Hospital readiness for implementation of health information system in public hospitals in Iraq: A mixed method approach.

Abstract

Hospital Information Systems (HIS) are becoming increasingly vital to the digital transformation of healthcare; nevertheless, their implementation in low and middle-income countries is frequently obstructed by structural, financial, and governance issues. In Iraq, the extensive adoption of HIS is still at an early stage, with limited empirical evidence concerning institutional readiness. This study thus examined the organizational readiness for HIS implementation in the public hospitals located in Al-Amara, Iraq, and identified the structural and organizational determinants that shaping this readiness. An explanatory sequential mixed-methods study was conducted across four public hospitals. Quantitatively, 100 of 125 eligible healthcare professionals and administrators completed a nine-domain, three-point readiness instrument adapted from the Organizational Capacity Assessment Tool (response rate = 80 %; CVI = 0.84; CRV = 0.75; α = 0.929). Qualitative data was collected using semi-structured interview with 65 purposively recruited participants and analyzed drawing on, thematic analysis and validated by expert panel techniques. Overall hospital readiness to HIS implementation was low to moderate, with the strongest performance in infrastructure and governance and major gaps in implementation planning, financial preparedness, and data management. Hospital affiliation was the most influential readiness factor, followed by bed capacity, electronic system use, and decision-making involvement, while demographic and professional characteristics showed no meaningful associations. Key barriers included fragmented infrastructure, financial instability, insufficient staff training, weak governance, and reliance on paper-based processes, although staff expressed cautious optimism about the benefits of HIS. The readiness for HIS in Al-Amara hospitals is mainly constrained by institutional and structural challenges, most notably unequal infrastructure across hospitals, rather than resistance to change. Therefore a sustainable implementation requires coordinated investments in infrastructure, financing, governance, and workforce development tailored to each hospital's specific needs rather than uniform system-wide solutions.