Technical requirements framework of hospital information systems: Design and evaluation

Background: Implementing the health information system (HIS) is more complex and costly than implementing other information systems. The present study was conducted to design and evaluate technical requirements for the HIS. Methods: The present study was conducted in 2016 by determining technical requirements for the HIS using the Delphi technique and then evaluating this system using a checklist based on the approved requirements. Results: The first part of the study designed a 73-item final list of technical requirements for the HIS in four domains, i.e. communication service, system architecture, security service and system response time. The evaluation results obtained in the second part showed that communication service was met in 63.8 of the HIS programs, system architecture in 65.5, security service in 72.4 and system response time in 76.3. Conclusions: A technical evaluation tool was designed and used to select and evaluate the HIS. The evaluation results suggested the study HIS was poorer in terms of communication service and system architecture than in the other two dimensions. © 2020 The Author(s)

Proposing electronic health record usability requirements based on enriched ISO 9241 metric usability model

Abstract Introduction: System usability assessment is among the important aspects in assessing the quality of clinical information technology, especially when the end users of the system are concerned. This study aims at providing a comprehensive list of system usability. Methods: This research is a descriptive cross-sectional one conducted using Delphi technique in three phases in 2013. After experts’ ideas were concluded, the final version of the questionnaire including 163 items in three phases was presented to 40 users of information systems in hospitals. The grading ranged from 0-4. Data analysis was conducted using SPSS software. Those requirements with a mean point of three or higher were finally confirmed. Results: The list of system usability requirements for electronic health record was designed and confirmed in nine areas including suitability for the task (24 items), self-descriptiveness (22 items), controllability (19 questions), conformity with user expectations (25 items), error tolerance (21 items), suitability for individualization (7 items), suitability for learning (19 items), visual clarity (18 items) and auditory presentation (8 items). Conclusion: A relatively comprehensive model including useful requirements for using EHR was presented which can increase functionality, effectiveness and users’ satisfaction. Thus, it is suggested that the present model be adopted by system designers and healthcare system institutions to assess those systems. Keywords: Electronic Health Records, Information System, Information Technolog

Fuzzy decision support systems to diagnose musculoskeletal disorders: A systematic literature review

Abstract Background and objective Musculoskeletal disorders (MSDs) are one of the most important causes of disability with a high prevalence. The accurate and timely diagnosis of these disorders is often difficult. Clinical decision support systems (CDSSs) can help physicians to diagnose diseases quickly and accurately. Given the ambiguous nature of MSDs, fuzzy logic can be helpful in designing the CDSSs knowledge bases. The present study aimed to review the studies on fuzzy CDSSs to diagnose MSDs. Methods A comprehensive search was conducted in Medline, Scopus, Cochrane Library, and ISI Web of Science databases to identify relevant studies published until March 15, 2016. Studies were included in which CDSSs were developed using fuzzy logic to diagnose MSDs, and tested their accuracy using real data from patients. Results Of the 3188 papers examined, 23 papers included according to the inclusion criteria. The results showed that among all the designed CDSSs only one (CADIAG-2) was implemented in the clinical environment. In about half of the included studies (52%), CDSSs were designed to diagnose inflammatory/infectious disorder of the bone and joint. In most of the included studies (70%), the knowledge was extracted using a combination of three methods (acquiring from experts, analyzing the data, and reviewing the literature). The median accuracy of fuzzy rule-based CDSSs was 91% and it was 90% for other fuzzy models. The most frequently used membership functions were triangular and trapezoidal functions, and the most used method for inference was the Mamdani. Conclusions In general, fuzzy CDSSs have a high accuracy to diagnose MSDs. Despite the high accuracy, these systems have been used to a limited extent in the clinical environments. To design of knowledge base for CDSSs to diagnose MSDs, rule-based methods are used more than other fuzzy methods. Keywords Musculoskeletal disorders Decision support systems Fuzzy logic Diagnose Revie

