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Introduction: The establishment of an integrated and standard metadata system tailored to the local needs in health information management aims to improve the status quo, which in turn, leads to optimal data protection, increase accessibility, and improve information retrieval and user satisfaction. As such, this study endeavors to investigate the constituents of the HISO 10040.4 schema for organizing clinical information from the perspective of health information specialists. Methods: This applied study was conducted in the 2022 winter. To collect data, documentary study and survey were used. The population included 24 faculty members from Tehran University of Medical Sciences in the field of health information management. An online researcher-made questionnaire with 23 questions was used to collect data, and its face validity was confirmed by 3 experts. Finally, the results were reported using descriptive statistics. Results: To organize health information, 22 metadata elements of the HISO 10040.4 schema were scored and evaluated by the experts. Based on the results, the mean and standard deviation of the measured metadata elements were approved by the research community, indicating the extent of their agreement regarding the importance of the elements in describing data in health information centers worksheets. Conclusion: The proposed metadata elements are based on the standard schema of organizing health information and approved by the research community; therefore, they can meet the needs of health information centers. [ABSTRACT FROM AUTHOR]

Background & Aims: Today, sport is considered one of the most important human welfare needs. Exercise and physical activity as a main strategy in helping the goals of body and soul health and increase the level of activity of the immune system and prevention of various diseases, and creating mental and physical security in sports, highlights the issue of athletes' health. (1). One of the most important of these sports is football. Football is not just a sport and its situation has been undergoing growing and expanding changes due to economic, social, cultural, health and even political influences (2). Has created constructive competition (3). Accidents on sports fields are an integral part of sports events. Sports activities, even with the implementation of all reasonable precautions, will have a level of risk, and in addition to all the benefits of sports programs, there is a possibility of sports injuries (4). For this reason, having a specialist physician who is aware of sports injuries during sports injuries is a requirement when holding sports competitions. Also, this physician must have full access to the athlete's medical information in order to perform better (8). Electronic storage of athletes' medical information can improve the physician's treatment process and lead to many potential benefits such as scientific research, statistical records of diagnostic and treatment methods, reporting, and time and cost savings (11). Weinstein et al. (2013) state in their research that when one of the players is injured, the treatment of injuries and disorders should be done by a doctor. The first step for the injured person is to diagnose and manage the injury by the doctor when the injury occurs. The second is the doctor's referral to the medical record and the initial treatment and transfer of the athlete to medical centers (12). Consonon et al. (2014) say that the importance of injury diagnosis is one of the essential factors for treatment and this is possible only with the presence of a physician at that time to prevent the destructive effects of injury. Time is the relationship between intermittent injuries and medical records (13). But Nordstrom (2014) is of the opinion that during the period of complete treatment and recovery, the primary care physician should be aware of the athlete's treatment process because it is possible to ignore some injuries and all this process should be recorded in the sports medicine file. (14). According to Peterson (2020), the assessment of sports injuries should be done by a sports medicine specialist. A high percentage of sports experts believe that having a sports doctor in stadiums and having a sports medicine file is a necessity for holding a match. It is a sport and shows the attention of sports officials to the health of players (15). In order to achieve the desired success, sports organizations must not only think about meeting the material needs of their athletes, but also prioritize their expectations about physical health after sporting events, and to meet such expectations as a necessity for Athletes' loyalty look. (16). Aman et al. (2018) in their research pointed out that doing sports, both at the amateur and professional levels, has a high risk of injury. They also showed that the probability of lower limb injuries in rugby and football is the highest. Has; Therefore, the presence of a physician at the time of the race is very important and vital to accelerate treatment (17). Gritch (2019) concluded in his research that amateur athletes strongly advocated the use of sports medical services to protect themselves from potential injuries (18); Also, other researchers such as Mirza Kooshaki et al. (2017) in their research entitled Developing Health Development Strategies with the Approach to Physical and Sports Activities concluded that public knowledge through the media, support for workplaces in sports, and encouraging physicians To prescribe sports activities, provide facilities to sports investors, observe sports standards of schools and universities, develop monitoring and counseling centers for citizens' health, employ sports experts in urban and rural health centers and houses, determine the role of each Government agencies in the field of sports, determining the share of sports from the financial credit of the health system transformation plan, urban design with a healthy city approach, preventing the orientation of sports management from financial credits, preventing the orientation of sports management of government agencies to championship and professional sports, The formation of the Deputy Minister of Health in the Ministry of Sports and the use of information and monitoring system were among the health development strategies with the approach of physical activity and sports (19). Methods: In the present study, the paradigm of qualitative research has been used. One of the reasons for the need for qualitative research is that qualitative methods can provide more detailed details of phenomena that are difficult to present in quantitative ways. مختلف Among the various qualitative methods, the network of themes method has been used. Answering the first and second research questions related to determining the indicators and effective factors on the health of football players with a sustainable development approach and explaining the relevant model and to achieve this research goal tried to use a qualitative research method of descriptive exploratory type. The present study is a qualitative descriptive-exploratory study. The sampling method is non-random, targeted and available. Data collection in 1399-1400 and the method of data collection was semi-structured interview. The statistical population is all experts of sports managers and health managers (physicians and medical staff) of the Islamic Republic of Iran. Semi-structured interviews with the question "What do you think are the health indicators of football players with a sustainable development approach?" The beginning and the rest of the questions were based on the answers of the interviewees. After interviewing 12 people in the field of physical education and sports medicine, the researcher felt that he had reached a theoretical similarity, but to be more sure, he continued the interviews up to 15 people, but what was said after 14 people was completely repetitive, and at the same time the interview And the basic themes are over. Results: After reviewing the interviews and removing similar codes; 113 codes were collected, which indicates the position of the health of football players with a sustainable development approach. These concepts were presented under three general topics: basic, organizing and comprehensive. Some of these topics include the coordination of sports federations with the Health Organization, the establishment and expansion of sports medical centers, the use of medical and sports specialists in sports clubs, determining the role of each One of the parts of sports medicine in providing services, forming the deputy of health in the Ministry of Sports, using the information and monitoring community system in the field of health, health development strategies, creating health networks in all parts of the country's football sport, creating upstream documents such as plan Health transformation, creating a document for the prevention of non-communicable diseases at all levels of football players, establishing organizations in the field of sports health at all levels of football in the country. Conclusion: The fact that the country's sports authorities pay the necessary attention to the health of athletes is a necessity for sustainable development and this issue should create a close relationship between medical staff and athletes. [ABSTRACT FROM AUTHOR]

