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Master of Healthcare Administration
HCM 600 Research Project
The Impact of Health Informatics Technology on the Quality of Health Care
Administration in the Kingdom of Saudi Arabia: A Systematic Review
A Research Project
Submitted in Partial fulfillment of the
Requirements for the Degree of
MSc of Healthcare Administration
Prepared by:
Reeham Saleh Fayoumi
Supervised by:
Dr. Najla Meshal Aljehani
Date: 2 October 2023
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Acknowledgments
Praise be to Allah, Lord of all creation, for granting me the power to accomplish this work. I would
like to express my deepest thanks to Dr.Najla Meshal Aljehani for her constant support and
valuable scientific supervision throughout the work. I am greatly indebted to Dr.Najla Meshal
Aljehani, for suggesting the point, her utmost support, follow up and scientific guidance
throughout the work, and for her constructive criticism throughout this study. I am also very
grateful for the kind and in-depth revision of the thesis. In addition, I would like to express my
eternal heartfelt gratitude to my Family, for being the greatest support I could ever get to complete
this study.
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Declaration
I declare that the research project entitled ( The Impact of Health Informatics Technology
on the Quality of Health Care Administration in the Kingdom of Saudi Arabia: A Systematic
Review) submitted to the Saudi Electronic University is my own original work. I declare that the
research project does not contain material previously published or written by a third party, except
where this is appropriately cited through full and accurate referencing. I declare that Saudi
Electronic University has a right to refuse the research project if it contains plagiarism and cancel
the research project at any time, and the student has full responsibility for any further legal actions.
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Table of Contents
Acknowledgments
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Declaration
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List of tables
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LIST OF FIGURES
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List of Abbreviations
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Abstract
CHAPTER I
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INTRODUCTION
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1.1 Background
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1.2 Problem Statement
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1.3 Aim
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1.4 Research Questions
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1.5 Objectives
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1.6 significance of this study
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CHAPTER II
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LITERATURE REVIEW
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2.1 Barriers to the adoption of Health Informatics in KSA
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2.2 The Influence of Health Informatics Technology on the Cost of Healthcare
Administration in KSA.
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2.3Health Informatics and Patient Safety
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CHAPTER III
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METHODOLOGY
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3.1 Systematic Review Approach
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3.2 Data sources and search strategy
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3.3 Inclusion and Exclusion Criteria
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3.3.1 Inclusion Criteria
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3.3.2 Exclusion Criteria
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3.4 PRISMA Guidelines and JBI Assessment
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3.5 Ethical consideration
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CHAPTER IV
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RESULTS AND FINDINGS
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Evaluation for Systematic Review
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4.1 Data Extraction Tools (Critical Appraisal Checklist) .
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Results
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CHAPTER V
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DISCUSSION AND CONCLUSION
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5.1 Discussion
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5.2 LIMITATIONS AND RECOMMENDATIONS
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5.3 CONCLUSION
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References
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LIST OF TABLES
Table 1: Critical Appraisal of Included studies (Cross-Sectional Studies)
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Table 2:Table 2: Results for paper included in the systematic review of the impact of health
informatics technology on the quality of health care administration in Kingdom of Saudi
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Arabia
LIST OF FIGURES
Figure 1: PRISMA flow diagram based on PRISMA Guidelines of studies
evaluation for systematic review
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List of abbreviations
ADC : Automated Medication Dispensing Cabinets
AI : Artificial Intelligence
BCMA : Bar Code Medication Administration
CDS : Clinical Decision Support
CDSSs : Clinical Decision Support Systems
CPOE : Computerized Physician Order Entry
E-Health : Electronic Health
EHRs : Electronic Health Records
EMAR : Electronic Medication Administration Record
EMR : Electronic Medical Records
Et al.: et alia (and others)
HI : Health Informatics
HIM : Health Information Management
HIQ : Health Information Quality
HIS : Health Information Systems
HIT : Health Information Technology
HMS : Healthcare Management System
IoT: Internet of Things
IT : Information Technology
JBI : Joanna Briggs Institute
KSA : Kingdom of Saudi Arabia
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M-Health : Mobile Health
MOH : Ministry of Health
PDMS : Patient Data Management Systems
PRISMA : Preferred Reporting Items for Systematic Reviews and Meta-analysis
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Abstract
Background: Health informatics technology has significantly impacted healthcare administration
in the Kingdom of Saudi Arabia (KSA). The technology has enhanced the accuracy and efficiency
of medical records and data management, improved patient safety, and enabled rapid decisionmaking by healthcare professionals.
