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International Journal of Medical Research &
Health Sciences, 2018, 7(5): 76-82
76

ISSN No: 2319-5886
E-health and its Transformation of Healthcare Delivery System
in Makkah,
Saudi Arabia
Tabrez Uz Zaman1*, Taher Mohammed Abdul Raheem2,
Ghassan Majed Alharbi3,
Moenes Faisal Shodri3, Ahmad Hamza Kutbi3, Sultan
Mohammed Alotaibi3 and
Khalid Salem Aldaadi3
1 Lecturer, Department of Health Information Management and
Technology, Faculty of Public
Health and Health Informatics, Umm Al Qura University,
Makkah Al Mukarrama, Saudi Arabia
2 Assistant Professor, Department of Health Information
Management and Technology, Faculty
of Public Health and Health Informatics, Umm Al Qura
University, Makkah Al Mukarrama,
Saudi Arabia
3 Interns, Department of Health Information Management and
Technology, Faculty of Public
Health and Health Informatics, Umm Al Qura University,
Makkah Al Mukarrama, Saudi Arabia
*Corresponding e-mail: [email protected]
ABSTRACT
Introduction: E-health is relatively a recent term and can be
shuffled with health informatics. It engulfs all forms of
digital and electronic processes found in healthcare provided
via information and communication technology (ICT)

channels. This study is an attempt to find out the level of
utilization and effectiveness of e-health in Saudi Arabia due
to the vast number of citizens, residents and pilgrims dependent
on the present healthcare system. Aim: 1. To assess
the utilization status of electronic health (e-health) in Makkah
city hospitals. 2. To measure the usefulness of e-health
in delivering good healthcare in Saudi Arabia. 3. To find out the
challenges cum barriers in implementing e-health
services in Saudi Arabia. Methods: A randomized study was
carried out in three important hospitals in the Makkah
Region. The entire number of samples collected for this study
was 51. They belong to the administrative and medical
staff in the hospitals and comprise of those staff who handle the
daily operations of delivering healthcare services to
the patients. Results: The hospitals - King Abdullah Medical
City (KAMC), King Faisal Hospital (KFH) and Al Noor
Specialist Hospital are using e-health but in different capacities.
The main challenges are the costs and expertise
of such innovative systems in information technology apart
from the lack of computer and technical expertise of
the hospital staff. Conclusion: E-health is widely used
nowadays and is playing a dynamic and modern role in the
delivery of healthcare in Saudi Arabia. This study brings out the
e-health utilization and application in the health
sector. It has exhibited that most of the clinical departments are
utilizing e-health at an optimum level.
Keywords: E-health, Healthcare delivery, Information and
Communication Technology, Challenges, Barriers
INTRODUCTION
E-health is relatively a recent term and can be shuffled with
health informatics. It engulfs all forms of digital and
electronic processes found in healthcare provided via
information and communication technology (ICT) channels

[1]. It ranges from informational, educational and commercial
services to shortest facilities presented by healthcare
organizations, professionals, and consumers themselves. Simply
stated, e-health is creating healthcare extra sufficient
and efficient, while allowing professionals and patients to enter
and manage data in ways that were earlier quite
impossible. The execution of information and communications
technology (ICT) in healthcare has taken a frontline
in the last 15 years. Its ability and flexibility to improve
usefulness and effectiveness have been recognized by
governments worldwide [2]. National strategies have been
noticed in Europe, Australia, North America, Middle East
and elsewhere and the aim of these strategies is to develop
health information infrastructures and “info structures”.
In addition, these strategies provide the standards and policies
for ensuring interoperability and data security [2].
Zaman, et al. Int J Med Res Health Sci 2018, 7(5): 76-82
77
Kadhim, et al.
Saudi Arabia has a population of approximately 31.7 million
with 3.2% growth rate and spread over 2,150,000
million km2. KSA has a total number of 548 hospitals with
overall 82,594 beds distributed across different cities and
provinces. The kingdom has high importance for followers of
Islam all around the globe. It is also the most important
Islamic destination for pilgrimage. Saudi Arabia represented by
the Ministry of Health (MOH) has dedicated vast
funds to enhance national healthcare services with the goal of
offering quality healthcare services to the citizens
and residents and expanding the coverage at the same time [3].

