ORIGINAL PAPER

High-Level Managers Considerations for RFID Adoption

in Hospitals: An Empirical Study in Taiwan
Hui-Min Lai & I-Chun Lin & Ling-Tzu Tseng
Received: 12 September 2013 / Accepted: 23 December 2013 / Published online: 21 January 2014
#Springer Science+Business Media New York 2014
Abstract Prior researches have indicated that an appropriate
adoption of information technology (IT) can help hospitals
significantly improve services and operations. Radio
Frequency Identification (RFID) is believed to be the next
generation innovation technology for automatic data collec-
tion and asset/people tracking. Based on the Technology
OrganizationEnvironment (TOE) framework, this study in-
vestigated high-level managers considerations for RFID
adoption in hospitals. This research reviewed literature related
IT adoption in business and followed the results of a prelim-
inary survey with 37 practical experts in hospitals to theorize a
model for the RFID adoption in hospitals. Through a field
survey of 102 hospitals and hypotheses testing, this research
identified key factors influencing RFID adoption. Follow-up
in-depth interviews with three high-level managers of IS
department from three case hospitals respectively also pre-
sented an insight into the decision of RFIDs adoption. Based
on the research findings, cost, ubiquity, compatibility, security
and privacy risk, top management support, hospital scale,
financial readiness and government policy were concluded
to be the key factors influencing RFID adoption in hospitals.
For practitioners, this study provided a comprehensive over-
view of government policies able to promote the technology,
while helping the RFID solution providers understand how to
reduce the IT barriers in order to enhance hospitals willing-
ness to adopt RFID.
Keywords Radio Frequency Identification (RFID)
.
Technology adoption
.
Technology-Organization-Environment (TOE) model
.
Hospitals
Introduction
National Health Insurance (NHI) was established by the
Taiwan Bureau of National Health Insurance (BNHI) in
1995, initially as a fee-for-service reimbursement system. It
has brought changes to hospitals operation ever since its
inception and continued to weighted heavily on hospitals
daily management. Recently, as an attempt to reduce BNHIs
huge deficit, the system was modified into a fixed reimburse-
ment, meaning global budget. This change put hospital man-
ager under greater pressure to keep the cost down. While
keeping cost benefits in check, hospitals have to face a differ-
ent challenge of delivering the best possible services brought
about by the increase awareness of patient rights. By nature,
hospitals are in an information-intensive industry and thus
require to invest in new technologies to maintain or improve
its performance. An increasing number of researches has
indicated that an appropriate adoption of information technol-
ogy (IT) can significantly improve quality and outcome [13].
However, Chang et al. [1] pointed out that not all hospitals
adopt IT without hesitation. The issue of what factors
influencing the adoption of ITin a healthcare setting becomes
an important question for all healthcare administrators.
Radio Frequency Identification (RFID) is a fast developing
and emerging technology that uses radio waves for data collec-
tion, information transfer and patient identification/tracking. It
can capture data efficiently and automatically without human
intervention [4]. The Institute for Information Industry reported
that the major RFIDadopters in Taiwan are businesses relating to
the retail, logistics, and transportation companies. However, there
are fast growing demands for RFIDin the healthcare industry [5].
Although there are extensive applications of RFID suitable for
the healthcare industry, only few hospitals have used RFID. The
H.<M. Lai
:
L.<T. Tseng
Department of Information Management, Chienkuo Technology
University, No.1, Chiehshou North Road, Changhua 500, Taiwan,
Republic of China
I.<C. Lin (*)
Department of Industrial Management and Institute of Health
Industry Management, National Yunlin University of Science and
Technology, No. 123 University Road, Sec. 3, Douliou,
Yunlin 64002, Taiwan, Republic of China
e-mail: ichunlin@yuntech.edu.tw
I.-C. Lin
e-mail: linichun104@gmail.com
J Med Syst (2014) 38:3
DOI 10.1007/s10916-013-0003-z
key reason for hospitals hesitation over RFIDadoption is its high
initial investment and the difficulty to envision the benefits. The
potential benefits of RFID adoption in hospitals include improv-
ing the quality of care, patient/customer satisfaction, and
searching for the efficiency of equipments [6]. More specifically,
it can be applied to medical personnel identification, such as
patient and neonatal management, and critical itemmanagement,
such as blood management, medical waste management, and
drug management. Furthermore, it can be used in personal
information management, such as sample management, medical
record management, and patient bedding/clothing management.
RFIDis believed to be the next generation innovation technology
for automatic data collection and asset/people tracking. Most of
the research related to RFID focused on the technology itself,
paying little emphasis on related management issues. What
promotes the adoption of RFIDin hospitals is also an important
research topic. The purpose of this study is to identify the salient
determinants of RFID adoption in the healthcare industry. For
researchers, this study contributes to a theoretical understanding
of the adoption of RFIDin hospitals. For practitioners, this study
provides a comprehensive overviewfor the government, helping
to shape the policies that promote the technology and in addition
for the RFID solution providers, enabling them to reduce the IT
barriers, so as to enhance hospitals willingness to adopt RFID.
Literature review
RFID and healthcare industry
RFIDtechnology is a wireless systemthat uses radio-frequency
electromagnetic fields to transfer data for identification pur-
poses. Three major components of a RFID system are as
follow: (1) Tag: also known as a transponder or a contactless
data carrier, it is planted to objects for identifying a set of
corresponding object and usually classified into two types:
active or passive depending on the existence of battery. An
active tag usually contains a battery and is able to can send out
information at any time, while enjoying a longer communica-
tion distance and a larger storage memory. It however has the
disadvantages of bulkiness, relatively short service life, the need
for stricter environmental requirements and higher costs. A
passive tag receives the electromagnetic waves transmitted by
the reader, using microcurrent through the induction process,
and then transmitting the information back to the reader. As a
result, it has a shorter communication distance. The fact that it
does not an external battery gives a passive tag several advan-
tages, such as compactness, a relatively long service life and
cheaper prices. (2) Reader: communicates with tags to enable
wireless data transfer. (3) Software Application: enables a read-
er to read or write the electronic tags. In theory, information
stored in a RFID tag is sent to a reader via contactless trans-
mission, allowing the reader to read the data before sending
them to a backend application by means of wired or wireless
transmission for further data analysis or other processing.
There are two main streams of previous studies regarding the
RFIDadoption in hospitals with one investigating the underlying
motivations and driving forces behind the adoption of RFID [7,
8] and the other looking at the potential utilization of RFID and
its effectiveness [6, 9]. The first stream, for example, was derived
fromthe perspectives of technology-push and need-pull, wherein
Lee & Shim [7] conducted a survey to investigate the likelihood
of adopting RFID in U.S. hospitals. In this survey, they found
one technology push factor (perceived benefits), two need pull
factors (performance gap and market uncertainty), and concluded
that the presence of champions (decision makers) was the most
important factor influencing the RFID adoption in the healthcare
industry. As a representative of the second stream, Zhou &
Piramuthu [9] confirmed that RFID-enabled real-time medical
process and labor management provided a marginal improve-
ment for the premium medical service providers, meaning that it
could generate appreciable improvement in terms of both effi-
ciency and service quality of public health care institutions.
