The retention duration of digital images in picture archiving and communication systems

Introduction

Every year, a large number of medical images such as MRIs, CT scans, and radiographs are prepared in hospitals, and a lot of money is spent on their preparation. Picture archiving and communication system (PACS) is an integrated image management system for maintaining and storing digital images. The objective of this study was to determine the storage duration of digital images in PACS.

Methods

This was a scoping review study in which we searched the PubMed and Embase databases using a combination of terms related to radiography, storage, and duration. The reference lists of included articles were checked to identify other relevant articles. Moreover, we searched Google to retrieve relevant gray literature and other information sources including guidelines. The selection process was carried out in three stages and was reported based on the PRISMA flowchart and the data were extracted using the data collection form.

Results

Based on the database search 2867 articles were identified, of which 13 articles were eligible for inclusion. Searching for gray literature identified 7 relevant sources. The results showed that based on the institutions' plans and regulations, different countries have different storage policies. In general, to store images between 6 and 240 months for short-term storage and between 0 and 240 months for long-term storage were considered.

Conclusion

Due to financial constraints and storage space requirements, healthcare organizations can provide a solution by drafting guidelines on the appropriate storage duration for medical images. The findings of this study can assist healthcare authorities and healthcare centers in employing PACS systems to manage and minimize storage space for medical images, thereby reducing storage costs.

Usability evaluation of emergency information systems in educational hospitals in Kerman, Iran

BACKGROUND

Smart and practical health information systems and applications with fewer errors are crucial for healthcare facilities. One method that ensures the proper design of health information systems (HIS) and applications is usability evaluation.

OBJECTIVE

This study aimed to evaluate the usability of the emergency information systems used at the emergency departments of four educational hospitals in Kerman, Iran.

METHOD

This study was conducted in two phases. In the first phase, the information systems' errors and shortages were identified using a semi-structured questionnaire by users (nurses and the IT staff). In the second phase, based on the results of the first phase, two questionnaires were designed for each group of users to their opinions about the usability of the emergency information systems.

RESULTS

The average score of "reducing and facilitating user's daily activities" was significantly different among hospitals (p = 0.03). Shahid Beheshti Hospital obtained the lowest usability score (17.5), and Afzalipour Hospital received the highest usability score (21.75). Moreover, the average score in "use of the HIS" for nurses and IT staff was 2.93 and 3.54 on a scale of 5, respectively.

CONCLUSION

Usability evaluation of health information systems is essential to ensure that these systems provide sufficient and accurate information and requirements for users and health care providers. Also, modifying health information systems based on the user views and expectations improves the quality of the system and user-system Interaction.

Extracting cancer concepts from clinical notes using natural language processing: a systematic review

BACKGROUND

Extracting information from free texts using natural language processing (NLP) can save time and reduce the hassle of manually extracting large quantities of data from incredibly complex clinical notes of cancer patients. This study aimed to systematically review studies that used NLP methods to identify cancer concepts from clinical notes automatically.

METHODS

PubMed, Scopus, Web of Science, and Embase were searched for English language papers using a combination of the terms concerning "Cancer", "NLP", "Coding", and "Registries" until June 29, 2021. Two reviewers independently assessed the eligibility of papers for inclusion in the review.

RESULTS

Most of the software programs used for concept extraction reported were developed by the researchers (n = 7). Rule-based algorithms were the most frequently used algorithms for developing these programs. In most articles, the criteria of accuracy (n = 14) and sensitivity (n = 12) were used to evaluate the algorithms. In addition, Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) and Unified Medical Language System (UMLS) were the most commonly used terminologies to identify concepts. Most studies focused on breast cancer (n = 4, 19%) and lung cancer (n = 4, 19%).

CONCLUSION

The use of NLP for extracting the concepts and symptoms of cancer has increased in recent years. The rule-based algorithms are well-liked algorithms by developers. Due to these algorithms' high accuracy and sensitivity in identifying and extracting cancer concepts, we suggested that future studies use these algorithms to extract the concepts of other diseases as well.

The preferred IT sources and tools of Iranian people for accessing health information

INTRODUCTION

People need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools.

METHODS

This national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions.

RESULTS

The participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05).

CONCLUSION

The results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.

A systematic review of data elements of computerized physician order entry (CPOE): mapping the data to FHIR

OBJECTIVE

Medication errors are the third leading cause of death. There are several methods to prevent prescription errors, one of which is to use a Computerized Physician Order Entry system (CPOE). In a CPOE system, necessary data needs to be collected so that making decisions about prescribing medications and treatment plans could be made. Although many CPOE systems have been developed worldwide, studies have yet to identify the necessary data and data elements of CPOE systems. This study aims to identify data elements of CPOE and standardize these data with Fast Healthcare Interoperability Resources (FHIR) to facilitate data sharing and integration with the electronic health record (EHR) system and reduce data diversity.

METHODS

PubMed, Web of Science, Embase, and Scopus databases for studies up to October 2019 were searched. Two reviewers independently assessed original articles to determine eligibility for inclusion in this review. All articles describing data elements of a COPE system were included. Data elements were obtained from the included articles' text, tables, and figures.Classification of the extracted data elements and mapping them to FHIR was done to facilitate data sharing and integration with the electronic health record (EHR) system and reduce data diversity. The final data elements of CPOE were categorized into five main categories of FHIR (foundation, base, clinical, financial, and specialized) and 146 resources, where possible. One of the researchers did mapping and checked and verified by the second researcher. If a data element could not be mapped to any FHIR resources, this data element was considered an extension to the most relevant resource.

RESULTS

We retrieved 5162 articles through database searches. After the full-text assessment, 21 articles were included. In total, 270 data elements were identified and mapped to the FHIR standard. These elements have been reported in 26 FHIR resources of 146 ones (18%). In total, 71 data elements were considered an extension.

CONCLUSIONS

The results of this study showed that the same data elements were not used in the CPOE systems, and the degree of homogeneity of these systems is limited. The mapping of extracted data with data elements used in the FHIR standard shows the extent to which these systems comply with existing standards. Considering the standards in these systems' design helps developers design more coherent systems that can share data with other systems.

The effect of electronic error-reporting forms on nurse's stress and the rate of error-reporting

OBJECTIVES

The patient safety culture includes a systematic approach that promotes safe care for patients and the leadership that supports it. Medical errors threaten patient safety. A significant portion of medical errors is committed by nurses. Although error-reporting provides valuable information to prevent errors, most nurses do not report their errors due to their high level of stress. This study was to investigate the effect of electronic error-reporting forms on nurses' stress and the rate of error-reporting.

METHODS

The nurses' level of stress was compared when using paper error-reporting and 6 months after using electronic forms. A revised version of the Coudron questionnaire was completed by 186 nurses. Data were analyzed by SPSS 23 using Wilcoxon test. The number of reported errors in paper and electronic media was compared over the same period.

RESULTS

Implementation of the electronic error-reporting form reduced the job stress of nurses by 22.22 points (p=.00) and increased the error-reporting rate by 12.86% (p<.05).

CONCLUSIONS

Although nurse's stress significantly decreases after implementing electronic error-reporting forms, their level of stress is still high and they are still at risk for physical and mental problems. Using methods like modifying the error-reporting form will increase the error-reporting rate.

