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Information and communications technology (ICT) now permeates almost all facets of life, including healthcare. ICT is able to improve consistency, accuracy, and efficiency of processes and detailed clinical information flow (Conrick, 2006). Healthcare organizations, with their requirements for knowledge and an educated workforce, are considered likely to be rapid adopters of ICT (Erl, 2005), but in practice, many healthcare providers are slow to adopt it, and healthcare as a whole is one of the sectors that invests least in it (CSC, 1999; E-Health Ontario, 2009).
A health information system (HIS) processes data, and provide information and knowledge in healthcare environments to support high-quality and efficient patient care (Haux et al., 2006. An HIS can be successfully adopted when it integrates people, processes (procedures), strategies (effective implementation), and technologies appropriately to support operations and management, and deliver essential information to improve the quality of healthcare (Almunawar & Anshari, 2014). The HIS has evolved through several stages that have been primarily influenced by the advancement of ICT.
There are several other technologies closely related to HIS. Health information technology (HIT) is computer hardware and software that deals with the storage, retrieval, sharing, and use of healthcare information, data, and knowledge for communication and decisions (Goldschmidt, 2005). Health informatics is concerned with the cognitive, information-processing, and communication tasks of medical practice, education and research, using information science and technology to support those tasks. Health informatics tools include computers, clinical guidelines, formal medical terminologies, and information and communication systems. The emphasis is on clinical and biomedical applications with the added possibility of integrating clinical components together or with administrative health information systems (Conrick, 2006).
Electronic health (e-health) has been described as the single most important revolution in healthcare since the advent of modern medicine, vaccines, or public health measures such as sanitation and clean water (Silber, 2003). Electronic health records (EHRs) reside at the centre of any health information system. An EHR is an individual patient’s medical record in a digital format. EHRs are the building blocks of an HIS that substitutes for the traditional paper record. An EHR system (EHR-S) coordinates the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed via computer, often through a network, enabling telemedicine. This enables the remote practice of medicine through the exchange of clinical information where patients and providers are geographically separated (Gustafson et al., 1993).
Consumer empowerment in healthcare is a feature of e-health deployment. Empowerment can be considered as a new paradigm in healthcare scenarios, allowing patients to make their own health-related decisions (Anshari & Almunawar, 2012). Consumer empowerment can be supported by allowing customers to control the process of their interactions with their healthcare providers, such as in accessing online services, booking online consultations, and paying online. Empowerment allows patients and their families to access their medical records online, which helps to create individual awareness of health.
In Taiwan, an e-health system called the National Health Insurance (NHI) system has achieved availability, accessibility, and utilization by providers, as shown by the high percentage of online claims and digital records (Chunhuei, Lee & Schoon, 2012). Its low administrative costs, 1.51% of its total expenditure for 2009 (BNHI, 2010), are strong evidence of its high impact.