Physicians' Perspectives with the E-prescribing System in Five Teaching Hospitals.

OBJECTIVES: Despite the evidence suggesting the potential of electronic prescribing (e-prescribing), this system also faces challenges that can lead to inefficiency and even failure. This study aimed to evaluate physicians' perspectives on the efficiency, effectiveness, opportunities, and challenges associated with the e-prescribing system. METHODS: In 2023, a descriptive analytics cross-sectional study was carried out. Due to the finite population size, all the physicians from five studied hospitals who agreed to participate in the study were included through the census method (n = 195). Data collection was conducted using a validated questionnaire. Data were analyzed using descriptive (mean, standard deviation, and frequency) and analytical (Pearson's correlation coefficient, two-sample t-test, one-way analysis of variance (ANOVA), and linear multiple regression model) statistics. RESULTS: The mean scores of efficiency and effectiveness were 47.47 ± 14.46 and 36.09 ± 10.67 out of 95 and 65, respectively. Removing the illegibility of the prescriptions (n = 22) was the most frequent opportunity and internet connectivity problem (n = 37) was the most frequent challenge associated with the e-prescribing system. There was a strong positive significant correlation between efficiency and effectiveness (r = 0.850, p < 0.01). Moreover, age was found to have a significant negative correlation with efficiency (B = -7.261, p = 0.004) and effectiveness (B = - 5.784, p = 0.002). CONCLUSION: Physicians believe that e-prescribing enhances the efficiency and effectiveness of their work. There are many opportunity and challenges to the use of e-prescription. Assessing the needs of physicians, actively participating and training them in the stages of design and implementation, and conducting regular evaluations of the e-prescribing system are crucial to overcome the challenges. Our finding offers insightful information about how doctors see the e-prescribing system at teaching hospitals and provide a basis for managers and policy makers at the local and national levels to support the implementation of this system and plan for improvement of its shortcomings.

Patients' perceptions, experiences, and satisfaction with e-prescribing system: A cross-sectional study.

INTRODUCTION: Electronic prescribing (e-prescribing) systems have the potential to increase the quality of care and reduce costs. Officially, since 22 December 2021, e-prescribing has been mandated in Iran. This study aimed to investigate the patients' perceptions about the e-prescribing system. METHODS: A descriptive-analytic cross-sectional study was conducted in 2023. The study sample comprised 394 patients who were referred to the pharmacies of five teaching hospitals. The sample size was estimated using Cochran's formula. Data collection was performed using a researcher-made questionnaire. The data were analyzed using descriptive (mean, standard deviation, frequency, and percentage) and analytic (Pearson and Spearman correlation, One-way ANOVA, and two-sample t-test) statistics. RESULTS: About 85 % of the patients were aware of the e-prescribing system, and 70 % of them preferred the e-prescribing. Almost 57 % of the patients believed that e-prescribing did not impact their medication adherence. The mean score of patients' satisfaction with e-prescribing, patients' attitude toward e-prescribing, and the impact of e-prescribing on patient care was 3.91 ± 0.046, 3.45 ± 0.028, and 3.10 ± 0.050 out of 5, respectively. There was a significant fair correlation between the impact of e-prescribing on patient care and patients' attitude towards e-prescribing. Additionally, there was a significant but poor correlation between patient satisfaction with the impact of e-prescribing on patient care and patients' attitude toward e-prescribing (P < 0.05). CONCLUSION: The majority of the patients demonstrated awareness of the e-prescribing system and expressed a preference for electronic prescribing. Patients reported overall positive satisfaction, as well as relatively positive perceptions and experiences with the evaluated e-prescribing system. From the patients' perspective, receiving the e-prescribing tracking code through SMS was the most popular method for tracking their prescriptions. A greater focus on patient engagement and considering their requirements and needs in the system are crucial to improve the delivery of patient-centered care.

Prevalence of maternal mortality causes based on ICD-MM: a systematic review and meta-analysis.