Objective: This systematic review aims to provide a comprehensive understanding of the role and
potential of health informatics technology by evaluating the impact of health informatics
technology on healthcare administration in the Kingdom of Saudi Arabia (KSA).
Methods: The study used systematic search using different databases such as Scopus, Google
Scholar, and PubMed using specific keywords related to health informatics, healthcare data
analytics, and healthcare administration in Saudi Arabia. The evidence was synthesized using a
narrative approach, ensuring the study adhered to PRISMA guidelines.
Results: Implementing health informatics technology across various healthcare administrations
led to a significant improvement in service efficiency. Furthermore, using health information
systems improved communication between healthcare providers and patients, resulting in a 25%
increase in patient satisfaction scores. Additionally, the adoption of health informatics technology
led to a 20% decrease in medical errors which enhanced the safety of patients. Generally, the
results indicate a substantial positive impact of health informatics technology on healthcare
administration in KSA.
Conclusion: Implementing health information systems has improved service delivery,
communication between providers and patients, and overall patient care. However, key challenges
include inadequate training and limited HIM program availability. Thus, more significant
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investment and standardization efforts must be fully leveraged to realize the potential of health
informatics technology in KSA.
CHAPTER I
INTRODUCTION
This chapter provides a background on the impact of health informatics technology on the
quality of health care administration in Kingdom of Saudi Arabia. After that a statement of the
problem will be presented. This will be followed by a discussion on the significance of the study.
Finally, the aim and objectives of the study will be presented.
1.1 Background
Health informatics technology has significantly impacted the quality of healthcare
administration in the Kingdom of Saudi Arabia (KSA) (Jamal et al., 2015). It has been instrumental
in improving the accuracy and speed of medical records and data management, enhancing patient
safety, and reducing medical errors (Khalifa, 2013). This improvement in data management has
enabled doctors, nurses, and other healthcare professionals to access and review patient records
quickly and easily, helping them in making rapid, informed decisions (Khalifa, 2013). Indeed,
implementing health informatics technology has allowed for the automation of administrative tasks
such as billing, processing of claims, and document management, thus, saving time and money
(Khalifa, 2013). It has also enabled the integration of different healthcare systems and provided
more comprehensive healthcare services. Additionally, the ability to exchange information and
resources between healthcare providers has been improved. According to Jamal et al., (2015), It is
evidenced that all the changes put in place have improved the health care quality within Saudi
Arabia, where the country uses information technology to improve the quality, safety, and
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efficiency of healthcare delivery, improve patient care access, and increase clinical outcomes’
accuracy. Thus, it has enabled healthcare providers to access a larger pool of information, improve
clinical decision-making, and reduce medical errors.
Health informatics technology has also enabled the use of electronic medical records
(EMR) in the Kingdom of Saudi Arabia which has allowed for more efficient and accurate patient
information management (Aldosari, 2014). It also improved the accuracy of clinical outcomes,
which has improved the quality of healthcare services in the country. Additionally, the utilization
of EMR has enabled healthcare providers to quickly access a patient’s medical history, improving
the efficiency of medical care delivery.
Health informatics technology has also enabled the development of health information
systems in the Kingdom of Saudi Arabia. These systems have enabled the tracking of health data,
the analysis of health trends, and the monitoring of health services (Aldosari, 2014). This has
allowed for better decision-making when it comes to healthcare services, as well as better
understanding of the populations’ needs. As a result, this has enabled the development of
preventive measures and better allocation of resources.
1.2 Problem Statement
The health sector transformation program (vision 2030) aims to restructure the Kingdom’s
health sector to be more comprehensive. The program seeks to reduce the health gaps between the
current healthcare practices and the national goals (Lee et al., 2018). To attain better health and
healthcare, technology has to be the key linking factor towards better medical advancement, health
care innovation, creating actionable information, improving clinical processes and outcomes and
in improving the overall patients’ and providers’ experience (Lee et al., 2018).
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The area of healthcare informatics and records analytics is swiftly evolving and has the
potential to enhance the efficiency, effectiveness, and accessibility of healthcare. However, despite
its potential, the use of healthcare informatics and data analytics in hospitals of KSA are an underexplored vicinity (Al Kuwaiti et al., 2018). Indeed, there is a lack of comprehensive understanding
of the impact of health informatics technology on healthcare administration in KSA (Al Kuwaiti
et al., 2018).
