Year

2009

Degree Name

Doctor of Philosophy

Department

School of Information Systems and Technology

Abstract

The ultimate goal of this study was to develop an appropriate framework to evaluate Taiwanese EHR systems success. The two main research questions were: (1) What are the most appropriate elements in evaluating Taiwanese EHR systems, based on considerations of HIS success, end-user perspective and socio-technical perspective? (2) What are the causal relationships between elements in such a user-centred Taiwanese EHR systems evaluation conceptual framework? A framework consisting of four aspects (organizational, technological, human and organizational net benefits), a nine-element model (healthcare environment, organizational behaviours, system quality, medical data quality, service quality, safety quality, user use, user satisfaction and organizational net benefits), and twenty related hypotheses were designed to answer the aforementioned questions.

This research designed a four phase structure by adopting an explicit triangulation research strategy (data, investigator, theory and method triangulation) to achieve its research aims: a conceptual EHR systems success evaluation framework was constructed in Phase I; a suitable instrument for the conceptual EHR systems success evaluation framework and its evaluation model was developed in Phase II; the validity and reliability of this evaluation instrument was confirmed in Phase III; the causal relationships of the research hypotheses was demonstrated in Phase VI. Accordingly, a modified Delphi method and content validity index for items (I-CVI)/content validity index for scales (S-CVI) were adopted to confirm the content validity of the Taiwanese EHR systems evaluation instrument.

As a result, the number of questions was reduced and modified from 76 to 74 (with a free-text). Further, in order to demonstrate the construct validity and reliability of the evaluation instrument, Item analysis, Exploratory Factor analysis (EFA), and Reliability analysis were performed. Based on the results of statistical analysis, this study concluded that the instrument could be effectively used to measure an end-user’s opinion of using EHR systems in Taiwan. Moreover, this study collected 966 valid instruments from four cooperating regional teaching hospitals in southern Taiwan for performing inferential statistics (Confirmatory Factor analysis, CFA; Path analysis, PA; One-way ANOVA and Linear regression) to demonstrate the EHR systems success evaluation framework.

Based on the results of both descriptive and inferential statistics by using SPSS15.0 and AMOS7.0, this study identified: (1) the proposed EHR system evaluation framework is applicable to Taiwanese hospitals; (2) the proposed evaluation instrument could be refined into three versions: health professionals, physicians and nurses; and (3) the results of inferential analysis could be used as evidence to verify the causal relationships between evaluation elements for explaining end-users’ opinions of EHR systems success in southern Taiwan.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.