Journal of

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Background: Study of the attitudes of health information management experts in health systems could be regarded in order to maximize utilization of information. The research reported here aimed to study of attitudes of medical records departments in Iran about mechanisms of development of health care system information technology.

Material and method: A cross- sectional research was developed by a questionnaire to study the atti­tudes of medical records departments of 17 universities by mail in Iran. 49 of them completed the questionnaire and returned it to us. Therefore the response rate was 70 percent. The data were saved by SPSS software and analyzed by statistical method.

Results: Faculty members of universities of medical sciences believe that the must hindrances of de­velopment of electronic health records in Iran are low budget and lack of standards.

Conclusion: Utilization of health information management experts attitudes could be assured the im­provement of health care information technology.

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Background: Septicemia is a life threatening status and needs rapid antibiotic treatment. Enterobacteri­acea are one of the most important causes of septicemia. So this study is therefore aimed to evaluate antibiotic sus­ceptibility of enterobacteriacea isolates in blood cultures in Shariati Hospital, Tehran, Iran.

Methods: This retrospective study was performed on 138 patients with positive blood culture in Shariati Hospital, Tehran, Iran in 2004, using disk diffusion and Macfarland standard. 

Results: Prevalence of isolated enterobacteriacea was respectively E. coli (n=74, 53.6%), Klebsiella (n=37, 26.8%), Enterobacter (n=21, 15.2%), Citrobacter (n=4, 2.9%), Salmonella paratyphi (n=1, 0.7%) and Proteus mirabilis (n=1, 0.7%). The most antibiotic susceptibility among enterobacteriaceaes was ciprofloxacin (60.4%), cloramphenicol (56.8 %) and gentamycin (49.3%). The most antibiotic re­sistance were seen among cephalotine (78%), cotrimoxazole (62.3 %) and ceftriaxon (57.5 %).

Conclusions: Due to dissimilarity between antibiotic consumption in laboratories and hospitals, it seems that to reach more proper conclusions and choosing better strategy for antibiotic consumption, cooperation should be between laboratories and physicians, plus synergism between drug prescription and antibiotic discs in laboratories.

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Background and Aim: Aging is a physiological process that is an unavoidable property of life. Decline in some dimensions of aging such as activity, income, health care and changes in life style are associated with increased risk of physical and mental health disorders. The aim of this study was to investigate the association between living areas and the demographic characteristics of elderly people in Tehran.

Materials and Methods: A cross - sectional / analytical study was conducted. The sample was consisted of 5600 elderly people and data was collected by using a questionnaire All analyses were undertaken using SPSS (Version 11.5).

Results: The results of this study showed that more 50% of subjects were illiterate and 30.5% of the were in schooling level. 62% of them reported at least one disease. We found significant differences between residences of north and south regions of Tehran for many of investigated variables.

Conclusion: These findings indicated that we need to pay more attention to elderly status specially those who are living in southern region.

 

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Background and Aim: Systematized Nomenclature of Medicine systems are the important supportive for electronic health record in registration and retrieval of data. Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) is the most comprehensive language and then the consistency of exchanged data across health care providers and finally the high effectiveness of health care.

Materials and Methods : This research is a descriptive - comparative study and has been done in certain time section. Ideally , it have been used the descriptive - comparative method for studying of selective countries.

Results : Findings of this study show that American and England countries have accepted the SNOMED CT with application in all clinical activities and Australia country is evaluating this system and is using older versions of SNOMED only in pathologic applications now. Study shows that SNOMED CT structure is complex and based of concept (clinical concept) and contains two fundamental parts : 1) content of SNOMED CT core (concepts , descriptions and relations) that are always constant 2) content of out of SNOMED CT core (mappings or relation with systems and local extensions) that according to health and management needs and native terms of country are different. Such a structure executes in different software applications.

Conclusion : SNOMED CT structure in America and England countries has been compared and with attention to similarities (content of SNOMED CT core) and differences (content of out of SNOMED CT core : cross mappings and local extensions) , a basic SNOMED CT structure has been provided for Iran. Because of SNOMED CT in Australia is under development, researcher has studied its evolution and execution process in this country and has provided an appropriate structural pattern for Iran.

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Background and Aim: The risk of infectious diseases in laboratory's personnel is high and several factors can increase these risk. Some of these factors are general, such as burning (with stray acid and base) and electric shock hazards. Which are not exclusive for laboratories. In other hand some several risk factors such as burning liquids are exclusive for laboratories. And there is limited information available about them.

