Journal of Health Information Management
Year:2011 | Volume:8 | Issue:3 (19)|Papers Count:24

Introduction: Health system performance assessment provides appropriate information about the status of health systems for governments and communities. Therefore, in the recent decade, many countries have focused on performance assessment and reporting in order to develop methods and tools as a mean to help achieving health goals. The present study tries to design an indicator-based model (including general aspects and related indicators) for health system assessment in Iran.Methods: This descriptive comparative applied research was carried out during 2008-2009 and included three phases: reviewing theoretical concepts, preparing health system performance assessment indicators draft and building consensus. Required data was collected via environmental scanning and face to face and web-based interviewing. Environmental scanning did not include a study population and the models extracted through this stage were used as information sources.However, the study population during interview and building consensus phases consisted of 31 Iranian health system experts. The reliability and validity of forms used in interviews were confirmed by the experts and test-retest, respectively. We used a purposive approach and opportunistic sampling method to determine the interviewees. Modified Delphi technique was utilized for building consensus. In order to analyze the data, descriptive statistics (percent, mean and standard deviation) was applied. In the environmental scanning stage of research, performance assessment initiatives were identified in Canada, Australia, New Zealand, the United Kingdom and the United States. In addition, transnational performance assessment frameworks of the World Health Organization (WHO), Organization for Economic Cooperation and Development (OECD), the International Organization for Standardization (ISO), Commonwealth Fund and the United States Agency for International Development (USAID) were reviewed and existing indicators in Iran were collected. In the interviewing stage, indicators proposed by the interviewees were obtained. Finally, all identified indicators were classified in 31 criteria to form the initial draft of indicators.Results: For consensus building, 2 processes of modified Delphi were conducted. In the first process, after 4 rounds, 14 criteria were selected for Iranian health system performance assessment including public health status, governance, accessibility, health expenditure, financing and equity, primary health care, aging care, quality of services, insurance system, hospital performance, research and development, privatization, efficiency and productivity, technology and health information system and also health outcomes. In the second process of Delphi, consensus was obtained on 175 indicators.Conclusion: The designed result- and indicator–based model provides an instrument for reviewing country's health system. Applying this model will offer policy–makers a major opportunity for performance improvement over time.

Introduction: Individuals and families' accessible incomes increase as a result of economic development and income inequality reduction. This in turn leads to health promotion in the community. So, this study mainly aimed to survey the effects of unequal income distribution on health in selected members of Organization of Islamic Countries (OIC).Methods: This descriptive-analytic study collected the data and information from the Internet, library resources and journals. The model used included some variables, such as income level, income inequality, level of savings and education level. The study population consisted of 18 members of OIC between 1980 and 2005. The analysis was performed using panel data method and random coefficient model. The data was entered into Microsoft Excel software. Then, estimation was made by FLeamer test in Stata 9.2. Finally, Eviews3 was used to demonstrate the effects of variables and the difference between cross-sectional data.Results: Considering life expectancy as a health index, and keeping the per capita income constant, income inequality (measured by Gini coefficient) had a reverse effect on health only in 6 out of 18 countries (according to inequality income hypothesis). Since life expectancy could not show the health changes in countries with more income inequality, the product of life expectancy and per capita income was used as health index. With income level, savings and education levels as control variables, it was observed that education and income have significantly positive effects on health.Conclusion: In the effort to promote health, one must emphasize not only on primary care systems, but also on issues such as improving income inequality, because an improvement in income distribution leads to increased level of life among masses of people through health, nutritional and educational enhancements.

Introduction: To assess efficiency as a relative concept, the difference between real and expected values must be determined by comparing the productivity of economic units of industry and the efficiency in potential production conditions. As economic units, hospitals need to utilize efficiency analysis in order to make optimal use of their available resources. Therefore, the present study compared the efficiency of different hospitals of Shahid Beheshti University of Medical Sciences.Methods: Since this applied analytical research referred to the documents and performance statistics of hospitals and therfore used real data, evaluating the validity and reliability had no relevance. In order to measure the relative efficiency of health care in 16 hospitals associated with Shahid Beheshti University of Medical Sciences and also to determine efficient and inefficient hospitals during 2005-2007, CCR (Charnes-Cooper-Rhodes) input oriented multiplier model of Data Envelopment Analysis (DEA) was used for data analysis. In addition, AP (Anderson-Peterson) model was used to rank efficient hospitals. LINDO software was utilized to solve the model.Results: Based on our results, 43.75%, 31.25% and 37.5% of hospitals were efficient respectively in 2005, 2006 and 2007.Conclusion: The results suggested that the efficiency of inefficient hospitals could be improved through the potential savings in resources (62.44% in infrastructure, 43.88% in the number of active beds, 37.15% in the number of physicians and 38.58% in the number of paramedics).

