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Abstract Introduction Health information systems play a crucial role in the delivery of efficient and effective healthcare. Poor usability is one of the reasons for their lack of acceptance and low usage by users. The aim of this study was to identify the usability problems of a national comprehensive health information system using the concurrent think-aloud method in the recording of childcare data. Methods A descriptive cross-sectional study was conducted in the health centers of Kashan University of Medical Sciences, Iran, in 2020. Ten healthcare providers as system's users were purposively selected to evaluate the system. To identify problems, a concurrent think-aloud evaluation was conducted. Two administrators of the system designed scenarios for ten childcare data recording tasks. By analysing the recorded files, usability problems were identified. The severity of the problems was then determined with the help of the users and problems were assigned to usability attributes based on their impact on the user. Results A total of 68 unique problems were identified in the system, of which 47.1% were rated as catastrophic problems. The participants assigned 47 problems (69%) to the user satisfaction attribute and 45 problems (66%) to the efficiency attribute; they also did not assign any problems to the effectiveness attribute. Conclusion The problems identified in the national comprehensive health information system using the think-aloud method were rated as major and catastrophic, which indicates poor usability of this system. Therefore, resolving the system problems will help increase user satisfaction and system efficiency, allowing more time to be spent on patient care and parent's education as well as improving overall quality of care.

Objectives: This study investigates how physicians in Iran's Social Security Organization outpatient clinics utilize EPS functionalities to optimize the system and enhance patient care.Methods: This descriptive cross-sectional study was conducted in Iran in 2020, involving a population of 118 physicians working in outpatient clinics of the Social Security Organization. A researcher-developed questionnaire was employed to assess five different functionalities of the EPS. The validity and reliability of the questionnaire were established through expert evaluation and Cronbach's alpha calculations. Participants' responses were scored on a scale from 0 to 4 (never=0, rarely=1, sometimes=2, often=3, always=4).Results: Physicians most frequently utilized the EPS functionalities for: "Recording and displaying patient medication history" (86.5%), "Selecting drugs from the medication list" (86.3%), "Providing pre-defined doses for selection by the physician" (66.6%), and "Alerts for repetitive treatments" (65.3%). Additionally, they reported using "Viewing and verifying prescribing information before sending electronically" (83.9%) and "Patient laboratory results" (82.2%). While features related to patient identification and data access were widely used, functionalities pertaining to alerts and decision support were utilized less frequently.Conclusion: Physicians demonstrated a strong reliance on the core functionalities of EPS, particularly for managing medication histories, drug selection, and reviewing prescriptions prior to transmission. This reliance underscores the importance of these functionalities in streamlining workflows, reducing errors, and improving patient care. Further development of EPS can enhance their potential benefits.

BackgroundAmong the numerous factors contributing to health care providers’ engagement with mobile apps, including user characteristics (eg, dexterity, anatomy, and attitude) and mobile features (eg, screen and button size), usability and quality of apps have been introduced as the most influential factors. ObjectiveThis study aims to investigate the usability and quality of the Head Computed Tomography Scan Appropriateness Criteria (HAC) mobile app for physicians’ computed tomography scan ordering. MethodsOur study design was primarily based on methodological triangulation by using mixed methods research involving quantitative and qualitative think-aloud usability testing, quantitative analysis of the Mobile Apps Rating Scale (MARS) for quality assessment, and debriefing across 3 phases. In total, 16 medical interns participated in quality assessment and testing usability characteristics, including efficiency, effectiveness, learnability, errors, and satisfaction with the HAC app. ResultsThe efficiency and effectiveness of the HAC app were deemed satisfactory, with ratings of 97.8% and 96.9%, respectively. MARS assessment scale indicated the overall favorable quality score of the HAC app (82 out of 100). Scoring 4 MARS subscales, Information (73.37 out of 100) and Engagement (73.48 out of 100) had the lowest scores, while Aesthetics had the highest score (87.86 out of 100). Analysis of the items in each MARS subscale revealed that in the Engagement subscale, the lowest score of the HAC app was “customization” (63.6 out of 100). In the Functionality subscale, the HAC app’s lowest value was “performance” (67.4 out of 100). Qualitative think-aloud usability testing of the HAC app found notable usability issues grouped into 8 main categories: lack of finger-friendly touch targets, poor search capabilities, input problems, inefficient data presentation and information control, unclear control and confirmation, lack of predictive capabilities, poor assistance and support, and unclear navigation logic. ConclusionsEvaluating the quality and usability of mobile apps using a mixed methods approach provides valuable information about their functionality and disadvantages. It is highly recommended to embrace a more holistic and mixed methods strategy when evaluating mobile apps, because results from a single method imperfectly reflect trustworthy and reliable information regarding the usability and quality of apps.

