|Year : 2016 | Volume
| Issue : 2 | Page : 105-110
Assessment of the hospital information system in compliance with Certification Commission for Healthcare Information Technology standard at Isfahan University of Medical Sciences' academic hospitals
Maryam Jahanbakhsh1, Ashgar Ehteshami2, Abbas Shafiei3
1 Health Management and Economic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Health Information Technology and Management, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||17-Mar-2016|
Dr. Ashgar Ehteshami
Assistant professor, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Introduction: Hospital information system (HIS) plays an important role in improving the quality of treatment in hospitals. These systems are considered as an information system that can have a great influence on the efficiency and effectiveness of hospital management. Assessment system as one of the most important debates in the hospital management system has received great emphasis. The present study was aimed to assess HISs of Isfahan academic hospitals and was performed using Certification Commission for Health Information Technology (CCHIT) standard. Methods: This study is an applied descriptive cross-sectional study, in which 11 academic HISs of Isfahan University of Medical Sciences were surveyed by using a CCHIT standard checklist with three areas (information management, patient management, and technical management). Obtained data were analyzed with SPSS software V. 18 (IBM), and descriptive statistics was used to examine measures of central tendencies. Results: Data analysis revealed that the mean score of information management, patient management, and technical management areas in compliance with CCHIT standard were 66.1, 63.5, and 64.6 percent, respectively. Conclusions: According to the results of this study, it can be expressed that the criteria of HIS has been implemented in a rather favorable way. Hence, to achieve the desired mode, planning must be done on designing systems to increase the efficiency of information management, patient management, and software and technical infrastructures.
Keywords: Academic hospital, assessment, Certification Commission for Health Information Technology, hospital information system
|How to cite this article:|
Jahanbakhsh M, Ehteshami A, Shafiei A. Assessment of the hospital information system in compliance with Certification Commission for Healthcare Information Technology standard at Isfahan University of Medical Sciences' academic hospitals. Int J Educ Psychol Res 2016;2:105-10
|How to cite this URL:|
Jahanbakhsh M, Ehteshami A, Shafiei A. Assessment of the hospital information system in compliance with Certification Commission for Healthcare Information Technology standard at Isfahan University of Medical Sciences' academic hospitals. Int J Educ Psychol Res [serial online] 2016 [cited 2019 Jul 22];2:105-10. Available from: http://www.ijeprjournal.org/text.asp?2016/2/2/105/178866
| Introduction|| |
Considering the mass volume of producing information and its diversity, health care structure, especially health centers is certainly needed information, communication, and science technologies and the product of this knowledge and technology is the creation of hospital information system (HIS). A HIS plays an effective role in improving quality and increase of efficiency, effectiveness, and safety of services. Its purpose is the management of information, which healthcare personnel require them for their tasks. It also provides opportunities for universal access to health care services and medical knowledge and in a simple sense it is a help to improve quality and give efficient health care to patients, which at first was advertent to the patient and then better management of medical care, nursing care, and support are of this type of health care service. The majority of HISs is made in a gradual process, commensurate to the primary needs of the organization instead of being made in a planned and controlled process. Hence, before implementing these systems, logical development of information systems in accordance with the needs of health services at all levels must be addressed. In this regard, there are four main steps for the creation and development of HISs, including the definition of objectives, design, implementation, and evaluation. Therefore, evaluation is an ongoing process in establishing a HIS with comprehensive framework and this system includes all various sections and groups and meet all the problems of organization, and its purpose is to ensure that system activity is consistent with expectations. According to Marashi's finding, the importance of reporting criteria and required outputs (57 percent), prevention of errors (52 percent), technical knowledge (59 percent), technical and educational documentation (43 percent), and interactions of doctors with system stated that 2.28 percent of users are dissatisfied with HISs in Iran while the satisfaction of users influences on productivity, return of capital, and acceptance of the system. In the HISs of Iran's hospital 2.46 percent criteria related to the suitability of software to customize it according to the demands and expectations, have not been met also, the suitability of the software for performing tasks of users, software capacity to be controlled by the user, software fallibility and self-descriptiveness of software 31.4, 30, 30.6, 32.2 percent, respectively, does not comply the standard. Furthermore, in the evaluation of implementation of HISs, human aspects, training and informing must be considered and user's abilities must be used for improving quality of information, patient treatment, and setting of technical standards. Jeremy in 2003 on the evaluation of health information systems concluded that often inefficiency and lack of flexibility of these systems causes information to be useless, so internal and external evaluations that will be preferably useful for both of these cases causing changes and remove defects in the content of information systems. Hamborg et al. in 2004, in a research entitled assessment of the HIS, using isometric measures has referred to support of health care employees, software compliance with the users' need considering performance improvement, prevention of errors, interferences, and reduction of cost. Isfahani et al. mentioned that observing standards of electronic registration of narcotics, drug interactions, and allergies were far acceptable results and ignoring