A quantitative study on completeness rate of documentation in psychiatric medical records.

Background: Mental disorders are one of the leading causes of illness and disability worldwide. According to the World Health Organization (WHO), one in four people in the world will be affected by mental or neurological disorders during their lifetime. Regular evaluation of mental health outcomes plays an important role in making decisions about timely treatment of the patient. Studies show that a medical record does not provide enough information about the diagnosis, current symptoms, psychiatric medications, and side effects of current medications and treatments for ongoing health care. In this study, the completeness of paper-based psychiatric records was investigated. Aim: The current study aimed to explore the completeness rate of paper-based psychiatric medical records (PMRs) and to investigate the factors effective on documentation status. Setting: The study was conducted in Ebnesina and Dr. Hejazi Psychiatric Hospital and Education Center. The case hospital is a psychiatric teaching hospital, which has 900 beds. Materials and Methods: The completeness rate of PMRs was determined using descriptive statistics. Fleiss' Kappa agreement and effective factors on PMRs' documentation status were assessed. Results: In total, 83.65% (n = 312) of the PMRs had at least one documentation defect. A significantly higher level of documentation completeness rate between different psychiatric wards was observed. Conclusion: Based on our results, it is suggested to conduct regular evaluation and provide feedback to the health-care providers, and conduct training courses.

Development an extended-information success system model (ISSM) based on nurses' point of view for hospital EHRs: a combined framework and questionnaire.

BACKGROUND: Understanding the hospital EHR success rate has great benefits for hospitals. The present study aimed to 1-Propose an extended-ISSM framework and a questionnaire in a systematic manner for EHR evaluation based on nurses' perspectives, 2-Determine the EHR success rate, and 3-Explore the effective factors contributing to EHR success. METHODS: The proposed framework was developed using ISSM, TAM3, TTF, HOT-FIT, and literature review in seven steps. A self-administrated structured 65-items questionnaire was developed with CVI: 90.27% and CVR: 94.34%. Construct validity was conducted using EFA and CFA. Eleven factors were identified, collectively accounting for 71.4% of the total variance. In the EFA step, 15 questions and two questions in EFA were excluded. Finally, 48 items remained in the framework including dimensions of technology, human, organization, ease of use, usefulness, and net benefits. The overall Cronbach's alpha value was 93.4%. In addition, the hospital EHR success rate was determined and categorized. In addition, effective factors on EHR success were explored. RESULTS: In total, 86 nurses participated in the study. On average, the "total hospital EHR success rate" was moderate. The total EHR success rates was ranging from 47.09 to 74.96%. The results of the Kruskal-Wallis test showed that there was a significant relationship between "gender" and "self-efficacy" (p-value: 0.042). A reverse relation between "years of experience using computers" and "training" (p-value: 0.012) was observed. "Years of experience using EHR" as well as "education level" (p-value: 0.001) and "ease of use" had a reverse relationship (p-value: 0.034). CONCLUSIONS: Our findings underscore the EHR success based on nurses' viewpoint in a developing country. Our results provide an instrument for comparison of EHR success rates in various hospitals.

Diagnostic and Therapeutic Costs of Patients With a Diagnosis of or Suspected Coronavirus Disease in Iran.

OBJECTIVES: To understand the social and individual effects of the disease and make decisions on the allocation of health resources, it is necessary to understand the economic burden of coronavirus disease (COVID-19); however, there are limited data in this field. This study aimed to estimate diagnostic and therapeutic costs of patients with a diagnosis of or suspected of COVID-19 disease admitted to hospitals in northeast Iran. METHODS: This descriptive and analytical research was conducted as a retrospective study using the data collected from 2980 patients admitted to 30 hospitals from February to April 2020 in Iran. For data collection, an appropriate data capture tool was designed to record detailed resource use. A multivariate regression analysis was performed to examine the association between the treatment costs and sociodemographic, disease severity, and underlying diseases. Data were analyzed using Excel 2017 (Microsoft, Redmond, WA) and SPSS version 21 software (SPSS Inc., Chicago, IL). RESULTS: The inpatient costs per patient were Int$416, of which 74% were paid by social health insurance systems, 19% by the government, and 7% by the patients. The largest cost components were hoteling (37%) and medicine (36%). The 4 subscales of age, sex, underlying disease, and severity predicted 48.6% of the cost variance. CONCLUSION: Understanding the economic consequences of diseases can help policymakers to make plans to reduce out-of-pocket payments and make plans for funding. Since COVID-19 is a newly emerging disease and there is no definitive cure for the disease, the discovery of an effective medicine may alter medical costs and reduce the hospital length of stay, therefore significantly reducing treatment costs.

Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.

BACKGROUND: The spread of COVID-19 as an infectious disease brings about many newly arrived challenges, which call for further research on the scope of its effect on life due to the special conditions of this disease. The present study is, therefore, an attempt to understand the lived experience of inpatients hospitalized with COVID-19. METHOD: In this phenomenological study, among patients with COVID-19 who were hospitalized in COVID-19 referral hospitals, 17 people were selected by random sampling method. Data were gathered by interviews and analysed using MAXQDA10 software. FINDINGS: Analysis revealed 4 main themes and 16 subthemes. Main themes included the (1) denial of the disease, (2) negative emotions upon arrival, (3) perception of social and psychological supports and (4) post-discharge concerns and problems. CONCLUSION: Patients with COVID-19 experience a different world of stresses, concerns and feelings in the course of their disease. Gaining a deeper insight into patients' experiences with this disease can help handle this disease more effectively and provide better post-corona nursing and psychological care and services.

Challenges faced by nurses while caring for COVID-19 patients: A qualitative study.

INTRODUCTION: In the COVID-19 crisis, nurses are directly involved in patient care, so they face many challenges. This study was performed to determine the challenges faced by nurses while caring for COVID-19 patients in Iran in 2020. MATERIALS AND METHODS: This qualitative, content analysis was conducted in Iran on ten nurses directly involved in the fight against the corona epidemic, selected through a purposeful sampling strategy. Data were collected through deep interviews consisting of open questions. All the interviews were recorded, and immediately after each interview, it was transcribed into written form. The data were analyzed using MAXQDA software. RESULTS: All the challenges could be classified into three main categories and 17 subcategories. The main categories were miss-management in controlling corona conditions, mental and physical complications and challenges in corona work conditions, and lack of sufficient workforce. CONCLUSION: Hospital managers and authorities play a significant role in meeting the financial needs and requirements of nurses, and can minimize the job discrimination prevalent at medical centers through providing financial and nonfinancial incentives for nurses. Moreover, the findings of the present study can help hospital managers and authorities to gain a better understanding of the experiences of nurses, and to take the necessary measures to obviate the challenges faced by nurses in public health emergencies.

Scoring systems of kidney donation from deceased donors: A systematic review.

Renal disease is the most prevalent disease. Kidney failure can cause physical problems. Hence, patients need to use dialysis therapy or kidney transplantation, and actually, people are in the waiting list for a transplant. This research aimed to extract the prognostic models that evaluate the preparation of kidney donors diagnosed with brain death (DBD). This research was a systematic review of PubMed, Science Direct, and general explorers up until 2020. It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P protocol. The assessment of the articles was done by the authors. This evaluation was supposed to be in the form of scoring, prioritizing, and ranking the donors in terms of their preparation. Eleven sources of information included 9 academic articles along with 2 Grey Sources from 7 different countries. 9 algorithms and models were extracted which included, overall 10 factors. All the models were comprised of 4 factors and about 90% of these models considered 4 or 5 factors to evaluate the preparation of kidney donors DBD. Over 60% of the models had taken into account age, blood pressure history, and creatinine factors. Disease prognosis facilitates a doctor's decision-making on the emergence of the disease. Prognostic models of renal diseases can be a great help to patients. A review of the related literature revealed that all the models received a high score in terms of the two factors they included, age and history of blood pressure.

Understanding key factors affecting on hospital electronic health record (EHR) adoption.

