Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.

Abstract:Healthcare information systems (HISs) are often implemented to enhance the quality and patient-centeredness of care, as well as to improve the efficiency and safety of the services. However, the outcomes of HISs implementations in both primary care and hospital settings have not met expectations. Research reports indicate that there is a need to study HISs implementation process and its organizational consequences.The aim of this paper has been to organize the knowledge gained in qualitative studies performed in association to HIS implementations and to use this knowledge to outline an updated structure for implementation planning. We found that the main action implication that could be drawn from the meta-analysis was that merely implementing a HIS will not automatically increase the organizational efficiency. We used a multi-disciplinary team for the analyses in order to cover as many aspects of the primary studies as possible. Nevertheless, our results should be interpreted as a high-order scheme, and not a predictive theory and the action recommendation need to be investigated in prospective studies.The results obtained shown that when implementing HISs in hospital and primary care environments, at a minimum, strategic, tactical, and operational actions have to be taken into consideration, through management involvement, integration in healthcare workflow and specially user involvement, education and training and through establishing compatibility between software and hardware. The results show also that many of the most important failures seem still to emerge from the absence of feedback from end-users to developers during the development process. What it is needed is the use of an implementation methodology that minimizes the information asymmetry in the implementation process, and that allows the accumulation of the knowledge capital needed to prevent rejection of the final system Keywords: health information system, implementation, failure IntroductionHealthcare information systems (HISs), such as computerized physician order entry (CPOE) and computer-based patient records (CPRs) have been implemented to enhance the quality and patient-centeredness of care, as well as to improve the efficiency and safety of the services (1). However, the outcomes of HIS implementations in both primary care and hospital settings have not met expectations. A number of research reports indicate undesired consequences (2, 3, 4, 5), also pointing out that implementation failures affect negatively the return of investments (6). In consequence, hospital managers have today realized that they may overlook interplays between the HIS and organizational performance, and in particular individual users' needs, problems, and demands, if they uncritically trust the promises made by vendors (7). This situation implies that there is an urgent need to make the best possible use of the scientific knowledge available about HIS implementation processes and their organizational consequences. Starting with a number of groundbreaking s...

Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers, as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system' productivity and effectiveness.

Background Students with complex health care services process face constant challenges with regard to health education. The mobile devices are an important tool that can install various applications for using information such as clinical guidelines, drug resources, clinical calculations, and the latest scientific evidence without any time and place limitations. And this happens only when students accept and use it. Objective The purpose of this article is to identify the factors influencing students in their intention to use mobile health (mHealth) by using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Methods A standard questionnaire was used to collect the data from nearly 302 Lorestan University of medical science students including nutrition and public health, paramedicine, nursing and midwifery, pharmacy, dentistry, and medical schools. The data were processed using LISREL (Scientific Software International, Inc., Lincolnwood, Illinois) and SPSS (IBM Corp., Armonk, New York) softwares and the statistical analysis technique was based on structural equation modeling (SEM). Result A total of 300 questionnaires including valid responses were used in this study. The results showed that mediator of age did not affect the predictors of intention to use mHealth, and the level of education and gender directly affected the intention to use. In addition, effort expectancy, facilitating condition, and behavioral intention directly and indirectly have effect on use, whereas the result revealed no significant relationship between two important processes of performance expectancy and social influence with students' behavioral intention to use the mHealth. Conclusions The present study provides valuable information on mobile health acceptance factors for widespread use of this device among students of universities of medical sciences as a base infrastructure for a variety of information about health services and learning. Review and comparison of results with other studies showed that mHealth acceptance factors were different from other end users (elderly, patients, and health professionals).

The results indicate that reduction of system unavailability due to technical issues will increase the perceived usefulness of IEPSs for pharmacists with regard to both work efficacy and pharmacological safety. We conclude that the introduction of an IEPS was well received by pharmacists; however, barriers to full acceptance remained, in particular, system unavailability due to technical problems.

BackgroundComputerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care.MethodsThe diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods.ResultsMore nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P < 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = < 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P < 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians' agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P < 0.001).ConclusionsQualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

The results confirmed that several factors in the TAM2 that were important in previous studies were not significant in paraclinical departments and in government-owned hospitals. The users' behavior factors are essential for successful usage of the system and should be considered. It provides valuable information for hospital system providers and policy makers in understanding the adoption challenges as well as practical guidance for the successful implementation of information systems in paraclinical departments.

The number of citations that a research paper receives can be used as a measure of its scientific impact. The objective of this study was to identify and to examine the characteristics of top 100 cited articles in the field of Medical Informatics based on data acquired from the Thomson Reuters' Web of Science (WOS) in October, 2016. The data was collected using two procedures: first we included articles published in the 24 journals listed in the "Medical Informatics" category; second, we retrieved articles using the key words: "informatics", "medical informatics", "biomedical informatics", "clinical informatics" and "health informatics". After removing duplicate records, articles were ranked by the number of citations they received. When the 100 top cited articles had been identified, we collected the following information for each record: all WOS database citations, year of publication, journal, author names, authors' affiliation, country of origin and topics indexed for each record. Citations for the top 100 articles ranged from 346 to 7875, and citations per year ranged from 11.12 to 525. The majority of articles were published in the 2000s (n=43) and 1990s (n=38). Articles were published across 10 journals, most commonly Statistics in medicine (n=71) and Medical decision making (n=28). The articles had an average of 2.47 authors. Statistics and biostatistics modeling was the most common topic (n=71), followed by artificial intelligence (n=12), and medical errors (n=3), other topics included data mining, diagnosis, bioinformatics, information retrieval, and medical imaging. Our bibliometric analysis illustrated a historical perspective on the progress of scientific research on Medical Informatics. Moreover, the findings of the current study provide an insight on the frequency of citations for top cited articles published in Medical Informatics as well as quality of the works, journals, and the trends steering Medical Informatics.