Identifying and prioritizing the key performance indicators for hospital management dashboard at a national level: Viewpoint of hospital managers

Participation of main users in identifying key performance indicators (KPIs) for management dashboards contributes to their success. The aim of this study was to identify and prioritize the KPIs of hospital management dashboards from the viewpoint of hospital managers. This study was conducted on managers of public hospitals at a national level in Iran in 2020. Data were collected using a self-administrated questionnaire. The KPIs were classified into five categories, namely financial, operational, human resources, safety and quality of care, services provided to patients. A total of 234 hospital managers participated in this study. Totally, 25 KPIs were determined for the hospital management dashboard, including the patient falls rate, waiting time for patients in the emergency department, patient satisfaction, total hospital revenue, financial balance, bed occupancy rate, patients' discharge with own agreement, average length of stay, and personnel satisfaction. For designing hospital management dashboards, the domains of services provided to patients, safety and quality of care, financial resources, human resources, and operational are important from the hospital managers' viewpoint, respectively. The results of this study can be helpful for developers of business intelligence tools, such as hospital management dashboards, to visualize the most important indicators for managers.

Designing a minimum data set of laboratory data for the electronic summary sheet of pediatric ward in Iran: A cross-sectional study

Background and Aim

Iranian hospitals are provided with hospital information systems (HISs) from different vendors, which make it hardly possible to summarize laboratory data in an consistent manner. Therefore, there is a need to design a minimum data set of laboratory data that will define standard criteria and reduce potential medical errors. The purpose of this study was to design a minimum data set (MDS) of laboratory data for an electronic summary sheet to be used in the pediatric ward of Iranian hospitals.

Methods

This study consists of three phases. In the first phase, out of 3997 medical records from the pediatric ward, 604 summary sheets were chosen as sample. The laboratory data of these sheets were examined and the recorded tests were categorized. In the second phase, based on the types of diagnosis we developed a list of tests. Then we asked the physicians of the ward to select which ones should be documented for each patient's diagnosis. In the third phase, the tests that were reported in 21%-80% of the records, and were verified by the same percentage of physicians, were evaluated by the experts' panel.

Results

In the first phase, 10,224 laboratory data were extracted. Of these, 144 data elements reported in more than 80% of the records, and more than 80% of experts approved them to be included in the MDS for patients' summary sheet. After data elements were investigated in the experts' panel, 292 items were chosen for the final list of the data set.

Conclusions

This MDS was designed such that, if implemented in hospital information systems, it could automatically enable registering data in the summary sheet when patient's diagnosis is registered.

Developing a minimum data set for cardiovascular Computerized Physician Order Entry (CPOE) and mapping the data set to FHIR: A multi-method approach

Many medical errors occur in the process of treating cardiovascular patients, and most of these errors are related to prescription errors. There are several, one of the methods to prevent prescription errors is the use of a computerized physician order entry (CPOE) system. One of the obstacles of implementing this system is improper design and non-compliance with user needs. one of the issues that should be considered in designing information systems is having a standard minimum data set (MDS). Although many computerized physicians order entry (CPOE) systems have been developed in the world, no study has identified the necessary data and minimum data set (MDS) of CPOE system, and published the process of creating this MDS. This study aimed to develop an MDS for cardiovascular CPOE and standardize it with Fast Healthcare Interoperability Resources (FHIR). A multi-method approach including systematic review for identifying data elements of CPOE, reviewing the content of medical records, validation of the data elements using the expert panel and, determination of the necessary data elements using a survey was conducted. Classification of the data elements and mapping them to FHIR were done to facilitate data sharing and integration with the electronic health record (EHR) system as well as to reduce data diversity. The final data elements of MDS were categorized into 5 main categories of FHIR (foundation, base, clinical, financial, and specialized) and 146 resources, where possible. Mapping was done by one of the researchers and checked and verified by the second researcher. Non-mapped data elements were added to relevant resources as extensions of existing FHIR resources. In total, 270 data elements were identified from the systematic review. After reviewing the content of 20 patients' medical records, 28 data elements were identified. After combination of data elements of two previous phases and removing duplication, 282 data elements remained. Data elements that were considered necessary to be included in CPOE by conducting a survey among cardiovascular physicians were 109 elements. From 146 resources of FHIR, the data elements of this MDS are covered by 5 resources. This study introduced an MDS for cardiovascular CPOE by combining suggested data elements of previous research, and the practical and local requirements identified in patients' medical records. To facilitate data sharing and integration with EHR, reduce data diversity, and also to categorize data, this MDS was standardized with FHIR. The steps we used to develop this MDS could be a model for creating MDS in other CPOEs and health information systems. This is the first time that the process of developing an MDS for cardiovascular CPOE has been presented in the literature.

Evaluating the usability of a cancer registry system using Cognitive Walkthrough, and assessing user agreement with its problems

OBJECTIVE/AIM

Good design of cancer registry systems makes them easy to use, while poor design of their user interfaces leads to user dissatisfaction and resistance. The objective of this study was to evaluate the usability of a cancer registry system using Cognitive Walkthrough (CW) and to assess users' agreement with its usability problems.

METHODS

CW was used to evaluate the registry system. We developed a checklist to help evaluators speed up the evaluation process, a problems form to collect the usability issues identified by the evaluators, and a problems severity form to determine the severity of problems by the evaluators. The problems were classified into two categories according to the CW questions and the system tasks. The agreement of the users with the system problems was examined by an online questionnaire. Users' agreement with the problems was then analyzed using the Interclass Correlation Coefficient in the SPSS 22 (Statistical Package for Social Science).

RESULTS

In this study, 114 problems were identified. In the categorization of problems based on the CW questions, 41% (n = 47) of the problems concerned the issue of "users do not know what to do at each stage of working with the system", 24% (n = 27) were classified as "users cannot link what they intend to do with system controls", and 22% (n = 25) were related to "user's lack of understanding of the system processes". Based on user tasks, about 36% (n = 41) of the problems were related to "removing patient duplication" and 33% (n = 38) were related to "registration of patient identification information". User agreement with the problems was high (CI 95% = 0.9 (0.96, 0.98)).

CONCLUSION

System problems often originate from user ignorance about what to do at each stage of using the system. Also, half of the system problems concern a mismatch between what users want to do and the system controls, or a lack of understanding about what the system does at different stages. Therefore, to avoid user confusion, designers should use clues and guides on the screen for users, design controls consistent with the user model of thinking, and provide appropriate feedback after each user action to help users understand what the system is doing. The high agreement of users with the problems showed that in the absence of users system designers can use CW to identify the problems that users face in the real environment.

The role of e-health on the public knowledge and behavior in preventing COVID-19

Background

Electronic health (e-health) technologies play an important role in improving public knowledge and behavior to control the COVID-19 pandemic. The present study aimed to investigate the role of e-health on the public knowledge and behavior in preventing COVID-19 in Kerman, a city in Iran.

Methods

The present descriptive cross-sectional study used an online survey in Kerman in November 2021. The research instrument was a tripartite questionnaire that included demographic information, the level of respondents' knowledge about COVID-19, the extent of change in respondents' behavior influenced by e-health. Negative binomial regression analysis was run to test the relationship between individual characteristics and the research variables with knowledge and behavior. Spearman correlation test was used to measure the correlation between the two main parts of the survey.

Results

As the negative binomial regression analysis results showed, the relationship between no demographic variable and the public knowledge and behavior was statistically significant (p < 0.001). The mean knowledge and behavior scores were 5.84 ± 2.55 and 11.95 ± 5.09, respectively, showing that people who used e-health had a high level of knowledge, and taking preventive measures was at a high level. The Spearman correlation coefficient test results showed a positive association between knowledge and behavior (r = 0.71).

Conclusion

E-health played a decisive role in increasing knowledge and improving behavior in preventing COVID-19. The results of our research can encourage the use of e-health to improve the public knowledge and behavior in pandemics such as COVID-19.

Prediction of mortality risk and duration of hospitalization of COVID-19 patients with chronic comorbidities based on machine learning algorithms

Background

The severity of coronavirus (COVID-19) in patients with chronic comorbidities is much higher than in other patients, which can lead to their death. Machine learning (ML) algorithms as a potential solution for rapid and early clinical evaluation of the severity of the disease can help in allocating and prioritizing resources to reduce mortality.