This study is an attempt to find out the level of
utilization of e-health in Saudi Arabia given the vast number of
citizens, residents and pilgrims dependent on the
present healthcare system. The e-health works to expand the
medication safety by minimizing medication errors
arising out of handwritten prescription orders. It augments
robust communication towards patient health [1]. This
study will help us to understand whether e-health was indeed
useful in delivering good healthcare in Saudi Arabia.
E-health helps in the prompt delivery of information around the
organization, dropping turnaround time in delivery
of medication, tracking down patients and processing lab work,
carrying out radiology exams and standardizing other
tasks [4,5]. The knowledge, health data, and information can
also be pooled to support research in public health at a
wide national level [1]. The electronic health records have been
increasingly adopted by Saudi hospitals across the
country. Although all e-health applications have a promising
future for Saudi Arabia, quite a lot of challenges also
exist in the organizational and technical level to implement the
e-health initiatives. This study also attempts to assess
the e-health status in the kingdom by determining the challenges
and barriers. It will also try to analyze the influence
of e-health on the new Saudi Arabian 2030 vision [6].
Aims of the study1.
To assess the utilization status of electronic health (e-health) in
Makkah city hospitals.
2. To measure the usefulness of e-health in delivering good
healthcare in Saudi Arabia.
3. To find out the challenges cum barriers in implementing e-
health services in Saudi Arabia.

METHODS
Study design
The current study was a prospective randomized study done in
three hospitals in the Makkah Region. Saudi Arabia
is made up 13 administrative regions. Each region has a number
of Ministry of Health hospitals depending upon the
healthcare requirements in that particular region. But the point
to be noted here is that the holy Makkah city has a
very high patient turnout consisting of pilgrims, citizens, and
residents. There is also a constant flow of pilgrims from
different countries all throughout the year. First of all we made
two broad stratifications of government and private
hospitals for the present study [7].
Inclusion and Exclusion Criteria: We selected those hospitals in
the Makkah region who were utilizing e-health
for providing healthcare to the population. E-health was not
utilized in the private hospitals as the implementation
required a high cost and they were not funded directly by the
Ministry of Health. So, the private hospitals were
excluded from the present study. So, we were left with only
seven government hospitals in holy Makkah city who
utilized e-health to deliver healthcare to their population.
Sampling
We selected a random sample of three hospitals namely King
Abdullah Medical City (KAMC), Al-Noor Specialist
Hospital and King Faisal Hospital (KFH). These three hospitals
are important Ministry of Health hospitals in Makkah
region with a high patient turnout.
Sample Size

The number of samples selected for this study was 51. It
comprised of the medical and administrative staff of the
hospitals who were handling the daily operations to deliver
healthcare services to the patients.
2.
3.
1.
78
Kadhim, et al.
Research Tools Used
The appropriate tool for this study was a pretested survey
questionnaire. The questionnaire aims to check the e-health
strategies, the implementation, and the utilization at these
hospitals. The different kinds of e-health applications used
the effectiveness in the patient care and effect on the quality of
services and finally the challenges and barriers in
implementation of e-health in these hospitals. Furthermore, it
will help us to get the perceptions of the staff towards
the acceptability and implantation of new software’s and
applications of e-health. The staff who participated in this
study was mostly healthcare professionals from the clinical
field, administration and health information management
departments. The data collected from different departments in
these hospitals was evaluated and analyzed for
percentage of utilization and the effectiveness in improving the

healthcare system. Also, the perception of the staff
in implementing the e-health was analyzed. SPSS version 19
was used for analyzing the data and finding the results.
Use of Technology
With regards to the electronic concept, the technology used for
this study was a tablet with assisted online survey
software. This software would facilitate the answering of the
questionnaire by the healthcare professionals. The
reason behind using this software was to increase the quality of
data entered and to review the answers with high
precision thus dropping the chances of errors in filling the
questionnaire [8,9].
Bias
The potential bias would have been approaching only the
technical staffs of different departments in the hospital
who were dealing with the e-health applications. This bias was
controlled by selecting healthcare professionals from
different fields like clinical, administration and health
information management departments who worked in the
hospitals.
RESULTS
It was found that all the three-selected used e-health in different
capacities. It was found that different applications of
e-health were used in these hospitals by the staff and it varied
for the three different hospitals depending on the patient
turnout and specialty of the hospital.
Figure 1 Utilization e-health in the selected hospitals (health
information management systems, electronic health records,
e-prescribing, etc.)