A health care industry is an information-intensive industry
and a proper adoption of ITcan have a significant impact on a
hospitals medical services quality [1]. However, many hos-
pitals are struggling with the ever-growing operating costs,
contributed by a combination of factors, such as rising wages,
necessary equipment purchases and malpractice lawsuits. For
the sake of efficiency, hospitals need to introduce a highly
dynamic operational process which reduces error rates and
improves equipment management. To this end, RFID adop-
tion offers a way. Currently, RFID applications in Taiwans
hospitals are including operation roommanagement; tracking/
identification/locating assets/patients; staff attendance man-
agement; blood bags/drugs/medical waste management;, neo-
natal management, patient escort management etc.
The factors affecting RFID adoption in various contexts
Several previous studies had focused on the different perspec-
tives of RFID adoption in various contexts. For example, Lee &
Shim [7] predicted the feasibility of RFID adoption in the health
care industry using the theory of technology-push and need-pull.
They surveyed the senior executives of 126 U.S. hospitals in
order to investigate the possible drivers. They assumed there
were three dimensions affecting RFID adoptions in organiza-
tions, which included: (1) technology-push: performance gap
and market uncertainty; (2) need-pull: vendor pressure and per-
ceived benefits; and (3) presence of champions. Their research
result showed that, except vendor pressure, the other
four variablesperformance gap, market uncertainty, per-
ceived benefits and presence of championshad signifi-
cant impact on the possibility of RFID adoption. Among
these factors, the presence of champions was the most impor-
tant factor. This study also proposed that a successful RFID
3, Page 2 of 17 J Med Syst (2014) 38:3
adoption should include technology-push, need-pull, and the
presence of champions for RFID.
Kim & Garrisons [10] study of 278 organizations in South
Korean retailers showed that organizational needs (ubiquity,
performance gaps, and job relevance), perceived factors (ben-
efits and cost Savings), and organizational readiness (financial
resources and technological knowledge) as the key factors
determining RFID Evaluation; and evaluation impacts its
adoption, and integration.
Another study conducted by Wang et al. [11], according to
the Technology-Organization-Environment (TOE) framework,
proposed that there were nine key variables affecting the RFID
adoption in the manufacturing industry, which comprised rel-
ative advantage, compatibility, complexity, top management
support, firm size, technology competence, information inten-
sity, competitive pressure, and trading partner pressure. They
surveyed IT executives of 133 manufacturers in Taiwan and
the results showed that complexity, compatibility, firm size,
competitive pressure, trading partner pressure and information
intensity could affect the RFID adopted by the manufacturers.
A further review of relevant literature helped us decide on the
key factors affecting RFID adoption in hospitals. Table 1 shows
the summary of these factors and their comparison with the
results of prior studies. These factors were categorized into three
dimensions: technological, organizational and environmental.
Method and materials
Research process and research model
The research process comprised three steps. First, this research
reviewed literature on IT adoption in business and followed the
results of a preliminary survey with 37 practical experts in
hospitals to theorize a model for the RFID adoption in hospitals.
According to Scott Morton [12], key factors affecting technology
adoption in business can be classified into three dimensions,
namely organizational dimension, environmental dimension
and characteristics of IT itself [12]. Grover & Goslar [13] pre-
sented a similar concept and the use of empirical testing. Based
on these, we formed the Technology-Organization-Environment
(TOE) framework in this study. In the preliminary survey (see
Appendix A), a total of 37 high-level mangers fromhospitals IS
or nursing departments were invited to participate in a question-
naire survey. They were asked to rank the factors from high to
low according to relative importance. The variables mentioned
more than 20 %in the questionnaires were selected (see Table 2).
Such selection criteria and suggestion was adopted by [14].
Afterward, our research model and hypotheses (H1H14) were
proposed as seen in Fig. 1.
Second, a field survey involving 102 hospitals was
conducted to test the research model during the period
of February to November 2011. Third, follow-up in-
depth interviews with three directors of IS department
in three case hospitals individually were conducted from
February to April, 2012, in which they were asked to
provide further qualitative data able to contribute to a
deeper understanding of the factors that determined the
adoption of RFID.
Hypotheses
Technology-RFID characteristics: H1 To H6
Cost Cost includes all kinds of cost associated with RFID
adoption, including cost of tags, readers, installation, system
integration, education and training, implementation, develop-
ment and operation [15]. Adopting innovative technology can
Table 1 Literature review and comparison
Study Research context Technology-RFID characteristics Organizational dimension Environmental dimension
A B C D E F G H I J K L M N O P Q R S T
Brown & Russell [55] Retail sector x x x x x x x x x x x
Lee & Shim [7] Healthcare x x x x x x x
Krasnova et al. [29] Automotive x
Madlberger [34] Supply chain x x x
Kim & Garrison [10] Supply chain x x x x x x x
Tsai et al. [26] Retail chains x x x x x
Wang et al. [11] Manufacturing x x x x x x x x
Hossain & Quaddus [41] Livestock x
Chong & Chan [8] Healthcare x x x x x x x x
APerceived benefits (or Relative advantage), BCompatibility, CComplexity, DCost, EUbiquity, FJob-related, GSecurity, FPerformance gap, I
Financial resources (or Financial readiness), JTechnological knowledge (or Technological readiness), KOrganizational size, LTop management
support, MPresence of champions, NVender pressure, OMarket uncertainty (or Competitive pressure), PStandards uncertainty (or External initiators
for changes), QExternal support, RGovernment policies, SInformation intensity, TExpectation of market trends
J Med Syst (2014) 38:3 Page 3 of 17, 3
bring relative benefits to organizations. However, relative
benefits are total benefits deducted by cost and cost is usually
taken into consideration when adopting an innovative tech-
nology [16, 17]. Prior research indicated that the main con-
straint of extensive use of RFID is the cost of tags [18].
Although the cost of RFID tags has decreased, the number
of tags required will be enormous if RFID is applied to patient
and drug management in hospitals. Coupled with other costs,
including hardware (PDA hand held devices and wireless
internet), software, development and maintenance, RFID
Table 2 The results of a prelimi-
nary survey (N=37)
Dimension Predictors Frequency Percentage
RFID characteristics Cost 33 89.19 %
Perceived benefits 32 86.49 %
Ubiquity 27 72.97 %
Complexity 15 40.54 %
Compatibility (System integration) 11 29.73 %
Perceived risk (Security and privacy) 8 21.62 %
Job-related 5 13.51 %
Organizational dimension Top management support 34 91.89 %
Hospital scale 32 86.49 %
Financial readiness 26 70.27 %
Technological readiness 22 59.46 %
User support 8 21.62 %
Presence of champions 5 13.51 %
Headcounts of IT department 5 13.51 %
Performance gap 2 5.41 %
Environmental dimension Government policies 31 83.78 %
External support (consultants, software suppliers) 27 72.97 %
Market uncertainty (Competitive pressure) 15 40.54 %
Interference of materials 6 16.22 %
Information intensity 4 10.81 %
Standards uncertainty 3 8.11 %
Vender pressure 2 5.41 %
Technology-RFID Characteristics
Cost ( )
Perceived Benefits (+)
Ubiquity (+)
Complexity ( )
Compatibility (+)
Security and Privacy Risk ( )
Organizational Dimension
Top Management Support (+)
Hospital Scale (+)
Financial Readiness (+)
Technological Readiness (+)
Users Support (+)
Environmental Dimension
Government Policies (+)
External Support (+)
Market Uncertainty (+)
Decision of RFID Adoption in
Hospitals
H1~H6 H7~H11
H12~H14
Fig. 1 Research framework
3, Page 4 of 17 J Med Syst (2014) 38:3
adoption brings a huge financial burden to hospitals. Prior
research confirmed that when the cost associated with inno-
vative technology adoption is too high, users will have diffi-
culties in the adoption [19, 20]. We therefore proposed hy-
pothesis 1:
H1: Cost has a negative effect on RFID adoption in
hospitals.