system in support of drug management and drug interactions have been observed. Raeisi et al. stated that observing criteria in the regional information system in comparison with the criteria of WHO is not desirable which adversely has affected the management of information system and health care. Ahmadi and Shahmoradi in a research entitled six-step process evaluation of health information system concluded that evaluators should be completely aware of all steps of evaluation. Saeedbakhsh concluded that HIS developers must pay attention to factors reducing user's learning time, providing better and more appropriate descriptions, providing more appropriate training, designing software in a way that user does not need much details to use it, easy ways to use the software command in the evolution of software. Ahmadi et al. study, 29.5 percent of users, mentioned that lack of automated monitoring of data by software is the cause of poor quality of information system and its non-coordination with the needs of users of HIS. Furthermore, in the evaluation of implementing HIS human aspects, education, and informing must be considered and users' abilities in implementing HISs must be used in future to improve information quality care and treatment of patients. Certification Commission for Health Information Technology (CCHIT) is an independent, nonprofit licensing organization for electronic medical records (EMR) of patients and includes a set of standard criteria for health information systems regarding systems' interaction, safety, security, and performance of HIS that most doctors by the existence of standard criteria feels more confident about improvement of health information systems in the future. CCHIT has provided more confidence in the markets of electronic health records for patients that formerly there was no such confidence.
With regard to the development of information and communications technologies in health systems, Changes in the health system softwares is inevitable, therefore to avoid redoing and to help improve the quality of care and decrease cost, ongoing evaluation of HISs must be made  to determine whether we have been able to achieve predetermined results or not? And whether the HIS project has been completed or not? And in fact, we can recognize past mistakes and avoid them by using systems evaluation  because in the health care system trial and error method is wrong and irrecoverable along with imposing additional cost on organization and before the occurrence of any mistake, deficiencies and problems must be identified and necessary activities must be taken to resolve them. Therefore, by continuous evaluation of the system and using its feedback to the organization, irreversible errors can be prevented and by identifying the strengths and weaknesses of the system and removing its deficiencies system quality can be improved.
The aim of this study was to assess the information systems of academic hospitals in Isfahan based on standard of Licensing Commission of Health Information Technology that this assessment was done based on three areas information management, patient management, and technical management to determine the rate of conformity of studied systems with three specified standard areas.
| Methods|| |
This research is an applied descriptive cross-sectional study, in which HIS in 11 academic hospitals of Isfahan University of Medical Sciences (including Shahid Beheshti, Shahid Chamran, Noor, Ali-Asghar, Imam Mousa-Kazem, Al-Zahra, Kashani, Feyz, Sayedoshohada, Farabi, and Amin) were surveyed by using a CCHIT standard checklist which contains 41 criteria that include 301 elements. Structural and content validity of the checklist was confirmed by academic members of the Isfahan University of Medical Science. Data were collected by returning to academic hospitals of the Isfahan University of Medical Science, observation of HISs, interview and completing the checklist. In this study, sampling is not done, and all of the 11 HISs implemented in the academic hospitals were assessed. Obtained data were analyzed with SPSS software V.18 (IBM) and descriptive statistics was used to examine measures of central tendencies.
| Results|| |
From the total of 11 examined hospitals, four different systems of Pooyasamane Diva, Sayan Rayan, Kowsar, and Rayavarane-Toos were studied. Generally, the results of the study have been presented in [Table 1] and [Table 2]. The mean rate of compliance of HIS of the Isfahan University of Medical Science based on the standard of Licensing Commission for Health Information Technology was 64.6 percent. The highest rate of compliance with these criteria is related to information management (66.1 percent), and the lowest rate of compliance with these criteria is related to patient management (63.5 percent). Furthermore, the rate of compliance with the criteria at technical management was calculated as 64.6 percent, and the total mean compliance of assessment criteria in HIS was calculated as 64.7 percent [Table 1].
|Table 1: Rate of compliance of hospital information system in academic hospitals of Isfahan University of Medical Sciences based on the standard licensing commission of health information technology|
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Based on the findings outlined in [Table 2], among criteria of information management area identification and maintenance of the patient's profile with mean 87.7 percent, criteria of recording incoming documents with mean 84.8 percent, data and outputs reporting criteria with mean 80 percent compared with other criteria had the highest mean values. Among these, the lowest rate of compliance of information management criteria is related to development instruction criteria with mean 18.1 percent and data assessment with mean 44.1 percent.
|Table 2: Rate of compliance of hospital information system criteria of academic hospitals of Isfahan University of Medical Science based on the standard of health information licensing commission separated based on the evaluation area|
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The highest rate of compliance with criteria of the patient management area is related to the electronic prescribing of drugs, medical referrals, and measurement of patients' clinical data with mean 100 percent and the lowest rate relates to patient-family-nurse training with mean 9 percent and the patient's preferences, language, religion, and culture were calculated with mean 18.1 percent.
