نشریه مدیریت سلامت
پیاپی 89 (پاییز 1401)

“Information and Communication Technology (ICT) governance” was introduced in developed countries in the late 1990s and replaced ICT management. In addition to the separation of the ICT responsibilities between different units/levels, ICT governance allowed universities to develop mechanisms for monitoring ICT decisions in line with the University's vision, mission, and strategic goals through the distribution of the decision-making rights to various stakeholders. This study aimed to investigate the ICT management challenges in the university under study and explore the need for ICT governance.

This is a qualitative-descriptive case study conducted in the three stages of preparation, identification, and analysis and prescription in one of the universities of medical sciences in Tehran (from November to December 2021).  Semi-structured interviews based on judgmental purposeful sampling and FGDs were used for data collection, and qualitative content analysis in ATLAS-ti software was used for data analysis.

Structurally, the only macro-policymaking body in the ICT field is the ICT council, which is inefficient in providing general direction and standards. In terms of processes, it lacks a mission and a long-term plan, and it has failed to integrate the university and ICT decisions, as well as steering decisions toward the university's goals. In terms of relational mechanisms, it hasn't been able to create a unified procedure in the implementation of ICT policies by creating a common language between ICT and the owners of the main processes in the university.

To get out of the current situation, the university needs serious changes in the ICT structure and the university users’ approach to ICT. These changes require the adoption of an indigenous ICT governance model tailored to the current and future problems and needs of the university toward full integration.

Today, one of the ways to provide healthcare services and achieve the goals of health systems is the participation of nongovernmental organizations (NGOs) in the health sector. The purpose of this study is to develop a model for the partnership of NGOs in Iran’s health system.

This qualitative study was conducted in three consecutive stages, between 2018-2021. In the first phase, by reviewing documents, literature, and interviews with 32 key informants from the Ministry of Health, Ministry of Interior, universities of medical sciences, medical scientific associations, and health-related NGOs, using content analysis, the current status of the partnership of NGOs in Iran’s health system was examined. In the second stage, the initial model for NGOs partnership in Iran’s health system was extracted and surveyed by an expert panel consensus. In the third stage, after two rounds of the Delphi technique with a consensus of more than 75%, the final model was approved.

Policy-making and planning, capacity building, provision of resources and facilities, organization and coordination, participation, and control and evaluation, are the six main dimensions of the model of NGOs’ partnership in Iran's health system.

It is expected that the main dimensions and sub-components of this model can help to develop and strengthen the role of NGOs in the Iranian health system. More participation of the NGOs in the health system facilitating the achievement of the goals of the health system and is effective to strengthen and improve public health.

Managers need to evaluate the performance of their subordinates in order to plan, organize, and improve the performance of their organizations. In this study, the performance and efficiency of the district's primary health care (PHC) system in the southeast of Iran were evaluated using the data envelopment analysis (DEA) model.

In this study, the efficiency of 9 cities affiliated to Kerman University of Medical Sciences was analyzed in 2019. The quantitative non-parametric DEA was used to evaluate the performance of the PHC system in the districts. Human forces, physical facilities, and vehicles were the variables used as the inputs, and the number of services and service recipients was considered as the outputs to measure efficiency. Data collection was done in the field using a checklist. The data were analyzed using the DEAP 2.1 software, efficiency was calculated with the output maximization approach and the assumption of variable returns to scale. It was carried out as linear programming with nine scenarios for nine districts in 2018.

The mean efficiency of the studied districts with the assumption of variable returns to scale was 0.68, indicating at least 32% capacity to increase efficiency in the studied PHC systems without any increase in production factors. According to the mean values, Kerman was efficient while the other 8 districts were inefficient. The most inefficient PHC systems were those of Shahr-e Babak, Baft, and Orzooieh.

Inefficiency in most PHC systems of the studied districts, indicating that PHC managers can provide more health services to the community through proper management of available resources. Inefficient districts can compare themselves with successful and reference districts to eliminate their shortcomings and improve their performance.

Hospitals now face the critical challenge of figuring out how to use healthcare information technology (IT) to raise the caliber of healthcare services as a result of the recent, rapid increase of medical information. Therefore, the current study was carried out with the intention of evaluating the attitude of the staff of the Baghdad teaching hospital, who are the most significant users of IT systems in the field of healthcare, in order to assess their readiness to embrace such systems.

Using a researcher-made questionnaire that included inquiries about the impact of IT on therapeutic, educational, research, and administrative activities, this descriptive-cross-sectional study was carried out in the first half of 2022 and examined the perspectives of 461 employees (using stratified sampling) of the Baghdad teaching hospital regarding the effects of IT in the healthcare system. The questionnaire's reliability was assessed using the split-half approach, and the correlation coefficient was 96%. The comments of various medical experts were also used to assess the validity of the questionnaire. The data was then examined using descriptive and analytical statistics with the aid of the SPSS 23.0.

In regards to the impact of IT on enhancing health, the research community as a whole—of which 39.7 percent of women and 60.3 percent of men in both clinical and administrative groups—had a positive attitude, scoring an average of 411.6.

