INFORMATION QUALITY AS SUCCESS DETERMINANT FOR HEALTH INFORMATION SYSTEMS Siti Asma Mohammed & Mohamad Norzamani Sahroni

Universiti Pendidikan Sultan Idris siti_asma@ftmk.upsi.edu.my Universiti Teknologi Mara Malaysia zamani@tmsk.uitm.edu.my Abstract Information quality has been regarded by most studies as one of the critical success factors of Health Information Systems (HIS) adoption. However, there are a number of studies that highlighted information quality as one of the reasons that might cause the low level of HIS adoption. This paper gives some overview of information quality as one of the critical success factors in existing information systems (IS) success models. Keywords: Health Information Systems, Information Quality, Success Factors 1. Introduction Medical records are increasingly becoming critical information resources in healthcare to support decision-making. Most medical records come from various sources and usually involve historical data. Historical data is very crucial as it will chronologically inform the medical history of a patient when diagnose is taken place. Information quality has been regarded by most studies as one of the critical success factors of HIS adoption. However, there are also number of studies that highlighted information quality produced by HIS, as one reason that might cause the low level of HIS adoption. Thus, the issue of completeness and correctness of the quality of information retrieved in HIS is becoming a major concern. Any missing, incomplete or inaccurate information gained may be harmful to the patient (Barrie & Marsh, 1992; Brown & Warmington, 2002; Mikkelsen & Aasly, 2005; Vandenberghe et al., 2005). This paper gives some overview of information quality as one of the critical success factors in existing information systems (IS) success models. In the last section, a view for future research work is given. 2. Information Quality in IS Adoption Model There are quite numbers of information systems adoption models that explain the critical success factors of information systems (IS) adoption. Information Quality has been frequently regarded as one of the determinant factors of HIS success (DeLone & McLean, 2003; Heeks, 2006; Yusof, Kuljis, Papazafeiropoulou, & Stergioulas, 2008). One common agreement found from these models is that identifying information quality as a product of successful information systems development. 2.1. Information Systems Success Model DeLone and McLean developed a taxonomy in 1992 that consists of six success dimensions of IS; system quality, information quality, use, user satisfaction, individual impact and organizational impact. The creation of this taxonomy and the IS success model is based on the theory of information. System quality refers to the production of information where system is the technology developed and responsible to create information. Information

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quality dimension is the result of the production and communicated to the users in various forms of output. These two dimensions later contribute to use, which is the information usage or consumption by the users. User satisfaction indicates reaction to the use of the information output. Information usage and reaction from users in turn contribute to individual impact, the influence the information has on the user, for example job productivity that finally affect the organization as a whole. The authors described, perspective of users is important when measuring information quality (DeLone & McLean, 1992). This denotes the significant relationship between user (human) and information flow when studying the IS success. Figure 1 illustrates the taxonomy of information systems success. This classical IS model are being used by many researches to prove and validate the interdependent dimensions. The old model is revised with new added dimension, which is service quality that measures the technical support services. Apart from that, individual and organizational impacts are combined into a single dimension called net benefit to show the overall impact of IS. Figure 1 presents the latest version of this model (DeLone & McLean, 2003). The six dimensions are linked in causal and temporal way as IS development is a dynamic process. For example, information quality precedes system use. Good information quality will result in effective use of IS and subsequently increase user satisfaction. In return, high user satisfaction will always increase the user intention to use the system. Several articles evaluated the role of information quality from the former model. Studies suggested that there are strong association between information quality and individual impact. Information quality affects individual decision-making performance, job effectiveness and quality of work. Information quality is also proven to have strong association with system use and net benefits in the updated model. In health care context, 64% of success determinants in a review of Inpatient Clinical IS using this model are information quality. Determinants of success in this model are applicable to evaluate the success of HIS adoption (Meijden, Tange, Troost, & Hasman, 2003).

