Conceptual Information System Success Model for ...

Conceptual Information System Success Model for Small and Medium Enterprise Clinic Information System Aliza bt Sarlan, Rohiza bt Ahmad, Wan Fatimah bt Wan Ahmad, P. D.D. Dominic Computer & Information Sciences Department Universiti Teknologi PETRONAS Tronoh, Perak, Malaysia {aliza_sarlan, rohiza_ahmad, fatimhd, dhanapal_d}@petronas.com.my Abstract—In general, small and medium enterprise (SME) business face substantially greater risks in Information Communication and Technology (ICT) implementation than large businesses do because of inadequate resources and limited education about ICT. There are many differences that exist between large companies and SME organizations in relation to adoption of ICT. To date, the SME clinics in general have not been convinced of the benefit of ICT. SME clinics utilize computerized system in supporting their businesses are still minimum and paper-based practices are still the norm. Hence, the objective of this paper is to report on the literature study related to identification of technology resistance and acceptance factors of ICT utilization in an organizations and study of any existing prominent theoretical frameworks on Information System (IS) Success Model. The study then outlines the proposed conceptual Success Model for SME Clinics Information System.

private healthcare. In addition, patients accessing private clinic or hospital services are mainly self-referred [2].

Keywords- Acceptance, Information Communication (ICT), Success Model, Small and Medium Enterprise (SME)

Even though issues pertaining to the adoption of ICT in public healthcare have been greatly discussed in the literature, the same cannot be said to the SMEs. There are too few reported works found in the literature which specifically address the ICT implementation of Health Information System for small and medium size clinic. Therefore, the primary objective of this research is to propose an ICT implementation strategy for small and medium size of clinics in health care industry in Malaysia. The study focuses to achieve the following secondary objectives:

I.

INTRODUCTION

Information Communication and Technology (ICT) has been known to be utilized and implemented in many organizations so as to improve the business process and increase customer satisfaction. As for healthcare, different requirements of this industry requires a careful planning of ICT implementation. Malaysian government has established a clear vision to embrace ICT in its attempt to modernize public services including the healthcare sector. The main agenda of the Malaysian Ministry of Health is to modernize all their services and improve their communication services to clients [1]. Private sector development in healthcare has occurred rapidly over the last two decades, and there are now more than 2700 clinics run by private practitioners and 197 private hospitals providing approximately 18% of the hospital beds in Malaysia [2]. Until May 2008, there are 5895 private medical clinics have registered with the Ministry of Health [1]. The rapid growth of private sector is due to rising demands of an increasing large proportion of the population who are becoming more informed about health with increasingly higher expectations and who possess the purchasing power to access

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There are many proprietary systems available for health care clinics. According to Tan in [3] there are many health information systems that being develop in the world’s market. The development was driven by the advancing ICT technologies that can support clinical applications as well as the emerging research interest in the field of healthcare information system and informatics. Many Malaysian clinics use a computer system to manage their daily operations. However, many more still use manual methods due to various factors. These resisting factors include the computer literacy level of the clinicians, and the support and cost factors involved when adopting a computerized system such as training, installation and maintenance costs.

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Study and investigate all issues related to ICT utilization at small and medium size of clinics,

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Designing the Clinic Information System (CIS) Framework tailored for small and medium size of clinics,

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Design and develop the CIS prototype using the proposed framework for small and medium size of clinics,

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Evaluate and study of users’ acceptance for the system,

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Propose the corporate strategy to improve the performance of clinics.

This research focuses on carrying out analysis to small and medium size of private clinics at various geographical areas in Malaysia. At this moment, focus is given to study and

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investigate all issues related to ICT utilization at small and medium size of clinics and design the Clinic Information System (CIS) Framework tailored for small and medium size of clinics. In detail, objectives to be achieved for this phase are as follows: •

Study and investigate on acceptance and resistance factors of ICT utilization

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Study and identify any prominent theoretical frameworks on Information System (IS) Success Model.

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Propose a conceptual Success Model for SME Clinics Information System (CIS) II.

BACKGROUND

In the previous report, various issues related to ICT implementation in healthcare industries were identified such as cost and capital constraints [4], limited data sharing due to standard and interoperability issues [5] and information gap problem between the primary and secondary healthcare provider [6]. There are also various technical issues for a successful implementation of telehealth discussed such as standard [6,7,8], security, interoperability [5], policy, and reliability; as well as human and social factors. Based on the report by United Nation Economic and Social Commission for Asia and the Pacific [9], the challenges that Malaysia faces in expanding ICT in healthcare includes high costs, inadequate human resources, computer literacy and adequacy in extension of infrastructure throughout the country. Pursuant to the literature reviews that have been conducted, major problems, future research objectives and scope of studies have been identified and reported in [10]. According to Lorenzi and Riley [11], information system fails for a number of reasons – communication, complexity, organization, technology and leadership. Four major categories of failure have been identified ie. technical shortcomings, project management shortcomings, organizational issues, and continuing information explosion Typically, less organizational resistance occurs in a small organization than a large one. However, small organization usually has fewer resources to handle the problems that arise on the technical side or the change management side [11]. Studies cited in Yusof et al. [12] found that: culture and process changes are reported to be the barriers to the wider use of healthcare systems including low level of expertise, lack of acceptance, and lack of medical staff sponsorship and alteration of workflow patterns. The study also found the highest success factors for Clinical Information Systems (CIS) are collaboration and cooperation, setting goals and courses. Highest failure criteria for CIS is response rate, while for administrative system is not understanding the organizational context and not foreseeing the extent to which the new CIS affects the organization, its structure and/or work procedure. Findings show that having the right user attitude and skills base together with good leadership, IT-friendly environment and

