NON-ACCEPTANCE OF ELECTRONIC MEDICAL/HEALTH RECORDS SYSTEM

NON-ACCEPTANCE OF ELECTRONIC MEDICAL/HEALTH RECORDS SYSTEM 

1.    Introduction

This study is based on the Technology Acceptance Model (TAM). The expectation of the study is to identify an information technology system, which was not accepted by people, and to identify the reasons for such non-acceptance by using TAM.

The information technology system selected as rejected by people, particularly by Medical Practitioners, is the ‘Electronic Medical/Health Records System’ and this study elaborates the reasons as to why the Electronic Medical/Health Records System was rejected by Doctors, by means of TAM.

2.    Theoretical Review

Technology Acceptance Model (TAM) is a theoretical framework that explains and predicts the user acceptance of information technology. It suggests that when users encounter a new information system innovation there are two main factors which will influence how and when they will use it.

One is Perceived Usefulness (PU), i.e., the degree to which a person believes that using a particular system would enhance his or her job performance. The other is Perceived Ease of Use (PEOU), i.e., the degree to which a person believes that using a particular system would be free from effort.

3.    Electronic Medical/Health Records System

Electronic Medical/health Records is a computerized medical information system, which collect, store and display patients’ information or an electronic record of health related information of individuals.

Traditionally health records of patients are paper based that involved with large amount of papers. Many shortcomings are there with this paper based medical records, such as, requirement of unnecessary space for document keeping, the possibility of missing important records, inability to maintain uniform record system, misinterpretations, repetition of same tests, wastage of resources and time etc.

On the other hand Electronic Medical/health Records system facilitates patients’ health and safety, quality of care instant availability of information, prompt identification of the illness, convenience treatment, save of money and resources, quick services, reduction of errors, improvement of communication of information to Doctors etc. which benefits both the patients as well as medical practitioners.

Though there are many advantages of the Electronic Medical/health Records system, medical practitioners are not willing to accept the implementation of the same.

4.    Reasons for non-acceptance of Electronic Medical/Health Records System

In this scenario, based on the TAM model, the reasons for non-acceptance of emerging technology, that is, Electronic Medical/Health Records System, are assessed mainly based on two assumptions;

            Perceived usefulness (PU)

            Perceived ease of use (PEOU)

4.1 Reasons for non-acceptance of Electronic Medical/Health Records System due to lack of Perceived usefulness:

§  More time consuming –

Medical Practitioners are supposed to spend more time when using an Electronic Medical/Health Records System, which they don’t prefer as it may reduce the number of patients they could treat per day. Further, more time consumption is required for data entering to the system, and getting familiarize with the system or learning.

§  Potential for mix-ups and confusion that can be frustrating, costly and even dangerous –

Though the use of Electronic Medical/Health Records System is said to be an advantage, some mistakes, errors, mix-ups of data etc, which are not only costly and frustrating but even dangerous are possible.  Thus, the Doctors as well as the patients are with some suspicion to resort to electronic records system. 

§  Compatible only with half of work but not compatible for all the work of Doctors –

 Electronic Medical/Health Records System can be used only for certain work of Doctors, but not for all the work. Therefore they are of the feeling that no point of moving to an electronic system that supports only few of their functions.

§  Possibility of fraudulent billing –

Parties can intentionally engage in malpractices such as generation of fraudulent bills. Such aspects hinder the trust among the Doctors and patients about electronic system.

§  Similar to other computerized systems, electronic records are also vulnerable to crashes, errors or defects –

Crash, error or defect occurred in the electronic system can trouble the smooth happening of patient care, may be even for considerable period, which can ultimately create negative or dangerous results. Unlike other computerized systems, since the patient care is a sensitive issue much concern should be to avoid such possibilities. Disruptive acts of external parties may cause enormous troubles and damages.

§  Requirement for large amount of investment –

A Doctor having a small or medium scale patient care center may find difficultly of affording the high investment required to establish Electronic Records System. 

§  Possibility of negatively affecting the relationship between the Doctors and Patients - 

The belief among the Medical Practitioners seems to be that with the introduction of an Electronic System the communication or the relationship among the Doctors and patients will be weakened or damaged. 

§  Security or privacy concerns –

By nature humans are more concern about their security and privacy. And when moving to an electronic system one of the major worries are security and privacy.

