Otaiby R^*

Master in Health Service Administration, Yarmouk University, Amman, Jordan

*Corresponding Author:: Otaiby R
Master in Health Service Administration
Yarmouk University
Amman, Jordan
Tel: +962790812481
E-mail: R.otaiby@hotmail.com

Received date: December 06, 2018; Accepted date: December 28, 2018; Published date:December 31, 2018

Keywords

Health information systems; Jordanian hospitals; Jordanian health care

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Introduction

In many countries, information and communication technology leaders are working to implement universal health coverage. They are grappling with the fact that although their insurance information systems are just now being formed, there are often underl…ying legacy health information systems that have been used to collect data for managing health care service delivery quality and that have provided important clues to emerging health issue.

Authoritative information is the basis for decision-making in all health system-building units and is primary for the implementation of health system policy, governance and management, health research, HR development, health education and training, and service delivery and finance (World Health Organization, 2008) [1].

Information System is known as a system that gives information used to the decision-making process at each level of an organization. Hence, Health Information System considered as a system that merges data collection, processing, reporting, and utilize of the information necessary for health service effectiveness and efficiency improvement by good management at all levels of health services (World Health Organization, 2004) [2].

Almunawar & Anshari [3] showed that health information systems are involving many terminologies that are: Health Informatics, which is the field that concerns itself with the cognitive, information processing, and communication works of medical practice, education, and research involving the information science and technology that reinforce those works. Another one is Health informatics tools, involving computers, clinical guidelines, and formal medical terminology, and information and communication systems. In other hands, emphasis is placed on medical and biological applications with additional potential for the integration of clinical components either with each other or with more administrative health information systems. In addition, health information technology is an information processing application that includes computer hardware and software that handles the storage of information, data, knowledge about health, data and knowledge in communication and decisionmaking.

Health information systems became of the main topics that interest managers in the health organizations, because it provide the potential to address high-speed data, which helps in providing information to make important decisions whether operational, investment or financing ones.

Generally, good health information system that create reliable, timely, and perfect quality data is between many factors enabling health program managers to monitor, evaluate, and progress health system performance and make evidence informed decisions [4].

The health sector in Jordan has witnessed major developments in health information systems. These systems have become available in all hospitals and in most health centers and represent an important development in the efficiency and effectiveness of the health service.

The Study Problem Statement

What is efficiency of Health information Systems (Retrieval of health information, Acquire health information, Efficiency of staff working the information system) Jordanian Hospitals?

What are the opportunities of Health information Systems to develop Jordanian health care?

Study Significance

Due to the significance of Health Information System, the study seeks to benefit Administrative and Medical Managers by clearing the opportunities of Health information Systems to develop Jordanian health care.

Hence, the importance of current study stems from the following points:

1 - Despite the importance of the subject of Health Information, there is a shortage in the research and studies that address this topic.

2 - The fact that the success and efficiency of information system has become the basic requirements for survival, and can capture the opportunities that health information systems may provide in develop Jordanian Health Care.

Study Objectives

The research aimed to achieve the following objectives:

1. Identify the efficiency of Health information Systems in Jordanian hospitals.

2. Identify the opportunities that Health information Systems provided to develop Jordanian health care.

Hypotheses of the Study

Ho: There is statistically significant relationship between Health Information System and develop Jordanian health care.

• Ho: There is statistically significant relationship between Retrieval of health information and develop Jordanian health care.

• Ho: There is no statistically significant relationship between Acquire health information and develop Jordanian health care.

• Ho: There is no statistically significant relationship between efficiency of staff working the information system and develop Jordanian health care.

Study Model

Below Figure 1 shows details of Health Information Systems.

hospital-medical-management-information-systems

Figure 1: Health information systems.

Related literature

Ratna & Kaur The impact of information technology on job related factors like health and safety, job satisfaction, performance, productivity and work life balance: The study aimed to finding out the impact of technology on various jobrelated factors, and 5 short lists of studies, namely health and safety, job satisfaction, performance, productivity and balance in working life. What is the working factor is getting the most affected with the introduction of technology the study was conducted with the help of the questionnaire based on the Lycert scale. Data was collected from 100 employees of BARCO & Fish Co., Ltd. The data was analyzed through the SPACE program and the superiority to know that performance is the most affected factor by introducing new technology, followed by job satisfaction, health, safety, productivity and balance in the working life. The factor analysis has transformed it into three elements in which element 1 has contributed more to the impact of technology [5].

