Maryam Ahmadi, Azadeh Bashiri,
Volume 8, Issue 2 (7-2014)
Abstract
Background and Aim: In order to better design an electronic health record system in the
country, determining standardized data elements for creating an integrated
information system is important. In this study, the minimum data set of
radiology reporting system is determined.
Materials and Methods: In this descriptive cross-sectional study, 13 radiologists, 3
anesthesiologists, 3 general practitioners and 3 insurance experts working in
the Imaging Center of Imam Khomeini hospital in Tehran were chosen. The
research tool was a questionnaire having 11 parts. Content validity and
test-retest method were used to measure the validity and reliability of the
questionnaire, respectively. Data analysis was performed using the SPSS
software.
Results: The highest means
reported were radiologists' written explanations and suggestions (9.6), image
interpretation (9.5), the name of contrast material (9.4), the name of imaging
procedure (9.3) type and date of previous measures (9.1), and the final
diagnosis (9) and the lowest averages belonged to referring physician's
address (4.8), relationship between patients and the primary individual insured
(4.3), and religion (2.2).
Conclusion: In an electronic health record system, due to
the importance of radiology reports for the diagnosis and future management of
a patient's clinical problems, it is necessary to pay attention to the minimum
set of data related to these reports such as administrative, insurance, patient
identity, and clinical data, and the results of radiological examinations for exchanging
with electronic health record system.
Reza Safdari, Masoumeh Hamidi, Mohsen Aghaee, Marjan Ghazi Saeedi ,
Volume 10, Issue 6 (3-2017)
Abstract
Background and Aim: The objective of this study was to design electronic card of health for schizophrenic patients to better manage their clinical information.
Materials and Methods: The study was conducted year 2014. The population of the study included 40 psychiatrists. The information, based on minimal clinical and demographic data, was gathered through field study and survey using a questionnaire. Referential and inferential statistics techniques were used to analyze the data. To schizophrenic patients' electronic health cards, various software were studied to design database, card and card reader.
Results: According to the results and observed frequencies, it was confirmed that the components of demographic and clinical information be inserted in the electronic card of health. The project includes hardware of card reader machine, card and visual studio software. Microsoft SQL Server, 2008, was applied to design database.
Conclusion: The electronic card of health for schizophrenic patients helps the treatment team to provide effective health care as well as medical records and hospital admission's staff in better management of patient information. It also reduces the problems of relatives and family members of the patients in the medical centers and facilitates, and the process of treatment of schizophrenic patients significantly. Using schizophrenia patient’s electronic health card, hospital in better management of patient information puts in good condition.
Reza Safdari, Somaye Mahdavi, Leila Shahmoradi, Khdijeh Adabi, Shahram Tahmasebian, Mahnaz Nazari,
Volume 12, Issue 5 (1-2019)
Abstract
Background and Aim: To provide effective care, health care providers need timely and appropriate information. Electronic records provide quick access and easy management of data. The aim of this study was to develop electronic health records for patients with hydatidiform mole and evaluation of completeness of medical records
Materials and Methods: This applied study was conducted in 2017. After verifying the minimum data set required for the system, data were extracted from patient records using a checklist and entered into SQL server. SQL server 2012 and Visual Studio 2013 to design electronic records and SPSS 20 for data analysis was used. Extent of data completion in patient records was also assesed.
Results: Data on the completion of paper records indicated that in 100% of cases, “address” item was filled in. The less completed data was related to carotene deficiency (%1.1). Our findings also showed that the eight most important items like age of first menstruation, first gestational age, interval between pregnancies, number of sexual partners, menstruation between pregnancies, contraceptive methods, social habits and radiotherapy, were not completed in all records.
Conclusion: Many of the important minimum data set for hydatidiform mole disease were either not completed or completed in limited numbers in paper records. By developing such health records, we can ensure better prevention and treatment, and regular follow-up for the patients and help them to save their time and costs.
Hamid Moghaddasi, Farkhondeh Asadi, Azamossadat Hosseini, Masoomeh Nouri Tahneh,
Volume 17, Issue 4 (10-2023)
Abstract
Background and Aim: The Hospital Information System is a complete one to provide high-quality patient care and enhance community health, so it must be designed and produced accordingly. In this regard, the current research was carried out with the aim of providing the document of standards for producing Hospital Information System software for Iran.
Materials and Methods: In this study, following extraction of the features and services of the Hospital Information System from the texts, they were matched with the generalities of the document of standards compiled by the Statistical Data Management and Information Technology Office of the Ministry of Health, Treatment, and Medical Education (SDMITO). Also, the Hospital Information System was reviewed observationally, all defects of document of standards were identified, and the document was amended throughout. After providing the proposed document of standards, it was consulted by a group of experts, which included ten health information management professors, ten medical informatics professors (with at least seven years of experience as members of the academic staff), and five heads of the information technology field of the Ministry of Health. An agreement coefficient of 85% was considered to accept and approve the document of standards. After obtaining the agreement coefficient, The Hospital Information System software production document of standards was provided.
Results: The document of standards provided for the production of Hospital Information System software includes the Hospital Information System design meta model, Hospital Information System subtypes, standards for the structure and content of Electronic Health Record, information terminology standards, data classification standards, security data standards, data exchange standards, clinical services, and management services, which were placed in the four areas of “features”, “services”, “documentation requirements” and “rules and policies”.
Conclusion: The application of this document of standards leads to the production of a higher quality, efficient, and standard Hospital Information System software, which is effective in improving the health level of society and provides the conditions for the implementation of Electronic Health Record.
Niloofar Mohammadzadeh, Zohreh Javanmard, Fatemeh Bahador,
Volume 19, Issue 2 (7-2025)
Abstract
Background and Aim: Today, with the digitalization of many healthcare processes, healthcare organizations strive to implement electronic health records (EHR) as effectively as possible. In this regard, the Meaningful Use (MU) program of EHRs was introduced in the United States. However, due to the existing challenges in this program and in order to accelerate the adoption of EHRs and reduce barriers, the Promoting Interoperability (PI) program was introduced by the Centers for Medicare and Medicaid Services (CMS). This study was conducted with the aim of reviewing the various dimensions of the PI within the EHR roadmap and examining strategies to overcome the obstacles of the MU program.
Materials and Methods: This scoping review was conducted in 2024. To assess the PI program, relevant articles were searched on PubMed, Scopus, and Web of Science databases, as well as electronic documents from CMS, without any time restrictions until March 2024. The searches employed the primary keywords “EHR,” “Meaningful Use,” “Promoting Interoperability,” and their synonyms. Additionally, a manual search was performed using the Google Scholar search engine to ensure comprehensive retrieval of all pertinent literature. Subsequently, articles and documents meeting inclusion criteria were selected, and their main characteristics were extracted.
Results: The review revealed that the PI program introduces substantial changes in EHR program requirements, objectives, and scoring methods. The core objectives of this program include: 1. electronic prescribing, 2. health information exchange, 3. provider-to-patient information transfer, and 4. public health and clinical data exchange. Furthermore, the program emphasizes additional requirements to enhance the quality of implementation, promote better sharing of EHR data, and improve clinical quality.
Conclusion: The Promoting Interoperability program has the potential to enhance patient health outcomes and reduce healthcare costs. Moreover, it is expected to gain increasing significance for hospitals as they adopt innovative healthcare delivery and payment models.
