2017 International Conference on Management Science & Engineering (24th)

August 17-20, 2017 Nomi, Japan

The Impacts Mechanism of Controlling System in Hospital on Quality of Care:

from Process and Outcome Perspectives
ZHANG Xiang-qunˈLI YanˈWU Xing-hanˈGUO Xi-tong
School of Management, Harbin Institute of Technology, P.R,China, 150001

 Additionally, when physicians can’t fulfill the contents of

Abstract: Considering complex environment of
hospital, the implementation of information systems
occurs lots of obstacles which impairs its effectiveness
and efficiency in medical process. In other words, there
exists lots of poor interactions between human and
information system use, such as the overload work
volume and medical errors resulting from inappropriate
behavior with new technology. Thus, we use quality
control system, an augmented system of electronic
medical records, to explore the complementary impacts
of information system to enhance the effectiveness of
information system us. Our study extracted physicians'
scores evaluated by the controlling system automatically
at a large urban hospital in China. To examine
relationship between controlling system and healthcare
organizational outcomes, we construct the fixed effect
model. Our results reveal an interesting progression over
time in how process standardization forming from
controlling system affects physician performance and
patient benefits. Our findings contribute to both
theoretical and practical Implications, in particular the
new insight of behavior change in healthcare and policy
directions.
Keywords: Quality control system, Process quality,
Outcome quality, Hospital Information Systems
1 Introduction
Overload work is common in Chinese top three
hospitals[1]. In order to mitigate this situation, many
countries invest money in hospital information system
(HIS). However, in a practical application, there still
various problems mainly concentrated on the interaction
between human and computer[2]. To some extent,
efficiency and quality was enhanced by this investment
of information system[3], controversy still exists. In other
words, on the contrary, human-computer interaction put
extra pressure on agents in hospital, for example,
physicians will spend time on typing patient records
especially when they have lower computer literacy.
The support of this study is from the National Natural
Science Foundation of China Grants (71531007,
71471048, and 71471049).
patients in HIS accurately and timely, undesirable
outcomes will be accumulated in system in course of
time. Thus, hospital administrators have to consider the
effect of IT employees performance according to IT
affordances including offering communication tools to
increase productivity, efficiency, and quality.
Additionally, hospital administrators must consider both
the differences of various systems and their various
impacts on patients.
As the main system in hospital, electronic medical
record (EMR) plays critical roles in improving quality of
care in hospital (Sharma, Chandrasekaran, Boyer, &
McDermott, 2016; Xiao et al., 2012). However, in
addition to this main stream system in hospital,
augmented systems are also important to various
organizational environment. (Sharma et al., 2016).
Therefore, referring to the impacts of information
systems in hospital, controversy till exists since the
complex interaction between human and system diversity,
such as the insignificant influence (Agha, 2014). As a
strategy, quality improvement can help organizations
attain a competitive advantage, such as higher reputation
and profitability[4]. Thus, for most of hospitals,
improvement of quality takes more than other
performance, such as patient satisfaction[5]. Moreover,
quality control system in hospital provides a procedure
for hospital quality monitoring which reduces errors by
removing illegible orders, facilitating communication,
promoting the tracking of orders, screening for
inappropriate orders, and alerting agents of actions to be
undertaken[6]. Based on them, we pose the following
question.
Does quality control system in hospital change the
physician behavior and improve the quality of care?
Considering the imbalance between effective uses
of information system and increasing workflow also
resulted from information system, we leverage this gap
to evaluate the impact of hospital information system, in
particular the impacts of quality control system which
limits physicians’ behavior in hospital. To test this
relationship, we constructed an empirical model by
theorizing the relationship between information system
and behavior change, and service quality. Then, we used

