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Ijaz, Faiza; Chaudhry, Naveed Iqbal

Article

Impact of health information technology adoption and

its drivers on quality of care & patient safety in the
health care sector of Pakistan

Pakistan Journal of Commerce and Social Sciences (PJCSS)

Provided in Cooperation with:

Johar Education Society, Pakistan (JESPK)

Suggested Citation: Ijaz, Faiza; Chaudhry, Naveed Iqbal (2021) : Impact of health information
technology adoption and its drivers on quality of care & patient safety in the health care sector
of Pakistan, Pakistan Journal of Commerce and Social Sciences (PJCSS), ISSN 2309-8619,
Johar Education Society, Pakistan (JESPK), Lahore, Vol. 15, Iss. 1, pp. 196-212

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Pakistan Journal of Commerce and Social Sciences
2021, Vol. 15 (1), 196-212
Pak J Commer Soc Sci

Impact of Health Information Technology Adoption

and its Drivers on Quality of Care & Patient Safety
in the Health Care Sector of Pakistan
Faiza Ijaz
Institute of Quality and Technology Management, University of the Punjab, Lahore, Pakistan
Email: faezaejaz@gmail.com

Naveed Iqbal Chaudhry (Corresponding author)

Department of Business Administration, University of the Punjab, Gujranwala, Pakistan
Email : naveed.iqbal@pugc.edu.pk

Article History
Received: 06 Nov 2020 Revised: 17 Mar 2021 Accepted: 24 Mar 2021 Published: 31 Mar 2021

Abstract
This research aims to examine the impact of IT launch, technical support regarding IT,
and the length of IT usage on healthcare outcomes including patient safety and quality of
care. This study examines health information technology adoption as a mediator in this
research model. To accomplish this purpose, the researchers collected data through a
selfadministered questionnaire from people working in the health sector of Pakistan. Data
was analyzed by using two statistical software SPSS and AMOS covering descriptive
analysis, confirmatory factor analysis, and structural equation modeling. Results of the
study impose that IT launch has a positive and significant impact on patient safety and
quality of care. Length of IT usage also has a positive and significant impact on patient
safety and quality of care. The technical support regarding IT has a positive and
significant impact on patient safety but an insignificant impact on the quality of care.
Moreover, results indicate that health IT adoption plays a significant mediating role in
this research model.
Keywords: health information technology adoption, patient safety, quality of care,
technological factors, Information technology launch, technical support, length of usage
of technology.
1. Introduction
Health information technology is practically being adopted in the health care sector of
developing countries. Using computerized system support the health data’s organization
and ensures the protected interchange of health statistics among customers, benefactors,
financiers, and quality controllers. Health information technology also includes the
adoption of communication and information expertise to collect, transmit, exhibit, or
 Ijaz & Chaudhry

