[Assessment of factors affecting kidney transplant survival based on literature review between 2000 and 2014]

Background: Improvements in immune-suppressing drugs have a short-term effect on kidney transplants but do not have much long-term effect. In order to increase the duration of kidney transplant survival, understanding the significant parameters is of great importance. This study aims to identify key parameters [before the transplant occurs] which affect kidney transplant survival

Materials and methods: To conduct this review, the scientific databases was searched and more than 200 related titles were retrieved; and the abstracts were reviewed to determine which studies were relevant to the study. The literature analysis was based on the goals of the studies themselves, the number of citations, and the reliability of the sources cited. Ultimately, 60 studies included for further analysis

Results: Based on the frequency of each parameter which influenced graft survival, the following parameters were determined to have higher frequencies compared to other parameters, with regards to survival time of the kidney transplant: the ages of the donor and recipient, socioeconomic status, immune-suppressing drugs, HLA matching, time on the waiting list, live or deceased donor, the decade in which the operation occurred, cold ischemia time, and reaction to antibiotics

Conclusion: The influence of some of the kidney transplant survival parameters was acknowledged in the majority of studies; however, some parameters have been the subject of disagreement among studies. In order to resolve this issue, we suggest a search of international data and meta-analysis of current literature to better understand the parameters of kidney transplant survival

Evaluation of Nursing Information Systems: Application of Usability Aspects in the Development of Systems / 대한의료정보학회지

OBJECTIVES: As the largest group providing healthcare services, nurses require well-designed information systems in their practice. This study aims to evaluate the usability of nursing information systems (NIS). METHODS: This cross-sectional survey was conducted in 2015. The settings of the study consisted of four hospitals affiliated with three medical universities in Tehran (Iran). The subjects of the study included nurses who had access to and used a NIS developed by four major software companies. The data were collected using a modified version of a usability questionnaire known as IsoMetrics, based on the International Standard ISO 9241, Part 11. The questionnaire is composed of 35 questions divided into seven general criteria. The validity of the questionnaire was determined by experts in the field, and the reliability was checked using Cronbach's alpha (α = 0.91). The questionnaire was then distributed to 184 nurses. RESULTS: The response rate was 64.6%. Among the seven ISO usability criteria, suitability for the task (3.10 ± 1.24) and suitability for learning (3.10 ± 1.27) had the highest mean value. The lowest mean value (2.37 ± 1.29) was related to the suitability for individualization. CONCLUSIONS: Addressing issues related to individualization and self-descriptiveness could improve the usability of nursing systems. Considering usability requirements in the design of a NIS will lead to the efficient and effective use of these systems.

effect of a well-designed computerized physician order entry on medication error reduction

Introduction: Paper-based prescription orders, commonly having numerous medication errors, can increase adverse drug events [ADEs] and threaten the patients safety

Computerized physician order entry [CPOE], as an appropriate alternative, can significantly reduce medication errors. This study aimed to investigate the effects of well-designed CPOE in reducing medication errors and ADEs

Method: Electronic databases including EBSCO Host, Web of Science, PubMed, SID, Google Scholar, Iranmedex, Irandoc were used to conduct the literature review. We reviewed all the papers published about CPOE and its impacts on medication errors from 1998 until 2015. Thus 56 articles were found

Considering the relevance of their title and abstract with the objectives of the study, and deleting repetitive cases, 32 articles were selected, among which 10 articles were directly related to the objectives of the study

Results: A number of studies indicate that CPOE can reduce the incidence of serious medication errors and ADEs. Nonetheless, there is evidence indicating that CPOE could negatively affect the patients health if the system is not well-designed

Conclusion: The replacement of conventional, paper-based prescription orders with well-designed CPOEs in hospitals could play a key role in minimizing medication errors and improving the patients' safety. To this end, the CPOEs have to be designed according to recent standards and needs

Electronic health record architecture: a systematic review

Numerous advantages are derived from the electronic health record [EHR]. Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases [2000 to Jun 2015]. Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture

Pharmacy Information Systems in Teaching Hospitals: A Multi-dimensional Evaluation Study / 대한의료정보학회지