978-1-5386-137/17/$31.00 ©2017 IEEE


fixed effects model and included control for relevant
observables (e.g., workloads, environment factors) to
estimate these impacts. Since one dimension will lead to
evaluation bias, we disentangled the variation of impacts
from different types of variables, in particular the process
and outcome variables. Furthermore, we collected our
data from a large hospital in China to support our study.
According to the results, we found that quality control
system benefits both the effectiveness and efficiency of
IT implementation. However, the impacts on process
variables are less significant than outcome variables.
This contributes to the literature of information system
impacts in healthcare, also promotes to better economic
and policy literature evaluating the impact of behavior
change according to our post-hoc analysis. In practical,
our work gives support to the hospital reform related to
information system.
2 Research Background and Literature
Review
2.1 Information Systems in Hospitals
Information systems provide an important support
for hospitals of highly specialized medical tasks and
services[7]. It has varieties of affordances in medical
process, including monitoring[8], controlling[9], decision
supporting[10] etc. Monitoring system is that gives
behaviors tracking and recording as documents to keep
the continuous of medical records[11]. Controlling system
offers reminders for physician, which reduces mistakes
by oblivion significantly[12]. Decision support system
uses technology to connect the standard databases and
help caregivers’ decision-making[13]ˈit can provide more
advanced therapeutic schedule to patients.
As a part of EMR, Quality Control System plays an
important role in complementing the drawback. Such as
the overload work resulting from inappropriate usage.
The quality control system will remind physician to input
patients’ information timely. If the physician show
noncompliance, the system will inform monitor who can
give physician a warning or record in performance.
Quality control system use standard medical process to
change caregivers’ behavior, including content and time.
In that, content mainly focuses on several parts, such as
diagnosis, records of ward-round, electronic medical
records, medical advice and so on, while time focuses
more on timetable of fulfilling information above, which
could help caregivers improve adherence standard,
medical process and improve patient health outcomes[14].
Monitoring the records of ward round by a quality
control system has been argued that it can improve the
patient outcomes[15], also the ward round quality[16]. Then
physician can fulfill a task smoothly.
2.2 Service Quality Theory
As defined before, service quality refers to the
outcome of an assessing process depending on the
comparison between consumers’ expectations and actual

