Management in health

XVIII/3/2014; pp. 26-33 QUALITY

ASSESSMENT OF END USER SATISFACTION OF

HOSPITAL INFORMATION SYSTEM
Dr. Rajesh Kumar SINHA1, Associate BACKGROUND: Hospital Information System (HIS) assist the hospital staff
in carrying out their clinical, nursing, administrative and other daily activities.
Professor Assessment of satisfaction of the end users in using the system is important to ensure
Susanna KURIAN2, Student the proper functioning of the system.
1,2
OBJECTIVE: To assess the satisfaction level of end user towards Hospital
Department of Health Information Management Information System.
School of Allied Health Sciences METHOD: A prospective cross sectional study was carried out among 127 end
Manipal University, India users of HIS, including nursing, front office, administrative, para medical, medical
records, maintenance and accounts staff of a womens hospital of Southern India.
The data was collected using a structured and validated questionnaire based on 5
point Likert scale from Extremely satisfied to Not satisfied (Score 5-1).
1. INTRODUCTION DATA ANALYSIS: The collected data was analysed using SPSS 20.0 and
Hospitals are very complex institutions with large presented in terms of frequency, percentage, mean score and standard deviation.
RESULTS: The study result revealed that the respondents were moderately satisfied
departments and units intended to coordinate care with the general and module specific features (Mean score < 4). The issues identified
of the patients [1]. It consists of different groups were mainly related to Outpatient, Inpatient, Payroll, and Ward Management
performing highly specified functions that lead to System to which suggestions were raised and implemented accordingly. The post-
the generation of large amount of data. An endless implementation satisfaction result indicated that the respondents were satisfied with
flow of data begins with the outpatient and admit- the implemented changes. Their major concern was to have regular induction and
ting departments and emanates from every depart- refresher training and to include their requirements in the HIS to assist them in
performing their daily routine tasks effectively.
ment throughout the hospital. Some data is vital CONCLUSION: The acceptability and sustainability of HIS largely depends on
for the care and well-being of patients, while other the inclusion of end users during the design and implementation of the system and
data enhance the overall efficiency of hospital their satisfaction with the same. The study result indicated the need to conduct
itself. The way the hospital responds to the chal- regular and refresher training, and assess the end user need and their interaction
lenges of managing these data determines the with HIS on a regular basis to achieve maximum satisfaction.
quality of patient cares and hence its success [2]. Keywords: Hospital Information System, Health Care Organization, Hospital,
Since last few decades, Information and communi- Information, End user satisfaction
cation technology has played a vital role in man-
aging healthcare data that are getting generated from the mentation. Their requirements should be addressed as this
various sources in the hospital. A Hospital Information creates a feeling that they are a part of the system and
System (HIS) as one of the important application of infor- hence become more enthusiastic to use them. Proper and
mation and communication technology, support the health- systematic training should be provided to the end users
care provider in managing variety of information generated regarding the use of the system [5].
in a hospital on a day to day basis. It is a comprehensive Satisfaction in a given situation is a persons feeling or
and integrated information system designed to collect, re- attitudes towards a variety of factors affecting that situa-
trieve, manipulate and use of information to support all the tion [6]. Similarly, end user satisfaction is significant to
administrative and clinical activities of a hospital [3]. successful implementation of hospital information system.
Initially hospital information systems were used only to It is generally understood that failure of these information
automate financial and accounting areas. But now with systems is mainly due to psychological and organizational
advancement in computer technology, it has pervaded al- issues. Therefore it is essential for the hospitals to assess
most every activity and revolutionized the entire flow of the end user satisfaction towards the usage of hospital in-
information within the hospital. Therefore, a good hospital formation system. This should be done on a regular basis
information system has the potential to improve the qual- to ensure satisfaction towards the system [7] [8] which
ity, safety and efficiency of healthcare apart from perform- ultimately lead to better acceptability and sustainability of
ing the routine administrative and financial tasks. Cur- the hospital information system in the health care organi-
rently, hospitals are becoming more dependent on these zation.
information systems in carrying out all the functions re-
lated to patient care, education and research for better and 2. METHODS
improved services and practices [4].
