Hamid Moghaddasi

services in improving the physical and mental health of patients is very effective. Their role is so important that in developing countries with doctor’s domination or shortage of physicians, to many people, nursing care is very effective in continuity of health care [1,2]. In general, it must be acknowledged that in nearly all countries of the world, both developing

Scientists are trying to create clinical decision support systems (CDSSs) to keep blood glucose level of diabetics in the permitted range, which is performed through precisely estimated dosage of insulin. This study aims at examining the evolution of CDSSs. In this review, scientific databases using a combination of sensitive keywords were searched out in articles published in accredited journals. The purpose was to find software associated with insulin therapy, with any technology used in them. The findings indicated that insulin therapy can be performed through new technologies related to CDSSs with two different approaches, open and closed, each consisting of two different functions. Furthermore, the effectiveness of CDSSs in glycemic control and development of related technologies were remarkable. It is anticipated that in the near future, CDSSs based on closed approach will be created, can act as an expert system in the form of a very small pump attached to the patient's body. Pump performance is not only affected by the improvements of CDSS, but also related to the daily growth of Nanoelectronics.

s study examines the problems encountered through the use of verbal orders and the various solutions offered to reduce the clinical errors caused by such method. Methods: 83 articles published in English between 2000 and 2016 were extracted from Pubmed, Pro-Quest, Google Scholar, and Science direct databases. After a qualitative review of these articles, 32 of them were selected that were relevant to the objective of this study. Background: Most of the aspects of verbal orders that have been studied include: the process of providing verbal orders and reason for errors, competency of the individuals who prescribe and receive verbal orders, method of documentation, limitations, authorization & validation, strategies, techniques and specific measures to enhance transparency and effectiveness, considering two characteristics of the content and context.Results: The most common recommendations for the paper method in order to reduce errors are to restrict the use of this kind of order and/or to repeat the order. Computerized Physician Order Entry (CPOE) & mobile CPOE tools are among the recommended health information technology solutions that not only increase the efficiency of the order process but also support the displacement of verbal prescribers. Conclusion: The use of mobile-based information systems is on the rise because they are more flexible and allow greater mobility to the users compared to other information systems. Furthermore, mobile-based information systems can collect, store and analyze the detailed information of verbal orders in a more efficient way.

Health justice is something that every country in the world needs. However, the existence of health disparities among different social groups and geographical regions in various countries of the world is inevitable. These health inequalities are a major obstacle in achieving health justice. There are a number of factors affecting health equity such as socioeconomic status, education level, age, religion, geographical position, racial and ethnical differences, gender minorities, environmental factors, accessibility level to healthcare services and resources, and also the quality of healthcare. Although eHealth has the potential of eliminating health inequalities leading to the establishment of health justice, it is essential that governments and health policy makers provide some measures to diminish major barriers facing the society members especially the elderly, poor, uneducated, and disabled people when implementing it. This can result in attaining the advantages of eHealth for establishing health equity.

Numerous advantages are derived from the electronic health record (EHR). Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases (2000 to Jun 2015). Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture.

National Health Information Network (NHIN) is a network in which all healthcare organizations, government agencies and other health-related organizations are connected to each other in order to exchange information about health. Due to the necessity of a framework for NHIN development, in this paper, according to the literature review, a definition for NHIN framework was provided, and then the NHIN-related projects were reviewed in the United States of America (USA) and the United Kingdom (UK), NHIN and National Program for Information Technology in the NHS (NPfIT), respectively. The Review of NHIN framework in the countries studied show some similarities and differences in each dimension that are discussed in this framework. NHIN guiding principles in the NHS NPfIT were not regarded or were considered incomplete, compared to the US. NHIN architecture in the US is decentralized while it is centralized in the UK. Based on the review of NHIN framework, these two countries represent important points that can be used in many other countries. However, it can be said that the development of NHIN not only means the implementation of national system or systems, or the binding of local health information systems, but it also needs to build on a framework in which many of the issues related to the formation of NHIN would be considered, including the cooperation between government, private sector and stakeholders with regard to local, national and international needs.