performance. Moreover, it is noted that quality is one of
the most important factors in service which is also a
foundation of competitive advantage. Service operators
in hospitals often evaluate the service quality provided to
their patients for improving their service, quickly
identifying the problems, and better evaluating patients’
satisfaction. As universally accepted, high patient
satisfaction is associated with better health outcomes,
service quality has close relation with medical
quality[17]. Some studies confirm that service quality has
five dimensions including medical service, admission,
discharge, overall service and social responsibility[18].
Thus, according to above, the setting of higher levels of
service quality in hospital will along with a higher level
of patient satisfaction and also behavior tendency.
Improvements in medical quality are clearly critical
elements of the value expected from quality control
systems[19]. Several studies found that quality
management is positively associated with the medical
quality. The medical quality in these studies include
reduce of mortality rates[20], improving vaccination
rates[21], increasing the adoption of recommended
procedures[22],and patient safety[23]. Information system
sometimes take roles of technical process management,
such as adherence to systems which are standardize and
operationalize that changes the agents’ behavior (Angst,
Devaraj, & D’Arcy, 2012). Providing digital input
functions as well as information supports to normalized
traditional medical process, information system in
hospital are promoted for their potential to assist
caregivers’ work and improve clinical processes (Bates et
al., 1999). As a controlling system aiming to frame
standard process, quality control system changes
physician’s existing routines and influences the direct
process performance. Thus, controlling system enables
operations affects their perceptions about system’s
impact in terms of improving process quality. Based on
the preceding discussion, we present our first set of
hypotheses relating to impacts of the quality controlling
system on the patients. Thus, we hypothesize:
Hypothesis 1 (H1): Quality control system
positively affects the process quality in healthcare.
Outcome refers to the end points of quality of care, such
as the improvement in health condition or survival.
Outcome variables are usually concrete and precisely
measured. Empirical evidence is significant in extant
research that the different types of information system
plays critical roles on patient health outcomes, such as
reducing mortality rate (Myers, Hubbard, Shaheen,
Dixon, & Kaplan, 2012), enhancing recovery status,
reducing readmission (Ayabakan, Bardhan, & Zheng,
2016). Referring to controlling system, it benefits for
several reasons. On one hand, complying with the system
reminder will avoid and reduce the possible of risk and
uncertainty during the treatment period. For example,
when the patient is emergency, controlling system will
guarantee that this patient has complete clinical test
which will find the problems immediately when they
come to the hospital. On the other hand, adherence to the
standard medical process will mitigate the overload work to avoid the sample bias. The description of data is
of physicians to some extent and distract the work to presented in Table 1.
several chips. Furthermore, they can have spare more on
diagnosing and communicate with patients. For example, Table 1. Summary Statistics (Observation=207)
they can write medical records every day per case, not
Variables Mean S.D. Min. Max.
delay to the last time when patients leave the hospital.
Based on this process, outcomes will be improved by Department 12 6.65 1 23
complying with system process, and we put forward our Evaluation Score 870 88 592 1157
hypotheses.
Hypothesis 2 (H2): Quality control system Length of stay 10.90 4.23 2.07 32.92
positively affects the outcome quality in healthcare. Mortality Rate 0.02 0.02 0 0.12
Cured Rate 0.35 0.34 0 1
3 Methodology
Recovery Rate 0.95 0.06 0.75 1
3.1 Data Setting Patient Numbers 37.95 28.53 0 142
Data collection. We collected data from a large Switching-in (%) 0.028 0.034 0 0.17
hospital in China that had applied quality control system
for couples of years. This is the first time they implement Readmission (%) 0.92 0.14 0.58 1.52
such systems to control the medical quality. Our data Undiagnosed (%) 0.05 0.06 0 0.27
collection had two parts. First, the authors have several
Switching-out Rate 0.03 0.03 0 0.15
discussions with physicians and managers in this hospital
since one of the author is the management employee in Bed Utilization (%) 90.08 27.25 4 154.19
this hospital. The examples applied into the illustration
about the impact of quality control system on the 3.2 Model Specification
doctor’s behavior are abstracted from these interviews We performed natural logarithm transformations on
and the real practical problems during hospital all variables to endorse the assumption of normality.
management. Second, the data was sourced from three Moreover, we used ordinary least square regression
datasets including first page of patients’ medical record, (OLS) to test our hypotheses, variables have introduced
outcomes on patients’ perspective, comprehensive in data section. However, the rate ranges from 0 to 1
evaluate result for medical care of basic section, and which do not belong to the normal distribution and is
monthly statement of basic section, ranging from inconsistent with basic assumption of OLS, so we used
2015/11 to 2016/06. fractional logit regression model to examine the impacts
Dependent variables. We extracted time-series data on dependent variables related to rate. Furthermore, to
on patient admission length and defined it as process examine how quality system affects quality of care, we
variable, cured rate, recovery rate, mortality rate as use panel data and a fixed effects regression model as
outcome variables. This data was extracted from patient follow:
discharge reports based on individual level. We ServiceOutcomeit = As + b * Log (ServiceQuanlityit)
aggregated these into department level by calculating the + d * Cst + eit
average number. The patient discharge reports include Here, ServiceOutcomeit is the patient outcome
patients’ basic admission statement and related time variable for a department i at time t which indicates the
which supports the hypotheses of process and outcome discharge status when they leave the hospital for any
variables as the measurements of medical quality. reasons. ServiceQuanlityit captures the average scores of
Independent Variables. We calculated the department i at time t. As refers to the department fixed
evaluation scores from department level. As the results of effects. And Cst is the department control variables.
system generated information, evaluation scores are the Above all, the department level fixed effects controls for
average physician score of every department which time-invariant differences across departments. The
measures the physician adherence behavior to system inclusion of these fixed effects makes each department in
from time and content perspectives. The scores were a given month comparable to any other department at
extracted from quality control system which marks other time periods. Additionally, there are other factors
automatically when users make errors, the system will influencing the time-serious variation of impacts, in
report the final scores every month per department. other words, the fixed effects cannot be the only
Control Variables. We extracted the patient number, measurement. To explain for these effects, several
switching-out number and bed utilization rates from control variables Cst are included in the model
medical monthly report. Medical monthly report is a specification in order to control the effects from the
traditional way to measure the medical quality which factors that vary within each department over time.
reflects the medical performance from organizational Description of these control variables have been
perspective. Thus, we can obtain statistic data from it as delineated earlier in the data section. Additionally, the
control variables in this study. Additionally, we also error terms are clustered at the department level to
consider the economics factors and other extrinsic factors account for autocorrelation in the data (Bertrand, Duflo,


