Technology Adoption of Patients Record Management System for Department of Health Treatment and Rehabilitation Center Using TOE Framework

—With the current administration’s war against drugs, the number of patients admitted to rehabilitation and treatment centers has drastically increased. The significant increase in the number of patients also means there is an increase in the volume of data the center needs to handle. At present, the center is using pen and paper as the means of records handling. The research aimed to develop a Patient Records Management System that can be used for handling the increasing volume of data as well as the other problems experienced, such as, data redundancy and data loss. The study used qualitative research wherein qualified respondents were chosen using purposive sampling. Five groups of respondents were identified; Administrators, Admitting Officers, Social Workers, Psychologists, and Nurses. The developed Patient Record Management System was evaluated using ISO 25010 Software Quality Model by target respondents. The survey showed that the developed system was assessed as “Very Good” in terms of functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. Furthermore, the respondents’ degree of adoption of a Patient Records Management System reveals that they “Agree” in all terms of operational, technical, and economic considerations. This study also identified internal IT infrastructure, compatibility, human resources, organizational structure as positive adoption factors with consideration to Technology Organization Environment (TOE) framework, while financial resources, industry adoption, and jurisdictional issues impede the adoption process.


I. INTRODUCTION
Health care institutions such as hospitals, clinics and health centers deal with providing care for the life and health of their patients. These organizations have long strived to keep patients satisfied as they provide medical care. [1] Good medical care relies on well trained doctors, nurses and on high quality facilities and equipment. Good medical care also relies on accurate, comprehensive, up-Manuscript received January 8, 2019; revised May 6, 2019.
to-date and accessible record keeping. Without these qualities, the medical personnel may not be able to offer the best treatment or worst, may misdiagnose the condition.
Patient record management systems in hospitals today necessitate a competent administration when handling patients, generating reports from cashier, and patient details which serves as a key factor for the flow of business transactions. [2] However, successful patient records management system also entails ensuring successful adoption and implementation.
Despite the availability of hospital management software in the market today, there is a scarcity when it comes to software intended for a rehabilitation and treatment center. Furthermore, adoption of information systems in hospitals is a complex task compared to other systems in different fields. [3] This study involves developing a Patient Records Management System that will address the problems encountered by the Department of Health Rehabilitation and Treatment Center (DOH-TRC) and covers the process of computerized record keeping starting from patient's admission to patient's evaluation for release. This study also focuses on the successful adoption of the system with respect to technological, organization and environmental factors.

A. Objectives of the Study
Based on the current research in the field of information technology, the goal of this study is to find solutions that contribute to the successful technology adoption in implementing Patient Record Management System for Department of Health Treatment and Rehabilitation Center. Using TOE framework, there is a need to investigate what capabilities successful Patient Record Management System are used, and how can these be adopted, implemented, and maintained.
Specifically, the study sought to provide solutions the following: 1.

A. Research Design
This study entitled "Technology Adoption of Patients Record Management System for Department of Health Treatment and Rehabilitation Center using TOE Framework" is a descriptive research employing qualitative approaches to assess the readiness level of respondents in the adoption of a Patients Record Management System. This descriptive study was conducted using self-administered questionnaire on three admitting officers, 124 social workers, 24 psychologists, and 29 nurses who were selected using purposive sampling. All respondents are employees of the center located at Camp Bagong Diwa, Bicutan, Taguig City.
Letters of request was sent to the center's administration for approval of conducting surveys to participating respondents. The survey is divided into three parts; evaluation of the developed system using ISO 25010 Quality Model, feasibility study, and evaluation of the respondent's perception using TOE Framework. Participant and Non-participant observation was also implemented all throughout the testing duration of the system. This method will allow the participants to listen to what each one has to say, which will give each one an opportunity to reflect on the opinions of the other respondents.

B. Research Instruments
Two experts validated the content of the questionnaire. Modifications based on relevance and clarity of the questions were done based on two experts' recommendations. After these modifications, the questionnaires together with a Letter of Consent form were submitted to the Center for Research and Development (CRD) of Adamson University for the protection of privacy and confidentiality of research information including data protection plan clearance. Questionnaires were then distributed to the different groups of respondents.
Quality parameters such as functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability and portability were measured using a 5-point scale ranging from "Excellent" (5) to "Very Poor" (1) (See Table I) while technical, operational and economic feasibility was measured using a 5-point scale ranging from "Strongly Agree" (5) to "Strongly Disagree" (1) (See Table I). Frequency counts, percentages, and mean were used to describe the respondents and their responses statistically. F-Test under one-way ANOVA was used to determine the significant difference between the perceptions of respondents in the feasibility of adopting a Patient Records Management System as well as the significant difference of their readiness levels. Table II shows the evaluation of respondents using the ISO 25010 Quality Model. All of the above indicators got an average of 4.00 which is interpreted as "Very Good". These findings can be attributed to the following reasons: (1) the respondents perceived that most functions or process needed by the rehabilitation center can be accessed in the system as well as forms and documents can be generated. (2) the developed system works and executes tasks efficiently (3) the system is compatible with other programs and other processes performed by the Rehabilitation and Treatment Center (4) the system can be accessed anytime by authorized users, meets the minimum requirements, always be available and will not have problems with lag or crashing (5) the respondents are very satisfied with how the system looks but also believe it can be improved (6) the developed system is well secured and only authorized users created by the admin can access the system. (7) the developed system can easily identify or be debugged in case of errors, and (8) This means the respondents perceived that developed system is very much portable.    This further implies that differing perceptions exist among the five (5) groups of respondents with the Admitting Officers' group being the most optimistic in adopting a Patient Records Management System in terms of technical feasibility. Such is manifested by their firsthand experiences as front-liners in admitting patients for rehabilitation. Furthermore, the Admitting Officers are also in charge of the day to day operations of record keeping thereby having enough knowledge to assess the sufficiency and upgradability of present resources for the new system, thus their most optimistic view.

