Nurses' Perception Regarding Barriers to use of Health Information System in the Teaching Hospital of Abbottabad

The Health Management Information System (HMIS) was designed to provide information on the status of ongoing health-related events. It has been designed to enhance data management in health care facilities. The effectiveness of this system depends on the appropriate collection, analysis, interpretation, and utilization of data. Objective: This study intended to generate knowledge to bridge this knowledge gap to overcome barriers to using and implementing integrated HIS. Methods: Descriptive cross-sectional design was used in this study. The data were collected in a Teaching hospital in Abbottabad from July 27, to Aug 3, 2022. Five item Likert scale was used to collect data from 206 nurses. Those who have one-year of experience with HMIS were included in this study. Result: More than half 51.9 % (n=107) of the study participants were female. Almost half 49.5% (n=102) of the participants responded with little and very few barriers in the use of health information systems, followed by much and very much by one-fourth of the participants 25.7% (n=53) and moderate 24.8% (n=51). technical (2.98±1.17) had the highest total mean scores followed by legal (2.95±1.19), organizational (2.91±1.15), and personal (2.90±1.16). Conclusions: The study concluded technical barrier as the top most and comprises computer shortage, internet breakdown and improper health information network. The nurses also reported workload due to documentation and access of an unauthorized person to information. perception barriers to use of

Nurses' Perception Regarding Barriers to use of Health Information System in the Teaching Hospital of Abbottabad Organization, people, and information systems are three factors that are crucial in the application of information technology in healthcare [5]. The Health Management Information System (HMIS) was designed to provide information on the status of ongoing health-related events to aid in effective management and evidence-based decision-making at all levels of health-care systems [6]. This system is important because they handle all patient data and information, including vital personal information and other in-depth medical data [7]. HMIS is broadly applied in developing and low-income countries and has been designed to enhance standard data management in health Nurses' Perception Regarding Barriers to Use of Health Information System

I N T R O D U C T I O N
The Health Management Information System (HMIS) was designed to provide information on the status of ongoing health-related events. It has been designed to enhance data management in health care facilities. The effectiveness of this system depends on the appropriate collection, analysis, interpretation, and utilization of data. Objective: This study intended to generate knowledge to bridge this knowledge gap to overcome barriers to using and implementing integrated HIS. Methods: Descriptive cross-sectional design was used in this study. The data were collected in a Teaching hospital in Abbottabad from July 27, to Aug 3, 2022. Five item Likert scale was used to collect data from 206 nurses. Those who have one-year of experience with HMIS were included in this study. Result: More than half 51.9 % (n=107) of the study participants were female. Almost half 49.5% (n=102) of the participants responded with little and very few barriers in the use of health information systems, followed by much and very much by one-fourth of the participants 25.7% (n=53) and moderate 24.8% (n=51 . It is anticipated that HMIS will measure the prevalence of disease-related morbidity and mortality in populations, monitor trends over time, and spot any odd tendencies to enable prompt response [9]. The effectiveness of a health information system depends on the appropriate collection, analysis, interpretation, and utilization of data at all levels. In most cases, incapacitated systems have a negative impact on system performance and e ciency [10]. Health IT has the potential to improve patient safety, but its use and implementation have been accompanied by unforeseen consequences and signi cant safety concerns [11][12]. For improving patient safety in healthcare systems that incorporate health IT, developing trustworthy, doable ways to quantify safety concerns at the intersection of health IT and patient safety is a signi cant problem [13]. User self-e cacy, usefulness, and simplicity of use are signi cantly impacted by management support, agreement, and high-quality information; these important elements increase system acceptability and allow managers to take into account the crucial variables for decision-making, system development, and improvement [14]. The development of an evidence-based information system requires educational activities to improve the attention and abilities of healthcare professionals [15]. To maintain safety and quality of care, collaboration, good managerial and organizational planning, effective technology, well-structured systems, and effective communication are all needed [16]. Health management information is essential for the continuous improvement of the health care system. It has been started in Pakistan in 2007 but the contemporary system in Pakistan is worse and of poor quality because it has never been accomplished. After the installation of MTI ACT 2015, KP Government started HMIS is teaching hospitals. but there are major challenges in the implementation and the use of health information systems. very limited studies have been done in Pakistan especially in KPK so it's a signi cant issue that needs to be investigated. This study intended to generate knowledge to bridge this knowledge gap to overcome barriers to using and implementing integrated HIS. A descriptive cross-sectional design was used in this study to understand nurse's perceptions regarding barriers to using Health information system in a teaching hospital of Abbottabad. Data were collected from July 27 to Aug 3, 2022, through a random sampling technique. The study population included nurses who worked in a teaching hospital where health information system has been installed. Nurses who had one-year of experience with HIS were included in this study. Nurses who on were long leaves during data collection and has less than one-year  Merely two participants were MSN in quali cation. 42.2% (n=87) of the participants had less than ve years of experience, followed by 6 to 10 years 29.6 % (n=61) and 16 to 20 years were 16.5 %(n=34). 11 to 15 years and above 20 years 4.9 and 6.8 % respectively as shown in Table 2. performance reduction during the use of HIS was the top barriers among organizations. More than One-third 37 %of the participants showed little concerns on learning new skills and conducting updated courses, followed by 32 % much and moderate 30 %, because The system has continuously changed with integrated information for the improvement of the health care system. Almost two-fth 37.4 % of the nurses reported shortage of IT personnel as a little barrier followed by much and moderate 31 % respectively. Shortage of information technology personnel had a great concern in the use of HIS. They are responsible for the maintenance and support of HIS user. Two-third of the study participants expressed concern over inappropriate planning. It is the most important step in the use of health information system and enables all health care workers especially Nurses to make a schedule and organize their task accordingly. More than three-fth of the nurses reported that inadequate maintenance of HIS, inappropriate support in the operational activities are the factors which affect the performance of this system. Senior managers are responsible for the training and evaluation of nurses' performance in the use of HIS but inadequate support from them leads to poor monitoring and evaluation. Despite the bene ts of HIS, three-quartile of Nurses reported when they are attached to the system during patient data documentation they remain detached from patients which leads decrease productivity in their work and ultimately compromises patient care.

