Finding ways to strengthen health care systems is a matter of great concern all around the world. Health care operations struggle with limited resources and diminishing workforce capabilities, making it imperative for effective and efficient operations. Hospital information systems (HIS) can help achieve this mission, providing reliable, timely, and relevant information about patient characteristics, reimbursement, and status of tests and quality metrics. However, there are still barriers toward the adoption of HIS by health care professionals. This study explores the inhibitors perceived by physicians for adopting HIS. The main motivation for this research is to answer the question: "What are the factors inhibiting physicians' use of Hospital Information Systems?" This research question is of great interest as physicians are considered to be the key to successful HIS deployment, adoption and use. This study takes a qualitative research approach, employing ninety-eight (98) interviews at nine different hospitals, complemented by more than 40 hours of workplace shadowing. We conducted our research in the United States, Chile and Germany, as the three countries have developed healthcare systems but take different approaches to fostering the use of IT in hospitals and have implemented at different organizational levels.

Our findings show that the alignment of user, system and process is important as expected. However, the results point out that leadership and organizational setting play vital roles, although they were often neglected in previous studies.