Informatics in Medicine Unlocked 9 (2017) 200–209

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Informatics in Medicine Unlocked

journal homepage: www.elsevier.com/locate/imu

Surveying the influence of laboratory information system: An

end-user perspective
Bakheet Aldosari *, Hisham A. Gadi, Abdullah Alanazi, Mowafa Househ
Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: The goal of the present survey is to investigate the effect of the Laboratory Information System (LIS)
Laboratory information system (LIS) among users in a tertiary healthcare facility in Saudi Arabia.
Health information systems (HIS) Methods: The current cross-sectional descriptive study was carried out at the National Guard laboratory depart-
End-users perception ment of KAMC in Riyadh. All the active users of LIS at the laboratory department were included in the study. A
KAMC total of 427 questionnaires were distributed of which 268 were returned completed. The response rate was
Saudi Arabia
62.76%. The study instrument was developed to examine the effect of LIS on end-users based on five interrelated
variables; External Communication, Service Outcomes, Personal Intentions, Personal Hassles, and Increased
Blame. Descriptive statistics, Pearson's correlation, and ANOVA were used to analyze the data.
Results: The users had a general positive perception towards the LIS system. A statistically significant relationship
between user characteristics and External Communication, Service Outcomes, Personal Hassles and Increased
Blame variables exists. The results showed a strong positive correlation between External Communication and
Service Outcomes variables and it showed a moderate positive correlation between Personal Hassles and
Increased Blame variables.
Conclusions: Overall, the study participants demonstrated a positive attitude towards the LIS on personal basis and
on the basis of their daily work routine. It is a good implication of LIS success in health care sector and paves the
way for incorporation of more advanced and efficient LIS system in the future.

1. Introduction
1.1. Background
The main purpose of establishing a medical laboratory is to conduct
the diagnostic tests to primarily diagnose the disease and analyze the
treatment outcome, thus aiding in prevention of diseases. The laboratory
information system (LIS) is a software system for managing, processing,
reporting, and storing laboratory information to deliver meaningful re-
sults within a stipulated time as needed by the doctors or lab technicians
[1]. In recent years, LIS has become a necessity of every laboratory. It not
only elevates the capacities of the clinical laboratories, but also reduces
the diagnostic errors and the time required for reporting results, thus
enhancing the decision making process leading to better treatment and
diagnostic outcomes [1–4]. Wurtz and Cameron [5] reported that LIS
usage while reporting and conveying results ameliorated the legal threats
by assuring the preciseness, completeness, and accuracy of the re-
ported results.
The LIS-based studies usually focused on assessing the software per-
formance and quality as a diagnostic and decision support tool in medical
laboratories. Considering all the studies, a significant number empha-
sized on examining the overall performance and quality of the LIS system
itself. Nonetheless, only few studies contemplated investigating the LIS
system's effect on users. The laboratory staffs not only use LIS but also
interact maximally with it to certify and pass on the results to other
physicians. Hence, the commencement of the LIS technology was asso-
ciated with higher expectations of in terms of good laboratory manage-
ment, better decision making capacities and improved overall
functioning of the medical organizations. The most crucial impact of LIS
is that it brings all the cadres of people working in a hospital under one
roof when it comes to gaining an access to accurate, appropriate, un-
derstandable, and comparative data [6]. This positive attitude also favors
increased usage of LIS by the hospital staffs [7,8]. This positive attitude
can be acquired only if the system does not brings in much of changes in
the work environments of the laboratory staffs including technical, so-
cial, and organizational factors. Nonetheless, introducing a new and

* Corresponding author.
E-mail address: bakheet.dosari@gmail.com (B. Aldosari).

https://doi.org/10.1016/j.imu.2017.09.002
Received 20 June 2017; Received in revised form 28 August 2017; Accepted 11 September 2017
Available online 14 September 2017
2352-9148/© 2017 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
B. Aldosari et al.
advanced technology has an effect on the clinical. Oborn and Barrett [9],
as well as Hill et al., [10] established that digitalization of information
has bought in fear among many clinical workers about losing their po-
sition and authority. This switch of power and control from laboratory
personnel has been a source of continuous concern for the LIS users.
Rather than considering LIS as a tool for complementing their role in
healthcare organization, the laboratory personnel have an impression
that their role is compromised by digitalization [11]. Therefore, it is
necessary to understand the perceptions and perspectives of the LIS-users
to describe its impact on them.
Delone and McLean [12] have determined the six main factors that
regulate the success of information systems. The most important factor
among them is the effect of the system on its users. According to Kaplan
[13], the effect of LIS is largely based on the system outcomes.
Ammenwerth et al. [14] and Carayon et al. [15] mentioned that by
endorsing digitalization of information in a health care organization,
significant changes is introduced in the workflow and users tasks.
Vogelsmeier et al. [16] pointed out that when the system's users find the
software complicated and inefficient, they look for alternative ways for
accomplishing their assigned tasks rather than struggling with the system
itself, thus. causes annoyance among the users [17]. In addition, intro-
duction of a technology can influence the users' performance leading to
personal frustrations and dislike for the system and limiting the system
usage if the users' requirements were not taken into account during
implementation [18–20]. Additionally, Peute and Jaspers [21] identified
that usability issues, such as paucity in the users involvement while
adoption of the system, can negatively affect the users performance, ul-
timately causing failure of the system.
Numerous studies have indicated that the anticipated overall ad-
vantages of LIS determine the users' attitudes towards it. Higher are the
benefits, greater is the acceptance level and intention to use [22–24]. In
fact, the perceived notion about system's ease of use and elevation in the
task performance of the working staff acts as a motivation for using the
information system [25,26]. Therefore, examining the effect of LIS sys-
tems on its users will impart us a clear view on the interaction between
user and the software system which will aid in identifying and over-
coming any shortcomings in attaining the expected benefits while
implementing the information system. Therefore, we aimed to explore
the effect of LIS on the laboratory personnel at King Abdul-Aziz Medical
City in Riyadh.
1.2. Goal of the study
The purpose of the current study is to investigate the status of LIS
impact among end users at the laboratory department in KAMC. It will
also try to explore whether there is a relationship between user charac-
teristics and the studied impact variables. The main research question for
this study is, “What type of impact does laboratory information system
(LIS) has on its intended users in the laboratory department?”
1.3. Objectives

Examining the effect of LIS on its end-users and analyzing their
performances.