Objective

The objective of this study was to predict the mortality risk and length of stay (LoS) of patients with COVID-19 and history of chronic comorbidities using ML algorithms.

Methods

This retrospective study was conducted by reviewing the medical records of COVID-19 patients with a history of chronic comorbidities from March 2020 to January 2021 in Afzalipour Hospital in Kerman, Iran. The outcome of patients, hospitalization was recorded as discharge or death. The filtering technique used to score the features and well-known ML algorithms were applied to predict the risk of mortality and LoS of patients. Ensemble Learning methods is also used. To evaluate the performance of the models, different measures including F1, precision, recall, and accuracy were calculated. The TRIPOD guideline assessed transparent reporting.

Results

This study was performed on 1291 patients, including 900 alive and 391 dead patients. Shortness of breath (53.6%), fever (30.1%), and cough (25.3%) were the three most common symptoms in patients. Diabetes mellitus(DM) (31.3%), hypertension (HTN) (27.3%), and ischemic heart disease (IHD) (14.2%) were the three most common chronic comorbidities of patients. Twenty-six important factors were extracted from each patient's record. Gradient boosting model with 84.15% accuracy was the best model for predicting mortality risk and multilayer perceptron (MLP) with rectified linear unit function (MSE = 38.96) was the best model for predicting the LoS. The most common chronic comorbidities among these patients were DM (31.3%), HTN (27.3%), and IHD (14.2%). The most important factors in predicting the risk of mortality were hyperlipidemia, diabetes, asthma, and cancer, and in predicting LoS was shortness of breath.

Conclusion

The results of this study showed that the use of ML algorithms can be a good tool to predict the risk of mortality and LoS of patients with COVID-19 and chronic comorbidities based on physiological conditions, symptoms, and demographic information of patients. The Gradient boosting and MLP algorithms can quickly identify patients at risk of death or long-term hospitalization and notify physicians to do appropriate interventions.

Evaluating and rating HIV/AIDS mobile apps using the feature-based application rating method and mobile app rating scale

Background

The purpose of this study was to evaluate HIV/AIDS mobile applications using the Mobile App Rating Scale (MARS) and rate the features of these applications using the new tool called the Feature-based Application Rating Method (FARM).

Methods

In this study, all available HIV/AIDS apps in Iran from Cafe Bazaar and Google Play Store due to inclusion criteria were studied. The evaluation of the quality of applications was done using the MARS tool and the FARM tool. The FARM, which was developed in this study, was applied to rank the features of the applications.

Results

In this study, 79 applications were included. The mean score of all apps using both tools was 3.58 (SD = 0.95) out of 5. The overall mean quality score based on the MARS was 3.14 (SD = 0.84), and the mean score of features based on FARM was 3.81 (SD = 1.23). This study showed a higher than moderate correlation between the scores assigned to apps based on the MARS and FARM tools (r > 0.4).

Conclusions

The HIV/AIDS mobile applications available in Iran had the "acceptable" ranking. Also, our study results showed that to evaluate mobile apps, using a single tool may not provide good insight to evaluators about the assessed apps. However, using more than one tool may provide more details about the evaluated apps. To improve the quality of mobile health apps and help users select the most desirable app, we suggested using tools like FARM for ranking apps based on the features of each app in the app stores.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-02029-8.

Investigating the role of health information technology in the control and management of Systemic Lupus Erythematosus (SLE): a systematic review

Background

Despite the use of health information technology (HIT) for controlling and managing lupus, its effectiveness has not been well studied. The objective of this study was to investigate the role of HIT in controlling and managing lupus.

Methods

We searched Scopus, PubMed, Web of Science, and Embase, using "self-management", "self-care" and "Systemic Lupus Erythematosus" keywords. Two researchers selected relevant papers and extracted data using a data collection form. Disagreements were resolved in consultation with the third and fourth researchers. After extraction, the data were analyzed.

Results

Totally, 23 papers met the inclusion criteria. About 75% of the studies used web and telephone-based technologies. Most services provided with health technologies were ‘Training’ and ‘consulting’. The ‘lifestyle" and ‘Consultation and education’ axes were the most widely used HIT services to control and manage lupus. While, ‘Better management and control of the disease’, ‘Increasing knowledge and awareness of people about lupus’ and ‘Improving behaviors and attitudes toward self-management and self-care’ were also the most important outcomes. ‘Collectiing patient data and information’, 'Providing education and consultation services to patients', 'Measuring patient-reported outcomes', and 'Increasing patients' knowledge and awareness of their disease' were the most important advantages of various technologies. 'Slow internet speed' and 'Challenges and problems related to appearance and usability' and 'Patient concerns about privacy and misuse of their data' were three disadvantages of technologies.

Conclusion

The findings showed that HIT can improve the management and control of lupus and facilitate self-efficacy, self-care, and self-management in patients. The axes and data elements identified in this study can be the basis for developing and implementing efficient HIT-based systems to improve, control, and manage lupus.

Evaluating the Quality of a Clinical Mobile App for Physicians' CT Scan Ordering Using the MARS Rating Scale

Given the lack of literature on the contributing factors to adopt mobile applications (apps) among physicians and the crucial role of the quality of the apps in their widespread use, the aim of this study is using the Mobile App Rating Scale (MARS) to evaluate the quality of the head CT scan appropriateness criteria app(HAC app). It was developed to assist medical interns and residents in ordering head CT scans. MARS is internationally recognized as an app rating tool and consists of four objective and subjective quality subscales quality subscale. Although the overall quality score of the HAC app was favorable (82 out of 100), it had low quality scores in the "information" (73.37 out of 100) and the "engagement" (73.48 out of 100) subscales. The HAC app appears to be functional to the physicians; however, it needs to improve its quality in terms of interactivity and effectiveness.

Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users' Work

The impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different dimensions of the users' work. The objective of this study was to evaluate the impact of the PACS on different dimensions of users' work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. This study was performed on the PACS users (n = 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users' work. Data were analyzed using descriptive statistics, ANOVA, and Pearson's correlation coefficient statistical tests. The mean of scores given by the PACS users was 4.31 ± 0.86 for external communication, 4.18 ± 0.96 for user intention to use the PACS, 3.91 ± 0.7 for service quality, 3.16 ± 0.56 for daily routine, and 3.08 ± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P < 0.01, CI = 95%). Factors such as user age (P < 0.01, CI = 95%), job (P < 0.001, CI = 95%), work experience (P < 0.001, CI = 95%), and PACS training method (P=0.037, CI = 95%) were related to the impact of the PACS on different dimensions of users' work. This study showed that the PACS has a positive effect on different dimensions of users' work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users' work and to maintain and strengthen the capabilities and functions of radiology departments.

Data Incompleteness Preventing Information Communication from Hospital Information Systems to the Iranian National Electronic Health Record (SEPAS)

Introduction: One of the well-known problems related to the information quality is the information incompleteness in health information systems. The purpose of this study was to investigate the completeness rate of patients’ information recorded in the hospital information system, sending information from which to Iranian electronic health record system (SEPAS) seemed to be unsuccessful.Methods: This study was conducted in six hospitals associated with Kerman University of Medical Sciences (KUMS) in Iran. In this study, 882 records which had failed to be sent from three hospital information systems to SEPAS were reviewed and the data were collected using a checklist. Data were analyzed using the descriptive and inferential statistics with SPSS.18.Results: A total of 18758 demographic and clinical information elements were examined. The rate of completeness was 55%. The highest completeness rate of demographic information was related to name, surname, gender, nationality, date of birth, father's name, marital status, place of residence, telephone number (79-100%), and in clinical information it was related to the final diagnosis (74%). The completeness rate of some information elements was significantly different among the hospitals (p <0.05). The completeness rate of information communicated to the Iranian national electronic health record was at a moderate level.Conclusion: This study showed that completeness rate is different among hospitals using the same hospital information system. The results of this study can help the health policymakers and developers of the national electronic health record in developing countries to improve completeness rate and also information quality in health information systems.