Almunawar & Anshari health information systems (HIS): Concept and technology: A health information system (HIS) is the intersection of between healthcare’s business process, and information systems to deliver better healthcare services. The nature of healthcare industry, which is highly influenced by economic, social, politic, and technological factors, has changed over time. This paper will address some important concepts of healthcare and related terminologies to provide a holistic view for HIS. Related technological milestones and major events are briefly summarized. The trends and rapid development of health information technologies are also discussed [2].

Rahimi et al. health information system implementation: A qualitative meta-analysis: The aim of this paper has been to organize the knowledge gained in qualitative studies performed in association to HIS implementations and to use this knowledge to outline an updated structure for implementation planning. The study used a multi-disciplinary team for the analyses in order to cover as many aspects of the primary studies as possible. The results show also that many of the most important failures seem still to emerge from the absence of feedback from end–users to developers during the development process. What it is needed is the use of an implementation methodology that minimizes the information asymmetry in the implementation process, and that allows the accumulation of the knowledge capital needed to prevent rejection of the final system [6].

Sobhani impact of information technology on productivity, a case study in telecommunications company in Tehran: The study aimed to examine the impact of investment in information technology on productivity in the telecommunications company in Tehran, using the Kop-Douglas model. 44 financial and economic data were collected since 1997 up to 2007 for driving the corresponding model. Weighted least square was run by SPSS 15 to test hypotheses. The result have indicated that IT investment not only makes the positive contribution is positive after dedications for depreciation and labor expenses. Further productivity analysis exposed the positive correlation between IT, Total Factor Productivity and labor productivity [7].

Crespi, Criscuolo & Haskel information technology, organizational change and productivity growth: evidence from UK firms: The study aimed to study the relationships between productivity growth, investment in information technology and organizational change, using the data of the UK Company. Consistent with the small number of other small studies, (a) IT seems to have high returns in the accounting sense of growth when organizational change is deleted; when organizational change is included, IT revenues are greatly reduced; (b) IT and organizational change Interaction in their impact on productivity growth, (c) non-investment in information technology and organizational change does not interact in their impact on the growth of productivity. The study concluded that: (a) competition is affected by competition and (b) we also have strong implications for the possibility of introducing regulatory change from ownership. US-owned companies are likely to provide a proportion of foreign-owned companies that are still more likely for British firms [8].

Research Method

This study based on quantitative method “quantitative research usually emphasizes quantification in the collection and analysis of data. As a research strategy it is deductivist and objectivist and incorporates a natural science model of the research process” [9]. In addition, Proctor (1997) [10] claimed that, “quantitative research produces numbers and figures”.

To determine this, the study will use descriptive and analytical approach to describe the opportunities of Health information Systems to develop Jordanian health care.

In this research, the researcher will use primary sources of data, and this kind of data derived from the self-completion questionnaire.

Study Population & Sample

The study community consists of all the administrative staff at Al- Bashir Hospital (Government hospital) and Specialized Hospital (Private hospital). For the purpose of the study, the random sample method was used. In order to find out the number of administrators in the two hospitals, the researcher conducted personal interviews with the staff of the human resources department in the two hospitals. The researcher found that the number of administrators is about 700 in the two hospitals.

To determine the sample size the researcher depends on (tools4dev.org) as follow Table 1:

Size of Population
Margin of error	>5000	5000	2500	1000	500	200
± 10%	96	94	93	88	81	65
± 7.5%	171	165	160	146	127	92
± 5%	384	357	333	278	217	132
± 3%	1067	880	748	516	341	169

Table 1: Sample Size.

Source: https://www.tools4dev.org/resources/how-to-choose-asample- size/

Table 1 Shows that as the sample size total population are (700) study sample size will be (278).

Data Sources

Proctor (1997) pointed out that, there are two main methods of collecting data, secondary and primary data. Each type consists of various methods of gathering data. In this research, two methods will be argued [10].

The Methods of Gathering Data in this Research will depends on the two methods secondary and primary data.