INTRODUCTION: This study investigated the factors affecting the acceptance of hospital electronic health record (EHR) adoption by users based on Technology Acceptance Model3 (TAM3). METHODS: The self-administered TAM3 questionnaire was used for data gathering. Content validity and reliability of the TAM3 questionnaire were measured. The relation between dependent, independent, and mediator variables was analyzed using multiple regression analysis. RESULTS: The results from 224 users indicated that subjective norm, job relevance, output quality, voluntariness, computer experience have significant impacts on perceived usefulness. Also, perceptions of external control and computer anxiety were identified as having significant impacts on perceived ease of use. Perceived usefulness did not have a mediator role between result demonstrability and behavioral intention. Perceived ease of use was not found to be a mediating factor in the relationship between computer self- efficacy and behavioral intention, as well as perceived enjoyment. CONCLUSIONS: The findings of the current study, provide valuable scientific evidence for key affecting factors on hospital EHR in Iran as a developing country. Our results showed the main constructs and relationships depicted in the TAM3 were found to be applicable to assess the adoption of hospital EHR.

Determining the Hospital Information System (HIS) Success Rate: Development of a New Instrument and Case Study.

BACKGROUND: Hospital Information System (HIS) is a type of health information system which is widely used in clinical settings. Determining the success rate of HISs is an ongoing area of research since its implications are of interest for researchers, physicians and managers. AIM: In the present study, we develop a novel instrument to measure HIS success rate based on users' viewpoints in a teaching hospital. METHODS: The study was conducted in Ebnesina and Dr Hejazi Psychiatric Hospital and education centre in Mashhad, Iran. The instrument for data collection was a self-administered structured questionnaire based on ISSM, covering seven dimensions, which includes system quality, information quality, service quality, system use, usefulness, satisfaction, and net benefits. The verification of content validity was carried out by an expert panel. The internal consistency of dimensions was measured by Cronbach's alpha. Pearson's correlation coefficient was calculated to evaluate the significance of associations between dimensions. The HIS success rate on users' viewpoints was determined. RESULTS: A total of 125 users participated in the study. The instrument was validated by an expert panel with the Content Validity Index (CVI): 0.85 and Content Validity Ratio (CVR): 0.86. The overall Cronbach's alpha value of the instrument was 0.93. The Pearson correlation coefficient showed significant positive relationships among the investigated dimensions. On average, HIS success rate in the hospital under study was 65% (CI: 64%, 67%). The dimensions of "usefulness", "system quality", and "net benefits" showed the highest rates of success, respectively. CONCLUSION: The instrument used in this study can be adopted for HIS evaluation in future studies. In the current study, a method was developed to determine the HIS success rate based on users' viewpoints. This method allows for the comparison of HIS success rates in various hospitals. As well, our findings underscore the viewpoints of HIS users in a developing country.'

Prediction models to measure transplant readiness of patients with renal failure: A systematic review.

Predicting the future of illness, a patient is facing helps the physicians to choose the best strategy to manage the disease. Models for predicting the readiness of candidates for kidney transplant can be very promising. This study sought to systematically review the predictive models and algorithms that assess the readiness of renal transplant candidates in different countries. This systematic review study was according to PRISMA-P protocol in PubMed and Science Direct databases and general search engines up to March 2017. Eligible studies were those that introduced a model to assess the readiness for renal transplantation of patients with chronic renal failure from cadavers and this assessment led to scoring prioritization or superiority among patients. We found 28 studies from 11 countries that met the search criteria and >50% of them were published from 2015 onward. Of the studies, nine models and algorithms were extracted that included 12 factors. Some models, including the European and Scandinavian models, were used jointly between different countries. All the models had at least four factors, and nearly 90% of the models considered four or five factors to measure kidney transplantation readiness. More than 50% of the models had age, dialysis duration, HLA type, and emergency status factors and, dialysis duration. Predictive models are important for renal transplant because of the significant reduction in number of cadavers and longer wait of candidates for a kidney transplant. Further studies can examine the effect of these models on the survival of the kidney transplant.

Quantitative Evaluation of Diabetic Medical Record Documentation.