Background The health information system provides an integrated platform and an information connection between the actors of the health system regardless of temporal and spatial limitations. Objective This study aims to investigate the factors affecting the development of electronic health record (EHR) system and predict the future of this system in Iran. Methods In this descriptive study, identification of the main factors for the development of HER and designing the future scenarios of this system was done using a questionnaire completed by 33 managers and experts of information technology in hospitals and medical universities in Guilan and Qazvin provinces of Iran. Data were analyzed in SPSS v. 22 and Expert Choice v. 11 applications. Results Three dimensions and six criteria were determined to explain the HER development. Dimensions included: information content, information architecture, and information security. The criteria were: Manpower, hardware and software infrastructure, speed of access to health services, operating costs, not dependent on the internet, and comprehensiveness. Moreover, eight scaled scenarios were determined for the future of the EHR system. Conclusion It is necessary to pay attention to information content, architecture, and security in development of the HER system in Iran. [ABSTRACT FROM AUTHOR]

Background & Aims: Thyroid disorders including hypothyroidism and hyperthyroidism are common condition in the world and the right diagnosis and treatment are important. Now a days screening for thyroid dysfunction recommend only in a specific situation, thus unnecessary tests could have undesirable outcomes such as improper sampling and costs related to long-term follow-up which could affect patients and health system. (5-10. Except for cases of inappropriate doing thyroid function tests, it should be noted that TSH measurement alone has a high sensitivity for the initial investigation and diagnosis of thyroid diseases (7, 10) so, in context of abnormal TSH it is necessary to measure other thyroid hormones. It is worth mentioning that in the case of hospitalized patients, thyroid laboratory disorders are more common without the presence of thyroid gland homeostasis disorder (11), which shows the necessity of paying more attention to the target population in requested examinations. Therefore, according to the importance of the subject, the present study investigated the request patterns of thyroid function tests and the logical cases of their request in Tehran's Firouzgar Hospital affiliated to Iran University of Medical Sciences, during the second 6 months of 2017. In this cross-sectional study, 484 inpatients for whom each of the Thyroid function tests was requested selected as a sample by census and included in the study. The samples included in the study were evaluated by clinical evaluation and history taking with the aim of finding the indications for thyroid test request, and if it is possible to diagnose thyroid function disorders in the next stage of the requested tests in terms of compliance with the algorithms and instructions The existing one was checked. Finally, if the laboratory tests lead to the final diagnosis, the proportionality of the requested functional test with the final diagnosis is checked. Methods: In this study, the definition of essential thyroid tests included the patients who have a known thyroid disease based on previous history or hospital records and clinical examinations, or there is a high clinical suspicion for their thyroid disease, it is reasonable to perform TSH & T4 & T3RU or TSH & FT4 tests. SPSS version 24 software was used for statistical analysis of data. Results: The average age of the participants in the study was 54.2 years with a standard deviation of 17 years and 59.4% were female. In total requested tests the most patients 101 (20.7%) were hospitalized in the neurology department and the least patients 2 (0.4%) were from the toxicology ward. Out of a total of 488 patients for whom thyroid tests were requested, only 259 patients were found to have a specific reason for requesting these types of tests based on the clinical records, history or clinical examination, and 99 patients (38.2%) were hypothyroid. TSH was requested for 477 patients, and the mean TSH was 3.583. Out of a total of 69 patients whose treatment status changed, 27 patients (39.1%) had an increase in the treatment dose. The most patients whom TSH was requested without indication, most cases (26.3%) were admitted to the neurology department. The most common pattern of requesting thyroid tests in people participating in our study was the combination of TSH, T3, T4. In this study, 69 patients out of 488 patients for whom thyroid tests were performed treatment was changed. Out of 194 patients who had a logical reason to request thyroid tests based on their previous history of thyroid diseases or current examination and history, only 54 patients, equivalent to 27.83%, have undergone treatment change. Conclusion: The purpose of this study was to examine the patterns of requests for thyroid function tests and to determine the logical cases of their requests in Firozgar Hospital in a period of 6 months. Considering that hypothyroidism and hyperthyroidism have a significant prevalence in the world and also due to the high prevalence of iodine deficiency in our country, thyroid diseases are also common. Since the symptoms of thyroid diseases are mostly nonspecific and shared with other diseases, it is better to avoid unnecessary sampling and related problems, including high cost, the need for long follow-up and the patient's and family's concern about the results. As a result of the tests, the measurement of thyroid function tests should be used only in reasonable cases and with a suitable pattern. There is no need to check thyroid tests in all hospitalized patients who are unrelated to thyroid diseases. In general, it seems that the measurement of thyroid tests in logical cases and with the correct pattern has positive results for the patient and health system. In the current study, thyroid tests were requested for 488 patients, compared to the study of Small et al., it can be said that the sample size of our study was slightly smaller than that study. (11) About 60% of the studied patients were women, which can indicate that thyroid tests are more common in women than in men, regardless of whether the request is reasonable or unreasonable. In terms of average age, it can be stated that thyroid tests are performed at different ages of people, although the average age in this study was 54 years, but a wide standard deviation of 17 years was also observed among patients. Regarding the frequency of unnecessary requests, T3 with 99.2%, TSH with 60.6%, and T4 with 59.4%, T3RU with 59%, and Anti TPO Ab with 38% had the highest to lowest amount respectively. It should be noted that all requests for fT3 and fT4 tests were unnecessary. In our study, the most number of cases for whom thyroid tests were requested were hospitalized in the departments of neurology, endocrinology, neurosurgery, and neurology ICU, respectively. It seems that this amount can be reduced if endocrinologists are consulted about the indication of requesting thyroid tests. The most common request patterns for thyroid function tests were TSH&T4&T3 with 69.87% and TSH&T4 with 15.57% respectively. In the study of Roti et al., the most common requested pattern with 56% was the combination of TSH, T3, T4, and for this reason, the two studies are similar (10). was requested, 27.83% of them had a change in their treatment procedure, which is higher compared to the study of Mr. Small et al., where only 2% of patients had a change in treatment (11). In our study, among the patients whose test results were in favor of changing the treatment or starting of thyroid medication or increasing the dose of drugs was the most common case with 39.1%. In this study, among patients who had a history of thyroid problems, TSH and T4 tests were reported as the most frequently performed tests among these people. In general, based on the obtained results, it seems that requesting all thyroid indicators at the same time is a common finding. It can also be added that the unusual patterns of requesting thyroid function tests, multiple cases of requesting thyroid function tests, and the non-optimal contractual TSH threshold level cause unnecessary requests for thyroid function tests. One of the most important limitations of this type of study is that the algorithms and instructions are different in different field of medicine and the way of requesting thyroid function tests may be different between two medical specialties. Another limitation of this study is the lack of sufficient previous studies. One of the final suggestions can be the point that cases of inappropriate requests for thyroid hormones in free hormones are taken at the same time as taking total hormone levels, which are the most suitable places for intervention to reduce cases of inappropriate requests for thyroid function tests. It is also suggested that studies with a larger sample size and a longer follow-up period be conducted in the future. [ABSTRACT FROM AUTHOR]