stock patient records (Alrahbi et al., 2021). In developing countries, the adoption of
information and communication technologies and the deployment of different technical
factors in the healthcare sector are recognized to be very influential for the improvement
of healthcare organizations and their efficiencies and competencies in the form of
enhanced quality of care and improved patient safety.
Implementation of a countrywide electronic health record (EHR) scheme in an emerging
nation like Turkey has presented a most important healthcare revolution manifest via
reform of prime care distribution and the real application of infrastructural upgrading and
technical support (Findikoglu & Watson-Manheim, 2016). The adoption of health
information technology refers to the adoption of new health IT tools both as hardware and
software that will be playing a major role in increasing productivity (Barton, 2010). It is
widely believed to provide good quality health services and increased patient safety to the
citizens. This is the reason why technically advanced nations like Europe are
revolutionizing HIT adoption across the continent in the recent era.
A prospective benefit of keeping patient accounts by electronic means is the reduction of
time to consult with a doctor. Many doctors are already using the phone and electronic
mails to discuss and delight their patients and colleagues. Gradually, clinicians can use
HIT to support the patient in controlling their prolonged diseases. According to Lavin,
Harper, and Barr (2015), launching and penetration of new technology like the adoption
of HIT through technical support can bring revolution in the health care industry across
the globe. However, launching or implementing new technology is not a trivial task to do
as the National Institute of Health additionally suggested that it is very important to have
technical support on hand for accurately implementing healthcare technology and for
reaping its benefits over time. For this important task to be accomplished, the National
Health Service alongside the associated medical services needs qualified graduates to
produce very important and efficient technical support in hospitals. Furthermore,
researchers suggest that IT adoption is evolving as an important influencing factor in
clinical gratification and quality improvement. Organizations across the world simply
cannot realize the actual benefits of the adoption of HIT in a short period of time. The
Healthcare sector’s progress can be assessed by measuring the achievement of specified
targets including both administrative and clinical targets which depend upon the length of use
of technology. Eventually, health organizations aim to enhance healthcare (Khalifa, 2013). To
fulfill this aim, there is an extreme need for persistent efforts and time to make IT an
important part of the organizational culture of healthcare organizations (McIntosh & Shaw,
2003).
In the current unpleasant situation of the health systems across the globe, numerous health
traders no longer retain the latest health innovations and implementations along with
technical support. They keep an eye on recommendations but do not monitor and measure
their routine of practice due to discrepancies in length of usage of information technology
and lack of coordination with one another. This problem is not prevailing in developing
countries only but it is also prevailing in technologically advanced countries (Chaudhry et
al., 2006). According to Ud Din et al. (2017), circumstances are more alarming domestically
as the governmental healthcare organizations in Pakistan have not adopted HIT or any good
technical support at present. Adoption of one or more HIT utilities resulted in enhanced safety
of the patients in different areas as it reduced errors and improved proficiency.

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Therefore, the purpose of this study is to evaluate elements or factors that motivate
clinicians to adopt HIT in the health sector. Secondly, it also aims to evaluate the
outcomes of adopting HIT for the safety and security of patients as well as QC in
Pakistan. The study tends to raise theoretical awareness regarding the importance of
information technology in the healthcare sector, which is likely to enhance information
technology adoption and utilization among different health care institutions in Pakistan.
Moreover, the study has also improvised with the outcomes of the adoption of healthcare
information technology, including patient safety and quality of care, which will be
adopted in Pakistani health care institutions to raise standards. This study aims to
examine the influence of information technology launch on a patient in the context of
Pakistani healthy organizations. It further tests the relationship between the length of
using technology and quality care for patient safety. Moreover, this study is testing the
adoption of HIT as the mediating factor in the relationship between launch information
technology and quality care and safety for the patient in hospitals of Pakistan, which is
one of the novel aspects of this study.
The coming portion of the paper is organized as follows: in the second portion of the
study, past relevant studies are discussed and reviewed to develop study hypotheses. The
third portion gives information regarding methodology, study model, study sample, and
ways for the measurement of the variables. The fourth portion of the study elaborates on
finding while the fifth and last part of the study sheds light on discussion and conclusion,
limitation, and recommendations for further research on the area.
2. Literature Review
2.1 Information Technology launch and Healthcare Outcomes
The information technology system is precariously used for a durable health care
arrangement. This system is adopted to improve the services’ quality through more
efficient and efficacious care. Unluckily, the maintenance of these system facilities in
some countries like African countries is questionable because of complaints associated
with the issuance of the service (Magrabi et al., 2016). Commonly, the workers can
understand the benefits and values of the health care information system (HCIH) to
enhance the effectiveness and efficiency of the information health care mechanism. The
issues in the implementation of this effective system are the lack of awareness as well as
the absence of knowledge about information technology. This lack of awareness and
knowledge can make the user confused while using the system resulting in less frequent
usage (Meri et al., 2019). Information technology is considered an important part of
health's E-health plan department in South Africa, where more than Rs 15 million have
been invested in many information technologies projects in current years. The first
Ethiopian information technology project’s implementation was failed in different aspects
of the National information technology project in South Africa. Lack of management
plan, high staff turnover, inadequate buy-in from consultants, and no business model are
regarded as some factors causing this failure (Campione et al., 2019). Further issues
include the transmission and connectivity of large files, incompatibility of software, and a
delegation of project management to health authorities who cannot estimate for ongoing
information technology services. The method of “if you put it in place, they will use it”
shows the absence of understanding about human management along with cultural factors
which are needed to be solved for achieving the goal of change management and