Background and Aim: A medication dashboard could provide executive directors and managers with the ability to manage medication resources in hospitals. This study aimed to design, implement, and evaluate a medication resources management dashboard for general hospitals. Materials and Methods: This study was of the development-applied type conducted in an academic therapeutic community center. Based on scientific sources, the dashboard’s key performance indicators (KPIs) and functional requirements were identified. The data collection tool was a questionnaire comprising demographic information, KPIs, and functional requirements. The dashboard conceptual model was designed using Rational Rose software, and then POWER BI software was used to develop the system. The usability of the dashboard was evaluated using the standard questionnaire for End User Computing Satisfaction by 10 users. The data were analyzed in SPSS software using descriptive statistics. Results: The most important KPIs determined for a medication resources management dashboard in general hospitals were “the ratio of antibiotic consumption to total number of drugs”, “the ratio of the antibiotic prescribed by general practitioners to total number of drugs”, “the ratio of patients for whom antibiotics were prescribed to all patients”, and “the ratio of the number of drug items prescribed by specialists to all physicians”. The most important functional requirements determined were “updating information at specific intervals “, “checking the dashboard at different time intervals”, “defining access levels to view the information”, and “choosing between graphical and tabular displays”. Usability evaluation showed that users’ satisfaction with the dashboard content variable was “very high” and for the other variables was at a “high” level. Conclusion: The KPIs associated with antibiotics and drug costs within the medication dashboard of general hospitals are high priority. Future studies should evaluate the impact of using a medication dashboard on hospital executive directors’ and managers’ decision-making.

BACKGROUND: Providing clinical guidelines to clinicians using innovative technologies seems practical and useful. This study aimed to design, develop, and evaluate a smartphone application to assist urologists in managing bladder cancer (BCM App). MATERIALS AND METHODS: The study was conducted in three phases, following the user-centered design model, at the urology clinic of Khorshid Hospital (Isfahan, Iran) in 2021. Components and functionalities for BCM App were specified in three focus group sessions with urologists and urology residents using clinical guidelines. Adopting the Delphi technique, the participants completed a questionnaire addressing issues including educating and informing clinicians, performing clinical calculations, representing graphical information, and recording patient information. A conceptual model for the app was designed, and the final product was developed. The usability of the BCM App was evaluated using the think-aloud technique by usability experts and end-users. RESULTS: The app’s components were categorized into three groups: Patient evaluation, disease staging and management, and patient follow-up. The app’s main components included “bladder cancer classification,” “disease grading and staging,” “management based on the disease stages,” “principles of intravesical treatment,” and “classifying follow-ups by disease stages.” Moreover, the most prominent app’s functionalities were “using staging and grading table,” “using American Urological Association risk stratification,” “calculating disease stages,” “calculating patient’s follow-up,” and “recording patient information.” The usability evaluation results revealed that the BCM App was at a “highly acceptable” level. CONCLUSION: To design and develop a smartphone app for managing bladder cancer, the involvement of urologists is crucial. Apart from assisting urologists in effectively managing bladder cancer, the proposed app has the potential to enhance residents’ knowledge and streamline their access to evidence.

Abstract Background This study aimed to assess health care needs, electronic health literacy, mobile phone usage, and intention to use it for self-management purposes by informal caregivers of children with burn injuries. Methods This cross-sectional research was carried out in 2021 with 112 informal caregivers of children with burns in a burn center in the north of Iran. The data collection tools were questionnaires that included the participants’ demographics, their E-Health Literacy, their current mobile phone usage, and their desires for mobile phone use for burn care services. Results Most informal caregivers had smartphones (83.0%) and Internet access (81.3%). Most participants occasionally used phone calls (63.4%), the Internet (45.5%), and social media (42.9) to receive information about psychosocial disorders, infection control, wound care, pain, itch, physical exercise, and feeding. Most participants have never used some of the mobile phone functionalities to receive burn-related information, such as applications/Software (99.1%) and e-mail (99.1%). Nevertheless, most informal caregivers desire to use mobile applications for self-management purposes in the future (88.4%). The mean eHealth literacy score was 25.01 (SD = 9.61). Informal caregivers who had higher education levels, access to the Internet, and lived in urban areas had higher eHealth literacy (P

Abstract Background Today, clinical decision support systems based on artificial intelligence can significantly help physicians in the correct diagnosis and quick rapid treatment of endophthalmitis as the most important cause of blindness in emergency diseases. This study aimed to design, develop, and evaluate an intelligent decision support system for acute postoperative endophthalmitis. Methods This study was conducted in 2020–2021 in three phases: analysis, design and development, and evaluation. The user needs and the features of the system were identified through interviews with end users. Data were analyzed using thematic analysis. The list of clinical signs of acute postoperative endophthalmitis was provided to ophthalmologists for prioritization. 4 algorithms support vector machine, decision tree classifier, k-nearest neighbors, and random forest were used in the design of the computing core of the system for disease diagnosis. The acute postoperative endophthalmitis diagnosis application was developed for using by physicians and patients. Based on the data of 60 acute postoperative endophthalmitis patients, 143 acute postoperative endophthalmitis records and 12 non-acute postoperative endophthalmitis records were identified. The learning process of the algorithm was performed on 70% of the data and 30% of the data was used for evaluation. Results The most important features of the application for physicians were selecting clinical signs and symptoms, predicting diagnosis based on artificial intelligence, physician–patient communication, selecting the appropriate treatment, and easy access to scientific resources. The results of the usability evaluation showed that the application was good with a mean (± SD) score of 7.73 ± 0.53 out of 10. Conclusion A decision support system with accuracy, precision, sensitivity and specificity, negative predictive values, F-measure and area under precision-recall curve 100% was created thanks to widespread participation, the use of clinical specialists' experiences and their awareness of patients' needs, as well as the availability of a comprehensive acute postoperative endophthalmitis clinical dataset.

