Introduction
The hospital information system (HIS) is one of the most widely used health information systems. Hospitals are among the most important centers providing healthcare services and require well-designed information systems to manage and control information [2]. Health information technology is recognized as one of the most important tools for improving the quality, efficiency and effectiveness of health services [3]. The implementation of information and communication technology has a significant impact on health service processes and outcomes [4]. These technologies enhance the quality of services in the health sector, specifically in clinical medicine and hospitals, to increase patient safety, staff efficiency and effectiveness, while also reducing organizational costs.
Since individual, organizational and technological characteristics are the main factors influencing the acceptance of the HIS system by personnel, the importance of this system is evident from its role in maintaining various types of data, including key information about patients, such as recording all medical services provided, including examinations, diagnoses, treatments, follow-up reports, and important medical decisions [12]. Therefore, the present study was conducted in a government hospital affiliated with the Guilan University of Medical Sciences in Rasht, where HIS has been deployed to achieve the aforementioned goals. The primary objective of deploying this system is to improve the quality of services provided. Consequently, this study aimed to identify factors affecting the acceptance of the HIS by users in government university centers in Rasht city.

Methods 
This cross-sectional study was conducted in eight government hospitals in Rasht in 2023. The studied population consisted of the HIS staff from eight teaching hospitals of Guilan University of Medical Sciences. According to the study by Chen et al. [14] and considering the correlation formula with a 95% confidence interval (CI) and a Z value of 1.96, the sample size was determined to be 131 individuals who were selected using available sampling.
The data were collected using a questionnaire based on the study by Chen et al. [14], which consisted of two parts: the first part contained demographic information about the individuals, while the second part included questions related to the level of acceptance of HISs.
All items were evaluated for the content validity ratio (CVR) and received a score of 0.78, while the content validity index (CVI) was calculated to be 0.8 for simplicity, relevance, and clarity, which is acceptable for a 10-person panel based on the Lawshe method. The validity of the questionnaire was assessed using the content validity method and was examined and confirmed by 20 subjects. The results of the Cronbach’s α coefficient for the questionnaire items were calculated to be 0.77. In this study, both structural equation modeling (SEM) and path analysis, which have a confirmatory approach, were employed using SPSS software, version 25 and PLs software, version 3.

Results 
Before testing the hypotheses, the normality of the data distribution was first assessed using the Kolmogorov-Smirnov test. The test results indicated that the data did not follow a normal distribution, given the significance level of less than 5% for the variables. For this reason, PLS software was utilized to test the research objectives. To determine the fit of the measurement model, three criteria—reliability, convergent validity and divergent validity—were employed. Composite reliability and Cronbach’s α were used to measure reliability. AVE values (>0.5), along with composite reliability values and Cronbach’s α values >0.7, confirmed convergent validity and the proper fit of the model. For divergent validity, the Fornell-Larcker analysis (1981) was used, which indicated that each construct had a higher correlation with itself than with other constructs.
To evaluate the fit of the structural model, the R² coefficients indicated that the fit of perceived ease of use, perceived usefulness and the level of HIS acceptance were at a good level. Additionally, according to the redundancy criteria recommended by Hensler et al. (2009), categorized as weak, medium, and strong for predicting the structural model, the structural model of the present study was shown to be appropriate and strong. The overall fit of the model was assessed using three values of 0.01, 0.25, and 0.36 for the overall fit index of the model (GOF), resulting in a GOF value of 0.700, which indicates an appropriate model fit when calculating the variance inflation factor (VIF). Furthermore, the SRMR, for which the acceptable limit is 0.1, confirmed the appropriate fit of the model. 
After testing the outer model and confirming the validity and reliability of the measurement model, the research hypotheses could be examined using the internal model. For this purpose, the t-statistic and path coefficients were utilized, which were found to be significant according to the PLS algorithm, as depicted.
To confirm the hypotheses and objectives of the partial index, the value of the t-statistic, should be >1.96 or l<-1.96. A value of the parameter within these two ranges indicates that the calculated values for the regression weights are not significant, meaning they are not different from zero at the 95% confidence level. Therefore, the path coefficients for team competence, information quality, and perceived usefulness with respect to system acceptance were determined to be 0.164, 0.420, and 0.172, respectively, and were all statistically significant and validated.