Minutes of educational councils in universities always contain valuable organizational knowledge and play an important role in micro and macro educational decision makings. Lack of storage system, organization and retrieval of these documents can be a major obstacle in the way of utilizing these precious documents. Designing and implementing of an appropriate software to manage minutes of educational councils can facilitate classifying these important documents and ease the access and visibility of their content as well. Therefore based on the structure and the content of educational council minutes of one school of medical sciences universities as a sample and the views of key stakeholders, researchers tried to design and implement a software for information and decisions management of minutes. This research is of developmental-applied type. In order to design the software, object-oriented analysis is used. In the analysis step, at first requirements are identified, extracted and defined based on the descriptive cataloging and subject analyzing of educational councils minutes and after final analysis, the required diagrams were drawn. Software architecture is determined based on the list of requirements and finally the drawn diagrams are converted to programming codes using C# programming language. In the end, the produced software has been tested to ensure its adaptation to the objectives of project and the defined requirements. In this study, it was tried that the designed software leads to the development of electronic database for minutes in order that the universities could have access to content and decisions of these meetings in due time and in appropriate manner. Despite the numerous capabilities of this software, it seems necessary that it be used more widely in order that we could review its improvement and optimization during its implementation in the actual operating environment. Subsequently, it is recommended that Universities of Medical Sciences use the software for information management and their educational meetings to facilitate the process of organizing, storing and retrieving of the documents. They can also contribute to the process of software upgrade for educational meetings in other universities.

Introduction: Equitable access to health services is one of the health justice criteria. E-health can sometimes be helpful in this regard. This study is aimed to find the use of cloud computing services across health system. Method: In the present review article, numerous research papers from different resources, such as MEDLINE, IEEE and Science direct, were studied. Based on the subject, 210 studies were found. After quality analysis of the papers, 78 studies were selected, from which 53 articles were directly related to the applications of cloud computing in health system. Findings: Cloud computing services are widely used in various industries. Therefore, health system takes advantage of the services. Findings indicate that, the applications of cloud computing in health system, including telemedicine, medical imaging, public and personal health, clinical and hospital information systems, medical decision support system, care, secondary use of health data, serve as different types of specialized software used to analyze gene sequences and archive huge biological data. Generally cloud computing services are available in two sectors in any health system as follows: E-health services and Bioinformatics. Conclusion: Facilitated access to the E-health services and big data in health systems are the main features of exploiting cloud computing services in health systems. Using cloud computing in health systems not only makes health services more affordable, but also helps nations to achieve health equity.

A B S T R A C T Introduction: Paper-based prescription orders, commonly having numerous medication errors, can increase adverse drug events (ADEs) and threaten the patient's safety. Computerized physician order entry (CPOE), as an appropriate alternative, can significantly reduce medication errors. This study aimed to investigate the effects of well-designed CPOE in reducing medication errors and ADEs. Method: Electronic databases including EBSCO Host, Web of Science, PubMed, SID, Google Scholar, Iranmedex, Irandoc were used to conduct the literature review. We reviewed all the papers published about CPOE and its impacts on medication errors from 1998 until 2015. Thus 56 articles were found. Considering the relevance of their title and abstract with the objectives of the study, and deleting repetitive cases, 32 articles were selected, among which 10 articles were directly related to the objectives of the study. Results:A number of studies indicate that CPOE can reduce the incidence of serious medication errors and ADEs. Nonetheless, there is evidence indicating that CPOE could negatively affect the patient's health if the system is not well-designed. Conclusion: The replacement of conventional, paper-based prescription orders with well-designed CPOEs in hospitals could play a key role in minimizing medication errors and improving the patients' safety. To this end, the CPOEs have to be designed according to recent standards and needs.

