Showing 7 results for Health Record
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, Hossein Dargahi, Farzin Halabchi, Kamran Shadanfar, Robab Abdolkhani,
Volume 8, Issue 2 (7-2014)
Abstract
Background
and Aim:
The quality of health record depends on the quality of its content and proper
documentation. Minimum data set makes a standard method for collecting key data
elements that make them easy to understand and enable comparison. The aim of
this study was to determine the minimum data set for Iranian athletes’ health
records.
Materials
and Methods: This study is an applied research of a descriptive - comparative type which was carried out in 2013. By using internal and external forms of documentation, a checklist was
created that included data elements of athletes health record and was subjected
to debate in Delphi method by experts in the field of sports medicine and health information management.
Results: From 97 elements which
were subjected to discussion, 85 elements by more than 75 percent of the
participants (as the main elements) and 12 elements by 50 to 75 percent of the
participants (as the proposed elements) were agreed upon. In about 97
elements of the
case, there was no significant difference between
responses of alumni groups
of sport pathology and sports medicine
specialists with medical record, medical
informatics and information
management professionals.
Conclusion: Minimum
data set of Iranian athletes’ health record with four information categories
including demographic information, health history, assessment and treatment
plan was presented. The proposed model is available for manual and electronic
medical records.
Khadije Moeil Tabaghdehi , Marjan Ghazisaeedi , Leila Shahmoradi , Hossein Karami,
Volume 11, Issue 5 (1-2018)
Abstract
Background and Aim: Thalassemia is a chronic disease which is extremely expensive, complex and debilitating. The management skill of thalassemia patients should be enhanced to minimize the risk of disease complications. The main purpose of this study was to develop personal electronic health records for thalassemia major patients.
Materials and Methods: This is a developmental applied study which was conducted to develop a personal electronic health record for thalassemia major. First, a questionnaire was prepared to determine the data elements and was filled by Hematology and Oncology professionals in the country (110 persons). Then, based on the results of needs analysis, the system was designed using PHP programming language and MySQL database and was evaluated by 50 thalassemia patients who referred to the Thalassemia Clinic of Bu Ali Sina Hospital of Mazandaran University of Medical of Sciences during the second half of the month of Aban. Finally, a standard questionnaire of usability and user satisfaction assessment was distributed among them.
Results: Usability evaluation of the system showed that patients evaluated the system at a good level with a mean rating of 7.91 (out of 9 points).
Conclusion: The web-based systems can be used to help thalassemia patients to control injection and reduce the complications of the disease and to promote health.
Mozhgan Tanhapour, Ali Asghar Safaei,
Volume 11, Issue 6 (3-2018)
Abstract
Background and Aim: Personal Health Record (PHR) systems play a key role in employing patient-centered care. Besides, the inclination to use Internet services has increased in recent years. The goal of this study is to describe the needed requirements for developing the proposed hybrid PHR model in a social network.
Materials and Methods: Using a descriptive study, a hybrid PHR model was designed in this paper to be implemented in the social health network. Then, by using observation, introspection and questionnaire methods, the requirements of the proposed social network were listed. The elicited requirements were then analyzed by SPSS 16 using descriptive statistics (absolute frequency). Finally, the proposed system was described in the Software Requirement Specification (SRS) standard format.
Results: The proposed hybrid PHR model has benefits of all existing PHR models and is most consistent with PHR definition (individuals control and manage their PHR). It is also applicable and reliable both for individuals and physicians. The results indicated that the proposed system had PHR capabilities as well as social network functionalities. So, the possibility of creating relations between individuals provided more benefits in comparison to other PHR models.
Conclusion: By providing reliable information, the social health network can improve patient-physician relationships. As a result, the proposed social health network can make possible the utilization of web 2.0 and social network capabilities in the healthcare field as well as the benefits of PHR records and patient-centered care.
Minoo Shahbazi, Reza Safdari, Mohammad Zarei,
Volume 12, Issue 2 (7-2018)
Abstract
Background and Aim: The quality of Electronic Health Records (EHRs) depends on the quality of its content and proper documentation. Determining the Minimum Data Set (MDS) to enhance the quality of electronic health records’ content and helping to improve the quality of health care provision to uveitis patients are essential matters. The aim of this study is to determine the essential MDS for uveitis patients’ electronic health records.
Materials and Methods: In this descriptive-analytical study, data collection tools for collecting the Minimum Data Set were library resources and internet-based database. The MDS was obtained through Likert scale questionnaire and was surveyed by 22 ophthalmologists and retina subspecialists.
Results: Among the elements of the survey, all cases with over 90% approval were considered as main elements. Regarding the importance of presented data elements, no significant difference was found between the responses of ophthalmologists who participated in this study.
Conclusion: The Minimum Data Set of uveitis patients’ electronic health records can be represented by five groups of demographic information: patients’ clinical records, laboratory information, type of uveitis, treatment guidelines, and the information of ophthalmic pictures. A suggested model for manual systems and electronic medical records is available.
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.