Conclusion 
In this study, information quality and system quality are two components of technological characteristics and are among the factors that affect the perception of usefulness, which in turn influences the acceptance of the HIS. Therefore, these two factors had a positive effect on the acceptance of the information system in Hefdah Shahrivar Hospital, Al-Zahra Hospital, Poursina Hospital, Amiralmomenin Hospital, Shafa Hospital, Velayat Hospital, Razi Hospital and Heshmat Hospital. 
Since the present study was conducted at the level of provincial hospitals to also consider the opinions of users in other cities, the role of organizational culture in the acceptance of HIS in the hospitals under study should be addressed in future research. Additionally, the acceptance of the HIS system in public and private hospitals should be compared. 
On the other hand, in the present study, the software used at the hospital level was a windows application. It is recommended that a web-based HIS be utilized to facilitate the use of the HIS by users. In addition to the features and benefits of the Windows application, patient data can also be recorded in the HIS system via a web browser. Users can easily record patient information in the shortest possible time without having to log in and out of the HIS software multiple times, which helps maintain the confidentiality of information and improves data recording efficiency. 
Furthermore, hospital information technology experts will be able to enable users to record data offline during communication interruptions (such as internet outages). Since the Windows application does not allow the HIS software to connect to basic insurance systems and to update drug amounts and insurance coverage, users inevitably have to manually record these processes. Failure to update drug amounts in the patient file promptly can lead to medication deductions. Therefore, by using web-based software, this issue will be eliminated, and access to the basic insurance system will be automatic. 
Additionally, due to the postponement of the implementation of various instructions, such as first-year tariffs for inpatient and outpatient services, nursing, and the efficient tariff plan (resulting from the delay in updating the Windows application by the company supporting the HIS software), the expected output of information from the HIS software should align with its input data recording. However, this alignment often does not exist or is accompanied by issues. Therefore, if web-based software is utilized, the time required for updating the HIS software through support companies will be reduced.
It is suggested that the patient information archive be defined in the form of standard medical groups to allow access by other government organizations or authorities (such as forensic medicine, law enforcement, etc.), facilitating electronic access to patient information and eliminating the need for in-person visits to obtain a copy of the file or CD. Additionally, access to electronic patient record information for treatment, education, and research users will be enhanced.
By providing appropriate platforms for access and improving learning capabilities in individuals, authorities can increase user satisfaction and commitment to their work. Therefore, upgrading the HIS will save time and enhance the quality of services provided in healthcare departments.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Guilan University of Medical Sciences, Rasht, Iran (Code: IR.GUMS.REC.1401.349).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interpretation of the results, and drafting of the manuscript. Each author approved the final version of the manuscript for submission.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
The authors would like to thank the Honorable Vice Chancellor for Research of Guilan University of Medical Sciences for their cooperation in conducting the study.

