Effects of mhealth applications on military personnel's physical and mental health: A systematic review.

This systematic review examined the effects of mobile health (mHealth) apps on the physical and mental health outcomes of military personnel. Fourteen studies (10 RCTs, 4 non-RCTs) published between 2000 and 2022 were included. While app-based interventions did not significantly improve clinical outcomes like HbA1c and blood pressure, they showed a statistically significant reduction in symptom severity of Posttraumatic Stress Disorder symptoms (PTSD), depression, and insomnia. Patients expressed satisfaction with the apps, though statistical significance was not reported. In addition to alleviating mental health symptoms, mHealth apps appear widely accepted by military personnel. Development and implementation of evidence-based mental health apps by healthcare professionals are recommended.

Improving asthma control and quality of life via a smartphone self-management app: A randomized controlled trial.

BACKGROUND: Mobile phone applications (apps) show promise for enhancing asthma self-management, but their effectiveness varies. This study examined the effect of a smartphone asthma app on asthma control and quality of life. METHODS: Using block randomization, 60 patients with asthma were allocated to an intervention group (n = 30) or control group (n = 30) for this single-blind randomized controlled trial. At baseline, both groups completed the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire-Marks (AQLQ-M). The intervention group used a smartphone-based asthma self-management app plus their regular treatment, while the control group received only usual care. Follow-up ACT and AQLQ-M assessments occurred at 3 and 6 months. SPSS version 26 was used for analysis, including descriptive statistics, non-parametric tests (Wilcoxon and Mann-Whitney U), and analysis of variance with repeated measurements. RESULTS: Both groups showed improved asthma control and quality of life at 3 and 6 months compared to baseline. However, after 6 months the intervention group had significantly greater improvement than controls (p < 0.05). Repeated measures ANOVA revealed divergent changes in ACT and AQLQ-M scores over time, with the intervention group demonstrating greater enhancement of asthma control and quality of life (p < 0.001). CONCLUSION: This study demonstrated that use of a smartphone-based asthma self-management app improved asthma control and quality of life after 6 months compared to usual care alone. These findings indicate that guideline-based asthma apps can positively impact outcomes.

Pregnant women's use and attitude toward Mobile phone features for self-management.

BACKGROUND: This study aimed to examine the current use of mobile phones by pregnant women and their attitudes towards the use of a variety of prenatal care services through mHealth. METHODS: This descriptive cross-sectional study was conducted in Iran in 2021. The study population included 168 pregnant women who referred to specialist obstetrics and gynecology clinic. The data collection tool was a questionnaire that included the demographics of the participants, their current mobile phone usage, and their attitudes toward mobile phone use for prenatal care services. The data were analyzed in SPSS with descriptive and analytical statistics. RESULTS: The majority of participants (84.2%) had a smartphone and access to mobile internet. More than half of the respondents (58.9%) used their mobile phone for (only) phone calls, and 36.7% occasionally used mobile internet to access prenatal care services. To get information about the pregnancy and to communicate with other pregnant women, the participants mainly used social media, and to get reminders, they preferred phone calls. CONCLUSIONS: In this study, pregnant women have a positive attitude towards using mobile phones for obtaining health services and prefer social media to seek prenatal care services. There seems to be a need for pregnant women to have high levels of digital health literacy and be advised by healthcare providers on using this technology to access prenatal care services.

The effectiveness of tele-triage during the COVID-19 pandemic: A systematic review and narrative synthesis.