good communication can have positive influence on the system adoption [12]. Salmeron and Bueno in [13] has identified various differences that exist between large companies and SMEs in relation to ICT adoption – greater uncertainty towards ICT, limited resources, and lack of vision for the potential of ICT for the competitive advantage. [13] use the institutional theory as an approach to understand the adoption and use of ICT in SMEs as well as the expected behaviors from industrial point of view. This study also has allowed describing ICT use in SME organizations, explaining their attitudes towards ICT. In the field of information system, there are a few known system adoption. These include Technology Acceptance Model (TAM), DeLone & McLean IS Success model (D&M) and Human-Organization-Technology-Fit (HOT-Fit) evaluation model. A. Technology Acceptance Model (TAM) In studies of the adoption of information systems/technology, Technology Acceptance Model (TAM) is one of the most dominant research models which have been widely used and referred by many studies on adoption and use of innovation and technologies [14,15]. TAM was developed by Davis et al in 1989 being one of the most influential and highly accepted model cited by many researchers for predicting end-user acceptance of technologies [14,15,16,17]. TAM is adapted from the Theory of Reasoned Action (TRA) model which explains and predicts the behavior of people in a specific situation [15]. According to TAM, an individual’s behavioral intention to use a system is determined by two beliefs [14,15,16,17,18]: •

Perceived Usefulness (PU) – the degree to which a user believes that using a particular system will enhance his/her job performance.

•

Perceived Ease of Use (PEOU) - the degree to which individual believes that using the system will reduce physical or mental effort.

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TAM provides a basis for tracing the impact of external variables on internal beliefs, attitude and intentions [15]. TAM is shown in Figure 1. Perceived Usefulness (PU) External Variables Perceived Ease of Use (PEOU)

Attitude toward Using (A)

Behavior al Intention (BI)

Actual Use

Figure 1. Technology Acceptance Model

The model proposes that external variables indirectly affect attitude towards using, which leads to actual system use by influencing perceived usefulness and perceived ease of use. A review of many research on IS acceptance and usage suggests that TAM has emerged as one of the most influential models in this research area [20]. However, this model does not consider

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for social influence in the adoption and utilization of new IS [15,16,17]. [17] cited the distinguished three different processes of social influence that affect individual behavior: compliance, identification and internalization. Hence, TAM has been extended to TAM2 in response to the criticism that the TAM does not consider social influence on user acceptance of IT. The elements of TAM2 are shown Figure 2 [15,16]. TAM2 was created by Venkatesh and Davis in 2000 to incorporate additional theoretical constructs including: • •

Social influence processes voluntariness, and image).

(Subjective

norm,

System Quality

System Use

Information Quality

Cognitive instrumental processes (job relevance, output quality and result demonstrability). Experience

organizational impacts measure effectiveness success [20]. It is proposed that the six success dimensions are to be interrelated rather than independent based on the process and causal considerations. The multidimensional relationships among the measures of IS success have been tested extensively in a number of IS studies [19,20]. Based on the research contributions and based on changes in the role and management of information systems, an updated version of original model is developed [19,20] and shown in Figure 4.

Net Benefits User Satisfaction

Service Quality

Voluntariness

Figure 4. Updated D&M IS Success Model Subjective Norm Image

Perceived Usefulness (PU)

Job Relevance

Intention to Use

Output Quality Perceived Ease of Use

Result Demonstrability

Usage Behavior

Technology Acceptance Model

Figure 2. Updated Technology Acceptance Model

B. DeLone & McLean IS Success Model In recognition of the importance of defining the IS dependent variables and IS success measures, DeLone & McLean (D&M) IS success model is reviewed in this study. D&M IS success model is one of the most popular, comprehensive framework for conceptualizing and operationalizing IS success for guiding the development of the dependent variable in IS research and for comparing results [15,19]. The D&M IS success model published in 1992 was based on theoretical and empirical IS research conducted by a number of researchers in the 1970s and 1980s. Since then, it has been used and referred by nearly 300 articles in refereed journals [19]. The model consists of six interrelated dimensions of success: System Quality, Information Quality, System Use, User Satisfaction, Individual Impacts, and Organizational Impacts [20]. Figure 3 shows the D&M IS Model. System Quality