Introduction: One of the important challenges for physicians is the choice of the right antibiotics for various diseases. In this regard, a mobile application could be helpful. The main purpose of this study was to compare the quality of mobile applications designed for an antibiotic prescription to help physicians in choosing the right antibiotic. Method: In this study, English non-commercial apps from the Apple App Store and the Google Play Store were searched using relevant keywords. The apps were selected and independently scored by an infectious disease specialist and a pharmacist using the Mobile Application Rating Scale (MARS). Kendall’s coefficient of concordance was used to assess inter-rater agreement. The Kolmogorov-Smirnov test was used to verify the normal distribution of the quantitative variables. Spearman's rank-order correlation was applied to determine the relationship between MARS scores and quantitative background variables and Mann-Whitney U tests for dichotomous variables. - Results: In the initial search until August 2022, 13 apps were eligible for evaluation. The MARS score obtained by applications without in-app advertisements (median: 3.9, IQR: 3.4-6.1) was significantly higher than applications containing advertisements (median: 2.9, IQR: 2.3-8.1) (P=0.029). In the objective domain of MARS, The highest mean domain score belonged to the engagement section (3.9±0.4) and the lowest mean domain score belonged to the functionality section (3.5±0.5). Conclusion: This study indicated that apps designed to help physicians prescribe antibiotics meet acceptable criteria. Considering objective scores of MARS, lower scores in the “engagement” section demonstrated that designers have paid less attention to this section in comparison to the “information quality” section.

Abstract 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.

Aims: This study aimed to determine the effect of E-learning on the understanding of appropriate antibiotic prescribing (AAP) by medical students and to assess their satisfaction with this method. Materials and Methods: This quasi-experimental study was conducted among the physiopathology students of Kashan University of Medical Sciences in the first and second semesters of 2020–2021. Students were divided into E-learning education as an intervention group (IG) and face-to-face education as a control group (CG). After the final examination, the mean scores of students in both groups were compared. In addition, the level of students' satisfaction in the IG with E-learning method was assessed using a standard questionnaire. Data were analyzed using SPSS 22. Results: We included 85 and 47 students in the CG and IG. The mean and standard deviation (SD) of the understanding score about antibiotics in the E-learning group and the face-to-face education group were 18.8 ± 1.26 and 17.16 ± 1.93 out of 19, respectively, which were statistically significantly different (P = 0.004). The mean and SD of the overall score of satisfaction of the students in the IG was 85.48 ± 23.08 out of 130 points (medium level). Furthermore, the level of satisfaction of male students was significantly higher than female students (P = 0.009). Conclusion: E-learning was effective in improving the process of educating students to the AAP. This education method can be used as an alternative or complementary of face-to-face education, especially in critical conditions such as the pandemic of diseases including COVID-19.

Abstract 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

Abstract 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.

Abstract 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

Abstract Background There is little evidence regarding the adoption and intention of using mobile apps by health care professionals (HCP) and the effectiveness of using mobile apps among physicians is still unclear. To address this challenge, the current study seeks two objectives: developing and implementing a head CT scan appropriateness criteria mobile app (HAC app), and investigating the effect of HAC app on CT scan order. Methods A one arm intervention quasi experimental study with before/after analysis was conducted in neurology & neurosurgery (N&N) departments at the academic hospital. We recruited all residents' encounters to N&N departments with head CT scan to examine the effect of HAC app on residents' CT scan utilization. The main outcome measure was CT scan order per patient for seven months at three points, before the intervention, during the intervention, after cessation of the intervention -post-intervention follow-up. Data for CT scan utilization were collected by reviewing medical records and then analyzed using descriptive statistics, Kruskal-Wallis, and Mann-Whitney tests. A focus group discussion with residents was performed to review and digest residents' experiences during interaction with the HAC app. Results Sixteen residents participated in this study; a total of 415 N&N encounters with CT scan order, pre-intervention 127 (30.6%), intervention phase 187 (45.1%), and 101 (24.3%) in the post-intervention follow-up phase were included in this study. Although total CT scan utilization was statistically significant during three-time points of the study (P = 0.027), no significant differences were found for CT utilization after cessation of the intervention (P = 1). Conclusion The effect of mobile devices on residents' CT scan ordering behavior remains open to debate since the changes were not long-lasting. Further studies based on real interactive experiences with mobile devices is advisable before it can be recommended for widespread use by HCP.

Objective: Many people suffer from kidney disease, and self-management is essential in these patients. Personal health record (PHR) can be used as a tool to improve self-management in these patients. This study aimed to identify a minimum data set (MDS) of PHR in dialysis patients. Methods: This descriptive and cross-sectional study was conducted in 2019, and national and international scientific literature entitled “Personal Health Record,” “Electronic Personal Health Record,” “Dialysis Patient Portal,” “Dialysis Health Record,” and “Dialysis Information Needs” by content analysis method was reviewed. A questionnaire with 14 items was designed to examine patients' problems and data needs based on the review of scientific literature and web-based PHRs. Based on the patients' survey and the review of scientific literature, a questionnaire with 114 questions was designed. Finally, with experts' opinions, data elements were determined. Results: An MDS for developing web-based PHR for patients under chronic dialysis was created with 17 data classes including demographic information, insurance information, contact information in case of emergency, information on dialysis sessions, physicians information, dialysis center information, information on individual measured values (blood pressure, blood sugar, and weight), disease history information, information on surgical procedures and operations, history of visits, allergies, vaccinations, family history, drugs, laboratory tests, diet, and education materials for the patient. Conclusion: In this study, an MDS was developed for a web-based PHR for dialysis patients. The use of standard data can help collect the data that is essential to improve the patient's health and track his medical condition.