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technology adoption (Mars, 2013). On the other hand, the implementation of new
technology is a difficult initiative. Persons become more comfortable as well as easy with
the use of the system, which is already employed. Furthermore, they may worry about the
time for relearning the new way to perform responsibilities that they are already doing
without any deliberation. They may show resistance to adopt a new system even though
in the end, the innovative HIT system helps to make all processes stress-free and more
economical. According to the study of Sittig et al. (2020), information technology has an
influential and significant impact on patient safety through enhanced technological
advancements and improvements in the healthcare system. According to many researchers,
information technology is likely to play a significant role in updating and improving the
healthcare sector, which enhances the level of patient safety and quality of health care (Pisani
et al., 2018; Seblega et al., 2015). An impulsive bombing or fault as well as this steep learning
curve normally make new technical operations less appealing. Based on the above discussion,
the following hypotheses are proposed:
➢ H1a: Information technology launch has a significant impact on patient safety.
➢ H1b: Information technology launch has a significant impact on the quality of care.
2.2 Technical Support Regarding Information Technology and Healthcare Outcomes
Many epidemiological studies have focused on connecting measures of IT technical
support and different physical health care outcomes. Nowadays, few studies are moving
into fresher areas such as health associations with support receipt as well as provision.
Researchers are also interested in the relevant pathways to outline involving potential
biological (inflammation) as well as behavioral (health behaviors) appliances.
Interventions struggling to apply basic effects of information technology support are
extensive. However, the lengthier term effects of such interferences on physical health
keep on being determined as such interferences show aptitude in manipulating the quality
of life in many protracted disease populations (Xie & Carayon, 2015). In technical
support, entities facilitate their workers through phones, television, product software, and
other electronic or mechanical goods instead of training, customization services, or
programs for health care (Fong et al., 2020). Regardless of the adjacent ubiquity of
mobile phones, some researchers emphasize putting into practice mobile health care apps
to support patients' treatment and primary care. Primary care clinicians habitually treat a
long-lasting conditions such as asthma as well as diabetes but mobile health can help
integrate addiction while dealing in primary care (Quanbeck et al., 2018). Several
researchers have associated the measurement with the app-based factors along with self-
assessments. Features of some apps are very popular such as mood diary, mechanically
initiated penalties unfavorably perceived (Sittig et al., 2020). Among the biggest
revolutions, the digital revolution has provided significant benefits to the health care
sector as the digital revolution has revolutionized the methods to store data and access
data which has enhanced patient safety for sure (Pisani et al., 2018). Healthcare
professionals are retrieving and utilizing the data of the patients from anywhere however,
it is kept safe and private. The facilities of the Internet and intranet have also allowed the
health care professionals to share the medical information significantly and rapidly,
which has made the health care operations more efficient (Seblega et al., 2015). Several
researchers suggest that the use of new technology features supports the health care of