The impact of the emergency medical services (EMS) automation system on patient care process and user workflow

Background

One of the important components of the health system is the emergency medical services (EMS) system. The EMS system was implemented at Kerman University of Medical Sciences teaching hospitals to communicate the situation of patients being transferred to the hospital by EMS and to provide facilities tailored to the patient's condition. The objective of this study was to investigate the impact of the EMS system on the patient care process and the workflow of users.

Methods

The hospital information system (HIS) report was used to investigate the impact of the EMS system on the patient care process and a questionnaire was distributed among 244 participants to determine its impact on the workflow of the users. Mann–Whitney U was used to analyze HIS reports, and Chi-square was used to analyze the data collected by questionnaires.

Results

The EMS system reduced the patient's stay in hospital by an average of 3 h and 45 min. It also increased the number of patients' discharge from the emergency room to 2.2% and reduced the death rate by 1.3% (p < 0.001). Besides, 78% of physicians, 75% of nurses and 83% of technicians stated that this system has positively influenced their workflow.

Conclusions

The EMS system reduced the patient's stay in hospital and mortality, and increased the speed of patient service, readiness of users to provide patient care and the number of discharged patients. However, problems such as inappropriate technical infrastructure of the EMS system should be solved to improve patients' recovery, reduce mortality and improve user satisfaction.

Development of a Minimum Data Set for Drug Module of Computerized Physician Order Entry System

Introduction: One way to reduce medication errors in the cardiovascular settings is to electronically prescribe medication through the computerized physician order entry system (CPOE). Improper design and non-compliance with users' needs are obstacles to implementing this system. Therefore, it is necessary to consider the standard minimum data set (MDS) of this system in order to meet the basic needs of its users. The aim of this study was to introduce MDS in the cardiovascular CPOE drug system to standardize data items as well as to facilitate data sharing and integration with other systems.Material and Methods: This study was a survey study conducted in 1399 in Iran. The study population was all cardiologists in Iran. The data collection tool was a researcher-made questionnaire consisting of 33 questions. Data were analyzed in SPSS-24 using descriptive statistics.Results: A total of 31 cardiologists participated in this study. The participants identified 19 of the 25 drug data items as essential for drug MDS. Five data items (Medication name, Medication dosage, Medication frequency, Medication start date and Patient medication history) were considered essential by more than 90% of the participants.Conclusion: The results of this study identified drug MDS for the cardiovascular CPOE system. The results of this study can be a model for CPOE system designers to develop new systems or upgrade existing systems.

Assessing parents' awareness about children's "first thousand days of life": a descriptive and analytical study

Background

Many adulthood illnesses are rooted in childhood, especially in the “first thousand days of life”. Despite parents’ role in children’s development, no study has examined parental awareness concerning this period. This study aimed to examine the awareness of parents concerning the “first thousand days of life” and the relationship between parents’ demographics and their awareness.

Methods

This study was conducted on 135 parents in Kerman, Iran, using a valid and reliable questionnaire developed by researchers based on the opinion of experts and relevant references. The relationship between participants’ demographics and their awareness was examined by multiple regression. The relationship between homogeneity of couples’ education degree and awareness was analyzed using ANOVA. Chi-square was used to examine the relationship between information sources and parents’ familiarity and to compare parents’ preferred sources.

Results

The average parental awareness was 41.96 ± 11.90. Eighty-three percent of the parents have not heard about the “first thousand days of life”. The source of information for 57% of the parents was friends and relatives (p < 0.0001). Overall, 87% of the parents desired to know about this period, and 47% liked using mobile applications for information (p < 0.0001).

Conclusions

Parents’ awareness about the “first thousand days of life” is lower than the average. Since the source of information concerning this period for most parents is friends and relatives and most parents are very interested in obtaining information, it is recommended that policy-makers use the capacity of other sources to increase parents’ awareness. Given the greater tendency of parents to obtain information through mobile applications, we suggest investing more in this source.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00673-6.

User Testing of an Admission, Discharge, Transfer System: Usability Evaluation

Introduction: To improve the first step of the hospitalization procedure, appropriate interaction must be established between users and the admission, discharge, and transfer system. The aim of this study was to evaluate the usability of the ADT system in some of selected Iranian non-teaching hospitals.Material and Methods: This study was cross-sectional research that has evaluated the usability of a selected ADT system using the think-aloud method by 11 medical record administrators. Users were asked to follow the provided scenario, then share and elaborate on what they saw, thought about, did, felt, and decided during their interaction with the system. Users' feedbacks were collected and organized into four main categories for further processing.Results: To evaluate the usability of an ADT system, four routine scenario tasks were followed by users and only 45.45% of them could implement all tasks. Overall, 36 independent problems were identified. All problems were related to the data entry categories that accounted for the largest share. The most important problems were related to the issues regarding "date of birth" field in this category which deals with the outpatient admission process.Conclusion: The study of the usability testing method indicated that the ADT subsystem of non-teaching hospital has many problems in interact with real users with the system. It showed that more than half of the users could not completely and successfully perform the entire real-world scenario tasks. Furthermore, the most usability problems were found in data entry categories.

Evaluation of HIV/AIDS-related mobile health applications content using an evidence-based content rating tool

Background

Despite the increasing number of mobile health applications, the validity of their content is understudied. The objective of this study was to rate the content of HIV/AIDS-related mobile applications and to determine the extent to which evidence-based medicine is being incorporated into their content using a new tool called the Evidence-based content rating tool of mobile health applications (EBCRT-mHealth).

Methods

All available HIV/AIDS-related applications in Iran from Cafe Bazaar and Google Play Store were evaluated. This study was first conducted in 2018, then after almost two years in 2021 was done again. In this study, researchers developed the EBCRT-mHealth tool to rate the content of applications based on the evidence-based medicine pyramid. Its reliability was calculated (α = 0.78), and five specialists confirmed its validity. Two reviewers independently reviewed all HIV/AIDS applications directly downloaded and installed from the Google Play Store and Cafe Bazaar.

Results

Out of 980 retrieved applications, in 2018, 85, and in 2021, 78 applications were included in the study. Only in 17 (28%) out of the 60 in 2018, and 25 (51%) in 2021 Google Play store applications the source of content information was mentioned. All Cafe Bazaar mobile applications mentioned the source of information. The mean rating of all application content in 2018 was 2.38 (SD = 0.74), and in 2021 was 2.90 (SD = 1.35) out of 5. The mean rating of the content of Cafe Bazaar applications in 2018 was 2.10 (SD = 0.49), and in 2021 was 1.94 (SD = 0.29). The mean content rating of Google Play store applications in 2018 was 2.50 (SD = 0.80) and in 2021 was 3.86 (SD = 1.18).

Conclusion

After two years, the rating of the content of HIV/AIDS-related applications available in Iran that existed in Cafe Bazaar decreased from "poor" to "inappropriate". Also, the content score of the Google Play Store applications increased from "poor" to "good". It is critical to ensure the credibility of the sources used in developing their content and removing applications with inappropriate and unreliable content from the App Stores. Also, mobile health application developers should use the highest quality information in their applications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01498-7.

The preferred method for reminding a child's vaccination schedule among Iranian parents

BACKGROUND

The most important reason for vaccination delay is the unawareness of the parents of vaccination schedule. The use of reminders can result in better vaccination coverage.

OBJECTIVES

This study aimed to determine the preferred method of receiving vaccination reminders from the parents' perspective.

