Citation

Shatem, Maryam and Keoy, Kay Hooi and Yeo, Sook Fern (2026) Beyond ISO Standards: What Really Drives EHRS Adoption in Developing Healthcare Systems. Journal of Logistics, Informatics and Service Science. ISSN 24092665

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Abstract

The Electronic Health Record Systems (EHRS) lie at the heart of digital transformation, however, in developing countries, their availability does not guarantee adoption. In Jordan, the EHR (Hakeem program) is facing different level of adoption between clinicians. This brings the necessity to understand the nature of interaction between sociotechnical effects on adoption. Therefore, based on the theoretical underpinning of Sociotechnical theory, the aim of this research is to examine whether and how the technical aspect of the software quality of ISO/IEC 9126 can be translated into the practical EHRS adoption and how the social effect of Perceived Usefulness (PU) reinforces or undermines these relationships. An explanatory mixed-method sequential design was used. Regression and moderation tests were used to analyze quantitative data of 201 clinicians, whereas thematic analysis of interviews with 10 clinicians enhanced the interpretation of statistical results. Results showed that the six dimensions of the software quality (Functionality, Reliability, Usability, Efficiency, Maintainability, Portability) were predictors of EHRS adoption (39% variance explained), with reliability and functionality being the most powerful predictors. Further, PU had a significant moderating effect on all the relationships. Qualitative findings revealed there are usability issues, use of hybrid paper based processes, a lack of system intelligence and external accessibility, and lack of efficiency in documentation workflows. Further extended emerging organizational conditions as compliance-based leadership, bureaucratic stagnation, insufficient training, and ineffective feedbacks were major limitations that influenced the engagement of users. Therefore, the results show that the ISO standards are necessary but not sufficient basis of EHRS adoption; as per the socio-technical systems theory, successful adoption will arise of the simultaneous optimization of technical quality, perceived clinical value by clinicians and favorable organizational configurations.

Item Type:	Article
Uncontrolled Keywords:	Healthcare Information Systems, Mixed Methods
Subjects:	H Social Sciences > HC Economic History and Conditions > HC94-1085 By region or country
Divisions:	Faculty of Business (FOB)
Depositing User:	Ms Rosnani Abd Wahab
Date Deposited:	03 Sep 2026 02:20
Last Modified:	03 Sep 2026 02:20
URII:	http://shdl.mmu.edu.my/id/eprint/16578

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