Introduction: Length of stay is one of the most important and most practical indices used in hospitals today and presents the performance and efficiency of the hospitals. On the other hand, hierarchical analysis technique, one of the group decision making techniques, is utilized to determine priorities. Therefore, this study was conducted to identify the factors affecting length of stay in Alzahra Hospital based on hierarchical analysis technique.Methods: This descriptive cross-sectional survey included the management, chief, educational supervisor, and also nursing and ward managers of Alzahra Hospital in Isfahan during 2009. All the subjects were selected by census sampling method. Data collection tool was the paired comparisons questionnaire. Data analysis was done by Expert Choice software.Results: Generally, patient's underlying disease (0.245), availability of beds (0.203), being discharged before holidays (0.657), coordination between paraclinical and treatment units (0.294), health personnel's awareness (0.241), performing various graphies in the hospital (0.286), and nurses' sympathy with the patients (0.517) were the most effective factors on length of stay.Conclusion: Identifying the factors effective in shortening the length of stay is one of the main responsibilities of hospital managers. Factors related to patient visit, coordination with other sectors and patient characteristics are the most important and need more planning and attention from hospital officials.

Hospitals are responsible to respond to legitimate demands for health information release while protecting the confidentiality of patient health records. This study investigated and compared laws and policies of health information disclosure for legal authorities in Iran and some selected countries.Methods: This descriptive-comparative study included health information disclosure laws and policies in selected countries such as the United States, Australia, England, Malaysia and Iran.Data were gathered from systematic internet search, library resources and communication with health information professionals. Data analysis was done using comparative tables and qualitative method.Results: The results showed that in all the five studied countries, there are specific written policies and procedures for health information disclosure for legal authorities. It was found that, without a judicial warrant, a patient consent is needed for medical record disclosure for courts, representatives of judicial authorities and law enforcement agencies.Conclusion: In all of the selected countries there are ordained limitations for health information release to protect patient rights.

Introduction: Determining the overlap rates is a quantitative method to compare database contents. In this survey, traditional overlap, relative overlap and synthetic degrees of freedom between PubMed as a free database and Scopus as a subscription-based one in the cardiovascular disease field have been determined.Methods: This descriptive applied research was done during January to June 2009. First, the descriptors related to three cardiovascular diseases, namely stroke, high Blood pressure and cerebrovascular accidents, were obtained from Emtree Thesaurus. Then, original articles on the three mentioned problems were retrieved from PubMed and Scopus by searching these descriptors. Primary raw data needed for overlap calculation were obtained using Reference Manager Software. Data analysis was done in Microsoft Excel.Results: A total of 9899 articles on cardiovascular diseases were retrieved from both databases, including 8593 and 7713 articles from PubMed and Scopus, respectively. There were 6407 common titles while 2186 and 1306 titles belonged only to PubMed and Scopus, respectively.The traditional overlaps were 68%, 66.7% and 60.7% for high blood pressure, cerebrovascular accidents and stroke, respectively. Relative overlap between PubMed and Scopus for stroke, high blood pressure and cerebrovascular accidents were 75.8% vs. 75.3%, 89.2% vs. 74.1% and 86.7% vs. 74.3%, respectively. Synthetic degrees of freedom were smaller than 0.5 for the three considered diseases.Conclusion: Due to PubMed's higher relative overlaps versus Scopus's, more user and librarians are led to use PubMed. Larger numbers of retrieved unique articles for each cardiovascular disease from PubMed as compared with Scopus, along the fact that it is free, makes PubMed preferable.

Introduction: In the age of information, in order for offering integrated library services to the users, librarians need to be knowledgable about new Web technologies and their applications in library services, especially in medical areas. This study investigates the level of knowledge and and usage of World Wide Web in library services among medical librarians in Tehran.Methods: The present descriptive survey used a questionnaire for data collection. The questionnaire was distributed between 70 medical librarians working in central libraries and faculty libraries in three universities of medical sciences: Tehran University of Medical Sciences, Iran University of Medical Sciences and Shahid Beheshti University of Medical Sciences. The subjects were randomly selected using the sample size formula. The reliability and validity of the questionnaire were approved by professors in Tehran University of Medical Sciences. The data were then analyzed by Likert scale and other statistical methods using SPSS software.Results: Based on the most important findings of this study, the majority of medical librarians knew usual web applications like Web browsers, search engines and discussion groups. However, only about 34% were familiar with facilities and applications of Web 2.0 such as podcast, Wikis, social networks and RSS. Finally, about 41% of librarians had used Web applications in library services.Conclusion: As the results show, the amount of familiarity with the new Web generations and usage Web applications in library services is relatively low.So, holding Web courses and encouraging medical librarians to know and use these technologies in library services should be considered by managers.

