Infrastructures of the System for Developing Electronic Health Record

The overall objective of a health system is to improve health through reducing disease, disability and death. Accomplishment of this goal depends on the worldwide integrated and coordinated care continuity. Information transmission is a prerequisite to ensure the continuity of care. Widespread acceptance of health information and communication technology (HICT) and developing systems such as Electronic Health Record (EHR), have changed the health care industry. Electronic Health Record is the main part of information management in an integrated health care system. Electronic health record provides access to all health information at organizational, regional, national and international  levels and allows for the patient's health data [usually with geographical distribution in several health information systems] to become integrated. Since Electronic health record integrates all  care events data, it can make data sharing possible between all care providers to consequently minimize the repeated diagnostic tests, and drug and treatment interactions. Furthermore, Also health care professionals can easily access to patient information at any time and this could lead to improving the quality of care and reduce costs. Accordingly, a productive system is required to provide the electronic health record. Given the significance of the electronic health record and its generating system in improvement of care quality and reducing the health care costs, authors decided to study the needs for developing the national EHR system (NHIN)  The main focus of this paper was on selecting material related to the system developing an EHR and it prerequisites. Electronic health record system is a new source of valuable intelligence of real world for the whole health care industry. Electronic health record system includes people, rules, standards, storage and processing equipments, communication and support facilities. To shape this, existence of components and their coordination is necessary. Electronic health record system are established to enhance patient care and its outcome, increase efficiency, improving the availability of information and minimizing the medical errors. With the Europe union formation that in fact was an important step toward globalization, the electronic health record passed the national borders and turned into a global concept to make possible the worldwide integration and sharing of the health data. Therefore international standards are needed to share patient health information between national health systems and across borders. Infrastructure or national information network  existence of proper hardware and software and finally participation  of  all stakeholders are necessary to develop the system. So it is necessary to prepare the infrastructures needed for development of the system in our country. Since EHR has a universal concept, it is needed to create a lifelong health information record for every individual accessible in  every point in the world

Presenting a Population-based Multiple Sclerosis Registry for Iran

 Introduction: Worldwide prevalence of Multiple Sclerosis (MS) is growing, and given the huge burden on the patient, the community and the healthcare system, prevention interventions and symptom management in order to improving the quality of life of these patients are of utmost importance. One of the most important strategies in this regard is providing the existence of an MS population-based registry. Accordingly, this research was aimed at providing a population-based MS registry model.Materials and Methods: This is a qualitative study, carried out within the years 2016 and 2017. The population of the present study consisted of models of multiple sclerosis population registries. In this study, a model was provided using library resources, informational networks and information retrieval from databases of PubMed, Google Scholar, Springer, Science direct, and Wiley and also through studying the registry of developed countries. Then, this model using Delphi technique and questionnaire tool was validated and after data analysis, the final model was presented.Results: In the present study, a demographic MS registry model including the following eight main criteria was proposed: registry goals, data sources, minimum data set, data set, data processing, various types of reports, quality control measures and patient follow-up procedures. Conclusion: Considering the prevalence of MS in Iran and the need for optimal data management, it is recommended that measures be taken to establish and use a national MS population-based registry and be one of the priorities of the Ministry of Health and Medical Education. 

Lessons Learned from the Population-Based Multiple Sclerosis Registries in the Developed Countries

Context: The prevalence of Multiple Sclerosis (MS) in the world has grown and has attracted particular attention on the international level and governments, has considered prevention interventions and managing the symptoms of the disease to reduce the economic burden and has improved the quality of life of these patients necessary. One of the most important strategies in this field is MS population-based registry. Accordingly, this study was designed to identify the components of MS population-based registries within the developed countries.Evidence Acquisition: The present study is a review article that was conducted in 2018. The population of the study consisted of MS population-based registry systems of developed countries such as USA, France, and Denmark. Based on the combination of related keywords, about 60 papers appropriately and after extraction, categorization and integration were formulated in the form of proper sequence for the purpose of the study.Results: The main components of MS population-based registries in developed countries included registry goals, information resources, Minimum Data Sets (MDS), types of processes, types of reports, quality control measures, data transmission time limits, responsible for recording and collecting data, responsible organization and executor, data transmission method and the privacy practicesConclusion: With regard to the results, it is suggested that the developing countries must consider creating an MS population-based registry as a national program due to their health system and the MS population-based registries structure in developed countries, so that they can adopt a suitable strategy for preventing and controlling the disease