Perceived benefits Perceived benefits are also called relative
advantage. When individuals perceive higher relative advan-
tage from RFID adoption, the adoption speed becomes faster
[21]. Perceived benefits is seen a key factor affecting RFID
adoption [7, 22]. When innovative technology can bring bene-
fits such as improving customer service quality and enabling
timely decision-making, organizations are motivated to adopt
such innovative technology [23]. Therefore, our study infers
that with higher perceived benefits of RFID such as improving
patient satisfaction, improving service quality and increasing
operating efficiency, hospitals are more likely to adopt RFID.
Here we proposed hypothesis 2:
H2: Perceived benefits have a positive effect on RFID
adoption in hospitals.
Ubiquity Ubiquity means that RFID systems can transmit
communicating, monitoring, and control signals to individuals
or objects to perform various functions, regardless of users
whereabouts. RFID can provide personalized and continuous
connection and communication [10] thanks to its light weight,
small size and easy connection with mobile communication
devices. In a vast and hectic workplace like a hospital, to
locate a person or search for an object can become an unwor-
thy waste of medical personnels capacity and time [24]. RFID
systems can read location or environment information from
RFID tags. Because of the computing power of mobile
devices and wireless local area network (WLAN), RFID
systems can be used in ubiquitous computing environ-
ments by reading RFID tags with mobile devices and
sending data to the database. Medical information and
history can be accessed and retrieved anytime and any-
where [25] to help reduce the rate of medical errors, extend
the coverage of medical services, and improve service quality.
Therefore, the ubiquitous nature of RFID makes it even more
suitable for medical management systems. Our study inferred
that hospitals are more motivated to adopt RFID when they
regard such a ubiquitous nature as a convenient feature. We
therefore propose hypothesis 3:
H3: Ubiquity has a positive effect on RFID adoption in
hospitals.
Complexity Complexity refers to the degree to which a
RFID technology is perceived as difficult to use RFID
[21]. Although organizations can benefit from adopting
innovative technology, they may also encounter difficul-
ties if innovative technology is too complicated. Prior
research have shown that complexity is one of the
obstacles to adopting RFID [11, 20, 26]. RFID has to
be installed and set up according to specific work en-
vironment and application purposes. Its hardware has to
withstand the heat and humidity in Taiwan in particular,
and be operated with different materials and in different work
environments [26]. Therefore, in order to have better data
transmission, the interference between backend systems of
RFID and existing IT systems has to be adjusted effectively
and this increases the level of complexity of adopting RFID
[26]. Here we proposed hypothesis 4:
H4: Complexity has a negative effect on RFID adoption
in hospitals.
Compatibility Compatibility is the degree to which a RFID
technology is perceived as consistent with the existing values,
needs, and past experiences of the potential adopter [21].
Technical compatibility measures whether such innovative
technology matches existing IT systems. With low compati-
bility, organizations are more resistant to changes. Studies
have shown that compatibility is one of the key factors of
RFID adoption [11]. Because changes in enterprises work
processes are involved in the implementation of RFID sys-
tems, users resistance to changes has significant impact
on RFID implementation [27]. We therefore proposed
hypothesis 5:
H5: Compatibility has a positive effect on RFID adoption
in hospitals.
Security and privacy risk Security and privacy risk prob-
lems are formed when organizations perceive uncertain-
ty and possible risks associated with RFID usage [28].
Although organizations can improve productivity by
adopting RFID, this also means a ubiquitous monitoring
[27] likely to expose organizations and individuals to
the threat of security and privacy breaches [18]. For
example, if RFID systems are not well-secured, there
might be unauthorized data access; or if hackers initiate
attacks against RFID systems, hospitals might incur
huge loss due to system malfunctioning. Here we proposed
hypothesis 6:
H6: Security and privacy risk has a negative effect on
RFID adoption in hospitals.
Organization dimension: H7 to H11
Top management support Top management usually refers to the
decision makers of innovative technology implementation who
J Med Syst (2014) 38:3 Page 5 of 17, 3
have greater influence on the adoption. RFID implementation
involves significant changes in financial investment and costly
processes; therefore can be a strategic decision requiring top
management support [29]. Top management support will affect
hospitals new IT adoptions [30]. Their support can effectively
mitigate users resistance against adopting new IT systems [17].
With the same IT investment in systems, the stronger the top
management commitment, the better the firm performance [31].
Top management are key to RFID adoption in an inter-
organizational system [22]. We therefore propose hypothesis 7:
H7: Top management support has a positive effect on
RFID adoption in hospitals.
Hospital scale In general, large-scale hospitals are more likely
to adopt innovative technology than small-scale hospitals
[3234], because compared to small ones, large ones usually
have more resources, more budget, better ITinfrastructure, better
technological environments and the ability to bear larger risks
[3234]. While smaller organizations are more likely to be
constrained by lack of resources, larger organizations can still
adopt innovative technology [35]. Prior research has indicated
that organization scale affects RFID adoption [11]. With more
resources, large-scale hospitals are able to assign internal experts
to deal with such tasks. Here we proposed hypothesis 8:
H8: Hospital scale has a positive effect on RFIDadoption
in hospitals.
Financial readiness Financial readiness refers to the level of
financial resources available in hospitals for RFID adoption
including installation costs, implementation and maintenance
[10]. Prior research have shown that due to financial con-
straints and lack of knowledge in IT systems, the growth of
ITadoption in small organizations is limited [36]. Only when
small organizations are financially ready and have sufficient
resources, adopting innovative IT technology is considered
feasible [35]. Iacovou et al. [37] believed that organizational
readiness includes both financial readiness and technological
readiness. Prior research have shown that financial readiness
affects the willingness for the automobile industry to adopt
RFID [29]. When hospitals are more financially ready, they
are more willing to adopt RFID. We therefore proposed hy-
pothesis 9:
H9: Financial readiness has a positive effect on RFID
adoption in hospitals.
Technological readiness Technological readiness refers to the
level of sophistication regarding ITusage and IT management in
an organization [37]. Small enterprises lack financial and tech-
nological resources; therefore, providing financial and techno-
logical support is one of the key factors promoting IT adoption
[37]. RFID being a radical innovative technology, users have to
learn new skills and establish new infrastructures to support
operations in RFID environment [22]. Therefore, we infer that
when hospitals are more technologically ready, they are more
likely to adopt RFID. Here we proposed hypothesis 10:
H10: Technological readiness has a positive effect on
RFID adoption in hospitals.
