While computer technology is extensively applied to handle affairs, hospital information system managers are facing a critical issue as to how to establish an information system that is suitable for hospitals to obtain optimal efficiency and benefits. Evaluation of information systems offers an important approach to determine whether a unit using the systems enables the existing facilities to function to the fullest extent possible. During the process from determining research objectives, developing a research framework and performing empirical analyses to obtaining the research findings, a better understanding has been achieved pertaining to a variety of hypotheses previously developed, and several conclusions and discussions are made, which are provided separately below:
Relationship among system quality, service quality, job satisfaction, and system performance
Our findings support the statement that system quality will positively influence service quality. This agrees with the assertions of previous relevant studies. For example, Keating et al. and McKinney et al. [14, 15] have pointed out that system quality could affect the service quality perceived by system users. Our findings also support the statement that system quality has a positive influence on job satisfaction. This agrees with the assertions of previous relevant studies. For example, Davis and DeLone and McLean [9, 16] have pointed out that system quality and information quality both affect the satisfaction among information system users. Other cases in which some past researchers’ viewpoints corresponded to the results of this study that system quality has a positive influence on system performance, for example; Asghari and Aissa and Babulak [25, 28] have showed that system quality and information quality simultaneously will affect system performance. The results show that only security, one of the system quality factors, has an insignificant influence on service quality, job satisfaction, and system performance. A possible reason is that most of the system users are physicians, nursing personnel and pharmacists who are less familiar with the safety measures that protect the system, unlike professional information personnel. Consequently, no significant influence of security can be detected on service quality, job satisfaction, and system performance in the analysis of the questionnaires.
This study also found that ease of use and efficiency about perceived system quality had significant influence on service quality, job satisfaction, and system performance. Information technology helps medical institutions to offer rapid, efficient and accurate medical services; however, information system users’ lack of professional knowledge regarding medical information technology as a result of their non-information related background, the innovative computer and information technology and increasing dependence on information have increased the workloads of information personnel. Under such circumstances, ease of use and efficiency become more important for enhancing information system service quality.
Relationship between service quality and system performance
Our findings support the statement that service quality will positively influence system performance. This agrees with the assertions of previous relevant studies. For example, Myers et al. and Pitt et al. [35, 36] have pointed out that service quality could affect the organizational system performance. The research findings indicate a significant positive influence of service timing and personnel responsiveness on system performance. The results also show that reliability, one of the service quality factors, has an insignificant influence on system performance.
A possible reason is that hospital employees are unfamiliar with information systems, and one of the potential causes of the departments’ unfamiliarity with information systems is that the systems developed by contractors are unable to meet users’ needs; individual and system performance is thus affected. More and more attention has been paid to the effect of information systems on administrative management performance and clinical performance. However, information system’s effect on teaching performance and research performance has not been recognized by hospital system users. Therefore, this is probably because the participants possess more computer operating skills than the knowledge with regard to knowledge management activities, such as how information systems can be utilized to support teaching and research. The reasons behind the results are issues that require each hospital’s attention and contemplation, and it is recommended that academia and hospitals join forces in the future to carry out related research and improvements.
Relationship between job satisfaction and system performance
Our findings also support the statement that job satisfaction has a positive influence on system performance. This agrees with the assertions of previous relevant studies. For example, Laudon and Laudon and Pettit et al. [41, 42] have pointed out that system performance may be improved by enhancing employee satisfaction. The results reveal that when employees are more satisfied with their jobs and love their jobs more, they devote more efforts to their jobs, leading to improved system performance. A significant positive causal relationship exists between these two factors.
Thus, information systems have a comprehensive influence on hospitals. These research findings may provide a basis for future hospitals to develop a new information system or improve the existing system, and may serve as reference for the information industry in developing high quality hospital information systems to enhance management efficiency and effectiveness. The research findings also offer a measurement tool to investigate whether the units using information systems allow the existing facilities to function to the fullest extent possible and to determine the benefits generated by hospital information systems. Consequently, medical care services that feature high quality, high efficiency and reduced medical care costs may be provided through analyses and improvement plans.
As verified by the empirical results, the success of hospital information systems does not merely rely on hardware equipment or software programs; administrative support in every aspect is also an important factor. It is necessary to acquire computer-related knowledge for information system users. Only when users are familiar with the process, functions and objectives of hospital information systems and adapt to changes in work processes or methods brought by information systems can information systems optimize their efficiency at work, information technology provide full support, operational procedures be accelerated, workloads be reduced, work quality be improved, and more achievements be gained with hospital information systems. As a result, in addition to the possession of expertise, personnel in charge of hospital systems should comply with the user orientation principles, which mean to respect users’ needs and opinions, in order to create an information system that meets individual needs and organizational performance goals. It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve the benefits generated by hospital information systems.
Employees believe that when they provide better quality of services, their work performance is improved as well. Hospital information systems offer intangible services. The design must be based on the perspective of system users in order to develop high quality system services that meet users’ needs and allow users easier access. By so doing, improved employee and organizational performance will surely become the subsequent results of enhanced service quality. One of the critical factors that lead to success or failure of an information system is the way the system is developed and maintained. Due to the differences in the internal scale and actual demands of each hospital, the ways in which information systems are developed and maintained are also different. With limited manpower and financial resources, regional and local hospitals (small and medium hospitals) still tend to outsource the hospital information system development project or purchase package software. Nonetheless, there is a quality gap among system developers or contractors. Under such circumstances, hospitals ought to be more cautious when choosing a contractor, and pay more attention to its techniques, capabilities, after-sales services, experiences and understanding of hospital demand. Moreover, hospitals need to provide a clear description of the specifications required, while contractors have to come up with a set of reasonable plans or theories regarding the operating process or method for the developed hospital information system, in order to maximize outsourcing benefits, effectively reduce management costs, enhance information users’ satisfaction, and increase overall net benefits.
Research limitations and future studies
Despite all the efforts that have been committed to a strict process in the construction of the research framework and selection of the research methods, this study is subject to certain environmental factors and subsequently some limitations, as follows:
This study examined a non-random convenience sample of information system users in a single country, and should be generalized cautiously to other populations. However, given the context of the study, the survey results exhibited adequate validity and reliability.
The questionnaire can merely probe into the attitudes participants hold toward the questions. To some degree, while the questions may lead to some subjective answers, it is difficult to derive participants’ true opinions on the subject. Thus, we suggest future researchers conduct in-depth interviews with the participants and utilize quantitative and qualitative approaches to obtain a more definitive result.
Cooper and Schindler  and Culyer and Newhouse  have proposed that using aggregation data for inference of individual behaviors might lead to biases. When individual data cannot be observed, using the average value for inference would easily result in biases, because average values cannot reflect individual differences. Therefore, the demographic variables (characteristics of the respondents) were taken as the control variables in this study, but it is expected that individual medical difference can be used as the unit of analysis in future studies to estimate its flexible influence, and hence to conclude the differences in various aspects (constructs) between different hospitals or different specialist departments, etc.
Finally, this study examined only one period, which would not reveal factors with long-term effects. A multiple period approach is suggested for follow-up study. Analyzing multiple periods of data would achieve more complete and objective statistical data.