Even though there appears to be a need for greater comprehension of how health informatics
technology affects the standard of health care management in the Kingdom of Saudi Arabia, more
systematically gathered and structured data are still required. Therefore, this study aims to examine
the impact of health informatics technology on the quality of healthcare administration in the
Kingdom of Saudi Arabia (Al Kuwaiti et al., 2018). This research targets to fill this gap by
conducting a systematic review of the current literature on healthcare informatics and files
analytics in hospitals of KSA. This research might assist healthcare groups to make informed
decisions on how to efficiently make use of healthcare informatics and data analytics to improve
healthcare administration.
1.3 Aim
To systematically review the impact of health informatics technology on the health care
administration in KSA.
1.4 Research Questions
What is the impact of health informatics technology on the health care administration in KSA?
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1.5 Objectives
•
To explore the current usage of health informatics technology within health care
administration in KSA.
•
To determine the barriers to adopting health informatics technology in health care
administration in KSA.
1.6 Significance of this study
Technology has created a significant landmark (Kumar & Singh, 2018). Informatics is
changing the healthcare system – the way health care providers and patients communicate is also
changing. Thus, understanding this new framework is important in re-defining health care quality.
The significance of this systematic review lies in its potential to provide a comprehensive
understanding of the impact of health informatics technology on healthcare administration in KSA.
This can inform policies and practices aimed at improving the quality and efficiency of healthcare
delivery in the country (Kumar & Singh, 2018).
This study might serve as a framework for future research efforts and the findings might
contribute highly toward meeting the national’s ‘e-Health’ goals (Kumar & Singh, 2018). This
review will provide valuable insights into the current state of health informatics technology usage
within healthcare administration in KSA, including the types of technology being used and the
extent of adoption. This information can help identify gaps in technology usage and inform efforts
to expand and optimize the use of health informatics technology in healthcare administration. The
findings of this systematic review can have broader implications beyond KSA. By identifying the
impact of health informatics technology on healthcare administration in KSA, this review might
provide insights that can inform policies and practices in other countries facing similar challenges.
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CHAPTER II
LITERATURE REVIEW
This chapter evaluates the literature review on the impact of health informatics technology
on the quality of health care administration in Kingdom of Saudi Arabia. The chapter will discuss
the barriers to adoption of health informatics in KSA, the influence of health informatics
technology on the cost of healthcare administration in KSA, health informatics and patient safety.
Introduction
Health informatics technology is increasingly being used in health care administration in
KSA. This technology offers many benefits in terms of efficiency, accuracy, and cost savings. In
recent years, KSA has implemented health information technology in its health care system,
including electronic medical records, health information systems, and health information
exchanges (Jamal et al., 2015). These technologies help in improving patient safety and quality of
care, as well as reduce costs. They allow data sharing across different providers, including
hospitals, laboratories, and pharmacies. In addition, they help to reduce errors in the reporting and
treatment processes and in billing (Jamal et al., 2015). The Ministry of Health in KSA has
implemented a nationwide electronic health record system, which includes all patients’ medical
information (Alshahrani et al., 2019). According to Jamal et al. (2015), this system is used to help
managing patient care and providing access to the latest medical research and treatments. It also
allows for tracking patient outcomes, which helps in improving the quality of care (Alduraywish
et al., 2020).
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In addition, health informatics technology has been used to improve the efficiency of
administrative processes. Electronic medical records, for example, are used to streamline the
collection, storage, and sharing of patient data. This helps in reducing administrative costs and in
improving patient safety (Aldosari et al., 2018). Overall, health informatics technology has greatly
improved the quality and efficiency of healthcare administration in KSA (Aldosari et al., 2018). It
has helped to reduce errors, improve patient safety, and reduce costs. It also enabled better access
to the latest medical research and treatments and improved tracking of patient outcomes.
However, a number of issues are associated with using this technology in the country that
needs to be addressed (Al Kuwaiti et al., 2018). One of the main issues is that the technology is
not always up-to-date or comprehensive. The lack of comprehensive and updated systems can lead
to errors and delays in delivery of healthcare services. Additionally, the systems may not be
interoperable, leading to data duplication and confusion. Furthermore, the current infrastructure of
the healthcare system in the Kingdom of Saudi Arabia is not robust enough to support effective
health informatics technology (Al Kuwaiti et al., 2018). This means that the technology cannot be
used to its full potential, leading to inefficient practices and a lack of integration between
departments.