STUDY DESIGN

Cross-sectional study.

METHODS

We studied the parents of under 7-year-old children who visited one of the six urban health centres in Mashhad for vaccination of their children in 2017. Three hundred parents were participated based on the convenience sampling method. Data were collected using a questionnaire consisting of five sections. Five Medical Informatics specialists confirmed the validity of the questionnaire. The data were analysed by descriptive-inferential statistics and the significance level was set at p < 0.05.

RESULTS

Around 94% of the participants wanted to be reminded about their children's vaccination schedule. Most of them (74.3%) preferred to receive reminders by short text messaging (SMS) and 42% preferred to be reminded 1 day before the vaccination date (n = 42%). The tendency to receive reminders and the preferred method had no significant correlation with participants' age, education degree and residential area.

CONCLUSIONS

The preferred reminder method from the parents' perspective was SMS. Despite the growth of information technology as well as people's access to the Internet, it seems that use of other methods such as SMS to remind and specifically educate parents in this respect is more common.

Evaluating hospital information system according to ISO 9241 part 12

Objectives

Compliance with standards in designing information systems leads to better utilization and ease of use for users. In this study, the compliance of a widely used hospital information system (HIS) with ISO 9241 part 12 was assessed.

Methods

This applied research is a descriptive, cross-sectional study in which the HIS of 8 hospitals affiliated with Kerman University of Medical Sciences was evaluated based on ISO 9241 part 12. Data were collected by using ISO 9241/12 checklist. The data was analyzed in SPSS 16 using descriptive statistics.

Results

The analysis of data showed that the total compliance of the software with the ISO 9241/12 was 72%. The compliance of the software based on different groups of recommendations was 79% with Organization of information, 91% with Graphic objects, and 58% with Coding techniques. Compliance with different subgroups of ISO recommendations ranged from 28% related to “color coding” in coding techniques to 97% related to “General recommendation for graphical objects” in Graphic objects.

Conclusion

According to this study, the design of a widely used HIS has fairly good compliance with the standard but still suffers from some problems. Considering the role of accurate, valid and timely information in management of the hospitals, and the difficulty of system optimization after implementation, it is necessary that software developers follow existing standards when designing health information systems.

Compliance with design principles: a case study of a widely used laboratory information system

Background

Laboratory information systems are widely used health information systems that have the potential to improve health care quality. Despite their benefits, many studies have indicated problems with user interaction with these systems due to poor interface design.

Aims

To evaluate the usability of a laboratory information system.

Methods

In this descriptive, cross-sectional study, we used heuristic evaluation to examine the user interface design of a laboratory information system in an academic hospital affiliated with Kerman University of Medical Sciences in 2017. This system is also used in 59 other Iranian hospitals .We investigated the usability of different parts of the usability of a laboratory information system (outpatient admission, inpatient admission, sample collection, and test result reporting). Data were collected using a standard form based on the heuristic evaluation method, and categorized based on their severity and violated heuristics. The content validity was confirmed by 3 medical informatics specialists.

Results

We identified 162 usability problems. In terms of the heuristics, the highest number of problems concerned flexibility and efficiency of use (n = 32, 19.75%) and the lowest concerned help users recognize, diagnose, and recover from errors (n = 2, 1.23%). In terms of different modules of the system, the highest number of problems (n = 51, 31.48%) concerned outpatient admission and the lowest (n = 29, 17.9%) concerned sample collection. In terms of severity, 45.06% of the problems were rated as major.

Conclusions

Despite widespread use of laboratory information systems, their user interface design has usability problems that diminish the quality of user interaction with these systems and may affect the quality of health care. Consideration of standards and principles for user interface design, such as the heuristics used in this study, could improve system usability.

Nurses' experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran

Background

Information technology (IT) plays an important role in nursing practice. Hence, nurses’ experiences and viewpoints about IT integration into healthcare help improve nurses’ adoption of IT. This study aimed to explore the nurses’ experiences and viewpoints about the benefits of IT integration and adoption in healthcare.

Methods

This study was conducted with a qualitative research approach. Participants included 14 nurses from four hospitals affiliated to a large medical university in Iran, who were selected using a purposive sampling method. Data were collected through semi-structured interviews and analyzed using the conventional content analysis of Lundman and Graneheim.

Results

Six categories in the study reflected the nurses’ experiences and viewpoints about the benefits of integrating IT into health care. These categories included improving the quality and efficiency of medical services and care, facilitating the communication management in the technological environment, improving information documentation, management, and monitoring, improving resource management, improving management performance and policymaking, and facilitating pathways of organizational and professional growth.

Conclusions

Lessons learned in this study can help overcoming the barriers of IT adoption, and developing appropriate strategies to familiarize nurses with the benefits of IT in healthcare settings. Healthcare managers are recommended to investigate the experiences of nurses with IT in their hospitals and organize courses to orient hesitant nurses toward adopting IT.

The efficiency and effectiveness of surgery information systems in Iran

Background

Despite the prevalent use and advantages of information systems in hospitals, some have failed to meet their predefined objectives. Surgery information system (SIS) is a sub-system of a hospital information system. Its effective and efficient operation could enhance patient care in the busy environment of operating rooms with multiple tasks. The objective of this study was to evaluate the effectiveness and efficiency of SIS in three educational hospitals.

Methods

Data were collected using a questionnaire completed by 82 users of SIS. This questionnaire contains three parts: 1) participants’ demographic information, 2) questions regarding the efficiency of SIS, and 3) questions about its effectiveness. An independent sample t-test was used to compare the efficiency and effectiveness among systems. Chi-squared and Fisher tests were used to determine the relationship between the participants’ demographics and efficiency and effectiveness as well as the relationship between efficiency and effectiveness.

Results

About 23% of the participants rated the system’s efficiency as low, 29% as medium, and 48% as high. Besides, 24% of the participants considered the effectiveness of the system as low, 31% as medium, and 45% as high. There was a significant correlation between the efficiency and effectiveness of SIS (p ≤ 0.0001).

Conclusion

Based on the perspective of most participants (44%)the efficiency and effectiveness of both surgery information systems were acceptable. The results suggest that these systems should be designed in a way that facilitate user’s interaction and reduce the time takes to complete tasks. The results could be useful for developing and designing an efficient and effective system.

Improving the informatics competency of critical care nurses: results of an interventional study in the southeast of Iran

BACKGROUND

Nursing informatics (NI) along with growth and development of health information technology (HIT) is becoming a fundamental part of all domains of nursing practice especially in critical care settings. Nurses are expected to equip with NI competency for providing patient-centered evidence-based care. Therefore, it is important and necessary to improve nurses' NI competency through educational programs for effective using of HIT. This study aimed to evaluate the impact of a training program on NI competency of critical care nurses.

METHODS

This interventional study was conducted in 2019. Stratified sampling technique was used to select 60 nurses working in critical care units of three hospitals affiliated with a large University of Medical Sciences in the southeast of Iran. These nurses were assigned randomly and equally to the control and intervention groups. NI competency was trained to the intervention group in a three-day workshop. Data were collected using demographic questionnaire and the adapted Nursing Informatics Competency Assessment Tool (NICAT) before and 1 month after the intervention. Rahman in the US (2015) developed and validated the original NICAT to assess self-reported NI competency of nurses with 30 items and three dimensions (Computer literacy, Informatics literacy Information management skills). The NICAT is scored on a five-point Likert scale and the overall score ranges from 30 to150. Two medical informatics specialists and eight nursing faculty members approved the validity of the adapted version of NICAT and its reliability was confirmed by Cronbach's alpha (95%).