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patients especially in the case of primary care (Daus et al., 2018). Hence, the following
hypotheses can be proposed:
➢ H2a: Technical Support regarding IT has a significant impact on patient safety.
➢ H2b: Technical Support regarding IT has a significant impact on the quality of care.
2.3 Length of Information Technical Usage and Healthcare Outcomes
Organizations across the world simply cannot realize the true benefits of acceptance of
health information technology in a short period. The performance of this sector can be
evaluated by measuring the fulfillment of specified targets, in both clinical and
administrative terms which are observable depending on the duration of use of
technology. The basic purpose of health organizations is to increase healthcare.
Therefore, the effect of time for accessing primary care has not been completely captured
in the current continuity of care indices (Ha et al., 2019). Electronic health record system
provides a variety of substantial compensations that are composed of advanced
maintenance as well as reduced health expense and prices. Plain involuntary
consequences after the application of such approaches are emerging. The National
Institute of Health stated that it is required to have practical support for IT along with its
usage over a long period for gaining real success in the sector of health care technology
(Singh & Sittig, 2016). Based on the above discussion regarding the length of information
technical usage, the following hypotheses are developed.
➢ H3a: Length of information technology usage has a significant impact on patient
safety.
➢ H3b: Length of information technology usage has a significant impact on the quality
of care.
2.4 The Mediating Role of Health Information Technology Adoption
Jones et al. (2014) suggest that the reason for using the system of information health
technology for clinical as well as economic health act (HITECH) by the US is to provide
health records electronically. Health information technology increases efficiency as well
as the quality of patient care. In the US, an open-source health system was surveyed. This
system consists of electronic medical records, personal health care records, and electronic
health records. The functionality, security features, and implementation technologies of
the system are impressive. Health information technology helps in proper health care of
customers and it is also linked with the informational technical support in which,
electronic devices or software are provided to workers or people so that, the treatment can
be available on primary stages of care. Health information technology project provides
online medical records of patients. In 2013, this system implementing team rolled out in
170 health services bringing the plan closer to the conventional target of 300 distributions
by 2015. With inherent trials of setting up software arrangement joined with limited
possessions, at that time, there is a need for advanced solutions to decrease the cost of this
software. The implementing team has to face some challenges such as software cost,
unreliable electricity, inadequate skills capacity, hardware costs, and constant system
support challenges that need to be met. However, HIT provides a lot of benefits as the
data of HIS can be used for examining patients’ records so, this system helps in the
treatment of patients especially in primary care (Karisa et al., 2014). Health information
technology is used to set records of patients online for primary care of patients. This

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document introduced eight dimensions to address many challenges for information

technology including engagement in design, implementation, expansion, and use as well
as assessment of HIT with the critical adaptive health system. Significant changes in
healthcare have been observed by various researchers after the adoption of information
technology as the health care operations have not only been modified and innovated but
also have become more efficient (Seblega et al., 2015). With the help of improved access
to medical information and data, the health care sector has become more efficient and the
data and information have become more private and secure. Big data is now being
considered a big success in the health care sector because it is allowing the healthcare
sector to gather a significant amount of data in minimal time (Pisani et al., 2018).
However, many researchers found that eight dimensions are not enough and they are
somewhat codependent as well as similar to the concepts of the configuration of other
adaptive mechanisms (Alotaibi & Federico, 2017). Two more dimensions of the system
are internal organizational functions such as policies, culture, and procedures, and
external organizational rules and regulations. HIS also plays an important role in the
treatment of patients and it also serves a moderating role for information technical
support (Sittig & Singh, 2015). Following are the hypotheses proposed about the
mediation of HIT in the current study.
➢ H4a: Health IT adoption significantly mediates the relationship between IT launch
and patient safety.
➢ H4b: Health IT adoption significantly mediates the relationship between IT launch
and quality of care.
➢ H5a: Health IT adoption significantly mediates the relationship between IT technical
support and patient safety.
➢ H5b: Health IT adoption significantly mediates the relationship between IT technical
support and quality of care.
➢ H6a: Health IT adoption significantly mediates the relationship between the length of
IT usage and patient safety.
➢ H6b: Health IT adoption significantly mediates the relationship between the length of
IT usage and quality of care.
The theoretical model presented in figure 1 shows the direct effects of information
technology launch, technical support regarding IT, and length of IT usage on health
outcomes (i.e. quality of care and patient’s safety). Moreover, health information
technology adoption has been utilized as the major mediator in relationships of IT launch,
technical support regarding IT, and length of IT usage with healthcare outcomes.
The following figure presents the theoretical model of the study:

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 Health Information Technology Adoption - Quality of Care & Patient Safety