A prospective cross sectional study was carried out in a
The implementation of Hospital Information System womens hospital of Southern India. It was carried out
should be well planned. Care should be taken while choos- among 127 end users of HIS; including nursing, front of-
ing the vendor and software. The chosen software should fice, administrative, para medical, medical records, main-
be able to meet the objectives of the organization. The end tenance and accounts staff. A structured and vali-
users should always be involved in the process of imple- dated questionnaire was used to assess the end user 26
 QUALITY Management in health
XVIII/3/2014; pp. 26-33

satisfaction level of respondents regarding the usage of tures. The result obtained is presented and discussed here
HIS. The study was conducted in three phases. The first under following headings:
phase included a structured interview to assess the end user
satisfaction towards the general features of the HIS. The
questionnaire based on 5 point Likert scale from Extremely 3.1 Results of the assessment of end user satisfaction
Satisfied to Not satisfied (Score 5-1) was used to collect level
the data. The questionnaire consisted 9 sections namely, 3.1.1 Characteristics of the respondents
Demographic Characteristics, General features, Out- Out of 127 respondents, 8 (6.3%) were male and 119
patient, Inpatient, Ward Management System, Equipment (93.7%) female. Among them, 40 (31.5%) were in the age
Management System, Pharmacy, Payroll and Accounts. group of 21-25 years, 49 (38.4%) of 26-30 years, 24
The questionnaire was administered to the respondents (18.9%) in 31-35 years, 9 (7.1%) in 36-40 years, 4 (3.2%)
after briefing them about the survey and taking their due of 41-45 years and 1 (0.8%) in the age group of 56-60
informed consent. During second phase, the issues and years. (Table.1)
suggestions raised by the respondents during the end user
satisfaction survey were studied and recommendations to Table 1 - Characteristics of the Respondents (n=127)
address these issues were provided and implemented. In F r e - Percent-
the third phase, a post implementation satisfaction survey quency age
was conducted among 25 end users who had reported the Gender-wise Distribution
issues and made suggestions during the initial survey. The Male 8 6.3
respondents were asked whether the suggestions given by Female 119 93.7
them are implanted and how satisfied they are with the Age-wise distribution (interval in years)
implementation. Here, the respondents were briefed about 21-25 40 31.5%
the purpose of the interview and prior expressed consent 26-30 49 38.4%
was obtained. The data collected during first and third 31-35 24 18.9%
phase was analysed using SPSS 20.0 and presented in 36-40 9 7.1%
terms of frequency, percentage, mean score and standard 41-45 4 3.2%
46-50 0 0%
deviation.
51-55 0 0%
56-60 1 .8%
3. RESULTS AND DISCUSSION Designation-wise distribution
Associate executive 5 3.9
The assessment of end user satisfaction was conducted Staff nurse 65 51.2
among 127 end users in three phases. The result obtained Associate staff nurse 16 12.6
in each phase is presented in the form of table and dis- In-charge 10 7.9
cussed under the following headings: Guest relations executive 7 5.5
Lab technician 4 3.1
Biochemist 1 .8
3.1 Results of the assessment of end user satisfaction Embryologist 1 .8
level Radiology technician 2 1.6
3.1.1 Characteristics of the Respondents OT technician 2 1.6
Assistant Manager 4 3.1
3.1.2 Knowledge about basic functionality of com- Pharmacist 7 5.5
puter Chief Operating Officer 2 1.6
3.1.3 Usage of Hospital Information System Distribution based on years of experience (interval in years)
1-5 73 57.5
3.1.4 Assessment about the general features of HIS
6-10 28 22.1
3.1.5 Module wise feedback of HIS 11-15 17 13.4
16-20 8 6.3
21-25 0 0
3.2 Implementation of recommendations 26-30 0 0
31-35 1 0.8
3.3 Results of the post-implementation satisfaction sur- Among 127 respondents, 89(70%) were nurses, 7(5%)
vey front office staff, 6(4%) administrative staff, 18(14%)
Phase 1 included the assessment of satisfaction level of the paramedical staff, 1 MRD staff, 2 maintenance staff and 4
end users of hospital information system where the end accounts staff. (Table.1)
users were asked about their knowledge about HIS and its About 73(57.5%) respondents had 1-5 years of working
usage. They were also asked to rate their level of satisfac- experience, 28(22.1%) with 6-10 years and 17(13.4%)
tion with regard to general and module specific fea- with 11-15 years, 8(6.3%) had 16-20 years
27
 Management in health
XVIII/3/2014; pp. 26-33
Table 2 - Distribution of respondents based on their
knowledge about basic functionality of computer (n=127)
Parameter Yes No
Knowledge f % F %
about basic 127 100 0 0 127
functionality
of computer
Note: n=total number of respondents, f=Frequency, %=Percentage
Table 3 - Distribution of respondents based on the usage
of Hospital Information System before (n=127)
Parameter Yes No
Have you used f f
% %
HIS before? 32 25.2 95 74.8 127
Note: n=total number of respondents
whereas 1 respondent had 31-35 years of experience in
their area of expertise. (Table 2)
3.1.2 Knowledge about basic functionality of computer
The success of any HIS implementation depends on the
knowledge of basic functionality of computer among end
users. In this study, all the respondents were found to have
the knowledge on the basic functionality of computer
(Table.2).
