figure 73: PMO HIS for diagnosis and medical care at earlier stage.Figure 74: PMO HIS discern alerts.0%56%0%22%22%0%Project Management Office (PMO):HIS Helped in Diagnosis at EarlierStageStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable6 5 4 3 2 1 0Sends alerts aboutincomplete tasksand informationAlerts aboutobtaining patients’allergy historyAlerts about drugsinteractionsAlerts about drugallergy whenprescribingmedications# of ParticipantsResearch Topics – CriteriaProject Management Office (PMO): ImprovingHealth Ouctomes – Discern AlertsStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable173Figure 75: PMO HIS for improving patients’ health outcomes.7 6 5 4 3 2 1 0# of ParticipantsResearch Topics – CriteriaProject Management Office (PMO): ImprovingHealth Ouctomes – Other AreasStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable174Figure 76: PMO HIS helped in improving patients’ health outcomes.Figure 77: PMO HIS challenges.33%67%0% 0% 0% 0%Project Management Office (PMO): HISHelped in Improving Health OutcomesStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeNot Applicable76543210Inadequatetraining andsupportingLayout andformattingdifficulty ofthe systemTechnicalproblemsTimeconsumptioncompared tothe paperbased formUserAcceptanceOther# of ParticipantsResearch Topics – CriteriaProject Management Office (PMO):Challenges in the HIS175Figure 78: PMO HIS solutions for challenges.8 6 4 2 010More training Extendingsupport periodSimplifying thesystem layout,format anddesignReward andpenalty strategyOther# of ParticipantsResearch Topics – CriteriaProject Management Office (PMO):Solutions for the Challenges176Table 7: Sample size.(Adapted from “How statistically valid are your survey results” n.d.).Appendix (H): Results Validity

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