User support User support refers to the change in users psy-
chological state, caused by using new systems and performing
their tasks with the systems [38]. Prior research has shown that
when users are not psychologically ready to accept new IT, their
attitude and behavior make them refuse to receive new informa-
tion from consulting firms [39]. Lin et al. [3] also indicated that
user resistance is a critical barrier for healthcare information
technology (HIT) adoption, as user resistance often leads to an
increase of cost in HIT implementation, and waste of resources
within a hospital. Lack of user support might lead to unoptimized
performance or failures [40]. When implementing RFID, hospi-
tals might have to change their entire work process. When
medical personnel provide low level of support for RFID imple-
mentation, the risk of failure implementation is increased. We
thus propose hypothesis 11:
H11: User support has a positive effect on RFIDadoption
in hospitals.
Environmental dimension: H12 to H14
Government policy Government policy includes govern-
ments financial support, training curriculum, specification
and policy stability [1]. When adopting RFID, organizations
expect to receive support from government with respect to
policies, incentives and subsidies to accelerate the rate of
adoption [41]. RFID planning promoted by government helps
reduce hospitals financial pressure by offering subsidies and
their continuance of the implementation plan. Here we pro-
posed hypothesis 12:
H12: Government policies positively affect RFID adop-
tion in hospitals.
External support Hospitals might lack RFID experts, but can
look for other support such as RFID consultants or venders
help. Thong et al. [42] indicates that the efficacy of consulting
firms and suppliers support affect the successful IT imple-
mentation. This is especially the case for small organizations
as compared to large enterprises due to the lack of internal
experts [35, 43, 44]. Consulting firms can provide profession-
al advice, analyze information needs, look for external con-
sultants with comprehensive experience helps organizations to
draw a complete picture of possible problems faced during
implementation [40, 45]. Suppliers, on the other hand, can
provide support such as hardware/software testing
3, Page 6 of 17 J Med Syst (2014) 38:3
environment, technical support, education and trainings [42].
Therefore, this study infers that support from consultants or
suppliers can help RFID adoption in hospitals. We therefore
propose hypothesis 13:
H13: External support positively affects RFID adoption
in hospitals.
Market uncertainty Market uncertainty is defined as the mo-
tivation of adopting RFID resulting from pressure from exter-
nal market [46]. The level of competition intensity between
organizations is positive related to their adoption of new IT
[13, 34, 47] and RFIDtechnology (e.g.,[7, 11, 20]). Therefore,
this study infers that higher the market uncertainty, the more
likely hospitals will look for new technology. Decision mak-
ing of RFID adoption is also affected. Here we proposed
hypothesis 14:
H14: Market uncertainty positively affects RFID adop-
tion in hospitals.
Measurement and data collection
A total of 15 variables were included in our research frame-
work, as seen in Fig. 1. Most of themwere measured by a five-
point Likert scale anchored between strongly disagree to
strongly agree, with hospital scale as an exception. The de-
pendent variable is whether hospitals adopt RFID or not. All
respondents were asked to choose from the following option
an answer that best describes the current status of RFID
adoption in their hospitals: adopted RFID, started using
RFID, planned to adopt RFID, and no RFID adoption plan.
According to the innovation diffusion theory, a hospital is
categorized as an adopter when its respondents identify it as
having adopted RFID and started using RFID. In con-
trary, when a hospitals respondents select planned to adopt
RFID and no RFID adoption plan as their answers, it is
categorized as a non-adopter.
According to Taiwans Bureau of National Health Insurance,
there are 510 district-level and above contract hospitals in 2010,
ranging frommedical center, regional hospital to district hospital.
To cover them as our survey target, we sent out 510 question-
naires via e-mail. In order to increase response rate, each partic-
ipant was awarded $7 (US) for participation. There were 102
valid responses (20 % valid response rate)a result similar to
other nationwide hospital surveys in [33]. Regarding the phases
and current status of hospitals RFID adoption (see Table 3), our
sample showed that 37 hospitals (36.3 %) were adopter hospitals
and 65 hospitals (63.7 %) were non-adopter hospitals. Table 4
provided respondent characteristics in detail.
Following Armstrong and Overtons suggestion [48], we
also examined the sample data for evidence of non-response
bias using t-test. The non-response bias was assessed by
verifying the differences between early respondents (35 %)
and late respondents (65 %), as late respondents were almost
similar to non-respondents. The result indicated that all the
independent variables from the 66 early respondents and the
36 late respondents are no significant differences (p<0.05).
Reliability and validity
The validity was examined in terms of content validity, con-
vergent validity, and discriminant validity. Content validity
was established from the extant literature, and a pilot test
was performed to improve the validity of the measures. A
confirmatory factor analysis (CFA) was conducted in order to
acquire evidence of convergent and discriminant validity. The
AMOS 18 software with maximum likelihood estimation was
used to perform the CFA. Results of Mardias test confirmed
that the data deviated from multivariate normality
1
.
Convergent validity is demonstrated when indicator factor
loadings () are significant and exceed the acceptable value
of 0.5 on their corresponding constructs as recommended by
[49], and the average variances extracted (AVE) of the construct
are larger than 0.5, exceeding the threshold value suggested by
[50]. All values in the CFA model exceeded 0.5 on their
corresponding constructs and the loadings within con-
struct are higher than those across construct (Appendix
B), and the AVE for all constructs exceeded the thresh-
old value of 0.5; thus, convergent validity was con-
firmed. Discriminant validity is demonstrated when the
square root of the AVE is greater than the inter-construct
correlations, as suggested by [50]. Table 5 shows that the
square root of the AVE values is greater than the inter-
correlations and thus exhibits acceptable discriminant validity.
Finally, construct reliability was assessed in terms of com-
posite reliability and Cronbach alpha value. Table 5 shows
that all composite reliabilities exceeded the minimal reliability
criteria of 0.7 recommended by [50]. All Cronbach alpha
values also exceeded 0.60, which is in the acceptable
range [50].
Table 3 Hospitals adoption RFID phase and current status
Adoption Category of adoption status N (%)
Adopter hospitals Already implemented
and used RFID
28 (27.5 %)
Started using RFID 9 (8.8 %)
Non-adopter hospitals Planned to use 8 (7.8 %)
Non-adopt 57 (55.9 %)
Overall 102 (100.0 %)
1
The results showed that the Mardia coefficients were 196.298<2915
(5355), the results of Mardias test confirmed that the data deviated
from multivariate normality.
J Med Syst (2014) 38:3 Page 7 of 17, 3
Hypotheses testing and results
The discriminant analysis was used for hypotheses testing.
