نشریه مدیریت اطلاعات سلامت
سال هشتم شماره 4 (پیاپی 20، مهر و آبان 1390)

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Equitable access to a basic set of health services at minimum quality and affordable price is the right of every citizen and in all countries the governments have the duty to deliver these services to the population. International trade in health services influences the balance between equitable distribution of these services, creating incentives to improve the efficiency of health systems, and managing the limited financial resourcesof the governments. It also creates opportunities and challenges for health systems and communities. This paper reviewed different modes of trade in health services and investigated the opportunities and challenges resulted from this kind of trade in the selected countries of ASEAN region to make Iranian health policy makers and operators aware of trade in health sector.•

This paper was resulted from a section of an applied descriptive-comparative study about international trade in health services conducted during 2008-2010. Data was collected using digital and printed resources. The research population included 3 countries of ASEAN region, namely Malaysia, Singapore, and Thailand. The extracted information was used to generally picture the status of international trade in health services in the region and to compare the related opportunities and challenges.•

International trade in health services in the studied countries involved 4 modes including supply as cross-border supply of the services, consumption abroad (health tourism), commercial presence (foreign direct investment), and temporary immigration of persons (health professionals). The trade provides opportunities for earning revenues and promoting the quality of available health services, but it also raises challenges in competing with other countries (of ASEAN) and in accessibility and affordability of health services for the country population.•

The most important challenges the ASEAN countries face in developing trade in health services include accelerating credit provision for service providers, portability of health insurance, developing and protecting the private sector, cooperation between the public and private sectors, and expanding the trade based on relative strengths of each country in order to improve the health sector.

Nowadays, knowledge management is one of the most effective factors in competitive advantages and success among organizations. Therefore, this study aimed to assess the principles of knowledge management in teaching hospitals of Iran University of Medical Sciences.

This applied descriptive cross-sectional study included 30 senior managers in ten teaching hospitals associated with Iran University of Medical Sciences during 2009. In order to gather data, a five-point Likert questionnaire was designed by the researchers. The questionnaire had a reliability of 0.874 (Cronbach’s alpha) and its validity was approved by the experts. Finally, the data was analyzed using descriptive statistics indices (average, median, and variance).

The findings indicated that knowledge transfer (3.64), knowledge assessment (3.84), knowledge application (3.41), knowledge sharing (3.34), and finally knowledge creation (3.19) had the highest average scores. At the end, the score of knowledge management was calculated as 3.4.

Considering the applied Likert scale, knowledge management scored above average and could be regarded as desirable. Moreover, according to the results, more attention should be paid to knowledge creation and knowledge sharing.

Due to increased costs of health sector, much effort has been done to compare the performance of hospitals and measure their efficiency in recent years. The purpose of this study was to evaluate the relative efficiency of public and private hospitals in Qom during 2007 using data envelopment analysis (DEA) approach. This was an applied and analytic study. The study population included all the 8 hospitals in Qom. There was no need to assess the validity and reliability since real data and performance statistics of hospitals were used. Input variables in this study were number of general practitioners, specialist physicians, and paramedical staff, as well as number of active beds. Output variables included number of inpatients and outpatients admitted. First, input variables weighted by analytical hierarchy process (AHP) and reduced to two variables, namely number of physicians and number of active beds. Then, input-oriented CCR (constant returns to scale (CRS)) and BCC (variable returns to scale (VRS)) were used to assess the performance of Qom hospitals in 2007. After determining inefficient hospitals, efficient hospitals were ranked using Anderson-Peterson (AP) model. Expert Choice, Win4Deap and DEA-Master were used to perform the calculations. CCR model indicated 3 hospitals as efficient and five hospitals as inefficient. The final ranking of hospitals based on this model was 1. Zahra; 2. Fatemi; 3. Izadi; 4. Vali-e-Asr; 5.Masoomeh; 6. Nekooyi; 7. Kamkar; and 8. Golpaygani.However, based on BCC model, four hospitals were efficient and four were inefficient. The final ranking was 1. Zahra; 2. Vali-e-Asr; 3. Izadi; 4. Fatemi; 5. Masoomeh; 6. Nekooyi; 7. Kamkar; and 8. Golpaygani. Most hospitals are not efficient. The performance of inefficient hospitals can be improved following the patterns used by reference hospitals and also by better financial and human resources management.