4.2 Reasons for non-acceptance of Electronic Medical/Health Records System due to lack of Perceived ease of use:

§  Necessity to be familiar with computers / lack of technical competency of the staff –

Medical Practitioners or Physicians are relatively less familiar with computers. Thus, they resist to the Electronic Medical/Health Records System, which requires sound computer literacy to operate smoothly.   Not only Doctors, but Nurses as well as patients will have to struggle with unfamiliar screens. 

§  System complexity –

Electronic Records System is a complex one, where all parties are in need to spent considerable time to be familiarize with and understand such system, prior to starting its successful operation.

§  Requirement to totally rely on the vendor –

An Electronic Medical Records System will be designed and developed by an external third party vendor, on whom it is necessary to rely on for each and every aspect. In a certain way, some sort of a risk. Any amendments or developments identified in the electronic system can only be incorporated through the vendor.

§  Lack of managerial support -

Managerial support is an essential factor to make success an effort. Thus, the support from the management of the Medical Institutions is a must to successfully implement Electronic Medical/health Records system. Proper leadership is another compulsory factor in need.

§  Lack of belief in an Electronic Medical/health Records system –

Lack of trust or belief in the society on an Electronic Medical/health Records system is also a major hindrance to realization of such system.

 5.   CONCLUSION

                 

Despite the considerable number of advantages of implanting an Electronic Medical/health Records System, it has not been a success mainly due to external variables, divided into two as lack of perceived usefulness and lack of perceived ease of use, for which reasons are elaborated above.

As a result the attitude toward using Electronic Medical/health Records System was not favorable. Thus, the particular Electronic Medical/health Records System has not been purchased by many, which shows poor behavioral intention to use.

Ultimately the actual usage of the Electronic Medical/health Records System was very much less.

By way of avoiding or overcoming the identified reasons for lack of perceived usefulness and perceived ease of use, the actual system use of Electronic Medical/health Records System can be improved.

FAILURE OF SINGLE WINDOW IMPLEMENTATION FOR IMPORT TRADE FACILITATION IN SRI LANKA

UNDERSTANDING THE FAILURE OF SINGLE WINDOW IMPLEMENTATION FOR IMPORT TRADE FACILITATION IN SRI LANKA 

1.    Introduction

 When an importer import a consignment to Sri Lanka there were extended process and cumbersome paper work, delays caused by regulatory agencies to clear that consignment with the manual clearing process. To avoid the above manual time consuming procedure the regulatory agencies such as Sri Lanka Customs, Port Authority, Bank of Ceylon, Inland revenue, etc. has introduced this single window concept to facilitate the traders(Both Import and Export). The Department of Customs established an Automated Data Processing (ADP) Division for the introduction of the ASYCUDA (Automated System for Customs Data) system in 1992 with a view to introducing automation of the export-import process and procedure.in 2011 they have introduced the advanced version of this system called ASYCUDA World that facilitate to fully automate the cargo clearance customs procedures. As a part of automation the databases of the Inland Revenue department also connected with the customs systemBut unfortunately the process has stopped and the other required institutes do not connected to the system for the last few years. Currently Traders only able to submit the electronic CUSDEC form to the Sri Lanka Customs and they have to send the hard copy of that CUSDE for further process as previous manual procedure.When refer to this single window concept implementation process it can clearly see the objectives of the project does not yet achieve.This research paper has conducted to analyses the reasons for the failure of implementation of the single window concept for the trade facilitation in Sri Lanka using the Actor Network (ANT) theory. 

 2.     The Actor - Network Theory

Actor network theory (ANT), also known as enrolment theory or the sociology of translation, emerged during the mid-1980s. This is defined as Heterogeneous network of aligned interests, including people, technology and organizations (Walsham and Sahay, 1999).

Actor Network theory has been used in different ways in analyzing the failures of an ICT project. In this study it has used the four stages of translation of Callon (1986) Problematization, interessement, enrolment and mobilization. These help to analyses and describe the process leading up to the failure, step by step from the Actor-Network’s formation until its collapse (Greener, 2006; Lee and Oh, 2006;Mahring et al., 2004) 

2.1 Problematization 

This is the first stage of the ANT, in this stage the focal actor decides the project objectives and selects the actors, according to the selected case the ministry of finance and planning is the focal actor and they have to set the OPP that can align the interests of different actors.In this Sri Lankan scenario the focal actor was unable to set an OPP that might hold important actors with different concerns together.ministry of finance and planning has focused only their interest than other actors like Other government ministries and Departments including the BOI, Ceylon Chamber of Commerce ministry of Agriculture, Archeology and private sector players such as , Transporters, and Freight Forwarders.Introduced ASYCUDA WORLD system has been given an opportunity to Importer to feed CUSDEC online from their offices. Before it was done by the Officers of Sri Lanka Customs once an Exporter submits the papers to their Key-in counters. Up to now this is the only procedure that upgraded with the new system. Since the Data bases of Inland Revenue linked with the Department of Customs Imports has to get the TIN numbers manually.It is clear that, ministry of finance and planning – the Focal actor is focused only their interest in the development of new system rather than aligning the interest of different actors. So the current system does not provide the expected return to the other actors.