BACKGROUND: Telehealth services were used by healthcare centers during the COVID-19 pandemic in order to identify and manage patients at the forefront of the healthcare system. As one of these technologies, tele-triage refers to the assessment of a patient's health status through telephone or another means of communication and recommending treatment or providing appropriate referrals in emergency rooms and primary care offices. This study aimed to perform a systematic review of the evidence on the effectiveness of tele-triage, as one of these technologies, during the COVID-19 pandemic. METHODS: Medline (via PubMed), Scopus, and Web of Science databases were searched for relevant English articles published since the pandemic's onset until December 30, 2021. Studies investigating the tele-triage's effect on patient safety, clinical outcomes, and patient satisfaction were included. Data on study characteristics, intervention characteristics, and their effects on study outcomes were extracted separately by two authors. A narrative synthesis of the included studies was ultimately performed. RESULTS: Out of the 6312 retrieved studies, 14 met the inclusion criteria. The tele-triage intervention was offered by an algorithm-based system in eight studies (57.14%) and by healthcare providers in six other studies (42.86%) to determine the patient's level of care. According to the results, tele-triage interventions during COVID-19 can reduce unnecessary emergency room visits (by 1.2-22.2%), improve clinical outcomes after intervention (such as would closure in diabetic feet), reduce mortality and injuries, and ensure patient satisfaction with tele-triage (53-98%). CONCLUSIONS: This study found that tele-triage interventions reduced unnecessary visits, improved clinical outcomes, reduced mortality, and injuries, increased patient satisfaction, reduced healthcare provider workload, improved access to primary care consultation, and increased patient safety and satisfaction. Therefore, tele-triage systems are not only suitable for providing acute and emergency care remotely but they are also recommended as an alternative tool to monitor and diagnose COVID-19.

A Global Overview of Acute Coronary Syndrome Registries: A Systematic Review.

The present study was conducted with the aim of identifying, and summarizing the characteristics of ACS registries at national, multinational and international levels. Literature was searched using keywords in the title and/or abstract without any time limit ending in March, 2021. After excluding duplicates, 2 reviewers independently reviewed the titles and/or abstracts and full text for inclusion. Each reviewer independently extracted the characteristics of the registries from included papers. Finally, the extracted characteristics were confirmed by a second reviewer. Out of the 1309 papers included, 71 ACS registries were identified (including 60 national and 11 multinational and international registries). Most national registries were being used in Europe. Most registries focused on measuring quality. In more than half of the registries, all types of ACS patients were enrolled. The diagnostic and drug classification systems were mentioned in eight and five registries, respectively. The design of 55 registries was hospital-based. The ability of computerized audit checks was made for 34 registries. More than half of the registries had patient consent and had a web-based design. In all the ACS registries, patient characteristics, clinical characteristics and treatment characteristics were recorded and post-discharge follow-up information was recorded in 45 registries. In the current situation and given that a limited number of countries in the world have national ACS registries, reviewing the results of this study and modeling the registries implemented in the leading countries can help countries without a registry to design it.

Determination of Characteristics and Data Elements Requirements in National Acute Coronary Syndrome Registries for Postdischarge Follow-up.

This study aimed to describe the current status and determine the postdischarge follow-up characteristics and data elements requirements in national acute coronary syndrome (ACS) registries. This descriptive comparative study was carried out in 2021 in 2 phases. First, postdischarge follow-up characteristics and data elements in national ACS registries were identified. The second phase was performed in 2 stages. First, an initial questionnaire was prepared in which the face and content validity were calculated. The final questionnaire included demographic and characteristics questions and 208 data elements using the Likert scale and an open-ended item in which the reliability was assessed through test-retest method. Second, the data elements were surveyed by 20 cardiologists using the Delphi technique. Postdischarge follow-up was done in 60% of national ACS registries. Follow-ups with intervals of 1-month and 12-month after discharge (average score of 3.87 and 4, respectively) through telephone interviews and face-to-face visits (average score of 4 and 3.81, respectively) obtained the highest average score. A total of 132 data elements were confirmed in the first and second rounds of the Delphi technique. Planning in order to perform postdischarge follow-up in registries without follow-up should be considered, which is recommended to be done by telephone interview at least in 1-month and 12-month postdischarge intervals. The data elements approved in this study will be helpful in registries with follow-up in order to develop the existing follow-up forms, and in registries without follow-up, from the beginning and design of the follow-up form.

Effect of mobile-based self-management application on stroke outcomes: a study protocol for triple blinded randomized controlled trial.