Mobile health is one of the most important electronic health services which use portable, smart devices, such as the mobile phone. With a very high rate of accessibility and a relatively low cost, this type of electronic health service can be used to offer health services to people anywhere, at any time. The main objective of the current study is to introduce the mobile health as a new service for promotion of self-care in the society. The study will continue to focus on numerous medical applications of mobile phone, particularly as an efficient and cost-effective modern device for self-care.

Numerous advantages are derived from the electronic health record (EHR). Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases (2000 to Jun 2015). Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture.

Introduction and Purpose: Ventilator-associated pneumonia is the second most common nosocomial infection that develops in patients admitted to the intensive care unit. The mortality rate for VAP ranges from 24% to 76% and is even higher than the primary illness. Based on the importance of this issue, many organizations have focused on strategies and guidelines to reduce the occurrence of complications such as ventilator associated pneumonia. Despite these guidelines, due to multi orders with different conditions and time periods, multi caregivers in the intensive care unit and human mistakes, still there are high rates of VAP. The purpose of this study is to provide an overview of real-time dashboards applications which were designed and implemented as a solution to reduce Ventilator-associated-pneumonia in Intensive Care Unit.

Poor documentation of healthcare data, including the recording of inaccurate and false information, is a concern for health data collections at all levels, whether large hospitals or small clinics (WHO 2003). The National Committee on Vital and Health Statistics (Meyer 2000; Center for Health Information Quality 2002) stated that high quality healthcare depends on access to accurate and comprehensive medical records. Such information is essential for effective diagnosis and treatment, measurement and improvement of healthcare quality, advancement of public health, improvement of healthcare productivity, and facilitation of cost reimbursement.
Rigby et al. (1998) commented on the beneficial effects of high quality information on healthcare quality, arguing that data quality is at the very ‘heart’ of medicine.

Mobile health is one of the most important electronic health services which use portable, smart devices, such as the mobile phone. With a very high rate of accessibility and a relatively low cost, this type of electronic health service can be used to offer health services to people anywhere, at any time. The main objective of the current study is to introduce the mobile health as a new service for promotion of self-care in the society. The study will continue to focus on numerous medical applications of mobile phone, particularly as an efficient and cost-effective modern device for self-care.

Numerous advantages are derived from the electronic health record (EHR).Though achieving such advantages depends on its architecture, at present no unique understanding of the architecture dimensions and specifications is available. Therefore, the aim of the present study is a systematic review of architecture perception of the electronic health record. The authors searched the literature in Science Direct, Scopus, PubMed and Proudest Databases (2000 to Jun 2015). Data extraction was done by 2 reviewers on content, structure, content/structure relationship, confidentiality and security of the EHR. Subsequent to refining the 87 retrieved studies, 25 studies were finally included in the study. In the studies and paradigms so far proposed for the EHR, a unique comprehensive architecture model from the viewpoint of research criteria has not been investigated and it has been considered only from some dimensions. Hence, we provide a new definition of the EHR architecture.

Background: Electronic Health Records (EHRs) are secure private lifetime records that can be shared by using interoperability standards between different organizations and units. These records are created by the productive system that is called EHR system. Implementing EHR systems has a number of advantages such as facilitating access to medical records, supporting patient care, and improving the quality of care and health care decisions. The project of electronic health record system in Iran, which is the goal of this study, is called SEPAS. With respect to the importance of EHR and EHR systems the researchers investigated the project from two perspectives: determining the coordinates of the project and how it evolved, and incorporating the coordinates of EHR system in this project. Methods: In this study two evaluation tools, a checklist and a questionnaire, were developed based on texts and reliable documentation. The questionnaire and the checklist were validated using content validity by receiving the experts' comments and the questionnaire's reliability was estimated through Test-retest(r =87%). Data were collected through study, observation, and interviews with experts and specialists of SEPAS project. Results: This research showed that SEPAS project, like any other project, could be evaluated. It has some aims; steps, operational phases and certain start and end time, but all the resources and required facilities for the project have not been considered. Therefore it could not satisfy its specified objective and the useful and unique changes which are the other characteristics of any project have not been achieved. In addition, the findings of EHR system coordinates can be determined in 4 categories as Standards and rules, Telecommunication-Communication facilities, Computer equipment and facilities and Stakeholders. Conclusions: The findings indicated that SEPAS has the ability to use all standards of medical terminology and health classification systems in the case of Maksa approval (The reference health coding of Iran).ISO13606 was used as the main standard in this project. Regarding the telecommunication-communication facilities of the project, the findings showed that its link is restricted to health care centers which does not cover other institutions and organizations involved in public health. The final result showed that SEPAS is in the early stages of execution. And the full implementation of EHR needs the provision of the infrastructure of the National Health Information Network that is the same as EHR system.