RESULTS

All 60 participants completed the educational program and returned the completed questionnaire. Majority of participants in the intervention and control groups were female (83.30%), married nurses (70.90, 73.30%) aged 30-40 years (51.6, 35.5%). In the pretest stage, both intervention and control groups were competent in terms of the NI competency and its dimensions, and no significant difference was observed between them (p = 0.65). However, in the posttest, the NI competency and its dimensions in the intervention group significantly increased with a large effect size compared with the control group (p = 0.001). This difference showed that the intervention group was proficient in the posttest stage. The highest mean difference in the intervention group was associated with the informatics literacy dimension and the lowest mean difference was associated with the informatics management skills dimension.

CONCLUSIONS

The improved scores of NI competency and its dimensions after using the training program implied the effectiveness of this method in enhancing the NI competency of nurses working in the critical care units. The application of the training program in diverse domains of nursing practice shows its high efficiency. The project is fundamental for improving nurses' NI competency through continuous educational programs in Iran, other cultures and contexts.

Investigating the satisfaction level of physicians in regards to implementing medical Picture Archiving and Communication System (PACS)

Background

User satisfaction with PACS is considered as one of the important criteria for assessing success in using PACS. The objective of this study was to determine the level of user satisfaction with PACS and to compare its functional features with traditional film-based systems.

Methods

This study was conducted in 2017. Residents at three large university hospitals in Kerman filled-out a self-administered questionnaire consisting of three parts: demographic information of participants, user satisfaction with PACS, comparing features of the two digital and traditional imaging systems. The validity of this questionnaire was approved by five medical informatics, radiology, and health information management specialists and its reliability was confirmed by Cronbach’s alpha (86%). Data were analyzed using descriptive statistics and the Spearman, Mann Whitney U and Kruskal-Wallis statistical tests.

Results

The mean of the participants’ ages was 31.4 (±4.4) years and 59% of the participants were females. The mean of physicians’ satisfaction with PACS’ had no significant relationship with their age (P = 0.611), experience of using PACS (P = 0.301), specialty (P = 0.093), and percent of interpretation of images with PACS (P = 0.762). It had a significant relationship with the participants’ computer skills (P = 0.022).

Conclusions

The mean of physicians’ satisfaction with PACS was at a moderate to a high level, yet there are still problems in the successful implementation of these systems and establishing interoperability between them. PACS has not fully met all the demands of physicians and has not achieved its predetermined objectives, such as all-access from different locations.

Use of the Internet by pregnant women to seek information about pregnancy and childbirth

Pregnant women get information about pregnancy andchild-birth from many sources, including the Internet. There is alack of evidence about the extent to which pregnant women usethis source. This study aimed to investigate the use of the Internetby pregnant women to search for information about pregnancyand childbirth. This study was conducted in Kerman, Iran. Threehundred eighty-five pregnant women waiting for their appointmentswith obstetricians/gynecologists participated in the survey byfilling out a questionnaire. The most common searched topicswere nutrition in pregnancy (81%), fetal development (67%), andcomplications of pregnancy (49%). The most popular sources ofinformation were physicians (61%), the Internet (51%), and printedsources (41%), respectively. More than half of the participantsdid not share the retrieved information from the Internet with theirhealth professionals. After being examined by a physician, 43% ofthe participants searched the Internet about the discussed topic.Beside physicians, the Internet is the second common source ofpregnancy and childbirth information for Iranian pregnant women.Future studies are needed to analyze the quality and accuracy ofonline pregnancy and childbirth information.

A combination of two methods for evaluating the usability of a hospital information system

Background

None of the evaluation methods can identify all the usability problems of information systems. So far, no study has sufficiently investigated the potential of a combination of these methods to identify usability problems. The present study aimed at examining the potential for combining two commonly utilized user-based and expert-based methods to evaluate the usability of a hospital information system.

Methods

Think aloud (TA) and Heuristic evaluation (HE) methods were used to identify the usability problems of two subsystems of the Social Security Electronic System in Iran. To this end, the problems were categorized into five groups based on ISO-Nielsen usability attributes. The Chi-square test was applied to compare the intended methods based on the total number of problems and the number of problems within each group, followed by utilizing the Mann-Whitney U test to compare the mean severity scores of these methods.

Results

The evaluation by combining these methods yielded 423 problems of which 75% varied between the methods. The two methods were significantly different in terms of the total number of problems, the number of problems in each usability group, and the mean severity of two satisfaction and efficiency attributes (P < 0.05). However, no significant difference was observed between the two methods based on the mean severity of problems and severity scores related to three usability attributes i.e., effectiveness, learnability, and error prevention (P > 0.05). In addition, the mean severity of problems identified by each method was at the “Major” level.

Conclusion

Based on the results, although the mean severity scores of the identified problems were not significantly different, these methods identify heterogeneous problems. HE mainly identifies problems related to satisfaction, learnability, and error prevention while TA detects problems related to effectiveness and efficiency attributes. Therefore, using a combination of these two methods can identify a wider range of usability problems.

LabSafety, the Pharmaceutical Laboratory Android Application, for Improving the Knowledge of Pharmacy Students

Currently, traditional paper methods may not effectively be used in education due to lack of access, outdated content, and poor graphics. Education through mobile-based applications is one of the alternative solutions. The objective of this study was to develop and evaluate LabSafety educational application and its effect on promoting the knowledge of pharmacy students. In this interventional study, the LabSafety application was first developed and evaluated for educating students about the safety measures in laboratories. Then, all pharmacy students from Kerman University of Medical Sciences (n = 316) were selected and randomly enrolled into one of three groups using simple random sampling: control (n = 106), traditional (n = 105), and application (n = 105) groups. To assess students' knowledge before and after the intervention, two valid and reliable (Cronbach's Alpha = 0.94 and 0.93, respectively) questionnaires were used. The results of the study showed no significant differences among the mean scores of the participants' knowledge before intervention (p = 0.82). After the intervention, the mean scores of the application group were 5.52 higher than the scores of the traditional group and 7.3 higher than the scores of the control group (p < 0.0001). Age had no significant effect on the posttest scores of the participants (p = 0.52). As a result, the use of this educational application can effectively increase the knowledge of all age groups of pharmacy students regarding safety measures in pharmaceutical laboratories. The mobile-based applications with online and offline access, interactive features, and user-friendly interfaces are more engaging and they can be used complementary to traditional training methods. © 2019 International Union of Biochemistry and Molecular Biology, 48(1):44-53, 2020.

Accuracy of Speech Recognition System’s Medical Report and Physicians' Experience in Hospitals

Introduction: Speech recognition(SR) technology has been existing for more than two decades. But, it has been rarely used in health care institutions and not applied uniformly in all the clinical domains. The aim of this study was to investigate the accuracy of speech recognition system in four different situations in the real environment of health services. We also report physicians' experience of using speech recognition technology.Method:. To do this study, NEVISA SR software professional v.3 was installed on the computers of expert physicians. The pre-designated medical report was tested by the physicians in four different modes including slow expression in a silent environment, slow expression in crowded environments, rapid expression in a silent environment and rapid expression in a busy environment.  After using the speech recognition software by 15 physicians in hospitals, a designed questionnaire was distributed among them. .Results: The results showed that the highest average accuracy of speech recognition software was in the silent environment by slow expression and the minimum average accuracy was in the busy environment by rapid expression. Of all the participants in the study, 53.3% of the physicians believed that the use of speech recognition system promoted the workflow.Conclusion: We found that software accuracy was generally higher than the expectation and its use required to upgrade the system and its operation.  In order to achieve the highest level of recognition rate and error reduction by speech recognition, influential factors such as environmental noise, type of software or hardware, training and experience of participants can be also considered.

