i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 8 4 ( 2 0 1 5 ) 166–188 journa l h omepage: www.ijmijournal.com Organizational decision to adopt hospital information system: An empirical investigation in the case of Malaysian public hospitals Hossein Ahmadi, Mehrbakhsh Nilashi * , Othman Ibrahim Faculty of Computing, Universiti Teknologi Malaysia, UTM Skudai, 81310 Johor, Malaysia a r t i c l e i n f o Article history: Received 1 October 2014 Received in revised form 11 December 2014 Accepted 26 December 2014 Keywords: Public hospital Hospital information system Adoption Organizational decision Human-Technology-Organization- Environment Multi-Criteria Decision Making a b s t r a c t Objectives: This study mainly integrates the mature Technology-Organization-Environment (TOE) framework and recently developed Human-Organization-Technology (HOT) fit model to identify factors that affect the hospital decision in adopting Hospital Information System (HIS). Methods: Accordingly, a hybrid Multi-Criteria-Decision-Making (MCDM) model is used to address the dependence relationships of factors with the aid of Analytic Network Processes (ANP) and Decision Making Trial and Evaluation Laboratory (DEMATEL) approaches. The ini- tial model of the study is designed by considering four main dimensions with 13 variables as organizational innovation adoption factors with respect to HIS. By using DEMATEL, the inter- dependencies strength among the dimensions and variables are tested. The ANP method is then adopted in order to determine the relative importance of the adoption factors, and is used to identify how these factors are weighted and prioritized by the public hospital pro- fessionals, who are wholly familiar with the HIS and have years of experience in decision making in hospitals’ Information System (IS) department. Results: The results of this study indicate that from the experts’ viewpoint “Perceived Tech- nical Competence” is the most important factor in the Human dimension. In the Technology dimension, the experts agree that the “Relative Advantage” is more important in relation to the other factors. In the Organization dimension, “Hospital Size” is considered more important rather than others. And, in the Environment dimension, according to the experts judgment, “Government Policy” is the most important factor. The results of ANP survey from experts also reveal that the experts in the HIS field believed that these factors should not be overlooked by managers of hospitals and the adoption of HIS is more related to more consideration of these factors. In addition, from the results, it is found that the experts are more concerned about Environment and Technology for the adoption HIS. Conclusions: The findings of this study make a novel contribution in the context of healthcare industry that is to improve the decision process of innovation in adoption stage and to help enhance more the diffusion of IS in the hospital setting, which by doing so, can provide plenty of profits to the patient community and the hospitals. © 2015 Elsevier Ireland Ltd. All rights reserved. ∗ Corresponding author. Tel.: +60 197608281; fax: +607 5531147. E-mail addresses: nilashidotnet@hotmail.com, nilashidotnet@yahoo.com (M. Nilashi). http://dx.doi.org/10.1016/j.ijmedinf.2014.12.004 1386-5056/© 2015 Elsevier Ireland Ltd. All rights reserved.