Investigating the factors that affect the LIS-users in the laboratory
environment.

Finding a correlation between the users' characteristics and the var-
iables affecting LIS usage.
2. Methodology
2.1. Study setting
The present study was carried out at the Department of Pathology &
Laboratory Medicine, King Abdul-Aziz Medical City (KAMC), Riyadh
from 13th May 2015 till 28th May 2015. Currently, KAMC is having the
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Informatics in Medicine Unlocked 9 (2017) 200–209
capacity of 1200 beds in total and approximately 3 million outpatient
visits a year, making it the most prominent hospital of the Middle East.
Moreover, the Department of Laboratory Medicine is internationally
accredited by the College of American Pathologists (CAP) and the
American Association of Blood Banks (AABB).
2.2. Participants
The target population included all the laboratory personnel working
at KAMC, Riyadh who are using LIS routinely in their medical practice
during the study period. The users approached in this study are all lab-
oratory department personnel who are working in the laboratory and
who are using the LIS in their daily practice. They are approached to test
their perception towards LIS impact on their daily work and on their
personal perception toward the system in general. In total, 427 LIS users
were approached to participate in the study.
2.3. Study design
The present study is designed as a descriptive cross-sectional research
and uses a survey-based method to collect data.
Based on the study of J. Anderson, C. Aydin, and B. Kaplan, the
current survey includes five features that estimate the effect of LIS on
laboratory staff [27]. These features help in evaluating the users' view-
point about LIS. They are external communications, service outcomes,
personal hassles, increased blame and personal intentions. Furthermore,
association between users' perceptions toward system and demographic
variables such as gender, age, work experience, area of work, academic
qualification, job position, LIS training, computer experience, and time
using LIS will be determined as well.
The LIS users opinion regarding various aspects of LIS was collected
using a questionnaire adopted from the work of Kaplan and Duchon
[28,29]. The questionnaire was developed for assessing the Laboratory
Computer System. The questionnaire was modified and updated to
include the current laboratory work. The study instrument was given to
four laboratory technicians and one pharmacist working at KAMC to
check the accuracy of the statements and to bring out any ambiguity in
the questionnaire statements before beginning the survey. After receiving
the feedback, few modifications were incorporated to the statements. The
questionnaire includes 37 questions which is categorized into
different parts:

The first part deals with demographic and background information of
the participants and consists of 9 questions.

The second part enlists the user responses on the variables influencing
the impact of LIS on users. The responses were recorded on five point
Likert scale ({Strongly Agree (SA), Agree (A), Neutral (N), Disagree
(D) and Strongly Disagree (SD)}). This section is further sub-divided
to contain:

Three questions related to external communication.

Six questions on service outcomes.

Two questions on personal intentions.

Eight questions related to personal hassles.

Nine questions on assessing user blame.
The questionnaires were distributed in paper-based format to the
participants. Each questionnaire had a cover page which gives a brief
description about the study goal along with the assurance of confiden-
tiality and privacy of the participants' information. The following scale
was used to convert the Likert scale responses to level of user agreement:
1–1.8 strongly disagree, >1.8–2.6 disagree, >2.6–3.4 neutral, >3.4–4.5
agree, >4.5 strongly agree [30].
2.4. Data analysis
The data analysis is based on Cronbach Alpha test to check for the
B. Aldosari et al. Informatics in Medicine Unlocked 9 (2017) 200–209

reliability and internal consistency of the study variables. When the Table 1
reliability scores are acceptable and satisfactory the rest of the analysis Demographics of the respondents.