BACKGROUND: Maternal mortality is a universal public health challenge. ICD-Maternal Mortality (ICD-MM) was introduced in 2012 to facilitate the gathering, analysis, and interpretation of data on maternal deaths worldwide. The present study aimed to estimate the global prevalence of maternal death causes through a systematic review and meta-analysis. METHODS: A systematic literature search was conducted using various databases, including Web of Science, PubMed, Scopus, ScienceDirect, Cochrane Library, as well as Persian databases such as MagIran and Scientific Information Database (SID). The search encompassed articles published until August 21, 2022. Thirty-four eligible articles were included in the final analysis. Analysis was performed using a meta-analysis approach. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, and random effects models with Mantel-Haenszel methods were employed using the STATA software version 14.2. RESULTS: The most prevalent causes of maternal deaths, listed in descending order from highest to lowest prevalence, were non-obstetric complications (48.32%), obstetric hemorrhage (17.63%), hypertensive disorders of pregnancy, childbirth, and the puerperium (14.01%), other obstetric complications (7.11%), pregnancy with abortive outcome (5.41%), pregnancy-related infection (5.26%), unanticipated complications of management (2.25%), unknown/undetermined causes (2.01%), and coincidental causes (1.59%), respectively. CONCLUSION: Non-obstetric complications, obstetric hemorrhage, and hypertensive disorders of pregnancy, childbirth, and puerperium were the most common causes of maternal deaths. To reduce the burden of maternal mortality causes, increasing awareness and promoting self-care management among women of reproductive age, and implementing effective screening mechanisms for high-risk mothers during pregnancy, childbirth, and the puerperium can play a significant role. ICD-MM enables the uniform collection and comparison of maternal death information at different levels (local, national, and international) by facilitating the consistent collection, analysis, and interpretation of data on maternal deaths. Our findings can be utilized by policymakers and managers at various levels to facilitate necessary planning aimed at reducing the burden of maternal mortality causes.

Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review.

INTRODUCTION: Burns are global public health devastating and life-threatening injuries. Telehealth can be an appropriate answer for the effective utilization of health care resources, prevention referrals and reduce socio-economic burden of burns injuries. Thus, this study aimed to systematically evaluate the applications, opportunities, and challenges of using telehealth in burn injuries management. METHODS: A structured search was conducted according to PRISMA statement guidelines in the Web of Science, PubMed, Scopus, and Science Direct as well as the Google Scholar for studies published until June 28, 2022. Of the total 2301 yielded studies, 36 articles were included in the final review. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS: Patient triage, transfer, and referral (38.9%) follow-up (22%), care (22%), consultation (9%), education (3%), and rehabilitation (3%) were the most prevalent application of telehealth, respectively. Our findings identified 72 unique concepts, eight initial themes, and two clinical and administrative final themes for opportunities of using telehealth in burn injury management. Furthermore, we identified 27 unique concepts, three initial themes, and two clinical and administrative final themes for remaining challenges. CONCLUSIONS: Despite providing pivotal opportunities such as improving burn injury diagnosis and quality of care, increasing patient and provider satisfaction, and cost containment using telehealth in burn injuries management, the concept faces challenges such as the impossibility of the physical examination of patients and technological difficulties. Our findings provide valuable information for policymakers and decision-makers infield of burn injuries and effective planning for using telehealth technology.

Security, confidentiality, privacy and patient safety in the hospital information systems from the users' perspective: A cross-sectional study.

INTRODUCTION: Patient safety maintenance and improvement is an expected core function of Hospital Information Systems (HISs). Patient safety can be affected by the privacy, confidentiality, and security of patient information. This study aimed to evaluate the security, confidentiality, privacy, and patient safety in the HISs from the users' perspective. METHODS: A descriptive, analytical, cross-sectional study was conducted in five teaching hospitals affiliated with Zahedan University of Medical Sciences in 2022. The research population consisted of users of HISs in the nursing, medical records, radiology, laboratory, and pharmacy departments. The sample included 397 participants. The data were collected using a researcher-made questionnaire and analyzed with the SPSS software using descriptive (mean, standard deviation, frequency, and percentage) and analytical (Pearson, Spearman, and chi-square tests) statistics. RESULTS: The mean score of patient information privacy, confidentiality, security, and patient safety was 3.19 ± 0.585, 2.48 ± 1.143, 2.53 ± 0.940, and 2.60 ± 0.959, respectively. Patient safety had a strong positive correlation with security and confidentiality, and a moderate positive correlation with patient information privacy (P < 0.05). CONCLUSION: The given HISs were at a relatively desirable level in terms of information privacy, security, and patient safety and at an undesirable level concerning confidentiality from the users' perspective. Developing guidelines and regulations regarding the privacy, confidentiality, security, and patient safety of HISs, supervising their implementation by responsible agencies and departments, and educating and training healthcare professionals about these concepts are essential to improve the existing situation in HISs of the evaluated hospitals.

Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran.