Introduction: Blockchain technology has emerged as the fourth industrial revolution in recent years, which can facilitate the management and exchange of patient records by developing a new infrastructure. A review of the literature indicates the lack of studies and the need for further study of the factors affecting the adoption of this technology in the healthcare industry. Therefore, the aim of the present study is to prioritize the factors related to the adoption of blockchain technology in the Electronic Health Record (EHR) systems. Methods: In this descriptive study, 15 factors related to blockchain adoption in EHR systems were identified by reviewing the scientific literature. Then, these factors were validated by 17 experts who were selected by targeted sampling method and divided into five categories: technological, legal, financial, environmental and organizational. Finally, the weight of each criterion was determined by the fuzzy best-worst method and the consistency of experts’ opinions was evaluated. Results: According to the judgments of experts, the legal criterion with 32 percent was identified as the most important factor in the adoption of blockchain technology in EHR systems. In addition, security and privacy (16.66 percent), compliance with legal requirements (13.10 percent), compliance with changes in laws (12.22 percent), incentives and rewards (7.01 percent) and standardization (6.87 percent) were identified as five most important sub-criteria in the adoption of the technology, respectively. Conclusion: With the help of the factors identified in this study and the weights determined for each of them, a method can be developed to assess the level of readiness of healthcare providers in adopting blockchain technology in EHR systems. [ABSTRACT FROM AUTHOR]

Introduction: Today, the implementation of electronic health records has caused great changes in the implementation of health industry services. Experts believe that use of electronic health records is the appropriate way to improve the quality of health services and reduce medical faults. Accordingly, this study endeavored to determine the role of electronic health records in quality of services of health centers in Najafabad City, Iran. Methods: This observational study was cross-sectional in terms of time. The population included the recipients of Najafabad health network services. 400 individuals were selected via Morgan table, and the quality (accuracy) of services, speed of service delivery, waiting time, and service continuity (percentage of services provided) were recorded for them in paper and electronically. Data were analyzed using t and ANOVA tests. Results: The comparison of paper and electronic services revealed that with the implementation of electronic health records, there had been no change in the speed of service delivery and continuity; however, it reduced the quality (accuracy) of the services provided and increased the waiting time for receiving services. Conclusion: The two factors of speed of service delivery and waiting time have fundamental role in the satisfaction of service recipients; the implementation of electronic health records has not changed speed of service delivery, but has increased waiting time. Plans should be made to reduce waiting time and increase recipient satisfaction.

Background and Objectives: Pre-hospital care report is a valid medical document containing demographic information, vital signs, times related to ambulance location, evaluations, and performed medical procedures. With the advancement of technology and communication, Asayar smart program has replaced the paper registration method. Therefore, the current study aimed to compare the time indicators and outcome of pre-hospital emergency operations in two methods of electronic registration with the Asayar program and paper registration. Methods: This descriptive-analytical cross-sectional study was conducted in Isfahan in 2019. A number of 700 missions registered by paper in 2017 and 230 missions recorded by Asayar program methods in 2018 were reviewed. Samples were selected by a stratified method with a proportional allocation approach. In order to collect data, researcher-made tools were designed, and content validity was examined. Data analysis was performed by propensity score matching, descriptive statistics, as well as Mann-Whitney and Wilcoxon tests. Results: The results demonstrated that incomplete data were obtained at 2.68% and 7.19% in the Asayar method and the paper method, respectively. The rates of hospital admission in the Asayar and paper methods were reported as 0.9% and 4.9%, respectively. Ambulance arrival time at the patientchr('39')s bedside, in the Asayar and paper methods were calculated at 8 min and 43 sec and 11 min and 30 sec, respectively. Moreover, the time of ambulance discharge from the hospital in the Asayar and paper methods were reported as 9 min and 20 sec and 12 min and 37 sec. Conclusion: As evidenced by the obtained results, documentation by the Asayar method reduced the lost data and increased patient admission in hospitals. Furthermore, it reduced the time of ambulance arrival at the patientchr('39')s bedside and the time of ambulance release.