2.1 Barriers to the adoption of Health Informatics in KSA
A literature review of the barriers to adopting health informatics technology in health care
administration in KSA revealed a range of issues. One of the primary factors was the cultural and
religious context of the country, which can make the adoption of new technologies difficult (Al
Kuwaiti et al., 2018). Additionally, there is a lack of understanding among healthcare providers
and administrators of the potential benefits of health informatics technology, as well as a lack of
resources and training to support the implementation of such technology (Al Kuwaiti et al., 2018).
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Other factors that hampered the adoption of such technology include the lack of
infrastructure to support the technology, the reluctance of healthcare providers to embrace new
technologies, financial and human resources, and cultural and legal barriers (Al Kuwaiti et al.,
2018). The lack of infrastructure to support the technology was among the reported barriers in the
literature. Many healthcare facilities in KSA do not have the necessary equipment, networks, and
software to effectively use health informatics technology (Al Kuwaiti et al., 2018). This
necessitates the installation of new equipment and the development of complex networks and
software programs. This requires a significant financial investment, which is not always feasible
for healthcare facilities in KSA (Aldosari et al., 2018).
The reluctance of healthcare providers to adopt new technologies was also reported as a
barrier. Many healthcare providers are reluctant to embrace new technologies due to fear of the
unknown, lack of knowledge, and lack of experience (Aldosari et al., 2018). This results in a lack
of understanding and appreciation of the potential benefits of health informatics technology.
Further, the lack of financial and human resources was reported as a barrier. Many
healthcare facilities in KSA lack the financial resources to invest in the necessary equipment,
networks, and software to implement health informatics technology (Aldosari et al., 2018).
Therefore, this can be associated to inadequate funds to train or acquire foreign health
professionals to seal the gap utilizing health technology. KSA Ministry of Health should consider
foreign professional with health technology skills to train their existing professionals.
The cultural and legal barriers were among the main barriers that the studies reported. In
KSA, there is a strong cultural emphasis on privacy, and there is often a reluctance to share medical
data (Khalifa, 2013). The laws in KSA also do not always provide adequate protection for the
usage and storage of medical data (Khalifa, 2013). This creates a reluctance to use health
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informatics technology, as many healthcare providers fear that their data could be exposed to
unauthorized users. Moreover, the law only limits health data leaks or use without the autonomy
of the patients, but this does not mean that the information cannot be breached (Khalifa, 2013).
Therefore, there is a need to implement health informatics to limit the barrier.
The infrastructure of the healthcare sector in KSA is also a barrier to adoption. Many
healthcare facilities and practices lack the necessary information technology infrastructure and
resources to effectively employ health informatics technology (Khalifa, 2013). Additionally, the
country’s health care system is largely paper based, with electronic medical records and other
digital tools being limited and difficult to access. The cost of health informatics technology can
also be an obstacle to its adoption since many healthcare providers and administrators may see the
investment as being too high for the potential benefit (Khalifa, 2013). Furthermore, the lack of
incentives for healthcare providers and administrators to adopt health informatics technology can
also create an obstacle (Khalifa, 2013).
Another issue is the lack of knowledgeable staff to manage the technology. Inadequate
training and lack of experience can cause improper use of such technology, leading to further
issues such as data loss, security breaches, and other operational problems. Finally, there are
Insufficient resources and funding for health informatics technology (Alshahrani et al., 2019). This
means that the technology is not as reliable or effective as it could be, leading to further problems
with the quality of healthcare administration in the Kingdom of Saudi Arabia. Therefore, the use
of health informatics technology in the Kingdom of Saudi Arabia is subject to several issues. These
include a lack of comprehensive and up-to-date systems, weak infrastructure, inadequate staff
training, and insufficient resources and funding (Alshahrani et al., 2019). If these issues are not
addressed, the quality of healthcare administration in the country may suffer.
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Thus, the literature suggests that there are a number of obstacles to the adoption of health
informatics technology in health care administration in KSA (Khalifa, 2013). The primary issues
relate to the cultural context, lack of understanding, infrastructure and resources, cost, and privacy
and security. Understanding and addressing these obstacles is important for the successful
implementation of health informatics technology in KSA.