• The risk of inappropriate decision making would be minimized if the managers are timely provided with accurate and adequate information. Obviously, hospital information system (HIS) plays an important role in today's rapidly changing organizations. This study was performed to assess the viewpoints of managers and network operators about the effect of HIS on the performance and processes of Imam Hossein Hospital in Shahroud during 2008.• This was an applied, descriptive cross-sectional study. Since the number of users and managers was limited (142 individuals) and due to the necessity of accurate data, all subjects were studied using census method. The participants completed a questionnaire including of 27 questions (7 general and 21 professional questions). The validity of the questionnaire was confirmed by the scientific method and its reliability was determined as 0.879 using test-retest. SPSS16 software was used to analyze the data and the results were shown as diagrams and tables.• The study population consisted of 33.1% men and 66.9% women. In addition, 64.6% of the subjects had a bachelor degree or higher. They were secretaries (9.2%), licensed practical nurses (8.5%), nurses (57.7%), headnurses and supervisors (6.9%). However, 17.7% had other jobs in operation rooms, midwifery wards, radiology, and laboratories. The average score of 71.92 (out of 100) indicated the positive attitude among the users and managers. Secretarie's attitudes scored the highest and headnurse's and supervisor's attitudes scored the lowest. There was no significant relation between attitudes average score and age, education level, sex, and number of hours worked with the network per day (P > 0.05). However, there attitudes average score and job experience were significantly related (P = 0.02).• Holding educational workshops about the use of modern information technologies in effective managemnet and presenting a feedback of the network performance with an approach on the analysis of cost-efficiency, cost- benefit and cost- effectiveness can help improve the current attitude among the users, especially managers.

• Emergency department is one of the most important hospital wards that offers emergency services to unstable patients 24 hours a day, 7 days a week. However, the way the services are offered reflects the general status of the hospital since patients with the most serious problems frequently refer to the emergency department. Emergency department waiting time is one of the indices used in evaluating hospitals. Therefore, the present study aimed to determine emergency department waiting time and to provide appropriate strategies to reduce this time at Alzahra hospital during 2009.• This was a descriptive, cross-sectional study. Observations and interviews were used to collect data. Ninety-seven patients were investigated. According to the objectives of the research, waiting time was assessed by a stopwatch, a checklist and patient records. The validity of the checklist was confirmed by the experts and hospital emergency officials. Descriptive and inferential statistics were used. The data was analyzed by SPSS.• The mean waiting time(from entrance to the emergency department until the final visit) in the screen was 8.41 ± 5.19 minutes. About 74.2% of patients waited for less than 10 minutes. Patients had to wait for their order to be checked by the admission nurses, as the first clinical practice, for an average of 48.72 ± 42.53 minutes. The mean waiting time from the physician's order until admission to the paraclinical units including electrocardiography, radiography, CT scan, sonography and laboratory, was 59.2 ± 46.26 minutes. The mean length of stay in the emergency department was 353.1 ± 249.2 minutes. However, 39% of patients stayed less than 4 hours. T-test revealed significant relations between the type of disease (internal diseases, surgery) and waiting time at electrocardiography (P = 0.02) and sonography (P = 0.04) units.• Since the screening was done for patients without any particular prioritization, it is necessary to establish a triage system in the emergency department of Alzahra hospital. Comparing mean waiting times to receive paraclinical services demonstrates the gap between the present status and available standards and highlights the serious need for paraclinical service process improvement. In order to prevent overcrowding, proper strategies are required to be used including prioritizing beds for emergency and non-emergency hospitalization, having an admissions coordinator, following the 30-minute rule, establishing a holding unit, direct admission of the patients, and scientific review of the number of CCU and ICU beds.

Collection development is a process to identify the strengths and weaknesses of the collection of a library based on the needs of the users which plays an important role in the of information systems management. The present research aimed to compare the process of collection development in the libraries of Isfahan University and Isfahan University of Medical sciences to recognize the problems faced by their executive managers and to offer suggestions for optimizing the process in the two aforementioned libraries.