3.1.3 Usage of HIS
The hospital information systems always have a chance of
acceptance or rejection depends on the previous experience
of the end users about hospital information system. The
study result evident only 32(25.2%) respondents, who have
the previous experience of using HIS where they claimed
that their experience was good and they expect similar fea-
ture and functionality with the present system of HIS.
(Table.3)
3.1.4 Assessment about the general features of HIS
The objective of the study was to assess the end user satis-
faction level towards the Hospital Information System. A
total of 127 end users were interviewed and they were
asked to rate the general and module specific features, they
use in the Hospital Information System. The response re-
ceived form all the respondents about the general features
of HIS are presented in the form of table and discussed
hereunder:
3.1.4.1 Data display
The display of information in hospital information system
should be clear and appropriate to the end users for its
comfortable usage. The study result evident that only 10
QUALITY
(7.9%) respondents were extremely satisfied whereas 45
(35.4%) were very satisfied and 65 (51.2%) moderately
Total satisfied with the data display feature of the HIS. The
mean score of the response 3.46 and the standard deviation
f % of 0.721 indicated the satisfaction level of respondents
100 towards the data display as moderate. (Table.4)
3.1.4.2 Response time
HIS is said to provide timely access to information as re-
sponse time is an important factor contributing to the effi-
ciency of hospital information systems [9]. Among 127
respondents, 57 (44.9%) respondents claimed that they are
Total
f
moderately satisfied with response time of the system
%
100
whereas 42 (32.3%) were slightly satisfied with it .The
mean score of 3.34 and standard deviation 0.693 shows the
satisfaction with the response time as moderate. (Table.4)
3.1.4.3 Accessibility
The HIS should provide comfortable access to data at
point of care in the healthcare facility [10]. The study re-
sult reported about 70(55.1%) respondents who were mod-
erately satisfied with the accessibility feature of HIS
whereas 41(32.3%) were found to be very satisfied. The
mean score and standard deviation being 3.34 and 0.693,
that indicates the related satisfaction level as moderate.
(Table.4)
3.1.4.4 Data input
A good data input feature assists the end users in entering
the correct data into the hospital information system. The
study results evident that 71(55.9%) respondents were
moderately satisfied with the data input feature of HIS
whereas 44 (34.6%) were very satisfied. The mean score
and standard deviation was found to be 3.39 and 0.657
which showed the related overall satisfaction of the HIS
among end users as moderate (Table.4).
3.1.4.5 Data Retrieval
The HIS should have the fast and secure data retrieval sys-
tem to assist the end user in accessing data irrespective of
location and geographical area. In view to this, 69 (54.3%)
respondents reported to be moderately satisfied, 39
(30.7%) very satisfied and only 3 (2.4%) extremely satis-
fied. The overall satisfaction related to the data retrieval
was found to be moderate with the mean score 3.23 and
standard deviation 0.692 respectively. (Table.4)
3.1.4.6 Format
The study results revealed that 72(56.7%) respondents
were moderately satisfied with the format of the HIS
where about 36(28.3%) were very satisfied and only 5
(3.9%) claimed to be extremely satisfied. The rea-
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Table 4 - Response related to General features of the module (n=127) usually unaware of the technical aspects of
Sl. Features ES VS MS SS NS M SD the system. Therefore strong technical sup-
No. f f f f f port should be provided to the end users
(%) (%) (%) (%) (%) during their use of the system. In this
1 Data display 10 45 65 7 0 3.46 0.721 study, about 60(47.2%) respondents were
(7.9%) (35.4%) (51.2%) (5.5%) (0%) found moderately satisfied with the techni-
2 Response time 2 22 57 42 5 2.80 0.827 cal support provided with respect to HIS.
(1.6%) (17.3%) (44.9%) (32.3%) (3.9%)
