ELECTRONIC HEALTH INFORMATION SYSTEMS (EHIS)

Abstract
Healthcare corporations view information technology as a means to improve services while
dealing with rising demand. However, the adoption and assessment of electronic health
information systems are hampered by problems and frequent failures (EHIS). EHIS
deployment is complex, and success is dependent on elements such as organizational
structure, technology, and human factors. It also necessitates extensive, multifaceted
evaluation in order to provide continuous input and ensure success. This study provides a
literature overview on EHIS deployment and evaluation, as well as problems and
recommendations for evaluators and healthcare organizations. It highlights elements that
either impede or promote successful EHIS adoption and offers appropriate assessment
methodologies, with the goal of assisting teams evaluating complex EHIS.

Introduction
Healthcare organizations with budget constraints are struggling to meet the demands brought
about by demographic and epidemiological shifts. There is hope that technology, particularly
health information systems (HIS), can address these challenges (Hillestad et al., 2005). Healt
h Information Systems (HIS) can bring several benefits to the healthcare industry, including c
ost reduction, error prevention, support for healthcare professionals, and improved patient acc
ess to healthcare services (Ammenwerth et al., 2003). It is expected to have positive impacts
on patients, families, and healthcare providers, both socially and economically (Jennett et al.,
2003). Despite of many adavtages, adoption of health information technology is modest, and
HIS are underutilized. When compared to other businesses, the healthcare industry has a
slower adoption rate (Wyatt & Wyatt, 2003). An examination of HIS adoption in seven
developed countries revealed that, while several have achieved high levels of primary care
electronic health record (EHR) adoption, they trail in inpatient EHRs and health information
exchange systems (Jha et al., 2008). The technology is often not widely accepted or used
(Wyatt & Wyatt, 2003) and has been described as having "low impact despite high tech". HIS
implementation faces numerous challenges and instances of implementation failure are
widely documented in the literature [14]. Implementation involves the steps of planning,
testing, adopting, and integrating a health information system (HIS) into routine use within an
organization. Despite the potential benefits of HIS, its implementation has faced challenges
for a long time as noted by Kaplan (Kaplan, 2001). Therefore, evaluating HIS
implementation and identifying successful features is crucial. Ten goals are outlined for
technology in healthcare: to be efficient, improve quality of care, be evidence-based,
empower patients, promote patient-doctor partnership, educate physicians and patients,
enable information exchange and communication, extend healthcare scope, be ethical, and be
equitable (Eysenbach, 2001). Seven tasks are identified by (Haux, 2006) i-e, 1) replacing
manual and paper-based processes with digital and automated systems; 2)Engaging patients
as users; 3) Utilizing data for healthcare planning and research; 4) Moving the focus from
technical aspects to management and strategic information; 5) Emphasizing image and
molecular data; 6) Adapting to new technologies as they emerge; 7) Expanding from local
system to national and global systems..
Healthcare lags behind in accepting information technology with only limited IT systems,
such as EHRs, being widely adopted (Hopper, 2015). The implementation of advanced
healthcare IT systems like ERP is low, with basic solutions from Microsoft and Google
leading the market (Hopper, 2015). Reasons for low acceptance include diverse revenue
streams, untrained personnel, complicated outsourced processes, high costs, and an
organizational culture resistant to change (Henrique & Godinho Filho, 2020).
The limited adoption of integrated healthcare IT solutions hampers continuous improvement
efforts that depend on data availability. The impact of technology adoption on healthcare
outcomes has been well-researched with positive results but the cost impact is still
inconclusive (Care, 2015). Hence, being a healthcare manager responsible for IT solution
decisions is challenging. This research aims to guide healthcare managers in adopting
information technology by presenting a comprehensive analysis of relevant literature. The
Technology-Context and before adoption Analysis-Implementation-Outcomes framework
provides a structured approach to the topic and serves as a reference for practitioners (Denyer
et al., 2008). The framework addresses the limitations of previous research by covering
specific topics and meeting the needs of healthcare stakeholders such as providers,
administrators, and policy makers (Jones et al., 2014).
Literature Review
The electronic health/medical records (EHRs) of patients is the core component of healthcare
information systems. It acts as a comprehensive database that stores all the information relate
d to a patient's healthcare journey, including their medical history, test results, and treatment
plans. The EHRs play a critical role in improving the quality of care and facilitating collabora
tion among healthcare providers. EHRs store patient data as individual records or comprehen
sive collections spanning various medical procedures (Ludwick & Doucette, 2009) or any oth
er treatment. These records are designed with the patient in mind, keeping all their health info
rmation in one place. The same software may have different names, depending on its usage a