The framework outlined three essential components of IS: Human, Organization and Technology and the impact of IS corresponding to eight interrelated dimensions of IS success: System Quality, Information Quality, Service Quality, System Use, User Satisfaction, Organizational Structure, Organizational environment and Net Benefits. Figure 5 shows the HOT-Fit framework. TECHNOLOGY

HUMAN

System Quality

System Use

Information Quality

User Satisfaction

Service Quality

Net Benefits

ORGANIZATION

Structure

Fit

Environment

Influence

Use Individual Impact

Information Quality

C. Human, Organization and Technology-Fit (HOT-Fit) Evaluation Model Yusof et al. [12] have developed a new evaluation framework, the Human, Organization and Technology–fit (HOT-Fit). The evaluation framework was developed based on IS Success Model and IT Organization Fit Model.

Organizational Impact

User Satisfaction

Figure 3. D&M IS Success Model

In the D&M IS Success Model, systems quality measures technical success; information quality measures semantic success; and use, user satisfaction, individual impacts and

Figure 5. HOT-Fit Framework

Their research findings show that having the right user attitude and skills base together with good leadership, ITfriendly environment and good communication can have positive influence on the system adoption. III.

METHODOLOGY

Currently, research is focusing at secondary data collected

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from various literature reviews from year 2000 to year 2006. Literature reviews and studies are focusing at various issues related to utilization and acceptance factors of ICT in an organization as well as identification of most prominent theoretical frameworks on information system success model. IV. PROPOSED CONCEPTUAL SME CLINIC INFORMATION SYSTEM (CIS) SUCCESS FRAMEWORK Building on previous studies on the evaluation approaches and models, a conceptual SME CIS Success Framework is developed. The goal of the SME CIS Success Framework is to better evaluate and implement CIS in SME clinics. This framework is developed based on the DeLeon & McLean IS success model, Technology Acceptance Model main construct, extended Technology Acceptance Model (TAM2) and Human-Organization-Technology-Fit (HOT-Fit) framework. The IS Success model, TAM main construct and TAM2 were adopted based on its comprehensiveness, specific evaluation categories, extensive validation and its applicability to SME CIS evaluation. In addition, the HOT-Fit framework also used to incorporate the concept of fit between the evaluation factors: human, organization and technology. The proposed conceptual SME CIS success model is shown in Figure 6.

V.

As a conclusion, many studies have been conducted in identifying issues related to the ICT in healthcare industry in general whether locally and internationally. Few technical issues were identified as critical in ensuring success implementation i.e. standard, security, interoperability and privacy. Given the importance of wide spread adoption for the success if IS in small and medium clinics, there is certainly a need to understand more about what factors are important in the CIS implementation in SME clinics. Hence, the study focuses on identifying a prominent theoretical framework in IS acceptance and success research to be used as a guideline. This study represents an early conceptual framework for SME CIS success model that was theoretically grounded based on the original Technology Acceptance Model (TAM), the extended Technology Acceptance Model (TAM2), the DeLone & McLean IS Success Model as well as the HumanOrganization-Technology-Fit (HOT-FIT) framework. Further study is needed to further validate the proposed framework by using data analysis based on hypotheses. In continuation of the research work, the following research activities and plan is outlined for the next phase.

Social Influence

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Development of research hypotheses based on the proposed conceptual model

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Design a survey instrument ie. questionnaires based on the conceptual success model proposed for this research

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Conduct a pilot survey before conducting the main survey to examine whether the proposed model is well developed and suitable to analyze SME CIS success

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Conduct data collection and data analysis for the pilot survey.

Subjective Norm

Image

Cognitive Instrumental

DeLone & McLean’s IS Success Model Perceived Usefulness

System Use

Job Relevance Output Quality

Perceived Ease of Use

Result Demonstrability

TAM2 Success Factor Demographic

User Satisfaction

Net Benefits

TAM Main Construct

Structure

Organization

Age Job Level

CONCLUSION & FUTURE DIRECTION

Environment

Work Experience

HOT-fit

Computer Skills Extended TAM2 Success

Finally, it is hope that the findings out of this study can be applied to the case of a specific small and medium size organization. Therefore, the proposed SME CIS Success model will be helpful for the SME clinics management to have a better understanding in regard to the success of information system implementation. REFERENCES

Figure 6. Proposed Conceptual SME CIS Success Model

The model suggested that social influence, cognitive instrumental as well as personal demographic information might have an influence on perceived usefulness and perceived ease of use of an information system. These perceptions might lead to successful system use, user satisfaction and net benefits. Besides that, the organization factors such as structure and environment might also have an impact on the successful adoption of the information system. Similarly, the success might also have an impact in shaping the structure and environment of the organization in future. All of the above assumptions will be later verified by proper data collection and analysis based on hypotheses.

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