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  • A FRACTAL-BASED MODEL TO IMPROVE COOPERATION

    AMONG PHYSICIANS IN DISTRIBUTED HEALTHCARE

    INFORMATION SYSTEMS

    NAWZAT S. AHMED

    THESIS SUBMITTED IN FULFILMENT

    OF THE REQUIREMENTS

    FOR THE DEGREE OF DOCTOR OF PHILOSOPHY

    FACULTY OF COMPUTER SCIENCE

    AND INFORMATION TECHNOLOGY

    UNIVERSITY OF MALAYA

    KUALA LUMPUR

    2013

  • i

    UNIVERSITY OF MALAYA

    ORIGINAL LITERARY DECLARATION

    Name of Candidate: Nawzat S. Ahmed (I.C./ Passport: G2023055 )

    Registration metric number: WHA080031

    Name of Degree: Doctor of Philosophy (PhD)

    Title of the thesis: A Fractal-based Model to Improve Cooperation among

    Physicians in Distributed Healthcare Information Systems

    Field of study: Information Systems

    I do solemnly and sincerely declare that:

    (1) I am the sole author/writer of this work; (2) This work is original; (3) Any use of any work in which copyright exists was done by way of fair dealing

    and for permitted purposes and any excerpt or extract form, or reference to or

    reproduction of any copyright work has been disclosed expressly and

    sufficiently and the title of the work and its authorship have been acknowledged

    in this work;

    (4) I do not have any actual knowledge nor do I ought reasonably to know that the making of this work constitutes an infringement of any copyright work;

    (5) I hereby assign all and every rights in the copyright to this work to the University of Malaya (‘UM’), who henceforth shall be owner of the copyright in

    this work and that any reproduction or use in any form or by any means

    whatsoever is prohibited without the written consent of UM having been first

    had and obtained;

    (6) I am fully aware that if in the course of making this work I have infringed any

    copyright whether intentionally or otherwise, I may be subject to legal action or

    any other action as may be determined by UM.

    Candidate’s Signature: Date: 24 September 2013

    Subscribed and solemnly declared before.

    Witness’s Signature: Date: 24 September 2013

    Name:

    Designation:

  • ii

    ABSTRACT

    The system cooperation has become an important issue and used in healthcare systems

    to exchange information and ideas among physicians. Healthcare systems generally

    have distributed structures and consist of individual centres supported by autonomous

    Healthcare Information Systems (HISs). HISs serve as bases for exchanging healthcare

    information among physicians within the hospital environment. In the available

    literature, many studies have developed cooperative HISs models to improve

    cooperation among physicians in sharing patient information, as depositories to provide

    better services. However, none of these studies focused on the development of

    cooperative HISs models to improve physician skills to provide quality care to patients.

    In most developing countries, such as Iraq, cooperation among physicians in sharing

    information and skills in the patient treatment within the hospital environment is still

    very poor. Such poor cooperation can lead to insufficient outcomes where lack of

    medical skills yield disastrous consequences. In this study, a fractal approach has been

    used in proposing the Fractal-based Healthcare Information System (FHIS) model to

    improve cooperation among physicians in sharing information and skills within same

    and between different hospitals. The data collection has been carried out at two

    government hospitals in Kurdistan region of Iraq, as a case study. The mixed method

    approach, which combines questionnaires and semi-structured interviews, conducted,

    (1) to determine the current levels of cooperation among physicians with regard to

    sharing information and skills in the patient treatment, within selected Iraqi hospitals,

    (2) to determine factors that affect such cooperation among physicians, (3) to determine

    how the activities of Research and Development (R&D) units affect cooperation among

    physicians, and (4) to develop a FHIS model intended to improve cooperation among

    physicians with regard to the sharing of information and skills. Questionnaires were

    distributed among one hundred physicians; however, only eighty one questionnaires

  • iii

    were completed and considered for analysis. Ten specialist physicians were selected for

    semi-structured interviews. Results showed an availability lack of cooperation among

    physicians. This lack of cooperation occurred because of significant factors, such as

    system units wish to maintain autonomy; a flexible cooperative approach is not the

    norm in the developing of cooperative HISs; large amounts of data are difficult to

    manage and control in manual and centralized systems; new knowledge is not acquired

    in a timely manner; physicians work independently; and R&D unit activities are weak.

    This study also concluded that a positive relation exists between R&D unit activities

    and cooperation among physicians using a simple regression analysis (F(1,79)=7.230).