nd the context in which it is being referred to. For example, the same software may be referre
d to as an electronic health record (EHR) (Ludwick & Doucette, 2009), when healthcare orga
nizations enter information into the system, an electronic medical record (EMR) when referri
ng to the clinical aspect of the software, or even as an electronic patient registry (EPR) when i
t acts as a centralized database of patient information. The terminology may vary, but the pur
pose of the software remains the same, which is to provide a comprehensive and centralized r
epository of patient information (Tomasi et al., 2004). EHRs have advanced features that enh
ance their functionality and provide additional benefits. These features include HR informatio
n systems, decision support systems, and new technologies such as Big Data and the Internet
of Things (IoT) in relation to medical equipment. The use of HR information systems helps in
managing organizational strategy and improving transparency in HR performance. The decisi
on support systems (Duan et al., 2011) provide clinical decision making support based on pati
ent data. The integration of Big Data and IoT enables the collection and analysis of large amo
unts of medical data and helps in monitoring medical equipment remotely (Jones et al., 201
4).
Decision support systems, used for nursing care, medical care and certain aspects of the medi
cal process such as medication administration, facilitate professionals' decisions by offering i
nformation on prior actions taken in similar situations (Rajeswari et al., 2018). Medical simul
ation is also a part of this category. IoT, a connection between various internet-connected dev
ices, has practical applications like temperature sensors, and BP instruments and glucose mon
itors (Mehta & Pandit, 2018). Big Data, an emerging technology linked to EHRs, provides th
e potential to analyze vast and complex data, find patterns to inform medical decisions, and o
ffer cost and quality decision support (Mehta & Pandit, 2018).
With a focus on patient-centered medical care and the ability of IT systems to exchange infor
mation, another type of HIS has emerged: the regional or national health information system.
These systems aim to improve health care delivery and enhance coordination among various
stakeholders (such as clinics, hospitals, pharmacies, and labs) by exchanging information at t
he regional or national level (Mäenpää et al., 2009). However, their use also brings increased
informational risks and heightened privacy and hardware needs (Mäenpää et al., 2009). Regio
nal or national health information systems vary in size and features, similar to EHRs.
Healthcare professionals are targeted by reminder applications, including HIS-associated and
standalone apps, educational smartphone apps, and consumer healthcare apps that allow com
munication with patients. Reminders are added to HIS to prompt healthcare professionals of p
atients needing various treatments or interventions, leading to improved quality of care by ens
uring procedures are performed correctly and timely. However, they can also be a source of st
ress for professionals (Backman et al., 2017).
The advancement of technology has made it possible for patients to have access to various so
ftware, including smartphone apps, consumer health apps, and internet-connected medical de
vices. Consumer health informatics aims to directly engage with patients, allowing them to pr
ovide information about their health and receive personalized health information in return. Th
is approach brings several benefits, such as reducing the cost of reaching patients, improving
professional interventions, and enhancing feedback to patients. By directly connecting with p
atients, healthcare organizations can improve the quality of care, enhance patient engagement,
and increase patient satisfaction (Gibbons et al., 2011).
Health-care apps for smartphones are a growing category of consumer HIS. With the
increasing affordability and accessibility of smartphone technology, many companies have
created software for various user groups such as consumers, healthcare professionals,
students, and medical organizations. The main features of these apps include medicine
information, clinical communication, disease diagnosis, hospital information, training and
education of diseases chronic diseases, and general health-care information (Mosa et al.,
2012).
Table 1 discuss the generalities and differences of EHIS Technologies. In this table, their
objective, strengths and weaknesses are extensively compared.

Table 1 EHIS Technologies

Author Objective Strengths Weaknesses

(Ludwick & Do To provide a 1. Acts as a comprehensive Terminology may vary,
ucette, 2009) comprehensive and database that stores all which can lead to
(Tomasi et al., 2 centralized repository of information related to a confusion among
004) patient information patient's healthcare journey different user groups.
(Jones et al., 20 through the use of 2. Improves the quality of care
14) electronic health/medical and facilitates collaboration
records (EHRs). among healthcare providers
3. Keeps all patient health
information in one place
4. Advanced features such as
HR information systems,
decision support systems,
and integration with Big
Data and IoT.
(Mäenpää et al., The objective of regional 1. Improves healthcare delivery 1. Increased
2009) or national health 2. Enhances coordination informational risks
information systems is to among stakeholders 2. Heightened privacy
improve healthcare
3. Facilitates exchange of and hardware needs
delivery and enhance
coordination among information at the regional or
various stakeholders. national level