Technical Barriers
Lack of a national health information network, poor internet, shortage of computers and no proper standards for data exchange are the main barriers identi ed in the technical categor y. Three-quar tile of the study participants reported that health information network has not established appropriately. In Pakistan, health information has connected intra-province. District health information system has been started but due to improper maintenance became worsen. After the installation of the Medical Teaching Institution Act 2015, a health information system has been started in teaching hospitals of Khyber Pakhtunkhwa but still not connected. Internet facility and enough equipment's are essential components in HIS. But majority of the participants reported that due to weak internet connectivity and a shortage of computers, the productivity and performance of HIS have declined.

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Health information system barriers were categorized into organizational, technical, personnel, and legal barriers. Ttest was run to measure the mean differences between barriers categories. Results showed a mean difference, technical (2.98±1.17) had the highest total mean scores followed by legal (2.95±1.19), organizational (2.91±1.15), and personal (2.90±1.16) as shown in Table 4.

Organizational barriers
Participation in new courses, shortage of IT experts, improper planning, inadequate maintenance, support, and new and updated skill. Untrained staff faced more di culties in the use of HIS compared to skilled staff.

Legal barriers
More than three-fth of the study participants stated that Access of unauthorized persons to information and data con dentiality were the main legal barriers. Nurses showed great concern about the access of an unauthorized person to patient information which may violate the patient rights to con dentiality and privacy. Association between Demographic variables and total Barrier categories score Chi-square test was run to check the association between demographic and total barriers categories score. Gender (p <0.05) Age group (p=0.005) showed a signi cant association with barriers and there is no association found between the level of education and total barrier categories score (p >0.05). Nurses' opinions by experience group and level of education showed no association with barrier categories. Gender showed an association with the organizational barrier (p =0.003) and Personal barrier (p=0.002). The association found age group with a personal barrier (p=0.002) and legal (p=0.003). . According to our study ndings Participation in new courses, shortage of IT experts, improper planning, inadequate maintenance, support, and performance reduction during the use of HIS was the top barriers among organizations. However, another study nding showed Cost, time and bene t analysis, unavailability of internet, shortage of trained workforce, inadequate infrastructure, social and cultural, countrywide policies and motivation of health care professionals are the barriers for which developing countries are struggling [20]. The ndings of another study revealed shortcomings in the planning and management process and a lack of coordination in health care setting [21]. The result of this study showed that Access of unauthorized persons to information and data con dentiality was the main legal barriers. while a Study conducted in Iran by Ahmadian et al., (2014) showed that errors in information access, lack of enough information networks, technical di culties in the system design, and inadequate organizational training [22].

C O N C L U S I O N S
The study concluded technical barrier as the top most and comprises computer shortage, internet breakdown and improper health information network. Ine cient planning, poor support and maintenance, attending new courses and decreased productivity are the organizational barriers identi ed in this study. The nurses also reported workload due to documentation and access of an unauthorized person to information.

C o n  i c t s o f I n t e r e s t
The authors declare no con ict of interest.

S o u r c e o f F u n d i n g
The author(s) received no nancial support for the research, authorship and/or publication of this article