process is continued. Also, the descriptive statistics are used to identify Demographics
demographic and response characteristics of study participants. The total Gender (N ¼ 268)
mean and standard deviation are calculated for each of the study vari- Male 125 46.6%
ables to use with the remaining analytical tests. Then Pearson correlation Female 143 53.4%
test was used to examine the strength and significance of relationship Total 268 100%
Age (years) (N ¼ 268)
between LIS impact variables. Later, the analysis of Variance (ANOVA) Less than 30 Years 96 35.8%
test was applied to examine the relationship between LIS user's charac- 31–40 Years 119 44.4%
teristics and LIS impact variables to identify if there were any relation- 41–50 Years 41 15.3%
ship between the impact variables and user characteristics towards the Above 50 Years 12 4.5%
Total 268 100%
LIS impact on their work. The analysis has been explained in
Degree of Qualification LIS (N ¼ 268)
detail below. Associate Degree 9 3.4%
Two hundred and ninety eight questionnaires were collected out of a Bachelor 239 89.2%
total 427 questionnaire with an initial response rate of 69.78%. After Master 15 5.5%
collecting all the questionnaires, they were analyzed for data integrity Doctorate 5 1.9%
Total 268 100%
and accuracy. Thirty questionnaires were discarded due to missing in- Years Of Experience With LIS (N ¼ 268)
formation, duplicate responses or response bias (i.e. choosing neutral to Less than 2 years 103 38.4%
all responses). After reviewing the questionnaires, the total number of 2 to 5 years 75 28.0%
questionnaires included in the analysis was 268, which represents 5 to 10 years 62 23.2%
More than 10 years 28 10.4%
62.76% of the total number distributed. The exclusion criteria mentioned
Total 268 100%
in data analysis section (missing information, duplicate answers and Current Job Position (N ¼ 268)
obvious response bias) led 30 questionnaires to be discarded resulting in Dept. Supervisor 14 5.2%
actual, acceptable questionnaires rate of 62.76%. Statistical Package for Laboratory Technologist I 51 19.0%
Social Sciences (SPSS 20) software was used for data entry and analysis. Laboratory Technologist II 127 47.4%
Pathologist 9 3.4%
Cronbach's Alpha test was used to check for the reliability and internal Administrative worker 43 16.0%
consistency of the study variables. The Cronbach Alpha scores for the Phlebotomist 24 9.0%
study variables were as follow; External Communication (0.84), Service Total 268 100%
Outcomes (0.83), Personal Intentions (0.68), Personal Hassel (0.77), and Health Care Experience (years) (N ¼ 268)
Less than 5 Years 100 37.3%
Increased Blame (0.79). The reliability scores were acceptable to
5–10 Years 91 34.0%
continue with the further analysis [31–33]. 11 – 15 Years 32 11.9%
Descriptive statistics were used to describe the demographics and More than 15 Years 45 16.8%
response characteristics of the study participants. Mean and standard Total 268 100%
deviation was calculated for each of the studied variables. Pearson cor- Area Of Specialty Within Laboratory (N ¼ 268)
Hematology 40 14.9%
relation test used to find the association between LIS impact variables.
Chemistry 39 14.6%
Analysis of Variance (ANOVA) test followed by LSD Post Hoc test was Microbiology 32 11.9%
applied to find the relationship between LIS user's characteristics and LIS Molecular Microbiology 15 5.6%
impact variables and to further analyze the where the significance result Immunopathology 21 7.8%
Blood Bank 34 12.7%
is presented in ANOVA test.
Anatomical Pathology 27 10.1%
Reception 39 14.6%
3. Results Laboratory Management 21 7.8%
Total 268 100%
3.1. Sample characteristics Type Of LIS Training (N ¼ 268)
Group training 92 34.3%
One to One training 80 29.9%
Table 1 shows the demographics and the characteristic of the study User Manual reading 24 9.0%
participants. Finally, 268 participants were included in the study of None 72 26.8%
which 53.4% were females. Majority of the participants were either <30 Total 268 100%
Computer Knowledge/Experience (N ¼ 2680)
years of age (35.8%) or within 31–40 years (44.4%). Very few partici-
Beginner with limited computer skills and privileges 48 17.9%
pants belonged to age groups. 41–50 years (15.3%) and >50 years Advanced beginner 121 45.1%
(4.5%). Most of the respondents received Bachelor's degree (89.2%) Experienced user who is able to assist others independently. 89 33.3%
followed by Master's Degree (5.5%), Associate Degree (3.4%), and Expert with an advanced training in computer science. 10 3.7
Doctorate Degree with (1.9%). About 34.8% of users were with <2 years Total 268 100%

of LIS exposure, 28.0% had2-5 years of LIS experience, 23.2% had 5–10
years and 10.4% had >10 years of LIS experience.
Considering occupation, the main group of the users were grade II
laboratory technicians (47.4%), followed by grade I laboratory techni-
cians (19.0%), administrative workers (16.0%), phlebotomists (9.0%),
department supervisors (5.2%), and pathologist (3.4%). The healthcare
experiences of participants were: <5 years with 37.3%, 5–10 years with
34.0%, 11–15 years (11.9%), and those with >15 years of experience
(16.8%). The area of work of the respondents in the laboratory were
Hematology (14.9%), Chemistry (14.6%), Microbiology (11.9%), Mo-
lecular Microbiology (5.6%), Immunopathology (7.8%), Blood Bank
(12.7%), Anatomical Pathology (10.1%), Reception (14.6%), and Labo-
ratory Management (7.8%). Analysis of the mode of training that the
respondents received for LIS revealed that 34.3% received group
training, 29.9% received one to one training, and 9% learned about LIS
by reading the LIS documentation. Surprisingly, 26.9% mentioned that
they had no formal training about the system. A greater proportion of the
participants' computer knowledge ranged between advanced beginners
(45.1%) and experienced users with 33.3%.
3.2. Sample characteristics
Examining the efficiency of LIS in establishing external communica-
tion revealed that most of the respondents viewed that LIS supports and
makes external communication easier. Maximum of the participants
agreed (17.9% strongly agree and 64.2% agree) that LIS makes sample