 Table 2. Results of Model
Dependent Variable:
Variables
Procedural: Length of Stay
Evaluation Score -0.787***(0.189)
Initial Patient Numbers -0.043(0.078)
Bed Utilization Rate -0.002**(0.001)
Readmission Rate 0.340**(0.144)
Undiagnosed Rate 0.433(0.334)
Diagnose Uncertainty Rate 0.327(0.602)
Switching-out Rate -0.390(0.542)
Switching-in Rate 1.170**(0.579)
Intercept
R-Squared 0.183
Sample Number Balanced Panel: n=23, T=9, N=207
& Mullainathan, 2004). Observations are at the
department-month level based on the monthly medical
reports across all in-sample patients admitted to this
hospital. Accordingly, there are 207 observations in total
and united in balance panel data for 23 departments of 9
periods.
4 Results
4.1. Main Results
There are two dependent variables including
procedural measurements and outcome measurements.
The results of the fixed model are presented in Table 2.
Procedural measurements. The results of the model
measuring procedural variables indicate that quality
control system has a significantly (p < 0.001) negative
relationship with the procedural variables, thereby
supporting hypotheses H1. Since we use average length
of stay to measure the impact of system, the results are
negative and consistent with models which indicates the
decreasing of stay length in hospital. Outcome
measurements. The results of the outcome
measurements model suggest that quality control system
has a significantly (p < 0.001) positive relationship with
the procedural variables, thereby supporting hypotheses
H2. Since we use cure rate to measure the impact of
system, the results are positive and consistent with
models which indicates the increasing trends of cure rate
in hospital.
4.2. Robustness Checks
In this section, we run the robustness checks of
main results with respect to alternative variables of
dependent variables. Since we leverage the analysis
based on the department level and the patients’ status are
different in diverse departments and situations, we take a
replace dependent variables to keep that our analysis is
robust. Since the results of comparing is opposite to