Materials and Methods: This cross-sectional study was designed to evaluate accidental exposures of all laboratories personnel of Teaching Hospitals of Tehran University of Medical Sciences during 2004- 2005. We selected 416 laboratories personnel's in 15 different teaching hospitably TUMS for our study. The data were collected using a questionnaire and SPSS software was applied for data analysis.

Results:There was no significant association between accidental exposures with gender (p=0.51), educational level (p=0.11) and age (0.09) of laboratories personnel. But, accidental exposures were lower among those who had job experience between 5 to 10 years (p<0.05) compare to less than 5 years or more than 10 years job experience.

Conclusions:Although age, gender and educational level of laboratories personnel did not influence their exposure to laboratory's accidents, little or extensive job experience may increase accidental exposures among them. 

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Background and Aim: Occupational diseases are certain types of diseases that have been caused by special jobs and subject to special circumstances. There are several factors that can intensify these diseases. Various countries have indicated that they have played an effective role in decreasing exposures and its economic costs and attracting optimal resources through establishment of a comprehensive information system for occupational diseases with a appropriate structure. Health improvement is considered as the first aim of the health system which requires a comprehensive, complete and integrated information system on occupational disease.

Materials and Methods: This is a descriptive Comparative study which was conducted in 2008 during which information systems in countries such as US, Finland, France and Iran have been studied based on their objectives and structures. Main instrument of this research was articles, books, magazines, valid internet sites in English language. Then, the gathered data were classified and analyzed.

Results: All the three selected countries had an electronic information system and database in the field of occupational disease. In Finland, data of occupational diseases as well as their damages are kept in separate databases while US lacks a comprehensive system. There are countless systems in these countries in this field. In France, supervision on laboratories is a priority. In Iran, there is no certain comprehensive system for registering diseases.

Discussion and Conclusion: All of these countries have the same objectives. Structure of occupational diseases information system, in Finland, is more comprehensive. Iran lacks such a system, so it is recommended to make use of the experiences of other countries and establish electronic comprehensive disease system in this country.

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Background and Aim: Development and evaluation of rehabilitation services as a section of health system, which plays an important role in the improvement of the quality of life, needs a mechanism for information management as well as other healthcare levels. The effectiveness of information management has been assured through standardization & ongoing evaluation of rehabilitation centers. There is no standardization on rehabilitation information management processes in Iran, Therefore we surveyed the standards of information management at Commission on Accreditation for Rehabilitation Facilities and compared them to same English & Australian rehabilitation services evaluation & standardization organizations. At the end, we present a framework for necessary standards for this field.

Materials and Methods: In this literature review article CARF standards in axis of information management infrastructural standards, data gathering, content of records, documentation principles, information reveal for confidentiality policies of standard classification has been investigated. We used reliable electronic references in this article.

Discussion and Conclusion: The CARF information management standards are included a standardized outcome-oriented program evaluation & management systems as a fundamental & infrastructural requirement, data gathering standards, internal content of patient records, the framework for complete documentation and maintenance of information confidentiality. Therefore CARF standards in term of information management are the most complete model and have enough details in compare to the others. The results indicate that CARF standards can be a proper model for standardization activities and evaluation rehabilitation centers.

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Background and Aim: Today, cardiovascular diseases are the most important public health challenges in the world. Prevention and management of cardiovascular diseases necessitate the existence of a comprehensive system for recording data. Patient medical document is one of the most important data which should be classified so to facilitate and expedite the treatment process. A comparison of cardiovascular disease classification systems could assist health care policy makers to battle cardiovascular diseases.

Materials and Methods: This descriptive-comparative study conducted during years 2007-2008. The cardiovascular diseases classification systems in USA, Australia, England and Canada were reviewed. Data collecting was done through literature review, Internet and e-mail.

Results : The cardiovascular disease classification systems of all the developed countries are national. The developed countries, with the exception of England, utilize a multiracial classification model, especially designed to reflect the individual requirements of every single one of them. This model employs health care standards, e-learning, annual educational programs, and consultation with experts. Iran lacks such a national classification system for cardiovascular diseases.

Discussion and Conclusion : In order to improve the management and prevention of cardiovascular diseases in Iran, it is essential that the cardiovascular disease classification system in the country be national.