Introduction: Blockchain can be defined as a distributed and immutable digital ledger that provides data transparency and user privacy. According to the applications of blockchain, conducting of each application needs planning and cost management. This study endeavored to identify and rank the uses of blockchain technology in healthcare. Methods: This descriptive study was done in the winter semester of the academic year of 2020. In the first phase, the uses of blockchain technology in healthcare were recognized from library resources using qualitative content analysis. In the next phase, these uses were prioritized by a panel of experts with 17 members. Then, we used fuzzy Stepwise Weight Assessment Ratio Analysis (SWARA) method for ranking the uses of blockchain in healthcare. Results: Electronic health records (0.43), smart contracts (0.21), internet of things infrastructure (0.15), information security and privacy (0.08), administrative management (0.06), and electronic voting (0.04) were the important applications of blockchain technology in healthcare. Conclusion: Finding of this study show that blockchain technology has important applications in healthcare electronic health records and smart contracts. Therefore, health system policymakers should provide the infrastructure for implementation of blockchain technology among medical and health organizations. This study can contribute to the research in the blockchain field, and enrich the literature on the application of this technology in healthcare.

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Background: The acceptance rate of electronic health recording systems has increased significantly, so that development of this technology in the medical sector has caused a huge change in the health care system. The aim of this study was to investigate the effect of investment in health information technology on financial performance with the mediating role of business process in Kohgiluyeh and Boyer-Ahmad hospitals in Iran. Methods: This applied and descriptive-causal study was conducted with an analytical approach. According to Morgan Table, the sample size was estimated as 341 individuals. The research instrument was a 31-item standard questionnaire validated using face validity, convergent reliability, divergent reliability, Cronbachchr('39')s alpha reliability, and compound reliability. To analyze the data, descriptive statistics and structural equation modeling were applied by Smart PLS and SPSS 20 software. Results: In this study, 9 research hypotheses were confirmed by path analysis and Structural Equation Modeling (SEM). Based on the findings, investing in health information technology whit significance amounts of 3.647 and path coefficient of 0.237 had a significant effect on financial performance. The overall business process (0.477) plays a mediating role in the path between these 2 variables. The research model had a suitable fit. Conclusion: Health information technology can increase the safety and efficiency of information, improve public health, ensure the privacy of the patients, and increase the assetschr('39') efficiency by reducing costs.

Background and purpose: High prevalence of Type 2 Diabetes Mellitus (T2DM) and its demand for regular care have resulted in a massive amount of electronic health records (EHRs). Hemoglobin A1c (HbA1c) and Fasting Blood Sugar (FBS) levels are two widely-used diagnostic measures for evaluation of diabetes care. This study aimed at assessing Family Medicine Plan (FMP) and exploring the trend of changes in FBS and HbA1c levels in patients attending a referral lab affiliated with Mazandaran University of Medical Sciences. Materials and methods: This cross-sectional survey was carried out in 12761 EHRs of a registry database containing the results of blood sugar tests and demographic features selected from over 250 thousand EHRs from 2012-2018. The records were categorized according to normal and abnormal levels of HbA1c (cut-off at 7%). The bivariate logistic regression model was performed by R v.3.6.1 and ggplot2 for data visulazation. Results: Abnormal HbA1c levels were seen in 37.1% of women, 36.7% of men, and 36.7% of the general population. There were significant associations between HbA1c level and age, type of insurance, FMP, kind of care plan, and the year of testing (P0.05). Conclusion: Despite the increasing prevalence of T2DM in Iran, the trend of blood sugar changes during these years showed that changes in HbA1c level was lower than 7% in studied citizens. Considerable attention to self-management in recent years indicates improvements in diagnosis and care of citizens at-risk of diabetes.

Patients apply the Personal Health Record (PHR) to access and use their record information and other medical resources. This study aimed to explain the concept, requirements, and challenges of PHR. This was a narrative literature review conducted by searching Medline, Embase, CINAHL, and Scientific Information Database (SID) databases. Different studies agreed that PHR should be electronic, and the patient should be able to manage and control it. PHR requirements were technical (interoperability and functionality), legal (data security, privacy, and confidentiality), and social (health literacy and personal responsibility) issues. PHR challenges could be categorized as organizational (change management), data (data custodianship, access, and content of PHR), and legal (liability and policy constraints). Successful implementation of PHR was based on understanding of the care environment, users, and needs. The widespread use of PHR required full cooperation of system designers, care providers, health policymakers, and the public.

