Hospital managers’ perception of the implementation of electronic health records in Saudi Arabia public hospitals

Abstract

Despite the potential of using Electronic Health Record (EHR) in hospitals for enhancing the quality of patient care and safety, it has been shown that the implementation of EHRs is low. Much research has focused on the clinical healthcare professionals’ perceptions of EHRs, but little is known about hospital managers. The hospital manager is in a position to serve as an agent for change in implementing EHR technology. The managers are pivotal in leading the implementation of the systems changes required to successfully implement EHRs and thus their perceptions and methodologies. This thesis focuses on hospital managers working in the secondary and tertiary care hospitals managed by the Ministry of Health (MOH) in Saudi Arabia. It examines the current status of EHR implementation and hospital manager perceptions’ of the introducing of integrated EHRs in Saudi Arabia public hospitals. Also, challenges facing hospital managers prior to the implementation of EHRs and their need to implement EHR successfully are addressed. A descriptive design, using a collective cross-sectional quantitative census survey was used to address the research questions. The survey was developed from the literature comprising a self-administered postal questionnaire. Saturation survey sampling was used to achieve completed questionnaires from each of the MOH hospital managers in Saudi Arabia. The questionnaires were distributed to all hospital managers working in MOH hospitals. A total of 220 hospital managers participated, of these 163 completed the questionnaires, representing a 74% response rate which contained complete information on key variables of sufficient validity to be included in subsequent analysis. An open-ended question was also included in the survey where hospital managers were asked to provide dialogue on their experience with EHR. The results show that none of the public hospital had fully implemented EHR and only third of the hospitals had partially implemented EHR. In addition, 41.1% of the hospital managers were not familiar with the concept of EHR and 73.6% had not used the EHR system. The Saudi Arabia hospital managers had a positive attitude towards the introduction of EHR, but were over confident in dealing with resistance from hospital staff. Moreover, the majority of respondents believed that current information technology IT infrastructures did not support the EHR implementation and also hospital staff were not prepared. Financial resources and unclear EHR implementation process model were identified as the most significant barriers to implement EHR in their hospitals. The primary facilitators to support the implementation of EHR were adequate EHR infrastructures, customising training and education program in health informatics, financial support and information on change management implementation. Since hospital managers are the core individuals in each hospital, this study has highlighted the significance of considering the hospital managers’ perception when implementing EHR. The findings may serve as a guiding tool for hospital managers that have not implemented EHR as well as for the MOH in Saudi Arabia.