BACKGROUND: Stroke is the main leading cause of long-term disabilities in the world. This protocol will be implemented for a study to evaluate the effects of an Android-based self-care application on patients with stroke. METHODS: The first stage will include the development of an android-based application using JAVA programming language for developing the user interface and ASP.NET Core for developing Web server. The second stage will be conducted using triple blinded randomized clinical trial (RCT). The sample size will include 60 patients with recent stroke and partial paralysis of limbs, who will be divided into two groups of intervention and control through permuted block randomization method. Patients in both groups will receive usual medical care, but those in the intervention group will also use an Android-based application for a period of two months. Outcomes will be assessed using valid and reliable questionnaires. DISCUSSION: The assessed outcomes will include stroke severity using National Institute of Health Stroke Scale (NIHSS) score, ability to perform activities of daily living using Barthel Index (BI) score, depression rate using Beck Depression Inventory (BDI-II) score, quality of life using EQ-5D-3L score, medication adherence using Modified Morisky Medication Adherence Scale (MMAS-8) score, patient satisfaction using Patient Satisfaction Questionnaire (PSQ) score and the number and type of complications in patients in two groups. These outcomes will be assessed at baseline, after two months and after three months from the beginning of the intervention. Intervention effects on the measured variables will also be evaluated using appropriate statistical tests based on the type of variable distribution. Potential consequences of the study might be the improvement of the measured variables in the intervention group compared to that of the control group. The expected results are that the intervention may significantly improve the status of the measured variables in the intervention group compared to that of the control group. If the outcomes of the intervention group do not change significantly compared to those of the control group, it can be due to different reasons. However, this can most likely be attributed to incorrect or insufficient use of the application by patients. TRIAL REGISTRATION: This protocol is registered in the Iranian registration of clinical trial (IRCT) on November 7, 2020 with the code IRCT20201015049037N1. URL: https://irct.ir/trial/51674.

Functional requirements of a mobile-based application for stroke self-management: A Delphi study.

This study aimed to determine the functional requirements of a self-management mobile application for stroke survivors. For extracting the initial functional requirements, a literature review as well as interviews with 17 patients and caregivers were done. The results were analyzed using the content analysis method. The initial extracted requirements were then provided to the specialists by the Delphi technique to determine the final functional requirements. Content validity ratio (CVR) and content validity index (CVI) were calculated according to the Lawshe model. Criteria for item approval included CVR > 0.49 and CVI > 0.79. Finally, the approved items were turned into a five-point Likert scale questionnaire and were then provided to 53 experts and items with a mean score higher than 3.75 were approved. Functional requirements including creating a user account, educational material, support services, providing reminders and alerts for drugs administration and physician appointments, and rehabilitation exercises (to improve balance, upper and lower extremities rehabilitation, and activities of daily living (ADLs)) were approved. Most of the approved functional requirements were related to rehabilitation exercises for improving upper limb motor function. The experts did not approve the requirements for using splints and slings or the recommendation to take some medications.

Comparison of usability evaluation methods for a health information system: heuristic evaluation versus cognitive walkthrough method.

BACKGROUND: There are differences of opinion regarding the selection of the most practical usability evaluation method among different methods. The present study aimed to compare two expert-based evaluation methods in order to assess a nursing module as the most widely used module of a Hospital Information System (HIS). METHODS: Five independent evaluators used the Heuristic Evaluation (HE) and Cognitive Walkthrough (CW) methods to evaluate the nursing module of Shafa HIS. In this regard, the number and severity of the recognized problems according to the usability attributes were compared using two evaluation methods. RESULTS: The HE and CW evaluation methods resulted in the identification of 104 and 24 unique problems, respectively, of which 33.3% of recognized problems in the CW evaluation method overlapped with the HE method. The average severity of the recognized problems was considered to be minor (2.34) in the HE method and major (2.77) in the CW evaluation method. There was a significant difference in terms of the total number and average severity of the recognized problems by these methods (P < 0.001). Based on the usability attribute, the HE method identified a larger number of problems concerning all usability attributes, and a significant difference was observed in terms of the number of recognized problems in both methods for all attributes except 'memorability'. Also, there was a significant difference between the two methods based on the average severity of recognized problems only in terms of 'learnability'. CONCLUSION: The HE method identified more problems with lower average severity while the CW was able to recognize fewer problems with higher average severity. Regarding the evaluation goal, the HE method was able to be used to improve the effectiveness and satisfaction of the HIS. Furthermore, the CW evaluation method is recommended to identify usability problems with the highest average severity, especially in terms of 'learnability'.