Patient
Quality of Safety
IT Launch Care

Technical Support Healthcare

Regarding IT HIT adoption Outcomes

Length of
IT Usage

Figure 1: Theoretical Framework 3. Research Methodology

This study followed a quantitative approach as a research methodology. Population for
this study involves healthcare organizations of Pakistan situated in Lahore and their staff
members i.e., doctors, nurses, and managerial staff. The sample was selected with the
utilization of the purposive sampling technique, which is suitable for this research
because, in this study, participants were selected based on the judgment of the
researchers. To obtain the required data from the selected sample, a self-administrative
research instrument was compiled. To measure the responses given by the respondents, a
Five-point Likert scale was used. This study was non-contrived as the research instrument
was distributed in a natural setting and no manipulation was made in the environment of
the respondents. Furthermore, researchers followed a cross-sectional research design for
this study (Bryman & Bell, 2011). Respondents were accessed through personal meetings
or e-mails and they were requested to fill the online questionnaire.
Respondents were guaranteed that their responses will be kept confidential and will not
be misused. Confidence was provided to them that the investigation would take place at
the summative level. According to formula, [number of questions in the instrument * 10]
at minimum, about 500 respondents were required to satisfy the generalizability of the
results of this study. About 550 questionnaires were distributed through personal
meetings and email. Out of 550, a total of 417 received responses were complete and
usable. Therefore, this study retained 417 responses so, the response rate for this study is
75.81%. The latest tools and techniques are applied to data through SPSS and Amos for
data analysis. The normality of data is checked with descriptive analysis. Moreover,
confirmatory factor analysis and structural equation modeling were performed for
analysis results of which have been interpreted and presented in the fourth section of this
paper.

3.1 Measures
The questionnaire for this study is adapted from prior studies and literature is the best
source for this purpose. The scale for HIT adoption is adapted from the study of Alam,

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Masum, Beh, and Hong (2016). The scale to measure the IT launch is adapted from the
study of Calantone and Di Benedetto (2012). The scale developed by the Aiken, Clarke,
Sloane, and Consortium (2002) is used here to measure the quality of care. To measure
the patient’s safety, the scale has been adapted from the study of (Xie & Carayon, 2015).
The scale for technical support regarding IT is adapted from the study of Martín-Rojas,
GarcíaMorales, and Bolívar-Ramos (2013). The scale for measuring the length of IT
usage is developed by the researcher and is evaluated through factor loading.
4. Study Findings
In this study, 204 females and 213 males participated. The total number of respondents is
417 from which 140 respondents (33.6%) reported their age falls within 41-45 years. 21
respondents (5%) reported their age less than 25 years. The age ranging from 26 to 31
years showed the frequency of 71, 31 to 35 years showed the frequency of 45, 36 to 40
years showed the frequency of 78, and the age above 45 years has shown the frequency of
62 with 14.9%. In the health sector, employee’s age factor plays a very important role. Of
the total 417 respondents, 178 (41.2%) respondents are qualified MBBS degree holders,
148 respondents are FCPS degree holders while the remaining 97 participants have other
degrees. The respondents' profile also shows that 181 respondents have 2 to 5 years’
experience, 141 respondents have 6 to 9 years of experience, 64 respondents have more
than 9 years’ experience, and only 31 respondents have less than 2 years’ experience.
4.1 Descriptive Analysis
Descriptive analysis is performed for identifying outliers and the normality of data. Values of mean,
minimum, and maximum tell about the presence or absence of outliers, while skewness value shows
the normality of data:
Table 1: Descriptive Statistics
N Min Max Mean SD Skewness
IFL 417 1.00 5.00 3.1442 1.1105 -.364 .120
TSRIT 417 1.00 5.00 3.3320 1.0938 -.549 .120
LUIT 417 1.00 5.00 3.5564 1.2232 -.603 .120
HIT 417 1.00 5.00 3.4506 1.1255 -.542 .120
PS 417 1.00 5.00 3.4868 1.1645 -.681 .120
QS 417 1.00 3.75 3.1001 .87484 -.580 .120
Valid N
417
(listwise)
Note: ITL=Launch of IT, TSRIT= technical support regarding IT, LUIT= length of IT usage,
HIT= Health information technology adoption, PS= patient Safety, and QS= Quality of Care.
The findings of table 1 show that the minimum value for each construct is one and the
maximum value is 5 so, there is no outlier in the data. The skewness value for each
variable is under the range limit i.e. -1 to +1.
4.2 Factor Analysis
To test the suitability of data and constructs, factor analysis is performed. This test checks
the selection capability for each variable with the whole model. It indicates the