Secondary data will represent by the literature review and field previous studies,

Primary data represents by the development of a questionnaire to measure the variables and dimensions of the study [11].

Questionnaire Design

A likert scale five-point questionnaire will be used as a tool to measure the dimensions of study variables based on the following values (Appendix file).

- Strongly Agree: (5) points

- Agree: (4) points

- Neutral: (3) points

- Disagree: (2) points.

- Strongly Disagree: (1) point.

Statistical Methods

Methods of data processing depended on number of statistical analysis techniques that found in the SPSS program.

1- Descriptive: Frequency, means, standard deviations.

2- Analytical: multi Regression analysis to test the Hypotheses of the study.

Results

A total of 278 questionnaires were distributed 265 were collected 2 questionnaires have been neglected due to uncompleted answers, 263 questionnaires data were suitable to be tested.

Statistical Analysis

1) Age

Table 2 Shows that:

Age		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	Less than 30 years	144	54.8	54.8	54.8
	30-40 years	95	36.1	36.1	90.9
	41-50 years	23	8.7	8.7	99.6
	More than 50 years	1	.4	.4	100.0
	Total	263	100.0	100.0

Table 2: Statistical Analysis of Age.

% 54.8 of the samples has less than 30 years old.

%36.1 has 30-40 years old.

%8.7 has 41-50 years old.

%0.4 has more than 50 years old.

2) Gender

Table 3 Shows that:

Gender		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	MALE	111	42.2	42.2	42.2
	FEMALE	152	57.8	57.8	100.0
	Total	263	100.0	100.0

Table 3: Statistical Analysis of Gender.

%57.8 of the samples were females, %42.2 were males

3) Educational Level

Table 4 Shows that:

Educational Level		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	High school or less	25	9.5	9.5	9.5
	Diploma	101	38.4	38.4	47.9
	Bachelor	118	44.9	44.9	92.8
	Master/ PhD	19	7.2	7.2	100.0
	Total	263	100.0	100.0

Table 4: Statistical Analysis of Educational Level.

• %44.9 of the samples hold Bachelor’s degree.

• %38.4 holds Diploma degree.

• %9.5 holds high school or less.

• %7.2 holds Master/ PhD degree.

3) Experience

Table 5 Shows that:

Experience		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	1-2 years	49	18.6	18.6	18.6
	2-5 years	129	49.0	49.0	67.7
	5-8 years	43	16.3	16.3	84.0
	more than 8years	42	16.0	16.0	100.0
	Total	263	100.0	100.0

Table 5: Statistical Analysis of Experience.

• % 49.0 of the samples has 2-5 years of experience.

• % 18.6 of the samples has 1-2 years of experience.

• %16.3 of the samples has 5-8 years of experience.

• %16.0 of the samples has more than 8 years of experience.

Reliability

Cronbach's Alpha was run to ensure Reliability of the study questionnaire; Table 6 shows the results:

Retrieval of health information
Cronbach's Alpha	N of Items
.906	5
Acquire health information
.882	5
working staff efficiency
.835	5
Health information Systems
.928	15
Develop Jordanian Health Care
.858	10

Table 6: Reliability Statistics.

Table 6 Indicates that Cronbach's Alpha values were more that %60 which indicates that the questionnaire has suitable Reliability, to analysis its data.

Presenting study results

(Likert Scale) was used in order to answer the questionnaire items based on these values:

- Strongly Agree: (5) points

- Agree: (4) points

- Neutral: (3) points

- Disagree: (2) points.

- Strongly Disagree: (1) point.

Thus we can say that categories less than (3) represent negative view, and categories more than (3) represent positive view. Also, the researcher used the following categories to judge the items estimation:

• Means (1-less than 2.5) low estimation

• Means (2.5-less than 3.5) medium estimation

• Means (3.5-5) high estimation.

The following tables present the arithmetic mean, standard deviation for the study dependent and independent variable:

Health information systems

Questions Related to (independent Variables) (Health information systems):

Retrieval of health information: To identify Retrieval of health information Means and Std. Deviation were execute, Table 7 shows the results:

No.	Statement	Mean	Std. Deviation
1	Information system always provides all the necessary information	4.084	1.045
2	The information provided by the current information system has details required by the various hospital departments and administrative levels and in all times that.	4.004	1.058
3	Used information system provides the importance and usefulness information needed for the Supreme Administrative levels	3.985	1.136
4	The devices used provide appropriate information that addresses Hospital objectives	4.069	1.015
5	Information system resulted statistical data and information requested by the various departments and sections of the hospital upon request.	4.077	1.059
Average		4.044	1.062

Table 7: Means and Std. Deviation of Identify Retrieval of health information.