Usability evaluation of a nursing information system by applying cognitive walkthrough method.

BACKGROUND AND OBJECTIVE: The user interface usability of the nursing information system (NIS) should be such that the nurses can learn and interact with it easily and quickly. Therefore, it is necessary to identify and solve the usability problems of these systems. The present study aimed to evaluate the usability of a NIS using the cognitive walkthrough (CW) evaluation method. METHODS: Based on five selected scenarios, five evaluators evaluated the NIS in Shafa Hospital Information System. After identifying the problems, the evaluators assigned each problem to one of the usability attributes. The severity of each identified problem was determined by the evaluators and five real users of the system. RESULTS: In total, 24 unique problems were identified. The average severity of the problems was determined by the evaluators (2.77) and the actual users (2.82) in the "major problem" category. The highest number of problems were assigned to the scenarios 3 and 2 with 15 and 14 problems, respectively. The highest average severity in terms of evaluations and actual users was related to the scenario 5 (3.06 and 2.94, respectively), which was in the "major problem" category. The highest number of problems were associated with learnability (8 problems) and efficiency (6 problems). CONCLUSION: Since most of the nurses do not have enough time for learning the system, and given that the selected scenarios for evaluation were based on the most frequent daily tasks that nurses performed using the NIS; The correction of usability problems in the scenarios 3 and 2 that had the highest number of problems and the scenario 5 that had the highest average severity and execution time; it can reduce the nurses' cognitive load and the learning time of the system and increase the efficiency of nurses.

Designing a national model for assessment of nursing informatics competency.

BACKGROUND: Due to the need for informatics competencies in the field of nursing, the present study was conducted to design a psychometric instrument to determine the qualification of informatics competencies of employed nurses in educational care centers. METHODS: The questionnaire was made by reviewing existing scientific resources and assessment tools. Two hundred nurses were selected using simple random sampling. Structural equation modeling was used using the measurement model technique and the average variance was calculated. Linear structural relations (LISREL) software was used to test the assumptions and correlations of the model. RESULTS: Findings showed relatively good estimation in the fit of first-order measurement model. The informatics knowledge subscale with a determining rate of 0.90 had the greatest explanatory effect among the subscales and informatics skill with a determining rate of 0.67 and basic computer skill with a determining rate of 0.60 were observed. The second-order measurement model of fitness indicators showed that the three factors can well explain the multidimensional construct of informatics competency. CONCLUSIONS: The designed tool can be used to develop educational strategies in relation to nursing students in the field of informatics and prepare them in the rich environment of information technology, which can be helpful in training nursing instructors.

Usability evaluation of selected picture archiving and communication systems at the national level: Analysis of users' viewpoints.

BACKGROUND AND OBJECTIVES: Picture Archiving and Communication System (PACS) can be considered as one of the most important information systems used in healthcare facilities and its usability problems can lead to delays in the acceptance of information systems, increased medical errors and also user dissatisfaction. The primary purpose of this study was to evaluate the usability of PACS from the perspective of its main users. METHODS: This study used a combination of qualitative and quantitative methods and was carried out in 2019 where the research community consisted of PACS in five selected companies in Iran. The statistical sample included 200 individuals using the PACS in several hospitals across the country. Moreover, the sample was selected using the multistage random method. The data were then collected using the standard Computer System Usability Questionnaire (CSUQ) consisting of 5 sections and 19 items. Finally, the data were analyzed by SPSS software, version 18 using both descriptive and inferential methods. Content analysis was done for the qualitative data sets. RESULTS: It was indicated that ease of use, as a category, was not significantly different from the perspective of various PACS users. However, the ANOVA test revealed that there were significant differences in terms of information quality, user interface quality, overall user satisfaction and usability of PACS from the users' perspectives. Furthermore, content analysis of users' comments showed that speeding up the image processing and frequent system failures were amongst the most positive and negative aspects of the PACS, respectively. CONCLUSIONS: According to the perspective of the users of the investigated PACS in Iran, the usability of these PACS had a favorable status regarding ease of use while provided lower information quality. Generally, based on the users' viewpoints, the PACS from Company B were the most usable while the PACS provided by Company D were the least usable. It is suggested that the information quality and user interface of systems be improved by using appropriate analysis and needs assessment of the end users.

