HIS Implementation in Small Hospital

Background: Budi Rahayu Hospital at Magelang City has implemented HIS in partnership with the SIMKES FKKMK laboratory of Gadjah Mada University since April 2021. During the initial four months of implementation, Budi Rahayu Hospital experienced various challenges. For understanding and overcome the challenges, it is necessary to construct a strategy of HIS implementation, and then offer a proper recommendation based on study.Methods: This study is a descriptive qualitative with action research design that describe four stages of action research i.e Diagnosing, Planning, Action, and Evaluation. On the Diagnosing stage, Author arrange an interview and discussion with Hospital Team. Next, Author plan a strategy to generate suitable recommendations for the successful implementation of HIS. In the Action stage, author conduct an implementation review and assistance. Author also manage an UAT as a evaluation stage distributed to respondents using a questionnaire. The study is performed by observing of HIS implementation from September – December 2021. The subject of this study is chosen purposively from departments involved, with total 20 end-users respondents on multiple service units to capture data in a real environtment when HIS is used for healthcare services to patients.Results: Strategic actions for smooth implementation is active involvements and collaboration from developer team and hospital team monitored by regional health services. the hospital team and developer team formed an online communication group as a place to discuss the problems encountered. There are monitoring activities that involved by regional health services, so the timeline that has been set runs according to the target and the hospital gets optimal benefits of HIS implementation. System acceptance is important for the further development of  HIS. The score of HIS acceptance at Budi Rahayu Hospital is 70% based on 85% scenario that execute successfully. Based on system performance, continues maintenance and communication among implementation team, HIS can be accepted with condition of continuous improvement and adjustment.Conclusions: Active involvements and collaboration from developer team and hospital team, performance improvement and availability of the system is very crucial for user acceptance, satisfaction and overall success of HIS implementation. Keywords: HIS, Implementation, UA

Development of implementation models for hospital information system (HIS) in Malaysian public hospitals

Studies have shown that Hospital Information System (HIS) implementation improve hospital’s management and activities in terms of cost and time reductions. However, there are only 15.2% out of 138 Malaysian Public Hospitals implemented HIS. Literatures have further highlighted various issues and challenges with regards to its implementation. Therefore, this study aimed to explore the implementation of THIS, IHIS and BHIS’s hospitals as well as factors affecting them. This study employed a mixed methods approach to answer the research objectives. In the first phase of this study, semi-structured interviews were conducted with nine participants consisted of the hospital directors, Information Technology officers and HIS users. It is found that THIS’s hospital implementation phases differed from IHIS and BHIS’s hospitals, while IHIS and BHIS’s hospitals have similar phases based on Business Interaction Phases of Business Action Theory. Human context was discovered to play important roles in the HIS implementation. A survey was conducted in the second phase of this study among HIS users at different categories of HIS’s hospitals. Two hundred and twenty-nine questionnaires were returned to yield a response rate of 45.8%. Based on ANOVA findings, factors affecting THIS implementation were significantly different from those in IHIS and BHIS’s hospitals. There was no significance different between IHIS and BHIS’s hospitals. There are three major contributions of this study: 1) Distinctive implementation phases for THIS hospital and IHIS-BHIS hospital were discovered for HIS implementation. 2) New models of HIS implementation which highlight the Human context were proposed, and 3) Different factors were found to affect HIS implementation at different types of HIS’s hospitals

The perception of primary health care's physicians in adoption of electronic health record-Timor Leste

Introduction: Electronic health record becomes the 21st-century innovation trend in developing countries. This digital system provides accurate, real data in real-time access, decreases paper-based documentation, enables access to patient’s previous health status and easy for follow-up, reduces of health status duplication and, allows accessible data sharing among health professionals in the primary health care setting. Purpose: This research aimed to identify and understand the perceptions of primary health care physicians in adopting the electronic health record in the Timor Leste context, specifically to identify benefit, barrier, and satisfaction of this system. Method: A cross-sectional online questionnaire survey was based on the study objectives administered to the medical doctor in primary health care level in Timor Leste who, received an electronic health record training and had an opportunity to utilize in the period between 2015 to 2017. The form was composed of 4 sections (sociodemographic information, benefit, barrier, and satisfaction), rated on a five-point Likert-scale. The samples were calculated by G*Power 3.1.9.4. The reliability was tested by Cronbach’s alpha. The statistical analysis with α= .05, CI= 95%. Result: The online questionnaire was distributed among 193 general physicians with, 84.5% responded rates. Most of the participants had young ages that acknowledge the importance of EHR in the primary health care sector. The majority perceived the most benefit of the EHR: decreased paper-based documentation, facilitated accessibility to patient data recorded previously, provided real-time data access, and reduction on health data duplication. However, barriers remain on the eHealth system indicated by a medical doctor, such as the necessity of frequent revision to technological development, compatibility of web browser, connectivity, and cost in adopting it. Overall, the physician in primary care settings perceived satisfaction toward the digital system. The eHealth was useful, appropriate, and essential for their work area, improved patient safety, elevated quality care, and enabled better communication among health professionals. There were statistically significant differences among ages toward benefit, the ability to use computer toward barrier and place using computer toward satisfaction of EHR usage. The positive slope of the benefit (β= .498; t= 11.361), had a statistically significant predictor on satisfaction on EHR implementation but barrier had negative statistical significance toward satisfaction (β = -.086; t= -1.794). The adjusted (R2= 51.0%). Conclusion: The satisfaction of EHR was influenced by the benefit perceived while utilizing the system and reducing the barrier. Political commitment, financial support, friendly user application, improved quality of internet connection and had a positive attitude toward EHR were crucial for successful implementation.open석

Health Economic Analysis of China’s Health Insurance System

This thesis consists of 3 chapters plus an introductory chapter and a concluding chapter. They are on three different topics, but they are all related to China’s health insurance system from 2000 to 2011. Chapter 1 is the introduction to the thesis, providing background to the Chinese insurance system, the theoretical underpinning of the three chapters, a description of the datasets used in the thesis, and an overview of the thesis. Chapter 2 investigates whether there is adverse or advantageous selection in China’s private health insurance market before 2003. We found evidence in favour of adverse selection in a pure private insurance market. For the public insurance group where people already got covered by a public insurance but face the choice of buying a supplementary private insurance, we found advantageous selection. Chapter 3 examines whether implementing nearly universal coverage in 2009 led to a decrease in individual preventive behaviour prior to illness, termed ex-ante moral hazard. We exploit the longitudinal dimension of data from 2006 and 2009 and use Coarsened Exact Matching methods. The results do not provide strong evidence for ex-ante moral hazard. Chapter 4 aims at evaluating whether there is ex-post moral hazard after the introduction of universal coverage. We measured ex-post moral hazard as the impact of co-payment rate on treatment cost, to assess the variation of total medical expenditure to patients due to the decrease of price. We conclude that there is ex-post moral hazard in outpatient services after the reform of universal coverage in China. Chapter 5 is the concluding chapter, including a summary of the findings, policy implications, strength and limitations of the thesis, and challenges for future research