Furthermore, the highest rate of compliance of technical management criteria relates to information backup, restore and maintenance, access, privacy, and destruction with mean 100 percent and the lowest rate relates to warnings, notifications, and criteria range with mean 0 percent and technical service criteria with 26.1 percent.
| Discussion|| |
According to the findings, the rate of compliance of information management criteria in HIS of selected academic hospitals was relatively desirable (66.1 percent) which had a distant from its desirable mode (100 percent). The results of the present study are in line with Kimiyafar's findings that the calculated information quality of HISs was about 45.6 percent. The study is also in line with Habibi's results that reported information management was 60.8 percent, Wright et al. expressed that most information system support of incoming data to the system is desirable  and Oroviogoicoechea and Watson in his study stated that the interaction of Information Technology system in patient's data and information analysis from the nurses' view equals to 92.5 percent, results of the present study are in line with results of these two mentioned studies so it can be said that evaluation of HIS based on information management area was relatively desirable but hospital software designers and experts must pay more attention to the following criteria to improve information quality in HIS: Support of clinical document, record management, complete documentation of clinical terms and codes by hospital software, and evaluation of clinical data recorded by the user.
The rate of compliance of patient management in the studied HIS has been relatively desirable (63.5 percent). Regarding patient's medical decisions, Kimiyafar et al. stated that the rate of compliance of existing criteria by hospitals' software equals to 48.9 percent. Isfahani et al. also reported that patient's drug information record in academic hospitals equals to 44.7 percent, and Azizi et al. stated that the patient's drug information record in clinical wards, pharmacy, and medical documents equals to 34.5 percent, 36.8 percent, and 29.7 percent, respectively. These results are not compatible with the results of the present study. Traverse pointed to increase of employees' productivity, interoperability between systems, health care quality through improved patient safety, more adherences to clinical practices, reduction of medical errors, and drug prescription. According to the studies and the present study, it can be concluded that the rate of compliance with patient management criteria in studied HISs is desirable and somehow are considered in HISs. However, the following criteria need Information Technology professionals' special attention: Presenting a list of the patient's allergies and adverse reactions, list of patients' problems in the system, management of patients' complications, support drugs interactions and patient's legal information, support patients schedule with medical staff, support patient training, and support clinical decisions and patient's preference.
The rate of compliance of technical management in the studied HISs was (64.6 percent) that was far from its desirable mode. The results of this study are in line with results of Kimiyafar's study who reported that compliance of technical and hardware cases with data concentration was equal to 69.2 percent. Saeedbakhsh et al. reported the rate of software's suitability for performing tasks was about 68.6 percent  and Sharifian et al. reported this rate was equal to 42.8 percent. Littlejones mentioned some reasons for project's failure of using HISs in South Africa were lack of appropriate technical infrastructure, users', designers', and project managers' different expectation, lack of attention to the cultural characteristics of the patient care, after qualitative and quantitative examining they stated that there was no significant difference between project failure in this country in comparison to other countries. Young stated that technical infrastructures are important factors in creating EMR, this result is in line with the result of the present study and it can be concluded that compliance of technical management criteria of the studied software is relatively desirable and somehow are considered in software development; However, to increase the capabilities of the studied software, promotion of the following criteria seems necessary: Clinical decision support by hospital software, support promotion of technical services and ranges in software, and software support for the warnings in hospital systems.
| Conclusions|| |
Assessment of HISs based on standard and known models to have qualified information system seems necessary. Altogether, the results of this study showed that compliance with CCHIT criteria in selected HISs of Isfahan University of Medical Sciences has been desirable. Meanwhile, experts and programmers paid more attention to information and patient management areas, but the technical management area was ignored somewhat. Considering that a successful HIS should be at the high and acceptable levels of the studied criteria, and must be designed for information systems, taking steps for development and promotion of HIS is necessary. Therefore, compliance with the criteria of the CCHIT standard in the development of information system is effective. To improve the situation, we suggest the followings:
- Before developing a system, need and feasibility assessments must be done by the relative organization
- Operation of national and international standards for the exchange of patient data between HISs
- Further evaluation of HISs using different criteria
- Using the same meanings and definitions and units throughout the HISs
- Idolizing international standards and establish a national standard for the design and development of HISs.
Financial support and sponsorship
This Article was part of a master thesis supported by Isfahan University of Medical Sciences (Grant No: 393330). We extend our sincere thanks to the information technology employees of Isfahan academic hospitals.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]