**5. Conclusions**

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

46 Advances in Health Management

The chapter endeavors to identify areas of HIS adoption in which focused effort would yield the most benefit in terms of effective use and user performance. In addressing the present gaps, the study did this by surveying system users at three Malaysian government hospitals using three different HIS packages during postimplementation. When the significance score did not clearly propose which construct and indicators required for operational improvement, the results were extended to include IPMA in ranking the possible constructs and attributes by highlighting the most critical areas for specific responses [58]. As a result, system quality should be maintained for continued effective use and knowledge quality for enhanced user performance. Specifically, effective use must be sustained by improving the design of HISs to fit with clinicians' work‐ flows. Then, the uses of CDSS and CPOE have to be regularly updated with latest features in accelerating patient care with right diagnosis and medications, thus guaranteeing that user per‐ formance does not decline. These additional findings also recommend an urgent action by the hospitals relating to the lack of security control and insufficient available computers.

For managerial implications, the extended findings are useful for decision‐makers at the gov‐ ernment level in allocating proper budgets during strategic planning with HIS scorecard tool for further system upgrades and new implementation at other health facilities. "Easy Guide to Efficiently Evaluate Your HIS" can be a standardized guideline in performing the system effectiveness evaluation survey among IT hospitals. As the performance scores of measur‐ ing attributes for all systems did not reach below 50%, the surveyed hospitals must promote the benefits of interoperable systems across the setting, as user performance will be increased exponentially. With high performance but low‐importance constructs, it will produce relevant prescriptions for courses of action that the IT departments and system vendors can re‐look and immediately fix these issues to avert user dissatisfaction and low productivity. Finally, the hospitals can focus on selected quality criteria and their measuring indicators for these purposes so that more spending may be concentrated on upgrading other health facilities for patient care.

To the best of our knowledge, this study is the first summative evaluation of a country's HISs by utilizing IPMA in the clinical setting. To produce a complete HIS evaluation before and after implementation, it is highly recommended for future health informatics researchers to include IPMA [18] along with new predictor of knowledge quality and improved effective use measures. This technique will therefore increase the rates of health worker's engagement in HIS evaluation survey by indirectly forcing them to choose what they believe to be the most important attributes for the system effectiveness and to rank those attributes by importance score in a clearly map rep‐ resentation. This powerful technique can be extrapolated and applied to other organizations or countries with extreme budget tight while offering efficient resource consumption. In achieving minimal health expenditure, IPMA can be further explored on how it will achieve potential cost savings by prioritizing health‐care spending in both developed and developing nations.