On the other hand 39(30.7%) said they are
3 Accessibility 6 41 70 10 0 3.34 0.693
(4.7%) (32.3%) (55.1%) (7.9%) (0%) slightly satisfied because of inadequate
4 Data input 6 44 71 6 0 3.39 0.657 technical support from the information sys-
(4.7%) (34.6%) (55.9%) (4.7%) (0%) tem department. The mean score 3.86 and
5 Data storage 7 47 66 6 1 3.42 0.706 standard deviation 0.794 indicated the sat-
(5.5%) (37.0%) (52.0%) (4.7%) (0.8%) isfaction level with respect to technical
6 Data retrieval 3 39 69 16 0 3.23 0.692 support as moderate to very satisfy.
(2.4%) (30.7%) (54.3%) (12.6%) (0%) (Table.4)
7 Format 5 36 72 14 0 3.25 0.701
(3.9%) (28.3%) (56.7%) (11.0%) (0%)
8 Customization 0 23 69 32 3 2.88 0.720 3.1.4.9 Training
(0%) (18.1%) (54.3%) (25.2%) (2.4%)
9 Technical sup- 2 23 60 39 3 2.86 0.794 Training has been identified as one of the
port (1.6%) (18.1%) (47.2%) (30.7%) (2.4%) key factor in the successful use of hospital
10 Training 5 22 61 37 2 2.93 0.828 information systems [6]. The importance of
(3.9%) (17.3%) (48%) (29.1%) (1.6%) training end users in the use of hospital
11 Job satisfaction 7 34 67 17 2 3.21 0.803 information systems and its direct impact
(5.5%) (26.8%) (52.8%) (13.4%) (1.6%) on the success of the implementation has
12 Reduction of 2 21 65 38 1 2.88 0.741 been discussed in many research works [3]
duplicate work (1.6%) (16.5%) (51.2%) (29.9%) (0.8%)
[12][13][14]. In this study, 61(48%) re-
13 Confidentiality 6 47 72 2 0 3.45 0.613
(4.7%) (37.0%) (56.7%) (1.6%) (0%) spondents were moderately satisfied with
14 Privacy 4 50 72 1 0 3.45 0.573 the training provided to them whereas 37
(3.1%) (39.4%) (56.7%) (0.8%) (0%) (29.1%) were slightly satisfied. The mean
15 Security of data 4 54 69 0 0 3.49 0.562 score 2.93 and standard deviation 0.828
(3.1%) (42.5%) (54.3%) (0%) (0%) indicate the overall satisfaction about train-
16 Overall satisfac- 4 37 76 10 0 3.28 0.651 ing as moderate. (Table.4)
tion (3.1%) (29.1%) (59.8%) (7.9%) (0%)
Note: n= total number of respondents, ES=Extremely satisfied, VS=Very satisfied, MS=
Moderately satisfied, SS=Slightly satisfied, NS=Not satisfied, M=Mean Score, 3.1.4.1 0Job satisfaction
SD=Standard deviation, f=Frequency, %=Percentage
Job satisfaction is important from the per-
the moderate satisfaction was the presentation of entry spective of maintaining and retaining the
forms which was not well organised. The mean score 3.25 appropriate employees within the organization [15]. The
and standard deviation 0.701 shows the overall satisfaction end user should feel good in working with the HIS be-
related to the presentation of format as moderate. (Table.4) cause it contribute directly to maximum job satisfaction
and considered to be very important for the successful
working of the organization itself. The study result indi-
3.1.4.7 Customisation cates that 67 (52.8 %) respondents were moderately satis-
Hospital based customisations are required for the HIS fied, 34(26.8%) very satisfied and about 17(13.4%) were
software to suit the working environment of the end users slightly satisfied and they also mentioned that the HIS is
and hospital. The end user needs should be assessed, ana- not assisting much in performing their jobs. The mean
lysed and implemented to enhance their overall satisfaction score 3.21 and standard deviation 0.803 shows overall
towards HIS [11]. The study result shows that 69 (54.3%) satisfaction as moderate with respect to the HIS support.
respondents were moderately satisfied with the customiza- (Table.4)
tions of the system and about 32(25.2%) were slightly sat-
isfied that drop down the overall satisfaction as slightly to
3.1.4.11. Reduction of duplicate work
moderate with the Mean score 2.88 and Standard Devia-
tion: 0.720. (Table.4) A good hospital information system should reduce the
duplication of information entries and reduce the end users
time in documenting patient and administrative data [4].
3.1.4.8 Technical support In this study, 65 (51.2%) respondents were found to be
Information technology is the backbone of hospital moderately satisfied with duplication of work in using
29 information systems. The end users of the HIS are HIS whereas 38(29.9%) were slightly satisfied because
 Management in health
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Table 5 - Response related to the module specific features of HIS (N= 127) and their work practices [17]. This study
Sl. Module Average MS
No.