The hospitals were classified into two groups: 37 adopters and
65 non-adopters. There were only two groups being used,
hence displaying only one function. This function provided
an index of overall model fit, which was then interpreted as the
proportion of variance explained (R
2
). A canonical correlation
Table 4 Respondent characteris-
tics (N=102)
Items Categories Frequency Percentage (%)
Hospital Level Medical center 10 9.8
Regional hospital 25 24.5
District hospital 67 65.7
Ownership Type Public hospital 5 4.9
Private hospital 58 56.9
Corporate Hospital 38 37.2
Privately managed public hospital 1 1.0
Number of Hospital Beds Less than 200 beds 31 30.4
201 to 700 beds 33 32.4
701 to 2000 beds 35 34.3
2001 to 4000 beds 3 2.9
Respondents Position Director of IS department 44 43.1
Deputy director of IS department 40 39.2
Others 18 17.7
Respondents Gender Male 68 66.7
Female 34 33.3
Respondents Age Less than 30 18 17.6
31 to 40 28 27.5
41 to 50 53 52.0
Over 50 3 2.9
Length of Service at Current Position Less than 5 years 16 15.7
6 to 10 years 13 12.7
11 to 15 years 48 47.1
16 to 20 years 9 8.8
Over 21 years 16 15.7
Table 5 Discriminant validity and reliability
Variables CR CA 1 2 3 4 5 6 7 8 9 10 11 12 13
1. COST 0.95 0.95 0.93
2. BEN 0.91 0.91 0.53 0.88
3. UBIQ 0.92 0.91 0.67 0.68 0.88
4. COMPLEX 0.82 0.80 0.28 0.32 0.24 0.78
5. COMPAT 0.95 0.95 0.69 0.62 0.62 0.33 0.91
6. RISK 0.81 0.77 0.56 0.33 0.40 0.36 0.68 0.83
7. TOPSUP 0.97 0.97 0.69 0.51 0.69 0.19 0.65 0.55 0.94
8. FINAN 0.94 0.94 0.53 0.38 0.55 0.18 0.44 0.35 0.46 0.94
9. TECH 0.77 0.76 0.06 0.04 0.08 0.34 0.16 0.39 0.13 0.03 0.73
10. USERSP 0.91 0.91 0.54 0.44 0.50 0.17 0.54 0.40 0.50 0.37 0.08 0.92
11. GOVPOL 0.92 0.91 0.62 0.56 0.49 0.13 0.67 0.44 0.65 0.32 0.005 0.47 0.89
12. EXSUP 0.95 0.95 0.62 0.57 0.58 0.27 0.60 0.48 0.56 0.44 0.03 0.53 0.55 0.87
13. MARKET 0.72 0.65 0.51 0.48 0.69 0.18 0.58 0.38 0.57 0.49 0.01 0.50 0.50 0.50 0.76
See Appendix B for abbreviations used in Tables 5 and 6
CRcomposite reliability, CA Cronbachs alpha. The bold numbers in the diagonal row are square roots of the Average Variances Extracted (AVE)
3, Page 8 of 17 J Med Syst (2014) 38:3
of 0.906 suggested that the model may explain 82.08 % of the
variation in the grouping variable, whether a respondent was
adopted or not. The Wilks lambda value of the dis-
criminant function was 0.192 (
2
=153.683, df=14, p=
0.000). Wilks lambda was used to determine whether
there was any difference existing between the groups. A
smaller Wilks lambda value indicated the higher discrimi-
nation power [49]. The result demonstrated that the Wilks
lambda value was 0.1192 (p=0.000), meaning this discrimi-
nant function could be used to discriminate between the
adopters and the non-adopters.
Three key indicators used in discriminant analysis included
discriminant loadings (or structure correlations), standardized
discriminant coefficients (or discriminant weight) and partial
F values. Discriminant loadings reflected the variance that the
independent variables shared with the discriminant function.
Standardized discriminant coefficient reflected the relative
contribution of its associated variables to the discriminant
function. The F values showed the associated significance of
each variable and larger F values indicating that it would have
greater discriminatory power [49].
The discriminant loadings for each variable are shown in
Table 6. The discriminant loadings were used to measure the
significance of the variables and the cutoff value was greater
than 0.3, as suggested by [49]. The variables exhibiting a
discriminant loading greater than 0.3 included costs, ubiquity,
compatibility, security and privacy risks, top management
support, hospital scale, and financial readiness. These seven
variables also had a high significance level and thus substan-
tially influenced the adoption of RFID. The discriminant
loading of government policy was less than 0.3, though the
standardized discriminant coefficient was higher than 0.3.
Therefore, it could also be considered as a predictive variable
of effective difference. While ranking the relative importance
of the factors based on F value, the list was as follows: security
and privacy risks, hospital scale, investing costs, top manage-
ment support, ubiquity, compatibility, financial readiness, and
government policy. To summarize, the results of discriminant
analysis supported the hypotheses H1, H3, H5, H6, H7, H8,
H9, and H12 (see Table 7). The percentages of classification
accuracy of the discriminant function for the adopters and
non-adopters groups were 97.3 % and 96.9 % respectively.
The overall classification accuracy was estimated to be
97.1 %. The histograms in Fig. 2 also showed that the dis-
criminant function did well.
Follow-up in-depth interviews
We invite three IS department directors from three cases
hospitals which have already implemented and used RFID
for our follow-up interviews after the field survey. Each inter-
view lasted between 60 and 120 min and its full content has
been recorded with the interviewees advanced permission.
Table 8 summarizes the results of these interviews.
Discussion and implications
The objective of this study was to find out what promotes the
adoption of RFID in hospitals. When discussing the results of
this study, we compared our research findings with those of
Chang & Chan [8] and Lee & Shim [7] (See Table 9). Both of
their research topics and contexts are similar to ours, though still
have some differences. In terms of sample source, Chong &
Chan [8] collected data from183 health companies and hospitals,
while we collected data from a total of 102 hospitals. On con-
siderations of RFIDs adoption, hospitals are different from
system suppliers. In most of the industries suppliers RFID
adoption would create vender pressure, forcing them into using
the same system. In reverse, if a vender is powerful enough and
large in scale, its RFIDadoption would create a push force for the
suppliers to adopt the system, such as in the case of Walmart. It
is therefore necessary to look at both sides, ie supplier and
vender, when exploring factors influencing an industrys adop-
tion of RFID. Despite this, given the current situation of the
healthcare industry, and as our field survey and interviews reveal,
the reasons behind a hospitals decision to adopt RFIDare mostly
from within itself, such as the hospitals own technological and
organizational considerations. This research based its sample
only in hospitals, since it intends only to look at the adoption
of RFIDin hospitals. In addition, Lee &Shim[7] focused on the
motivations and driving forces behind the adoption of RFID in
the healthcare industry by using the theory of technology-push
and need-pull. Our research provides a more comprehensive
model that integrates technological, organizational and environ-
ment factors in order to understand hospitals considerations
regarding RFID adoption.
Key findings and insights
The major findings from this study are as follows. First, cost
as a key factor in hospitals considerations of RFID adoption
(discriminant loading = 0.402, Wilks lambda=0.594, F=
68.317 and p=0.000). This is consistent with previous re-
search, which revealed that the cost was the major constraint
on the widespread use of RFID technologies [18]. The IS
department director from case hospital A indicated in the
follow-up interview: the cost of RFID tags is very high.
Combining that with the costs of RFID transmitters, readers,
encoders and antenna equipments, the initial investment costs
are very huge. The patient identification is a relatively lower
cost investment due to the use of passive RFIDtags. However,
the equipment managements, e.g., x-ray equipments, mobile
nursing stations, ECG and ultrasound machines, all have
higher relative investment costs due to the use of active
J Med Syst (2014) 38:3 Page 9 of 17, 3
RFID tags. Therefore, it is an extremely high investment cost
for the hospital. And the respondents of hospital B stated:
using passive RFID tags makes the investment cost of access
control management cheaper than that using active RFIDtags,
meaning it can be more widely used.