The optimistic outlook of the research community demonstrates that the investigated hospital is appropriate for the introduction and advancement of IT.

Integrated health system (SIB) is a common electronic health records, widely used in Iranian healthcare centers. The present study aimed to investigate the usability of this system among selected users.

A descriptive-analytical study was designed and conducted in 2021 with participation of 196 healthcare workers. Usability of the system was tested by means of the System Usability Scale (SUS) and the IsoMetric Standard Questionnaire. Data analysis was applied using SPSS version 26 software.

SUS showed a marginal usability for the system. All the 7 dimensions of the isometric questionnaire were found to be within the relatively favorable range with an average score of 3.1 to 3.2. SIB system was unacceptable for 30.6% of users, marginaly acceptable for 45.4%, and acceptable for 23.9% of users. Results showed a significant but inverse relationship between usability of the system with the average time past on it during a working day (p<0.039). Women estimated this system as more usable compared to men (p = 0.007).

The present study emphasized that SIB system needs specific considerations to become more usabile, and compatible with ergonomic dialogue principles. The most effective modifications would be included eliminating complicated steps, harmonizing relevant process, reducing memory-based process, individualization, error tolerancy, and user-centered design.

Electronic prescription has been implemented in many countries and the first use of this technology was in outpatient care. In this study, perspective of physicians and pharmacists working in private and public sector (social security organization affiliated clinics) in Guilan province were studied.

This study was performed in 2021. The questionnaire was developed using a literature review and evaluated in terms of reliability and validity. The final questionnaire (9 dimensions and 31 questions) was distributed electronically among all private and public physicians and pharmacists (social security organization affiliated clinics) in Guilan province. 405 people (268 physicians and 137 pharmacists) answered the questions. The data were analyzed via descriptive analysis using SPSS version 26.

Mean of dimensions included actual use (3.41), social influence (3.09), behavioral intention (3.05), expected effort (2.96), habit (2.93), trust (2.91), expected performance (2.81), facilitating conditions (2.62) and price value (2.55). The score of price value indicted that participants believed that the cost and benefits of the system is not balanced. The score of facilitating conditions showed that users did not have adequate financial, human, educational and supportive resources.

According to results, electronic prescription system was not considered a useful technology based on the participants’ perspectives. Barriers, vendors’ cooperation to improve the system, government’s legal and regulatory support should be considered to remove adoption barriers and improve electronic prescription system in ambulatory settings.

Anticoagulation therapy is one of the most important strategies for preventing clot formation and subsequent stroke, with warfarin representing the most widely used oral anticoagulant. However, predicting the outcomes of warfarin administration poses a major challenge for physicians because of the narrow boundary between the therapeutic and toxic levels of warfarin. Clinical decision support systems (CDSSs) can be used as a tool to improve both adherence to clinical guidelines and transfer of evidence-based knowledge to daily clinical practice for dose adjustment, thereby helping reduce medical errors. The aim of this study was to develop a prototype CDSS for predicting warfarin doses according to computerized clinical guidelines.

This applied developmental study involving a qualitative design was conducted in two major steps.First, computer-interpretable guidelines were extracted from existing clinical guidelines as a workflow diagram for warfarin therapy and were subsequently evaluated by an expert panel. Second, a prototype CDSS was designed with PHP programming language and SQL database, and Nielson’s heuristic evaluation checklist was used for usability testing.

In the first step, the findings were presented in two main workflows and two sub-workflows. In the second step, a prototype CDSS was designed. The overall usability of the prototype was found to be at a "relatively acceptable" level, with a rating percentage of 92.09.

The usability evaluation results suggest that CDSSs similar to the one presented herein could serve as valuable clinical decision support tools for estimating warfarin dosage. These promising results call for further research aimed at exploring the feasibility of implementing such systems in clinical settings.

Clinical coding is a complex and error-prone process. Correct clinical coding requires high-quality documentation of medical records. This study aimed to identify the quality of medical records documentation and the accuracy of coding with ICD-10 compared to ICD-11.

This cross-sectional descriptive study was conducted in 2022. The samples were chosen from 11638 medical records of patients admitted at the Shahid Mohammadi teaching hospital with the diagnosis of injury, poisoning, and certain other consequences of external causes. Using Cochran's formula, 500 medical records were evaluated. The research was conducted in two stages to check the accuracy of coding and the defects in the documentation of medical records for coding. The research data collection tools were separate checklists for each stage. Data were analyzed using descriptive statistics in SPSS software.

The number of codes allocated to the studied medical records was 1673 and 1468 codes based on ICD-10 and ICD-11 classification systems, respectively. The majority of records (98%) had at least one type of major or minor error, 23% had only major errors, 46% had only minor errors, and 31% had both types of ICD-10 coding errors. Moreover, 81% and 26% of the medical records contained adequate information to fully or relatively fully describe the codes using ICD-10 and ICD-11 classification systems, respectively.

Compared to ICD-10, there were more defects in the documentation of medical records for coding with ICD-11. Development written documentation guidelines by ICD-11, using templates and reminders, and providing feedback to healthcare providers. Using automated coding support tools, coding audits, and continuous training of coders are essential for coding quality improvement.