The food and drug administration (FDA) usually monitors drug dispensing practices to manage their resources. Despite advances in information technology, traditional paper-based processes are used for this purpose in several low and middle income countries. This study aimed to determine the necessities, requirements, and implementation challenges of using pharmacy surveillance information systems (PSISs) to monitor the dispensing practice of under-controlled drugs and substances. This qualitative study was conducted in 2021. The population of the study was 16 FDA managers and pharmacy owners and pharmacy information systems (PIS) users in Iran. First, data collection was performed through open-ended, semi-structured interviews. Then, a focus group including experts in pharmacology, health information management, medical informatics, and information technology reviewed and confirmed the necessities, requirements, users' information needs, and implementation challenges of the PSIS. The results of the study showed that improving safety, conducting utilization management, reducing doctor shopping, and supporting patients were the most important reasons to monitor the dispensing practice of under-controlled drugs. The participants believed that the electronic monitoring of the dispensing of under-controlled drugs is essential and can increase the accuracy, timeliness, and ease of performing relevant processes. Based on the participants’ opinions, registering the data related to patients, prescribers, prescriptions, and pharmacies is necessary. The system should have functionalities to prevent illegal events and generate timely and updated reports. Resistance of stakeholders and shortage of infrastructure were identified as the main challenges for the implementation. Improving safety and supporting patients necessitate monitoring the dispensing practice of under-controlled drugs. To monitor this important practice, using a PSIS is necessary and it can support and facilitate the related processes.

Background: Patients with cardiovascular disorders (CVD) are at higher risk for potential drug-drug interactions (pDDIs) due to complex treatment regimens. This study aimed to evaluate pDDI patterns in physicians’ prescriptions in a specialized heart center using simple software. Methods: This cross-sectional study identified severe and related interactions during a 2-stage survey of experts. The data collected included age, sex, the date of admission and discharge, the length of hospital stay, drug names, inpatient wards, and the final diagnosis. The extracted drug interactions were used as a source of software knowledge. The software was designed using the SQL Server and the C # programming language. Results: Of 24 875 patients included in the study, 14 695 (59.1%) were male. The average age was 62 years. Based on the survey of experts, only 57 pairs of severe pDDIs were identified. The designed software evaluated 185 516 prescriptions. The incidence of pDDIs was 10.5%. The average number of prescriptions per patient was 7.5. The highest frequency of pDDIs was detected in patients with diseases of the lymphatic system (15.0%). Aspirin with heparin (14.3%) and heparin with clopidogrel (11.7%) were the most common documented pDDIs. Conclusion: This study reports the prevalence of pDDIs in a cardiac center. Patients with lymphatic system disorders, male patients, and older patients were at higher risk of pDDIs. This study shows that pDDIs are common among CVD patients and highlights the need to use computer software to screen patients’ prescriptions to assist in detection and prevention.

Abstract Background Antibiotic prescribing is common worldwide. There are several original studies about antibiotic prescribing in the healthcare setting of Iran reporting different levels of prescribing. The aim of this systematic review and meta-analysis was to determine the prevalence of antibiotic prescribing in both inpatient and outpatient settings in Iran, an example of a developing country. Methods To identify published studies on antibiotic prescribing, databases such as ISI, Scopus, PubMed, Google Scholar, and Electronic Persian were searched in Iran till January 2020. Eligible studies were those analyzing original data on the prescription and use of antibiotics in outpatient or inpatient settings in Iran. Moreover, all studies that used an intervention to improve antibiotic prescribing were included. The quality of the included studies was assessed using self-administered quality assessment criteria. The meta-analysis of prevalence of antibiotic prescribing was conducted based on the meta-analysis of observational studies in epidemiology guidelines. To calculate pooled rates, the random-effects model was used. Results A total of 54 studies (39 outpatients and 15 inpatients) were included in this study. The median of antibiotic prescribing in the outpatient and inpatient settings accounted for 45.25% and 68.2% of patients, respectively. The results of meta-analysis also showed that the antibiotic prescribing accounted for 45% of prescriptions in outpatient settings and 39.5%, 66%, and 75.3% of patients in all wards, pediatrics wards, and ICU wards of inpatient settings, respectively. The most commonly prescribed antibiotic classes in outpatient settings were penicillins, cephalosporins, and macrolides, while in inpatient settings, these were cephalosporins, penicillins, and carbapenems. There were seven studies using interventions to improve antibiotic prescribing pattern. It should be mentioned that intervention in a study had a statistically significant effect on improving antibiotic prescribing (p

Abstract Background Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals. Method Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. Studies using CDSSs as an intervention to improve laboratory test ordering as the primary aim were included. The study populations in the included studies were laboratory tests, physicians ordering laboratory tests, or the patients for whom laboratory tests were ordered. The included papers were evaluated for their outcomes related to the effect of CDSSs which were categorized based on the outcomes related to tests, physician, and patients. The primary outcome measures were the number and cost of the ordered laboratory tests. The instrument from The National Heart Lung and Blood Institute (NIH) was used to assess the quality of the included studies. Moreover, we applied a checklist for assessing the quality and features of the CDSSs presented in the included studies. A narrative synthesis was used to describe and compare the designs and the results of included studies. Result Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. In addition, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare. Conclusion CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However, the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