1 Out-patient (n=36) 2.85
2 In-patient (n= 84) 3.34
3 Diagnostic (n=100) 3.56
4 Ward Management System (n=76) 3.49
5 Equipment Management System (n=127 ) 3.05
6 Pharmacy (n=93) 3.5
7 Admin (n=7) 3.20
8 Payroll (n=2) 2 moderate. (Table.4)
9 Accounts (n=4)
Note: n= Total number of actual respondents. MS= Mean Score
HIS used to increase their time in documenting the patient
and other data on paper as well as in all administrative
work. The mean score and standard deviation was found
2.88 and 0.741 respectively which showed the satisfaction
level as moderate. (Table.4) The similar finding was re-
ported in the study of Nour El Din, where the users com-
plained that the hospital information systems adds more
work and require more time and effort and decreases their
productivity [16].
3.1.4.12. Confidentiality
Information generated in the hospital information system
can be of many types i.e. identification data, clinical or-
ders, laboratory results, administrative data etc. It is impor-
tant to maintain the confidentiality of these data in the
good interest of both the patient and the healthcare pro-
vider. When the question asked to rate their satisfaction in
terms of HIS support in maintaining the confidentiality of
patient data, 72(56.7%) rated that they are moderately sat-
isfied with the support of HIS in maintaining the confiden-
tiality of patient and other data. The mean score and stan-
dard deviation being 3.45 and 0.613 which signified the
satisfaction level with respect the HIS support in maintain-
ing the confidentiality of data, as moderate. (Table.4)
3.1.4.13. Privacy
Protecting the privacy of health and other administrative
data in hospital information system is important to ensure
that individuals right to privacy is being protected. When
the respondents were asked whether the HIS support them
in protecting the privacy of patient and other administra-
tive data, about 72(56.7%) respondents rated their satisfac-
tion level as moderate. The mean score and standard devia-
tion was found to be 3.45 and 0.573 which denoted the
satisfaction level as moderate. (Table.4)
3.1.4.14. Security of data
The secure management of patient and other data using
hospital information system has a strong impact on quality
of patient care, patient rights and health care professionals
QUALITY
also pointed out the issues with respect to
the use of HIS and it support in managing
the secure patient data. The satisfaction
level were found to be moderate among 69
(54.3%) respondents, very satisfied among
54(42.5%) and extremely satisfied among 4
(3.1%) respondents. The mean score 3.49
and standard deviation 0.562 revealed the
overall satisfaction with the above issues as
3.75
3.1.4.15. Overall satisfaction
Usefulness of a system is often measured by examining
the user satisfaction with the system [18]. When the re-
spondents were asked to rate their overall satisfaction with
respect to the support of HIS in performing their day to
day activities, 76(59.8%) respondents claimed that they
are moderately satisfied with the overall working of HIS.
The mean score 3.28 and Standard deviation 0.651 also
indicate the overall satisfaction of HIS as moderate.
(Table.4)
As stated earlier, previous experience of hospital informa-
tion system has a direct impact on the acceptance and re-
jection of the system. The result of the study also revealed
the significance (p<0.05) of use of HIS with the response
time, job satisfaction, reduction in duplication of work and
customization.
3 1.5 Module wise feedback on HIS
The respondents were also asked to rate their level of satis-
faction about the module they use for performing their day
to data activities. The validated questionnaire based on 5
Point Likert scale from Extremely Satisfied to Not Satis-
fied (Score 5 1) was use to collect their response. The
result obtained is present in the form of table and dis-
cussed hereunder:
3 1.5.1 Out-patient Module
The Outpatient module is being used in Front office,
MRD, OPD and Emergency departments. This module
takes care of the outpatient registration, billing, doctors
appointment, scan appointments, vaccination appoint-
ments, file management, racks patient movement and ob-
tain various reports.
A total of 36 respondents were found to use outpatient
module to document patient data. When they were asked
to rate their response regarding their satisfaction level
about the out-patient module in terms of storage of demo-
graphic data, reduced patient handling time, interoperabil-
ity, timesaving, file management, tracking of patient infor-
mation, outpatient billing, doctors appointment, scan ap-
pointments, vaccination appointments and reports. The
average mean score and standard deviation was 30
 QUALITY
found to be 2.85 and 0.688. The result indicated the overall
satisfaction of the respondents with the features of out-
patient module to be moderate. (Table.5)
3 1.5.2 In-patient Module
This module deals with the patient admission, consultation,
treatment, billing, discharge and OT management. Among
127, 84 respondents, who were the actual users and hence,
rated their response with respect to the features of in-
patient module namely; inpatient billing, storage of inpa-
tient information, tracking of patient information, reduc-
tion of duplicate work, room and bed allocation, bed trans-
fer, procedure and surgery listing and reports. The mean
score and standard deviation of the response related to the
above feature was found to be 3.34 and 0.687 which de-
noted the satisfaction level as moderate with the features of
in-patient module. (Table.5)
3 1.5.3 Diagnostic Module
This is the radiology and laboratory information system.