Second, contrary to our expectations, hypothesis 2 (perceived
benefit factor) was not supported (discriminant loading =
0.207). Krasnova et al. [29] proposed that RFID technology
had never been an end in itself, since the benefits of RFID was
too lowor absent compared to its investment costs. In our follow-
up interviews, the IS department director from case hospital A
indicated that a hospital must be operated in the most cost-
effective way, since a hospitals income is not high enough. ROI
(return on investment) is key factor. If an investment and its
Table 7 The results of hypotheses testing
Variables Discriminant loading Standardized discriminant coefficient F values Rank
a
Results
Cost (H1) 0.402 0.137 68.317 3 Support
Perceived benefits (H2) 0.207 0.115 17.999 No support
Ubiquity (H3) 0.349 0.308 51.541 5 Support
Complexity (H4) 0.094 0.068 3.695 No support
Compatibility (H5) 0.347 0.104 50.826 6 Support
Security and privacy risk (H6) 0.468 0.434 92.301 1 Support
Top management support (H7) 0.378 0.415 60.435 4 Support
Hospital scale (H8) 0.463 0.827 90.505 2 Support
Financial readiness (H9) 0.326 0.184 44.727 7 Support
Technological readiness (H10) 0.126 0.081 6.652 No support
User support (H11) 0.238 0.067 23.99 No support
Government policy (H12) 0.179 0.302 13.528 8 Support
External support (H13) 0.269 0.196 30.646 No support
Market uncertainty (H14) 0.256 0.174 27.557 No support
a
means there is not enough discrimination power
Table 6 Discriminant analysis
Variables Discriminant
loading
Standardized
discriminant coefficient
Wilks lambda F values Significance level Adopted Nonadopt
Mean S.D Mean S.D.
COST 0.402 0.137 0.594 68.317 0.000 2.29 0.61 3.74 0.96
BEN 0.207 0.115 0.847 17.999 0.000 2.31 0.55 2.99 0.89
UBIQ 0.349 0.308 0.660 51.541 0.000 2.13 0.58 3.10 0.70
COMPLEX 0.094 0.068 0.964 3.695 0.057 3.08 0.51 2.85 0.63
COMPAT 0.347 0.104 0.663 50.826 0.000 2.20 0.52 3.43 0.98
RISK 0.468 0.434 0.520 92.301 0.000 3.59 0.54 2.57 0.51
TOPSUP 0.378 0.415 0.623 60.435 0.000 2.19 0.86 3.61 0.90
SCALE 0.463 0.827 0.525 90.505 0.000 2.89 0.57 1.65 0.67
FINAN 0.326 0.184 0.691 44.727 0.000 1.85 0.42 2.74 0.74
TECH 0.126 0.081 0.938 6.652 0.011 3.12 0.47 2.81 0.63
USERSP 0.238 0.067 0.807 23.990 0.000 2.58 1.24 3.62 0.88
GOVPOL 0.179 0.302 0.881 13.528 0.000 2.86 0.75 3.49 0.88
EXSUP 0.269 0.196 0.765 30.646 0.000 2.47 0.87 3.55 0.99
MARKET 0.256 0.174 0.784 27.557 0.000 2.78 0.81 3.65 0.79
Classification accuracy
Predicted adopter Predicted non-adopter Total
Actual adopter 36 (97.3 %) 1(2.7 %) 37
Actual non-adopter 2 (3.1 %) 63 (96.9 %) 65
Overall accuracy 97.1 %
3, Page 10 of 17 J Med Syst (2014) 38:3
returns cannot be balanced, you will not want to implement
RFID at all. Similarly, the IS department director from case
hospital Bpointed out: it seems very hard to get very noticeable
benefits. However, the ISdepartment director fromcase hospital
Cexpressed: RFIDtechnology has really changed the workflow
within our hospital. For instance, the hospitals escort system can
manage the staff locations more effectively and has a better control
over patients waiting time. It can improve the service quality, but
eventually it is impossible to reduce the overhead costs.
Third, contrary to expectations, hypothesis 4 (complexity
factor) was non-supported (discriminant loading=0.094). The
IS department director from case hospital A indicated: as for
the technology, a team of professors at a university together
with the vendors have provided full assistance for our hospital,
so that we did not encounter any problems at all. The IS
department director from case hospital C pointed out: in the
process of introducing RFID technology the development of
technical systems was actually the easiest part, but integrating
RFID into HIS was not an easy job.
Fourth, as expected, security and privacy risks were confirmed
in this research to be the key factors regarding hospitals consid-
erations of RFID adoption (discriminant loading=0.468,
A
d
o
p
t
e
r
P
r
e
d
i
c
t
e
d

G
r
o
u
p
N
o
n
-
a
d
o
p
t
e
r
Fig. 2 Histograms showing the
distribution of discriminant scores
for adopter hospitals and non-
adopter hospitals
Table 8 The results of the IS department directors interviews
Case Hospital Hospital A Hospital B Hospital C
Hospital level & ownership
type
Regional & Public hospitals District & Corporate hospitals Medical center & Corporate
hospitals
Number of beds 600 280 1600
Number of employees 1100 440 4100
RFID implementation date 2007 2006 2007
RFID applications & scope Access control management, Drug
management, Medical equipments
management, Patient identification
Access control management, Patients
exercise time in the Health Promotion
Center, Meeting attendance
Access control management,
Patient escort, Specimen
delivery
System Integration HIS HIS HIS
Project leader Director of IS Director of IS Director of IS
Key factors in high-level
managers considerations
of RFID adoption
Cost, Perceived benefit, Ubiquity, Top
management support, Government
policy
Hospital scale, Compatibility, Financial
readiness, User support, Security &
privacy risk
Compatibility, Ubiquity,
Security & privacy risk, Top
management support
Healthcare information system (HIS)
J Med Syst (2014) 38:3 Page 11 of 17, 3
discriminant coefficient=0.434, Wilks lambda=0.520, F=
92.301 and p=0.000). Patient privacy is becoming a matter of
great concern when using RFID tags that send out information
without the knowledge of the tagged entity. The relevant devel-
opments in RFID cryptography was important [9]. The IS de-
partment director from case hospital B pointed out: RFID helps
manage patient data more effectively, although it also increases
the risks of data loss, contributing to patients resistance. Hence,
patient data should be encrypted in order to protect individual
privacy. The IS department director from case hospital C indi-
cated: RFID can track the locations of both the escort personnel
and patients all the time, which may cause their resistance to be
tagged.
Fifth, contrary to expectations, this research found hypothe-
sis 10 (technological readiness factor) non-supported (discrim-
inant loading=0.126). The IS department director from case
hospital A indicated: with the assistance from schools, IT
vendors and the Ministry of Economic Affairs, we experienced
no technical difficulties. Additionally, thanks to the hospitals
own IT Department, there were few technical problems during
the process of RFID applications. The IS department director
from case hospital B stated: with the vendors assistance, the
technology was not a big problem. In addition, The IS depart-
ment director from case hospital C indicated: since the escort
system was developed by our Information Department and
manufacturers, we were able to enjoy full technical supports.