The perception percentage of e-health systems utilization in
Makkah city hospitals showed that most of the hospitals
use the e-health system. KAMC uses the electronic health
system and electronic concept as an adopted approach
and 98% of the departments utilized e-health. King Faisal
Hospital (KFH) adopted the e-health system in around
96% of the departments. Al Noor general hospital used e-health
system which is 76.9% as it is still implementing
new applications of e-health. We found that Al Noor general
hospitals’ utilization of e-health needs a boost and it is
significantly lower as compared to the other two hospitals.
(Figure 1).
79
Kadhim, et al.
Figure 2 Electronic health records (EHR) utilization based on
the kingdom’s e-health strategy
The perception percentage in the bar chart shown in the Figure
2 shows that 3.9% have disagreed with the use of EHR
according to the kingdom’s e-health strategy, 5.9% remain
undecided, 39.2% have agreed, and 51% have strongly
agreed with using EHR as part of an e-health strategy in
hospitals respectively. The disagreed percentage is not
significant.
Figure 3 Implementation of e-health and improvement of
healthcare delivery system in Saudi Arabia

The above data plotted in Figure 3 as a bar chart indicates the
extent of the implementation of e-health on the healthcare
delivery system in Saudi Arabia. We found out that 29.4% and
39.2% of healthcare professionals have agreed and
strongly agreed with the fact that the implementation of e-health
has improved the healthcare delivery system,
but 27.5% couldn’t decide whether the implementation has
indeed improved the healthcare system. Finally, 3.9%
disagreed that e-health implementation has improved the
healthcare delivery system and it is not very significant.
Figure 4 Difficulties in implementation of e-health in the
hospitals
80
Kadhim, et al.
The above pie chart expresses the percentage of health
professionals who faced difficulty while implementing E-health
system in the hospital. The principal percentage was the neutral
segment that constituted 43.1%, meaning that they
faced a balance of difficult and good times during
implementation owing to lack of training and expertise in these
applications and also the language as most of the speakers are
Arabic, while the least percentage constituted 7.8% who
said that the implementation was easy. 35.3% said that it was a
difficult option and 13.7% said it was very difficult to
implement e-health in the hospitals.
Figure 5 Perception of acceptability of e-health among

employees
The perception among the participants about acceptance of
employees for e-health in the hospitals is depicted in
Figure 5. It is shown above that 35% of the participants agree
that there has been adequate acceptance for e-health in
the hospitals between employees. A 31% are neutral and they
have accepted the e-health system but were not very
happy with their performance, 20% of employees found the
implementation as unacceptable and 4% do not accept
the e-health system at all. Overall, there is acceptance of the e-
health system but implementation is not complete
as a result the employees have problem in acceptability. Also,
training and skills of the employees are also areas of
concern for operating the e-health applications.
DISCUSSION
In this study, the researchers found that the current utilization
status of e-health system in Makkah city hospitals
is satisfactory. The hospitals King Abdullah Medical City
(KAMC) and King Faisal Hospital (KFH) are using the
e-health applications at their maximum capacities. Al Noor
general hospital is little behind in the implementation and
utilization of e-health. Most of the departments like department
of medical records, information technology department,
pharmacy department, laboratory, ICUs, appointment and
reception departments as well as other clinical departments
have e-health utilization. But not all the hospitals have
converted from paper medical records to electronic health
records. There is partial implantation of some of the aspects of
the EHR. This study also found out the implementation
and utilization of e-health following the country’s strategy for
achieving complete e-health utilization in the Saudi
Arabian Vision 2030. According to Altuwajiri’s research
published in 2008 e-health implementation benefits the