This module helps the end user in maintaining all the labo-
ratory and radiology investigations during the treatment of
the patient. About 100 users rated their satisfaction with
respect to Diagnostic module in terms of i.e. test requisi-
tions, order handling, results handling, report generation
and information on investigations. The result showed the
average mean score and standard deviation to be 3.56 and
0.750 and indicated the overall satisfaction as moderate to
very satisfy. (Table.5)
3 1.5.4 Ward Management System (WMS)
This module manages the nursing services provide by the
nursing staff in the inpatient wards. Its features include bed
transfer, drug indents, service management, diet indents
etc. It helps to track the information about the inpatients. A
total of 76 end users found to be using WMS where they
have asked to rate their satisfaction about the features of
ward management system namely, tracking of patient in-
formation, drug indents, request handling, complaint re-
porting, service management, bed transfer, procedure and
surgery listing and reports. The average mean score 3.49
and the standard deviation 0.715 of the response showed
the satisfaction level as moderate with the ward manage-
ment system. (Table.5)
3 1.5.5 Equipment Management System
This module deals with all kind of maintenance report,
break down/ complaint reporting and rectification of com-
plaints. The 127 end users of equipment management sys-
tem module were asked to rate their satisfaction level re-
garding its features i.e. biomed waste management, com-
plaint registering, rectification of complaints, instruments
management and sterile supplies. The results indi-
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Management in health
XVIII/3/2014; pp. 26-33
cated the overall satisfaction with the above features as
moderate with the average mean score and standard devia-
tion of 3.05 and 0.691. (Table.5)
3 1.5.6 Pharmacy Module
It helps in managing the drug indents, issuing and dispens-
ing drugs, and stock management. It also provides the
complete stock report, sales details of a particular item and
the expired medicine list. Around 93 end users were asked
to rate their response about their satisfaction with the fea-
tures of pharmacy module namely, drug indents, display
of medication lists, stock management, billing, drug issu-
ing, and purchase management. The mean score and stan-
dard deviation being 3.5 and 0.675 which reported the
satisfaction level as moderate to very satisfy. (Table.5)
3 1.5.7 Admin Module
The administration module maintains the information sys-
tem for the Operations department. About 7 end users of
Admin module were identified and they were asked to rate
their response regarding their satisfaction level with fea-
tures such as report generation, format of reports, accuracy
of data, masters and statistics. The average mean score
and standard deviation was found to be 3.20 and 0.743.
This signified the overall satisfaction regarding the admin
module as moderate. (Table.5)
3 1.5.8 Payroll Module
It is the Human Resource Management module. It helps in
managing the manpower (employees) of the hospital. It
provides facilities for employees salary management and
calculation of provident fund and professional taxes. Only
2 end users of Payroll module were identified and they
have asked to rate their satisfaction level with respect to
the features of payroll module namely, storage of em-
ployee information, pay slip issuing, salary management,
leave allotment and various reports. The average mean
score and standard deviation being 2 and 0.565 revealed
that the end users were slightly satisfied with the feature
of payroll module. (Table.5)
3 1.5.9 Accounts Module
The end users of Accounts module were asked to reveal
their satisfaction level regarding its features, which are,
financial reports, audit management, stock management,
budget calculation, vouchers, TDS and other reports. The
response received from 4 end users of Account module
showed the average mean score and standard deviation as
3.75 and 0.711 which indicated their satisfaction level as
very satisfied. (Table.5)
The end users satisfaction survey result evident the satis-
faction level as moderate with most of the feature of
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XVIII/3/2014; pp. 26-33 QUALITY

Table 6 - Response related to Post Implementation Satisfaction Survey The pay slip was send to employees even
S l . Changes suggested Implemented ES VS MS SS NS after they resigned and left the hospital.