Table 7 indicates the attitudes of the sample towards questionnaire statements of Retrieval of health information; Average mean (4.044), Std. (1.062).

It is noted that the average mean was more than (3.500) that indicates that there is high degree of estimation for the variables of retrieval of health information.

Acquire health information: To identify Acquire health information Means and Std. Deviation were execute, Table 8 shows the results:

No.	Statement	Mean	Std. Deviation
6	Information provided by information systems accurate	4.141	0.957
7	Information provided by information systems reliable.	4.111	0.952
8	Information provided by information systems is highly efficient.	4.050	1.033
9	Information provided by the information systems fit with various emergency and urgent circumstances.	4.077	1.024
10	Information provided by the information systems is useful for each case.	3.996	1.107
Average		4.075	1.014

Table 8: Means and Std. Deviation of Acquire health information.

Table 8 indicates the attitudes of the sample towards questionnaire statements of Acquire health information; Average mean (4.075), Std. (1.014).

It is noted that the average mean was more than (3.500) that indicates that there is positive estimation, in high degree of appreciation for the variables of Acquire health information.

Working staff efficiency: To identify working staff efficiency Means and Std. Deviation were executed, Table 9 shows the results:

No.	Statement	Mean	Std. Deviation
11	Individuals working in information systems have high efficiency in dealing with the available hardware.	3.924	1.170
12	The employees provided with the basic skills necessary to deal with the modern systems.	3.909	1.108
13	Employees subjecting to training sessions on a regular basis	3.843	1.181
14	The administration recruits individuals with high experience in information system.	3.931	1.176
15	Employees in every department have efficiency in dealing with information system.	4.076	1.101
Average		3.937	1.147

Table 9: Means and Std. Deviation of Identify working staff efficiency.

Table 9 indicates the attitudes of the sample towards questionnaire statements of working staff efficiency; Average mean (3.937), Std. (1.147).

Variables	Mean	Std. Deviation
Retrieval of health information	4.044	1.062
Acquire health information	4.075	1.014
Working staff efficiency	3.937	1.147
Health information systems	4.019	1.074

Table 10: Means and Std. Deviation of Identify Independent variable.

It is noted that the average mean was more than (3.500) that indicates that there is high degree of estimation for the variables of working staff efficiency.

Health information systems: The Table 10 presents the arithmetic mean, standard deviation for the study Independent variables:

Table 10 indicates the attitudes of the sample towards Independent variables.

Independent variable Health information systems; Average mean (4.019), Std. (1.074).

It is noted that the average mean was more than (3.500) that indicates that there is high degree of estimation for the independent variable Health information systems.

Where Acquire health information was came at first rank with mean (4.075) std. (1.014), while Retrieval of health information was in the second rank with mean (4.044) std. (1.062), next, working staff efficiency was in the last rank with mean (3.937) std. (1.147).

Develop jordanian health care: To identify Develop Jordanian Health Care Means and Std. Deviation were execute, Table 11 shows the results:

No.	Statement	Mean	Std. Deviation
16	Information system Improves patients waiting management	4.027	1.074
17	Information system Improves the knowledge about patients’ history	4.012	1.089
18	information system Improves health service quality	4.183	0.914
19	information system helps to serve more patients	4.126	0.998
20	information system Reduce medical errors	4.212	1.014
21	information system Improve health conditions and healing rates	4.195	0.989
22	information system Increase patient satisfaction of provided services	4.054	1.018
23	information system Increase the efficiency of nursing Communication with doctors	3.968	1.102
24	information system Increase the efficiency of Medication communication	3.969	1.068
25	information system improves Physical environment	3.876	1.125
Average		4.062	1.039

Table 11: Means and Std. Deviation of Identify Develop Jordanian Health Care.

Table 11 indicates the attitudes of the sample towards questionnaire statements of Develop Jordanian Health Care; Average mean (4.062), Std. (1.039).

