Evaluation of the Usability of Admission and Medical Record Information System: A Heuristic Evaluation

Introduction: Admission and medical record system (AMRS) is one of the most important subsystems of hospital information system, which is used by many users in admission, discharge, and health information management. Interface usability problems can reduce user speed, precision, and efficiency in user-system interaction. This study aimed to identify the usability problems of AMRS in a hospital information system. Method: In this descriptive cross-sectional study, five health information technology experts evaluated AMRS in a hospital information system using heuristic evaluation. Then, the system usability problems were categorized according to Nielsen's 10 usability principles and their severity were determined. Results: Totally, 62 unique usability problems were detected. The most frequent problems were related to "consistency and standards" (n=9) and ''recognition rather than recall" (n=9), and the least frequent ones was related to "flexibility and efficiency of use" (n=1). 59.7% of the identified problems were categorized as big and severe problems. The highest average severity of problems belonged to "system’s visibility" and "aesthetic and minimalist design", and the least average severity belonged to "error prevention". Conclusion: Using heuristic evaluation, a large number of usability problems in AMRS were identified. According to experts' opinions, most of the HIS interface problems were big and severe, and they need to be modified by designers and developers of these systems

Future of Health Information Technology Positions and Professional Qualifications of Employees

Introduction: The optimal use of information technology in health sector requires due attention to human resources training. The purpose of this study was to determine the future of health information technology positions and professional qualifications of the employees to achieve them. Methods: This qualitative-quantitative study was conducted in 2016. A nonsystematic review of the articles published over the last 10 years was performed in well-known databases and websites using relevant keywords. Positions were extracted and then discussed using the Delphi technique in a panel of experts of 25 members including board members and faculty members of medical universities across the country. Agreedupon positions were confirmed and job descriptions and professional qualifications were identified and compiled. An applied cross-sectional study was conducted on all health information management employees (38 people) of hospitals affiliated with Kashan University of Medical Sciences to determine the existing gap. A researcher-made questionnaire was developed based on the professional qualifications obtained for the expert panel and distributed after being checked for validity. Reliability was approved with Cronbach's alpha (0.91). Data were analyzed using descriptive statistics in terms of frequency and percentage. Results: The future health information technology positions were found to be health information management, insurance and accounting, information technology, computer applications, and data management. Professional qualifications of statistics and epidemiology, disease classification, information storage and retrieval, health data management, legal considerations and information security, information technology, and software engineering concepts were determined. The most effective qualification was knowledge of storage and retrieval methods. Employees’ skills in statistics and epidemiology were at an average level. Conclusion: New positions are constantly being introduced into the field of health information technology. Continuous curriculum revisions and additional courses for insurance and accounting, data storage and retrieval, statistics and epidemiology are essential

Intention of Continuing to use the Hospital Information System: Integrating the elaboration-likelihood, social influence and cognitive learning

Introduction: Anticipating effective factors in information system acceptance by using persuasive messages, is one of the main issues less focused on so far. This is one of the first attempts at using the elaboration-likelihood model combined with the perception of emotional, cognitive, self-efficacy, informational and normative influence constructs, in order to investigate the determinants of intention to continue use of the hospital information system in Iran. Methods: The present study is a cross-sectional survey conducted in 2014. 600 nursing staff were chosen from clinical sectors of public hospitals using purposive sampling. The questionnaire survey was in two parts: Part one was comprised of demographic data, and part two included 52 questions pertaining to the constructs of the model in the study. To analyze the data, structural equation model using LISREL 8.5 software was applied. Result: The findings suggest that self-efficacy (t= 6.01, β= 0.21), affective response (t= 5.84, β= 0.23), and cognitive response (t= 4.97, β= 0.21) explained 64% of the variance for the intention of continuing to use the hospital information system. Furthermore, the final model was able to explain 0.46 for self-efficacy, 0.44 for normative social influence, 0.52 for affective response, 0.55 for informational social influence, and 0.53 for cognitive response. Conclusion: Designing the necessary mechanisms and effective use of appropriate strategies to improve emotional and cognitive understanding and self-efficacy of the nursing staff is required, in order to increase the intention of continued use of the hospital information system in Ira

