**4. Recommendations for improving system effectiveness at minimal cost**

#### **4.1. HIS scorecard**

**Target construct: user performance**

42 Advances in Health Management

**Target construct: user performance**

**Attribute (question item) Performance Importance Discrepancy** Timely access (recqual\_1) 0.070 0.019 0.051 Records consistency (recqual\_2) 0.073 0.013 0.060 Standardized format (recqual\_3) 0.074 0.020 0.054 Records accuracy (recqual\_4) 0.064 0.018 0.046 Repeated tests prevention (recqual\_5) 0.063 0.016 0.047 Records completeness (recqual\_6) 0.073 0.020 0.053 Data protection (secc\_2) 0.065 0.029 0.036 Robust security control (secc\_3) 0.066 0.005 0.061 Secure and safe (secc\_4) 0.066 0.036 0.030 Quick assistance (servqual\_1) 0.067 0.010 0.057 Problem solver (servqual\_2) 0.069 0.011 0.058 Follow‐up service (servqual\_3) 0.066 0.012 0.054 Adequate training (servqual\_4) 0.068 0.011 0.057 Workflows fit (syscom\_1) 0.068 0.066 0.002 Work styles fit (syscom\_2) 0.068 0.063 0.005 Clinical practices fit (syscom\_3) 0.067 0.028 0.039 Patient needs fit (syscom\_4) 0.069 0.047 0.022 Interoperable systems (sysi\_1) 0.070 0.012 0.058 Treatment cost reduction (sysi\_2) 0.070 0.032 0.038 Coordinated care (sysi\_3) 0.075 0.024 0.051

Faster network (adin\_1) 0.074 0.012 0.062 Adequate computers (adin\_2) 0.072 0.007 0.065 Ease of task completion (effuse\_1) 0.074 0.032 0.042 Misdiagnosis prevention (effuse\_2) 0.068 0.040 0.028 Right medication (effuse\_3) 0.064 0.038 0.026 Learning of knowledge (knowqual\_1) 0.066 0.084 ‐0.018 Researching of knowledge (knowqual\_2) 0.067 0.080 ‐0.013 Applying of knowledge (knowqual\_3) 0.067 0.091 ‐0.024 Decision‐making capability (knowqual\_5) 0.067 0.094 ‐0.027 Problem‐solving capability (knowqual\_6) 0.066 0.112 ‐0.046 Complete medical source (knowqual\_7) 0.067 0.083 ‐0.016 Timely access (recqual\_1) 0.070 0.029 0.041 Records consistency (recqual\_2) 0.073 0.020 0.053 Standardized format (recqual\_3) 0.074 0.030 0.044

Unfortunately, the Ministry and hospitals in Malaysia did not perform strategic planning in the design, implementation, and upgrade of the HISs. In fact, the future direction of the Ministry is to develop HIS product for extending the system to other hospitals. At present, they are only focused on delivering maintenance services and operational support to existing HISs to ensure uninterrupted hospital services. These services will be continued until a new in‐house system is entirely designed and deployed in all IT hospitals. So far, the selected vendor has been initiating the plan for HIS development and implementation, while the Ministry has been the sole licensed user of the product.

In addressing the gaps through proper strategic planning in order to achieve effective use and enhanced user performance objectives, the balanced scorecard (BSC) framework, desig‐ nated as HIS scorecard (**Figure 5**), is extended on the basis of the applicability of the empiri‐ cal study results that is highly recommended for the Ministry and IT hospitals. The scorecard is designed by extracting the key results from the IPMA on the basis of the importance scores of the estimated constructs at the indicator level of the analysis. With this scorecard, the respective parties can focus on the development of concrete goals and strategies from vali‐ dated evidence‐based findings for the planning and evaluation of the system implementation rather than on the initiation of a new BSC template. More importantly, it can serve two central purposes:


Consequently, the transformation of the study findings into a measurable scorecard will empower the hospital administrators and decision‐makers, thus facilitating their thorough understanding on how the performance of HISs positively influences their strategic decision‐ making through systematic monitoring and increased effective use. Thus, it may contribute to adequate governance because of increased quality of patient care, and facilitates the efficient or prudent use of government budgets.