BACKGROUND: The documentation of medical records of diabetic patients is very important for the treatment of diabetes. The purpose of this study was to conduct quantitative evaluations of the Diabetic Medical Record (DMR) and Documentation Completeness Rate (DCR). METHODS: In this retrospective study, we evaluated the DCR of DMRs in the Comprehensive Diabetes Center of Imam Reza Hospital (CDRIRH). A checklist was prepared to evaluate the DCR. The overall assessment of the DCR was represented according to the following rating: 95-100% as strong, 75-94% as moderate, and less than 75% as weak. The free texts that physicians recorded in the DMRs were extracted to identify the data elements that physicians must record. In addition, the clinical importance of the data elements of the DMRs from the perspective of the endocrinologists was determined and then compared with the DCR. RESULTS: In this study, 1,200 DMRs and DCRs for 50 data elements in eight major categories were evaluated. The total DCR average was 30% and data elements in the laboratory test results category demonstrated the highest DCR (50.5%), whereas the least percentage was demonstrated in the internal visits category. The DCR for the other main categories was: demographic information = 48.5%; patient referral information = 14.2%; diagnosis = 5%; anti-hyperglycemic medications = 25.5%; diabetic complications = 17.7%; and results of specialty and subspecialty consultation = 41.7%. The evaluation of the free text data element in the DMRs indicated that physicians documented free text data elements in three categories. CONCLUSION: Our results demonstrated a weak level of documentation in the DMRs. The physicians had written many data elements in the margins of the DMRs. Therefore, it indicates the necessity to modify and change the structure of the DMR.

Usability Evaluation of an Admission, Discharge, and Transfer Information System: A Heuristic Evaluation.

BACKGROUND: Admission, discharge and, transfer (ADT) process is one of the most important hospital workflows. ADT system is a part of a hospital information system (HIS). AIM: The objective of this study was to evaluate the usability of the ADT system. METHODS: The study performed at Mashhad University of Medical Sciences (MUMS) hospitals. Data collection instrument was a validated checklist of Pierotti heuristic evaluation. To determine the severity of usability problems, a hybrid of Nielson and Tampere unit for computer-human interaction (TAUCHI) severity scaling algorithm was used. Usability problems were divided into five categories (major, severe, minor, cosmetic, and technical). Six experts evaluated the ADT system independently. According to TAUCHI severity scale, if a feature has not yet been implemented in the ADT system, evaluators considered it a technical usability problem. Therefore, usability problems due to non-design feature in the ADT system were identified. Finally, the mean severity of each usability problems was calculated. RESULTS: A total of 186 usability problems were identified. The frequency of major, sever, minor and cosmetic usability problems were 2, 65, 69 and 50, respectively. A total of 55 usability problems by the evaluators were recognised as technical problems. The highest mismatch with usability principles was related to the "recognition rather than recall". The range of the mean severity of usability problems was between 0-2.31. CONCLUSIONS: Our result showed that although implementation of IHIS on a large scale, it still suffered from unresolved usability problems. Identification of usability problems and evaluation of their level of severity, which was simultaneously performed in this study, can be used as a guide to evaluate the usability of other HISs.

E-Health: a global approach with extensive semantic variation.

In recent years, there has been considerable attention towards the development of information and communication technology (ICT) in health care delivery known as 'E-Health'. The term "E-Health" is almost a new concept and the E-Health projects mainly aim to improve service delivery to people, though different countries might have different approaches in using E-Health. The focus of this study is to review factors influencing the development of E-Health projects, as these factors could lead to an extensive semantic variation. This study reviews the E-Health status in different countries based on existing reports and documents about E-health projects in developed and developing countries and also based on the reports and documents provided by WHO, International Telecommunication Union (ITU); and World Bank. The review of the documents showed that the E-Health status in different countries is depended upon three key factors including the potential of ICT, economic capacity and the level of health status. The review of the documents indicated that there might be different meanings for the concept of E-Health in different countries, and the semantic variation in E-Health concept is related to the level of E-Health developments and implementations. Therefore, developing a clear definition of E-Health is needed.