Journal of

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.

Background and Aim: In any country, one of the fundamental goals of health policymakers is to facilitate the people's access to treatment and health care services. Therefore, the aim of this study was to identify factors that influence recievers' access to delivered services in urban health care services.

Materials and Methods: We performed this descriptive and cross sectional study in year 2008. We used the multi-stage sampling method for selecting 57 staffs of urban health care centers as statistical samples. The valid and reliable questionnaire for gathering data was designed. Data was analyzed by SPSS 2 version 13 software.

Results: Our findings indicate that mean scores of individual, geographical, financial and structural factor was 2.29 (61.4% with high impact), 2.42 (57.9% with high impact), 2.27 (56.1% with high impact) and 2.58 (86% with high impact), respectively. (Our mean score range was 0 to 3).

Conclusion: According to the assessment of employee's viewpoint of Urban Health Care Centers, all of four individual, geographical, financial and structural factors had high influence on person's access to health care services in Urban Health Care Centers. Consequently this study has presented suggestions (according to the findings) for improving access to delivered services in urban health care centers.

Background and Aim: The use of electronic operations in health care industry has many positive points such as health care quality improvement, reduction in costs, and increased efficiency. Besides talking about the concept of Mobile Commerce (M-Commerce) as well as its benefits and challenges, the present article presents suitable approaches to benefit more from this new technology in the field of health, especially in the private sector.

Materials and Methods: This review article was performed based on a literature review and a search through such valid sites as Science Direct, Emerald, and Magiran, and also an advanced search in Google. In this paper, the researchers studied national and international documents about the application of communication and IT tools -- particularly mobile and wireless tools, E-commerce, and M-commerce -- from 1996 to 2011.

Results: E-business can be considered as one of the subsets of E-Health, and M-commerce as one of the E-business models is a very useful tool in developing countries. With this tool, organizations located in remote places can have access to potential customers and gain valuble benefits. Efficient application of E-business models in Iran requires the identification of opportunities and barriers as well as the preparation of suitable and basic plans with regard to socio-economic factors together with the provision of executive, legal, technological, and communications infrastructures.

Background and Aim: Health information System (HIS) is a comprehensive software used to unify and transfer hospital data effectively. It is vastly employed to improve input quality, decrease data-transfer time, increase satisfaction level, promote health services quality, and minimize hospital costs.

Materials and Methods: This is an applied-descriptive study. The research population consisted of 120 HIS users who worked before and after the HIS application at Masih-Daneshvari Hospital. For data collection purposes, a questionnaire was used. The data were then analyzed with SPSS software, and descriptive and inferential statistical methods.

Results: According to data analysis, the application of the existing communication system among the different sections and wards was very good (81%), the accessibility to patient medical information and facilitating treatment processes were good (44% and 61%, respectively), and the analysis of budgeting data (11%), the possibility of clinical researches (19%), the presentation of guides for operators (18%), and the accessibility to statistical and financial data (17% and 22%, respectively) were assessed as poor.

Conclusion: The results of this survey show that the application of Hospital Information System has a positive effect on accuracy, facility, and treatment processes, and emphasize the importance of programming to enhance the quality of hospital services.

  Background and Aim: Family physician is the core in the world efforts for quality improvement, cost effectiveness, and equity in the health care systems. The main purpose of this present study was to investigate situation of the family physician program and identify referral route in this program in six pilot cities in Khuzestan province .

  Materials and Methods: A cross-sectional descriptive study was conducted in 2011. Pre-designed checklists were used for collecting data. In this study, 15 healthcare team in six pilot cities for family physician program in Khuzestan province were examined and their specified referral levels for each city was investigated and compared with the national instruction to identify current gaps.

  Results: The least number of staff belonged to nutrition, nurses and physicions respectively. In the second referral level cities, Specialists did not welcome the program . In Mahshar, a second level city, five specialists have been registered to family physician program. In the third level, 28/5 percent of specialist were enrolled in this program.

  Conclusion : It seems that it is necessary to facilitate patient access to physicians under contract with family physician program and referral system in second and third levels. Therefore, establishing a motivation system for attracting specialist and improving their maintenance situation can also be beneficial.

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.

 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.