FIGURE 1- INFORMATION SYSTEMS SUCCESS MODEL Source From: Delone, William H., And Ephraim R. Mclean. 1992. Information Systems Success: The Quest For Dependent Variable. Information Systemsrresearch 3 (1):60-95

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FIGURE 2- UPDATED INFORMATION SYSTEMS SUCCESS MODEL Source From: Delone, William H., And Ephraim R. Mclean. 2003. The Delone And Mclean Model Of Information Systems Success: A Ten-Year Update. Journal Of Management Information Systems 19 (4):9-30 2.2 Design-reality gaps Model A health-focused model introduces gap features explains that the gap existed between reality and design of HIS will determine the success and failure of its adoption. The model, ITPOSMO is focusing on developer design and user reality design encourages two-way communication rather than traditional top-down approach in IS development. The developer is expected to communicate about the real design from user and later show the design to the user. The user will understand the design and fill in the gap necessary. Heeks highlighted technical, managerial and medical rationality as three generic examples of large gaps that likely will contribute to HIS failure. Technical rationality is system developer technologybased worldview has control over user design and does not consider the cultural and political values. Managerial rationality is the health managers are bind with external stakeholders objectives that usually involves legal, bureaucratic and financial issues. The stakeholders such as the government and shareholders may have their own special interest that always associated with money. Thus, the health manager decision of HIS design might dominate and limit the reality design. Medical rationality is the concern is always diseases and injuries however not patient related. There are seven success dimensions. Table 1 below describes each ITPOSMO dimension. The ITPOSMO model is shown in Figure 3. An example of using this model at a UK hospital indicates there was a huge gap between the information realities and the information of the system designed (Heeks, 2006). TABLE 1: DEFINITIONS OF ITPOSMO DIMENSIONS Dimension Description Information Technology Information quantity, quality, and flow; informal information Computer Hardware, and software; telecommunications; other healthcare technology Information-handling, decision-making, actions/transactions, other healthcare processes, informal processes Objectives and values of medical staff, non-medical staff, other stakeholders Staff numbers; technical skills; management skills; healthcare skills;

Processes

Objectives and values Staffing and skills

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other skills; knowledge and Management systems; management structures; informal systems Initial investment, ongoing expenditure, time, other healthcare resources Source From: Heeks, R. 2006. Health information systems: Failure, success and improvisation. International Journal of Medical Informatics 75 (2):125-137 Management systems structures Other resources

FIGURE 3- ITPOSMO DESIGN-REALITY GAPS MODEL Source From: Heeks, R. 2006. Health information systems: Failure, success and improvisation.International Journal of Medical Informatics 75 (2):125-137 Both models highlighted information quality as one of the success determinants for HIS adoption. DeLone and McLean provides clear success dimensions of IS and strongly emphasized the six dimensions relationship as dynamic rather than static. However, it is unclear of what constitutes the quality dimensions especially the information quality dimension and the model does not include the organization factors and fit relationships. The question can be asked is how to ensure the information is in quality state before it can precede system usage ? Model by Heeks include a wider view of dimensions as it represents a sociotechnical view that supports the role of human and organization elements. The information dimension description shows that besides regarding it as an output, information flow need to take into consideration. The definition of processes dimension includes information handling. This depicts information and processes are interrelated. However, this model does not explain further the relationships between all these dimensions. 2.3 Human, Organization and Technology-fit (HOT-fit) The IS adoption models in previous section concentrate strongly on the technical individual attributes and system users. Heeks (2006) touched a little bit on the organization aspects. However, both does not emphasized on the clinical processes or tasks and the fit relationship among them. It is believed that clinical tasks is an important component as well in studying fit (Ammenwerth, Iller, & Mahler, 2006; Tsiknakis, 2009). A model that focuses in evaluating HIS adoption is H (Human), O (Organization), T (Technology)-fit model (Yusof et al., 2008). This model made an extension of DeLone McLean model by adding the organization factors, their dimensions and measure that is
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pertinent to HIS evaluation. This model also adds the fit relationship from the ITOrganization Fit Model between the human, organization and technology factors. These three factors have eight interrelated dimensions as seen in Figure 4 and example of the evaluation measures in Figure 5. Information quality is a dimension under the technology factor derived from user perspective that concerns with the information produced by HIS. Information Quality affects the System Use in temporal and causal way. User knowledge and training are to measure users system use behavior, which later will influence information quality produced. Clinical process is a measure under the Organizational Structure dimension. Organizational Structure affects System Use in one way relationship. The fit relationship in HIS is the ability of the stakeholders, clinical practices and the HIS to align each other strategically. Information Quality concerns with the information produced by HIS and the measures are subjective as it is derived from the user perspective. System Use refers to breadth and occurrence of HIS usage by the users and it is a voluntary use. Good Information Quality will increase System Use and eventually increase User Satisfaction. System Use and User Satisfaction directly affect the Net Benefits. Similarly, higher net benefits will subsequently increase System Use and User Satisfaction. The same relationship applies to Organization Structure and Net Benefits. Both affect each other in temporal way. HOT-fit framework as it provides strong conceptual model as a foundation to do HIS evaluation. It also provides a useful practical technique when demonstrated in real life with the case study of Fundus Imaging System (FIS) in UK.