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B. Aldosari et al.
distribution easier. Similarly, 78.3% (16.4% strongly agreed and 61.9%
agreed) opined that LIS supports communication with other departments
while 11.2% were neutral and 10.5% disagreed with it (9.4% disagreed
and 1.1% strongly disagreed). On the same note, 72.7% agreed to the
statement that LIS improved the relationship with other departments by
establishing communication with them, while 14.2% were neutral. Still,
13.1% of the respondents disagreed to the above statement (Table 2).
Analyzing the statement if LIS affects the service outcomes also
showed that most of the respondents predominantly opined that LIS in-
creases the service outcome (Table 3). Approximately, 82.1% of the
participants opined that the LIS improved the overall laboratory service
while only 7.5% disagreed to it. Accordingly, 81.6% agreed that the LIS
improves the workflow and management of the laboratory. Again, 83.9%
accepted that the accuracy and speed of laboratory test is enhanced after
LIS implementation. A larger proportion of the respondents (59.3%)
agreed that the LIS covered their work related needs while 17.6% dis-
agreed to it. The explanatory information with test reports also improved
with LIS with 68.6% agreeing to it, while 24.2% were neutral, and only
7.2% disagreed to it. Further, a greater proportion (82.4%) of the re-
spondents concurred that LIS enforcement should have be made even
earlier. However, about 14.6% of the respondents were neutral while
only 3.0% disagreed to it. Personally, most of the LIS users supported the
use of LIS system (Table 5). Approximately, 28.7% disagreed to the
statement that they do not have any intention in using the LIS. On the
contrary, more than half (53.4%) of the respondents disagreed to the
above statement and only 5.6% were neutral. Moreover, about 77.2%
appreciated working with LIS, while 14.6% depreciate its use and 8.25%
responded indifferently. The LIS users perspective on the inconveniences
caused by the LIS is displayed in Table 6. Even though 63.8% of the re-
spondents believed that phone inquiries has not increased due to LIS, a
significant proportion of them (29.1%) opined that phone inquiries are
indeed increased due to LIS, only 7.1% were neutral. Although most of
the participants (70.3%) opined that their work satisfaction has increased
because of LIS system, a considerable of them 23.1% disagreed to it
(6.75% had indifferent opinion). Approximately 60.8% of the re-
spondents considered that implementation of LIS had eased their daily
work demands; a significant portion (33.2%) of them opined that LIS
increased their routine work load (6.0% were neutral). On evaluating the
statement that if applying LIS has altered their job responsibilities from
being a laboratory technician to computer clerks, majority disagreed
(65.6%) to the statement. Even then about 25.8% have accepted that LIS
has indeed changed their job from being technicians to become computer
clerks. While 44% opined that LIS has enhanced their work re-
sponsibility, 50% disagreed to the statement. On examining the state-
ment, if there are certain occasions when they have to work around LIS to
run tests and procedures, 59.7% respondents negated it while 35.1%
accepted it, the remaining 5.2% had indifferent opinion. Finally, under
this variable, users were questioned if LIS assisted them to increase their
overall work efficiency and productivity. Approximately, 81.7% believed
that their work efficiency and productivity is increased while 12.3% to
have disagreed (6% were neutral) (see Table 4).
Subsequently, the participants were also asked to rate the questions
criticizing LIS. The response to those questions is shown in Table 6. A vast
Table 2
Response to external communication.
External Communication Strongly
Agree
N %
The LIS makes it easier to distribute samples for the appropriate department in 48 17.9
daily work activities.
The LIS supports communication between laboratory and other personnel in the 44 16.4
organization
The LIS improves the relationships between laboratory and other medical 37 13.7
departments
TOTAL
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Informatics in Medicine Unlocked 9 (2017) 200–209
majority of the respondents disagreed to the statement that the com-
plaints of physicians and nurses complaints have increased after LIS
installation while 16.0% agreed to it and 14.2% were neutral. Nearly,
half of the respondents (51.5%) opined that they don't receive complaints
on matter which are not caused the laboratory, while 38.8% agreed that
they receive more complaints that were not caused by the laboratory (9%
had indifferent opinion) to the statement. On questioning, if they believe
that physicians and nurses do not like the LIS system, nearly64.1% dis-
agreed while 23.1% accepted the statement (12.7% were neutral).
Nearly, 45.6%believed that they have extra work due to quality
accreditation organization requirements, Fifty one percent of the re-
spondents opined that they were blamed for errors that were caused by
the LIS while 39.5% disagreed to the statement, (10.1% were neutral).
When the participants were asked if they consider that the ISD controls
the lab after LIS installation, 48.1% answered positively; while 41.5%
answered negatively to the same statement (10.4% were neutral). On
questioning about the effect of LIS on cooperativeness of the medical
personnel, 76.9% believed that clinical staff was equally cooperative as
before the application of LIS. About 20.5% had an invariant opinion,
while only 2.6% opined that medical staff was less cooperative after
installation of LIS. Accordingly, 52.9% opined that clinical staff appre-
ciated LIS, while 38.5% believed that clinical personnel did not
welcomed LIS. Finally, 70.5% of the users disbelieved that LIS causes
problems toward the laboratory while 17.9% accepted that the statement
(11.6% were neutral).
3.3. Relationship between study variables towards LIS impact
The relationship between the study variables (External Communica-
tion, Service Outcomes, Personal Intention, Personal Hassles and
Increased Blame) and effect of LIS was analyzed using Pearson's corre-
lation test (Table 7). A significant positive correlation was observed be-
tween External Communication and Service Outcomes (r ¼ .778,
p ¼ .000) while a moderate positive correlation was seen between
External Communication and Personal Intention (r ¼ .531, p ¼ .000)
[33]. A negative correlation was seen between External Communication
and Personal Hassles (r ¼ .304, p ¼ .005  0.05) as well as between
External Communication and Increased Blame (r ¼ .396, p ¼ .000).
Service Outcomes was positively correlated with Personal Intention
(r ¼ .453, p ¼ .000) [34]. On the contrary, Service Outcomes was
negatively associated with Increased Blame (r ¼ .407, p ¼ .000). As-
sociation between Service Outcomes and Personal Hassles was absent
(r ¼ .196, p ¼ .001). Similarly, Personal Intention was not associated
with Personal Hassles (r ¼ .191, p ¼ .000) and Increased Blame
(r ¼ .153, p ¼ .010). Finally, Personal Hassles was moderately corre-
lated with Increased Blame (r ¼ .507, p ¼ .000) [34].
3.4. LIS user's differences in perception toward LIS impact
The difference between LIS users' opinion and LIS impact variables
(External Communication, Service Outcomes, Personal Intention, Per-
sonal Hassles and Increased Blame) was tested using ANOVA (Table 8).
Significant difference was observed between Health care experience and
Agree Neutral Disagree Strongly Total Mean SD
Disagree
N % N % N % N %
172 64.2 31 11.6 15 5.6 2 0.7 268 3.92 .763
166 61.9 30 11.2 25 9.4 3 1.1 268 3.83 .851
158 59.0 38 14.2 27 10.1 8 3.0 268 3.70 .931
268 3.82 .745
B. Aldosari et al. Informatics in Medicine Unlocked 9 (2017) 200–209

Table 3
Response to service outcomes.