مقدمه: دسترسی به اطلاعات کامل بیمار، نقش مهمی در بهبود مراقبت‌های بالینی و کاهش اشتباهات پزشکی دارد. در این خصوص، پرونده الکترونیک سلامت، قسمت اصلی یک سیستم اطلاعات سلامت یکپارچه محسوب می‌شود. هدف از انجام پژوهش حاضر، تحلیل کتاب‌سنجی و متن‌کاوی تولیدات علمی منتشر شده در حوزه پرونده الکترونیک سلامت در پایگاه PubMed بود. روش بررسی: این مطالعه به روش کتاب‌سنجی و متن‌کاوی در بازه زمانی سال‌های 2009 تا 2019 بر روی 6863 مقاله انجام شد. داده‌ها با استفاده از نرم‌افزارهای Excel و VOSviewer و ابزار Voyant مورد تجزیه و تحلیل قرار گرفت. یافته‌ها: در حوزه مورد نظر، موضوعات پرونده الکترونیک سلامت، سلامت، مراقبت بهداشتی و سیستم‌های مراقبت بهداشتی اهمیت زیادی در پایگاه PubMed داشت. تولید مقالات در حوزه پرونده الکترونیک سلامت طی ده سال روندی صعودی را نشان داد و کشور آمریکا پرتولیدترین کشور در این حوزه بود. بیشترین مقالات به David Bates، Dean Sittig و Hardeep Singh اختصاص داشت. نتیجه‌گیری: نقشه هم‌رخدادی واژگان برای هر کدام از واژه‌ها، نماینده یک مفهوم یا حوزه تحقیقاتی در سلامت می‌باشد. نتایج به دست آمده می‌تواند دید روشنی به منظور سیاست‌گذاری علمی این حوزه برای تأثیرگذاری بر تخصیص و توزیع منابع در فعالیت‌های علمی و فنی ارایه نماید. همچنین، می‌تواند به محققان در انتخاب موضوعات داغ و کسب بینش جامعی از چارچوب علمی حوزه مورد نظر کمک نماید.

Background and purpose: High prevalence of Type 2 Diabetes Mellitus (T2DM) and its demand for regular care have resulted in a massive amount of electronic health records (EHRs). Hemoglobin A1c (HbA1c) and Fasting Blood Sugar (FBS) levels are two widely-used diagnostic measures for evaluation of diabetes care. This study aimed at assessing Family Medicine Plan (FMP) and exploring the trend of changes in FBS and HbA1c levels in patients attending a referral lab affiliated with Mazandaran University of Medical Sciences. Materials and methods: This cross-sectional survey was carried out in 12761 EHRs of a registry database containing the results of blood sugar tests and demographic features selected from over 250 thousand EHRs from 2012-2018. The records were categorized according to normal and abnormal levels of HbA1c (cut-off at 7%). The bivariate logistic regression model was performed by R v.3.6.1 and ggplot2 for data visulazation. Results: Abnormal HbA1c levels were seen in 37.1% of women, 36.7% of men, and 36.7% of the general population. There were significant associations between HbA1c level and age, type of insurance, FMP, kind of care plan, and the year of testing (P<0.001), but, no significant relationship was found between HbA1c level and gender (P>0.05). Conclusion: Despite the increasing prevalence of T2DM in Iran, the trend of blood sugar changes during these years showed that changes in HbA1c level was lower than 7% in studied citizens. Considerable attention to self-management in recent years indicates improvements in diagnosis and care of citizens at-risk of diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is one of the leading causes of death in women. Therefore, the accuracy and speed of diagnosis are crucial in the treatment procedure. In this regard, the BI-RADS classification system has been used for the standardization of mammography reports. However, there is much disagreement among physicians about the BI-RADS values. The aim of this paper is to diagnose BI-RADS by natural language processing of mammography reports and clinical information from the electronic health records and combining them to identify molecular subtypes and help patient follow-up. Methods: In this study, 1200 mammography reports and electronic health records obtained from Namazi Educational and Medical Center for years between 2015-2017. After text processing, the vector with 160 features was obtained, then 18 features were extracted by referring to the electronic health records. Finally, 178 features were used by SVM and naïve Bayesian to predict BI-RADS and molecular subtypes, respectively. Results: The values of Accuracy, Positive Prediction Value, Negative Prediction Value, Sensitivity, and Specificity were calculated to evaluate the results. Accuracy was 85.42% for BI-RADS and 72.31% for molecular subtypes. Conclusion: The proposed decision support system was an appropriate model to help the physician to diagnose breast cancer and categorize patients. It was also found that the combined information, including electronic medical records of patients and designated molecular subtypes along with mammography reports, can be useful in diagnosing the disease and defining the treatment follow-up. [ABSTRACT FROM AUTHOR]

Technological progress and changes have affected the field of medicine and health. Also, the electronic health record is used for convenience of treatment, prevention and diagnosis, but it has advantages and disadvantages that we have studied them in this research. Method: Qualitative research methods and Grounded theory were used for the sociological study of electronic health record, and in order to achieve a comprehensive theory in this field by using the theoretical saturation method, twenty experts in the fields of medicine, policy, sociology and informatics that They were familiar with electronic health records, were selected from the community of experts as the statistical population and by using the three stages of open, axial and selective coding, important concepts and categories were extracted in each stage. Results: The most important result of the research is multidimensional effects of electronic health record. Electronic health record by reducing emotional interaction and prioritizing registered data reduces the intimacy in the patient-physician relationship, and recording data in the specific political and economic environment of the country bring a fear of social stigma and disclosure, especially when system security, investing, and training employees face some problems, and the constant changes of managers reduce their risk-taking and positive effects. Conclusion: In order to have a proper system and comprehensive and pervasive use of electronic health record, cultural, managerial and technological changes are necessary. Cultural contextualization in the society and among individuals, risky and efficient management and the use of integrated information systems along with system security can increase efficiency. Moreover, this efficiency will lead to research, development and progress. [ABSTRACT FROM AUTHOR]