Comparing Type 2 Diabetes Logbooks in Selected Countries

Context: According to the wide range of patients with type 2 diabetes and their unique characteristics, the process of treatment should be personalized for them. The most important step towards treatment and care of them is preparing daily reports by patients in logbooks. Diabetes organizations and associations have provided various logbooks for diabetic patients, with different structures. Evidence Acquisition: In this review study, articles and documents relating to type 2 diabetes logbooks were collected from relevant databases. From 60 articles, 28 titles including 23 articles related to type 2 diabetes and five logbooks from various diabetes organization were selected. The criterion for the selection was the validity of the organization offering the logbooks. Then, their data elements were compared. Results: The findings showed that the data elements of blood glucose, physical activity, meal and medication are fundamental data to record in type 2 diabetes logbooks. However, different organizations have considered different data elements for their logbooks and the number of their data elements is different from each other. In addition, few logbooks included all data elements. Conclusion: To achieve the best results from personalization of care in type 2 diabetes patients, it is necessary to record measurable self-care behaviors so that the process of the disease is completely controllable. Therefore, it is necessary for diabetes logbooks to have all these necessary elements so that the physician would make decisions based on sufficient data and the process of treatment would come in effective

National Health Information Network: Lessons Learned From the USA and the UK

National Health Information Network (NHIN) is a network in which all health care organizations, government agencies and other health-related organizations are connected to each other to exchange information about health. Due to the necessity of a framework for NHIN development, in this paper, according to the literature review, a definition for NHIN framework was provided, and then the NHIN related projects were reviewed in the United States of America (USA) and the United Kingdom (UK), NHIN and National Programme for Information Technology in the NHS (NPfIT), respectively. The Review of NHIN framework in the countries studied show some similarities and differences in each dimension that are discussed in this framework. NHIN guiding principles in the NHS NPfIT were not regarded or were considered incomplete, compared to the US. NHIN architecture in the US is decentralized while it is centralized in the UK. Based on the review of NHIN framework, these two countries represent important points that can be used in many other countries. However, it can be said that the development of NHIN does not only mean the implementation of national system or systems, or the binding of local health information systems, but It also needs to build on a framework in which many of the issues related to the formation of NHIN would be considered; including the cooperation between government, private sector and stakeholders with regard to local, national and international needs

Electronic Health Record Architecture: A Systematic Review

Numerous advantages are derived from the electronic health record (EHR).Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases (2000 to Jun 2015).  Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture

A Survey on Intensive Care Unit Information Systems in Hospitals Affiliated with Shahid Beheshti University of Medical Sciences

Introduction: The information system of the intensive care unit has been designed and established in order to manage patients’ data and quickly retrieve patients’ information in this unit. This research was carried out to study the information system of the ICU and reporting capabilities in the hospitals affiliated with Shahid Beheshti University of Medical Sciences (SBMU). Methods: In this descriptive cross-sectional study, the study population included ICU information systems in seven hospitals that had the system in place. Data gathering tools were a questionnaire and a checklist. The content validity was performed to ensure the validity of the checklist and questionnaire. The test-retest method was used to determine the questionnaire reliability (r = 0.89). Data were analyzed using descriptive statistics. Results: Data collection in the ICU information system in all hospitals understudy is done both in the form of paper forms and electronically. Regarding reporting capability,  patients’ demographic information reports, admission reports, discharge reports, transfers, diagnoses, mortality, and management reports, none of the studied hospitals, the automatic reporting capability scores (GCS), reporting patient safety indicators through alerts and reminders, reporting the cost of medications, reporting disease severity, including Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE), were not observed. Conclusion: Implementing comprehensive and integrated ICU information systems can be an effective step towards organizing patient information and improving the quality of service provided to them. Therefore, the deployment of an ICU information system is necessary to improve care delivery in ICUs

Assessment the effect of saffron ethanolic extract (Crocus sativus L.) on oxidative damages in aged male rat liver

Using antioxidant nutrients may be a good diet strategy for the prevention of oxidative stress associated to agerelated disease. We assessed the changes in activities of antioxidant enzymes (superoxide Dismutase-SOD Glutathione-S-Transferase-GST, Catalase-CAT) and the levels of lipid Per-oxidation (Malondialdehyde -MDA) in liver and serum nitric oxide (NO) of rats 2, 10 and 20 months old, and to determine the effect of saffron on the status of selected oxidative stress. The aged rats were given intraperitoneal injection of saffron extract daily for 4-week. Data were analyzed using ANOVA-One way followed by Tukey-Kramer Post-Hoc test for multiple comparisons. The results demonstrated that aging caused significant increase in the levels of serum NO and MDA with a reduction in the activities of SOD, GST and CAT in liver. This study showed that saffron ameliorated increased serum NO and MDA levels and decreased GST activity in liver of 20 months old rats. Therefore, saffron can be effective to protect susceptible aged liver

Health websites visual structure: the necessity of developing a comprehensive design guideline

Using health-related websites and their information increasingly develops and some concerns on its quality arise as well. Different factors affect the quality of health websites which visual structure is one of the most important factors. The aim of the current study is to explain the role of health websites` visual structure in users’ views on their quality and reliability as well as its role in obtaining health information by users. Furthermore, the need for a comprehensive guideline for designing such websites is discussed. The review showed that health website’s appearance has an important role in users view on its credibility. Furthermore, it was revealed that there is no comprehensive national or international guideline to health websites design. Considering the importance of visual structure of health websites, there is an emergent need to develop a national guideline to obviate the problems of non-consistent, poor or personalized design of health websites.