JMIR Publications

ABSTRACT

Background:

The Ministry of Health (MOH) Malaysia integrated the Casemix System into the Total Hospital Information System (THIS) to enhance healthcare delivery, resource efficiency, and cost-effectiveness. Casemix, a patient classification tool, plays a vital role in clinical documentation, hospital financing, and management decisions by grouping patients based on diagnoses and resource use. When embedded within THIS, it enables automated clinical coding, streamlined workflows, and improved hospital performance. However, the system’s success depends largely on its acceptance by healthcare professionals, especially medical doctors responsible for accurate documentation and coding. Despite its significance, few empirical studies have examined the key factors influencing Casemix acceptance in Malaysia’s integrated hospital information system context. Understanding these factors is essential for ensuring successful implementation and sustained use.

Objective:

This study aims to investigate the interrelationships between critical success factors (CSFs) namely system quality (SY), information quality (IQ), service quality (SQ), organizational characteristics (ORG), perceived ease of use (PEOU), perceived usefulness (PU), and intention to use (ITU) on user acceptance (UA) of the Casemix system in hospitals equipped with THIS.

Methods:

This study employed a cross-sectional design using a self-administered online questionnaire that was re-developed by adopting and adapting previously validated instruments, grounded in the Human-Organization-Technology Fit and Technology Acceptance Model frameworks. The instrument underwent rigorous validation and reliability procedures, including content and criterion validation through expert review, exploratory factor analysis to assess item appropriateness, and confirmatory factor analysis to establish construct, convergent, and discriminant validity. Proportionate stratified random sampling was used to ensure equitable representation of medical doctors across five MOH hospitals, each representing one of Malaysia’s geographical zones. The minimum required sample size of 375 was proportionally distributed across four categories of medical doctors within these hospitals. Based on structural equation modeling (SEM) standards, a total of 343 valid responses were obtained, yielding a response rate of 91.5%. Path analysis was conducted using Covariance-Based SEM with SPSS AMOS v24.0 to assess direct relationships among the study constructs.

Results:

Path analysis revealed that SY (β=-0.262, p=0.043) and IQ (β=0.307, p=0.014) significantly influenced PEOU. PEOU (β=0.105, p=0.017) and PU (β=0.580, p<0.001) significantly influenced ITU, which strongly predicted UA (β=0.788, p<0.001). PEOU did not substantially impact PU (β=0.086, p=0.070), nor did SQ (β=0.146, p=0.188) and ORG (β=0.197, p=0.214) significantly influence PEOU. Based on the beta coefficients and statistical significance, the CSFs were categorized into higher-ranked predictors (ITU, PU, IQ, SY) and lower-ranked predictors (ORG, SQ, PEOU) groups. Higher-ranked predictors demonstrated statistically significant relationships and relatively stronger beta coefficients.

Conclusions:

This study offers empirical insights into key factors influencing Casemix system acceptance and informs strategies to support its successful implementation in THIS-equipped hospitals. The findings also contribute to addressing current research gaps and guiding future evaluations of healthcare information systems.