It is noted that the average mean was more than (3.500) that indicates that there is high degree of estimation for the variables of Develop Jordanian Health Care.

Hypothesis analysis

Main hypothesis: Ho: There is statistically significant relationship between Health Information System and develop Jordanian health care.

To test this hypothesis, multi Regression used to find out if there is a statistically significant relationship between Health Information System and develop Jordanian health care.

Model summary: Table 12 shows the value of the correlation coefficient between the independent & dependent variables, reaching its value (0.696) as shown, the value of the coefficient of determination (R2) reaches value of (0.484), therefore the independent variables managed to explain (% 48.4 ) from changes in the dependent variable and the rest is attributable to other factors.

The significance of aggregate multiple regression models: Table 12 represents the results of analysis of variance ANOVA to test the significance of regression model:

Model	R	R Square	Adjusted R Square	Std. Error of the Estimate
1	.696a	.484	.478	.50627

a. Predictors: (Constant), staff, Acquire, Retrieval

Table 12: Model Summary.

Table 13 analysis of variance, which aims to identify the explanatory model of independent Health Information System for statistical through (F)

Model		Sum of Squares	df	Mean Square	F	Sig.
1	Regression	62.328	3	20.776	81.056	.000b
	Residual	66.385	259	.256
	Total	128.713	262

a. Dependent Variable: Develop
b. Predictors: (Constant), staff, Acquire, Retrieval

Table 13: ANOVA.

The Examined (F) value was equal to (81.056) with possibility value (0.000) which is lower than the specific value (0.05), and that shows that there is significant relationship between Health Information System and develop Jordanian health care.

So we accept the nil hypotheses and reject the alternative:

There is significant relationship between Health Information System and develop Jordanian health care.

Thus indicates that there is at least one independent variable has an effect on the dependent, which can be a significant variable.

Significance regression equation coefficients: Table 14 shows the regression coefficients for the capabilities of statistical tests values as shown below.

Model		Unstandardized Coefficients		Standardized Coefficients	t	Sig.
Model		B	Std. Error	Beta	t	Sig.
1	(Constant)	1.556	.168		9.241	.000
	Retrieval	.220	.051	.286	4.347	.000
	Acquire	.117	.054	.140	2.157	.032
	staff	.290	.047	.368	6.156	.000

a. Dependent Variable: Develop

Table 14: Coefficients.

Sub-hypotheses: H01: There is statistically significant relationship between Retrieval of health information and develop Jordanian health care.

Table 14 indicates that there is a significant statistical relationship between Retrieval of health information and develop Jordanian health care, where the test calculated (t) (4.347) are higher than the tabular value (1.984) and the level of significance (0.00) were less than (α ≤ 0.05).

H02: There is no statistically significant relationship between Acquire health information and develop Jordanian health care.

Table 14 indicates that there is a significant statistical relationship between Acquire health information and develop Jordanian health care, where the test calculated (t) (2.157) are higher than the tabular value (1.984) and the level of significance (0.032) were less than (α ≤ 0.05).

H03: There is no statistically significant relationship between efficiency of staff working the information system and develop Jordanian health care.

Table 14 indicates that there is a significant statistical relationship between efficiency of staff working the information system and develop Jordanian health care, where the test calculated (t) (6.156) are higher than the tabular value (1.984) and the level of significance (0.00) were less than (α ≤ 0.05).

Discussion

The results show that Health Information system applied efficiently Jordanian hospitals Where Acquire health information was came at first rank, while Retrieval of health information was in the second rank, working staff efficiency was in the last rank and all variables were at high level.

The results show that there is significant relationship between Health Information System and develop Jordanian health care.

The study considers that the application of health information systems is at a high level. However, the leaders of the hospitals need to employ these practices in developing the service in hospitals by finding better ways to keep up with the international standards in quality of service in hospitals by directing health information systems to the quality of work and the speed of implementation.

Administrations in hospitals should come up with statistics about the problems and medical errors that occur in hospitals and address the causes using health information systems.

References

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World Health Organization (2004) Developing Health Management Information Systems: A Practical Guide For Developing Countries, World Health Organization: Regional Office for the Western Pacific.
Almunawar M, Anshari M (2012) Health Information Systems (HIS): Concept and Technology.
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