 2.2 Interessement

At the interessement moment, the Focal actor uses various devices to lock important actors into their respective position and establish a balance powers between actors, ensuring that these actors are able to overcome a series of obstacles and go through OPP (Callon, 1986)In the beginning ministry of finance and planning was not allowed and not aware of the difficulties faced by the different actors and later offered little help to them with tackling the problems.
Secondly, the officers of Sri Lanka Customs required hard copies of E-CDN and it should send along with the consignments. Since they can view it through the system, so far they need Hard copies to cross check with the ASYCUDA SYSTEM.Also an Importer cannot pay their Bills, Statutory charges or obtain online Country of origin through the system so far. Still, it processes manually and all papers – supporting documents should file to each section to get the things done. These functions of the above system does not activated in Sri Lanka.

 2.3. Enrolment

 Sri Lanka Customs were ready to facilitate paperless movements & online procedures under the new system. So far the focal actor – ministry of finance and planning failed to provide fully automated online submission, online paying facility and obtain country of origin certificates, TIN numbers and other required certifications from the system.
In this scenario ministry of finance and planning was not properly coordinates with the other ministries to get them together to implement this automated system. They have to coordinate and arrange the procedures of getting the all required government institutions functioning under different ministries that connected to the import trade to obtain required certifications online. 2.4.  Mobilization On the other hand, due bad ICT infrastructure, issues in internet access, low productivity and frequent server downs, IT security threats the other actors in the network are not relying on the system. Nothing has been changed from the Old systems to a new system, rather than adding extra payment from the Importers and Exporters entering Initial data in to the system which is an additional work to the client.

 3.     Conclusion 

The concept of the Single window project is to facilitate the import and export trade with the development of the other infrastructure such as sea and air ports. Under that ministry of finance and planning is expected to facilitate this project but this was not success. Sri Lanka has only partially implemented the automated system despite the fact that the Sri Lanka Automated Cargo Clearance System was initiated about 12 years back.

The progress to date has been poor with still more than 35 per cent of the import CUSDECs being processed manually. According to stakeholders interviewed only about 40 per cent of the entire import process has been automated on average and most of them are not satisfied with the status of automation in the country. Not surprisingly, the benefits from automation have been limited and it has had a limited impact on the small and medium scale traders and agents.Currently, the system only allows for the lodgment of the Customs declaration form and receipt of approval. Thereafter, the process is entirely manual and still involves a lot of paper work and visits to different locations to import or export a good. Some stakeholders thought was too high considering the fact that they can only lodge the CUSDEC electronically but have to do the rest manually. The expected level of service that need to obtain from the implementation of automated clearing system is not contributing to the system due to issues in implementation and the implementation progress  getting the log time than the expected.In the interessement stage, the key challenge faced by focal actor is to support other actors in the actor-network to work properly and avoid betrayals appearing, by employing different mechanisms. The other factor is the focal actor should be guaranteed with a stable status, which is critical for the actor-network to survive the translation process.The Final conclusion is the project of Single Window implementation in Sri Lanka is became a failed project according to the Actor- Network Theory.

Virtual Campus failure in Sri Lanka

Virtual Campus failure in Sri Lanka

Introduction

ABC Virtual Campus is a web-based portal developed by ABC institute to offer wide range of educational resources and features for students’ convenience. This system is developed for the purposes of enabling students to download study and course work materials, collect exam entry cards, view evaluation feedbacks and results, important messages and discussion forums. In simple terms, it is a student centric web portal enabling students’ learning process easy and faster. Students who are enrolled in the institute are provided with the access to the modules that are elected by them and eighteen types of service options are provided under each module. Viewing reports, online markers, academic corner, instant messenger, student admission, notice board, exam corner, book list and lecturer resources corner are some access options that are provided.