Electronic health records (EHRs) have existed for some time, yet few of them are applicable to
conditions in developing countries of Southeast (SE) Asia. EHRs everywhere face similar problems:
1) availability; 2) ownership; 3) compatibility; 4) cost. The newer field of Web-based “personal” or
“personally controlled” health records (PHRs) is evolving, and they partially address these problems.
However, in large areas of SE Asia there is no or only very limited Web access. Developing countries
do have many cellphone users and cellphone services. Therefore, the PHR concept can be extended to
include cellphone records. Mobile health systems up to now have centered on healthcare providers
rather than on “normal people”, and have often required broadband networks. We describe a minimalist
“Portable Personal Health Record” (PPHR) - a simple, portable, digital record to represent the health
history of a single person. It is a mobile phone application owned and maintained by the users, and
therefore available. The PPHR functionality emphasizes simplicity over medical exactness, so it is not
the same as a “medical record.” Data entry is via lists derived from the International Classification for
Primary Care (ICPC-2e) for compatibility; data is stored on the phone as name-value pairs (ISO 18308),
and is transmitted as SMSs via the almost ubiquitous GSM network. The records can be translated
to Continuity of Care Record (CCR) format for compatibility and inclusion in standards-compliant,
Web-based PHR systems. The application is provided as open-source. User testing in Sarawak, East
Malaysia, shows that this application is positively received by “normal people”.

Introduction: The review of medical records with the aim of assessing the quality of codes has long been conducted in different countries. Auditing medical coding, as an instructive approach, could help to review the quality of codes objectively using defined attributes, and this in turn would lead to improvement of the quality of codes.
Method: The current study aimed to present a model for auditing the quality of clinical codes. The audit model was formed after reviewing other audit models, considering their strengths and weaknesses. A clear definition was presented for each quality attribute and more detailed criteria were then set for assessing the quality of codes.
Results: The audit tool (based on the quality attributes included legibility, relevancy, completeness, accuracy, definition and timeliness); led to development of an audit model for assessing the quality of medical coding. Delphi technique was then used to reassure the validity of the model.
Conclusion: The inclusive audit model designed could provide a reliable and valid basis for assessing the quality of codes considering more quality attributes and their clear definition. The inter-observer check suggested in the method of auditing is of particular importance to reassure the reliability of coding.

Introduction: Laws, regulations, and guidelines are necessary external stimuli that influence the management of health data. They serve as external mechanisms for the reinforcement and quality improvement of health information. Despite their inevitable significance, such laws have not yet been sufficiently formulated in Iran. The current study explores reasons for inadequacies in the health information laws.
Methods: In this descriptive study, health-related laws and regulations from the United States, the United Kingdom, and Iran were first collected, using a review of the literature and available data. Then, bearing in mind the significant deficiencies in health information laws in Iran, the researchers asked a group of managers and policy makers in the healthcare field to complete a questionnaire to explore the reasons for such deficiencies. A test-retest method was used to determine the reliability of the questionnaire. Descriptive statistics and tables were then used to analyze the data.
Findings: Experts’ opinion on reasons for deficiencies in health information laws and regulations in Iran are divided into four principal groups: cultural conditions of the community, the status of the health information system, characteristics of managers and policy makers in the healthcare field, and awareness level among public beneficiaries about laws.
Conclusions: The health departments or ministries in developed countries have brought about suitable changes in their affiliated organizations by developing external data enhancement mechanisms such as information-related laws and standards, and accreditation of healthcare organizations. At the same time, healthcare organizations, under obligations imposed by the external forces, try to elevate the quality of information. Therefore, this study suggests that raising healthcare managers’ awareness of the importance of passing health information laws, as an effective external mechanism, is essential.