This descriptive survey was conducted in 2009 and included 2 central, 15 school, and 12 department libraries, as well as 10 libraries belonging to therapeutic educational centers and 1 library associated with research centers. All mentioned libraries were supervised by Isfahan University and Isfahan University of Medical Sciences. Data was collected by distributing a questionnaire among mangers of the 40 studied libraries and also interviewing with the managers of central libraries in the two universities. After face and content validity of the questionnaire were evaluated, its reliability was determined by Cronbach's alpha coefficient (86%). Data analysis was done using descriptive and inferential statistical methods (chi-square test) in SPSS15 and Microsoft Excel.

Research findings showed that in more than 70% of the studied libraries, less than 25% of necessary resources were provided using ways other than purchasing. In addition, only 17.5% of the libraries in the two universities had written collection development guidelines. In the collection development field, the libraries faced problems regarding writing collection development policies and also implementing the written policies.

Considering the problems in writing collection development policies in the studied libraries, a pattern needs to be provided to optimize the process.

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This article intends to compare information literacy of International Branch students with Nursing students of Jundi Shapur University of Medical Sciences – Abadan Branch.•

This research is of survey-descriptive type which has been conducted using a questionnaire to collect the data. The population studied included 222 students studying at the international branch and nursing school of Jundi Shapur University of Medical Sciences -Abadan Branch.•To analyze the data, SPSS13 was used. Descriptive analysis including frequency, prevalence, average and standard deviation as well as analytical statistics ANOVA, T-test and Tukey were implemented.•

The findings showed that International Branch students enjoy a higher level of information literacy than nursing students. However, in general, the subjects enjoy an average level of information literacy and that there is no significant difference between the information literacy levels of freshmen and senior students. Other findings suggest that the subjects were at an average level in finding their required information resources in the library, as well as using computer and other accessories.•Self-confidence in seeking information, assessment of retrieved information and self-satisfaction from the results of their searches and the ability to seek help from a librarian were all at an average level. However, the students stood at a low level as to finding their required information on the internet and using logical operators. The subjects used books more than any other information sources, and information networks stand as the first channel for seeking information.•

Since information literacy of the population was at an average level, planning for educational programs to promote information literacy of students is essential.

• Since prescription is a way of communication between the pharmacist, physician and patient, inattention to its principles may result in mis-consumption or incomplete use of the medicine, drug interactions, and increased probable adverse effects. Therefore, this research tried to investigate physician's commitment to principles of prescription writing for outpatients insured by Medical Services Insurance Organization in Kashan.• This cross-sectional descriptive study was performed on prescriptions of 1500 outpatient insured by Medical Services Insurance Organization in Kashan during 2007. The patients were selected by systematic random sampling. Data regarding legibility, pharmaceutical form, directions for consumption, physician and patient's identity were collected from the prescriptions. The data was then registered in a checklist prepared based on the World Health Organization (WHO) guidelines. By scoring the prescriptions between 0-21 they were divided into five categories of very weak, weak, moderate, good, and very good. Finally, the data was analyzed by descriptive statistics.• The prescriptions included 5245 drugs, 4661 (88.86%) of which were legible. Pharmaceutical form and directions for use were mentioned for 3807 (72.58%) and 2750 (52.44%) of the prescribed drugs, respectively. The average score of commitment to principles of prescription writing was determined as good (15.01). Moreover, dermatologists scored the lowest (12.18) and psychiatrists the highest (16.29).• Although physicians are acceptably committed to principles of prescription writing, they may need to pay more attention to recording directions for use. Therefore, employing prescription computer software packages in physician's offices, preparing new forms with specific places to make sure all necessary information is cited, including more units regarding practical prescription writing in the curriculum of medical students, and persistent retraining for physicians are suggested.