    The FHIS has been implemented in participating hospitals to evaluate the system

    usability and the effect of this system in improving cooperation among physicians. The

    mixed method of questionnaires and semi-structured interviews were conducted in the

    evaluation process. Results indicated that the FHIS is satisfactorily (system usability

    scale scores = 75.04) and the cooperation among physicians in sharing healthcare

    information corresponds to significant improvements in skill using a paired samples T

    test (t(55)=-20.486). Further research needs to consider the cooperation between

    administrative and financial sections as well as the data-viewing privacy of physicians.

  • iv

    ABSTRAK

    Sistem koperasi telah menjadi satu isu yang penting dan digunakan di dalam sistem

    penjagaan kesihatan untuk pertukaran maklumat dan idea di kalangan para doktor.

    Sistem penjagaan kesihatan amnya mempunyai struktur teragih dan terdiri daripada

    pusat tersendiri yang disokong secara autonomi oleh Sistem Maklumat Kesihatan

    (SMK). SMK merupakan asas bagi pertukaran maklumat penjagaan kesihatan di

    kalangan pakar-pakar perubatan dalam persekitaran hospital. Dalam dapatan literatur,

    banyak kajian telah membangunkan model koperasi SKM untuk meningkatkan

    kerjasama di kalangan pakar-pakar perubatan dalam berkongsi maklumat pesakit

    sebagai rizab untuk menyediakan perkhidmatan yang lebih baik. Walau bagaimanapun,

    tiada kajian yang tertumpu kepada pembangunan model SMK koperasi untuk

    meningkatkan kemahiran doktor di dalam menyediakan rawatan yang berkualiti kepada

    pesakit. Di kebanyakan negara membangun seperti Iraq, kerjasama di kalangan doktor

    dalam perkongsian maklumat dan kemahiran untuk rawatan pesakit dalam persekitaran

    hospital masih sedikit. Kurangnya kerjasama menjurus kepada hasil yang tidak begitu

    memuaskan di mana kekurangan dari segi kemahiran perubatan boleh mengakibatkan

    kesan buruk. Dalam kajian ini, pendekatan fraktal telah digunakan dalam

    mencadangkan model Sistem Maklumat Kesihatan berasaskan Fraktal bagi

    meningkatkan kerjasama di kalangan pakar-pakar perubatan dalam perkongsian

    maklumat dan kemahiran sama ada dalam hospital yang sama dan di antara hospital

    yang berbeza. Kajian kes melibatkan pengumpulan data yang dilaksanakan di dua buah

    hospital kerajaan di daerah Kurdistan, Iraq. Kaedah kajin secara gabungan iaitu soal

    selidik dan temu bual separa berstruktur telah digunakan (1) untuk menentukan tahap

    kerjasama semasa di antara doktor berkaitan perkongsian maklumat dan kemahiran

    dalam merawat pesakit di hospital terpilih di Iraq, (2) untuk menentukan faktor-faktor

    yang mempengaruhi kerjasama di kalangan doktor, (3) untuk menentukan bagaimana

  • v

    aktiviti unit penyelidikan dan pembangunan mempengaruhi kerjasama di kalangan

    pakar perubatan, dan (4) untuk membangunkan model Sistem Maklumat Kesihatan

    berasaskan Fraktal yang bertujuan untuk meningkatkan kerjasama di kalangan pakar-

    pakar perubatan dalam perkongsian maklumat dan kemahiran. Soal selidik telah

    diedarkan kepada 100 orang doktor namun hanya 81 soal selidik sahaja yang lengkap

    dan dipertimbangkan untuk analisis. Seramai sepuluh orang doktor pakar telah dipilih

    untuk temuduga separa berstruktur. Keputusan menunjukkan kurangnya kerjasama di

    kalangan pakar-pakar perubatan. Ini berlaku kerana faktor-faktor utama seperti sistem

    unit ingin terus mengekalkan autonomi; pendekatan koperasi yang fleksibel adalah

    bukan kebiasaan dalam membangun SMK koperasi; jumlah data yang besar sukar untuk

    diurus dan dikawal dalam sistem manual dan berpusat; pengetahuan terkini tidak

    diperoleh pada masa yang tepat; para doktor bekerja secara bebas dan aktiviti unit

    penyelidikan dan pembangunan adalah lemah. Dengan menggunakan analisis reg