(Rajeswari et To facilitate 1. Offers information on prior The implementation and

al., 2018). (Meh professionals' decisions
ta & Pandit, 201 in nursing care, medical
care and medication
8).
administration using
decision support systems 2.
and technology such as
IoT and Big Data.
3.
(Backman et al., To improve the quality 1.
2017) of care by reminding
healthcare professionals 2.
actions taken in similar
situations to inform decision-
making
Utilizes IoT technology for
practical applications such as
temperature monitoring and
glucose monitoring
Enables the analysis of vast
and complex data to inform
medical decisions and
provide cost and quality
decision support.
Targeted towards healthcare
professionals
Variety of reminders
maintenance of these
systems can be costly.
There are also privacy
and security concerns
related to the storage and
transfer of sensitive
medical information.
The use of IoT and Big
Data also requires the
availability of
specialized personnel,
such as data analysts and
technicians, to manage
and interpret the vast
amount of data
generated. The accuracy
and completeness of the
data collected and
analyzed can also be
questionable. Finally,
there may be ethical
concerns regarding the
use of patient data for
purposes other than
improving medical care,
such as research or
marketing.
Can be a source of stress
for healthcare
professionals
 of patients needing available through HIS-
treatments or associated and standalone
interventions. apps, educational
smartphone apps, and
consumer healthcare apps
3. Improves quality of care by
ensuring procedures are
performed correctly and
timely
(Gibbons et al., To improve the quality 1. Patients have access to One potential
2011) of care by engaging various software disadvantage of
directly with patients 2. Improves professional engaging directly with
through the use of interventions and enhances patients through
technology. feedback to patients technology is a digital
3. Reduces cost of reaching divide, where certain
patients populations may not
4. Improves quality of care, have access to the
patient engagement, and technology or the skills
satisfaction to use it, leading to
unequal access to
healthcare information
and services.
Additionally, privacy
and security concerns
may arise due to the
sensitive nature of
personal health
information being shared
and stored through
technology. There may
also be potential errors in
information transmission
or interpretation, leading
to incorrect diagnoses or
treatments.
(Mosa et al., To provide healthcare 1. Growing category of there may be privacy
2012) information and support consumer HIS. concerns related to the
through smartphone apps 2. Increasing affordability and storage and use of
for various user groups. accessibility of smartphone personal health
technology information. Not all apps
3. Provides information for are regulated or have to
various user groups follow strict security
including consumers, protocols, which can
healthcare professionals, increase the risk of data
students, and medical breaches or unauthorized
organizations access to sensitive
4. Includes a range of features information. Some apps
such as medicine may also not be fully
information, clinical accurate or reliable,
communication, disease leading to incorrect
diagnosis, hospital medical advice or
information, training and diagnoses, which can
 education on diseases, and harm patients.
general healthcare Furthermore, there may
information. be disparities in access to
technology and
healthcare information,
with some populations
lacking the resources or
knowledge to effectively
utilize these apps.

Conclusion
In medical organizations, the medical process is key and medical professionals play a crucial
role. Adoption of new Health Information Systems (HIS) may be hindered by their resistance
due to inadequate preparation by managers. To ensure successful HIS adoption, managers
must consider key success factors that reflect the complexity of healthcare organizations.
These factors should be taken into account before initiating any major changes. To
summarize, the implementation of HIS goes beyond mere adoption and requires proper
change management within healthcare organizations to fully reap its benefits. The assessment
of the necessity for information technology may only need to be done once, but ongoing
monitoring of technology and systems is crucial for the organization. Utilizing a maturity
model can aid in tracking progress and communicating desired outcomes for the digital
transformation journey. The benefit of maturity models is that they provide benchmarks and
goals for the organization, which can be adjusted based on changes in the environment.
Future studies in the field of healthcare information systems should shift their focus from
evaluating the adoption of traditional information systems to the digital transformation of
healthcare organizations. This means exploring the impact of technology on the entire
healthcare organization, including its processes, culture, and stakeholders. By focusing on the
digital transformation, future studies can provide a more comprehensive understanding of the
benefits and challenges of adopting technology in healthcare and provide valuable insights
for healthcare organizations looking to embrace digital transformation.
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