Sixth, contrary to expectations, hypothesis 11 (user support
factor) was found non-supported in this study (discriminant
loading = 0.238). The possible reasons are top management
request, meantime, promoting RFID was a hospital policy. In
addition, the other possible reason is healthcare industry char-
acteristic. Medical staff could not choose whether to accept it or
not under a hospital policy and top management request.
Doctors enjoy a higher degree of independence, in comparison
to other medical staff that are lower-ranked in a hospitals chain
of command and trained to follow order either willingly or as a
compliance with policies. That is, they will use and accept a new
system if hospital rules dictate. Therefore, hypothesis 11 was
found non-supported in this research. In our follow-up inter-
views, the IS department director fromcase hospital Bindicated:
to improve our service quality is of a high priority, and to meet
this demand medical staff have to cooperate with hospitals
RFID policy. The IS department director from case hospital
C pointed out: due to the changes in workflow processes
caused by the introduction of RFID, medical staff were resistant
at first, but eventually became more acceptant when feeling the
benefits of optimized processes and shorter patient escort time.
Seventh, contrary to expectations, hypothesis 13 (external
support factor) was found in this research non-supported
(discriminant loading = 0.269). During our follow-up inter-
views, the IS department director fromcase hospital Apointed
out at the initial stage, we were cooperating with the
outsourcing partners, but after a period of time, our IT
Department took charge of the subsequent operations. The
IS department director from case hospital C indicated: after
implementing RFID, our IT Department was capable of man-
aging the subsequent operations.
Finally, contrary to expectations, this research found hypoth-
esis 14 (market uncertainty) non-supported (discriminant load-
ing = 0.256). The IS department director from case hospital A
pointed out in the follow-up interview that when we found out
that our competitors are using RFID, we were, of course,
motivated to adopt the technology, though we still need to
consider the financial conditions of the hospital itself before
determine whether the benefits outweigh the costs. Also, the
IS department director from case hospital B indicated: depend-
ing on the scale, hospitals have different business strategies that
affect the degree of urgency involving the RFID adoption. Our
competitors decisions to adopt RFID did not affect our
decision-making at all.
Table 9 The comparison of this study and two recent researches relating to RFID adoption in hospitals
Study Sample source & research
context
Theoretical
foundation
Consideration of the RFID adoption
This study 102 hospitals in Taiwan TOE Technology: cost
a
, perceived benefits, ubiquity
a
, complexity,
compatibility
a
, security and privacy risk
a
Organization: top management support
a
, hospital scale
a
, financial
readiness
a
, technological readiness, user support
Environment: government policy
a
, external support, market uncertainty
Chong & Chan [8] 183 health companies and
hospitals in Malaysian
TOE Technology: relative advantage, compatibility, complexity
a
, cost
a
, security
a
Organization: top management support
a
, organization size
a
, financial
resources, technological knowledge
a
Environment: competitive pressure
a
, expectation of market trends
a
Lee & Shim [7] 126 hospitals in the U.S. technology-push
and need-pull
Technology: perceived benefits
a
Organization: performance gap
a
, presence of champions
a
Environment: vendor pressure, market uncertainty
a
a
means that hypothesis is supported
3, Page 12 of 17 J Med Syst (2014) 38:3
Academic implications
The academic contributions of this study are mainly three folds.
First, we developed a more comprehensive model regarding
hospitals considerations of RFID adoption based on a well-
known TOE framework, experts opinions and the results from
a preliminary survey, a field survey and follow-up in-depth
interviews. Since every industry is different in its own way, prior
studies on other industries were not able to fully explain the
situation in the healthcare industry. This study fills in the research
gap. Second, this research contributes to the information system
researches and healthcare researches by confirming several deci-
sion factors of the RFID adoption in hospitals, which better the
understanding of why a hospital decide to adopt RFID or not.
Third, our research findings indicated that RFIDs characteristics
and organizational dimension, instead of the environmental char-
acteristics, have the relative importance in RFID adoption. The
most importance factor of RFID characteristics is the concern
over privacy and security. Consistent with prior research, the
most common fear referred to the misuse of data collected by
RFID tags, resulting in an undesirable intrusion into the privacy
risk of individuals [28]. This study contributes to the current
understanding of the influence on privacy and security
concerning the adoption of RFID in hospitals by theoretical
analysis and empirical testing. Hospital scale as the most impor-
tant organizational factors, this study looked at a number of
hospitals to see the reasons behind their adoption or non-
adoption of RFID.
Practical implications
The practical contributions of this study are four folds. First, the
empirical finding of this study showed that RFID in hospitals is
still in an early adoption stage. Of the 102 hospitals surveyed,
only 37 hospitals are currently using RFID and 8 hospitals are
planning to use. Hospitals can refer to the findings for their
decisions over RFID. Second, this study showed that technolog-
ical factors, such as security and privacy concerns, costs, ubiq-
uity, and compatibility are key considerations regarding RFID
adoption in hospitals. This is especially important in the context
of hospitals where workflowprocesses are complex and change-
able, thus, RFID characteristics is an important factor affecting
the RFID adoption. RFID vendors may need to consider analyz-
ing and demonstrating technological benefits based on the expe-
rience from other precedent hospital adoption. This will give
non-adopters a better picture of how the technology can benefit
them and encourage their decision to consider RFID adoption.
Third, this study also found that hospital scale, top management
support and financial readiness are the important factors in
hospitals decisions regarding RFIDadoption. The research find-
ings suggest that, to promote the RFID adoption in the hospitals,
the financial support is a key factor on the initial adoption in the
hospitals. Top management support was shown to be crucial.
Besides, RFID vendors should know that the hospital scale can
determine howmuch it can benefit fromadopting the technology,
and therefore their decision to do so. Finally, this study showed
that hospitals consideration regarding RFID adoption is rely
highly on government policy and grant support. Education train-
ing and funding from the government play a critical factor at the
initial stage of RFID adoption. To increase the pace of adoption
and to ensure a continued usage of the adopted technology, the
government should communicate the advantages of RFID to
hospitals properly and provide necessary supports along the way.
Conclusion and limitations
The goal of this study is to identify the salient determinants of
RFIDadoption in the hospital environment. The TOEframework
derived from the literature related to the RFID adoption, and
preliminary surveys were used to theorize a model for the RFID
adoption in hospitals. The data collected from a field survey of
102 hospitals provided an empirical support for the proposed
model. Our follow-up interviews with senior managers furthered
the understanding of such complex and dynamic aspects regard-
ing the RFID adoption motivations. The findings of this study
enabled a better understanding of factors affecting hospitals
decision on RFID adoption and their relative importance.
There are several limitations in this study. First, the research
sample was collected solely from Taiwans hospitals, meaning
that no cultural difference was involved. For this reason, it may
limit the generalizability of our findings. Second, this study
adopted a discriminant analysis to validate its hypotheses.
However, the number of participating hospitals, which have
adopted the RFID technologies, was low, mainly because the
healthcare industry was relatively slow in adopting the IT [51].
Third, the result of an organization promoting a new technology
is not always good. Future researches can try to link a hospi-
tals decision-making process to the outcomes of such a decision
in term RFID adoption. Finally, we hope this study can contrib-
ute to the initial adoption research and help draw attention to it.