Introduction: Today, the use of mobile applications to help self-care in patients with chronic diseases has increased. The objective of this study was to investigate the quality of Persian mobile applications related to patients with diabetes and hypertension. Method: This analytical study was conducted on all Persian mobile applications related to diabetes and hypertension in 2019. The mobile applications were searched in the Café Bazaar app store using the keywords such as “diabetes”, “blood sugar” and “blood pressure”. The APPLICATIONs Scoring System was used in this study. Two evaluators assessed the applications and in cases of disagreement a third evaluator was consulted. Results: In total, 179 Persian mobile applications were investigated. The mean and standard deviation of the quality of applications related to diabetes and hypertension based on the applied tools were 7.31±1.49 and 7.22±1.24 out of 16, respectively. More than 75% of these applications were comprehensive and less than 7% used authentic scientific resources. More than 80% of these applications were user-friendly and could work offline. Conclusion: The results of this study showed that most of the Persian mobile applications related to diabetes and hypertension were at a moderate level. Most of the mobile application developers took into account the interactive aspects of applications but paid less attention to providing a scientific content. Evaluating the quality of health-related mobile applications is recommended to app store managers before low-quality applications are available to public.

Abstract 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.

Abstract 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.

Abstract Background Mobile health has potential for promotion of self-management in patients with chronic diseases. This study was conducted to investigate smartphone usage in patients with type II diabetes and their intention to use it for self-management. Methods This cross-sectional study was conducted in 2018 with 176 patients with type II diabetes visiting a specialized diabetes clinic or one of two endocrinology and metabolism specialists in north of Iran. Data were collected using a validated questionnaire containing items on demographic characteristics, disease information, use of mobile phones, smartphones and the internet, and intention to use mobile phones for diabetes self-management. Results The majority of the participants had mobile phones (94.9%), smartphones (61.1%), and daily access to the internet (81.3%), and used phones two hours per day on average (80.1%). They mostly used mobile phones to contact friends (89.2%) and search for information (50.6%), and their greatest intention for using smartphones and the internet for self-management was related to dietary planning (96%), checking blood glucose (90.9%), and contacting specialists (87.5%). Younger participants were more interested in using smartphone applications (apps) (P

Background: In the end stages of chronic kidney disease, patients need kidney replacement therapy, such as dialysis and transplantation. Self-care and self-management are essential in dialysis patients at this stage. One of the tools that can facilitate self-management for patients is Personal Health Records (PHRs). This study aimed to design, develop and evaluate a PHR for patients under dialysis. Materials and methods: In this study, a PHR was developed in three phases. In the first phase, the minimum data set for the PHR was determined by literature review as well as surveys of patients and experts. In the second phase, the PHR was designed by the PHP web programming language. In the third phase, the usability of designed system was evaluated by the heuristic evaluation method. Results: Literature review and surveys of patients and experts led to the identification of 17 main data sets. In this study, 114 fields were created through 41 tables in the MySQL database. After evaluating the designed system, 26 unique problems were identified. The highest percentage of problems with 19% (n = 5) was related to “error prevention”. Conclusions: The designed PHR for patients undergoing chronic dialysis had satisfactory usability. Therefore, this web-based system can be efficiently used for the disease management of dialysis patients.

Introduction: Admission and medical record system (AMRS) is one of the most important subsystems of hospital information system, which is used by many users in admission, discharge, and health information management. Interface usability problems can reduce user speed, precision, and efficiency in user-system interaction. This study aimed to identify the usability problems of AMRS in a hospital information system. Method: In this descriptive cross-sectional study, five health information technology experts evaluated AMRS in a hospital information system using heuristic evaluation. Then, the system usability problems were categorized according to Nielsen's 10 usability principles and their severity were determined. Results: Totally, 62 unique usability problems were detected. The most frequent problems were related to "consistency and standards" (n=9) and ''recognition rather than recall" (n=9), and the least frequent ones was related to "flexibility and efficiency of use" (n=1). 59.7% of the identified problems were categorized as big and severe problems. The highest average severity of problems belonged to "system’s visibility" and "aesthetic and minimalist design", and the least average severity belonged to "error prevention". Conclusion: Using heuristic evaluation, a large number of usability problems in AMRS were identified. According to experts' opinions, most of the HIS interface problems were big and severe, and they need to be modified by designers and developers of these systems.