#### **4.2. Concise HIS effectiveness guideline**

In acquiring the inputs for every indicator in the scorecard, we have developed simple ways to evaluate the effectiveness of HIS by proposing "Easy Guide to Efficiently Evaluate Your HIS" in the form of flowchart diagram (see **Figure 6**) for practitioners. The subsequent steps are described as follows:


**Figure 5.** HIS scorecard.

they are only focused on delivering maintenance services and operational support to existing HISs to ensure uninterrupted hospital services. These services will be continued until a new in‐house system is entirely designed and deployed in all IT hospitals. So far, the selected vendor has been initiating the plan for HIS development and implementation, while the Ministry has

In addressing the gaps through proper strategic planning in order to achieve effective use and enhanced user performance objectives, the balanced scorecard (BSC) framework, desig‐ nated as HIS scorecard (**Figure 5**), is extended on the basis of the applicability of the empiri‐ cal study results that is highly recommended for the Ministry and IT hospitals. The scorecard is designed by extracting the key results from the IPMA on the basis of the importance scores of the estimated constructs at the indicator level of the analysis. With this scorecard, the respective parties can focus on the development of concrete goals and strategies from vali‐ dated evidence‐based findings for the planning and evaluation of the system implementation rather than on the initiation of a new BSC template. More importantly, it can serve two central

• As a metric for the policymakers at the Ministry level that facilitates effective decisions concern‐ ing the expenditures of HISs in new hospitals or upgrading the current ones. In this regard, the team implementing HIS must define their specific, measurable, achievable, realistic, and time‐frame (SMART) actions in order to achieve high effectiveness in their goal concerning predefined system quality, records quality, service quality, knowledge quality, and effective use indicators. After all actions for each strategy have been undertaken, the hospital manage‐ ment will present the completed scorecard with the assistance of the implementing team in front of the Board of Directors of the Ministry during the annual strategic plan meeting. Thus, HIS scorecard can be a significant measurable indicator to guide the strategic direction and the

objectives of the national health technology investments in the present and future.

on how to execute simple evaluation survey using a concise guideline.

• As a performance measurement for the auditors that assess whether or not the implemented HIS in a single IT hospital is effective. Specifically, it serves as a checklist that determines whether the previous actionable plans are well executed. The next session will further explain

Consequently, the transformation of the study findings into a measurable scorecard will empower the hospital administrators and decision‐makers, thus facilitating their thorough understanding on how the performance of HISs positively influences their strategic decision‐ making through systematic monitoring and increased effective use. Thus, it may contribute to adequate governance because of increased quality of patient care, and facilitates the efficient

In acquiring the inputs for every indicator in the scorecard, we have developed simple ways to evaluate the effectiveness of HIS by proposing "Easy Guide to Efficiently Evaluate Your HIS" in the form of flowchart diagram (see **Figure 6**) for practitioners. The subsequent steps

been the sole licensed user of the product.

44 Advances in Health Management

or prudent use of government budgets.

**4.2. Concise HIS effectiveness guideline**

are described as follows:

purposes:

**Figure 6.** Easy guide to efficiently evaluate your HIS.

Hence, "Easy Guide to Efficiently Evaluate Your HIS" can allow a hospital to assess the system effectiveness efficiently not only at the individual but also at the organizational level by responsible IT department in cooperation with clinical research centers' staffs. Through applying this clear guideline, the precision of HIS performance measurement will be greater and contributes to the effectiveness of the subsequent decision‐making by HIS users, stake‐ holders, and policymakers resulting from a good reputation of successful implementation while reducing costs for future upgrades and sustaining effective use and user performance. The guideline can be the best practical evaluation tool at very minimal cost to be executed for a comprehensive HIS evaluation survey at the national level.