Dependent Variable:
Outcome: Cure Rate
2.023**(1.208)
-0.421***(0.143)
-0.022***(0.005)
1.346(0.889)
-7.163***(2.466)
-2.093(3.061)
-5.336(3.943)
-1.033(4.291)
-11.626(8.091)
0.383
hypotheses we have before. We use these two-replaced
outcome dependent variables, recovery rate and mortality
rate from our data, in that these are also two dependent
variables which can reflect the patient status when they
leave the hospital. The robust results are represented in
Table 3 which are all significant and consistent with
results before. In other words, according to the robust
test, the impacts on outcome variables are still more
significant than process variables during the medical
process
5 Discussion
This study aims to examine how subsystem aiming
to control user behavior during medical process and
effects from the different types of quality of care.
Drawing on the literature in hospital information system,
service quality, and leveraging a unique dataset with
time-variation that through multiple departments and
multiple time periods, we empirically explore the
interplay between the quality control systems and two
type’s quality of care. According to the results of models,
our study has following conclusions. First, controlling
system can improve medical quality even though it limits
the physician behavior. Previous research showed the
potential of monitoring system in hospital rather than
controlling system because of the resistant emotion
towards new technology and some habits (Aron, Dutta,
Janakiraman, & Pathak, 2011). Contrarily, our study
gives strong support to the benefits from controlling
system which provides new insight for both theoretical
and practical perspectives. Moreover, it is an incentive
way for physicians to improve adherence of system.
Second, controlling system improves both process
quality and outcome quality. Previous research explored
the impacts on quality of care (Miller & Tucker, 2009),
also the impacts of surveillance, prevention, and control
system (Atreja et al., 2008). Our study puts forward a
 Table 3 Results of Robustness Checks
Variables
Recovery Rate
Evaluation Score 2.290***(0.667)
Initial Patient Numbers -0.146(0.114)
Bed Utilization Rate -0.000(0.004)
Readmission Rate 0.814(0.666)
Undiagnosed Rate 1.142(1.351)
Diagnose Uncertainty Rate -2.004(2.415)
Switching-out Rate 1.104(3.596)
Switching-in Rate -1.177(3.194)
Intercept -12.827***(4.377)
R-Squared 0.05
Sample Number Balanced Panel: n=23, T=9, N=207
new insight to measure the medical quality. Third,
comparing with outcome quality, the impacts of
controlling system on process quality has less significant
results but more on outcome variables which means the
reflection of the new technology may be more obvious
on outcome variables. This may have some reasons.
When we discuss about process quality, it is sometimes a
two-side sword. The outcome variables may have more
directly effects from variations about work process. Then,
we explain the theoretical and material implications of
this research in the following,
5.1. Theoretical and Practical Implications
Theoretical Implications. First, we extend the
literature of hospital information system. Recent research
in information system domain relied on causality
relationship from economics to explore how the interplay
between information systems and participants help
promote organization’s performance. Similarly, we
demonstrate that the controlling system changes the
interaction ways and operation patterns among agents in
healthcare environments, also changes the work style as
before. In other words, the controlling system
complements the overload work resulting from the
inappropriate implementation of information system.
Thus, the implication is that the controlling system
enhances the value of the other clinical information
system.
Second, we extend the search of different types of
subsystem in hospital, in particular the role of quality
control system in hospital. Current research on
controlling system and the impact on quality of care
posits that comparing with controlling, monitoring in
organizations related to the activities of doctors’ behavior
in hospitals is more valuable (Aron et al., 2011). Our
findings reveal the positive impacts of quality controlling
system which tests the roles in turn and posits new
research about different types of information system in
hospital.

