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: 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.

Background & Aim: Unified Medical Language System (UMLS) is an extensive ontology of biomedical knowledge developed and maintained by U.S. National Library of Medicine (NLM). Traditional Iranian Medicine (TIM) does not have any position in the structure of metathesaurus of UMLS. The main aim of this study was designing a scheme of TIM cluster's crotch mapping in the structure of metathesaurus of UMLS. Moreover, the TIM position and its proportion in the domain of vocabulary and concepts of universal medical knowledge was another aim of this study.

Materials and Methods: System analysis was the method of this study. To investigate structure of UMLS metathesaurus, and to survey lacking of TIM cluster's crotch, we applied UMLS Knowledge Source (KS) by using inductive, deductive, inductive-deductive approaches. 

Results: One Concept Unique Identifier (CUI) two synonym terms with Lexical Unique Identifier (LUI), L0025131 and L6330122 two ancestor and parent concept nine concepts which with TIM crotch were the child concepts of two ancestor and parent eighteen sibling concepts six narrower and five other related found concepts were identified for the proposal TIM crotch mapping in metathesaurus of UMLS. In addition, we found the "Biomedical Occupation or Discipline" semantic type assigned to it.

Conclusions: Current domain of metathesaurus of UMLS does not represent complete and formal domain and position of TIM. Therefore, this metathesaurus needs to depict a domain and position for TIM.

Background and Aim: Thalassemia is a genetic disease whit relative or complete lack of alpha or beta globin chain. Patients with moderate and severe form need to have multitransfusion in early life. Occurrence of all immunization against blood group antigens in patients with thalassemia is relatively high and may have difficulties in treatment and transfusion. Antibody production against this blood groups cause lots of problems like preparation of compatible blood for transfusion. Correct diagnosis of blood group phenotype due to existence of dual population of donor and patient RBC would be difficult.

Materials and Methods: In this study, randomly from 40 thalassemic patients, before blood transfusion, 4cc of peripheral blood collected in tubes containing EDTA. Also, 10 healthy individuals who had no history of blood transfusion were in the study as control for serological (agglutination) and molecular results . Phenotyping of patients and control group was done by tube agglutination method by commercial antibody. For molecular test, Allele Specific Primer Amplification (ASPA) PCR was performed for each antigens in separate micro tubes.

Results: In this study' we could set up a method that can amlify any of Rh C c E and E gene separately by a pair of specific primer in a same thermal conditions.Comparison of results of two methods showed that in the control group with no transfusion history. Similar results in phenotyping and genotyping was observed. But in patients, results of two methods had lots of differences.

Discussion and Conclusion: The advantage of this method over PCR-RFLP method is that' all four genes can be amplified the in a same concentration and temperature conditions, and ability to determine the individual's antigen, immediately by electrophoresis. Therefore, Since the above method is simple and inexpensive for medical and research centers it is recommended.

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.

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.

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.

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.

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.

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: Learning may be the only sustainable competitive advantage for all organizations. A learning organization is an organisation where people continually expand their capacity to create results they truly desire new and expansive patterns of thinking are nurtured collective aspirations are set free people are continually learning from what others have learned. The aim of this research is to study whether a learning organization and its subsystems are established in Shahrekord University of Medical Sciences (SKUMS).

Materials and Methods: This descriptive-survey study was conducted in 2012. Marquardt's standard questionnaire was used to measure learning organization based on Likert's scale with a Cronbach's Alpha coefficient of 0.946. The research sample consisted of 177 staff members (bachelor's degree holders and bove) in seven vice-chancellorships of SKUMS, selected through simple random sampling.

Results: The findings of the study are twofold. (1) According to the results of one-sample t-test with a 95% confidence interval, the mean scores in learning organization and sub-systems of learning dynamics, people empowerment, knowledge management and technology application subsysems were higher than the assumed mean of 3 however, the figure turned out to be equal to the assumed mean for the organization transformation subsystem, and (2) Based on Freidman Test, there was a significant difference between the means of at least 2 learning organization subsystems.

Conclusion: According to the research findings, more attention should be paid to the subsystems of learning organization establishment and balanced development of these subsystems.

Background and Aim: According to the objectives of the information systems and to avoid duplication and help to improve the quality of care and reduce costs, HIS ongoing evaluation should be conducted to achieve these goals. This study has evaluated hospital information systems in selected hospitals with the use of "integrated hospital information system evaluation criteria-2011".

Materials and Methods: This study was a descriptive-sectional research. The study population consisted of information systems in Shohada, Rsool Akram, Khatamolanbia, Imam Khomeyni and Milad hospitals. The data collection tool was a checklist of HIS indicators. Checklist was completed with direct observation and interviews with HIS users in selected hospitals. Data was analyzed by SPSS statistical software, and results were presented in statistical tables and charts.

Results: In the studied hospitals most of the subtypes of organizational and server components of the hospital information system has been set up and used. However, pharmacy, decision support, medical services, communication services and telemedicine information systems, are not yet fully set up in the studied hospitals.

Conclusion: Most subtypes of organizational and server components, currently exist in all fields in the studied hospitals.

Background and Aim: Financial reforms in the healthcare system go back to 1384. This study aims to analyze and summarize the most important strengths of implementing the first phase of the reform in units affiliated with the Ministry of Health and Medical Education from the experts' point of view at middle and operational levels.