Service Outcomes Strongly Agree Neutral Disagree Strongly Total Mean SD

Agree Disagree

N % N % N % N % N %

The LIS improves the laboratory's service. 61 22.8 159 59.3 28 10.4 18 6.8 2 0.7 268 3.96 .818
The LIS enhances and improves laboratory workflow and management. 47 17.5 172 64.1 24 9.0 20 7.5 5 1.9 268 3.88 .848
The introduction of the LIS has improved the accuracy and speed of laboratory 51 19 174 64.9 31 11.6 11 4.1 1 0.4 268 3.98 .710
tests results.
The LIS system covers all our work related needs in the department. 17 6.3 142 53 62 23.1 42 15.7 5 1.9 268 3.46 .896
The LIS system provides a better explanatory information with test reports 21 7.8 163 60.8 65 24.2 18 6.8 1 0.4 268 3.69 .727
The LIS should have been implemented in the organization a long time ago 40 14.9 181 67.5 39 14.6 8 3.0 0 0 268 3.94 .642
TOTAL 268 3.81 .579

Table 4
Response to personal intention.

Personal Intention Strongly Agree Neutral Disagree Strongly Total Mean SD

Agree Disagree

N % N % N % N % N %

I don't intend to use the LIS system as much as possible 4 1.5 73 27.2 15 5.6 143 53.4 33 12.3 268 2.52 1.06
I enjoy using the LIS system as much as possible. 22 8.2 185 69.0 22 8.2 39 14.6 0 0 268 3.70 .814
TOTAL 268 3.59 .835

Table 5
Response to personal hassel.

Personal Hassel Strongly Agree Neutral Disagree Strongly Total Mean SD

Agree Disagree

N % N % N % N % N %

Phone inquiries regarding test results have increased since the 14 5.2 64 23.9 19 7.1 168 62.7 3 1.1 268 2.60 1.01
introduction of the LIS system.
My overall work satisfaction has increased since the introduction of the 12 4.5 176 65.7 18 6.7 55 20.5 7 2.6 268 3.48 .953
LIS.
The LIS system makes it difficult to meet all work demands 13 4.9 76 28.3 16 6.0 156 58.2 7 2.6 268 2.41 1.05
The workload placed on me has increased because of the LIS system. 15 5.6 86 32 16 6.0 146 54.5 5 1.9 268 2.52 1.07
The LIS system has minimized my job from being a laboratory 9 3.4 60 22.4 23 8.6 159 59.3 17 6.3 268 2.37 1.01
technologist to an office clerk.
I have more work responsibility because of the LIS system. 10 3.7 108 40.3 13 4.9 134 50.0 3 1.1 268 2.95 1.04
Sometimes we need to find a way around the LIS to run laboratory 12 4.5 82 30.6 14 5.2 155 57.8 5 1.9 268 2.60 1.05
tests.
Using the LIS system enables me to accomplish tasks more quickly and 16 6.0 203 75.7 16 6.0 31 11.6 2 0.7 268 3.74 .766
increases my productivity.
TOTAL 268 2.81 .403

Table 6
Response to increased blame.

Increased Blame Strongly Agree Neutral Disagree Strongly Total Mean SD

Agree Disagree

N % N % N % N % N %

Physicians and nurses complaints have increased after the LIS installation 7 2.6 36 13.4 38 14.2 184 68.7 3 1.1 268 2.27 .836
People call the lab now with more questions and complaints that were not 20 7.5 84 31.3 24 9.0 138 51.5 2 0.7 268 2.63 1.07
caused by the laboratory
I do not believe that the physicians and nurses like the LIS system 11 4.1 51 19.0 34 12.8 166 61.9 6 2.2 268 2.50 .955
Because of the LIS system, we do a lot of extra work related to accreditation 31 11.6 91 34 36 13.4 108 40.3 2 0.7 268 3.15 1.10
organizations (CAP, JCI … etc.)
We are blamed for LIS system errors that is beyond our control (LIS errors, ISD 45 16.8 90 33.6 27 10.1 104 38.8 2 0.7 268 3.06 1.16
errors, insufficient samples for tests … etc.)
Since the LIS system installation, I believe that the Information system 21 7.8 108 40.3 28 10.4 106 39.6 5 1.9 268 3.12 1.08
department (ISD) controls the laboratory
Physicians and nurses become less cooperative with laboratory staff after the 6 2.2 26 9.7 55 20.5 180 67.2 1 0.4 268 2.16 .765
LIS system installation
Physicians and nurses are less appreciative of the LIS system introduction to 10 3.7 93 34.8 23 8.6 140 52.2 2 0.7 268 2.88 1.01
the laboratory
The LIS system causes problems toward the laboratory department/staff 6 2.2 42 15.7 31 11.6 173 64.5 16 6 268 2.20 .903
TOTAL 268 2.65 .552

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B. Aldosari et al. Informatics in Medicine Unlocked 9 (2017) 200–209

Table 7
Correlation analysis between study variables towards LIS impact.

External Communication External Communication

Service Outcomes .778 Service Outcomes
P ¼ .000
Personal Intention .453 .531 Personal Intention
P ¼ .000 P ¼ .000
Personal Hassles .191 .196 .304 Personal Hassles
P ¼ .000 P ¼ .001 P ¼ .005
Increased Blame .507 .153 .407 .396 Increased Blame
P ¼ .000 P ¼ .010 P ¼ .000 P ¼ .000