BACKGROUND: Due to the chronic, progressive, and debilitating nature of breast cancer-related lymphedema (BCRL), it is necessary to observe and maintain self-care management accordingly. This study was conducted to develop a mobile application based on the Android operating system for self-care management of Iranian patients with BCRL. METHODS: An applied developmental study was conducted in 2020. The users' information needs assessment as well as design, development, implementation, and evaluation of the mobile app for self-care management of patients with BCRL was done by searching the literature, reviewing the existing mobile applications, and surveying the users' needs. The mobile app was designed using the Android Studio environment and Java programming language in the Android operating system. The usability of the app was evaluated by 30 patients with BCRL using the questionnaire for user interface satisfaction-seventh version (QUIS 7). RESULTS: The mobile app for BCRL included demographic information, clinical information, lifestyle and system functions (drug use, nutrition, exercise, smoking cessation, communication, and test time reminder). User usability evaluation of the app content and functions confirmed that it was appropriate and satisfactory for the self-management of women with BCRL. CONCLUSION: The mobile app was appropriate in terms of the content, function, and quality for improving the patients' lifestyle and education and self-management of BCRL symptoms according to its usability evaluation from the end-users' (patients) perspective. It is suggested that studies should be performed to confirm the effectiveness and identify the clinical significance of the app.

Quality of death certificates completion for COVID-19 cases in the southeast of Iran: A cross-sectional study.

Background and Aim: Death certificate (DC) data provides a basis for public health policies and statistics and contributes to the evaluation of a pandemic's evolution. This study aimed to evaluate the quality of the COVID-19-related DC completion. Methods: A descriptive-analytical study was conducted to review a total of 339 medical records and DCs issued for COVID-19 cases from February 20 to September 21, 2020. A univariate analysis (χ 2 as an unadjusted analysis) was performed, and multiple logistic regression models (odd ratio [OR] and 95% confidence interval [CI] as adjusted analyses) were used to evaluate the associations between variables. Results: Errors in DCs were classified as major and minor. All of the 339 examined DCs were erroneous; more than half of DCs (57.8%) had at least one major error; all of them had at least one minor error. Improper sequencing (49.3%), unacceptable underlying causes of death (UCOD) (33.3%), recording more than one cause per line (20.1%), listing general conditions instead of specific terms (11.2%), illegible handwriting (8.3%), competing causes (6.2%), and mechanisms (3.8%) were most common major errors, respectively. Absence of time interval (100%), listing mechanism allying with UCOD (51.6%), using abbreviations (45.4%), missing major comorbidities (16.5%), and listing major comorbidities in part I (16.5%) were most common minor errors, respectively. Conclusion: The rate of both major and minor errors was high. Using automated tools for recording and selecting death cause(s), promoting certifiers' skills on DC completion, and applying quality control mechanisms in DC documentation can improve death data and statistics.

Death certificate errors in three teaching hospitals of Zahedan, southeast of Iran.

Accurate completion of death certificates is of critical importance for public health policy and statistical purposes. In assessing 936 available death certificates, most contained one or more errors. Minor errors (e.g. absence of time intervals) were more common than major errors (e.g. the use of general terms instead of specific conditions). Providing education, complying with standards established by the World Health Organization, applying quality control of death certificates, and correcting deficient death certificates in the hospitals seem necessary to inform the effectiveness of public health programs, future health policies, quality health planning, and prioritization of health and medical research programs.

Affecting factors of cloud computing adoption in public hospitals affiliated with Zahedan University of Medical Sciences: A cross-sectional study in the Southeast of Iran.

OBJECTIVE: Health care organizations require cloud computing to remain efficient and cost-effective, and provide high-quality health care services. Adoption of this technology by users plays a critical role in the success of its application. This study aimed to determine factors affecting cloud computing adoption in public hospitals affiliated with Zahedan University of Medical Sciences. METHODS: A cross-sectional descriptive and analytic study was performed in 2017. The study population comprised information technology and hospital information system authorities and hospital information system users. The sample consisted of 573 participants. The data were collected using a questionnaire and analyzed with the Statistical Package for Social Sciences software using descriptive and analytical statistics. RESULTS: The mean score of environmental, human, organizational, technological, and intention dimensions of cloud computing adoption was 3.39 ± 0.81, 3.27 ± 0.63, 3.19 ± 0.71, 3 ± 0.43, and 3.55 ± 1.10, respectively. Furthermore, a significant positive relationship was found between intention of cloud computing adoption and environmental (R = 0.521, p = 0.000), organizational (R = 0.426, p = 0.000), human (R = 0.492, p = 0.000), and technological dimensions (R = 0.157, p = 0.000). CONCLUSIONS: Benefits of cloud computing adoption, relative advantage, and competitive pressure were identified as the most influential factors in accepting cloud computing. Simplifying the users' understanding of this technology and its application, improving the staff's technical capabilities, promoting executive managers' understanding of the nature and functions of cloud computing, and fully supporting and increasing governmental mandates for adoption of new technologies are necessary for facilitating the adoption of cloud computing in given hospitals.