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percentage of modification in the middle of variables affected by common variance. The

coming two tables show the outcomes of Factor loading and KMO:
Table 2: KMO and Bartlett's Test
KMO of Sampling Adequacy .959
Approx. Chi-Square 36222.172
Bartlett's Test Df 1225
Sig. .000
Results of KMO of sampling adequacy are considered significant and adequate if KMO is
greater than 0.50. In this case, KMO is .959 which makes the result of the factor analysis
to be useful. Bartlett’s test is applied to test the correlation matrix hypothesis which states
that it is an identity matrix implicating that variables are not related and not suitable for
structure detection. A value less than .05 is considered significant in this case. The value
in the current case at 1225 df is .00, which shows the significance of this factor analysis.
Table 3: Reliability
Constructs N Cronbach Alpha
IFL 7 .916
TSRIT 14 .931
LUIT 3 .897
HIT 11 .901
PS 11 .923
QS 4 .912
Cronbach Alpha is a measure of internal consistency, which represents how accurately a
related set of items are representing and measuring a construct and how the variables are
closely related to each other as a set. This is also known as the measure of scale
reliability. A value greater than 0.9 is considered excellent, a value greater than 0.8 and
less than 0.9 is considered good, a value greater than 0.7 and less than 0.8 is considered
acceptable while a value lower than 0.5 is considered unacceptable. Based on this
criterion, all of the values presented against the current variables in table 3 are showing
that these variables have excellent internal consistency.

4.3 Measurement Model

CFA is a test applied to confirm the convergent and discriminant validity of the model.
There are some indicators which are used to check the model fitness, like “χ 2 =Chi-
square", "DF=Degree of Freedom", "CMIN=Minimum Chi-square", "GFI=Goodness of
Fit Index", "RMSEA=Root Mean Square Error of Approximation", "NFI=Normed Fit
Index", and "CFI=Comparative Fit Index".
Table 4: Model Fit Intercept (N=436)
Model Fit Indices Threshold Range Observed Values
Nested χ2 4010.898
Model Df S 1147
χ2 / df Lesser than 5 3.497

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 Ijaz & Chaudhry

GFI ≤ .80 .80

IFI ≤ .90 .922
CFI ≤ .90 .922
RMSE ≥ .08 .077
A
Outcomes of the study presented in the above table show that all values are under the
threshold range, which shows that the model of the study is a good fit. For the model to
be significantly fit, the observed values should be according to the threshold range. It can
be observed that the value for GFI is .80 which is according to the threshold range. The
same is the case for the values of IFI and CFI. Moreover, the value of RMSEA is equal to
.077, which is according to the threshold range i.e. less than or equal to .08. The path
diagram of the confirmatory factor analysis is presented in figure 2.
4.4 Structural Equation Modeling (SEM)
In AMOS, the most appropriate regression approach is SEM which is applied to examine
the indirect as well as direct effects at the same time. This approach is generally the
combination of multiple regression explorations and factor analysis. Utilized for the
purpose to test the influence of one construct on another in the current study, it is run to
check the hypotheses. The current study prefers to use the path analysis approach for
SEM because the main advantage of this approach is the enclosure of relationships
amongst variables working as interpreters in one single model.

