The adoption of ICT in Malaysian public hospitals: the interoperability of electronic health records and health information systems

There have been a number of researches that investigated ICT adoption in Malaysian healthcare. With the small number of hospitals that adopt ICT in their daily clinical and administrative operations, the possibility to enable data exchange across 131 public hospitals in Malaysia is still a long journey. In addition to those studies, this research was framed under six objectives, which aim to critically review existing literature on the subject matter, identify barriers of ICT adoption in Malaysia, understand the administrative context during the pre and post-ICT adoption, and recommend possible solutions to the Ministry of Health of Malaysia (MoHM) in its efforts to implement interoperable electronic health records (EHR) and health information systems (HTIS). Specifically, this research aimed to identify the factors that had significant impacts to the processes of implementing interoperable EHR and HTIS by the MoHM. Furthermore, it also aimed to propose relevant actors who should involve in the implementation phases. These factors and actors were used to develop a model for implementing interoperable EHR and HTIS in Malaysia. To gather the needed data, series of interviews were conducted with three groups of participants. They were ICT administrators of MoHM, ICT and medical record administrators of three hospitals, and physicians of three hospitals. To ensure the interview feedback was representing the context of EHR and HTIS implementation in Malaysia, two hospital categories were selected, which included the hospitals with HTIS and non-HTIS hospitals. The government documents were then used to triangulate the feedback to ensure dependability, credibility, transferability and conformity of the findings. Two techniques were used to analyse the data, which were thematic analysis and theme matching. These two techniques were modified from its original method, known as pattern matching. The originality of this research was presented in the findings and methods to transform them into solutions and provide recommendation to the MoHM. In general, the results showed that the technological factors contributed less to the success of the implementation of interoperable EHR and HTIS compared to the managerial and administrative factors. Four main practical and social contributions were identified from this research, which included synchronisation of managerial elements, political determination and change management transformation, optimisation of use of existing legacy system (Patient Management System) and finally the roles of actors. Nevertheless, the findings of this research would be more dependable and transferable if more participants had been willing to participate especially among the physicians and those who managed the ICT adoptions under the MoHM.