Introduction: Since international increase of scientific productions is an indicator in assessing different countries, the purpose of this research is to investigate the scientific productions of Iranian type I pharmacy faculty members (universities of Isfahan, Tabriz, Shiraz, Tehran and Mashhad) in the Institute for Scientific Information (ISI) during 2006-2008.Methods: In this scientometric research the scientific products of 261 faculty members of Iranian type I pharmacy colleges, indexed in the ISI during 2006-2008, were studied. In order to collect data, the ISI was first searched for the names of all Iranian type I pharmacy faculty members.Then, their addresses and other necessary data were extracted. Finally, the data was analyzed using the analytical software in the ISI and the results were shown in tables.Results: The results show that 84% of the research population were men and 16% were women.Therefore, men had more scientific productions (more than 80%). The scientific productions of Iranian type I pharmacy faculty members indexed in the ISI were 362 articles (89.50% men, 10.52% women), 409 articles (89.48% men, 10.52% women), and 411 articles (92.94% men, 7.06% women) in 2006, 2007 and 2008, respectively.Conclusion: Based on our results, schools of pharmacy at Tehran, Tabriz, Mashhad, Shiraz, Isfahan and Shahid Beheshti universities of medical sciences produced 42%, 18%, 13%, 11%, 10% and 6% of the scientific productions, respectively. Scientific production growth rate was also found to be 4%.

Introduction: Since the design of bibliographic databases affects their usefulness in medical subjects and how they can be utilized by the users, and also considering the necessity of adherence to international standards in designing, this study aimed to assess five Persian bibliographic databases, including IranMedex, Irandoc, Magiran, ParsMedline and Scientific Information Database (SID), using the Gulliver online database evaluation tool.Methods: This survey was conducted in 2009 using a checklist, the validity of which was confirmed. The data was collected through an evaluation tool named "Gulliver online database evaluation tool". All descriptive analyses were performed using SPSS 15.Results: The checklist included 12 criteria: entry page, searching, limiting, record viewing and manipulating, graphics, record retrieval, selective dissemination of information services, general design, terminology, icon design and placement, help and advanced features. In general, IranMedex and Irandoc achieved the highest scores (45.8% and 45% of the total score, respectively). ParsMedline, SID and Magiran scored 40%, 38.3% and 37.5%, respectively.Conclusion: Since the highest score among the studied databases was lower than 50% of the total score defined by the evaluation tool, it is concluded that Persian bibliographic databases are not designed properly. Therefore, it is necessary to supervise database designing and their adherence to international standards.

Introduction: Considering the necessity of uniformity and consistency in the structures of abstracts and also increasing their precision, correctness, and exhaustivity, this research aims to investigate the adherence to abstracting standards (ISO 214) in Persian abstracts of general medicine theses in Arak University of Medical Sciences during 1999-2008.Methods: This applied descriptive study reviewed all theses registered in the central library of Arak University of Medical Sciences and finally, selected 328 theses as the statistical population.In order to prepare the required standards and also to determine the consistency of the theses with abstracting standards, the original text of International Organization for Standardization (ISO) in abstracting and its translated Persian text were studied. A checklist designed based on ISO abstracting standards was used for data collection. The validity and reliability of the checklist were confirmed by the experts. Data analysis was performed in SPSS software. The results were shown as frequency, percentage and chi-square indices.Results: The highest rate of adherence to including bibliographic information was seen in 2005 (48 abstracts (16.4%)). However, the findings and secondary results were not mentioned in any abstracts. The findings of chi-square test showed that except “purpose”, there was a significant difference in the adherence to the standards in different years.Conclusion: Adherence to form-related abstracting standards (ISO 214) e. g. research results, preserving the main information of the theses, etc. was acceptable. However, content abstracting standards including purpose, findings, etc. were not adequetly deployed.

Introduction: Limited resources and rapid increase of costs, makes productivity improvement in hospitals considerably important. This study tries to measure the productivity in medical records departments of selected hospitals and provide a comprehensive image of their performance.Methods: This applied descriptive analytical study tries to assess the Malmquist index in medical records departments of Tehran University of Medical Sciences hospitals during 2006-2008. Data gathering was conducted through interviews and studying the statistics of all activities in medical records departments. The data was analyzed using DEAP 2.1 software.Results: This study showed that while medical records departments in Razi and Vali-e-Asr had the highest improvement in productivity, the rates at Imam Khomeini Hospital and the Heart Center were almost constant. In addition, medical records department of Farabi and Ziaeeyan hospitals had the lowest total factor productivity index.Conclusion: Considering the improved Malmquist index in more than one-third of studied medical records departments, they can provide a good model for productivity improvement in other departments. Moreover, other methods, such as hiring medical records graduates and experienced managers, can help improve the productivity in the mentioned departments.