 This is a platform for managing, tracking, promoting and sharing information with easy to use on-line tools that aims to connect the campus community 24 hours a day, seven days a week. This Virtual campus is globally accessed by students whereas the utilization has been identified as very minimal. This assignment focuses on the reasons for such minimum level of utilization of portal and suggestions for overcoming the difficulties with reference to the Actor Network Theory (ANT). The actors of the ABC virtual campus are the portal administrator, lecturers and student service employees. Students are the other actors of this network. The non-human factor involved is the ABC virtual Campus. Reasons for failure of the ABC virtual Campus The following are identified as technical difficulties faced by the portal administrators in using ABC virtual campus, Difficulties in handling bulk data simultaneously This is a MySQL-driven database system in which bulk data cannot be handled simultaneously. During the situations of data overflow, this system becomes idle and loses its functioning ability. Difficulties in load balancing When multiple users are logged on to the portal, load of the data is not balanced effectively and the data processing speed is decreased. Hence users are reluctant to access the system for their information requirements.

Hence addition or editing cannot be done easily through web. No centralized administrative privileges Though administrator has the authority to update and handle the portal, he/she is not provided with access to all options in the portal. For example, students are provided with some options which cannot be seen under the administrator’s access list. The following are identified as the hurdles for lecturers and student services employees to utilize ABC virtual campus in an optimum level,

No notification system for student registrations

When a case file of a student’s registration is opened locally by the student services and processed for registrations, no any notifications are sent denoting the completion of student registration process that takes considerable amount of time. However, the relevant student is notified about the completion of registration process. No method to record student attendance to the online system There is no any systemic way to record the student access information and attendance for the online sessions.

Therefore, the confirmation on students’ utilization of the information shared and the participation cannot be measured quantitatively. The following are identified as the reasons from the student’s end for not using the web portal for their learning purposes,

Not a multi-lingual platform

Though this system is accessed globally by students from different region, it does not have other language options apart from English. No real time online group chat facility The system consists of information sharing platform as “White boards”, however it is not quick and effective like real time chat. Students highly prefer real time communication platform for them to share their thoughts and sort out their issues. Lack of fluency in web-based learning process The undergraduate students are lacking of fluency and confident in using an information system for their learning purposes. Also, only an initial level of introductory session is conducted to the students in accessing the portal, whereas no any discussion and problem solving forums are conduct in-person once the students start using it. Students who are adopted to class-room teaching and in-person information sharing practices lacking of confidence in getting maximum information from it.

 They still depend on in-person announcements related to their assignments, exams and results. Complex interface of the system The content of the system is not arranged in an order where all types of relevant and irrelevant menus are visible for all types of users. The scattered nature of icons and improper partition of menu mislead the users to access the required destination.

No feedback, notification and acknowledgement process in the system Feedback of the users cannot be tracked in the system. Also no any notifying mechanism is implemented for users to be informed on the updates of the system. This leads to situations such as students need to be informed via other media about the update in the system.

 Overcoming the failure using ANT This part of the report provides suggestions for solving above mentioned difficulties in handling the ABC Virtual campus system in view of the ANT. In the problematization stage, the actants of this system needs to be identified prior to development of the system. i.e, the users of this system such as student service employees, system administrators, lecturers and students need to be identified and the purpose of developing the system needs to be shared with them. The expected benefit of the technological improvement needs to be communicated to all users of the system. When the need for developing and implementing the system and expected outcomes is clearly defined, the important features and structure of the system can be planned. The requirements, needs and interests of all students, lecturers, administrators and student services employees needs to be discussed and identified to define the features of the system. The interconnection between the features used by all parties need to be identified. For example, student performance information access needs to be provided to lectures and students. Administrator should have the access to all privileges which is facilitated for students.

 The link between students and student services, students and lecturers, student services and lecturers, and administrator and all other actants need to be satisfied in the system. In the intersegments stage, the interest and confident to deal with the system for learning purposes need to be developed among the students. The convenience and flexibility of using the system needs to be felt by the lecturers, students and students’ services employees. The purpose of existence of the system, which is acting as a hub connecting all actants for information sharing purposes needs to be felt and realized by all users. Various levels of audience-targeted training needs to be provided for all types of users. This will help users to get better understanding about the system and share their issues in dealing with the system. In the enrolment stage, interdependency among students, lecturers, and students’ services need to be developed via the system.