 Background and Aim: : Technical knowledge of managers of health care industry regarding budgeting have an essential function on increased efficiency of organizations working in this sector, since every single right decision, rely on appropriate knowledge and analysis. Therefore, the purpose of this study was assessment of technical knowledge of managers of health care system regarding budgeting.

 Materials and Methods: This was a descriptive  -analytic, cross- sectional study. From 80 managers of Tabriz Medical Sciences University 63 participated in the study and a questionnaire was employed to collect data. Data was analyzed by Spss 16 software, Pearson correlation test, T test and ANOVA.

 Results: Mean of total scores was 16.9±4.6 of 30. There was no significant difference between total scores in different courses (P=0.276) and positions (P=0.431). Mean of total scores between women and men (P=0.782) were the same.

 There weren't significant relation between technical knowledge of managers with age (p=0.392, r=0.1), job background (p=0.299, r=0.1) and management background (p=0.121, r=0.2).

 Conclusion: With respect to low level of manager's awareness about budgeting,improving of technical knowledge is essential. Lack of significant relation between technical knowledge of managers and their length of management practices, with unstable situation, may harm seriously organizational achievements. Reviewing and promotion of educational programs and continuous training of managers with respect to budgeting seems to be an essential need for improving manager's performance.

 Background and Aim: The hypothesis of supplier induced demand has attracted a lot of attention over the past three decades. Most studies in this field agree that healthcare providers have the ability to influence the demand for their products. The purpose of this study is to evaluate the role of institutions in the phenomenon of induced demand. This study has been done using experts' experiences in Isfahan University of Medical Sciences.

 Materials and Methods: This is a qualitative study in which the semi-structured interview was used for data generation. The participants were those informed in this regard and considered as experts. For data saturation, purposive sampling was done. In this study, 17 people were interviewed, and criteria such as reliability and stability were considered. The anonymity of the interviewees was guaranteed. The data were transcribed and categorized, and then analyzed using thematic analysis.

 Results: In the present study, thematic analysis was conducted and 30 sub-themes and 2 main themes were extracted. The two main themes were healthcare insurance organizations and other health organizations. Each of the themes had its own sub-themes.

 Conclusion: The findings help health policy-makers have a better picture regarding the role of various institutions in the phenomenon of induced demand.

Background and Aim: In a severely inflationary environment with unemployment, social problems increase and, therefore, high health care expenses are imposed on the society.

Materials and Methods: This was a correlational study. Panel data model and EVeiws 6 software were used in this study. The data were collected from the World Bank website. The required pre-tests, including F-Limer and Hauseman tests, were given to check the appropriateness of data and to determine a appropriate model. Following the pre-tests, the results were estimated in the form of a regression model.

Results: The results indicated that F-test and t-statistic were significant, and that R² statistic was high. In the three models, R² was 99%, 99% and 98%, respectively. Moreover, it can be said that employment is positively related with life expectancy, but negatively related with infant mortality and total fertility rate. Also, inflation is negatively related with life expectancy, but positively related with infant mortality, and total fertility rate. Finally, Gross Domestic Product (GDP) is negatively related with total fertility rate and life expectancy, but has no meaningful relationship with infant mortality (p = 0.31).

Conclusion: Employment, inflation and GDP are the variables that have the greatest impact on health indicators. however, life expectancy is more sensitive to explanatory variables.

Background and Aim: In recent years, the family physician plan has been implemented as a main strategy of the health system in Iran. Therefore, the necessity to reform organizational structure based on new goals and strategies is felt more than before. The aim of this study is to review and summarize all cases about Iran’s organizational structure and its challenges in primary healthcare system.

Materials and Methods: This study is a systematic review. All relevant databases, bibliography of related papers, and laws were searched using appropriate search strategies and keywords. To evaluate the quality of selected papers, CASP tool was applied by two experts, and their choices were discussed to reach a final decision.

Results: Fourteen final cases were categorized in two groups: papers and upstream policies and laws. The results revealed the ineffectiveness of current organizational structure at different levels. The majority of the findings suggested proper reforms in the system. Centralization and delegation processes were the main dimensions studied.

Conclusion: Due to fundamental changes in goals and strategies, certain reforms in the organizational structure of health system in Iran are indispensable, especially at peripheral levels.

Key words: Primary Health Care System, Organizational Structure, Iran

Background and Aim: In recent years, the family physician plan has been implemented as a main strategy of the health system in Iran. Therefore, the necessity to reform organizational structure based on new goals and strategies is felt more than before. The aim of this study is to review and summarize all cases about Iran’s organizational structure and its challenges in primary healthcare system.