FIGURE 4- HOT-FIT MODEL (A)

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FIGURE 5 HOT-FIT EVALUATION MEASURES (B) Source (a)(b) From: Yusof, M. M., J. Kuljis, A. Papazafeiropoulou, and L. K. Stergioulas. 2008. An evaluation framework for Health Information Systems: human, organization and technology-fit factors (HOT-fit). International Journal of Medical Informatics 77 (6):386398. 3. Conclusions and Future Work Although most models give better understanding in relation to information quality concepts, they have limitations in providing the way to measure the information quality and in providing a clear measurement scales. Lack of information quality measurement can create difficulty in assessing, managing, monitoring and improving HIS information quality. Therefore, this research will study in depth to investigate the information quality quantifiable measurements based on KPI approach to improve and manage HIS information quality. 4. References Ammenwerth, E., Iller, C., & Mahler, C. (2006). IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study. BMC Medical Informatics and Decision Making, 6(1), 3. Barrie, J. L., & Marsh, D. R. (1992). Quality of data in the Manchester orthopaedic database. British Medical Journal, 304(6820), 159. Brown, P. J. B., & Warmington, V. (2002). Data quality probesexploiting and improving the quality of electronic patient record data and patient care. International Journal of Medical Informatics, 68(1-3), 91-98. DeLone, W. H., & McLean, E. R. (1992). Information Systems Success: The Quest for Dependent Variable. Information Systems Research, 3(1), 60-95. DeLone, W. H., & McLean, E. R. (2003). The DeLone and McLean Model of Information Systems Success: A Ten-Year Update. Journal of Management Information Systems, 19(4), 9-30. Heeks, R. (2006). Health information systems: Failure, success and improvisation. International Journal of Medical Informatics, 75(2), 125-137. Meijden, M. J. v. D., Tange, H. J., Troost, J., & Hasman, A. (2003). Determinants of Success of Inpatient Clinical Information Systems: A Literature Review. J Am Med Inform Assoc, 10, 235-243. Mikkelsen, G., & Aasly, J. (2005). Consequences of impaired data quality on information retrieval in electronic patient records. International Journal of Medical Informatics, 74, 387-394. Tsiknakis, M., and Angelina Kouroubali. (2009). Organizational Factors affecting successful adoption of innovative eHealth services: A case study employing the FITT framework. International Journal of Medical Informatics 78, 39-52. Vandenberghe, H. E. E., Van Casteren, V., Jonckheer, P., Bastiaens, H., Van der Heyden, J., Lafontaine, M. F., et al. (2005). Collecting information on the quality of prescribing in primary care using semi-automatic data extraction from GPs electronic medical records. International Journal of Medical Informatics, 74(5), 367-376. Yusof, M. M., Kuljis, J., Papazafeiropoulou, A., & Stergioulas, L. K. (2008). An evaluation framework for Health Information Systems: human, organization and technology-fit factors (HOT-fit). International Journal of Medical Informatics, 77(6), 386-398.

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