Opportunities and Challenges of Telehealth in Disease Management during COVID-19 Pandemic: A Scoping Review.

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic is an unexpected universal problem that has changed health care access across the world. Telehealth is an effective solution for health care delivery during disasters and public health emergencies. This study was conducted to summarize the opportunities and challenges of using telehealth in health care delivery during the COVID-19 pandemic. METHODS: A structured search was performed in the Web of Science, PubMed, Science Direct, and Scopus databases, as well as the Google Scholar search engine, for studies published until November 4, 2020. The reviewers analyzed 112 studies and identified opportunities and challenges. This review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS: A total of 112 unique opportunities of telehealth application during the pandemic were categorized into 4 key themes, such as (1) clinical, (2) organizational, (3) technical, and (4) social, which were further divided into 11 initial themes and 26 unique concepts. Furthermore, 106 unique challenges were categorized into 6 key themes, such as (1) legal, (2) clinical, (3) organizational, (40 technical, (5) socioeconomic, and (6) data quality, which were divided into 16 initial themes and 37 unique concepts altogether. The clinical opportunities and legal challenges were the most frequent opportunities and challenges, respectively. CONCLUSION: The COVID-19 pandemic significantly accelerated the use of telehealth. This study could offer useful information to policymakers about the opportunities and challenges of implementing telehealth for providing accessible, safe, and efficient health care delivery to the patient population during and after COVID-19. Furthermore, it can assist policymakers to make informed decisions on implementing telehealth in response to the COVID-19 pandemic by addressing the obstacles ahead.

Common errors in reporting cause-of-death statement on death certificates: A systematic review and meta-analysis.

The prevalence of death certificate (DC) completion errors is a universal issue. This research aimed to estimate the global prevalence of DC errors by performing a systematic review and meta-analysis. Databases including Web of Science, PubMed, Science Direct, Scopus, and Google search engine were searched by September 4, 2020. Thirty-five articles were included in the final analysis. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, random effects models with Mantel-Haenszel methods were employed using STATA version 14.2 software. Absence of time interval (80.9%), absence/inappropriateness of comorbidities (45.1%), incorrect underlying cause-of-death (COD) statement (38.9%), improper sequence (36.2%), mechanism of death with underlying COD (UCOD) (33.6%), abbreviations (33.0%), mechanism only (23.9%), competing causes (21.5%), two or more condition per line (19.3%), incorrect COD (18.0%), nonspecific or ill-defined condition (16.4%), blanks/repetitive phrases (12.5%), and illegible handwriting (11.6%) were the most prevalent errors, respectively. Lack of or poor training/educating of certifiers, lack of physician understandings about the importance of DC and absence of quality assurance mechanisms were identified as the most significant causes of DC errors. Furthermore, providing ongoing, targeted and interactive training/education, and establishment of quality control and tracking mechanisms for completion of deficient DCs were suggested as the important improving solutions.

Development a national minimum data set (MDS) of the information management system for disability in Iran.

BACKGROUND: Disability management and policymaking require complete and valid data on disability. OBJECTIVE: Development of a minimum data set (MDS) of the information management system for disability in Iran. METHODS: This descriptive, cross-sectional study was performed in 2017. Data were collected from the documents of persons with disabilities data bank of the State Welfare Organization of Iran available at "payment.behzisti.net", and data elements of the Ministry of Health and Medical Education (MOHME) resources, in addition to the Internet and library. A checklist was used for data collection. The Delphi technique was applied to reach a consensus about the data elements using a questionnaire. The content validity and reliability of the questionnaire were assessed by experts' opinions and the test-retest method, respectively. RESULTS: An MDS of disability was developed including administrative and clinical categories with 130 and 345 data elements, respectively. Two hundred and thirty eight data elements were mandatory elements (administrative: 60, clinical: 178) and the rest were optional elements. CONCLUSIONS: An MDS can be a starting point for standardizing the disability data. A minimum data set has the potential to standardize the data and overcome the problem of low-quality disability data in Iran through providing consistent, complete and uniform data elements. Thus, the use of this MDS is useful in determination of the level of disability and its benefits, and in policy-making and effective planning for providing persons with disabilities with more efficient and cost-effective services.