Introduction: A patient's medical record is the most important source for medical research, education and law. The physician's role, as the head of the medical team, in registration of accurate information of diagnoses, orders and observations is of utmost importance. This research aimed to determine the rate of adherence to principles of diagnosis recording in medical records of patients with fractures hospitalized at Urmia Motahari Hospital.Methods: This cross-sectional survey was conducted on the records of patients admitted to Urmia Motahari Hospital with a final diagnosis of fracture in 2007. A sample size of 400 records was selected randomly. A checklist was used to determine whether or not the necessary information was recorded. The checklist, the validity and reliability of which have been confirmed, included anatomic site, type, shape (closed or open), external cause and fracture related injuries. The results were shown as frequency tables.Results: Based on our results, the most recorded item was the site of fracture (97.25%) and the lowest was the shape of fracture (7%). None of records included all items. In addition, only 1.25% of the records contained 4 items.Conclusion: Incomplete recording of final diagnosis in the patient's record is one of the main problems of documentation. Chart writing is one of the most important responsibilities of physicians and medical teams, which, according to our results, is not taken seriously. Chart writing can be improved by workshops. Establishment of rules for documentation can also increase the adherence to principles of documentation.

Scientific journals provide a platform for reviewing, publishing and dissemination of the results of new scientific findings and discoveries and cannot be replaced by any other platform. Given the important role of scientific journals in dissemination of information, management of such journals takes a high priority. The accurate management of scientific journals takes place only when the different responsibilities of people including editors, authors, peer reviewers and readers are taken into consideration. The aim of the present article is to discuss the different tasks and roles of the above mentioned people in the management of scientific journals in health domain.

In order to reach the electronic health record's (EHR's) goals and also for the users to employ it with confidence, integrated standards in the field of structure, content, data exchange, information production, architecture and system security must be formulated. Before establishment of EHR, we should accept current standards or change them due to meet the needs of society and/or patterns from organization standards. American Society for Testing and Materials (ASTM), Health Level 7th (HL7) and International Standard Organization (ISO) have started doing spread EHR-related activities and standardizations from years ago. Therefore, these organizations would be pioneers and good patterns in expanding EHR.Considering the wide range of EHR-related activities, international acceptance and accessible information offered by ASTM, HL7 and ISO, the present applied comparative study reviewed the features (including structure, content, exchange, vocabulary, confidentiality, data types, clinical documents, infrastructure, financial, messaging, auditing and quality), activities and standards of EHR in these selected organizations. Data was collected from printed texts, periodicals, the Internet and reliable databases. Finally, data comparison was made in comparative tables.Studying the features of these non-governmental organizations revealed that HL7 is the newest. In addition, ISO has the broadest scope of activities including report making, data recording, structure and content standardization. ASTM was the only organization that makes special standards. All three have a comprehensive definition for EHR, but ASTM pays more attention to the needs of users, HL7 takes a structured data set, features, communication and messaging into consideration, whereas ISO gives more priority to computerized processing capabilities. Although ISO has the aspects of confidentiality, infrastructure and different data, is offers the lowest diversity and accuracy.

Introduction: The entrance of the hospital is the reception and the communication with patients starts from this unit. The efficiency of the unit would be clear when all general rules including facilities and activities are controlled. This study compared the status of the reception units of Shiraz and Ahwaz  educational hospitals.Methods: This cross-sectional study, conducted in 2008, compared the reception units of 7 hospitals in Shiraz and 7 hospitals in Ahvaz. Data collection was performed through interview and direct observation. The data was enetered in standard checklists confirmed by the Ministry of Health. The validity and stability of data collection tools were verified and the results were shown in frequency distribution percentage tables.Results: The percentage of essential equipments found in the educational hospitals of Shiraz and Ahvaz was 39% and 49%, respectively. Reception units had no role in patients' release in Ahvaz hospitals, but 28% of patients release was done by the reception units in Shiraz hospitals.Conclusion: According to the results of this study, 22% and 31% of reception units in Ahvaz and Shiraz, respectively, followed the standards. Hospital staff in Shiraz had higher education compared with those in Ahvaz. The authorities need to be more responsible in solving the existing problems in reception units. They should also make more effort to improve the quality of medical records units.

Due to the complexity of medical decision making, the application of information systems to support clinical decisions has increased. In this regard, the role of artificial intelligence (AI) is significant. This article discusses the opportunities and challenges of these systems. Technology limitations, cost, expert maintenance, clinical data entry, some issues in knowledge acquisition and knowledge engineering, modeling of medical knowledge, accuracy of the systems and the methods to validate the systems, errors in the systems and accountability, the limited scope of the systems, as well as the necessity of integrating AI systems in routine practice are the main challenges that should be overcome or adequately answered to increase the application of these systems.