B. Respondents' Degree of Adoption of a New
2) Operational feasibility Operational feasibility means that a proposed system will be used effectively after it has been developed. [4] This part of the survey aims to get the perception of respondents with regards to the operational feasibility of adopting a Patient Record Management System. Table V shows the summary of the responses regarding the operational feasibility indicators in adopting a Patient Record Management System. This further implies that differing perceptions exist among the five (5) groups of respondents with the Admitting Officers' group being the most optimistic in adopting a Patient Records Management System in terms of operational feasibility. Such is manifested by their knowledge on standard operating practices and procedures.
3) Economic feasibility Economic Feasibility means that the projected benefits of the proposed system outweigh the estimated costs. [4] The willingness of the target Rehabilitation and Treatment Centre to adopt a Patient Record Management System is also affected by financial constraints.  This further implies that differing perceptions exist among the five (5) groups of respondents with the Admitting Officers' group being the most optimistic in adopting a Patient Records Management System in terms of economic feasibility. Such is manifested by their knowledge on the availability, prices, and advantages of both storage solutions and software solutions. Furthermore, the Admitting Officers are hands-on employees in performing their daily tasks and they firmly believe that adopting a Patient Records Management System is cost-effective and will bring enough return of investment in the long run, thus, their most optimistic view.

C. Respondents' Degree of Adopting a Patient Record
Management System with Consideration to Technology, Organization, and Environmental Aspects The Technology-Organization-Environment (TOE) framework (Tornatzky et al., 1990), has been used as a lens for studying IS adoption at the organizational level. [5] TOE posits that successful adoption is not just a function of appropriate technology, but suggests that factors across technological, organizational and environmental contexts influence successful IS adoption at the organizational level. [6] This part of the survey attempted to determine the degree of adoption of a Patient Record Management System as perceived by the respondents working in the center

Technology Factors
Internal IT infrastructure IT infrastructure in the center is updated to suit the implementation of the Patient Records Management System Positive There is a sufficient capacity of data storage.
IT hardware and connectivity is upto-date.

Compatibility
The software is compatible with IT hardware and infrastructure required for Patient Records Management System.

Positive
Compatibility with the staff skills, talents and attitude.
Integration amongst different department/users is evident.

Human Resources
A professional IT team is ready to handle and support the adoption.
Positive IT experts and managers are capable of increasing staff confidence in technology adoption.
Availability of a training plan.  Table IX summarizes the technology, organization, and environmental factors based on the focus group discussion conducted with the respondents. Technology factors such as internal IT infrastructure, compatibility, and human resources were rated as positive contributory factors. Furthermore, organizational factors such as strategy and organizational structure are contributory factors to adoption, while financial resources impedes adoption. This supports the study of Nam & Pardo which states that critical factors to success include dedicated funding, leadership of top management, organizational culture, training, executive support, human resource management, and investment in technology. [7] Environmental factors such as industry adoption and jurisdictional issues also impedes adoption process. The results agree with the study of Murad & Thompson that there are four principal external environment factors that may influence decisions to adopt a new technology. These are: customers, competitors, government regulations, and economy. [8] IV. CONCLUSION Using the ISO 25010 Quality model as evaluation tool, results show that the system was "Very Good" in terms of functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability and portability.

Strategy
The study also confirmed that the respondents' degree of adoption of a new Patient Record Management System were affirmative in all terms of operational, technical, and economic considerations. However, respondents disagreed when asked if the system is in line with the organization's budget.
The findings discussed suggest that for the successful adoption of Patient Records Management System technology factors such as internal IT infrastructure, compatibility, and human resource support must be present; organizational factors such as strategic adoption plan and support from top level management must be strong.
Furthermore, financial resources and environmental factors such as technology adoption framework and making it a priority hinders technology adoption.
In line with the findings, and conclusion presented, the following recommendations are set forth. (1) Test the Patient Records Management System in the different Treatment and Rehabilitation Centers in the country. (2) Perform Current State Assessment and Gap Analysis with all stakeholders; Administrators, Admitting Officers, Nurses, Psychologists, and Social Workers before adopting the system. (3) Develop a roadmap that is aligned with the organization's strategic plan with prior focus on the budget of adopting such system.