Background and purpose: Urban family physician was implemented as a pilot project in Fars and Mazandaran provinces in Iran since 2012. This study aimed at SWOT analysis of urban family physician from the perspective of beneficiaries. Materials and methods: This qualitative research was conducted through in-depth and semi-structured interviews in 2016. Nine people including faculty members, family physicians, senior managers and health professionals who were fully informed about the family physician project. They were selected via purposive sampling. Verbatim transcription of interview data was done and analyzed using framework method. Results: The main strengths included health services provision, easy accessibility to health services, classification of services, and decrease in unnecessary costs. The weak points according to SWOT analysis included management and planning, human resources, physical resources, referral system, electronic health records, payment mechanism, health services purchasing organizations, intersectoral coordination, and assessment and control systems. Authorities’ support, legal backing, educated human resources, and capacity of private section along public section were identified as the opportunities of the project. Furthermore, failure in public-private sector cooperation, health market and, society needs were considered as the threats. Conclusion: This study showed the strengths and weaknesses of family physician plan, and the opportunities and threats it is faced with. Hence, it is necessary to find solutions and perform necessary interventions in order to eliminate the weaknesses and threats and maintain and improve the strengths and opportunities before its implementation throughout the country.

Introduction: Considering the fact that the health reform plan has been implemented for five years, it is necessary to re-evaluate the plan and adapt it to the needs and macro policies of our society. Therefore, the current study aimed to use health-related scientific evidences together with the experiences, opinion, and expertise of field professionals to achieve priorities for health reform plan and adapt them to future needs of the country. Methods: This qualitative study was conducted in 2018. At first, scientific evidences were gathered through review of literature, and then a semi-structured interview was developed to collect data from 15 health professsionals and experts chosen through a snowball sampling method. Data were analyzed using content analysis method. Results: The results demonstrated the existence of 12 policies which were then prioritized by using Interpretive- Structural Modelling. Conclusion. Evidence-based policymaking should be used as the main approach in health system, and careful attention should be paid to policies for the old, for preventing diseases and promoting mental health, for accident and incident, for modifying internal processes, such as electronic health records, and for developing health guidelines, referral system and family doctors. [ABSTRACT FROM AUTHOR]

Introduction: Problem-oriented medical record (POMR) is a method of documentation and medical record organization. Problem list is the main component of POMR and the core of the electronic health record (EHR) definition. The aim of the present study was to explain the requirements and challenges in establishing an electronic problem list in hospitals. Methods: This descriptive-applied study was conducted in 2016 in Alzahra Hospital affiliated with Isfahan University of Medical Sciences, Iran. One of the requirements of patient problem lists was content development that, after designing the software, was implemented at neurosurgery and neurology wards. Results: Establishing an electronic problem list showed that content development was its most challenging requirement. These challenge included terminology, patient problems documentation, and interdisciplinary documentation management. Conclusion: Implementation of the problem list as a key component of POMR, especially in inpatient settings with various treatment groups, has challenging requirements. Thus, it requires knowledge and administrative, financial, and technical support.

Introduction: In order to design and develop an efficient electronic health record (EHR) in Iran, the assimilation of health information systems based on a common language for the interpretation and sharing of information with HER is essential. The current research provides an object-oriented design for gynecology data management based on unified modeling language (UML). By applying this model, it is possible to improve interoperability capabilities of Iranian EHR. Methods: This applied, developmental, and cross-sectional study was carried out in 2015. First, published minimum data sets on gynecology and prenatal care in Iran were evaluated. Then, experts assessed and verified the most comprehensive minimum data set for Iran. In the next step, an object-oriented model was designed based on specific data patterns which were extracted from international standards matched with Iranian EHR to satisfy the interoperability requirements of healthcare information. Finally, the object-oriented design was created by applying UML in visual paradigm software package and the prototype of the system was developed. Results: The designed system was directly used by 3 people as main users (clinical secretor, physician, and system administrator). Moreover, this system can interact with the Iranian EHR as an external actor. Use case, activity, sequence, and class diagrams were drawn. Data elements were coded based on national coding standards. Conclusion: Coordination of standardization of different components using software analysis and design is necessary for the successful implementation and pervasive acceptance of EHRs. Object-oriented analysis and design provide a suitable tool for the modeling complexity in software systems. Applying content and technical standards in the design and implementation of EHRs render it useful and applicable in terms of information integration and interoperability.

Introduction: Today, increasing development of technology in communication sciences has facilitated access to basic information in the area of individual health. One of the most important decisions in the field of health is measuring the health level of students; thus, designing electronic records is a step toward addressing the requirements of healthcare providers in the assessment of various health indexes in children. Methods: First, a comparative study was carried out on the content and structure of paper-based and electronic systems for children's health in leading countries in this field (Australia, England, and USA). Then, the required information was collected using health measuring database and elementary school students' health measurement sheets. Subsequently, a checklist with three axes of demographic and social information, screening tests, and physician's assessment was compiled and distributed among professionals Results: Among 62 surveyed elements were approved as main elements and 2 as suggested elements. Based on the results of the survey, data elements were approved by the study population and the software was designed in SQL server database management system by C# language. Conclusion: This application provides the registration and reporting of students' health indexes. Therefore, it helps healthcare providers recognize troubled children and make decisions and targeted plans.

