The Implementation of Hospital Information System (HIS) in Tertiary Hospitals in Malaysia: A Qualitative Study

Authors: Aniza Ismail, Ahmad Taufik Jamil, Ahmad Fareed A. Rahman, Jannatul Madihah Abu Bakar, Natrah Mohd Saad, Hussain Saadi

Affiliations: Department of Community Health, UKM Medical Centre; Department of Information Technology, UKM Medical Centre

Published: Malaysian Journal of Public Health Medicine, 2010, Vol. 10(2): 16–24  |  ISSN: 1675-0306

Last reviewed: March 2026

Background and Context

Hospital Information Systems (HIS) represent a foundational pillar of modern healthcare delivery. Defined as comprehensive, integrated information systems designed to manage the administrative, financial, and clinical aspects of hospital operations, HIS adoption has become a key priority for healthcare systems worldwide. In Malaysia, the Ministry of Health (MOH) has invested substantially in Total Hospital Information Systems (THIS) for its newer tertiary hospitals, while older facilities have pursued incremental digitisation strategies.

The Malaysian healthcare landscape at the time of this study comprised both highly digitised paperless hospitals — such as Selayang Hospital and Putrajaya Hospital — and facilities still relying on hybrid paper-electronic workflows. The Klang Valley, home to the nation’s largest concentration of tertiary medical centres, served as a natural laboratory for studying the challenges and opportunities of HIS implementation in a developing country context. Less than 10% of Malaysian public hospitals had implemented comprehensive HIS at the time of the study, highlighting the urgent need for evidence on implementation best practices.

Study Objectives and Design

This qualitative study aimed to describe the key aspects of HIS implementation across three tertiary hospitals in the Klang Valley: Serdang Hospital, Selayang Hospital, and Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The researchers sought to capture both the system provider and end-user perspectives through in-depth interviews conducted in September 2009.

A semi-structured interview guide was used to explore multiple dimensions of HIS implementation, including the origins and development of each system, staffing requirements, the scope of clinical and administrative modules deployed, technical support infrastructure, system usability, training programmes, hardware adequacy, and data security protocols. Content analysis was employed to identify recurring themes across the three sites.

Key Themes and Findings

System Development and Deployment Models

The study revealed two distinct approaches to HIS development among the three hospitals. Two hospitals received their IT systems as turnkey projects, bundled with the building construction contract. The systems and software were pre-determined by MOH headquarters, leaving little room for local customisation. In contrast, one hospital developed its system entirely in-house, building the IT infrastructure from the ground up. This in-house approach, while more resource-intensive initially, offered greater flexibility in adapting to evolving clinical needs.

UKMMC’s Caring Hospital Enterprise System (C-HEtS) represented an innovative in-house development model that demonstrated the potential for locally developed solutions to meet the specific needs of Malaysian tertiary care. The Selayang Hospital system, implemented as part of a large government procurement through vendors such as IBM and HP, represented the standardised procurement model favoured by MOH for its newer facilities.

Human Resource Requirements

Significant variation existed in the IT staffing models across the three hospitals. One hospital reported needing a large complement of IT experts to develop and maintain its in-house system, while another operated efficiently with just five officers — one IT officer and three computer programmers plus the department head. The study highlighted that hospitals with vendor-supplied systems typically required fewer in-house IT staff, relying instead on vendor support contracts, whereas in-house developments demanded substantial ongoing technical personnel.

Scope of Implementation

The scope of HIS deployment varied considerably. All three hospitals had implemented core modules including patient registration, admission-discharge-transfer (ADT), laboratory information systems, pharmacy systems, and radiology information systems. However, the depth of integration differed, with some hospitals achieving near-complete paperless workflows while others maintained parallel paper systems for certain clinical functions. The scope of implementation was closely related to the maturity of each hospital’s IT infrastructure and the extent of clinical staff engagement with the system.

Support Systems and Infrastructure

Adequate technical support was identified as critical for sustaining HIS operations. The hospitals reported different models — from dedicated IT departments headed by IT experts to reliance on external vendor help desks. The study emphasised that hospitals must establish robust IT departments to ensure sustainability and continuity of their information systems, particularly for troubleshooting, system updates, and data recovery.

User-Friendliness and Training

The usability of HIS interfaces emerged as a significant factor in staff adoption and system utilisation. End-users across all three hospitals expressed mixed views on system user-friendliness, with some modules praised for their intuitive design while others were criticised for requiring excessive steps to complete routine tasks. Training was compulsory at all three hospitals, which helped reduce technical problems arising from misuse. The researchers noted that raising users’ understanding of system requirements and benefits was essential to ensuring successful adoption.

Data Security

All three hospitals had implemented multi-layered security protocols including individual login identification codes with passwords, audit trails for monitoring data access and usage, and comprehensive backup systems for patient information. The study highlighted that securing electronic patient data was crucial, as unsecured data could be violated and abused. The confidentiality of patient records in electronic systems required ongoing vigilance and investment in security infrastructure.

Implications for Malaysian Healthcare

The findings carried several important implications for the expansion of HIS in Malaysian public hospitals. First, the study demonstrated that there is no single optimal model for HIS implementation — both turnkey procurement and in-house development can succeed when supported by adequate resources and institutional commitment. Second, the critical role of human resources was underscored: regardless of the development model, hospitals need skilled IT personnel to manage and maintain their systems.

The researchers recommended that MOH develop standardised guidelines for HIS implementation that account for the different resource levels and institutional capacities across the Malaysian hospital network. They also advocated for increased investment in IT training for clinical staff, emphasising that technology adoption in healthcare is fundamentally a human challenge as much as a technical one.

Significance in Malaysian Health Informatics

This study has accumulated over 90 citations in the academic literature and is widely referenced in subsequent research on healthcare IT adoption in Southeast Asia. It provided one of the earliest systematic qualitative assessments of HIS implementation in Malaysian tertiary hospitals, establishing a baseline understanding that informed later studies on electronic medical records, clinical decision support systems, and national health information exchange initiatives.

The paper also contributed to the broader discourse on healthcare digitisation in developing countries, demonstrating that the challenges faced by Malaysian hospitals — including funding constraints, workforce readiness, and infrastructure limitations — mirror those encountered in healthcare systems across the developing world. The in-house development success at UKMMC offered an important counter-narrative to the assumption that developing countries must rely entirely on imported technology solutions.

Limitations

As a qualitative study focused on three hospitals within the Klang Valley, the findings may not be fully generalisable to the broader Malaysian hospital network, particularly rural and district hospitals with different resource profiles. The study was conducted at a single point in time (September 2009) and thus captured a snapshot of rapidly evolving IT landscapes. The research relied on self-reported data from interviews, which may be subject to social desirability bias, particularly among system providers. Additionally, the study did not assess the impact of HIS on clinical outcomes, patient safety, or cost-effectiveness, areas that would benefit from subsequent quantitative research.

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