Evaluating inappropriate patient stay and its reasons based on the appropriateness evaluation protocol

Background: Hospital beds are among valuable resources for care delivery. Therefore, optimum use of them is crucial for increasing the efficiency of health-care services and controlling health-care costs. Objective: This study intended to evaluate inappropriate patient stay (IPS) in hospital settings and its reasons based on the appropriateness evaluation protocol. Methods: This cross-sectional study was conducted on 335 patients hospitalized in a tertiary care university hospital. Data were gathered prospectively by 13 hospital nurses during a 6-month period. IPS rate was evaluated using a checklist, the 27 criteria of which were related to medical services, nursing/life support services, and patient's conditions. Moreover, a 12-item checklist was used to determine physician-, hospital-, and patient/family-related factors behind inappropriate hospital stay. Results: In total, 121 of 1925 (6.3) hospitalization days of 335 patients were determined to be inappropriate. Neurosurgery and gynecology wards had the highest and the lowest inappropriate hospital stay rates (22.5 vs. 0), respectively. The main reasons behind inappropriate hospital stay were hospital-related factors (33.1), physician-related factors (29.1), and patient-related factors (21.3). Conclusion: A wide variety of physician-, hospital-, and patient/family-related factors contribute to IPS. Given the multifactorial causes of IPS, reducing its rate necessitates multidisciplinary approaches

The Effect of Feedback and Incentive Mechanisms on Improving Residents’ Medical Record Documentation Procedure

Introduction: Studies indicate that using behavior changing interventions may improve medical record documentation. This study aimed to examine the effect of feedback and incentive mechanisms on medical record documentation among surgery residents in Kashan University of Medical Sciences. Methods: This quasi-experimental study examined the effect of feedback and incentive mechanisms on 19 surgery residents’ medical record documentation in Kashan Shahid Beheshti Hospital in 2013-14. During three phases of pre-intervention, post-intervention and 3 months after intervention, five medical records for each resident (total=95) were selected and assessed using a checklist. Data were analyzed by means of t-test and Wilcoxon test. Results: There were significant changes in surgical residents’ medical record documentation during pre- intervention, post-intervention three months after intervention (P=0.0001). Findings showed that the rate of documentation in medical history form, course of disease, reception and discharge summary, and surgery report had significant changes after the interventions (P= 0.0001). Conclusion: Since the results showed that feedback and incentive mechanisms had positive impacts on improving residents’ documentation behavior, it is suggested that residents’ documentation performance should be regularly assessed and feedbacks be provided for other residents and stakeholders

The Effect of Educational Intervention on Medical Diagnosis Recording among Residents in Kashan University of Medical Sciences

Introduction: Studies indicate that using interventions including education may improve medical record documentation and decrease incomplete files. Since, physicians play a crucial role in medical record documentation, the researchers aimed to examine the effect of educational intervention on observing principles of medical diagnosis recording among residents in Kashan University of Medical Sciences. Methods: This quasi-experimental study was conducted in 2010 on 19 specialty residents (from internal medicine, obstetrics and gynecology, and surgery) in Kashan University. During a 5-hour workshop, guidelines for recording diagnostic information related to surgery, obstetrics and internal medicine were taught. Before and after the intervention, five medical records from each resident were assessed using a checklist which was designed based on diagnostic information related to each discipline. Data were analyzed through paired t and Wilkoxson test. Results: There was no improvement in recording obstetric diagnoses (type of delivery, place of delivery, outcome of delivery, complication of delivery) after the training. Also training did not have any effect on documentation of underlying cause and clinical manifestations of diseases by internal medicine residents and surgery residents (P=0.285 and P=0.584). Conclusion: Administering an educational intervention alone did not improve recording of diagnosis among residents. It seems that to have complete, accurate and high quality medical recording requires interaction we should consider other solutions, including three main key components, namely, management, health information management professionals and health care providers. Therefore, developing such an interaction is recommended