External Communication (p ¼ .009) as well as between Health care

Table 9
experience and Service Outcomes (p ¼ .010). Further, there were Post Hoc Test results for Healthcare Experience with External Communication.
considerable differences between the area of specialty in the laboratory
(I) How long (J) How Mean Std. Sig. 95% Confidence
and External Communication (p ¼ .002), Service Outcomes (p ¼ .000),
have you long have Difference Error Interval
Personal Hassles (p ¼ .003) and Increased Blame (p ¼ .016). Further- been you been (I-J)
Lower Upper
more, statistically significant difference between job position and Service working in working in
Bound Bound
Outcomes (p ¼ .027) as well as between computer knowledge/experi- health care health care
field? field?
ence and External Communication (p ¼ .007). Nonetheless, no difference
(Select one) (Select one)
was found between LIS users characteristics and LIS impact vari-
ables (p > 0.05). Less than 5–10 Years .35564* .10623 .001 .1465 .5648
5 Years
In order to identify which specific group showed the significant dif-
ferences, LSD Post Hoc test was applied on the user characteristics group Only Significant p values are shown (p < 0.05).
that showed p values < 0.05 in ANOVA. Significant difference existed
between user's health care experience and External Communication as
Table 10
well as also with Service Outcomes. LIS users with 5–10 years of Post hoc test for healthcare experience with service outcomes.
healthcare experience were considerably different toward the role of
(I) How long (J) How Mean Std. Sig. 95% Confidence
External Communication, and Service Outcomes in LIS impact than those have you long have Difference Error Interval
with <5 years of experience (p  0.05) (Table 9, Table 10). The second been you been (I-J)
Lower Upper
group which showed significant difference was area of specialty with working in working in
Bound Bound
External Communication, Service Outcomes, Personal Hassles, and health care health care
field? field?
Increased Blame. Blood bank and reception area personnel's had signif-
(Select one) (Select one)
icant mean difference toward External Communication variable role in
LIS impact than those working in hematology, chemistry, molecular Less than 5–10 Years .27901* .08270 .001 .1162 .4418
5 Years
microbiology, immunopathology, and anatomical pathology de-
partments (p < 0.05) (Table 11). Post-Hoc analysis of area of specialty Only Significant p values are shown (p < 0.05).

with the Service Outcomes also indicated significant relationship be-

tween different areas in the laboratory (Table 12). LIS users working in
blood bank and reception area had significant mean difference toward
Service Outcomes variable role in LIS impact than those working in other
departments (p  0.05).
Similarly, Post Hoc test also exhibited a statistically significant mean
difference between LIS-users of microbiology, anatomical pathology, and
laboratory management departments and of hematology, chemistry,
immunopathology, blood bank departments and reception area
(p < 0.05) (Table 13). Lastly, area of specialty was significantly related
with Increased Blame. Subsequent Post-Hoc test showed a statistically
significant mean difference between LIS-users working in Anatomical
Pathology, Hematology, Chemistry, Microbiology and Laboratory
Management and those working in Blood Bank and Reception areas
(p  0.05) (Table 14). Further, Post-Hoc analysis of user's current job
position with Service Outcomes variable showed a statistically significant
mean difference between Phlebotomist and department Supervisors,
Laboratory Technologist grade I, Laboratory Technologist grade II and
Pathologist (Table 15). Additionally, administrative workers expressed a
statistically significant mean difference between them and the patholo-
gists. Lastly, LIS users with beginner computer skills showed statistically
significant mean difference with External Communication variable than
and those who are experienced, advanced and expert in computer
experience skills (Table 16).

Table 8
ANOVA Results indicating Differences between User's Characteristics and LIS Impact Variables.

LIS User Characteristic External Service Outcomes Personal Intention Personal Hassles Increased Blame
(N ¼ 268) Communication

F Sig F Sig F Sig F Sig F Sig

Gender .066 .798 .001 .979 .864 .354 2.516 .058 1.180 .278
Age (years) 1.604 .189 1.980 .117 .291 .832 1.949 .122 1.375 .251
Years Of Experience With LIS 1.591 .192 2.128 .097 .712 .545 .965 .410 1.013 .388
Health Care Experience (years) 3.942 .009** 3.853 .010** .744 .526 1.771 .153 .544 .653
Area Of Specialty Within Laboratory 3.130 .002** 4.399 .000** 1.442 .179 3.068 .003** 2.812 .016**
Degree of Qualification .647 .586 1.104 .348 2.287 .079 .723 .539 .828 .479
Current Job Position 1.909 .093 2.568 .027** 1.571 .168 .733 .599 .461 .805
Type Of LIS Training .674 .569 .199 .897 .131 .942 .323 .809 .332 .802
Computer Knowledge/Experience 4.135 .007** 1.839 .140 1.629 .183 2.277 .080 .632 .595

**Significant p values (p < 0.05).

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B. Aldosari et al. Informatics in Medicine Unlocked 9 (2017) 200–209

Table 11
Area of specialty post hoc test with external communication.

(I) In which area of laboratory do you currently (J) In which area of laboratory do you currently Mean Std. Sig. 95% Confidence
specialize? (Select a primary specialty) specialize? (Select a primary specialty) Difference (I- Error Interval
J)
Lower Upper
Bound Bound

Hematology Blood Bank .41618 .16855 .014 .0843 .7481

Reception .52201 .16260 .001 .2018 .8422
Chemistry Blood Bank .48391 .16954 .005 .1501 .8178
Reception .58974 .16363 .000 .2675 .9120
Molecular Microbiology Reception .43590 .21953 .048 .0036 .8682
Immunopathology Blood Bank .40943 .20054 .042 .0145 .8043
Reception .51526 .19557 .009 .1301 .9004
Anatomical Pathology Blood Bank .52760 .18626 .005 .1608 .8944
Reception .63343 .18090 .001 .2772 .9896

Only Significant p values are shown (p < 0.05).

Table 12
Area of specialty post hoc test with service outcomes variable.

(I) In which area of laboratory do you currently (J) In which area of laboratory do you currently Mean Std. Sig. 95% Confidence
specialize? (Select a primary specialty) specialize? (Select a primary specialty) Difference (I- Error Interval
J)
Lower Upper
Bound Bound

Hematology Blood Bank .41225 .12886 .002 .1585 .6660

Reception .45876 .12432 .000 .2140 .7036
Chemistry Blood Bank .42358 .12962 .001 .1683 .6788
Reception .47009 .12510 .000 .2237 .7164
Microbiology Blood Bank .31955 .13606 .020 .0516 .5875
Reception .36605 .13177 .006 .1066 .6255
Molecular Microbiology Blood Bank .49281 .17124 .004 .1556 .8300
Reception .53932 .16784 .001 .2088 .8698
Immunopathology Blood Bank .40710 .15333 .008 .1052 .7090
Reception .45360 .14953 .003 .1592 .7480
Anatomical Pathology Blood Bank .50145 .14241 .001 .2210 .7819
Reception .54796 .13831 .000 .2756 .8203
Laboratory Management Blood Bank .32773 .15333 .033 .0258 .6297
Reception .37424 .14953 .013 .0798 .6687

Only Significant p values are shown (p < 0.05).