Identification and Classification of Usability Problems in a Nursing Information System: A Heuristic Evaluation.

Nursing information system is a system that nurses are required to use in order to perform their daily activities. Poor user interface design of nursing information system can cause problems in nurses' interaction with the system. This research aimed to evaluate the usability of nursing information system. During this study, five evaluators examined the nursing information system with the heuristic evaluation method and by using the checklist of Nielsen usability principles. Then, the identified problems were categorized into 10 Nielsen usability principles, and the severity of the problems was determined. They also attributed each problem to one of usability attributes. A total of 104 unique problems were identified. Most of the problems were related to the principle of "consistency and standards." More than a third of the identified problems were classed as major and catastrophe, with the highest severity in the average problems of "help and documentation" and "error prevention." Most of the identified problems were attributed to effectiveness and satisfaction. Because a significant number of identified usability problems in nursing information system were major and catastrophe and were attributed to effectiveness and satisfaction, being able to remedy the problems could improve nurses' interaction with the system user interface and increase satisfaction and effectiveness of nurses.

The use of mobile phone functionalities by patients with asthma and their desire to use for self-care purposes.

BACKGROUND: Mobile health (mHealth) has good potential for promoting self-care in patients suffering from chronic diseases. The patients' positive attitude toward this technology is a key factor for the successful implementation. The present study was conducted to investigate the asthma patients' use of mobile phone functionalities and their desire to receive self-care services through this technology. METHODS: This survey study was conducted in Iran in 2018. The study population consisted of 146 patients suffering from asthma. The data collection tool was a questionnaire containing items on the demographic characteristics of patients, current use of mobile phone functionalities, and desire to use them for receiving self-care services. Data were analyzed using descriptive and analytical statistics. RESULTS: Out of the 160 questionnaires distributed, 146 (91.25%) were completed. The majority of the participants had smartphones (84.9%). Less than half of the participants occasionally used mobile phone functionalities including mobile phone calls (42.5%) and mobile Internet (40.4%) to receive asthma-related information. A significant number of the participants had never used smartphone applications (72.6%) and E-mail (66.4%) to receive asthma-related information. The participants had their greatest use of Internet search, followed by social media, to receive information about asthma symptoms, allergenic and irritating substances, medicinal therapy, and how to use therapy aids. The participants were most willing to use social media for receiving asthma information, communicating with other patients, receiving reminders about doctor's appointment, and receiving warnings about the lack of asthma control. CONCLUSION: In Iran as a developing country, asthma patients use Internet search mostly to receive instructional information and are willing to use social media rather than other mobile phone functionalities to receive self-care services. These patients believe that mobile phones are appropriate for receiving instructional information and reminders.

Technical requirements framework of hospital information systems: design and evaluation.

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

Phone-based interventions to control gestational weight gain: a systematic review on features and effects.

Objective: The aim of this study was to summarize the evidence regarding the effects and the features of phone-based interventions to control gestational weight gain (GWG).Methods: We included studies that evaluated the effects of phone-based interventions on controlling GWG. The characteristics of studies, effects, and features of interventions were extracted.Results: A total of 12 studies met the inclusion criteria. Outcomes were categorized into three groups (GWG control, proportion of women returning to pre-pregnancy weight, and proportion of women who exceeded the Institute of Medicine recommendations for GWG). Although most studies (66%) showed a statistically significant positive effect of phone-based interventions on the GWG control, the effects on the other outcome categories were found to be inconsistent. While the included studies used phone call and short messaging service (SMS), no study used the other functions of telephones and mobile phones such as video call, internet access, social networks, and smartphone applications. Regarding the functionalities, phone calls were used to provide guidance for healthy weight gain and communication with healthcare providers. SMS provided reminders, educational materials, and guidance.Conclusion: Phone-based interventions can help pregnant women control GWG by providing guidance, reminders, and educational materials. When these interventions use multiple functionalities, they are more effective in controlling GWG.

Enhancing Asthma Patients' Self-Management through Smartphone-Based Application: Design, Usability Evaluation, and Educational Intervention.