References

1. Ebnehoseini Z, Tabesh H, Deldar K, Mostafavi SM. Determining the Hospital Information System (HIS) Success Rate: Development of a new instrument and case study. Journal of Medical Sciences. 2019; 7(9):1407-14. [DOI:10.3889/oamjms.2019.294] [PMID]
2. Mirzaei A, Shanbehzadeh M. [Evaluation of Hospital Information System (HIS) in selected hospital of Ilam University of Medical Science (Persian)]. Technology and Research Information System Ilam university of Medical Sciences. 2019; 1(4). [Link]
3. Sun J, Qu Z. Understanding health information technology adoption: A synthesis of literature from an activity perspective. Information Systems Frontiers. 2015; 17:1177-90. [DOI:10.1007/s10796-014-9497-2]
4. Rahimi B, Nadri H, Lotfnezhad Afshar H, Timpka T. A systematic review of the technology acceptance model in health informatics. Applied Clinical Informatics. 2018; 09(03):604-34. [DOI:10.1055/s-0038-1668091] [PMID]
5. Nadri H, Rahimi B, Lotfnezhad Afshar H, Samadbeik M, Garavand A. Factors affecting acceptance of hospital information systems based on extended technology acceptance model: A case study in three paraclinical departments. Applied Clinical Informatics. 2018; 9(2):238-47. [DOI:10.1055/s-0038-1641595] [PMID]
6. Garavand A, Samadbeik M, Kafashi M, Abhari S. Acceptance of health information technologies, acceptance of mobile health: A review article. Journal of Biomedical Physics Engineering. 2017; 7(4):403-8. [PMID]
7. Mokhtari S, Eskandari S, Ayazi Z. [Operators' performance evaluation on the hospital information system about the deductions of educational and medical Hajar hospital in 2012 (Persian)]. Journal of Shahrekord University of Medical Sciences. 2014, 15:86-91. [Link]
8. Rahmanipour A, Tabeli H, Shikhi A. [The mediating role of employee information literacy in the relationship between managers' communication skills and employees' acceptance of information technology (Persian)]. Journal of New Research Approaches in Management and Accounting. 2021; 4(15):12-26. [Link]
9. Zare Fazlollahi Z, Tamjid S, Rahimi B. [Utilization of information technology by clinical residents in Urmia University Hospitals (Persian)]. Health Information Management. 2013; 10(2):1-9. [Link]
10. Raadabadi M, Mobaraki H, Nazari A, Bakhteyari M. [Investigations the functional indicators change due to implementation information system in Sina hospital (Persian)]. Journal of Shahrekord University of Medical Sciences. 2013, 15(5):90-6. [Link]
11. Sun Y, Wang N, Guo X, Peng Z. Understanding the acceptance of mobile health services: A comparison and integration of alternative models. Journal of Electronic Commerce Research. 2013; 14(2):183-200. [Link]
12. Khalifa M, Alswailem O. Hospital Information Systems (HIS) acceptance and satisfaction: A case study of a Tertiary Care Hospital. Procedia Computer Science. 2015; 63:198 - 204. [DOI:10.1016/j.procs.2015.08.334]
13. Yusof, M, Ahmed Y, Azizatul Y. Evaluating E-government system effectiveness using an integrated socio- technical and fit approach. Information Technology Journal. 2013; 12(5):894-906. [DOI:10.3923/itj.2013.894.906]
14. Chen RF, Hsiao JL. An investigation in physicians' acceptance of hospital information systems: A case study. International Journal of medical Information. 2012; 81(12):810-20. [DOI:10.1016/j.ijmedinf.2012.05.003] [PMID]
15. Mohammadi S. [Structural analysis the effect of organizational silence & voice on job engagement and organizational health of female nurses (Persian)]. Women in Development and Politics. 2021; 18(4):601-17. [DOI:10.22059/jwdp.2021.315084.1007930]
16. Shahzad K, Jianqiu Z, Sardar T, Hafeez M, Shaheen A, Wang L. Hospital information-system (HIS) acceptance: A physician's stance. Human Systems Management. 2019; 38:159-68.  [DOI:10.3233/HSM-180415]
17. Rashidi Z, Orakifar N, Neisi A. [Evaluation of hospital information system acceptance from the point of view of users of teaching hospitals of Ahvaz Jundishapur University of Medical Sciences according to the information technology usage model (Persian)]. Jundishapur Journal of Medical Sciences. 2023; 22(2):193-202. [DOI:10.32592/JSMJ.22.2.193]
18. Hayavi Haghighi MH, Alipour J. [Evaluating the acceptance of the hospital information system from the users' point of view according to the model of using information technology (Persian)]. Journal of Modern Medical Information Sciences. 2020; 6(3):1-7. [DOI:10.29252/jmis.6.3.1]
19. Baratpour M, Mehraeen E, Bagheri S, Azarpouyeh M, Parvin S. [Factors affecting hospital information system acceptance by nurses based on the technology acceptance model (ATM) (Persian)]. Nursing and Midwifery Journal. 2017; 15(1):27-36. [Link]
20. Kamal SA, Shafiq M, Kakria P. Investigating acceptance of telemedicine services through an extended technology acceptance model (TAM). Technology in Society. 2020; 60:101212. [DOI:10.1016/j.techsoc.2019.101212]
21. Granić A, Marangunić N. Technology acceptance model in educational context: A systematic literature review. British Journal of Educational Technology. 2019; 50(5):2572-93. [DOI:10.1111/bjet.12864]
22. Mberi M, Kekwaletswe R. A model for acceptance and use of health information systems for South African health practitioners. International Journal of Innovative Science and Research Technology. 2020; 5(6):1296-130. [Link]
23. AlQudah A, Al-Emran M, Shaalan Kh. Technology acceptance in healthcare: A systematic review.  Applied Sciences. 2021; 11(22):10537. [DOI:10.3390/app112210537]