The relationship between user interface problems of an admission, discharge and transfer module and usability features: a usability testing method

Background

The admission, discharge and transfer (ADT) module is used in the hospital information system (HIS) for the purposes of managing appointments, patient admission, daily control of hospital beds, planning surgery procedures, keeping up-to-date on patient discharges, and registering patient transfers within or outside the hospital. The present study aimed to evaluate the usability of ADT module of a HIS through usability testing and assess the relationship between the number of user interface problems and usability features (i.e. effectiveness, efficiency, and satisfaction).

Methods

This descriptive analytical study was conducted in Shahid Beheshti hospital in Kashan, Iran, in 2017. The participating users were eight students in their last semester of a Bachelor of Health Information Technology Sciences degree. First, the users were introduced to the module functions in a two-hour session; ten days later, the users were asked to perform scenarios designed based on seven tasks and take notes of the problems encountered in performing each task after it was over. Effectiveness was measured based on the rate of completing the tasks, efficiency based on the time taken to perform each task, and satisfaction based on the users’ answers to a satisfaction questionnaire. The relationship between these three usability features and the number of problems noted was assessed using Spearman’s test in SPSS version 16.

Results

Thirteen unique usability problems were identified from the perspective of the users. Effectiveness was rated as 58.9%, efficiency as 53.3%, and mean user satisfaction as 53.4 ± 10.6. The number of problems in each task had significant relationships to the effectiveness (P = 0.009) and efficiency (P = 0.016) scores. User satisfaction also had a significant relationship with the effectiveness (P = 0.043) but not with the efficiency (P = 0.230) scores.

Conclusions

In the view of the potential users, a HIS, used in more than 200 hospitals in a developing country, has several usability problems in its ADT module and its effectiveness, efficiency, and user satisfaction were not acceptable. The number of usability problems in the HIS user interface affected the effectiveness, efficiency and user satisfaction of the system.

Evaluating the demographic and clinical minimum data sets of Iranian National Electronic Health Record

BACKGROUND

Designing a standard data set is necessary to overcome the dispersion of data among different health information systems. The objective of this study was to evaluate the current demographic and clinical minimum data sets (MDSs) of Iranian National Electronic Health Record (known as SEPAS) and to identify most necessary data elements.

METHODS

Data were collected using a list of current demographic and clinical data of SEPAS and a self-administered questionnaire. All faculty members of six health related fields and the hospital authorities, and IT and HIM administrators of 6 hospitals in Kerman University of Medical Sciences were invited to participate in this study. The content validity of the questionnaire was confirmed by six medical informatics and HIM experts and the reliability was determined by Cronbach's alpha (α =0.95). SPSS v18 was used to generate descriptive statistics.

RESULTS

Survey results indicated that 15 data elements should become mandatory elements of MDS for communicating data to SEPAS. These elements include patient's name, surname, father's name, nationality, cell number, job, residential address, residence place, passport number (for non-Iranian patients), diagnosis date, death time, death place and the unit of the hospital where the patient died. Moreover, participants suggested 33 additional demographic and clinical data elements to be communicated mandatorily to SEPAS.

CONCLUSION

The results of this study showed that the minimum data sets of Iranian national electronic health record needs to be revised. Using the proposed MDSs by this study can improve the quality and efficiency of information and reduce redundancy by adding necessary data and preventing communication of unnecessary data. The method employed in this study can be used for investigating, refining and completing the MDSs of other health information systems.

Improving the knowledge of pregnant women using a pre-eclampsia app: A controlled before and after study

OBJECTIVE

The objective of this study was to investigate the effect of a pre-eclampsia mobile application on the knowledge of pregnant women.

METHODS

Following development of a pre-eclampsia mobile application, we conducted a controlled before and after study during a three-month period in 2018. The study population consisted of pregnant women attended to obstetrician clinics and offices in Kerman, Iran of whom, 110 sample participants were divided into two intervention and control groups. The participants completed a questionnaire of pre-eclampsia knowledge at baseline and 1-month follow up. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression.

RESULTS

A total of 108 pregnant women with an average age of 28 years participated in this study. There was no significant difference between the scores of the two groups before the intervention (p=0.94). Their difference after the intervention was highly significant (p<0.001). The difference between the knowledge of the participants before and after the intervention was significant in the both groups (p<0.05). The results showed that the knowledge score of the participants after the intervention was significantly associated with their group and assessment score before the intervention (p<0.001).

CONCLUSION

The results showed that the use of a mobile-based educational application improves the knowledge of pregnant women about pre-eclampsia. Increasing women's knowledge about pre-eclampsia may enables them to identify its signs and symptoms, resulting in the early detection and management of this condition, and likely reduction of its adverse consequences.

TRIAL REGISTRATION

IRCT2017050633837N1.

Factors influencing the selection of a picture archiving and communication system: A qualitative study

BACKGROUND

Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection.

METHODS

This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim.

RESULTS

Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories.

CONCLUSION

The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.

Usability testing of bed information management system: A think-aloud method

Not considering the usability in designing clinical information systems causes problems in human–computer interaction and patient dissatisfaction. Therefore, in this study, the usability of the bed information management system (BIMS) was examined by think-aloud method. This cross-sectional study was conducted on the BIMS in 50 noneducational hospitals. Participants consisted of three groups including users, facilitators, and technical support. To carry out the study, a scenario consisting of four tasks was designed. Three researchers analyzed the recorded files to identify the usability problems and their severity. The mean time of the evaluation process was 20:33 ± 4:47 s. The total number of the problems identifies by users was 80 cases. Data entry and layout problems with 38 (48%) and 33 (41%) cases were the most frequently found problems, respectively. About 61% and 55% of the data entry and layout problems had a minor severity (Severity 2), respectively. Furthermore, 43 (54%) cases of the problems were resolved by the users and 32 (40%) cases by the facilitator assistance. This study showed that a large number of the problems were due to the system poor design. Furthermore, by increasing the users’ level of knowledge about the system, it is possible to enhance user-system interaction. It is recommended that before designing and implementing a system, the system should be evaluated for usability, and the users should be educated in clinical information systems.

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.

Evaluating the agreement of users with usability problems identified by heuristic evaluation

OBJECTIVE

Heuristic evaluation (HE) is an inspection method that can be used for identifying usability problems of health information systems. There is insufficient evidence to what extent these problems are experienced by users in their working environment. The objective of this study was to investigate the agreement of real end users of a health information system with the problems identified by HE.

METHODS

First, the emergency information system of educational hospitals in Kerman, Iran was evaluated by a heuristic evaluation. Then, a valid and reliable (Cronbach's alpha = 0.95) electronic questionnaire was designed based on the results of the first phase.

RESULTS

Among 127 identified problems, the highest number of problems was related to the "consistency and standards" heuristic (18.9%). The user agreement coefficient with heuristic results was 0.5. The highest agreement of the participants was on the problems related to the "help user recognize, diagnose and recover from errors" heuristic (78%). There was a significant relationship between participants age and work experience with a computer (p < 0.05).

CONCLUSION

The agreement rate of real end users with the results of HE was at a medium level. Therefore, in some areas, the perception of evaluators in using this method is not consistent with the users experience with a system. This can result in identifying minor issues and ignoring important system-critical usability issues. The HE is appropriate for identifying specific problems, such as problems related to identifying and correcting errors, but in some areas, such as consistency and standards in the design of a system, it identifies minor or ineffective problems.

Usability evaluation of obstetrics and gynecology information system using cognitive walkthrough method

Background and aim

Obstetrics and gynecology information system is a critical component of the HIS in social security organization health centers. The objective of this study was to evaluate the usability of this system using the cognitive walkthrough method. Also, the present study provided a detailed formal description of how the cognitive usability evaluation can be applied and reported for a health care information system.