Abstract Background The admission, discharge and transfer (ADT) module is used in the hospital information system (HIS) for the purposes of managing appointments, patient admission, daily control of hospital beds, planning surgery procedures, keeping up-to-date on patient discharges, and registering patient transfers within or outside the hospital. The present study aimed to evaluate the usability of ADT module of a HIS through usability testing and assess the relationship between the number of user interface problems and usability features (i.e. effectiveness, efficiency, and satisfaction). Methods This descriptive analytical study was conducted in Shahid Beheshti hospital in Kashan, Iran, in 2017. The participating users were eight students in their last semester of a Bachelor of Health Information Technology Sciences degree. First, the users were introduced to the module functions in a two-hour session; ten days later, the users were asked to perform scenarios designed based on seven tasks and take notes of the problems encountered in performing each task after it was over. Effectiveness was measured based on the rate of completing the tasks, efficiency based on the time taken to perform each task, and satisfaction based on the users’ answers to a satisfaction questionnaire. The relationship between these three usability features and the number of problems noted was assessed using Spearman’s test in SPSS version 16. Results Thirteen unique usability problems were identified from the perspective of the users. Effectiveness was rated as 58.9%, efficiency as 53.3%, and mean user satisfaction as 53.4 ± 10.6. The number of problems in each task had significant relationships to the effectiveness (P = 0.009) and efficiency (P = 0.016) scores. User satisfaction also had a significant relationship with the effectiveness (P = 0.043) but not with the efficiency (P = 0.230) scores. Conclusions In the view of the potential users, a HIS, used in more than 200 hospitals in a developing country, has several usability problems in its ADT module and its effectiveness, efficiency, and user satisfaction were not acceptable. The number of usability problems in the HIS user interface affected the effectiveness, efficiency and user satisfaction of the system.

Given the lack of empirical evidence and limited literature on dashboard development and its usefulness, it is still not clear how to deliver automated feedback using a dashboard to improve the physicians' practice. Therefore, the present prospective and quasi-experimental study aimed to investigate the effect of automated feedback with a dashboard on ordering laboratory tests by neurology residents. The dashboard development and implementation were performed by an interdisciplinary subcommittee formed in a general teaching hospital with 510 beds in Kashan, Iran. The changes in the laboratory tests ordered by the neurology residents for each patient was considered as the main outcome of the present study, which was assessed three months before the intervention (baseline assessment) and three months during the intervention (post-intervention assessment) to investigate the effectiveness of providing feedback with the dashboard in reducing the number of laboratory tests ordered. Moreover, data analysis was performed using the Kolmogorov–Smirnov test, t-test, and Mann-Whitney test. According to our findings, a total number of 3038 tests were ordered before the intervention, while this value significantly decreased to 1840 in the post-intervention assessment (P = 0.031). In addition, the proportion of laboratory tests per patient was 0.45 ± 0.35 in the baseline assessments, which significantly decreased to 0.37 ± 0.27 after the intervention (P = 0.013), and the monthly number of tests ordered for each patient was 13.14 ± 8.84 pre-intervention, which significantly decreased to 11.09 ± 5.75 after the intervention (P = 0.015). Also, 22 tests out of 29 tests studied were ordered less frequently after the intervention; however, the reduction was significant only for four tests, including the alkaline phosphatase (p = 0.025), high-density lipoprotein (p = 0.037), urine culture (p = 0.037), and arterial blood gas (p = 0.034). We concluded that peer-compared automated feedback with a dashboard could simply change the physicians' behavior in ordering laboratory tests. Given the observed effectiveness in changing the residents' behavior, automated feedback with a dashboard can be integrated into the routine clinical performance evaluations of the medical residents. Nevertheless, more empirical evidence is required to confirm the effectiveness of this intervention before widespread use.

Background: Chronic heart failure (CHF) is one of the serious chronic progressive conditions with the highest incidence, mortality, and disability so that its complications can be controlled and prevented through self-care behaviors. An electronic personal health record (e-PHR) can increase patients' understanding of their level of health to improve it. Objective: This study aimed to design an e-PHR system and assess its usability for patients with CHF. Methods: This applied developmental research was conducted in 2019. Based on the literature review, a questionnaire was designed to assess and determine the data elements required for the e-PHR system of patients with CHF by 14 cardiologists and 40 nurses employed at Cardiology departments of hospitals in Iran. Then the system was designed and developed using the PHP programing language and MySQL database server and implemented on a web server. The system's usability was assessed by three cardiologists and three patients using the System Usability Scale (SUS) questionnaire and five health information technology experts using Nielsen's usability heuristics. Results: The experts approved the system design elements, including 225 data elements, such as identity information, vital signs, diet and liquids, health records, symptoms, medications, vaccination, tests, social records, physical activities, sexual activities, and travel. The most important elements in this system were social records (98.52%) and physical activities (97.53%), whereas the least important element was vaccination (80%). Patients and cardiologists gave 83.33 and 85 SUS scores to the designed system, respectively. In other words, they evaluated the system usability at a ''good'' level. Based on Nielsen's usability heuristics, the system had 30 unique problems, with overall average severity of 2.39. Conclusion: The designed e-PHR system for CHF patients obtained good and satisfactory results in usability assessment. Therefore, this web-based system can be easily employed for the condition management of patients with CHF.

Aim: to evaluate the usability of a comprehensive national health information system by the heuristic method. Introduction: Presently, information systems are widely being used in healthcare settings. Methods: Five independent evaluators assessed the user interface design of this system in terms of its compliance with a set of predetermined standard principles, also known as Jakob Nielsen's 10 general principles. Problems were reassessed in the presence of all evaluators, and similar cases were merged and a single list of unique problems was prepared. After a second assessment, the evaluators determined and categorized problem severity in five domains, including: the absence of a problem (zero point), a cosmetic problem (1 point), a minor problem (2 points), a major problem (3 points) and a catastrophic problem (4 points). Data were then analyzed in a spreadsheet using descriptive statistical tests. Results: The “recognition rather than recall” principle with 13 problems (21.3% of all cases) had the greatest frequency among all problems, while the “match between system and the real world” and “help and documentation” principles with 1 problem (1.6% of all cases) had the least frequency. Moreover, principles such as “help users recognize, diagnose and recover from errors”, “error prevention”, and “help and documentation” had a mean severity of 2.8, 2.8, and 3.4, respectively. Consequently, they were considered as catastrophic and major problems. Conclusions: Based on the viewpoint of evaluation experts, a large portion of problems in this system were classified into major and catastrophic categories, which primarily indicates the poor usability of this system. Therefore, it is highly recommended that authorities be notified of the issues in writing in order to resolve them in a future update. Finally, special consideration should be given to the meticulous evaluation of these systems during preliminary stages of design and development, so as to encounter fewer issues on a national level at the time of implementation.