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 Health Information Technology Adoption - Quality of Care & Patient Safety

Figure 2: CFA Table 6: Structural Equation Modeling

Effects Hypothesized Path Β S. E P Conclusion

Linear Effects
Hypothesis 1a (+) ITL→ PS .149 .039 .000 Accepted
Hypothesis 1b (+) ITL→ QC .280 .052 .003 Accepted
Hypothesis 2a (+) TSRIT→ PS .192 .053 .000 Accepted
Hypothesis 2b (+) TSRIT→ QC .050 .040 .318 Rejected
Hypothesis 3a (+) LUIT→ PS .212 .048 .000 Accepted
Hypothesis 3b (+) LUIT→ QC .129 .036 .010 Accepted
Mediation Effect
Hypothesis 4a (+) ITL→HIT→PS .027 .013 .010 Accepted
Hypothesis 4b (+) ITL→ HIT→QC .037 .019 .010 Accepted
Hypothesis 5a (+) TSRIT→ HIT→PS .020 .011 .021 Accepted
Hypothesis 5b (+) TSRIT→ HIT→QC .028 .012 .021 Accepted
Hypothesis 6a (+) LUIT→ HIT→PS .074 .026 .010 Accepted
Hypothesis 6b (+) LUIT→ HIT→QC .102 .023 .010 Accepted
Note: ITL=Launch of IT, TSRIT= technical support regarding IT, LUIT= length of IT usage,
HIT= Health information technology adoption, PS= patient Safety, and QS= Quality of Care.
Table 6 presents the results of SEM, findings indicate that the launch of IT has a
significant and positive influence on patient safety. It also has a significant and positive
influence on the system of quality care. Results show that a one-unit increase in ITL
brings a 14.9 percent increase in patient safety and a 28 percent increase in the quality of
care. Findings of SEM modeling also indicate that technical support regarding
information technology has a significant and positive effect on the safety of patients
while it has an insignificant impact on the quality of care because the probability value
against this effect is greater than .05. The impact of length of IT usage on patient’s safety
is also significant and its size is .212 while the impact of length of IT usage on quality of
care is .129 which is also significant. It means that if the length of IT usage increases by
one unit, it will bring 21.2% positive and significant change in patient’s safety and 12.9%
significant and positive change in the quality of care. Moreover, this study has checked
the health information technology adoption as a mediator. The findings of this study
indicate that it significantly mediates the relationship between all independent variables
and dependent variables. So, all eleven hypotheses of the study were accepted while only
one hypothesis was rejected. Figure 3 presents the snapshot of the structural model taken
while running SEM in AMOS.

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Figure 3: Structural Equation Modelling

Outcomes of the study show that the 11 hypotheses of the study were accepted, and one is
rejected. The first hypothesis of the study indicated that information technology launch
has a significant and positive influence on patient safety. The findings of the current
research prove this hypothesis to be true so, the current results are similar to the results of
Anderson, Frogner, Johns, and Reinhardt (2006) & McBride and LeVasseur (2017).
Similarly, information technology launch has significant and a positive impact on the
quality of care. These findings are also aligned with the literature. A study conducted by
Ramesh, Wu, and He (2013) also shows that information technology launch is
significantly correlated with health care outcomes. The second hypothesis of this study
stated that technical support regarding IT significantly and positively influences health
care outcomes while findings of the current study showed that technical support regarding
IT has an insignificant impact on quality of care. This outcome of the study is not
consistent with the finding of Carayon et al. (2006). However, technical support
regarding IT has shown a positive and significant impact on patient safety, Therefore,
hypothesis 2a is accepted and 2b is rejected. Moreover, results regarding hypothesis 3a
and hypothesis 3b revealed that length of IT usage has a significant and positive influence
on health care outcomes and these results are also constant with several prior studies e.g.
(Nguyen et al., 2010; Wang et al., 2006). Health information technology adoption is
playing a mediating role in this research model as findings of the study indicated that
healthy information technology significantly mediates relationships of Information
technology launch, technical support, and length of usage of technology with healthcare
outcomes. These findings are also consistent with prior studies such as (Koivusilta, Lintonen,
& Rimpelä, 2007; Lee & Coughlin, 2015; Punamäki, Wallenius, & Rimpelä, 2007). Hence,
the overall findings show the alignment with the existing literature.
5. Conclusion
Numerous health care professionals encouraged the adoption of information technology
healthcare (ITH). Despite the surplus proof on the paybacks of HIT, a substantial number
of health professionals are still working manually. Present-day developments of swift
technical tools are necessary to recognize the impact of technological factors on

