Discuss the results to other similar studies results both in similarities and differences.

Evaluation of System Usability of the Healthcare Information System at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia Introduction: Almost all hospital services and patient information are managed by a hospital information system (HIS). A Healthcare information system (HIS) is software that organizes and manages health information in healthcare settings. Patient information, hospital admissions, and regular hospital services are gathered, maintained, and controlled by (HIS) [1,2]. The HIS plays a substantial and clearly defined role in healthcare organizations [3,4]. Many industries rely on their investment in information technology since it affects business operations and organizational effectiveness [5,6]. The HIS has a positive impact on both health organizations and public health as well [3,7,8]. It is imperative that HIS be incorporated into a comprehensive plan to increase patient safety and the quality of healthcare [9,10]. By using HIS, medical errors are decreased, performance is increased, resources are managed effectively, and information is transmitted more promptly; thus, it will improve the user’s satisfaction [3,11–13]. In addition, it will increase quality and drive down costs [3,8,11]. Aside from this, it will provide easier and faster access to health information [14,15]. By using electronic health records as a data source, not only the most pertinent and crucial information can be gathered. But also save time by eliminating the need to read handwriting, check previous visits, or get information from another department [16,17]. HIS comprises different components, but the three most crucial are radiology, laboratory, and nursing information systems [3,18]. Electronic documentation is essential to nursing practice [19–24]. Information technology will influence various aspects of nursing care by health information technology [19,25]. Earlier studies showed that the comprehensiveness, quality of nursing services, and documentation were all improved by electronic documentation [16,20,26–28]. Alternatively, in a different study, nurses said that using HIS results in longer documentation times [16,29]. However, computerized clinical documentation will improve safe, moral, and efficient nursing care [30–32]. Besides that, HIS is currently used worldwide; it has various usability drawbacks and issues [33,34]. Studies have indicated that several health information systems needed to be better adopted or could not accomplish their intended objectives [35,36]. For instance, some systems may result in errors, and others providers may expect to do their tasks for a long period of time [35,37–39]. Several factors affect the usability of the system, including user control, complexity, and poor interface [3,13,40–42]. Asystem with poor usability may be prone to errors and become problematic, and lead to less efficacy and efficiency [35,39,43,44]. In contrast, a user-friendly information system increases productivity, decreases errors, increases efficiency, and increases users’ acceptance [33,45,46].To be able to recognize and address these issues, it is strongly advised to analyze the usability of the systems, as it is one of the primary causes of these deficiencies [35,36,47–50]. Conducting a usability analysis will allow the developer to identify and fix user problems, therefore saving money by updating the system instead of implementing a new one [51,52]. It has been demonstrated that usability can be determined through user interaction with the system [3,53]. The literature contains a variety of methods for evaluating the usability of a system through user involvement. For example, surveys, user testing, system logs, interviews, and others [1,43]. However, the use of a variety of methodologies for evaluating HIS usability is preferable [54]. Considering the significance of the HIS and how users contribute to its efficiency. HIS usability has been evaluated in different studies. However, to our knowledge, there have been no published studies assessing the usability of the Healthcare Information system (TrackCare) in Sultan bin Abdulaziz Humanitarian City (SBAHC) in Saudi Arabia. TrakCare is a Web-based healthcare information system that provides electronic patient records for health organizations. With a single data repository, it offers clinical, administrative, lab, and community care functionality. It allows patient information to be shared securely and seamlessly between all departments. The system is currently available in different healthcare organizations in over 27 countries [55]. One of these organizations is SBAHC. Therefore, this study aims to evaluate the TrackCare information system’s usability and identify areas affecting user usability within SBAHC. Moreover, the study attempts to answer the main research question: Is the healthcare information system (TrackCare) usable with the healthcare providers at Sultan bin Abdulaziz Humanitarian City in Riyadh, Saudi Arabia? This study intends to use mixed methods of quantitative and qualitative approaches by conducting a crosssectional online survey and face-to-face interviews with participants. Literature Review: Usability and its impacts: A person’s perspective on technology’s utility and satisfaction with a system can have an impact on how the system will perform [32,56]. According to numerous studies, information system usability qualities include user satisfaction, system effectiveness, and simplicity of use. These aspects must be addressed to improve the users’ experience with the system [33,34,50,57,58]. Information system usability enhancement can result in more productive users, fewer errors, and more system efficacy and efficiency. As a consequence, it will increase user acceptance and satisfaction [19,33,45,46,59].On the contrary, some difficulties can arise for healthcare companies as a result of problems encounter the users [3,60]. For example, Goldermann et al. evaluated many German Picture Archiving and communication Systems (PACS) and found various issues with picture quality, the integrity of data, and efficacy [33,61]. Researchers have also suggested that usability issues may contribute to various medical errors, including incorrect prescription dosage entries [33,62,63]. Further, The Institute of Medicine has identified the ineffective usability of health information as an obstacle to providing safe and effective service [64,65]. There are frequent usability issues with the existing HIS, including issues with stability, user control, flexibility, and lack of assistance [40–42]. Apart from this, one of the major issues affecting users’ interaction with the system is an inappropriate user interface and a system conflict with the clinical process [3,13]. Moreover, the multitude of windows and options as well as the requirement to use numerous systems, make using the HIS even more challenging [40]. Illustrated by usability issues, such as complex data entry and use, have become major causes of worry for physicians [40,66–68]. According to earlier research, cognitive effort and time constraints at work are related to the stress experienced by physicians due to the usability issues with HIS [40,66,69]. The usability of HIS affects doctors’ health due to strain, and causes burnout and poor work outcome [40,70–73]. Additionally, more time behind pressure is tied to technical issues in information systems [40,74]. In another study, doctors demonstrated higher negative expression of HIS systems when poorly constructed, unresponsiveness systems and system breakdowns were frequent [19,75]. Similarly, among nurses who are a special category of HIS users, usability issues like workflow disruptions and complex documentation have also been increasingly acknowledged. [70,76–79]. Studies showed nurses experienced strain and psychological suffering due to the unreliability or inefficiency of HIS [19,80–84]. Consequently, frustration has been linked to improper system usability for both nurses and physicians [80]. Therefore, Digital tools and HIS systems that are excellent usability are crucial in healthcare [19]. It is essential to pay attention to usability issues with health organizations’ information systems [1]. When usability problems in a HIS lead to medical errors, they can be more concerning. Health providers may enter incorrect information due to certain interface issues and might threaten the patient [1,63]. Detecting and fixing usability issues are crucial actions to avoid them impairing user performance and spending time [1,85]. Evaluation of System Usability: It has been demonstrated that usability analysis lowers the number of end-user issues. Also, the cost of implementing change requests that would have been more expensive to fix as a result of failing to perform usability studies [51,52]. In literature, several methods are used to evaluate HIS worldwide, but usability testing is one of the most effective and popular methods [3,86]. Usability tests are carried out throughout the system design and before and after implementation. The approaches for evaluating user interfaces can be divided into those that involve experts and those that involve users [1,87]. In examination with experts, inspectors examine the software to identify usability issues using heuristics or best practices. In the user-involved approaches, professionals ask end users for feedback on the system’s usability by utilizing surveys, user testing, system logs, interviews, and other techniques to understand how users use the system’s features [1,43]. As the user interacts with the system, usability can be assessed, and looked at in several aspects [3,53]. However, usability testing often highlights how satisfactory the user experience is in terms of users’ viewpoint [3,53,88]. The System Usability Scale (SUS) questionnaire is the most popular metric for rating a system’s usability among users [89]. It is a Likert scale where the respondent is asked a statement and is then asked to rate how much they agree or disagree with it on a scale of 5 or 7 [89,90]. Also, it is a valid and reliable scale [91,92]. This scale has been used as the main instrument in some research to evaluate the usability of healthcare systems [93–95]. However, this tool is not diagnostic as it does not tell which part of the system makes it useless[91,92]. Therefore, several studies have combined this scale with different scales, or other techniques, such as semi-structured interviews [96,97]. It has been determined that evaluating HIS usability using a variety of methodologies is preferable [54].In summary, the literature demonstrates how important Health Information Systems are to healthcare organizations. However, some issues are limiting HIS use. Usability is one of these issues, which negatively impacts users and system functions. As a result, evaluating the system’s usability is crucial to addressing these issues. This study uses a System Usability Scale (SUS) questionnaire and a semi-structured interview to evaluate the usability of the healthcare information system (TrackCare) among healthcare providers in SBAHC. By focusing on the following: 1) measuring the acceptability level of the healthcare information system among healthcare providers at SBAHC in Riyadh. 