One of the most commonly used methods for training is simulation. It is important to examine the effects of simulation training of health information systems on the knowledge, attitude, and skill in trainees. This review provided a summary of relevant literature on how simulation training affects the learning of health information systems and determine the features and functional capabilities of existing simulators. Studies and websites using simulation training to teach health information systems were included. Studies were searched through Medline (via PubMed), Scopus, and ISI Web of Science and websites through Google search by the end of 2019. The characteristics of studies, features, and functional capabilities of simulators and effects on learning outcomes were extracted. The included studies and websites were categorized according to different characteristics including simulation types, learning outcome categories, and the effects of simulation training on learning outcomes. The learning outcomes were categorized into four groups: knowledge, attitude, skill, and satisfaction. The effects of interventions on outcomes were categorized into statistically significant positive, positive without statistical argument, no effect (not statistically significant), negative without statistical argument, or statistically significant negative. Ten studies and eight websites that used simulation training to teach health information systems (mainly electronic health record [EHR]) were included. EHR simulation was performed in 80% of the included studies and trainees in 70% of studies were physicians and nurses. All studies were conducted in three developed countries. In the included studies, four learning outcomes (i.e. skill, attitude, knowledge, and satisfaction) were assessed. Ninety percent of the included studies assessed skill-related outcomes, with more than half mentioning significant improvement. Thirty percent of the included studies assessed outcomes-related knowledge and attitude, all of which reported the positive effects of simulation training. The simulators offered a variety of functional capabilities, while all of which simulated the clinical data entry process. In teaching health information systems, especially EHRs, simulation training enhances skill, attitude, knowledge, and satisfaction of health-care providers and students.

BACKGROUND: Hospital Statistics and Information System is one of the most important health information systems in Iran used in all hospitals in this country. Usability problems can reduce the speed and precision of users when interacting with this system. This study aimed to identify the usability problems of a national health system called “AVAB”. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted in 2020, and three experts evaluated the usability of this system independently by the heuristic evaluation method. Nielsen's usability principles were used to identify usability problems and to classify their severity. RESULTS: A total of 86 unique problems were identified. The highest number of problems were related to the two principles of “help and documentation” and “match between system and the real world” with 23 and 11 usability problems, respectively. The lowest number of problems were related to the two principles of “visibility of system status” and “help users recognize, diagnose, and recover from errors,” each with three problems. 58.1% of the identified problems were in the group of major and catastrophic problems. CONCLUSIONS: With the help of heuristic evaluation method, a significant number of usability problems of Hospital Statistics and Information System were identified. Most of the identified problems were major and catastrophic, and it is necessary to solve these problems by the designers and developers of this system.

Introduction: The optimal use of information technology in health sector requires due attention to human resources training. The purpose of this study was to determine the future of health information technology positions and professional qualifications of the employees to achieve them. Methods: This qualitative-quantitative study was conducted in 2016. A nonsystematic review of the articles published over the last 10 years was performed in well-known databases and websites using relevant keywords. Positions were extracted and then discussed using the Delphi technique in a panel of experts of 25 members including board members and faculty members of medical universities across the country. Agreed-upon positions were confirmed and job descriptions and professional qualifications were identified and compiled. An applied cross-sectional study was conducted on all health information management employees (38 people) of hospitals affiliated with Kashan University of Medical Sciences to determine the existing gap. A researcher-made questionnaire was developed based on the professional qualifications obtained for the expert panel and distributed after being checked for validity. Reliability was approved with Cronbach's alpha (0.91). Data were analyzed using descriptive statistics in terms of frequency and percentage. Results: The future health information technology positions were found to be health information management, insurance and accounting, information technology, computer applications, and data management. Professional qualifications of statistics and epidemiology, disease classification, information storage and retrieval, health data management, legal considerations and information security, information technology, and software engineering concepts were determined. The most effective qualification was knowledge of storage and retrieval methods. Employees’ skills in statistics and epidemiology were at an average level. Conclusion: New positions are constantly being introduced into the field of health information technology. Continuous curriculum revisions and additional courses for insurance and accounting, data storage and retrieval, statistics and epidemiology are essential.