• Since users have a critical role in the success of a hospital information system, and also considering software companies as information system service providers-not only product sellers, this study was conducted to evaluate the hospital information system (HIS) software based on user requirements in Iran.• Through a descriptive study, 5 vendors, which had the best selling software products among the university hospitals, were selected. According to the defined criteria, HIS software products were evaluated based on a checklist and through observation in 8 hospitals. The primary checklist was developed after reviewing literature, and the catalogues/brochures provided by HIS vendors. It was then modified according to the viewpoints of end users and experts. Test-retest was used to confirm the validity of the checklist. In addition, a pilot study was conducted to evaluate the reliability of the checklist. Data was collected by means of direct observation and interviewing the uses and heads of IT departments at hospitals. In order to analyze the data descriptive statistics was used in SPSS.• Although Boo-Ali company had the highest rate of user satisfaction (67%), it could not efficiently meet an average rate of 58.6% of user's needs (medical records (74.5%), pharmacy (58.6%), laboratory (74.5%), nursing (23.3%), radiology (51.4%), and financial (65.4%)). Minimum user requirements (29%) were met by Qeshm Microware (29%). However, the highest satisfaction rates in pharmacy (58.6%), laboratory (69%), and nursing (60%) belonged to this company.• None of the HIS software products could completely meet the end user's expectations in all fields. This may be a result of poor user participation in the designing process. It can be concluded that Iran is still taking its first steps in HIS designing and since users are of utmost importance in the process, using a comprehensive approach based on organizational goals and workflow and user requirements seems necessary.

Since increasing the number of indexing and abstracting services covering a journal would increase the total citations received by the journal, this study tried to investigate the reasons why Iranian journals are not indexed by foreign databases including ISI Web of Science and Scopus. This was a descriptive and interpretative study resulting in guidelines for Iranian editors and authors. It also made the comparison between Iranian journals possible. The results of the study showed that Iranian journals are not well-indexed by foreign databases and search engines due to lack of standard interfaces, low-quality content, delay in publication and poor review. Editors of Iranian journals should consider international journal publishing standards and ask foreign indexing and abstracting services (ISI Web of Science, Scopus, etc.) and search engines (for example Google Scholar) to index Iranian journals.

• Hospital information system (HIS) is a computerized system which is used as an electronic tool for patient information management and plays a significant role in providing quality health care services. Therefore, HIS user's satisfaction about the quality of the services offered is crucial in assessing and more importantly improving the technical aspects of the system. On the other hand, user's dissatisfaction can affect costs and health care quality. Thus, the present study tries to evaluate user's satisfaction about the quality of HIS in hospitals associated with Kermanshah University of Medical Sciences.• This applied, descriptive cross-sectional research was conducted on 80 users of two hospitals with HIS in Kermanshah during 2007. Simple and availability sampling methods were used. A questionnaire was designed for data gathering. The reliability and validity of the questionnaire were confirmed by test-retest (r = 0.80). SPSS was used for descriptive data analysis.• The findings indicated relative satisfaction levels among 39.3%, 36.9%, and 38.2% of the users about the quality of HIS interfaces, quality of HIS functions, and the quality of HIS information, respectively. In addition, 30.4% of the users were slightly satisfied with the quality of HIS performance. In general, 34.9% of the users considered the quality of HIS as satisfactory.• Based on our findings, the general reasons for low satisfaction levels among the users about the quality of HIS were lack or absence of education about HIS for users, absence of medical staff in HIS support teams and existence of manual processes.

• In order to fulfill the health and medical needs of rural people, Iran's Medical Services Insurance Organization approved a plan to provide rural health insurance in 2005. The plan aimed to make an appropriate context for the activities of private health care service providers in the rural areas and to meet public expectations for access to specialized medical services. In this study, rural health insurance was evaluated using the general justice index.• This was a analytical study which used the comparative method to assess rural health insurance scheme based on general justice. The study compared the average health and medical costs of rural families in three different provinces in 2004 (the year before the project), 2006 and 2007 (after the plan was implemented).• Although the rural health insurance plan was expected to significantly lower the average health and medical costs of rural households (as an index to assess the project based on general justice), our results did not reveal such a reduction.• A major expectation from the rural health insurance plan was to improve rural general justice. However, this study could not confirm a significant improvement in general justice due to implementation of the plan.