Dependent Variable
Mortality Rate
-2.534**(1.025)
0.245(0.152)
0.020***(0.006)
-1.357(0.960)
-0.717(1.674)
-1.361(3.139)
8.664*(5.166)
0.794(4.813)
11.120(63987)
0.121
Third, we posit different types of variables.
Previous research shows the different results in one
dimension. Our findings answer the questions about the
mechanism of effectiveness and efficiency related to
clinical information system and extend the exploration of
this process. Specific classifications will help us better
understand the impact and controversy results from
previous research.
Practical Implications. First, recent study pointed
out the importance to implement information system into
hospital and also the severe budget constraints and
increasing workflow for caregivers. Our findings make it
clear that the implementation of controlling system will
benefit the organizational performance even though it
limits the behavior of physicians and changed it. Thus,
considering the low costs of this subsystem, hospitals can
consider to adopt it as the way to mitigate the drawbacks
from other influences.
Second, limited value of outcome variables on
quality of care. Our findings show the priority of
outcome variables. This will give directions for
management to use different system measuring the
different index. One of the functions related the
information system implemented in hospital is to statistic
the data and give reports to evaluate organizational
performance. Our work contributes to motivate
management be more focus on corresponding index and
enlarge the impacts.
5.2. Limitations and Future Research
Although this study helps us to better explain the
specific effects of controlling system on quality of care,
it is not without the limitations. This study used data
from department level which is still from the
organizational perspective not individual perspective.
However, it is better to measure the impacts from
individual level when it comes to the behavior change. In
other words, the average calculation will lead to some
bias of test. This motivates to the further research by
using data from physician level which can give better
perspective to explore the changing. Then, it is also
limited by data, we have deficiency data such as the time
of system implementation which created obstacles for
this study to use other methodology such as
difference-in-difference to test the causality. Then, our
research compared the different types of variables. But
recent research posits the comparing between monitoring
and controlling system, this is not addressed in this paper
which requires further research to furnish related
literatures.
6 Conclusion
In conclusion, this study provides several new
insights for the roles of quality control affordances on
two critical types of quality of care, such as process and
outcome quality. Our findings related to these two
variables indicate that controlling system promotes
quality of care by regulating user behavior. Even though
such system limits physician behavior, and increases the
workflow to some extent, the results still show the
positive side which argues that the controlling system is
not useless comparing with monitoring system in
hospital. We believe that this study can be extended to
examine the casual relationship between the various
technologies and policy interventions and medical
process such as enacting personalized system design for
certain departments to satisfy their requirements. Further
research can also focus on the individual level variation
of behavior change, people’s adherence with the various
controlling system orders, and also interactions among
different types of system in hospital. In particular, this
study can be applied as a foundation for further research
on how incentive intervention in quality management be
integrated as part of the technological mechanisms for
creating the optimal quality outcomes. We believe that
our findings will spawn further research in this important
domain.
Acknowledgements
The support of this study is from the National
Natural Science Foundation of China Grants (71531007,
71471048, and 71471049).
References
[1]J. Dai, X. Wang, and F. J. Ayala, "Medical informatics
and the 'three long, one short' problem of large urban
hospitals in china," JAMA, vol. 316, no. 3, pp. 269 -
270, 2016.
[2]M. Hibbeln, J. L. Jenkins, C. Schneider, J. S. Valacich,
M. Weinmann, "How is your User Feeling? Inferring
Emotion Through Human - Computer Interaction
Devices," MIS Quarterly, vol. 41, no. 1, p. 1, 2017.
[3]N. Zakaria and S. A. Mohd Yusof, "Understanding