Table 13
Area of specialty post hoc test with personal hassles.

(I) In which area of laboratory do you currently (J) In which area of laboratory do you currently Mean Std. Sig. 95% Confidence
specialize? (Select a primary specialty) specialize? (Select a primary specialty) Difference (I- Error Interval
J)
Lower Upper
Bound Bound

Hematology Anatomical Pathology .27211 .12752 .034 .0210 .5232

Chemistry Microbiology .29327 .12212 .017 .0528 .5337
Anatomical Pathology .46225 .12818 .000 .2098 .7147
Laboratory Management .40339 .13858 .004 .1305 .6763
Immunopathology Anatomical Pathology .39815 .14896 .008 .1048 .6915
Laboratory Management .33929 .15800 .033 .0282 .6504
Blood Bank Microbiology .26471 .12610 .037 .0164 .5130
Anatomical Pathology .43369 .13198 .001 .1738 .6936
Laboratory Management .37482 .14210 .009 .0950 .6546
Reception Anatomical Pathology .39494 .12818 .002 .1425 .6473
Laboratory Management .33608 .13858 .016 .0632 .6090

Only Significant p values are shown (p < 0.05).

4. Discussion
The purpose of the present survey is to investigate the effect of LIS on
its users based on their personal experience with the system. The rele-
vance of this study exists in the fact that there are insufficient researches
available till date which assessed either the individual or organizational
impact of the LIS in hospitals and medical centers of Saudi Arabia. The
present study explored the impact of LIS using five dimensions, which
encompasses LIS-related betterment of workflow and services, the user's
intention to use the system and the problems that might be generated by
the system itself [27,28]. Nonetheless, LIS is the most important sup-
portive technique which helps in the diagnosis and constant monitoring
of the patients' care in hospitals. It integrates with the HIS infrastructure
and assists laboratory personnel's in entering, archiving, and communi-
cating laboratory-related data to other departments. Our results indicate
that hospital staff using who are using LIS had a positive and supportive
view for the LIS to be an essential HIS in their practice. Accordingly, the
findings of our study are consistent with other studies in literature
[35–43]. The study also discusses the importance of the LIS in the study's
background. The study has mentioned the anticipated benefits of health

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B. Aldosari et al. Informatics in Medicine Unlocked 9 (2017) 200–209

Table 14
Area of specialty post hoc test with increased blame.

(I) In which area of laboratory do you currently (J) In which area of laboratory do you currently Mean Std. Sig. 95% Confidence
specialize? (Select a primary specialty) specialize? (Select a primary specialty) Difference (I- Error Interval
J)
Lower Upper
Bound Bound

Blood Bank Anatomical Pathology .28637* .13949 .041 .0117 .5611

Reception Hematology .44416* .12178 .000 .2044 .6840
Chemistry .27920* .12254 .024 .0379 .5205
Microbiology .32888* .12907 .011 .0747 .5830
Anatomical Pathology .49066* .13548 .000 .2239 .7574
Laboratory Management .31136* .14647 .034 .0229 .5998

Only Significant p values are shown (p < 0.05).

Table 15
Current job Position Post Hoc Test with Service Outcomes.

(I) Please select your current job position: (J) Please select your current job position: Mean Difference (I-J) Std. Error Sig. 95% Confidence Interval

Lower Bound Upper Bound

Dept. Supervisor Phlebotomist .40575 .19221 .036 .0273 .7842

Laboratory Technologist I Phlebotomist .38685 .14148 .007 .1083 .6654
Laboratory Technologist II Phlebotomist .29336 .12722 .022 .0429 .5439
Pathologist Administrative worker .44574 .20951 .034 .0332 .8583
Phlebotomist .63194 .22340 .005 .1921 1.0718

Only Significant p values are shown (p < 0.05).

Table 16
Computer knowledge/experience post hoc test with external communication.

(I) On the whole, how sophisticated/knowledgeable a (J) On the whole, how sophisticated/knowledgeable a Mean Std. Sig. 95% Confidence
computer user do you consider yourself? computer user do you consider yourself? Difference Error Interval
(I-J)
Lower Upper
Bound Bound

Advanced beginner. Beginner with limited computer skills and privileges .32203 .12495 .011 .0760 .5680
Experienced user who is able to assist others independently Beginner with limited computer skills and privileges .34168 .13117 .010 .0834 .6000
Expert with an advanced training in computer science. Beginner with limited computer skills and privileges .76528 .25462 .003 .2639 1.2666

Only Significant p values are shown (p < 0.05).