No Yes No f f f f f Additional allowances such as loss of pay,
over time, extra wages were not calculated
1 Outpatient Module: 1 1 by the system.
File management date corrected (n=1)
2 Inpatient Module: 5 5
Pharmacy Return head added (n=5) 3.2 Implementation of recommendations
3 Ward Management System 5 1 2 2 1 During the survey, end users also provided
Diet intend started ( n= 5) suggestions to improve the overall perform-
4 Outpatient Module: 3 1 2
ance of HIS. As the objective of the study
Token system started (n=3)
5 Inpatient Module: 2 2
was to provide recommendations, sugges-
NICU-3rd consultation visit added (n=2) tions to the related issues, if any and imple-
6 Payroll Module: 2 1 1 ment the same. The issues were studied and
Provident Fund Calculation (n=2) discussed and recommendations to solve the
7 Payroll Module: 2 2 issues were communicated to the Chief Op-
Pay slip issuing proper (n=2) erating Officer, IT Manager and the vendor.
8 Payroll Module: 2 2 The recommendations related to the above
Loss of pay and extra earnings calcula- issues given and implemented were:
tion (n=2)
9 Run time errors (n=14) 14 5 7 The issues related to the date for updat-
10 System slow (n=9) 9 6 3 ing of status of medical record in the medi-
Note: n= total number of actual respondents, ES= Extremely satisfied, VS=Very satisfied, cal record module was corrected to avoid
MS= Moderately satisfied, SS=Slightly satisfied, NS=Not satisfied, f=Frequency any confusion.
A head called Pharmacy Return in IP
HIS. During the survey, the respondents pointed out the final bill sheet is included to show the pharmacy re-
issues related to the overall functionality of HIS. These turns in the final bill of the patient.
issues were department and module specific and needed
A diet masters is created in the Dietetics module and
improvement to enhance the level of acceptance. The vari-
also trained the staff to use diet indents in ward man-
ous issues identified are listed below as per the module:
agement system.
Outpatient Module: In File Management page of out- A token system is started in the outpatient module to
patient module, while marking IN, when the files are
avoid unnecessary waiting time and queue in the out-
returned in the MRD, the date of all the entries use to
patient department.
change including those which were returned in the
previous days. Another issue was the Token system Multiple options for entering the consultation visits is
for patient queue which was not present in outpatient added in the NICU module.
module. To avoid run time errors, the system is downgraded
IP Module: While preparing the final billing sheet dur- from Windows 8 to XP, as XP supports the .exe ver-
ing patient discharge, the pharmacy return amount is sion software better.
not shown in the billing sheet which uses to create The error related to the calculation of provident fund
confusion among patients. The NICU In-charge felt and extra allowance is rectified in the payroll module.
that the inpatient module should have the provision for Even the pay slip issuing issues is also resolved.
adding multiple visits of the consultant.
Ward Management System (WMS): The features re- 3.3 Results of Post Implementation Satisfaction Survey
lated to the specific diet plan were not present in the The objective of the study was to assess the end user satis-
diet indent of WMS. Due to this, nurses were finding faction towards implemented recommendations. The sam-
difficult to indent the specific diet from cafeteria. ple included only those who had pointed out issues and
Hence, the nurses used to manage the diet indent given suggestions during the initial satisfaction survey. A
manually. total of 25 end users were identified who have raised the
Run time errors- In some systems run time errors used issues and given recommendation to improve the overall
to happen while staff performed their work. This re- functionality of hospital information system. The respon-
quires the staff to do the entire work all over again. dents were asked to state whether the issues are resolved
The emergency room system were found to be slow and changes are implemented. They were also asked to
and use to take more time to respond and delay the rate their satisfaction on a five point Liker scale from Ex-
processes of patient admission. tremely Satisfied to Not Satisfied on a score of 5 to 1.
Payroll: The provident fund calculation was not accu- During post implementation survey, all the respondents
rate which caused the staff to calculate it manually. were found to be satisfied with the changes
32
 QUALITY Management in health
XVIII/3/2014; pp. 26-33

made to the system. During the survey, the requirement of
a separate medical record department module has been
identified, as it was raised by the medical records depart-
ment staff to perform all their functions using a single
module. The same is communicated to the IT manager and
implemented where all the end users found to be satisfied
with the changes. (Table.6)
4. CONCLUSION
Hospital Information System plays a vital role in modern
healthcare. On the other hand, end user satisfaction is criti-
cal for the existence of information system itself.
The study investigated the satisfaction of end users to-
wards the hospital information system and establishes a
firm system to continuously improve the satisfaction
among end users. The result showed that almost all the
users were satisfied with overall functionality of the sys-
tem. Some dissatisfaction existing among the end users is
because of not addressing the user requirements and not
involving them during the design and implementation of
the system. The end users also lacked a proper platform to
express their issues regarding the hospital information
system and therefore most of their issues remained unad-
dressed by the administration. The need identified was to
conduct similar studies in the future to achieve maximum
sustainability of Hospital Information System.