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Background and Aim: Today, psychological diseases like so many diseases, have an old history. Clinical Information System of psychological diseases resulting from war is a part of the information management system of mental illnesses, due to the management of mental patients from the war. This study is aimed to compare information management of psychological diseases in American, Australia and England with Iran.

Methods and Materials: This research is a study. At first, the existing situation was studied in three Psychiatric Centers in Ahvaz and Tehran with the use of a cheek list. Then information system of psychological disease has been studied in elected countries and based on the need of our own country, proposing practical solutions for Iran.

Results: The results of this study showed that there was no a information system of psychological disease in Iran. Also, four factors of this system including (goals, content structure, informational elements, information registration criteria) are reviewed in four selective countries.

Discussion and Conclusion: The design and implementation of this system in psychiatric centers is recommended to set two main goals including quality control and cost control in Iran.

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Background and Aim: Analysis of efficiency in hospitals, as the most expensive operating unit of the health system, is very important. This costly unit has several departments that one of them is medical records. This study is trying to analyze the efficiency of medical records department for the enhancement of using medical records facilities.

Materials and Methods: In this study, technical, scale and managerial efficiency of medical records department has been studied by data envelopment analysis method, and assuming the scale efficiency variable and the input axis. Information used in this study was the input variables (number of technician personnel and lower and Master of Science personnel and higher), output variables (number of emergency and outpatient and inpatient medical records and the number of filing unit visitors to respond) during 2007-2009.

Results: The average technical efficiency of medical records departments is 84 percent, that indicates there is at least 16 percent capacity for an increase in performance. Average of management and scale Performance in units during the 3 years of study are 95 and 89 percent respectively. Most input surplus is relevant to technician and lower personnel. The average performance of these units in general hospitals is 80 percent and in specialized activities is 92 percent.

Discussion and Conclusion: Relationship between studied indicators in this study with performance medical records departments showed that using such as employee personnel with undergraduate degrees and higher and educated in medical records filed, the use of managers with enough experience in this department and more use of computer systems for unit activities can fill 16 percent capacity of performance improvement in these units.

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Background and Aim: The benefits of a unique computerized medical records and communication equipments is utilized to collect, storage, process, extract and relate to patient care information and management information. If this utilization is in accordance with the needs of managers and staff of medical records, many of the nation's health system problems will be dissolved. Information systems in health supply system by compiling, analyzing and publishing data provide utilization of information improve the health of the society. The purpose of this study is to investigate the process of clinical information systems in general hospitals of Tehran University of Medical Sciences based on available clinical information system in these hospitals.

Materials and Methods: This descriptive study is an application study that conducted in order to determine the process of clinical information system in general hospitals of Tehran University of Medical Sciences based on available clinical information in these hospitals. The required data have been collected by a valid and reliable questionnaire. Descriptive statistics were used to analyze data.

Results: With regard to the current condition and the importance of survey of the process of clinical information system in the studied hospitals, the authors provided the desired checklist in general hospitals with studying the related system in America, Australia and England countries, on the basis of country requirements in the form of clinical information system processes. We studied clinical information system processes in departments of admission, filling and retrieving, statistical and coding and also soft wares in this department.

Discussion and Conclusion: It is necessary to create a coordinated and integrated clinical information system with suitable process and empower experts in the field of proper use of data with regard to the position of information system in each organization and its fundamental role in the adoption of accurate policies. We found that relative frequency of clinical information system processes is more than 60% in this department and clinical information system elements was observed 75% in all the departments except admission.

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Background and Aim: One of the most important reasons why organizations are distinguished from one another is the degree of application and implementation of information technology in their organizational activities. In this regard, individual factors contribute considerably to the application of information technology (IT). Such factors include employees' perceptions and attitudes towards information technology and their demographic characteristics which affect the level of information technology acceptance and implementation.

Materials and Methods: In this cross-sectional study, 110 middle managers from teaching hospitals of Tehran University of Medical Sciences (TUMS) were chosen. A structured questionnaire was used as the data collection device and its validity and reliability were confirmed by a pilot study.

Results: Of the participants, 62.9% were males and 37.1% were females. The findings show that there is a statistically significant relationship between perception and making decisions based on the implementation of information technology. However, there was no significant relationship between work experience, education and training on the one hand and IT implementation on the other.

