Investigating a New Framework for Hospital Information System Adoption: A Case on Malaysia

Hossein Ahmadi, Othman Ibrahim, Mehrbakhsh Nilashi


Hospital Information System (HIS) has been designed to provide numerous values to the healthcare community and indirectly provide benefits to the patients. Despite this only a few hospitals in Malaysia have actually adopted it, thus this paper  by relying on secondary data aims to provide more insight to the literature review of HIS adoption in the context of Malaysia. In light of this, the study introduces a new combination of three theories namely Technology Organization Environment (TOE) framework, institutional theory along with Human Organization Technology (HOT-fit) model to address the slow rate of HIS adoption by Malaysian public hospitals. We argue that each theoretical perspective has its own explanatory power and that a combination of these three facilitate a much richer interpretation of Information System (IS) implementation regarding the macro-level analysis. Thus, it is hoped, to represent some directions for future research to demonstrate the relationship existing in our new proposed research framework where hospitals by paying attention may take an action in order to achieve a better HIS adoption decision making.


Public hospitals, HIS, Adoption decision, TOE framework, Institutional theory, HOT-fit model

Full Text:

Abstract PDF


Abdullah, B. (2008). Impact of Teleradiology in Clinical Practice: A Malaysian Perspective Teleradiology (pp. 203-215): Springer.

Ahmadi, H., Darvishi, M., Nilashi, M., Almaee, A., Ibrahim, O., Zolghadri, A. H., Farahmand, M. (2014). Evaluating the Critical Factors for Electronic Medical Record Adoption Using Fuzzy Approaches. International Journal of Innovation and Scientific Research, 9(2), 268-284.

Ahmadi, H., Nilashi, M., & Ibrahim, O. (2015). Organizational decision to adopt hospital information system: An empirical investigation in the case of Malaysian public hospitals. International journal of medical informatics, 84(3), 166-188.

Ahmadi, H., Nilashi, M., Ibrahim, O., Ramayah, T., Wong, M. W., Alizadeh, M., Almaee, A. (2015). Exploring Potential Factors in Total Hospital Information System Adoption. Journal of Soft Computing and Decision Support Systems, 2(1), 52-59.

Ahmadi, H., Osmani, M., Nilashi, M., Ibrahim, O., Raisian, K., & Zakaria, R. (2013). Ranking The Meso Level Critical Factors Of Electronic Medical Records Adoption Using Fuzzy Topsis Method. International Journal of Health, Physical Education and Computer Science in Sports, 12(1), 43-47.

Ahmadi, H., Rad, M. S., Almaee, A., Nilashi, M., Ibrahim, O., Dahlan, H. M., & Zakaria, R. (2014). Ranking the Macro-Level Critical Success Factors of Electronic Medical Record Adoption Using Fuzzy AHP Method. International Journal of Innovation and Scientific Research, 8(1), 35-42.

Ahmadi, H., Rad, M. S., Nazari, M., Nilashi, M., & Ibrahim, O. (2014). Evaluating the Factors Affecting the Implementation of Hospital Information System (HIS) Using AHP Method. Life Science Journal, 11(3).

Ahmadi, H., Rad, M. S., Nilashi, M., Ibrahim, O., & Almaee, A. (2013). Ranking The Micro Level Critical Factors Of Electronic Medical Records Adoption Using Topsis Method. Health Informatics, 4(2).

Aron, R., Dutta, S., Janakiraman, R., & Pathak, P. A. (2011). The impact of automation of systems on medical errors: evidence from field research. Information systems research, 22(3), 429-446.

Bardach, N. S., Huang, J., Brand, R., & Hsu, J. (2009). Evolving health information technology and the timely availability of visit diagnoses from ambulatory visits: A natural experiment in an integrated delivery system. BMC medical informatics and decision making, 9(1), 35.

Castro, D. (2007). Improving Health Care: Why a Dose of IT May Be Just What the Doctor Ordered. ITIF Reports.

Chang, I., Hwang, H.-G., Hung, M.-C., Lin, M.-H., & Yen, D. C. (2007). Factors affecting the adoption of electronic signature: Executives' perspective of hospital information department. Decision Support Systems, 44(1), 350-359.