BACKGROUND: In their apprenticeship program, health information technology (HIT) students are deprived of the ample opportunity to work with the hospital information system (HIS). This study aimed to design an interactive simulator for the HIS training and evaluate its effects on the informatics skills of HIT students. MATERIALS AND METHODS: This study was conducted on 16 Bachelor of Science students of HIT at Kashan University of Medical Sciences in 2019. After the functionalities and features of the simulator were determined based on similar existing simulators, expert opinions were received to simulate eight important processes of admission, discharge, and transfer module in HIS. The scores of students' skills and time taken to perform the processes were recorded and analyzed before and after the educational intervention. After they were trained by the simulator, the students filled out a usability evaluation questionnaire. The data were then analyzed in SPSS version 21. RESULTS: The simulators of health information systems were characterized by interactivity, multimedia applications, practice exercises, tests, and feedback. After the students were trained by the developed simulator, their skills scores improved significantly in 75% (6/8) of the processes, and the timespans of all processes decreased significantly (P < 0.05). The usability evaluation indicated the usability of the simulator was at a “good” level. CONCLUSIONS: According to the study results, using the simulator improves the informatics skills of HIT students in working with HIS. It is recommended that this method also be used in other apprenticeship programs to teach health information systems.

The objective of this study was to determine incidence rate, type, and pattern of clinically relevant potential drug-drug interactions (pDDIs) in a large outpatient population of a developing country. A retrospective, descriptive cross-sectional study was conducted on outpatients’ prescriptions in Khorasan Razavi province, Iran, over 12 months. A list of 25 clinically relevant DDIs, which are likely to occur in the outpatient setting, was used as the reference. Most frequent clinically relevant pDDIs, most common drugs contributing to the pDDIs, and the pattern of pDDIs for each medical specialty were determined. Descriptive statistics were used to report the results. In total, out of 8,169,142 prescriptions, 6,096 clinically relevant pDDIs were identified. The most common identified pDDIs were theophyllines-quinolones, warfarin-nonsteroidal anti-inflammatory drugs, benzodiazepines-azole antifungal agents, and anticoagulants-thyroid hormones. The most common drugs contributing to the identified pDDIs were ciprofloxacin, theophylline, warfarin, aminophylline, alprazolam, levothyroxine, and selegiline. While the incidence rate of clinically relevant pDDIs in prescriptions of general practitioners, internists, and cardiologists was the highest, the average pDDI incidence per 10,000 prescriptions of pulmonologists, infectious disease specialists, and cardiologists was highest. Although a small proportion of the analyzed prescriptions contained drug pairs with potential for clinically relevant DDIs, a significant number of outpatients have been exposed to the adverse effects associated with these interactions. It is recommended that in addition to training physicians and pharmacists, other effective interventions such as computerized alerting systems and electronic prescribing systems be designed and implemented.

مقدمه: در دهه‌ی اخیر الگوریتم‌های یادگیری ماشین به ابزار مفیدی جهت داده‌کاوی در داده‌های پزشکی، برای تولید مدل‌های پیش‌بینی تبدیل شده‌اند. سوختگي از جمله بيماري‌هايي است كه پيش‌بيني پيامد آن از اهميت زيادي برخوردار است. هدف این مطالعه بررسی عملکرد دو الگوریتم پراستفاده‌ی یادگیری ماشین یعنی شبکه‌ی عصبی و درخت تصمیم و مقایسه با روش آماری رگرسيون لجستيك در پیش‌بینی پيامد بیماران سوختگی بوده است. روش بررسی: در این مطالعه مشاهده‌ای گذشته‌نگر، پس از انجام پردازش اولیه‌ی داده‌ها و تعیین پيامد (زنده یا فوت)، دو الگوریتم یادگیری ماشین (شبکه‌ی عصبی و درخت تصمیم) به همراه روش آماری رگرسيون لجستيك برای تولید مدل‌های پیش‌بینی روی داده‌های 4804 بیمار سوختگی بیمارستان طالقانی اهواز مربوط به سال‌های 1380 تا 1386 اعمال گردید. برای پردازش اولیه‌ی داده‌ها نرم‌افزار SPSS16 و در مرحله‌ی مدل‌سازی از Clementine 12.0 استفاده شد. همچنین با به‌کارگیری تکنیک 10-Fold Cross Validation، معیارهای ارزیابی کارایی برای داده‌های تست محاسبه و مقایسه شدند. یافته‌ها: نتایج نشان داد الگوریتم شبکه‌ی عصبی با دقت 97 درصد منجر به دقیق‌ترین مدل روی داده‌های مورد مطالعه می‌شود. مدل درخت تصمیم با دقت 95 درصد در رده‌ی دوم و مدل رگرسيون لجستيك با دقت 90 درصد کم‌ترین دقت را داشت. سایر معیارهای ارزیابی مانند حساسیت (Sensitivity)، ویژگی (Specificity)، PPV (Positive Predictive Value) و NPV (Negative Predictive Value) و AUC (Area Under the Curve) نیز کارایی مدل شبکه‌ی عصبی را بالاتر از دو مدل دیگر نشان دادند. نتیجه‌گیری: تحليل نتایج این مطالعه و مطالعات مشابه نشان می‌دهند که الگوریتم‌های یادگیری ماشین نسبت به روش‌های آماری منجر به تولید مدل‌های دقیق‌تری می‌شوند. بسته به ماهیت و میزان داده‌ها و همچنین جامعه‌ی پژوهش، الگوریتم‌های مختلف یادگیری ماشین، رفتارهای متفاوتی دارند که به‌نظر می‌رسد دقت مدل‌های شبکه‌ی عصبی از سایر مدل‌ها بیشتر می‌باشد. واژ‌ه‌های کلیدی: داده‌کاوی؛ یادگیری ماشین؛ پیش‌بینی؛ درخت تصمیم؛ شبکه‌ی عصبی مصنوعی؛ سوختگی‌ها