Technology and People Issues in Hospital Information
System Adoption: Case study of a tertiary hospital in
Malaysia," Journal of Infection and Public Health, vol. 9,
no. 6, pp. 774 - 780, 11// 2016.
[4]M. Emmert, F. Taheri-Zadeh, B. Kolb, and U. Sander,
"Public reporting of hospital quality shows inconsistent
ranking results," Health Policy, vol. 121, no. 1, pp. 17-26,
1// 2017.
[5]B. Graham, "Defining and Measuring Patient
Satisfaction," The Journal of Hand Surgery, vol. 41, no.
9, pp. 929-931, 9// 2016.
[6]M. A. van Wijk, J. van der Lei, M. Mosseveld, A. M.
Bohnen, and J. H. van Bemmel, "Assessment of decision
support for blood test ordering in primary care. a
randomized trial," (in eng), Annals of internal medicine,
vol. 134, no. 4, pp. 274-281, 2001/02// 2001.
[7]H. Ahmadi, M. Nilashi, L. Shahmoradi, and O.
Ibrahim, "Hospital Information System adoption Expert
perspectives on an adoption framework for Malaysian
public hospitals," Computers in Human Behavior, vol. 67,
pp. 161 - 189, 2// 2017.
[8]R. Marques, J. Gregorio, F. Pinheiro, P. Povoa, S.
Miguel Mira da, and L. V. Lapao, "How can information
systems provide support to nurses hand hygiene
performance Using gamification and indoor location to
improve hand hygiene awareness and reduce hospital
infections," BMC Medical Informatics and Decision
Making, vol. 17, no. 1, 2017.
[9]C. Wang et al., "Efficacy of computer based
endoscope cleaning and disinfection using a hospital
management information system," American journal of
infection control, vol. 44, no. 8, pp. e141-e143, 2016.
[10]L. S. Elliott, J. C. Henderson, M. B. Neradilek, N. A.
Moyer, K. C. Ashcraft, and R. K. Thirumaran, "Clinical
impact of pharmacogenetic profiling with a clinical
decision support tool in polypharmacy home health
patients: A prospective pilot randomized controlled trial,"
PLOS One, vol. 12, no. 2, p. e0170905, 2017.
[11]F. Steimle, M. Wieland, B. Mitschang, S. Wagner,
and F. Leymann, "Extended provisioning security and
analysis techniques for the ECHO health data
management system," Computing, vol. 99, no. 2, pp.
183-201, 2017// 2017.
[12]E. Lopez-Valeiras, J. Gomez-Conde, and R. J.
Lunkes, "Employee reactions to the use of management
control systems in hospitals: motivation vs. threat,"
Gaceta Sanitaria, 2017.
[13]K. M. Cresswell, L. Lee, H. Mozaffar, R. Williams,
A. Sheikh, and N. e. P. T. on behalf of the, "Sustained
User Engagement in Health Information Technology The
Long Road from Implementation to System Optimization
of Computerized Physician Order Entry and Clinical
Decision Support Systems for Prescribing in Hospitals in
England," Health Services Research, 2016.
[14]J. Force, I. Thomas, F. Buckley, "Reviving post-take
surgical ward round teaching," The Clinical Teacher, vol.
11, no. 2, pp. 109-115, 2014.
[15]P. Pucher, R. Aggarwal, and A. W. Darzi, "Surgical
ward round quality, and impact on variable patient
outcomes," Journal of the American College of Surgeons,
vol. 217, no. 3, Supplement, p. S103, 9// 2013.
[16]P. H. Pucher, R. Aggarwal, P. Singh, T. Srisatkunam,
A. Twaij, and A. Darzi, "Ward simulation to improve
surgical ward round performance: a randomized
controlled trial of a simulation based curriculum," (in
eng), Annals of surgery, vol. 260, no. 2, pp. 236-243,
2014/08// 2014.
[17]O. Groene, "Patient centredness and quality
improvement efforts in hospitals: rationale, measurement,
implementation," (in eng), International journal for
quality in health care journal of the International Society
for Quality in Health Care, vol. 23, no. 5, pp. 531-537,
2011/10// 2011.
[18]M. Amin and S. Zahora Nasharuddin, "Hospital
service quality and its effects on patient satisfaction and
behavioural intention," Clinical Governance An
International Journal, vol. 18, no. 3, pp. 238-254,
2013/07/19 2013.
[19]R. Agarwal, G. Gao, C. DesRoches, and A. K. Jha,

"Research Commentary The Digital Transformation of
Healthcare: Current Status and the Road Ahead,"
Information Systems Research, vol. 21, no. 4, pp.
796-809, 2010.
[20]R. Amarasingham, L. Plantinga, M. Diener-West, D.
J. Gaskin, and N. R. Powe, "Clinical information
technologies and inpatient outcomes: a multiple hospital
study," (in eng), Arch Intern Med, vol. 169, no. 2, pp.
108-14, Jan 26 2009.
[21]P. R. Dexter, S. M. Perkins, K. S. Maharry, K. Jones,
and C. J. McDonald, "Inpatient computer-based standing
orders vs physician reminders to increase influenza and
pneumococcal vaccination rates: A randomized trial,"
JAMA, vol. 292, no. 19, pp. 2366-2371, 2004.
[22]N. Kuher et al., "Electronic alerts to prevent venous
thromboembolism among hospitalized patients," (in eng),
N Engl J Med, vol. 352, no. 10, pp. 969-77, Mar 10
2005.
[23]R. Aro, S. Dutta, R. Janakiraman, and P. A. Pathak,
"The impact of automation of systems on medical errors:
evidence from field research," Information Systems
Research, vol. 22, no. 3, pp. 429-446 %@ 1047-7047,
2011.