OBJECTIVES: In hospitals, the pharmacy information system (PIS) is usually a sub-system of the hospital information system (HIS). The PIS supports the distribution and management of drugs, shows drug and medical device inventory, and facilitates preparing needed reports. In this study, pharmacy information systems implemented in general teaching hospitals affiliated to medical universities in Tehran (Iran) were evaluated using a multi-dimensional tool. METHODS: This was an evaluation study conducted in 2015. To collect data, a checklist was developed by reviewing the relevant literature; this checklist included both general and specific criteria to evaluate pharmacy information systems. The checklist was then validated by medical informatics experts and pharmacists. The sample of the study included five PIS in general-teaching hospitals affiliated to three medical universities in Tehran (Iran). Data were collected using the checklist and through observing the systems. The findings were presented as tables. RESULTS: Five PIS were evaluated in the five general-teaching hospitals that had the highest bed numbers. The findings showed that the evaluated pharmacy information systems lacked some important general and specific criteria. Among the general evaluation criteria, it was found that only two of the PIS studied were capable of restricting repeated attempts made for unauthorized access to the systems. With respect to the specific evaluation criteria, no attention was paid to the patient safety aspect. CONCLUSIONS: The PIS studied were mainly designed to support financial tasks; little attention was paid to clinical and patient safety features.

Improving the quality of clinical coding: a comprehensive audit model

Introduction: The review of medical records with the aim of assessing the quality of codes has long been conducted in different countries. Auditing medical coding, as an instructive approach, could help to review the quality of codes objectively using defined attributes, and this in turn would lead to improvement of the quality of codes

Method: The current study aimed to present a model for auditing the quality of clinical codes. The audit model was formed after reviewing other audit models, considering their strengths and weaknesses. A clear definition was presented for each quality attribute and more detailed criteria were then set for assessing the quality of codes

Results: The audit tool [based on the quality attributes included legibility, relevancy, completeness, accuracy, definition and timeliness]; led to development of an audit model for assessing the quality of medical coding. Delphi technique was then used to reassure the validity of the model

Conclusion: The inclusive audit model designed could provide a reliable and valid basis for assessing the quality of codes considering more quality attributes and their clear definition. The inter-observer check suggested in the method of auditing is of particular importance to reassure the reliability of coding

Telesurgery information management systems in university hospitals of Tehran

This is a descriptive study with research population coming from "telesurgery information management systems" in 23 teaching hospitals of Shahid Beheshti and Tehran universities of medical sciences in 2011.The study used stratified and simple random sampling methods for subject selection, followed by observation and interview for data collection. According to the results, video camera with 100% application, was the most frequently used equipment in the hospitals for telesurgery data gathering. Visual data analysis for developing three dimensional models was common just in 10% of hospitals. Fiber Optic and satellite, with 40% application rate, were the most frequently used telecommunication equipments in the hospitals. The study indicated the significance of accurate and appropriate management of telesurgery information as the first step for appropriate implementation of telesurgery programs in Iran

Investigating the quality control of laboratory information in university hospitals of Tehran in 2011

Clinical laboratory results play an important role in helping physicians in diagnosis and treatment. In view of the direct effect of the working methods on the quality of data in the laboratory, quality control of data and results in the Biochemistry Ward of Laboratory includes taking into account all the factors and variables relating to all the pre-analytical, analytical and post-analytical steps at this ward. The objective of this study was to examine the quality control of data and results in the biochemistry departments of hospital laboratories in universities of medical sciences in Tehran. Current study was a descriptive research, and 40 biochemistry laboratories in universities of medical sciences in Tehran constituted the settings of the study. Data were collected by a checklist and a questionnaire using observation and interview. Using the checklist, 33 effective factors in the pre-analytical step; 18 effective factors in the analytical step and 8 effective factors in post-analytical step were examined. The questionnaire included questions relating to biochemical factors in the laboratories, while the factors affecting the quality of the results were examined by using checklist. Data from questions and observations were analyzed by using descriptive statistics and by determining the absolute and relative frequencies. Results showed that in all settings of the study, 58%, 68% and 87% of the factors affecting the pre-analytical, analytical and post-analytical data and results were taken into consideration respectively. However, the biochemistry directors remarked that they considered 77% and 89% of the first two groups of factors respectively, and the third groups of factors were considered only by observation. according to the findings by the checklists, sufficient attention was paid to 58% of the factors effective on pre-analytical data quality [Identifying the patient; Labeling the sample while collecting the sample; etc.], 68% of the factors effective on analytical data quality [Analyzing the samples during the 1 to 4 hours following the collection of the samples; Using control samples for evaluating the operation of instruments once in every 8 hours; etc.] and 87% of the factors effective on the post-analytical data quality [Legibility of the hand-written reports; Similarity of the hand-written reports to the typewritten report, in terms of patient ID data record; etc.] while there is no enough attention paid to other factors in pre-analytical step [Preparing the patient; Paying attention to the physiological changes of the patient's body; etc.], analytical step [availability of written guidelines for performing certain work where the samples are analyzed; Calibrating the instruments according to the standard program; etc.] and post-analytical step [precision in recording distinguishing features in real values]. Also, by comparing the findings obtained using the two tools, it can be found out that the findings do not match each other in certain factors and that the amount of findings obtained from the questionnaire is more than the findings obtained from the checklists