Methods

This study was conducted at the Mashhad University of Medical Sciences' usability lab from March 2016 to June 2017. A two-phase approach was used to conduct the cognitive walkthrough evaluation: preparatory and evaluation. The preparation was done in three stages: first, we investigated users' capabilities and background knowledge through a semi-structured interview. Second, the evaluation scenario was developed based on the most common tasks in routine workflow of users. Finally, each task was broken down into sequences of actions. In the evaluation phase, three usability experts independently assessed each action using a four-item checklist. Problems were categorized thematically and were reported from three different perspectives: Question-based, Task-based, and Evaluator-based. The data were then analyzed to understand the contribution of each task, along with its mean severity score.

Results

Evaluators' responses were compared and any conflict was resolved in an expert panel. A total of 116 usability problems were identified based on the consensus of the evaluators. Inadequate system feedback was found to be the main source of 43% of the problems, and resulted in users confusion.

Conclusion

Since the system was evaluated in its pilot implementation phase, there was an opportunity to prevent future potential usability problems. The use of a mixed quantitative and qualitative approach in this usability study provided a more comprehensive perspective of the system problems. This study provided a detailed description of conducting CW usability evaluation which can be used as a practical guide for future studies.

Augmentation of the think aloud method with users' perspectives for the selection of a picture archiving and communication system

OBJECTIVES

Users attitude toward a picture archiving and communication system (PACS) and their interaction with this system are among the most important factors that influence its acceptance. This study aimed to augment the user's interaction with the user's perspective to select a usable PACS among three systems available on the market.

METHODS

We augmented the think aloud (TA) usability evaluation method with the Post-Study System Usability Questionnaire (PSSUQ) to compare user interaction problems of three PACS user interfaces. Four radiologists and four internist physicians participated in this study. Usability characteristics including efficiency, effectiveness, learnability, error, and satisfaction were used to assess the usability of each PACS.

RESULTS

There was a significant difference in efficiency (p = 0.01), effectiveness (p = 0.005), learnability (p = 0.001), and satisfaction (p = 0.009). However, no significant difference in the number of errors (p = 0.18), mouse clicks and keystrokes (p = 0.12), and the number of usability problems (p = 0.6) were observed among the three PACS systems studied.

CONCLUSIONS

This study showed that applying the proposed approach to augment TA with the user's perspective addresses almost all of the theoretical aspects of usability and can be employed to select the most usable PACS.

Comparison of heuristic and cognitive walkthrough usability evaluation methods for evaluating health information systems

Objective

There are several user-based and expert-based usability evaluation methods that may perform differently according to the context in which they are used. The objective of this study was to compare 2 expert-based methods, heuristic evaluation (HE) and cognitive walkthrough (CW), for evaluating usability of health care information systems.

Materials and methods

Five evaluators independently evaluated a medical office management system using HE and CW. We compared the 2 methods in terms of the number of identified usability problems, their severity, and the coverage of each method.

Results

In total, 156 problems were identified using the 2 methods. HE identified a significantly higher number of problems related to the "satisfaction" attribute ( P  = .002). The number of problems identified using CW concerning the "learnability" attribute was significantly higher than those identified using HE ( P  = .005). There was no significant difference between the number of problems identified by HE, based on different usability attributes ( P  = .232). Results of CW showed a significant difference between the number of problems related to usability attributes ( P  < .0001). The average severity of problems identified using CW was significantly higher than that of HE ( P  < .0001).

Conclusion

This study showed that HE and CW do not differ significantly in terms of the number of usability problems identified, but they differ based on the severity of problems and the coverage of some usability attributes. The results suggest that CW would be the preferred method for evaluating systems intended for novice users and HE for users who have experience with similar systems. However, more studies are needed to support this finding.

Health information needs of pregnant women: information sources, motives and barriers

BACKGROUND

Pregnant women should be provided with relevant and useful information to manage this specific period of their lives. Assessing information needs of this group is a prerequisite for providing this information.

OBJECTIVE

The aim of this study was to assess the information needs of pregnant women during their pregnancy and childbirth.

METHODS

This descriptive study was conducted on the pregnant women who attended antenatal clinics and obstetricians/gynaecologists' offices in Kerman, Iran, in 2015. Data were collected using a self-administered, valid and reliable questionnaire. A total of 400 women participated in the study.

FINDINGS

Most pregnant women needed information about care of the foetus (n = 344, 86%), physical and psychological complications after delivery (n = 333, 83%), development and growth of the foetus (n = 330, 82.5%), pregnancy nutrition (n = 327, 82%) and special tests during pregnancy (n = 326, 81.5%). They mostly (n = 195, 49%) looked for information when they were suffering from a disease or pregnancy complications.

CONCLUSIONS

As pregnant women need extensive information to be able to take care of themselves and their babies, their information needs should be identified and taken into consideration when planning educational programmes for this group of women.

The pedagogical effect of a health education application for deaf and hard of hearing students in elementary schools

Background

Deaf or hard-of-hearing children experience difficulties in learning health principles. But technology has significantly improved their ability to learn. The challenge in e-learning is to design attractive applications while having an educational aspect.

Objective

The aims of this study were to determine the pedagogical effectiveness of a health education application for deaf and hard of hearing students in elementary schools, and to investigate the student’s perceptions in different educational grades about the educational effectiveness of the text, graphics, video clips, and animation in the application.

Methods

The study design was quasi experimental and was conducted in Mashhad in 2016. Study population were deaf or hard-of-hearing students in elementary schools. The intervention included health application training to deaf and hard-of-hearing students in Mashhad. A questionnaire was used for data gathering. The pedagogical effectiveness was determined by measuring the modified Adapted Pedagogical Index. This index was created based on the characteristics of the application and study population. Statistical analysis was performed using the Kruskal-Wallis and Mann–Whitney tests with Bonferroni adjustment by SPSS 22.

Results

Eighty-two students participated in the intervention. The value of modified Adapted Pedagogical Index was 0.669, indicating that the application was effective. The results of Kruskal-Wallis H and Mann–Whitney U test showed significant differences in different educational grades. (p<0.008)

Conclusion

Using information technology can improve the education of deaf and hard-of-hearing students. Modified Adapted Pedagogical Index can be used for evaluation of non-interactive applications for elementary school children who are deaf or hard of hearing.

Challenges of using Hospital Information Systems by nurses: comparing academic and non-academic hospitals

Background and aim

Hospital Information Systems (HIS) are used for easy access to information, improvement of documentation and reducing errors. Nonetheless, using these systems is faced with some barriers and obstacles. This study identifies the challenges and the obstacles of using these systems in the academic and non-academic hospitals in Kerman.

Methods

This is a cross-sectional study which was carried out in 2015. The statistical population in this study consisted of the nurses who had been working in the academic and non-academic hospitals in Kerman. A questionnaire consisting of two sections was used. The first section consisted of the demographic information of the participants and the second section comprised 34 questions about the challenges of HIS use. Data were analyzed by the descriptive and statistical analysis (t-test, and ANOVA) using SPSS 19 software.

Results

The most common and important challenges in the academic hospitals were about human environment factors, particularly “negative attitude of society toward using HIS”. In the non-academic hospitals, the most common and important challenges were related to human factors, and among them, “no incentive to use system” was the main factor. The results of the t-test method revealed that there was a significant relationship between gender and the mean score of challenges related to the organizational environment category in the academic hospitals and between familiarity with HIS and mean score of human environment factors (p<0.05). The results of the ANOVA test also revealed that the educational degree and work experience in the healthcare environment (years) in the academic hospitals have a significant relationship with the mean score related to the hardware challenges, as well, experience with HIS has a significant relationship, with the mean score related to the human challenges (p<0.05).

Conclusion

The most important challenges in using the information systems are the factors related to the human environment and the human factors. The results of this study can bring a good perspective to the policy makers and the managers regarding obstacles of using HISs from the nurses’ perspective, so that they can solve their problems and can successfully implement these systems.