Usability evaluation of three admission and medical records subsystems integrated into nationwide hospital information systems: Heuristic evaluation

Introduction: Usability is one of the quality criteria for information systems and its weakness is one of the main barriers to the adoption of these systems. The purpose of this study was to evaluate the usability of admission and medical records module of three widely used hospital information systems (HISs). Methods: In this descriptive study the usability of admission and medical records module of three HISs (HIS1, HIS2, and HIS3) was evaluated using heuristic evaluation method. For each HIS, three expert users of the same system assessed the user interface independently, completed a usability evaluation checklist, and rated severity of each identified problem. The checklist was based on Nielsen's heuristics. For each HIS, three heuristics that have the highest and lowest problem rates and greatest severity of problems were categorized into three separate groups. The results were analyzed using descriptive statistics. Results: Although HIS1 and HIS2 were used in more hospitals than HIS3, the results showed that the usability problem rates of them were significantly higher than HIS3. The heuristics of "help and documentation", "flexibility and efficiency of use", and "visibility of system status" in the three HISs were categorized into the "highest rate of problems", "lowest rate of problems", and "highest severity of problems" groups, respectively. The heuristics of "diagnose and recover from errors", "error prevention", and "help and documentation" in HIS1 and HIS2 were categorized into the "highest rate of problems" group. Conclusions: The results of this study and previous studies show that the most common usability problems with HISs are related to heuristics of "help and documentation", "error prevention", and "help users recognize, diagnose and recover from errors." Also, the large number of hospitals using one HIS does not demonstrate its high usability to others. © 2018 Mehrdad Farzandipour, Ehsan Nabovati, Gholam-Hosein Zaeimi, Reza Khajouei

Medical universities educational and research online services: Benchmarking universities' website towards E-government

Background: Websites as one of the initial steps towards an e-government adoption do facilitate delivery of online and customer-oriented services. In this study we intended to investigate the role of the websites of medical universities in providing educational and research services following the E-government maturity model in the Iranian universities. Methods: This descriptive and cross-sectional study was conducted through content analysis and benchmarking the websites in 2012. The research population included the entire medical university website (37). Delivery of educational and research services through these university websites including information, interaction, transaction, and Integration were investigated using a checklist. The data were then analyzed by means of descriptive statistics and using SPSS software. Results: Level of educational and research services by websites of the medical universities type I and II was evaluated medium as 1.99 and 1.89, respectively. All the universities gained a mean score of 1 out of 3 in terms of integration of educational and research services. Conclusions: Results of the study indicated that Iranian universities have passed information and interaction stages, but they have not made much progress in transaction and integration stages. Failure to adapt to e-government in Iranian medical universities in which limiting factors such as users' e-literacy, access to the internet and ICT infrastructure are not so crucial as in other organizations, suggest that e-government realization goes beyond technical challenges. © AVICENA 2014

Collection of statistical data in university hospitals of Kashan, 2000

Background: Problems in recording, data collection and reporting are common in university hospitals. Thus, the present study was carried out to determine these problems and also facilitate the conditions of reporting statistical data in Kashan university in 2000.Materials and Methods: All statistics units of Kashan university were included in this descriptive study. A questionnaire was considered for data collection in different wards, emergency room, admission unit, operation room, radiology department, laboratory and different clinics. These questionnaires were completed by interview and direct observation. Calculation of different statistical indices were observed and matched with standard methods. Results: All study units have medical record system. Previously designed sheets were used for data collection and reporting in 83 of study units, however, clinics have not these sheets. 35 of hospital indices were calculated, of which 48 were correctly calculated. These indices were reported to 14 of hospital managers. Data were collected daily in 56 and monthly in 44 for the hospitals. Conclusion: Despite the presence of facilities for data collection, the process of data collection and reporting was not appropriate. Further studies are highly recommended to determine the underlying factors

Evaluation of factors influencing accuracy of principal procedure coding based on ICD-9-CM: an Iranian study.