patient in providing better patient care in the hospitals [10].
E-health plays a substantial role in saving a patient’s life,
reducing physician misunderstanding or errors that will
also reflect the patient health [11]. On the other hand, with
regards to management, e-health is supporting a smooth
and gradual movement of information around an organization,
helping a hospital to achieve a paperless concept with
reduced time for healthcare delivery. This study found that e-
health is also playing a vital role in improving healthcare
services by providing appropriate tools e.g. telehealth,
telemedicine, PACS, e-prescribing, EMR, etc. This is consistent
with a study done to find out how telehealth can empower
patient care through the adapting the information and
communication technology for healthcare purposes [12]. This
finding of the study can also be supported by WHO’s
ranking of the healthcare services in Saudi Arabia as 26th in the
world and 2nd in the Gulf Cooperation Council (GCC)
and the Middle East [13].
Challenges and barriers were also a part of the study objectives.
This study tried to find the reason or the gap which is
81
Kadhim, et al.
an impediment to achieving complete implementation of e-
health. In many developing countries, we find that the main
challenges were implementing the e-health system, the training
and skills available with the staff, perceptions about
the e-health system and so on. In our study we found the staff

had difficulties in implementation and acceptability of
e-health systems. This can be attributed to lack of training and
supervision in these departments. Some studies have
also highlighted that the technical and computer expertise of the
hospital staff affect the level of implementation
and utilization of e-health [14-16]. The key issues to be
addressed prior to execution of any systems for hospital
information are the technical skills and expertise of the
healthcare professionals [15]. The main social barriers are lack
of computer literacy and resistance to use the new system. The
language issue is another identified barrier to EMR
implementation in Saudi Arabia. The reason is that Arabic is the
first language and the systems implemented here are
mostly in English.
Some of the above stated barriers had not been previously
identified in the Kingdom of Saudi Arabia. A wide variety
of research articles on these barriers have highlighted these
points [16-18]. Both Alanazy’s, et al., in 2014 shows that
the implementation barriers were apparent despite the two
studies occurring in different time periods as well as in
different geographical arrears (the central region in 2006 and
western region in 2010, respectively) [4,5]. Khalifa’s
research done in 2013 identified the barricades to Health
information systems (his) and electronic medical records’
implementation as human barriers, financial barriers, regulatory
and legal barriers, technical barriers and organizational
barriers [19]. However, this study could not measure the
satisfaction level of the staff using these applications.
Further, this study highlights some solutions to solve this
problem. The health information management and
technology professionals can manage the e-health systems in a
better way given the fact that they study a wide variety
of courses relating to this field. The current employees lack the
scientific qualification and required training needed

for this field [20]. The technical and computer expertise of the
hospital staff affect the level of implementation and
utilization of e-health. Therefore, it is essential to incorporate
training courses for increasing the technical knowledge
as well as language education for the staff for better
performance. According to the Vision 2030 of Saudi Arabia,
the government is trying to diversify the country’s oil-
dependent economy. The national transformation program is
promoting efficient conversion of all the important government
agencies and to induce coordination among them to
achieve common national goals [21].
CONCLUSION
E-health is widely used nowadays and plays a dynamic and
modern role in the delivery of healthcare in Saudi Arabia.
This study brings out the e-health utilization and application in
the health sector. It has exhibited that most of the
clinical departments are utilizing e-health at an optimum level.
This study also brought to light that employees face
some challenges and barriers to the implementation of e-health.
Finally, this is paving the way for a new technology-
driven economy which will benefit all the sectors.
DECLARATIONS
Acknowledgement
We express our sincere gratitude to the hospital staff in King
Abdullah Medical City (KAMC), Al-Noor hospital and
King Faisal hospital (KFH) for their constant support and
cooperation during the entire duration of the project. We
would like to thank our Honorable’ Dean- Faculty of Public
Health and Health Informatics, Dr. Wahib Al Harbi for
his constant support during the entire duration of the research
project.

Conflict of Interest
The authors have disclosed no conflict of interest, financial or
otherwise.
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coding systems, frameworks, and infrastructures.
John Wiley & Sons, 2012.
[2] Mitchell, Stacy Alicia, and Ulku Yaylacicegi. “Analysis of
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in Texas Acute Care Hospitals.” Journal of Information Systems
Applied Research, Vol. 6, No. 1, 2013, pp. 49-56.
[3] Abdulwahab Alkhamis, M. S. “Health care system in Saudi
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[4] Hasanain, Rihab, Kirsten Vallmuur, and Michele Clark.
“Progress and challenges in the implementation of
Electronic Medical Records in Saudi Arabia: a systematic
review.” Health Informatics-An International Journal,
Vol. 3, No. 2, 2014.
[5] Alanazy, S. “Factors Associated With Implementation Of