Chang, I., Hwang, H.-G., Yen, D. C., & Lian, J.-W. (2006). Critical factors for adopting PACS in Taiwan: Views of radiology department directors. Decision Support Systems, 42(2), 1042-1053.

Chen, Y.-Y., Jan, J.-K., & Chen, C.-L. (2005). A fair and secure mobile billing system. Computer Networks, 48(4), 517-524.

Currie, W. L. (2012). Institutional isomorphism and change: the national programme for IT–10 years on. Journal of Information Technology, 27(3), 236-248.

Damanpour, F., & Gopalakrishnan, S. (1998). Theories of organizational structure and innovation adoption: the role of environmental change. Journal of Engineering and Technology Management, 15(1), 1-24.

DiMaggio, P. J., & Powell, W. W. (1983). The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. American sociological review, 147-160.

Ettlie, J. E. (1986). Implementing manufacturing technologies: Lessons from experience. Managing technological innovation, 72-104.

Gibbs, J. L., & Kraemer, K. L. (2004). A Cross‐Country Investigation of the Determinants of Scope of E‐commerce Use: An Institutional Approach. Electronic Markets, 14(2), 124-137.

Grover, V. (1993). An Empirically Derived Model for the Adoption of Customer‐based Interorganizational Systems*. Decision Sciences, 24(3), 603-640.

Hassan, G. (2004). Managing a multiple hospital HIS implementation project. Paper presented at the E-Health Asia Conference.

Haveman, H. A. (1993). Follow the leader: Mimetic isomorphism and entry into new markets. Administrative Science Quarterly, 593-627.

Hsiao, S.-J., Li, Y.-C., Chen, Y.-L., & Ko, H.-C. (2009). Critical factors for the adoption of mobile nursing information systems in Taiwan: the nursing department administrators’ perspective. Journal of medical systems, 33(5), 369-377.

Hung, S.-Y., Chen, C. C., & Lee, W.-J. (2009). Moving hospitals toward e-learning adoption: an empirical investigation. Journal of Organizational Change Management, 22(3), 239-256.

Ismail, A., Jamil, A. T., Rahman, A. F. A., Bakar, J. M. A., Saad, N. M., & Saadi, H. (2010). The implementation of Hospital Information System (HIS) in tertiary hospitals in malaysia: a qualitative study. Malaysian Journal of Public Health Medicine, 10(2), 16-24.

Ismail, N. I., Abdullah, N. H., Shamsudin, A., & Ariffin, N. A. N. (2013). Implementation Differences of Hospital Information System (HIS) in Malaysian Public Hospitals. Technology, 20(21), 22.

Jensen, T. B., Kjærgaard, A., & Svejvig, P. (2009). Using institutional theory with sensemaking theory: a case study of information system implementation in healthcare. Journal of Information Technology, 24(4), 343-353.

Jeyaraj, A., Rottman, J. W., & Lacity, M. C. (2006). A review of the predictors, linkages, and biases in IT innovation adoption research. Journal of Information Technology, 21(1), 1-23.

Kambil, A., Kamis, A., Koufaris, M., & Lucas Jr, H. C. (2000). Influences on the corporate adoption of web technology. Communications of the ACM, 43(11es), 9.

Khoumbati, K., Themistocleous, M., & Irani, Z. (2006). Evaluating the adoption of enterprise application integration in health-care organizations. Journal of management information systems, 22(4), 69-108.

Kim, C.-y., Lee, J.-S., & Kim, Y.-I. (2002). Early stage evolution of a hospital information system in a middle income country: A case study of Korea. International journal of healthcare technology and management, 4(6), 514-524.

Klöcker, P., Bernnat, R., & Veit, D. (2014). Implementation Through Force Or Measure? How Institutional Pressures Shape National Ehealth Implementation Programs.

Kuan, K. K., & Chau, P. Y. (2001). A perception-based model for EDI adoption in small businesses using a technology–organization–environment framework. Information & Management, 38(8), 507-521.

Lee, C.-P., & Shim, J. P. (2007). An exploratory study of radio frequency identification (RFID) adoption in the healthcare industry. European Journal of Information Systems, 16(6), 712-724.

Lee, H. W., Ramayah, T., & Zakaria, N. (2012). External factors in hospital information system (HIS) adoption model: a case on malaysia. Journal of medical systems, 36(4), 2129-2140.