ACKNOWLEDGEMENT
We are thankful to the hospital authority for allowing us
to conduct the study.

References
1. J. Adler. Milstein, and D. W. Bates. 2010. Paperless healthcare: Progress and challenges of an IT-enabled healthcare system. Busi-
ness Horizons. 2010 Vol.53. No.2.
2. G. D. Kunder. Hospital Information System. Hospitals Facilities Planning and Management. 2nd Ed. TBS. 2004
3. Yaseen A. Hayajneh. et.al. Extend of Use, Perceptions, and Knowledge of a Hospital Information System by Staff Physicians.
[Cited on 2014 February 14]. Available from: hayajneh.startlogic.com/research/Extent_of_Use_.pdf
4. Information System. 2014. [Cited on 2014 February 14] Available from: http://en.wikipedia.org/wiki/
Hospital_information_system.
5. Mohd-Fadhil NF, Jusop M, Abdullah AA. 2012. Hospital Information System (SIS) Implementation In A Public Hospital: A Case
Study From Malaysia. [Cited on 2014 March 5]Available from: http://www.fareastjournals.com/files/FEJPBV8N3P1.pdf
6. SimaAjami, ZohrehMohammadi. 2012. Training and its Impact on Hospital Information System (SIS) Success. [Cited on 2014
March 22]. Available from:omicsgroup.org/journals/training-and-its-impact-on-hospital-information- system-SIS-success-2165-
7866.100011.
7. Wixom BH, Todd PA . 2005. A theoretical integration of user satisfaction and technology acceptance. 16. 85-102. [Cited on 2014
April 3] Available from: www.lib.yuntech.edu.tw/~exam/exam_new/100/dmi.pdf.
8. Norman Au, W T Eric Ngai, T C Edwin Chang. Extending the understanding of end user information systems satisfaction forma-
tion: An equitable fulfilment model approach. [Cited on 2014 April 10] Available from: http://misq.org/extending-the-
understanding-of-end-user-information-systems-satisfaction-formation-an-equitable-needs-fulfillment-model-approach.html
9. Mohan Bansal. Hospital Management and Information System. Medical Informatics. 2st Ed. McGraw Hill. 2003
10. Benefits of hospital information system. 2010. [Cited on 2014 May 5] Available from:http://www.healthcareglobal.com/
news_archive/industry-focus/management-best-practices/benefits-hospital-information-system.
11. Indah Mohd Amin. 2011. Assessing User Satisfaction of using Hospital Information System (SIS) in Malaysia. Proceedings of the
International Conference on Social Science and Humanity. [Cited on 2014 April 28]. Available from: http://www.ipedr.com/vol5/
no1/45-H00097.pdf.
12. Mohamed Khalifa. 2014. Technical and Human Challenges of Implementing Hospital Information Systems in Saudi Arabia. Jour-
nal of Health Informatics in Developing Countries [JHIDC]. [Cited on 2014 May 12] Available from: www.jhidc.org/index.php/
jhidc/article/view/111.
13. PoonE. G. et.al .2004. Overcoming barriers to adopting and implementing computerized physician order entry systems in US hos-
pitals. Health Affairs, 23(4), 184-190. [Cited on 2014 May 12] Available from:www.ncbi.nlm.nih.gov/pmc /articles/
PMC1480209.
14. Heeks, R. 2006. Health information systems: Failure, success and improvisation. International journal of medical informatics, 75
(2), 125-127. [Cited on 2014 May 18]. Available from: www.ncbi.nlm.nih.gov/pubmed/16112893.
15. Carrie Bloomfield. The Facts About Job Satisfaction. [Cited on 2014 May 18]. Availablefrom:www.icr-global.org/EasySiteWeb/
GAtewayLink.aspc?alld=4464
16. Nour El Din. 2007. Physicians use of and attitudes toward electronic medical record system implemented at a teaching hospital in
Saudi Arabia. The Journal of the Egyptian Public Health Association, 82(5-6), 347-364. [Cited on 2014 May 22].Available from:
www.ncbi.nlm.nih.gov/pubmed/18706293.
17. Laurinda B. Harman. et. al. 2012. Electronic Health Record: Privacy, Confidentiality, and Security. [Cited on 2014 May 24].
Available from: http://virtualmentor.ama-assn.org/2012/09/stas1-1209.html.
18. Ammenwerth E, et.al. 2001. Evaluation of clinical Information systems. What can be evaluated and what cannot? [Cited on 2014
May 22]. Available from: www.ncbi.nlm.nih.gov/pubmed//11737529
33