To evaluate the accuracy of procedural coding and the factors that influence it, 246 records were randomly selected from four teaching hospitals in Kashan, Iran. "Recodes" were assigned blindly and then compared to the original codes. Furthermore, the coders' professional behaviors were carefully observed during the coding process. Coding errors were classified as major or minor. The relations between coding accuracy and possible effective factors were analyzed by chi(2) or Fisher exact tests as well as the odds ratio (OR) and the 95 percent confidence interval for the OR. The results showed that using a tabular index for rechecking codes reduces errors (83 percent vs. 72 percent accuracy). Further, more thorough documentation by the clinician positively affected coding accuracy, though this relation was not significant. Readability of records decreased errors overall (p = .003), including major ones (p = .012). Moreover, records with no abbreviations had fewer major errors (p = .021). In conclusion, not using abbreviations, ensuring more readable documentation, and paying more attention to available information increased coding accuracy and the quality of procedure databases

Accuracy of diagnostic coding based on ICD-10

Background: Using hospital databases to retrieve information, doing epidemiologic researches and making administrative decisions extremely depend on an accurate classification based on clinical coding. The researchers aim was to determine the validity of diagnostic coding based on ICD10 . Materials and Methods: 370 medical records were selected from KAUMS teaching hospitals in 2008. We abstracted and recoded the first - sequenced diagnostic codes based on ICD10. The validity was determined by the agreement between original codes and recodes as gold standard. The coding errors were classified into major and minor. The major code errors were those happened in nature and topography. Others were considered as minor. Possible determinants were studied through a checklist and observation methods. The data were analyzed through X2, fisher test, OR, and CI 95% for OR. Results: Diagnostic codes accuracy was 77.3%. There were 84 (22.7%) errors in diagnostic codes so that 28 (33.3%) of them were major and 56 (66.7%) were minor. Using coding book and not using abbreviation reduced errors significantly. Complete records review reduced errors . Documenting more information especially diseases etiology increased errors. In addition, the relationship between readability of records and code accuracy was not significant. Conclusion: Majority�of diagnostic codes were accurate. to reduce current errors, Coders’ factors such as�more attention to available information and better documentation (e.g. not using abbreviation) can increase the quality of diagnostic coding and its databases

Factors associated with quality of informed consent in patients admitted for surgery: An Iranian study

Informed consent is regarded as a pillar of medical ethics. The purpose of this study was to evaluate perceptions of the informed consent process prior to surgery. Three hundred elective surgery patients were randomly selected from three teaching hospitals in Kashan, Iran, and asked to complete a questionnaire about four key aspects of the informed consent process: information disclosure, voluntariness, comprehension, and their relationship with physicians. Data were scored and analyzed using univariate and multivariate methods. Based on the responses, the perceived quality of information disclosure (7.96 ± 4.9 out of 18 points), comprehension of the consent form (0.55 ± 1.1 out of 4 points), and voluntariness (1.73 ± 2.1 out of 8 points) were considered to be unacceptable and the perceived quality of the physician-patient relationships (10.6 ± 4.1 out of 14 points) acceptable. Most of the participants (88.7) reported that they had requested to be informed about the complications of the surgical procedures, including severe complications such as death, but most of them did not receive this information. The most important factors associated with the perceived quality of informed consent were the patient's level of education and type of surgery. In conclusion, practices consistent with the principles of informed consent have not been adequately implemented in the surgical departments of these hospitals in Kashan. To improve current practices, patients should receive more information about the risks and benefits of surgery as well as any available alternatives. Information about the expected length of hospital stay, post-discharge follow-up, and the cost of surgery should also be provided to patients. To improve the perceived quality of the informed consent process, more emphasis should be placed on ensuring that patients receive the requested information in amanner they can comprehend. Redesigning consent forms may be an important step in improving the patients' experience of the informed consent process. © Taylor & Francis Group, LLC