information system on performance and clinical practice influence users'
attitudes. The most important role of LIS is bringing together all relevant
clinical partners in healthcare organizations to ensure that users of LIS
have access to reliable, authoritative, useable, understandable, compar-
ative data.
Laboratory information system have been established to augment
communication between patients and health care professionals, enables
patients to play a more dynamic role in their own treatment and self-
management and leads to an increase self-efficiency [44,52–54]. We
observed a strong positive relationship between the factors that favors
the improvement which LIS has introduced to users' work i.e. External
Communication and Service Outcomes. Additionally, a statistically sig-
nificant but moderately positive relationship between the factors that
analyses difficulties associated with LIS users i.e. Personal Hassles and
Increased Blame. Our study findings point out to the fact that electronic
laboratory information systems have a large potential to augment patient
care and public health monitoring in poor settings that face several
challenges such as lack of trained personnel, limited transportation, and
large coverage areas.
Our study is in complete consensus with the findings of a cross-
€
sectional study conducted by the Sezgin and Ozkan-Yõldõrõm (2016)
to identify the factors influencing the usage and acceptance of pharma-
ceutical service systems by pharmacists stated that usefulness, ease of
use, and other system factors affected the pharmacists' intention to use
the pharmaceutical technology [41,42,53,54]. Another study by Han-
dayani et al. (2017) identified 15 important HIS user acceptance factors
and concluded that non-technological dimensions, such as human and
organizational dimensions influence HIS user acceptance to a greater
extent than technological dimensions [54,55]. Nonetheless, a negative
correlation between the variables that supports improvements and those
analyzing problems shows that any increase in one will cause a decrease
in the other. Indeed, LIS users believed that the installation and usage of
the software has made the communications and relationships better with
other clinical departments which in turn increased the quality and speed
of analytical procedures in the laboratory. All these good features of LIS
have made its users to have a positive intention for using the system. LIS-
users opined that the system did not delay their work nor caused less
cooperation and appreciation from other doctors and nurses
[2,5,24,35,36,45–51].
Considerable association of different factors like external communi-
cation, service outcomes, personal hassles and increased blame was
observed with users' health care experience, departments inside the
laboratory, current job position, and computer knowledge. Job area
within the laboratory has the strongest effect on the four of the study
variables (External Communication, Service Outcomes, Personal Hassles,
and Increased Blame) than any other LIS-user features. This is attributed
to the differences in working system and workload of the laboratory of
each department. Age, gender, education level, receipt of formal training
on LIS, and LIS-experience was unrelated to any of the study variables.
Although, the results of the current study indicates comprehensively a
favorable attitude towards LIS usage, there are few aspects which dem-
onstrates some basic issues that might have an effect on the user/system
interaction in the future. One of such important aspect is absence of any
formal training for some of the LIS users. Despite the fact that the current

207
B. Aldosari et al.
study has not observed any association between the receipt of training
and ease of LIS use, numerous study have specified receiving training on
any new HIS software as a determiner in the success or failure of HIS
[44,45]. Furthermore, a significant number of users have reported that
they use workarounds on LIS to run tests or enter procedures. It can lead
to mistakes and errors while performing analysis, thus causing uncer-
tainty in the results. Together, it indicates that the LIS system does not
consider and include every aspect of the users' preconditions which ob-
ligates them to find different ways to finish their daily routine
[16,46,47]. Similarly, around half of the respondents were occasionally
blamed for errors related to the system or work processes. Criticizing
users for system-related mistakes creates an undesirable mindset for the
system usage and for other clinical departments too. We believe that
accusing users without identifying the underlying causes for it within the
system or process is only concealing the problem. Therefore, the present
study suggests a detailed investigation of the whole working environ-
ment to properly establish the origin and type of such mistakes rather
than just blaming users [48–50].
Finally, more or less than half of the users opined that the information
system department controls the laboratory. It causes users to feel that
their power is lost on an important part of their work. The primary reason
behind this issue is that the information system department monitors the
operation of LIS inside the laboratory which gives the laboratory staff an
impression that they are just end-users with no command on the system.
A feeling of losing power or job freedom can complicate their daily job
routine [9,10,51].
In summary, the results of the current research demonstrated the
success of the study impact variables in scrutinizing and examining the
effect of LIS on its users in the laboratory. Users had an overall positive
view on LIS usage on their daily work as well as on their personal
perception towards the system. However, while some labs may be able to
function sufficiently on their LIS, the information management needs of
bigger labs and specialty service labs cannot be met as the LIS vendors
make their software to meet the needs common to the majority of the labs
rather than to meet the needs of a particular lab. Also, every lab has some
unique needs owing to their size, local environment, people and clientele.
Therefore, the Laboratory vendors should try to act toward LIS to
improve and enhance the system efficiency and functions. Nonetheless,
laboratory management should also target on the issues which were
indicated by users to affect the user/system interaction in the future.
Further, they should increase the ongoing effort in training and famil-
iarizing the users with the system to augment their positive perception
and reduce the use of workarounds on the system to achieve their work.
Additionally, more effort should be targeted on fulfilling the users ne-
cessity in the system, thus aiding in eliminating the vulnerabilities
indicated by the users.
5. Limitations and recommendations
The target population included all the LIS users working at the
Department of Laboratory Medicine in KAMC, Riyadh. The reason behind
restricted data collection time is due to the long period it took for sub-
mitting and acquiring the approval. Making the sample size larger by
including other hospitals which also uses LIS and giving more time in
questionnaire distribution and collection will provide a better response
rate and insight on the effect of LIS in Saudi Arabia healthcare sector. In
addition, studying the user's subjectivity via qualitative analysis when
dealing with the system can add more depth and illustrative findings than
just using quantitative approach. A combination of interviews and
quantitative approach can provide meaningful results that can capture
most of the users' perception toward the system and get to more under-
lying themes that cannot be captured using quantitative approach alone.
We also propose to conduct more researches investigating the effect of
LIS to look for more dimensions concerning the prediction of the effect
of LIS.
208
Informatics in Medicine Unlocked 9 (2017) 200–209
6. Conclusion
In conclusion, the LIS users have a positive outlook toward the LIS
usage. Study variables (External Communication, Service Outcome,
Personal Intentions, Personal Hassles, and Increased Blame) have proved
to be satisfactory in examining the effect of LIS on laboratory staff. The
outcome of this study contributes to an initial assessment which can help
future improvements and modifications regarding user/system interac-
tion. Presence of favorers for LIS is a good sign of the success of the
system in the work surrounding which will pave the way for more
advanced and user efficient systems in the future.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
H.G and B. D contributed to the study concept, design and imple-
mentation, analysis and interpretation of the findings, and preparation of
the manuscript. B. D contributed to the study approval. H.G and A.A
contributed to the study final manuscript format, review and editing for
publication.
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