Introduction: Changes in the health care system and society along with increase in the power of technology have imposed a mounting pressure on policymakers, healthcare providers, and the health care system to develop electronic medical record systems. Therefore, the aim of this study was to analyze the strengths, weaknesses, opportunities, and threats (SWOT) of implemented electronic health record systems from the perspective of hospital managers of Tehran University of Medical Sciences, Iran, in 2015. Methods: This was a cross-sectional, descriptive, and analytical study. The study population included all managers of hospitals affiliated to Tehran University of Medical Sciences. The research instrument was a questionnaire which gathered information on internal factors (strengths and weaknesses) and external factors (opportunities and threats) of electronic health record systems. Data analysis was performed using descriptive statistics and SWOT analysis. Results: The most important strength of electronic records was quick and timely access to information (weight rating: 0.147) and the most important weakness was lack of equipment and hardware necessary for the implementation of electronic health records (weight score: 0.094). Moreover, the sharing of information between health service providers and better management of information (weight score: 0.121) were reported as the most important opportunities, and lack of strategic planning in the field of electronic health records (weight score: 0.127) as the most important threat for these record systems. Conclusion: Politicians and investors in healthcare can use the strategies presented in this research to improve and accelerate the implementation of electronic health records in Iran. Furthermore, drawing a strategic plan, designing standards for security, privacy, and sharing of information, and increasing resources and financing are the steps that can be taken to better implement electronic health records.

Introduction: Achieving the potential benefits of electronic health record (EHR) requires data interoperability. Interoperability of a summary record is more practical than a detailed record. Interoperability requirements include identification and development uniform and standard EHR structure. This study aimed to provide an architecture model for the summary record. Methods: This was an applied and descriptive study. In this study, EHR standards and structural models were studied. After studying the standards, a structural model was designed in accordance with the summary record and health information management. Delphi technique was also used to consult informatics experts. Results: Content analysis and descriptive statistics were respectively used for preparation of the model and its validating. A proposed model was prepared based on integration of the Continuity of Care Document (CCD), Medical Markup Language (MML) and ISO 13606 [Electronic health record extract (EHR extract)] structural models and was accepted by experts. Conclusion: It seems that merging the structural models of MML, CCD and standards of EHR extract can lead to designing a structural model for summary HER brief since these models have the potential of interoperability and mapping with each other. The designed model can also be a suitable framework for organizing and sharing the records across wide geographic area.

Introduction: Inaccurate and delayed entry of information are one of the sources of failure in the communication of information between hospital information systems and electronic health record in Iran. The purpose of this study was to investigate the accuracy and timeliness rate of patients’ information in hospital information system whose information was not successfully sent to electronic health record system. Methods: In this descriptive study, conducted in 2016, 882 records which had failed to be sent from hospital information systems to electronic health record system were reviewed. A checklist was used to collect data which were then analyzed by SPSS.22 to calculate the frequency of accurate and timely data entry in hospital information systems. Results: A total of 18758 demographic and clinical information were examined. Overall, the accurate and timely data entry in hospital information systems were 97% and 99.87%, respectively. The highest rate of inaccurate information was related to patients’ identification numbers, national codes, full addresses and places of residence, and the highest rate of delayed data entry was related to final diagnosis and causes of patient death. Conclusion: The results demonstrated a high rate of accurate and timely data entry in hospital information systems. The results also identified some sources of inaccurate and delayed data entry which could be attributed to the negligence of the users. Therefore, it is recommended to hold orientation sessions to enhance users’ knowledge about accurate and timely data entry, and also design systems capable of producing feedback in order to improve the accuracy and timeliness of data entry. [ABSTRACT FROM AUTHOR]

Introduction: Readmission is among the causes of overcrowding in hospital emergency departments. Identifying the characteristics of patients with readmission helps healthcare administrators propose more effective strategies to reduce the frequency of their readmission to the emergency department. This study was designed to investigate the characteristics of readmitted patients in emergency departments of hospitals affiliated with Iran University of Medical Sciences. Methods: Patients with more than 5 times admissions to emergency wards of Rasoul-e-Akram, 7 Tir martyrs, and Firoozgar Hospitals from March 2017 to March 2018 were selected using Health information system (HIS), which recorded computerized patient information. Frequency of referrals and patient complaints during readmission to emergency departments were extracted from patient records. Results: Out of all referrals to hospitals (around 20 thousand patients), 208 patients were readmitted to emergency departments of the mentioned hospitals more than five times (minimum 5 and maximum 10 times). Mean readmission frequency was 6.40 ± 1.26 times and mean patient age was 52.53±17.02 years. Most frequent underlying illnesses were cancer, asthma and chronic obstructive pulmonary disease (COPD), and heart ischemic; and the least frequent were schizophrenia, aplastic anemia, and drug addiction. Conclusion: There was a significant correlation between age and readmission (p-value=0.001). Cancer, COPD, and ischemic heart diseases were the most common causes of readmission to the emergency department. Shortness of breath, chest pain and weakness were the most common complaints at the time of readmission in this study. [ABSTRACT FROM AUTHOR]

Given the importance of information technology in health sector, planning and identifying the prospect and a future road map is important in this area. For this purpose, applying a systematic approach to study the future of health information technology is essential. The key technology is one of the approaches used in the foresight studies and it is conducted by interviewing experts. The aim of this study was to use key technology approach to identify the most important health information technologies for Iran until 2025. This qualitative study was conducted in two phases. The first phase was related to developing a mind map of health information technologies based on the literature review and an expert panel results. In the second phase, semi-structured interviews were conducted with 13 experts to identify the key health information technologies for Iran until 2025. In the first phase, content analysis and in the second phase, framework analysis was used to analyze data. According to the results, the main themes were immediate, cheap, stable, and secure access to the maximum health records of the entire population, equitable access to resources and services of the health counter, development of knowledge management in medical and health sciences, development of governmental electronic services (backup) in health system, development of m-health, IT governance in health and development of national HIT infrastructure. In total, 19 key health information technologies were identified which were related to the main themes. The development of electronic health records, national health information network, data sharing, patient's personal health record (PHR), m-health, clinical decision support systems and health information technology infrastructure were found to be the most important health information technologies for Iran until 2025. It seems that identifying key health information technologies can help to facilitate strategic and operational planning in this area and help to allocate resources realistically. [ABSTRACT FROM AUTHOR]