For future studies there is a variety of post-adoption behaviors
such as the expansion or long-term continuance of RFID adop-
tion that is worthy of examination.
Acknowledgments This study was supported by the Chienkuo Tech-
nology University, Taiwan, R.O.C., under Grant No. CTU-101-RP-IM-
003-015-A. We are thankful for all participators, in particular Dr. Tien-
Cheng Hsu, director of the IS Department and Mr. Tzu-Chia Huang
system engineer for the IS Department, from Changhua Christia Medcial
Center. The authors would also like to thank the anonymous reviewers
and editors for their constructive comments.
Conflict of interest All authors have no financial or non-financial
interests that may be relevant to the submitted work. There is without
any possibility of favoritismor personal gain conducted via this study. So,
the authors declare they have no conflict of interests.
J Med Syst (2014) 38:3 Page 13 of 17, 3
Appendix A
Appendix B
Table 10 Preliminary survey items
RFID characteristics 1. Which of the following characteristics of RFID is the key to RFID adoption decision making? (multiple choices)
Perceived benefits: Hospitals adopt RFID because it can bring relative advantage against existing information technology.
Compatibility: Hospitals adopt RFID because it matches existing value, need and past experience.
Complexity: Hospitals do not adopt RFID because it is difficult to use.
Cost: Hospitals do not adopt RFID because of the cost associated with RFID adoption including cost of tags, readers,
installation, system integration, education and training, implementation, development and operation.
Ubiquity: Hospitals adopt RFID because it provides personalized and continuous connection and communication.
Work-related: Hospitals adopt RFID because it is appropriate to use it at work.
2. Besides the aforementioned factors, what are other characteristics of RFID that would affect your hospitals RFID adoption
decision making? (open-ended question)
Organizational
dimension
1. Which of the following characteristics of RFID is the key to RFID adoption decision making? (multiple choices)
Performance gap: Hospitals adopt RFID because there are gaps in performance and satisfaction with respect to information
technology.
Financial readiness: Hospitals adopt RFID because hospitals have financial resources to support RFID purchases,
implementation and maintenance.
Technological readiness: Hospitals adopt RFID because hospitals have high maturity with respect to the use and
management of information technology.
Hospital scale: Hospitals adopt RFID because there are more medical personnel and hospital beds.
Top management support: Hospitals adopt RFID because of support and commitment from top management.
Presence of champions: Hospitals adopt RFID because management realizes the usefulness of adopting innovative
information technology and provides necessary authorization and resources during development and implementation.
2. Besides the aforementioned factors, what are other characteristics of RFID that would affect your hospitals RFID adoption
decision making? (open-ended question)
Environmental
dimension
1. Which of the following characteristics of RFID is the key to RFID adoption decision making? (multiple choices)
Vender pressure: Hospitals motivation to adopt RFID comes from vender pressure.
Market uncertainty/competitive pressure: Hospitals motivation to adopt RFID comes from pressure from external market.
Standards uncertainty: Hospitals obstacle to adopting RFID comes from lack of standards setting.
External support: Hospitals adopt RFID because of the support received, such as support from suppliers and consultants.
Government policies: Hospitals adopt RFID because the government provides financial support, training curriculum and
policy descriptions and stability of government policies.
Information intensity: Hospitals adopt RFID because hospitals highly rely on information.
2. Besides the aforementioned factors, what are other characteristics of RFID that would affect your hospitals RFID adoption
decision making? (open-ended question)
Table 11 Constructs and items
Item Question Factor loading
a
Cost [23, 52]
COST1 The costs of adoption of RFID are far greater than the expected benefits. 0.937
COST2 The costs of maintenance and supports for RFID are very high for our hospital. 0.960
COST3 The amount of money and time invested in training employees to use RFID are very high. 0.883
Perceived benefits [7]
BEN1 RFID overhead costs will be reduced. 0.845
3, Page 14 of 17 J Med Syst (2014) 38:3
Table 11 (continued)
Item Question Factor loading
a
BEN2 RFID will improve the customer service. 0.905
BEN3 RFID will improve the hospital image and expertise. 0.896
Ubiquity [10]
UBIQ1 RFID provides our hospital with communication and connectivity at anytime-and-anywhere. 0.922
UBIQ2 The communication and information accessibility in anytime-and-anywhere provided by RFID
is highly critical for the effectiveness our hospital.
0.925
UBIQ3 My hospital requires personalized and uninterrupted connection and communication. 0.803
Complexity [23, 26]
COMPLEX1 The skills required to use RFID are too complex for the most of our employees. 0.776
COMPLEX2 Integrating RFID into our current work practices is very difficult. 0.922
COMPLEX3 RFID may encounter little or no harmonization between standards, e.g. due to the lack of unified
standards for RFID that may increase the complexity of relevant applications or operations.
0.619
Compatibility [53]
COMPAT1 Using RFID technology is compatible with all aspects of my works. 0.866
COMPAT2 Using a RFID technology is completely compatible with my current situations. 0.883
COMPAT3 I think that using RFID technology will fit well with the way I work. 0.919
COMPAT4 Using RFID technology fits into my work style. 0.902
Security and privacy risk (Developed based on Cases [54])
RISK1 Use of RFID may cause my personal information to be stolen. N/A
RISK2 I do not think it is safe to use RFID because of the privacy and security concerns. 0.920
RISK3 I have doubts about the data security of RFID applications. 0.683
Top management support [23]
TOPSUP1 The top management enthusiastically supports the RFID adoption. 0.958
TOPSUP2 The top management has allocated adequate resources to the RFID adoption. 0.948
TOPSUP3 Top management is aware of the benefits of RFID adoption. 0.952
TOPSUP4 Top management actively encourages employees to use RFID technologies in their daily activities. 0.942
Hospital scale
SCALE Number of beds in the hospital.
Financial readiness (Developed based on [7])
FINAN1 Our hospital has the financial resources for adopting RFID. 0.988
FINAN2 The overall information systems budgets are significant enough to support the development and
implementation of RFID applications.
0.896
Technological readiness [10]
TECH1 We use RFID because we know the technology. 0.607
TECH2 We have the technical knowledge and skills to implement RFID. 0.913
TECH3 We know how to integrate RFID with the existing systems of our hospital. 0.635
User support [38]
USERSP1 Employees (and patients) are enthusiastic about the RFID adoption. 0.805
USERSP2 Employees (and patients) have a negative opinion about the RFID adoption. (Reverse) N/A
USERSP3 Employees (and patients) are ready to accept the changes caused by the RFID adoption. 0.915
Government policy [1]
GOVPOL1 Financial aid for the installation will be provided by the government. 0.851
GOVPOL2 Training courses will be provided by the government. 0.821
GOVPOL3 Specification and stability of government policies. 0.989
External support [42]
EXSUP1 RFID suppliers will offer adequate technical supports after the implementation of RFID applications. 0.955
EXSUP2 High quality of technical supports will be provided by the RFID suppliers. 0.965
EXSUP3 High quality of training programs will be provided by the RFID suppliers. 0.950
EXSUP4 Effectiveness in performing information requirements analysis will be provided by the consultants. 0.894
EXSUP5 Effectiveness in recommending suitable solutions will be provided by the consultants. 0.888
J Med Syst (2014) 38:3 Page 15 of 17, 3
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