Factors Affecting Acceptance of Hospital Information Systems in Public Hospitals of Zahedan University of Medical Sciences: A Cross-Sectional Study.

A hospital information system is used to support a wide range of operations and activities in the hospital. This study was conducted to determine the factors affecting hospital information system acceptance by users. A cross-sectional, descriptive, analytic study was performed in 2018. The study population included 550 users of the system. The data were collected using a questionnaire and analyzed using the SPSS software. A significant moderate positive correlation was found between hospital information system acceptance and perceived usefulness (r = 0.54, P < 0.01), perceived ease of use (r = 0.41, P < 0.01), human factors (r = 0.46, P < 0.01) and technological factors (r = 0.54, P < 0.01). A significant weak positive correlation was detected between the acceptance of the hospital information system and organizational factors (r = 0.35, P < 0.01). Perceived usefulness of the system, social influence, system quality, perceived ease of use of the system, and top managers' supports had the most substantial influence on the users' intention to accept a hospital information system. User education, preparation of guidelines suited to the user specialty or department, incorporating users' work needs into the capabilities of the hospital information system, and improving the system to an ideal level are important considerations.

Success or failure of hospital information systems of public hospitals affiliated with Zahedan University of Medical Sciences: A cross sectional study in the Southeast of Iran.

INTRODUCTION: After implementation, evaluation of hospital information systems (HISs) is critical to ensure the fulfillment of the system goals. This study aimed to assess the success or failure of HISs in public hospitals affiliated with Zahedan University of Medical Sciences. MATERIALS AND METHODS: A cross-sectional descriptive and analytic study was performed in 2016. The study population comprised IT and HIS authorities and hospital information system users. The sample consisted of 468 participants. The data were collected using two questionnaires and analyzed with the SPSS software using descriptive and analytical statistics. RESULTS: The mean score of functional, behavioral, ethical, organizational, cultural and educational factors from the users' perspective was 3.14±0.66, 2.97± 0.60, 3.39±0.70, 2.96±0.642, 3.09±0.63, and 2.95±0.74, respectively. The mean score of organizational, behavioral, cultural, technological, educational and legal factors from IT and HIS authorities' perspective was 3.51±0.54, 3.35±0.45, 2.75±0.61, 3.58±0.32, and 3.96±0.59, respectively. CONCLUSIONS: The evaluated hospital information systems were considered relatively successful in terms of functional, ethical, and cultural factors but were considered as a relative failure in terms of behavioral, organizational, and educational factors form the users' perspective. Only the legal factor showed success, while organizational, behavioral, technical and educational factors showed relative success and the cultural factor showed relative failure from HIS and IT authorities' perspective. Therefore, assessing the users' needs before implementing the system, involving them in various stages of implementation, training them, and improving their computer skills seem to be necessary to achieve a better level of system success.

Development a minimum data set of the information management system for burns.

BACKGROUND: Burns are the most common and destructive injuries in across of the world and especially in developing countries. Nevertheless, a standard tool for collecting the data of burn injury has not been developed yet. The purpose of this study was to develop a minimum data set (MDS) of the information management system for burns in Iran. MATERIALS AND METHODS: This descriptive and cross-sectional study was performed in 2014. Data were collected from hospitals affiliated with Hormozgan and Iran University of Medical Sciences and medical documents centers, emergency centers and legal medicine centers located in Bandar Abbas city, in addition to internet access and library. Investigated documents were burn injury records in 2013, and documents that retrieved from the internet, and printed materials. Records were selected randomly based on T20-T29 categories from ICD-10. Data were collected using a checklist. In order to make a consensus about the data elements the decision Delphi technique was applied using a questionnaire. The content validity and reliability of questionnaire were assessed by expert's opinions and test-retest method, respectively. RESULTS: An MDS of burns was developed. This MDS divided into two categories: administrative and clinical with six and 17 section and 161 and 311 data elements respectively. CONCLUSIONS: This study showed that comprehensive and uniform data elements about burns do not exist in Iran. Therefore a MDS was developed for burns in Iran. Development of an MDS will result in standardization and effective management of the data through providing uniform and comprehensive data elements for burns. Thus, comparability of the extracted information from different analyses and researches will be possible in various levels. In addition, establishment of policies and prevention and control of burns will be possible, which results in the improvement of the quality of care and containment of costs.