Electronic Health Records In Saudi Arabias.” University
of Medicine and Dentistry of New Jersey, ProQuest, 2006.
[6] General Authority for Statistics. “Population by Gender ,
Age Groups and Nationality (Saudi/Non-Saudi)”. 2018,
[https://www.stats.gov.sa/en/].
[7] https://www.moi.gov.sa
[8] Arnold, Steve, et al. “Electronic Health Records: A Global
Perspective. Overview.” The Healthcare Information
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[9] Ajami, Sima, and Tayyebe Bagheri-Tadi. “Barriers for
adopting electronic health records (EHRs) by physicians.”
Acta Informatica Medica, Vol. 21, No. 2, 2013, pp. 129-34.
[10] Altuwaijri, Majid M. “Electronic-health in Saudi Arabia.
Just around the corner?.” Saudi Medical Journal, Vol.
29, No. 2, 2008, pp. 171-78.
[11] Aldosari, Bakheet. “Rates, levels, and determinants of
electronic health record system adoption: A study of
hospitals in Riyadh, Saudi Arabia.” International Journal of
Medical Informatics, Vol. 83, No. 5, 2014, pp. 330-42.
[12] Zaman, Tabrez Uz, and Akhtar Ali. “Adapting Information
and Communication Technology to Empower
Patients.-.” International Journal of Health Sciences and
Research, Vol. 5, No. 7, 2015, pp. 405-11.
[13] World Health Organization. “Electronic Health Records
Manual for Developing Countries.” World Health
Organization. 2006,
[http://www.wpro.who.int/NR/rdonlyres/5753F8CF-8A78-4639-
BEFCF0EE9B3CBA0A/0/

EHRmanual.pdf].
[14] Alsulame, Khaled, Mohamed Khalifa, and Mowafa Househ.
“E-health status in Saudi Arabia: A review of current
literature.” Health Policy and Technology, Vol. 5, No. 2, 2016,
pp. 204-10.
[15] HASANAIN, Rihab Abdulaziz, and Helen COOPER. “
Solution
s to overcome technical and social barriers to
electronic health records implementation in Saudi public and
private hospitals.” Journal of Health Informatics in
Developing Countries, Vol. 8, No. 1, 2014.
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“Barriers to the widespread adoption of health data
standards: an exploratory qualitative study in tertiary healthcare
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Healthcare Knowledge Management model for
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Mediterranean & Middle Eastern Conference on
Information Systems, 2010.

[18] McNeil, Barbara J., et al. “Computer literacy study: report
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[19] Khalifa, Mohamed. “Technical and human challenges of
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Arabia.” Journal of Health Informatics in Developing Countries,
Vol. 8, No. 1, 2014.
[20] Alakhram, Nasser Ali Ahmed, and Tabrez Uz Zaman. “The
Impact of Managerial Education on the Importance
and Competence of a Job-A Study about the Perceptions of
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Running Head: PROGRAM EVALUATON PLAN FOR
EDUCATION 1

PROGRAM EVALUATON PLAN FOR EDUCATION
6
Program Evaluation Plan for Education
Lauren Klevis
EDU: 571
Professor: Anthony Jacob
October 18th, 2019
In any education set up, a program evaluation plan is necessary

since it provides an excellent roadmap to clarify the steps
required to assess the process and progress of an outcome.
Therefore, the following article gives a useful program
evaluation plan, which is based on anti-bullying in many high
schools. It sets an effective program for anti-bullying in schools
and addresses the following; the elements of a worthy object for
program evaluation, the program’s history, and reasons for
choosing the program. It also gives the advantages for
evaluating the program and the limitations encountered in
conducting the program evaluation.
The Elements for Program Evaluation
The most widely-spread and dangerous type of violence that has
affected many high school students is known as bullying. It
affects the students’ psychological and emotional state and has
resulted in terrible long-term adverse consequences (Ansary,
Elias, Greene & Green, 2015. Therefore, the program evaluation
focuses on anti-bullying as a type of violence that seems to have
grown out of control despite efforts by various parties. The
issues relating to anti-bullying are addressed by the disciplinary
department in the school and headed by the deputy principle.
The target population consists mostly of the victims of bullying
are the newly admitted students aged between thirteen to fifteen
years old. The department for disciplinary actions also forms an
integral source of information for the evaluation program.
The Program’s History, Primary Purpose, Expected Outcomes