OBJECTIVE: The aim of this study was to design and evaluate a smartphone-based application for improving self-management in patients with asthma and evaluate its effects on their knowledge. METHODS: In this applied research, based on the Clinical Practice Guideline and a systematic review, a questionnaire was designed to determine the application information content and functionality requirements by 15 pediatric and adult asthma and allergy specialist. Then the application was designed and developed using Adobe Air software on the Android operating system. Usability evaluation of the mobile application was performed using the standard questionnaire for user interaction satisfaction (QUIS), which completed by 30 patients with asthma, 8 information technology (IT) specialists, and 2 asthma and allergy specialists. Self-management knowledge of 30 asthma patients was measured using a researcher-made questionnaire before and after using the application. RESULTS: The number of specialists in the both Delphi rounds was 15 and the mean work experiences were 17.6 years. The most important elements for asthma self-management were avoiding exposure to allergen and triggers (96%), drug treatment (94.6%), and how to use the therapeutic tools (92.4%), and the most important functionalities were alerting the patients when they did not control asthma (92%), setting reminders for timely drug use (85.4%) and therapeutic tools (82.6%), recording prescription drugs (82.6%), and peak flow meter values (82%). Usability evaluation showed that 30 patients with asthma, 8 IT specialists, and 2 physicians evaluated the application at a "good" level. The mean score of the patients' knowledge before intervention was 2.43 ± 0.95 which after intervention was significantly increased to 4.3 ± 0.56 (p < 0.001). CONCLUSION: Considering the desirable outcomes of application evaluation and a positive impact of this educational intervention on asthma patients' knowledge, it is possible to use mobile-based self-management programs to help these patients to manage illness and gain knowledge and self-management skills.

Iranian Health Information Technology Acceptance Model (IHITAM) from Users' Views.

INTRODUCTION: Information technology (IT) is an important component of medical informatics. Information needs to be accepted by users to function effectively. At different ages and from different views, several models have been proposed and used to show factors affecting users' IT acceptance. However, such models are in need of frequent revision and development due to variable conditions. AIM: The present research aims to design a new health IT acceptance model from Iranian users' views. The research aims both to design a model for status quo by reviewing previous models and consider features of Iranian users. METHODS: This is a correlative, cross-sectional study. Firstly, the primary model was presented by studying important IT acceptance models. Then, a structured questionnaire was designed and, after confirmation of validity and reliability of the questionnaire, it was given to users of information and health IT systems in different wards of hospitals in Iran. Data were analyzed by SPSS and Lisrel and the final model was designed by structural equations. RESULTS: The model showed that there are six key factors which are effective on attitude and use intention including performance expectancy, observability, effort expectancy, facilitating conditions, empowerment and subjective norms via three interface factors of perceived usefulness, perceived ease of use, self-efficacy. The size of technology use is an important factor in technology acceptance and application as well. CONCLUSION: The present model has more details compared to the other models and can show a new image of important factors in technology acceptance and their relationships.

Quality of patient information in emergency department.

PURPOSE: Data comprise one of the key resources currently used in organizations. High-quality data are those that are appropriate for use by the customer. The quality of data is a key factor in determining the level of healthcare in hospitals, and its improvement leads to an improved quality of health and treatment and ultimately increases patient satisfaction. The purpose of this paper is to assess the quality of emergency patients' information in a hospital information system. DESIGN/METHODOLOGY/APPROACH: This cross-sectional study was conducted on 385 randomly selected records of patients admitted to the emergency department of Shahid Beheshti Hospital in Kashan, Iran, in 2016. Data on five dimensions of quality, including accuracy, accessibility, timeliness, completeness and definition, were collected using a researcher-made checklist and were then analyzed in SPSS. The results are presented using descriptive statistics, such as frequency distribution and percentage. FINDINGS: The overall quality of emergency patients' information in the hospital information system was 86 percent, and the dimensions of quality scored 87.7 percent for accuracy, 86.8 percent for completeness, 83.9 percent for timeliness, 79 percent for definition and 62.1 percent for accessibility. ORIGINALITY/VALUE: Increasing the quality of patient information at emergency departments can lead to improvements in the timely diagnosis and management of diseases and patient and personnel satisfaction, and reduce hospital costs.