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technical requirements, system features, compatibility, and ICT<br />

infrastructure were identified as main technical factors which<br />

influenced the effectiveness of technical exchange between the<br />

Saudi MoH and CDC.<br />

5.1.1 Ease of Use<br />

The system as implemented is perceived as being easy to use as<br />

revealed by the case study. Participants representing the Saudi<br />

team said: “The system, as a system, was not so complicated.”,<br />

“The system is very user friendly from the perspective of the end<br />

user.” The ease of use of the implemented system minimized the<br />

time and energy required to learn how to use it, and increased the<br />

likelihood of successful adoption within the available time frame<br />

as pointed out by one participant: “Understanding the system and<br />

how it works did not represent an issue for us at all, and we were<br />

able to learn it in a short period of time.”<br />

5.1.2 The Ability to Meet Technical Requirements<br />

The ready availability of the required hardware smoothed the<br />

acquisition of the required resources, which in turn accelerated the<br />

implementation process for the Hajj-MDSS. Participants were<br />

able to avoid challenges stemming from a lack of the required<br />

technical resources, as discussed by participants: “There were no<br />

challenges associated with obtaining the required hardware<br />

devices. The purchasing process was handled smoothly, and was<br />

completed in about one day. The servers, too, were readily<br />

available and inexpensive.”<br />

5.1.3 System Features<br />

The study points to the importance of considering national and<br />

organizational contexts during the selection process of any system<br />

to be adapted to suit a new context. In this instance, the selected<br />

software lacks important features such as the support for Arabic<br />

and the Hijri Calender (HC), which is the official calendar in<br />

Saudi Arabia. Top level management at the Saudi MoH adjusted<br />

to these limitations, and agreed to move forward using the<br />

Gregorian calendar and English language. These limitations did,<br />

however, place an undue burden on those Saudi public health<br />

practitioners who worked with the system, as top level<br />

management at the MoH decided to maintain the existing paperbased<br />

system while integrating the new one.<br />

5.1.4 Compatibility<br />

The selected software relies on Extensible Markup Language<br />

(XML) to facilitate the sharing of structured data across the<br />

different components of the MDSS. While XML is becoming the<br />

standard for electronic data exchange and serves the needs of the<br />

implemented system well, it also carries with it some particular<br />

disadvantages which negatively influenced the potential<br />

effectiveness of the system. In this instance, there was other<br />

required software which was incompatible with XML files. Most<br />

importantly, the XML data format is not compatible with the<br />

InstantAtlas software used to display data for decision makers. To<br />

display the data using InstantAtlas, participants had to translate<br />

the XML data file to a discrete data file manually, which was a<br />

time consuming process. The process influenced the quality of<br />

displayed data to some extent.<br />

5.1.5 ICT Infrastructure<br />

The implemented system is dependent on two telecommunication<br />

modalities: the Internet and a cellular network. The use of these<br />

communication modalities peaked during the Hajj, and resulted in<br />

congested communication traffic, which in turn negatively<br />

117<br />

influenced the functionality of the system during the 2009 Hajj, as<br />

discussed by multiple participants: e.g. “The system relies on a<br />

communication network to facilitate the transfer of data from the<br />

field and public health facilities to the server, using the mobile<br />

phones' SIM cards and the Internet. Network traffic peaked during<br />

the days of the Hajj, leading to critical technical challenges, but<br />

there was no way to discover these challenges prior to the onset of<br />

the implementation process.”<br />

5.2 Knowledge and Information Context<br />

The case study identified codifiability, perception of the content’s<br />

value, sensitivity, and confidentiality as additional factors that<br />

influenced the effectiveness of knowledge and information<br />

exchange during the collaboration toward adopting the Hajj-<br />

MDSS.<br />

5.2.1 Codifiability<br />

A portion of the content exchanged was explicit and easily<br />

expressed in written form [Table 4]. The case study found that this<br />

type of content is easy to share among TPSKN participants. The<br />

ready and frequent exchange of such content allowed participants<br />

to speed up the implementation process, in turn allowing more<br />

time for the exchange of the type of tacit content which required<br />

direct interaction. One clear example of this type of content is the<br />

system requirements that CDC experts sent to their counterparts in<br />

the MoH in written form. Saudi IT specialists commented that the<br />

system’s requirements were clear, and they did not encounter any<br />

difficulties in interpreting them: “The CDC gave us the database<br />

design and the technical specifications of the needed resources.<br />

We studied these specifications on our own and obtained the<br />

required smart phones, servers, and other technical resources.”<br />

5.2.2 Value<br />

All interviewees noted the high degree of transparency, and<br />

stressed that content was freely exchanged between both sides.<br />

One Saudi participant commented: “Any time we were set to<br />

conduct an activity which required the exchange of specific<br />

expertise, we found [the CDC] here and willing to assist.”<br />

Similarly, one CDC participant noted, “We were able to access all<br />

of the information we needed to conduct our work.”<br />

The study focused on data stored within the system. This data<br />

consists of both important information about reported cases and<br />

confidential patient information. Participants answered questions<br />

related to their perception of the value, sensitivity, and<br />

confidentiality of this data. The case study revealed that the value<br />

of this data was limited to decision making during the Hajj, and<br />

for subsequent research purposes. The Saudi MoH presented no<br />

obstacles or objections to sharing this data with researchers. As<br />

the CDC experts were there to assist in decision-making, this<br />

attitude facilitated the exchange of system data amongst and<br />

between all participants as revealed in the case study.<br />

5.2.3 Sensitivity<br />

In this case, while participants from the Saudi side discussed the<br />

insistence of the Saudi MoH on having control over the data<br />

stored within the system as they consider such data as being<br />

sensitive, the preference for having full control over the data did<br />

not influence the intention to share that data with the CDC, as the<br />

study has shown. This would not have been the case, however, if<br />

the intention of the CDC had been to secure full access, retain full<br />

control over the data, or connect the system to other existing<br />

systems. Providing evidence for the latter statement requires

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