Pharmacy information systems in Tehran university hospitals and their relationship with pharmaceutical companies

Background: A pharmacy information system must retrieve process and update the information it obtains for safe and effective use of drugs. It is used to manage drug usage in the patient health care process and to communicate a large volume of information to pharmacy and pharmaceutical firms. Bearing in mind such issues, the current study adopted a descriptive method of research to investigate the pharmacy information systems in university hospitals and their relationship with pharmaceutical firms. The research data were collected through observation and interview based on a checklist and a questionnaire. Validity and reliability of the data gathering tools were specified through content validity and test re-test methods. The collected data were then analyzed, using a set of descriptive statistics. According to the results, pharmacy information systems in the hospitals under study were partially computerized. Databases for drugs, patients and prescriber databases, with different values of 50.1%, 21.9%, and 33.3% respectively, were not complete, as had been recorded in the pharmacy information system of the hospitals. The pharmacy information system is normally used to support therapeutic activities and the inventory, but such support had not been provided for 43.9 % of the hospitals. 32.2 % of the hospitals under study had not reported pharmaceutical information such as statistical data and drugs' prices. Also, 27.3% of the pharmaceutical firms did not have any relationship with pharmacy information systems. Pharmaceutical companies had developed some relationship, on marketing issues, with hospital pharmacies. The findings were in favor of further therapeutic activities by pharmacy information systems, which could be achieved by improving relationship between hospitals and pharmaceutical firms, particularly in Tehran. This could help to manage drug consumption and supervision, after marketing, in order to eliminate adverse drug reactions and develop high quality pharmaceutical services

Infrastructures of the system for developing electronic health record

The overall objective of a health system is to improve health through reducing disease, disability and death. Accomplishment of this goal depends on the worldwide integrated and coordinated care continuity. Information transmission is a prerequisite to ensure the continuity of care. Widespread acceptance of health information and communication technology [HICT] and developing systems such as Electronic Health Record [EHR], have changed the health care industry. Electronic Health Record is the main part of information management in an integrated health care system. Electronic health record provides access to all health information at organizational, regional, national and international levels and allows for the patient's health data [usually with geographical distribution in several health information systems] to become integrated. Since Electronic health record integrates all care events data, it can make data sharing possible between all care providers to consequently minimize the repeated diagnostic tests, and drug and treatment interactions. Furthermore, Also health care professionals can easily access to patient information at any time and this could lead to improving the quality of care and reduce costs. Accordingly, a productive system is required to provide the electronic health record. Given the significance of the electronic health record and its generating system in improvement of care quality and reducing the health care costs, authors decided to study the needs for developing the national EHR system [NHIN] The main focus of this paper was on selecting material related to the system developing an EHR and it prerequisites. Electronic health record system is a new source of valuable intelligence of real world for the whole health care industry. Electronic health record system includes people, rules, standards, storage and processing equipments, communication and support facilities. To shape this, existence of components and their coordination is necessary. Electronic health record system are established to enhance patient care and its outcome, increase efficiency, improving the availability of information and minimizing the medical errors. With the Europe union formation that in fact was an important step toward globalization, the electronic health record passed the national borders and turned into a global concept to make possible the worldwide integration and sharing of the health data. Therefore international standards are needed to share patient health information between national health systems and across borders. Infrastructure or national information network existence of proper hardware and software and finally participation of all stakeholders are necessary to develop the system. So it is necessary to prepare the infrastructures needed for development of the system in our country. Since EHR has a universal concept, it is needed to create a lifelong health information record for every individual accessible in every point in the world

[Designing minimum data sets of diabetes mellitus: basis of effectiveness indicators of diabetes management]