Conclusion: The results show that human factors (perception and decision) have a considerable impact on the implementation of information technology. Top managers and experts should consider the important aspects of human factors and also the factors affecting them.

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Background and Aim: Annually, large amounts of fees that paid by hospitals will not be reimbursed as deductions by health insurances and takes irreparable financial losses to hospitals. The purpose of this study was to determine the amount of deductions imposed on hospital bills of Tehran University of Medical Sciences and their causes related to documentation.

Materials and Methods: The present research was a cross-sectional and descriptive study performed in year 2009 on educational hospitals of Tehran University of Medical Sciences. All deductions reports related to Medical Services and Social Insurance related to year 2008 was collected from Income Unit of hospitals. The amount of deduction of each hospital was extracted and organized in the form of comparative tables. Data was analysed by descriptive statistics and Excel application. Then, the amount, type and causes of annually deduction of each hospital was determined.

Results: Most deductions imposed on inpatient bills have been related to the tests, appliances, medicine, residency, surgeon commission, and anesthesia and for outpatient bills have been related to visit, tests and medicine which most of them have been created due to documentation deficiencies.

Conclusion: Most of deductions are due to unfamiliarity of care staff with documentation requirements of insurance organizations. Therefore it is necessary to use a multi-aspect mechanism including education of documentation principles to staff, supervision on record control in the Medical Record Unit and establishment of a committee by university for related activities.

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Background and Aim: These days with the improvements in science and technology the number of individuals who suffer from genetic disorders should be drastically less. A crucial method for preventing these disorders, in the first place, is by genetic counseling. Educating the public in regards to how they can avoid producing affected children. Materials and Methods: In this retrospective cross- sectional study, all the files of the couples attending Genetics Clinic of the Imam Khomeini Hospital Complex, during 1995 to 2004 were studied. The data were collected using a reliable questionnaire and SPSS software was applied for data analysis. Results: The most important variable in this study was the relationship between the couples. The most frequent among the consanguineous marriages was the cross first cousins (45.3%), and the least frequency belonged to non-related marriages (6.4%). The most frequent genetic diseases belonged to children who their parents were parallel first cousins (84.8%). Conclusions: Due to the importance of genetic counseling in relation to reducing the frequency of the genetic disorders in society, educating the general public about compulsory genetic counseling before marriage, is the cheapest and the most effective approach in limiting the number of patients with genetic abnormalities.

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Background and Aim: With the increasing spread of technology, the use of telemedicine to treat diseases is increasing. Diseases of the ear, throat and nose, are among the most common illnesses, especially among children, which can be diagnosed and treated through tele-otolaryngology.

Materials and Methods: This comparative study is conducted in the United Stated, Australia and England. The information needed for the present study was collected from print sources such as texts, journals, and articles found in such databases as Medline, Embase, CINAHL, Web of knowledge, Google Scholar, and Scopus. To this end, certain key words like Telemedicine, Telehealthotolaryngology, ENT, ear diseases, otology and Teleconsultation were used.

Results: The most common way to send information is through the standard otoscopy, video-otoscopy and videoconferencing equipment (Audio-Video Receiver). The information needed for Telehealthotolaryngology includes demographic information (patient's name, identification number, date of receiving services) together with the data related to the diagnosis and treatment of the disease (disease history, radiology and scan results, eardrum images, laboratory results and previous consultation results).

Conclusion: For telehealthotolaryngology, suitable equipment is required to transmit audio-visual data properly so that ENT specialists and audiologists can benefit from it in their examination and treatment. The application of this method can help patients to economize on their treatment expenses and to follow their treatment in a better way.

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Background and Aim: Urban health is one of the challenges of the 21st century. Rapid growth and expanding urbanization have implications for health. In this regard, information technology can remove a large number of modern cities' problems. Therefore, the present article aims to study modern information technologies in the development of urban health.

Materials and Methods: This is a review article based on library research and Internet searches on valid websites such as Science Direct, Magiran, Springer and advanced searches in Google. Some 164 domestic and foreign texts were studied on such topics as the application of ICT tools including cell phones and wireless tools, GIS, and RFID in the field of urban health in 2011. Finally, 30 sources were used.

Conclusion: Information and communication technologies play an important role in improving people's health and enhancing the quality of their lives. Effective utilization of information and communication technologies requires the identification of opportunities and constraints, and the formulation of appropriate planning principles with regard to social and economic factors together with preparing the technological, communication and telecommunications, legal and administrative infrastructure

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Background and Aim: Decision support systems(DSSs) refer to one of the types of information technology applications that can help clinicians to make right and timely decisions about patients. The aim of this study is to learn more about DSSs and their applications and effects on health care.