2) What areas or factors may affect the system usability of the healthcare information system among healthcare providers at SBAHC in Riyadh, Saudi Arabia? Objectives of the Study: Aim of the Study: (Instructions: state the goal you need to achieve) research questions. This Study Aims to answer this question; What is the usability level of the healthcare information system (TrackCare) at the Sultan bin Abdulaziz Humanitarian City in Riyadh, Saudi Arabia? Specific Objectives: (Instructions: state the details of each objective that will finally lead to achievement of the goal) • To measure the system acceptance of the healthcare information system (TrackCare) among healthcare providers at Sultan bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia. Secondary Objectives: (Instructions: these are subsidiary objectives that could be studied during the course of the project but are not the main objectives of the study, they are optional and vary according to the type of the study) • To identify areas affecting system usability of the healthcare information system among healthcare providers at Sultan bin Abdulaziz Humanitarian City in Riyadh. Materials and Methods: (Instructions: Describe the research methods that could best achieve the study objectives, recommend to attached flow charts). This study will be conducted by distributing an online questionnaire) via Email and WhatsApp among healthcare providers in Sultan bin Abdulaziz Humanitarian City, Riyadh. The questionnaire will be the English version of (System Usability Scale), which is a valid and reliable scale to assess system usability from users’ perspectives. Also,a semi-structural interview, with open ended questions to identify negative and positive issues affecting system usability. The study will collect data for 2 months or until obtaining the desired sample. The study’s results will measure the system usability of the healthcare information system (TrackCare). The results will demonstrate what the negative and positive factors affecting system usability according to the user’s viewpoint among healthcare providers at Sultan bin Abdulaziz Humanitarian City. Study Area/Setting: (Instructions: describe the area or setting where the study will be conducted. This description should cover the details relevant to the study topic). The study will be conducted at Sultan bin Abdulaziz humanitarian city (SBAHC), a rehabilitation and medical center providing inpatient and outpatient services in Riyadh, Saudi Arabia. This facility currently uses the TrackCare InterSystems Version 2022 as a healthcare information system which was implemented in 2004. Study Subjects: (Instructions: Inclusion and exclusion criteria of the study subjects) Inclusion criteria: • Full-time Clinical staff who are working at SBAHC. • Clinical staff who are using the TrackCare information system include (Physicians, Nurses, Pharmacists, Nutritionists, Radiologists, Physical Therapists, Occupational Therapists, Vocational Therapists, and Psychologists). • Fluent in English. • Work experience of more than one year. Exclusion criteria: • Clinical staff not working at SBAHC. • Staff rather than healthcare providers. • Part-time clinical staff. • Not fluent in the English language. • Trainers, interns, or working at the facility for less than one year. • Study Design: (Instructions: mention the type of study design is a cross-sectional, casecontrol, intervention study, etc..). The study will be a quantitative cross-sectional descriptive study and a Phenomenological qualitative study. We will use a self-administered online questionnaire (System Usability Scale), to measure the system usability with the healthcare information system (TrackCare) among healthcare providers at SBAHC. Also, we will use faceto-face semi-structured interviews with open-ended questions to identify the negative and positive aspects affecting users’ usability of the TrackCare information system among the clinical users at SBAHC. Sample Size: (Instructions: mention the input criteria for sample size estimation.) • The number of clinical staff working in SBAHC is 996. By using an online calculator named calculator.net, available at https://www.calculator.net/sample-size-calculator.html with the following parameters: • Population size = 996. • The margin of error is 5%. • Confidence Interval is 95%. • Population proportion 50%. Thus, the estimated sample size is ≥ 278. Sampling Technique: (Instructions: mention the sampling technique, (e.g., randomization) that will be used to obtain a representative sample for your target population.) The sample will be obtained using a non-probability convenience sampling method. The sample will be recruited via email and WhatsApp, with an invitation link to participate in a self-administered online questionnaire. For the interview, it is going to be convince sampling by asking clinical staff (regular users’ level) at SBAHC who is likely to agree to participate in the interview. The sample is going to be 7-15 participants or till reach the saturation. Data Collection methods, instruments used, measurements (Instructions: Describe the instruments used for data collection (questionnaire, observation recording from, etc.), and studied variables included in these instruments, as well as the methods used to test for the validity and reliability of the instrument. Techniques used should be briefly described and referenced. Study definitions [e.g., case definition] should