Knowledge serves as the most essential career point and is more important than facilities and equipments. Since many companies are destined to vanish unless they are innovative, the ability to learn, change and adapt seems to be vital. Therefore, this study evaluated the performance of Hashemi Nejad Hospital in 2007 based on the measurement, analysis, and knowledge management category of Malcolm Baldrige criteria. This was a descriptive cross-sectional study. Malcolm Baldrige checklist (2006), whose validity and reliability have been confirmed before, was used to collect data. The study was conducted in Hashemi Nejad Hospital, an educational hospital in Tehran affiliated to Iran University of Medical Sciences. Data was collected by interviewing chief managers of the hospital, studying the records and documents in each criterion, and separately filling the checklist related to both education and health fields. The data obtained from all phases was analyzed qualitatively using descriptive statistics. Knowledge management criteria included 90 points out of which Hashemi Nejad Hospital scored 40 (44%) in treatment and 18 (20%) in education fields. In the treatment field, 21 (52.5%) points belonged to measurement, analysis, and review of performance and 19 (47.5%) scores belonged to information and knowledge management. In the educational aria, 14 (78%) belonged to measurement, analysis, and improvement of organizational performance and 4 (22%) belonged to information management and information technology. According to Likert’s method, the hospital’s performance in medical and educational fields scored average and weak, respectively. These results indicate the necessity of paying more attention towards knowledge management, especially in educational area. Therefore, an effective and efficient program to improve knowledge management in this hospital seems essential. Based on our findings, Barldrige’s model can be applied as a comprehensive model for evaluating the performance of knowledge management of medical-educational institutes.

• Successful interaction between people requires motivation and social influence. Therefore, the purpose of the present research was to study the relationship between the 11 indices of social influence of heads of departments from the viewpoint of faculty members at Isfahan University of Medical Sciences and its relation with demographic characteristics in academic year of 2008-2009.• This was a descriptive-correlational study. Stratified sampling was used to select 104 individuals from all faculty members (645 people) of Isfahan University of Medical Sciences in the educational year of 2008-2009. To collect data, Yukl's influence behavior questionnaire (2003) with 44 five-point items considering demographic characteristics (sex, age, marital status, education, and management experience) was used. The reliability of the questionnaire was calculated to be 0.83. Cramer correlation coefficient was used to analyze the data.• Findings of correlation coefficient did not show a significant relation between social influence indicators and demographic characteristics except for management experience.• It can be concluded that an increase in the management experience among faculty members would lead to an increased use of influence indicators by the managers.

• Voluntary counseling and testing (VCT) for HIV infection is a confidential service offered to individuals in the community. This study intended to present a pattern for regional surveillance of VCT services in Iran.• This was an applied descriptive study. At first, the existing regional VCT surveillance in 2009 was investigated through visiting the Clinical Deputy of Medical Sciences Universities, interviewing, considering the available forms and documents, and application of checklists. Then, the regional VCT surveillance of some selected countries including the USA, the UK, and Australia were studied. The next step was to design and poll a pattern (using Delphi method) based on Iran's requirements. The validity and reliability of the related tools were confirmed using the content validity method and test-retest method, respectively. The descriptive theoretical analysis of data was performed via a comparison between the studied countries.• Considering the current situation of Iran and lack of a comprehensive system, the investigators used the guidelines of the WHO and experiences in the US, the UK, and Australia to present a pattern for regional VCT surveillance. The pattern consisted of four aspects including data collection and reporting, data clarification, data analysis, and data distribution. Delphi method showed an agreement rate of 38.1 out of 44 (86.6%) and therefore confirmed the pattern.• Since the VCT centers collect most HIV-related data, a comprehensive knowledge about their services and outcomes can have a significant role in designing and improving HIV/AIDS interventions and strategies. Considering the fact that the prevalence of the disease differs in various provinces and regions of the country, clarification, analysis and publication of regional data are highly important.

• Since health is one of God's great bounties bestowed on human, he should attempt to keep it especially in today's machine life. Therefore, people have to be educated before any kind of disease occurs. This study aimed to analyze the contents of secondary school textbooks regarding health education indices such as skin health, oral hygiene, nutrition, sports and physical activity, diseases (including HIV/AIDS), and smoking and drug abuse.• This descriptive study used Shannon entropy for content analysis. The analysis unit included pages of secondary school books (including texts, questions, exercises, and pictures) during the educational year of 2008-2009. Totally, 15 books containing 1915 pages were included. In order to confirm the reliability, available resources were used to select health information- and education-related components and indexes. The extracted indices and components were then studied by a number of physicians, health experts and managers and their viewpoints were considered to improve the research.• The highest and lowest frequency and importance coefficient were related to sports and physical activity (14 cases) and smoking and drug abuse (no cases were found), respectively.• Curriculum is the basic approach and strategy in health promotion among students. Hence, the school books should emphasize essential health-related education. However, unfortunately, some aspects of health information have been overlooked in secondary school textbooks.