Lian, J.-W., Yen, D. C., & Wang, Y.-T. (2014). An exploratory study to understand the critical factors affecting the decision to adopt cloud computing in Taiwan hospital. International Journal of Information Management, 34(1), 28-36.

Liang, H., Saraf, N., Hu, Q., & Xue, Y. (2007). Assimilation of enterprise systems: the effect of institutional pressures and the mediating role of top management. MIS quarterly, 59-87.

Lin, C.-H., Lin, I.-C., Roan, J.-S., & Yeh, J.-S. (2012). Critical Factors Influencing Hospitals’ Adoption of HL7 Version 2 Standards: An Empirical Investigation. Journal of medical systems, 36(3), 1183-1192.

Liu, C.-F. (2011). Key factors influencing the intention of telecare adoption: An institutional perspective. Telemedicine and e-Health, 17(4), 288-293.

Low, C., Chen, Y., & Wu, M. (2011). Understanding the determinants of cloud computing adoption. Industrial Management & Data Systems, 111(7), 1006-1023.

Luxton, D. D., Kayl, R. A., & Mishkind, M. C. (2012). mHealth data security: The need for HIPAA-compliant standardization. Telemedicine and e-Health, 18(4), 284-288.

Mackenbach, J. P., Maas, P. J., & Bonsel, G. J. (2008). Volksgezondheid en gezondheidszorg: Elsevier Gezondheidszorg.

Mekonnen, S. M., & Sahay, S. (2008). An institutional analysis on the dynamics of the interaction between standardizing and scaling processes: a case study from Ethiopia. European Journal of Information Systems, 17(3), 279-289.

Mohan, J., & Razali Raja Yaacob, R. (2004). The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights. International Journal of Medical Informatics, 73(3), 217-227. doi:

MOH-Malaysia. (2014). Ministry of Health Official Website Retrieved 07 July 2014, from

Oliveira, T., & Martins, M. F. (2011a). Literature Review of Information Technology Adoption Models at Firm Level. Electronic Journal of Information Systems Evaluation, 14(1).

Oliveira, T., & Martins, M. F. (2011b). Literature review of information technology adoption models at firm level. The Electronic Journal Information Systems Evaluation, 14(1), 110-121.

Premkumar, G., & Roberts, M. (1999). Adoption of new information technologies in rural small businesses. Omega, 27(4), 467-484.

Rogers Everett, M. (1995). Diffusion of innovations. New York.

Ross, J. W., Beath, C. M., & Goodhue, D. L. (1996). Develop long-term competitiveness through IT assets. Sloan management review, 38(1), 31-42.

Siddiquee, N. A. (2006). Public management reform in Malaysia: Recent initiatives and experiences. International Journal of Public Sector Management, 19(4), 339-358.

Sulaiman, H. (2011). Healthcare Information Systems Assimilation: The Malaysian Experience. RMIT University.

Sulaiman, H., & Wickramasinghe, N. (2014). Assimilating Healthcare Information Systems in a Malaysian Hospital. Communications of the Association for Information Systems, 34(1), 66.

Thong, J. Y. (1999). An integrated model of information systems adoption in small businesses. Journal of management information systems, 15(4), 187-214.

Ting, S., Kwok, S. K., Tsang, A. H., & Lee, W. (2011). Critical elements and lessons learnt from the implementation of an RFID-enabled healthcare management system in a medical organization. Journal of medical systems, 35(4), 657-669.

Tornatzky, L. G., Fleischer, M., & Chakrabarti, A. K. (1990). The processes of technological innovation (Vol. 273): Lexington Books Lexington, MA.

Yap, C. S. (1990). Distinguishing characteristics of organizations using computers. Information & Management, 18(2), 97-107.

Yusof, M. M., Papazafeiropoulou, A., Paul, R. J., & Stergioulas, L. K. (2008). Investigating evaluation frameworks for health information systems. International journal of medical informatics, 77(6), 377-385.

Zhu, K., Kraemer, K., & Xu, S. (2003). Electronic business adoption by European firms: a cross-country assessment of the facilitators and inhibitors. European Journal of Information Systems, 12(4), 251-268.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.