be mentioned. This study will use two methods to accomplish the study objectives. The first method is by using a self-administered online questionnaire. The second method is by using face-to-face interviews. Questionnaire: • The first part of the questionnaire will cover the demographic data Results A total of 263 participants completed the online questionnaire. Majority 192 (73.0%) of participants were aged between 20-40 years; with a predominance of female 161 (61.2%). Regarding the specialty, the medics were distributed almost more or less the same across the specializations with considerable majority 86 (32.7%) being therapists. The vast majority 260 (98.9%) of the medics had a full-time contract with more than half 201 (76.4%) having more than 2 years’ work experience at Sultan Bin Abdulaziz Humanitarian City (SBAHC). Table 1: Socio-demographic information of the Participants (N=263) Socio-demographic information Category Frequency and proportion n (%) Age 20-30 years 96 (36.5%) 31-40 96 (36.5%) 41-50 51 (19.4%) 51-60 19 (7.2%) 60+ years 1 (0.4%) Female 161 (61.2%) Male 102 (38.8%) Physician 32 (12.2%) Nursing 63 (24.0%) Therapists 86 (32.7%) Pharmacists 22 (8.4%) Radiologist 18 (6.7%) Laboratory specialists 17 (6.5) Others 25 (9.5%) Full-time 260 (98.9%) Part-time 3 (1.1) Less than 1 year 23 (8.7%) 1-2 years 39 (14.8%) More than 2 years 201 (76.4) Gender Specialty Contract type Work experience at SBAHC Socio-demographic information presented in frequencies (n) and proportion (%) Table 2 presents the acceptance level of healthcare information system expressed in terms of system usability scale. Majority 54 (20.5%) and 50 (19.0%) of the participants strongly agreed and agreed that they would like to use TrakCare frequently. 84 (32.0%) of the participants accepted that they believed that TrakCare was easy to use; 86 (32.7%) of the participants indicated that most people would learn to use TrakCare very quickly. Additionally, 113 (42.9%) of the participants accepted that they felt very confidents using the TrakCare. However, 80 (30.4%) of the participants noted that they found the TrakCare unnecessarily complex; with 92 (35.0%) of them indicating that they needed to learn a lot of things before they could get going with TrakCare. Table 2: System Usability Scale (SUS) Strongly disagree (1) (2) (3) (4) Strongly Agree (5) I think that I would like to use TrakCare frequently I found the TrakCare unnecessarily complex I thought the TrakCare was easy to use 18 (6.8%) 65 (24.7%) 76 (28.9%) 50 (19.0%) 54 (20.5%) 49 (18.6%) 61 (23.2%) 73 (27.8%) 64 (24.3%) 16 (6.1%) 23 (8.7%) 70 (26.6%) 86 (32.7%) 57 (21.7%) 27 (10.3%) I think that I would need the support of a technical person to be able to use TrakCare I found the various functions in the TrakCare were well integrated I thought there was too much inconsistency in this TrakCare Imagine that most people would learn to use TrakCare very quickly 54 (20.5%) 85 (32.3%) 54 (20.5%) 40 (15.2%) 30 (11.4%) 23 (8.7%) 85 (32.3%) 86 (32.7%) 48 (18.3%) 21 (8.0%) 27 (10.3%) 79 (30.0%) 88 (33.5%) 49 (18.6%) 20 (7.6%) 40 (15.2%) 73 (27.8%) 64 (24.3%) 59 (22.4%) 27 (10.3%) I found the TrakCare very awkward to use I felt very confident using the TrakCare 60 (22.8%) 84 (31.9%) 73 (27.8%) 32 (12.2%) 14 (5.3%) 12 (4.6%) 60 (22.8%) 78 (29.7%) 69 (26.2%) 44 (16.7%) I needed to learn a lot of things before I could get going with TrakCare 29 (11.0%) 84 (31.9%) 58 (22.1%) 63 (24.0%) 29 (11.0%) Statement System Usability Scale presented in frequencies (n) and proportion (%) Table 3 below illustrates the statements on acceptability level of healthcare systems expressed in terms of means and standard deviation. Majority of the statements had a mean >2.5 which indicated a shift towards agreement on the statements regarding healthcare systems. The results found the statement on participants feeling very confident inn using TrakCare had the highest mean 3.28± 1.68 while the statements that participants found the TrakCare very awkward to use had the lowest mean 2.45± 1.42. Table 3: Statements on acceptability levels of Healthcare system Statement I think that I would like to use TrakCare frequently I found the TrakCare unnecessarily complex I thought the TrakCare was easy to use Mean SD 3.22 2.76 2.98 1.62 1.53 1.59 I think that I would need the support of a technical person to be able to use TrakCare I found the various functions in the TrakCare were well integrated I thought there was too much inconsistency in this TrakCare Imagine that most people would learn to use TrakCare very quickly 2.63 2.84 2.83 2.85 1.44 1.65 1.63 1.66 I found the TrakCare very awkward to use I felt very confident using the TrakCare I needed to learn a lot of things before I could get going with TrakCare 2.45 3.28 2.92 1.42 1.68 1.57 Statements on acceptability level of healthcare system presented in Mean and standard deviation Table 4 presents the association between demographic information and level of acceptance of healthcare systems among the participants. The results found a significant association between the level of level of healthcare system and specialty, contract type and work experience at Sultan Bin Abdulaziz Humanitarian City with (p-value is 0.05). Table 4: Association between demographic information and acceptability level of healthcare systems Characteristics Category Age 20-30 years 31-40 41-50 51-60 60+ years Score P-value 3.12 ±1.36 3.02 ± 1.42 2.64 ± 1.33 2.65 ± 1.72 2.54 ± 1.64 0.074 Gender Female 3.22 ± 1.68 0.421 Male 2.98 ± 1.56 Specialty Physician 3.61±1.19

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