Today, e-health plays a significant role in enhancing the quality of healthcare services. However, noticeable differences still exist in developing and applying e-health across the world. The aim of the current study is to present a model for assessing e-health status in different countries. This study was conducted using a cross-sectional design. Five indicators were determined, and the combination of the indicators was considered as "e-health status indicators." At the next stage, a weight coefficient was assigned to each indicator. Then the identified information and communication technology by the International Telecommunication Union (ITU) composed of four groups was assigned as a basis for sampling. One-third of each group of the ranking was selected randomly, and ultimately scores of the indicators were calculated for each country. Then the status of e-health was determined for countries under study, in particular for Iran. The validity of the tool was evaluated through content validity, and the test-retest method was used to check the reliability. The current study resulted in developing a model for measuring e-health status. The model helped to measure the e-health status score for Iran and other countries under study. The model designed in this study can be used by organizations such as the ITU to grade countries according to their e-health status. According to the model, countries with a higher e-health grade could have a higher chance of success in e-health development and deployment.

The organizational structure of medical record departments in Iran is not appropriate for the efficient management of healthcare information. In addition, there is no strong information management division to provide comprehensive information management services in hospitals in Iran. Therefore, a suggested model was designed based on four main axes: 1) specifications of a Health Information Management Division, 2) specifications of a Healthcare Information Management Department, 3) the functions of the Healthcare Information Management Department, and 4) the units of the Healthcare Information Management Department. The validity of the model was determined through use of the Delphi technique. The results of the validation process show that the majority of experts agree with the model and consider it to be appropriate and applicable for hospitals in Iran. The model is therefore recommended for hospitals in Iran.

In recent years, there has been considerable attention towards the development of information and communication technology (ICT) in health care delivery known as 'E-Health'. The term "E-Health" is almost a new concept and the E-Health projects mainly aim to improve service delivery to people, though different countries might have different approaches in using E-Health. The focus of this study is to review factors influencing the development of E-Health projects, as these factors could lead to an extensive semantic variation. This study reviews the E-Health status in different countries based on existing reports and documents about E-health projects in developed and developing countries and also based on the reports and documents provided by WHO, International Telecommunication Union (ITU); and World Bank. The review of the documents showed that the E-Health status in different countries is depended upon three key factors including the potential of ICT, economic cap...

Patient Safety Information Systems (PSIS) are prerequisite for any patient safety program. The purpose of the study was to review PSISs in developed countries and to customize a preliminary framework for such systems for Iran. Three developed countries in the field of patient safety including the USA, England and Australia were selected and their PSISs or reporting systems were studied. In addition, 15 unstructured interviews were conducted with Iranian informants. In the developed countries, specific regulations have been formulated regarding reporting and recording of patient safety incidents. Based on these regulations, a variety of patient safety data needs to be collected. In addition, the reportable incidents, the mechanisms of data analysis, the entities involved in the system, tools and technologies as well as feedback mechanisms have been defined well. In the field of patient safety, the Iranian health system is still in its infancy and lacks a formal information system for collecting, analyzing, disseminating and sharing patient safety information. Based on other countries' experiences, a preliminary framework for an Iranian PSIS was suggested. Developing a PSIS for Iranian hospitals is crucially needed. In this regard, Iranian hospitals and health authorities should develop standardized data sets, standard forms for reporting, mechanisms for data analysis and feedback modes.