2.2 The Influence of Health Informatics Technology on the Cost of Healthcare
Administration in KSA
Health informatics technology has become an important part of healthcare administration
in KSA. It has made managing patient records and other administrative tasks more efficient and
cost-effective (Alduraywish et al., 2020). Implementing health informatics technology has enabled
healthcare providers in KSA to streamline their administrative processes, allowing them to reduce
their administrative costs. Health informatics technology has enabled healthcare providers to
reduce staff costs and paper-based processes (Alduraywish et al., 2020). It has increased the
accuracy and consistency of data, resulting in decreased costs for manual data entry and storage
(Alduraywish et al., 2020). Additionally, it has allowed healthcare providers to improve their
patient satisfaction and engagement, reducing the costs associated with patient complaints.
Health informatics technology has also enabled healthcare providers to improve accuracy
and reduce errors in the care process. This has reduced costs associated with errors and patient
safety issues (Alduraywish et al., 2020). It has also enabled healthcare providers to reduce the time
needed to process billing and claims, resulting in improved reimbursement rates and reduced
administrative costs. Finally, health informatics technology has enabled healthcare providers to
improve communication and collaboration between medical staff, resulting in fewer duplicated
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efforts and reduced costs (Alharbi et al., 2021). It has allowed healthcare providers to improve
their patient record management and access, resulting in improved efficiency and cost savings.
Health informatics technology, such as electronic health records (EHRs) and clinical
decision support systems (CDSSs), has been widely adopted in healthcare settings, including
KSA.In KSA, the implementation of health informatics technology has been linked to decreased
healthcare costs due to improved data accuracy and enhanced clinical decision-making. A study
by Rahman & Alsharqi (2019) found that the use of health informatics in KSA resulted in a
decrease in the cost of healthcare administration.
In addition to cost savings, the use of health informatics technology has been linked to
improved patient care. For example, a study by Alharbi et al. (2021) found that the use of health
informatics technology in KSA resulted in improved patient outcomes and increased patient
satisfaction. The use of health informatics technology in KSA was also associated with improved
healthcare provider performance, including improved accuracy in medical diagnoses and reduced
medical errors. The literature suggests that the use of health informatics technology in KSA has
the potential to reduce healthcare costs and improve patient care (Alharbi et al., 2021). However,
further research is needed to evaluate the full impact of health informatics technology on the cost
of healthcare administration in KSA. Additionally, further research is needed to evaluate the best
practices for the effective implementation and use of health informatics technology in KSA.
2.3 Health Informatics and Patient Safety
Health Informatics and Patient Safety in KSA is a topic that has recently become a major
concern in the healthcare system. Health Informatics is the use of information technology to
support healthcare activities, including patient safety (Rahman & Alsharqi, 2019).
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The Saudi government has implemented several initiatives to improve the quality of health
informatics and patient safety in the country. The Saudi Ministry of Health has launched a health
informatics surveillance system to monitor and report on events and outcomes in the healthcare
system. The system is designed to track infections, medical errors, and adverse events in hospitals,
clinics, and other healthcare settings (Rahman & Alsharqi, 2019). In addition, the Ministry of
Health has established a National Electronic Health Information System to improve patient safety
by ensuring that all providers have access to accurate and up-to-date patient information. Several
studies have been conducted to evaluate the impact of health informatics and patient safety in
Saudi Arabia (Marar et al., 2019: Rahman & Alsharqi, 2019). These studies have found that the
implementation of health informatics has resulted in improved patient safety, reduced costs, and
improved quality of care. There has also been an increased focus on patient safety initiatives in the
country, resulting in more attention to patient safety and quality of care.
Health informatics technology can improve patient safety in healthcare administration in
KSA by providing better patient data management, communication between healthcare providers,
and quality of care (Aldosari, 2014). The first-way health informatics technology can improve
patient safety is by providing better patient data management. By utilizing electronic health records
(EHRs), healthcare providers can access and store patient data in a secure and organized manner.
This allows for more accurate and efficient patient information and data management, which can
lead to better patient safety (Rahman & Alsharqi, 2019). Additionally, health informatics
technology can track patient health outcomes and provide real-time notifications of changes in
patient health. This can help healthcare providers respond quickly to changes in patient health and
provide the necessary care promptly.
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Another way that health informatics technology can improve patient safety is by improving
communication between healthcare providers. By utilizing telemedicine and other communication
technology, healthcare providers can more easily communicate with each other, allowing for better
care coordination (Alharbi et al., 2021). Indeed, health informatics technology can facilitate
communication between patients and their healthcare providers, allowing for more accurate
communication about patient health and medical treatments (Alharbi et al., 2021).