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healthcare performance by the adoption of HIT. Therefore, the purpose of this study was
to observe the influence of IT launch, technical support regarding IT, and the launch of IT
usage on healthcare outcomes including quality care and patient safety. This study also
evaluates the health information technology adoption as the mediator in the current
research model. To accomplish this purpose, researchers collected quantitative data
through a selfadministrative questionnaire from the office of the health care department in
Pakistan. Collected data was analyzed by using two statistical software SPSS and AMOS
and different statistical tests were applied including descriptive statistics, confirmatory
factor analysis, convergent validity, discriminant validity, and SEM. Findings of the
study indicate that IT launch has a significant and positive influence on quality care and
safety of patients. Length of IT usage also has a significant and positive effect on the
quality of care and safety of patients. However, technical support regarding IT has a
significant and positive impact on the safety of patients but it shows an insignificant
influence on quality care. Results regarding the mediation indicated that health
information technology adoption significantly mediates relationships of Information
technology launch, technical support, and length of usage of technology with healthcare
outcomes.
5.1 Research Implications
Pakistan is a developing country and several areas require proper attention and
improvement but before improvement, enhancing knowledge of the Pakistani people and
increasing awareness regarding the importance of adoption of information technology for
the health care sector are needed. This study tends to raise awareness regarding the
importance of information technology in the healthcare sector, which is going to enhance
the information technology adoption and utilization by different health care institutions in
Pakistan. Moreover, the study has also discussed and evaluated different outcomes of the
adoption of healthcare information technology, including patient safety and quality of
care, which will be adopted in Pakistani health care institutions to raise standards. This
study has several theoretical and practical implications and policy-making
recommendations. From a theoretical perspective, this study tends to enhance the
literature of healthcare IT by gathering up-to-date factual indications and evidence of the
relationship between funding in the adoption of HIT through the launch of information
technology, usage of technology, and technical support and resulting benefits including
quality care and safety of patients. From the practical perspective, the current study would
help healthcare bodies/organizations to understand the importance of IT for the health care
sector in Pakistan.
In Pakistan, progress and innovation regarding information technology are already under
consideration, but this study has significantly considered patient safety and quality of care
in the context of health care information technology adoption so, this study can motivate
them towards the launch and utilization of information technology in the healthcare
sector. The findings of this study show that the adoption of health care information
technology boosts the progress of the health system in Pakistan. For example, it reduces
financial expenses. According to a study of CCHIT.org, about 50 percent of resources of
finance are wasted due to inefficient progress and technology so, we can save these
resources by applying the IT system. HIT is also helpful for getting faster lab results.
Despite the financial crisis, IT is one of the most lucrative sectors in Pakistan. We are still

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not realizing the true potential of IT. It is imperative to make use of IT in the health sector
to accelerate the progress of the health sector. The greatest property, which attracts the
interest of physicians to HIT is that it allows immediate accessibility of medical
information to doctor and patient, which is crucial for the timely diagnosis and start of
therapy. Therefore, this study recommends to the government as well as other officials to give
serious attention to HIT in the health sector especially while making policies for the growth
and improvement of this sector.
5.2 Research Limitations and Further Suggestions
The current study has several limitations that can be considered while defining avenues
for further research. The major drawback of this research is related to the features of the
study population and sample. The findings of this study will apply only to the healthcare
sector of Pakistan. Some respondents may have been inclined in their replies by the
favoritism of societal adequacy. However, the private nature of the survey may help in
lessening such preferences. This kind of study is viewed as suspicious in Pakistan due to
the conventional native approach of organizations and individuals. Both are unwilling to
unveil their behavior, particularly to a stranger. All these limitations can be removed by
improving research in the area of HIT and by expanding this research in multiple
developed nations. Future studies can focus on a variable like innovation in the health
care techniques as the outcome of the implementation of information technology in
Pakistan. Such studies will raise awareness regarding different information technology
techniques that can make treatments more efficient and quick.
Grant Support Details / Funding
This research work received no research grant.
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