Introduction: Physicians’ resistance to accepting and adopting Electronic Health Care Record (EHCR) ‎is still a serious challenge to the nationwide adoption of EHCR. As a result, ‎identification of the factors that contribute to this challenge is valuable. Thus, this study ‎was performed to survey the effect of physicians' characteristics on adoption of EHCR. Methods: A Descriptive-analytical survey was applied in this study. The study population ‎consisted of physicians who worked in 26 hospitals affiliated to Tehran University of ‎Medical Sciences, Iran. From among them, 270 physicians were selected to participate ‎in this research. The data gathering tool was a questionnaire the validity and reliability ‎of which were confirmed. The data were collected, and then, analyzed using path ‎analysis in structural equation modeling (SEM) in SPSS and AMOS software. Results: The results showed that there is no significant correlation between physicians’ ‎characteristics, such as age, work experience, computer familiarity, and EHCR ‎familiarity, and perceived usefulness (PU) and perceived ease of use (PEOU). In ‎addition, no significant correlation was observed between physicians’ characteristics ‎and the technology acceptance model (TAM) variables. Conclusion: Physicians’ characteristics did not have any significant effect on accepting and ‎adopting EHCR. Therefore, it is suggested that policymakers and managers focus on ‎other factors that affect EHCR acceptance and implementation.

Background and purpose: Urban family physician was implemented as a pilot project in Fars and Mazandaran provinces in Iran since 2012. This study aimed at SWOT analysis of urban family physician from the perspective of beneficiaries. Materials and methods: This qualitative research was conducted through in-depth and semistructured interviews in 2016. Nine people including faculty members, family physicians, senior managers and health professionals who were fully informed about the family physician project. They were selected via purposive sampling. Verbatim transcription of interview data was done and analyzed using framework method. Results: The main strengths included health services provision, easy accessibility to health services, classification of services, and decrease in unnecessary costs. The weak points according to SWOT analysis included management and planning, human resources, physical resources, referral system, electronic health records, payment mechanism, health services purchasing organizations, intersectoral coordination, and assessment and control systems. Authorities' support, legal backing, educated human resources, and capacity of private section along public section were identified as the opportunities of the project. Furthermore, failure in public-private sector cooperation, health market and, society needs were considered as the threats. Conclusion: This study showed the strengths and weaknesses of family physician plan, and the opportunities and threats it is faced with. Hence, it is necessary to find solutions and perform necessary interventions in order to eliminate the weaknesses and threats and maintain and improve the strengths and opportunities before its implementation throughout the country. [ABSTRACT FROM AUTHOR]

Background and Objective: Chronic kidney disease (CKD) is a reticent but fatal disease worldwide. It is a health challenging issue due to its destructive, progressive and largely asymptomatic nature leading to kidney failure, accompanied by cardiovascular disease and costly treatment. Since there are fundamental problems increasing physician's effort in the process of diagnosis, electronic medical record system was designed in order to facilitate diagnosis by practitioners. Materials and Methods: This research is of applied kind. The method of collecting information included books, articles, international system survey, patients' records and the use of questionnaires. Results: The system was designed to provide instant access to patients' records and detect stages of disease at the time of diagnosis and is deemed to be valuable due to its facility, speed and accuracy. Its primary stage use, support the accuracy of this software in eventual diagnosis by more than 5%. Conclusion: Improved quality of care, accurate organization of medical records, ease of use and accessibility, decreased medical errors, immediate access to information in different places, decision -supporting technology and process improvement are among merits of this system. [ABSTRACT FROM AUTHOR]

Guideline-based Decision Support Systems helps clinician to choose the best treatment in specific clinical situations. Since it is difficult for doctors to remember all effective measures of diagnosis and the average visit time for each patient less than 20 minutes, so integrate guideline with clinical decision support system help doctors to choose the best course of treatment in the clinical setting. This paper is a literature review and have implication to clinical guidelines concepts, guideline-based decision support system, challenges and technical considerations. The best and fastest approach to use of guideline is their integration with hospital information system or electronic health record. The development of these systems require careful design of clinical guidelines development, decision models, and reusable software components and appropriate computing infrastructures in the clinical environment. Currently, XML is the best choice for packaging data and information sharing, but there isn't a specific standard that fully provide interoperability with EHR. Ease of learning is one of the main issues in the guideline based EHR. Guideline must be designed that their use is simple so developers. Clinical guidelines integration with information systems and electronic medical records lead to increase adherence to clinical guidelines in health care, quality of care provided to patients, ensuring patient safety and reduce costs . [ABSTRACT FROM AUTHOR]

Cloud computing as a new technology with Internet infrastructure and new approaches can be of significant benefits in providing medical services electronically. Applying this technology in E-Health requires consideration of various factors. The main objective of this study is to identify and rank the factors influencing the adoption of E-Health cloud. Based on the Technology-Organization-Environment (TOE) framework and Human-Organization-Technology fit (HOT-fit) model, 16 sub-factors were identified in four major factors. With the survey of 60 experts, academics and experts in health information technology and with the help of fuzzy analytical hierarchy process had ranked these sub-factors and factors. In the literature, considering the newness of the subject, no domestic or foreign study has covered this number of criteria. The results show that when deciding to adopt cloud computing in e-health technological, human, organizational and environmental factors must be considered respectively. [ABSTRACT FROM AUTHOR]