Health informatics technology can also improve the quality of care provided to patients.
By utilizing analytics and data analysis, healthcare providers can better understand patients’ health
and the effectiveness of medical treatments (Marar et al., 2019). This technology can further
monitor patient health over time and detect potential health risks or changes in patient health. This
can help healthcare providers provide more personalized patient care and ensure that patients are
receiving the best possible care.
In conclusion, health informatics and patient safety in KSA is a critical issue. The Saudi
government has implemented several initiatives to improve the quality of health informatics and
patient safety in the country. Studies have demonstrated that the implementation of health
informatics has resulted in improved patient safety, reduced costs, and improved quality of care.
Further research is needed to evaluate the impact of health informatics and patient safety in KSA
and to assess how it can be further improved.
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CHAPTER III
METHODOLOGY
This chapter presents the method that was used to search for research articles from the
databases. The exclusion and inclusion criteria are then presented. Then, the chapter will present
the methods in which results were analyzed which will be followed by a discussion of the ethical
considerations that were observed for the study.
3.1 Systematic Review Approach
This study employed a systematic review. The outcomes of this study were collected
through a review of past studies. The systematic review approach is an innovative and
comprehensive method for evaluating a body of evidence. This research study allowed the
researcher to review and synthesize the evidence needed to make effective evidence-based
decisions (Zawacki-Richter et al., 2021). Systematic reviews also provide comprehensive evidence
for the given research question (Zawacki-Richter et al., 2021).
The first step in this systematic process is the interpretation of a research question. This
study focused on finding effective and comprehensive answers to the question focused in the most
effective manner (Zawacki-Richter et al., 2021). Once the research question was formulated for
the study, the next step was to search and identify the relevant literature from relevant databases
(Zawacki-Richter et al., 2021). After the identification of the literature, the literature was then
assessed to check the relevance of the data in answering the research question (Tawfik et al., 2019).
The sources were reviewed and evaluated to ensure that all articles met the predetermined
standards (Zawacki-Richter et al., 2021). With the help of the exclusion and inclusion criteria,
irrelevant articles, journals, articles, and papers, were extracted (Koym, 2020). JBI assessment and
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PRISMA analysis were also performed to ensure that only relevant studies were selected (Pigott
& Polanin, 2019). The sources’ quality was also assessed, and sources that failed to reach the
desired criteria were eliminated.
3.2 Data sources and search strategy
This research project used three main search engines for the extraction of information –
Scopus, Google Scholar, and PubMed. Various keywords were used to explore various health
informatics and healthcare data analytics in healthcare management such as (health informatics
technology OR e-health OR telehealth OR telemedicine OR m-health OR medical informatics)
AND (healthcare OR health care OR health care administration OR healthcare administration)
AND (KSA OR Kingdom of Saudi Arabia). (“impact*” OR “influence*” OR “effect*” OR
“benefit*” OR “challenge*” OR “barrier*” OR “advantage*”) AND (healthcare OR health care
administration ) AND (KSA OR Kingdom of Saudi Arabia. The selection of this information was
made from extracting data from several journals that explain the management of healthcare of
hospitals in KSA and other articles to ‘healthcare data analytics,’ “healthcare informatics,” and
“healthcare management” in combination with “KSA” to better refine the search results
(Dhivyalakshmi & Umamakeswari, 2018).
The search strategy was developed to identify articles relevant to the research questions
(Zawacki-Richter et al., 2021). A two-stage screening process was used to assess the eligibility of
studies. In the first stage, titles and abstracts were assessed; in the second stage, full-text articles
were assessed (Zawacki-Richter et al., 2021). Data extraction and quality assessment were
conducted on the included studies (Tawfik et al., 2019). The data were synthesized using a
narrative approach to discuss the impact of health informatics technology on healthcare
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administration in KSA. In the second stage, full-text articles were assessed. Data extraction and
quality assessment were conducted on the included studies (Tawfik et al., 2019).
After identifying the sources and collecting data, the next step was synthesizing the
evidence (Tawfik et al., 2019). Data synthesis was done systematically by extracting the relevant
information from each of the studies and then combining the collected information to create a
better cohesive story (Tawfik et al., 2019). The data synthesis process includes summarizing the
study results, comparing different results, and contrasting the collected results, and drawing
conclusions based on the data findings (Tawfik et al., 2019). During this process, any gaps within
the stud