Materials and Methods: In this qualitative research study, 15 coaches of the new financial health management reform along with 8 financial managers of Medical Universities were selected purposefully to participate in expert panels to be interviewed. Data were saturated following the interviews. The data analysis process was conducted applying Kruger method with one of the researchers having no conflicts of interest with the topic.

Results: Human resources enabling, effective trainings, integrated information system, dynamic culture, structural appropriateness, efficiency and effectiveness, and perfect facilities were the seven themes extracted from the content analysis of the interviews each theme was further divided into some sub-themes.

Conclusion: Recognition of the strengths of the first phase of health system's financial management reform may help bring about the possibility of more correct and exact planning to direct these changes and maintain the achievements as well as designing a long-term horizon and determining an ideal vision for the next phases of the reform.

  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: Considering the information needs of users improves the quality of care . We aimed to Survey the Compliance Rate of Surgical Information Systems with The Information Needs of surgeons.

Materials and Methods: This was a descriptive and original study. Statistical Society consisted of two groups. First was the hospital information systems in hospitals of Tehran University of Medical Sciences and Shahid Beheshti were the first group. The Second group were 982 surgeons. Hospitals that had the highest number of surgeries were the research sample. Researcher gathered data in two steps. First by questionnaire and then checklist was used to collect the data by interviewing the technicians’ of systems . All data has been analyzed by descriptive analysis.

Results: In Rasul and Emam hospitals surgical information systems in scheduling section(50%) had highest conformity with surgeons needs. In flexibility section in all hospitals except of Shariati, they had 50% conformity with information needs of surgeons.

Conclusion: From surgeons view flexibility capability, scheduling and accessing data had highest priority although systems from display capability had not the conformity with the user needs. In designing the surgical information systems in future it is better to consider these capabilities.

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: Strategic thinking plays a very important role in guarding organizational survival and increasing development in today's dynamic and changing environment. One of the elements of strategic thinking is systemic thinking, which forms the conceptual framework to solve issues in an organization. This study aims to determine the ability of Tehran University of Medical Sciences (TUMS) senior managers to stick to systemic thinking based on Friedrik Goldman’s model.

Materials and Methods: This is a cross-sectional, descriptive- analytic study conducted on a sample of 100 TUMS senior managers in 2010. The data collection instrument was a standard questionnaire on systemic thinking, the response rate of which turned out to be 97%. The reliability and validity of the questionnaire were confirmed prior to its distribution. SPSS software was used for data analysis. To this end, single sample t-test and Friedman statistical methods were also applied.

Results: The findings revealed that the ability of systemic thinking was optimal among most TUMS senior managers.

Conclusion : Enhancing and strengthening systemic thinking among TUMS senior managers are suggested, especially regarding omniscient and multi-end approach.

 Background and Aim: To optimize emergency services depend s on appropriate management structures and efficient and effective information system design . This study aim ed to investigate emergency department staff's information needs of emergency information system and to design a conceptual model of these needs.

 Materials and Methods: This descriptive study was performed among nurses and emergency medicine professionals working in emergency units of 9 hospitals affiliated to Tehran and Shahid Beheshti U niversities of M edical S ciences . Data w ere collected by interviewing 25 staff members in the emergency department , model d esign by RUP method and UML language and questionnaire d istribution among 315 staff members in the emergency department. Data collected were analyzed by descriptive statistics and SPSS.

 Results: Most nurses and emergency medicine physicians believed that multiple data elements such as time of patient’s first visit and procedure , t he latest status of patient, medical procedure taken , and paraclinical procedure taken must exist in the emergency information system . Also 68.3% (108) of them agreed with the relationship between data elements required in the clinical practice process .

 Conclusion : It is concluded that the presence of identity , clinical , and paraclinical data in emergency information systems can produce an electronic medical record. According to these data, elements can improve the coordination between the hospital emergency and pre- hospital rescue teams , controlling of victim status , access to patient reports and quality of service to patients.

Background and Aim: Stewardship and delivery of health services are considered as the most important areas in the healthcare system of the Islamic Republic of Iran in 1404. This study was conducted to investigate the main challenges in medical education stewardship because of its importance in the management and leadership of education from the viewpoint of education process providers.

Materials and Methods: This qualitative research was conducted using thematic and framework analyses to obtain the collective view of faculty members of Medical Sciences Universities in Iran. The data were collected applying deep semi-structured interviews. To increase the acceptability of the study, four criteria of Lincoln and Gupta were used. Codes, categories and themes were extracted by expert researchers of qualitative studies who had no conflict of interests with the topic.

Results: Of the 24 faculty members interviewed, 7 were females and 17 were males. They comprised 5 full professors, 8 associate professors, 9 assistant professors and 2 lecturers. The findings of the interviews were categorized in three main lines of stewardship in health system in the form of main and sub themes so that there were 2, 2 and 5 main themes in each line, respectively.

Conclusion : Since many of the challenges extracted from the present interviews are considered as essential interventions for achieving the stewardship functions of health system -- and, as a result, medical education -- , it is important to pay more attention to these challenges and at the same time conduct more complete studies to get more practicable solutions to these problems.

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.