Materials and Methods: This study is a systematic review. All relevant databases, bibliography of related papers, and laws were searched using appropriate search strategies and keywords. To evaluate the quality of selected papers, CASP tool was applied by two experts, and their choices were discussed to reach a final decision.

Results: Fourteen final cases were categorized in two groups: papers and upstream policies and laws. The results revealed the ineffectiveness of current organizational structure at different levels. The majority of the findings suggested proper reforms in the system. Centralization and delegation processes were the main dimensions studied.

Conclusion: Due to fundamental changes in goals and strategies, certain reforms in the organizational structure of health system in Iran are indispensable, especially at peripheral levels.

Background and Aim: Today, customer perception assessment as a way to measure satisfaction and expectations has an important role in improving the quality of services and organizational excellence. This study aims to measure customers’ perception at the Health Deputy of Iran’s Ministry of Health and Medical Education (MOHME).

Materials and Methods: This cross-sectional study was performed in 2012-2013. The population comprised the health deputies of medical universities, among which 13 of the universities were randomly selected. As the main customers of MOHME health deputy, these universities’ managers and experts were asked questions like a census. The data collection device was the national award standard questionnaire consisting of 2 sections and 26 questions. The data were analyzed by SPSS 18 with level.

Results: Of the 267 managers and experts, 147 (56.1%) were male. Many of them (57.3%) had a bachelor's degree. Most of them (91.6%) were employed in technical units. The average perceived level of managers and experts regarding their reputation and image was 3.3±0.7, production and service 3.1±0.7, support while and after providing services 3.0±0.7, and loyalty and honesty 3.3±0.8 out of a maximum 5 points, respectively. There was no significant relationship between administrators and experts’ perception level on the one hand, and individual and organizational factors on the other (P>0.05).

Conclusion: The study showed that customers’ perception of indices related to the quality of relationships, services and measures was at a moderate level. Therefore, it is recommended that the department of health should design and implement an appropriate intervention program for organizational excellence.

Background & Aim: Because of extension of health services and comprehensive receivers, the need for health services management is inevitable. Despite the availability of health care services, people do not embrace the full range of these services. This study was conducted to determine the reasons for unwillingness to use health care services presented to age group under 9 years from perspective of health workers in Qom province, during 2013.

Materials and Methods: This cross-sectional study was done to evaluate the perspective of health personals about services that presented to population with age group less than 9 years. This study was done with a questionnaire as a matrix evaluation of health services. Data were analyzed by Spss 15 Software. Chi square test were used for the evaluation of the hypothesis.

Results: The main reasons for the lack of interest to receive the health care services from perspective of health workers were: lack of health knowledge in recipients of services, inadequate information, poor methods of health care delivery, quality of health care and unsuitable access to health care.

Conclusion: To encourage people to get the health care services provided at health centers in Qom province should hold training meetings, to enhance the knowledge of health care recipients. About presentation of services and methods of service delivery in health centers, we should give enough knowledge to people. Also we should try to promote the level of services, while people motivate to get the services.

Background and Aim: With the assumption that health is as one of the luxury goods, therefore making efforts in reducing health spending and inflation in this section will be ineffective.
But if health is an essential service, then in the national level for better redistribution of the resources and financial protection of the households against the health expenditures will be needed. The main objective of this study was determination of income impact of health care expenditures in Tehran household in years 2011-2012.
Materials and Methods: This study was a population based survey. The instrument of data gathering was a "WHO questionnaire" which was integrated by interview with an acquainted person in each one of the 792 families who live in Tehran. The least ordinary squares, Granger causality test, Breusch-Pagan-Godfery and White heteroskedasticity test were used for data analysis. Eviews 8 software was used for running the tests. 
Results: The results showed that heath is a cause for increasing income but the converse is not true. Otherwise, Health with income elasticity equal to 0.25 is an essential service, and is not perceived as luxury goods. Moreover results represented that income is not a good variable for rationalizing the variation of health expenditures.
Conclusion: Health was an essential good, and although income changes affect the expenditures of health care, but the sensitivity is not high and recommended that health policy-makers should in adoption policies such as tariff increases do a comprehensive survey because prices increase are borne by the consumers.