Measurement of diabetes management effectiveness includes the process of care and its quality, health outcome and response to care before everything; it needs a conceptual framework about this universal disease. Minimum Data Set [MDS] of diabetes make this framework by using standard data element with unique definition and effectiveness indicators preparation of diabetes management. Therefore, this research was accomplished to study the MDS of diabetes as diabetes management effectiveness indicators in America, Australia, Scotland, and Finland and also, presentation of model for Iran. This research was an applied descriptive study. At first, we used a questionnaire and checklist to study MDS of diabetes in Tehran; then in selected countries, MDS of diabetes was assessed by published and electronic literatures and at the end, the proposed model was designed in accordance to country's needs taking discerning people attitude upon it by Delphi technique. A data analysis in study stage of MDS of diabetes in the selective countries was done by comparative tables and determination of similarities and differences of the MDS. In the stage of gaining credit for model, it accomplished with descriptive statistics to the extent of absolute and relative frequency. MDS of diabetes for Iran presented in 12 forms and diabetes management effectiveness indicators on base of studying in America, Australia, Scotland, and Finland countries and needs of our country and after doing Delphi technique with 98 percent agreement confirmed. MDS provides continuous care of patients, communication among providers and analysis of patient and patient society care effectiveness. So, it causes decrease of threatening diabetic complications. Collection of MDS of diabetes increases the quality of care assessment and effectiveness indicators for management of care process, quality of services, and health outcome

Situation analysis of hematology information systems in educational-therapeutic hospital laboratories of Shaheed Beheshti University of Medical Sciences

Hematology section provides valuable information for diagnosis and treatment of patients to improve the health of them. In this regard Hematology Information System led to deliver produced information accurately and timely. Present study aimed to analyze the situation of Hematology Information Systems in hospital laboratories. In this descriptive study, 13 Hematology Information Systems of hospital laboratories in Shaheed Beheshti University of medical Sciences were assessed. Data were gathered through observing and questioning by checklist and questionnaire tools. The questionnaire content validity and its reliability were approved. The analysis of data was conducted based on descriptive analysis. 76.92 percent of Hematology Information Systems were semi-mechanized type and others were mechanized. Dividing data to three groups, results showed averagely patient data elements were in 79.4 percent, sample data elements in 93.85 percent, and test data elements in all of the systems. In 87.5 percent of them, processing of data was done by auto-analyzers. In all of the systems, data were gathered by request forms, labels and computers. Communication networks were not used in 76.92 percent of Hematology Information Systems. Only 15.38 percent of them used the statistical softwares for data analysis. Also, only 23.08 percent of systems were applied the communication networks. 80 percent of systems had workers of data gathering, processing and distributing. Mechanized systems can meet the users' needs better; therefore gathering, processing, and information distributing steps were done correctly

[Information managers: the powerful strategists of health care organizations in future]

Nowadays, importance of health information and managing health information resources is growing. Managing information resources requires a variety of knowledge and skills. So, information managers find themselves as a valuable person in health care organizations. This article aimed to overview the importance, roles, duties, and organizational position of information managers in health care organizations. Information managers would be as future powerful strategists in health care organizations; to this end, they must furnish themselves to a variety of knowledge and skills such as information management, information technology, and related technical issues, management capabilities and understanding clinical processes

[National HIV/AIDS surveillance pattern for Iran's health system]

The present research has been conducted to design the HIV/AIDS Surveillance system for Iran applying WHO recommendations, using the experiences of the countries having the lead in the design and implementation of the system. In this descriptive study of applied kind, we initially investigated the existing circumstances governing Iran's HIV/AIDS information system from the Ministry of Health using a checklist. Subsequently, the HIV/AIDS surveillance system of selected countries [USA, United Kingdom and Australia] were studied and based on the country's requirements, a model was proposed and designed for Iran. The Delphi technique was utilized to find the views of 24 experts in infectious diseases and Health Information Management. The validity of research instruments was measured using content validity and the reliability was obtained using attest-retest method. A model for HIV/AIDS surveillance system was presented based on WHO recommendations and using the experiences of selected countries. This was presented in six axes: general specifications of the system, minimum data set, data collection and reporting, data processing, data processing rules, and data distribution. Using Delphi technique, the results were approved obtaining the score of 36.3 out of 44 [82.5 percent]: TV The design and implementation of HIV/AIDS surveillance system at the nation level in Iran is proposed for a better understanding of the epidemic procedure and spreading behaviors as well as focusing on the at high risk subpopulations and designing a prevention and care system using high quality data