First, bullying refers to a type of violence that is initiated by
one or more students against another who becomes the victim. It
includes all forms of physical or psychological intimidation. It
affects many high school students, which led to the formation of
the anti-bullying department. The department receives and
investigates cases of bullying among students. Despite the
efforts of the department, it remains a menace that interferes
with the learning program of many students (Ansary et al.,
2015). Therefore, the program aims at finding out the steps
developed by the anti-bullying department and how efficient
they help reduce cases of school dropouts due to bullying. The
anticipated results are that; accurate and regular measures
would be put in place by every department in charge of anti-
bullying in schools.
Reasons for Choosing the Program
The effects of bullying have, over time, had detrimental acts
that cause psychological, emotional, and physical harassment
among students. As a result, program evaluation is conducted
due to the following reasons. First, the program assesses the
challenges that anti-disciplinary face that limits their efforts to
fight cases of student harassment in schools.
Secondly, it has been selected due to increased incidences of
school drop outs and drug abuse by students. Also, the students
continue to record poor performance, which is attributed to the
lack of appropriate learning environment to enable students to

concentrate on their studies (Policy, 2014). As a result, the
program finds what measures need to be taken before it becomes
worse than it appears.
The third reason for the program evaluation is to determine the
best strategy that schools can implement to end bullying. For
example, by introducing high penalties such as expulsion and
taking legal measures against their parents for not being
responsible for counseling the children. The students expelled
should also be barred from registering in different schools until
they can prove that they have reformed to continue with the
studies (Policy, 2014). Therefore, the program evaluates anti-
bullying methods to make schools become a friendly
environment for learning purposes.
Advantages of Evaluating the Program at this time
First, the program has been designed to ensure that many cases
of student drop out from high schools are reduced. Bullying by
senior students makes the school unbearable to support learning
activities. For example, newly admitted students who cannot
tolerate the act would resolve in drug-taking as a way to avoid
embarrassment. Therefore, the programs aim at creating the best
ways possible strategies that would address the high school
bullying. The plans are developed by working together with the
disciplinary department (Stake, 2013). It is also achieved by

involving other stakeholders such as the parents. They need to
counsel their children against participating in student
harassment.
Secondly, the program is important because it will transform
schools to become friendly learning environments by
eliminating cases of bullying. During admission that marks a
person’s entry in school, there are often great desires and
expectations that each student holds and would want to
accomplish in the course of learning. Students join schools
optimistic that they will achieve their dreams and also meet new
friends. However, after joining, they meet senior students who
intimidate and threaten them (Stake, 2013). As a result, their
positive attitudes towards school and interest in learning change
all of a sudden. Since they and naïve and face constant
intimidation from senior students, their personality about school
gets adversely affected.
Constraints in conducting an evaluation of this program and a
method of addressing them
The assessment of the program has not been easy since it
encountered several oppositions from the key stakeholders to
implement the anti-bullying measures in schools. First, many
parents are not willing to be held responsible when their
children participate in bullying activities. The parents feel that
it is the role of the teachers to ensure that schools become free
from harassment among students (Ansary et al., 2015).

Secondly, there is laxity on the part of the department in charge
of ensuring that the anti-bullying measures are entirely
implemented. The program proposes that until the standards are
enforced consistently, they would not realize the desired
outcomes. Therefore, it calls for co-operation by every party
such as the students themselves, the teachers, and the parents.
Finally, the program lays a strong ground for anti-bullying in
schools. As highlighted above, it is a big challenge for students
that go through it since it interferes with their self-esteem and
leads to the loss of their confidence and, in extreme cases it
causes suicidal feelings that make some succumb to death.
Therefore, the program evaluation has developed a plan that
takes into consideration the cooperation of all stakeholders to
foster a sense of shared purpose for anti-bullying in schools.

References
Ansary, N. S., Elias, M. J., Greene, M. B., & Green, S. (2015).
Bullying in Schools: Research
Has Yet to Precisely Prescribe a Remedy for School
Bullying, but Some Guidelines
Are Emerging to Help Schools Choose Programs
That Best Fit Their Situation. Phi
Delta Kappan, 97(2), 30.
Policy, A. B. (2014). Taxal & Fernilee CE Primary School.
Policy.
Stake, R. E. (2013). The Coutenance of Educational Evaluation.

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