The skills to handle the obstacles in using the system needs to be improved. In the mobilization of allies stage, the real purpose of every actant needs to be served by the system. i.e, Students, lecturers and students’ services should satisfy their learning, information sharing, and communication needs via the system. Further, improvements and enhancements that could be done to upgrade the functionality of the system needs to be suggested by the users. Conclusion in the problemitization stage, the appropriate Database Management System (DBMS) that solves the bulk data and data balancing issues has to be chosen. Expectations of the students, lecturers, students’ services need to be discussed and listed. Serious attention needs to be paid on providing access authorities to all parties and the administrator should be informed about the access authorities of all the other users.

The interconnection between all users’ needs to be identified and linked. In the intersegments stage, customized and common training needs to be provided to all types of users. Real-time online chat mechanism need to be implemented to make the users get maximum benefits from the system and to create the interdependency in the enrolment stage. When the users are comfortable in using the system and the objective of implementing the system is achieved, students, lecturers and student services will make suggestions for further development of the system. If the ABC virtual campus is developed and executed accordingly, it could have been an effective learning system which serves the needs of students, lecturers and students’ services.

Critical Analysis of the Technology Acceptance Model

Critical Analysis of the Technology Acceptance Model

 Executive Summery

As an essential requirement in the Management Information Systems (MBA-540) students need to assess Technology Acceptance Model with the intension of analyzing practical example in the real business environment. Therefore it was decided to analyze Navision ERP system introduced to Analytical Instruments (Pvt) Limited and its acceptance and rejection by the employees who are using the system.

In the first chapter introduction and discussed and forward the basic identification of the selected organization and the past situation of the organization without the Navision ERP. Thereafter discussion will be on TAM model and the next Navision ERP system Introduction and its acceptance and rejection among employees critical evaluation has presented. Thereafter summery and conclusion and finally referred research and text list.

Analytical Instruments (Pvt) Limited.(AIPL)

A 25 year old organization originally sales driven trading business and it is having a turnover nearly 4 billion LKR. Probably the market leader in the scientific instrumentation industry in Sri Lanka and ICT involvement it considerably high and ICT used to gain competitive edge in the industry. In resent past AIPL was able to introduce a major change in to their internal system that is introduction of Navision ERP system. This introduction was done due to various pressing issues in the past Q soft ERP system. According to the preliminary discussions had with the ICT service provider Navision will be overcoming most of the available draw backs in the q soft system.

On time invoicing, correct inventory records, proper financial records marketing records and information will be easily obtainable by the Navision. So that total staff that is directly interacting with system were trained on the usage of the system and external staff was train about the possible requirements that can be obtain from the Navision. The major emphasis on the Navision is that it will increase the effectiveness of the internal sales support staff of the AIPL. Additionally the Sales man in the field will be benefitted from this.

After introducing the system to the organization the situation was not that much accepted, according to sales mans view point. On the other hand some of the practiced processes and procedures also changed that was another negative factor for the effectiveness of the Navision. In this scenario, the complications in acceptance evaluated by using TAM model.

Critical Evaluation According to TAM

AIPL employees are always welcome new technologies unless it complies with PU & PEOU. Q-Soft ERP system was not effective when the organization grow larger so that people has to move to new technology. On the other hand sales forces are the person who brings revenue to the organization so that facilitation from the office staff is a must. In addition to that keeping them free from office work will increase their effective sales time which can use to bring in sales. On the other hand effective sales forecasting and budgeting will bill increase the effectiveness of the sales strategies? Other than that walk in customers should be treated quickly which was not happened previously.

With all those expectations Navision was brought in to the organization. In fact it was practiced with considerable difficulty due to various reasons major reason is that operators are not adequately trained, therefore unexpected delays and errors were occurred, at the same time report generation was quiet remarkable and effective information was able to drawn from the Navision. Previously manually generated target Vs achievement report was generated by a single key struck.

In addition to that stock records were high in accuracy so that prompt delivery planning and delivering was easy. In logistics handling previously information obtained through a phone call but sometimes it was not accurate. In promising a delivery date to a customer need to be concrete and should be matched so that the world of mouth information was not adequate so that more accurate information could be obtained from Navision with very limited time period.

Previously invoicing was not easy for a walking customer so that number of walking customers were dissatisfied. With the available system it was overcame. Therefore introduction of the Navision was really effective to the organization and it was successful. The major reasons behind are meeting the two major assumptions. So that perceived usefulness and perceived ease of use were matched by the technology so that it created a successful launching of the new technology.