Materials and Methods: In this systematic review, articles which were published between 2000 and 2012, which were available as full texts through databases and search engines -- such as PubMED, EBSCO host research, Google scholar and Yahoo -- and which were also of clinical-trial type were examined besides, certain books in this area were used as primary sources.

Conclusion : The findings show that DSSs were applied in five areas in health care, which had a significant effect on improving the process of care and the performance of providers. These areas are as follows: disease progress management(15.15%), care and treatment(27.27%), medication(27.27%), evaluation(27.27%), and preventation(12.12%). In general, improvement can be seen in three areas: quality of care and patient safety, cost effectiveness, and provider’s level of knowledge.

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 Background and Aim: One of the most important reasons why organizations are distinguished from each other is the extent to which each applies information technology. Among the most important factors playing a role in the application of information technology are organizational factors such as organizational resources, organizational knowledge, processes, management structure, values and goals all these elements affect the level of information technology acceptance and application. Therefore, this study aims to determine the degree to which the above-mentioned elements can affect the application of information technology by middle managers of Tehran University of Medical Sciences (TUMS) teaching hospitals.

 Materials and Methods: This is a cross-sectional, descriptive-analytic study conducted in 2010. The subjects comprised 110 middle managers of TUMS teaching hospitals. The data-collection instrument was a questionnaire structured by the researchers, and its validity and reliability were confirmed prior to the study. The response rate was 80%.

 Results: The participants consisted of 56 (62.9%) males and 33 (37.1%) females. The findings of the study showed that there was a statistically significant relationship between organizational resources, organizational knowledge, processes, management structure, values and goals on the one hand and the application of information technology in TUMS hospitals on the other (p<0.01).

 Conclusion: The results show that organizational factors have a considerable impact on the application of information technology. Besides, managers and experts should consider the important aspects and effects of these organizational factors.

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Background and Aim: If the evaluation is done from the perspective of users, Successful development of measures and features related to use and implementation of hospital information system and identify areas that need further consideration is to be provided. The main purpose of this study was assessment the views of physicians and nurses of hospital information system identify the effective criteria for the use of it and their satisfaction.

Materials and Methods: Present research is a descriptive cross-sectional study and was applied in public- education hospitals of Tehran University of Medical Sciences in 2012- 2013. The main tool was a questionnaire prepared by reviewing relevant literature in databases Iranmedex, Magiran, SID, PubMed, Science direct, Google scholar, and surveys by experts. In order to determine the validity, a questionnaire was distributed among 5 experts in the area of ​​information technology. After completion of the questionnaires, results were analyzed using software SPSS17.

Results: Information systems in half of the hospitals surveyed from the perspective of research community have an average of 30 - 60 percent capabilities in order management. Also users in all surveyed hospitals with more than 43 % agree the ease of using hospital systems.

Conclusion : User satisfaction is a guarantee for the implementation of information system. To improve the situation and move towards the ideal condition we suggest users needs in hospital information systems should be considered. Also design and system should be Compatible with the skills and knowledge of users as possible.

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 Background and Aim: The applicability of any technology to enter a certain field is determined by defining the advantages and disadvantages of the system in that field. The aim of this study is to show the advantages and limitations of using speech recognition systems in health care and providing practical solutions to improve the acceptability of the system in that field.

 Materials and Methods: This is a descriptive research with a review method that employs library resources and online databases such as Proquest, Pubmed, Science Direct, Ovid and Scientific Information databases using key words like speech recognition software, health care, benefits, barriers, and solutions.

 Results: Speech recognition system has many advantages like increased accuracy of medical documentation, and reduced documentation time. It is a tool for data entry into electronic health records. However, there are several limitations in applying the system in Iran, such as the lack of definition of database system and the high cost of hardware and software.

 Conclusion: Considering the study results in relation to the benefits and limitations of systems in healthcare area, solutions such as production of a national integrated database for the exchange of health information, improving database to increase the accuracy of word recognition, and training the users of the system can reduce the limitations of the system to some extent. Also, in the country’s movement towards the implementation of electronic health records and the users’ need to enter data into the computer, the software is a good alternative to keyboard and mouse input.