Development of hospital information systems: user participation and factors affecting it

Users involvement in the electronic health information systems development process in Uganda: what is missing in relation to requirements gathering and analysis

User involvement in the electronic health information systems (eHIS) development process is crucial for gathering and analysing requirements that accurately reflect user needs. This is because their involvement is linked to the gathering and analysis of requirements that align with user needs. However, several studies reveal that there is still limited user involvement during these crucial phases, leading to the development of ineffective and inefficient systems that do not reflect user needs. Thus, this study explored how users were involved in the requirements gathering and analysis phases during eHIS development, with an aim of identifying the missing elements that hindered the design of more effective and effective eHIS. A cross-sectional survey, encompassing secondary and primary users, explored their involvement in the requirements gathering, analysis and design phases, using both open-ended and close ended questionnaires. Respondents (n = 140) were purposively selected from 20 organizations in northern and central Uganda. Data were cleaned and analysed using Microsoft Excel. The findings revealed a dominant use of a top-down approach, favouring the capture of high-level requirements at the Ministry of Health level, and among implementing partners. However, less attention was given to gathering and analysing requirements from facility-level users. Even when collected, primary users reported that their opinions and recommendations were often ignored/disregarded, resulting in eHIS designs with usability-related challenges. This study underscores the critical need for active user involvement in the early stages of eHIS development to ensure alignment with user needs and work practices.

Requirements specification, design, and evaluation of dental image exchange and management system with user-centered approach: A case study in Iran

Background and Aims

Systems existing in hospital or clinic settings offer services within the physical environment. Examples of such systems include picture archiving and communication systems, which provide remote services for patients. To develop a successful system, methods like software development life cycles (SDLCs) and design techniques, such as prototyping, are needed. This study aimed to specify requirements, design, and evaluation of dental image exchange and management system using a user-centered approach.

Methods

This cross-sectional study was conducted in four phases, each corresponding to different stages of SDLCs. User-needs data were used to gathered by interviews and observations. A prototype was developed using object-oriented programming and presented to users for feedback. Finally, focus group was used to finalized the prototype into the desired system.

Results

User needs were identified and prioritized from the outset, with ease of use, security, and mobile apps being their most essential requirements. The prototype underwent several iterations of design and evaluation in focus group sessions until users were satisfied, and their feedback was incorporated. Eventually, the prototype was refined into the final system with users' consent.

Conclusion

The study revealed that instant access to information, voluntary participation, user interface (UI) design, and usefulness were critical variables for users and should be integral to any system. Successful implementation of such a system requires careful consideration of end-users' needs and their application to the system. Moreover, integrating the system with electronic health records can further enhance the treatment process and the efficiency of medical staff. The voluntary perspective of users played a significant role in achieving an exemplary UI and overall satisfaction with the system. Developers and policymakers should consider these aspects in similar system development projects.

End-users' perspectives on factors affecting implementation and utilization of the Iranian electronic health record system: a qualitative study in a developing country

BACKGROUND

As one of the most important information technologies for storing, managing, and exchanging health information, the electronic health record (EHR) plays a major role in the health system. However, these systems in developing countries have been associated with multidimensional issues. The purpose of the present study was the assessment of nonclinical end-users' points of view on the implementation and utilization of the Iranian electronic health record system.

METHODS

This was a large qualitative study conducted in 2021 for 7 months from February to August. In this study, data were collected through in-depth semi-structured interviews with 70 non-clinical end-users in 22 public and six private hospitals of West Azerbaijan province in Iran. To analyze the data, the thematic analysis method was used.

RESULTS

The study results indicated that technical, human, cultural, managerial, and financial readiness are the most important factors affecting the implementation of EHRs in Iran. Among the mentioned factors, technical and human readiness were emphasized more by the users. Also, technical, organizational, human, and managerial factors were identified as factors influencing EHRs utilization, and technical and organizational factors had a stronger role in the system utilization.

CONCLUSIONS

According to the results, several factors influence EHR implementation and adequate utilization in Iran. To achieve the predetermined goals of this system, implementation issues and problems of using the system should be considered and solved.

The effects of electronic nursing handover on patient safety in the general (non-COVID-19) and COVID-19 intensive care units: a quasi-experimental study

BACKGROUND

The unprecedented increase in the nurses' workload is one of the issues affecting the quality and safety of patient care in the Intensive Care Units (ICUs). The electronic nursing handover can share sufficient, relevant, and necessary data about patients with greater efficiency and accuracy and prevent their information from being deleted. Therefore, this study aimed to determine and compare the effect of the Electronic Nursing Handover System (ENHS) on patient safety in General ICU and COVID-19 ICU.

METHOD

This is a quasi-experimental study conducted during an 8-month period from 22 to 2021 to 26 June 2022 using a test-retest design. A total of 29 nurses working in the General and COVID-19 ICUs participated in this study. Data were collected using a five-part questionnaire consisting of demographic information, handover quality, handover efficiency, error reduction, and handover time. Data analysis was conducted in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) using the chi-squared test, paired t-test, and Analysis of Covariance (ANCOVA).

RESULTS

The results showed that the mean scores of handover quality and efficiency, reduction of clinical error, and handover time in the electronic handover were significantly higher than those obtained in the paper-based method. The results showed that the mean score of patient safety in the COVID-19 ICU was 177.40 ± 30.416 for the paper-based handover and 251.40 ± 29.049 for the electronic handover (p = .0001). Moreover, the mean score of patient safety in the general ICU was 209.21 ± 23.072 for the paper-based handover and 251.93 ± 23.381 for the electronic one (p = .0001).

CONCLUSION

The use of ENHS significantly improved the quality and efficiency of shift handover, reduced the possibility of clinical error, saved handover time, and finally increased patient safety compared to the paper-based method. The results also showed the positive perspectives of ICU nurses toward the positive effect of ENHS on the patient safety improvement.

Effectiveness of a smartphone-based educational intervention to improve breastfeeding

Background

Exclusive breastfeeding (EBF) is essential during the first six months of life and confers countless benefits to mothers and infants. This study aimed to assess the effectiveness of a smartphone-based educational intervention to improve new mothers’ breastfeeding for infants younger than six months of age in Urmia, Iran.

Methods

A randomized controlled trial study was conducted from January to December 2019 with 40 new mothers and their first child aged < 3 months, assigned to the intervention (mobile app education + routine care) and control groups (routine care). The mean age of infants was 1.25 and 0.98 months for each group consequently. The designed app content categorized according to seven sections (the importance of breastfeeding, behavioral methods, complementary feeding and EBF, pumping and manual expression, managing common breast-related and breastfeeding problems, breastfeeding tips in special situations, and common queries) for educating the required knowledge to nursing mothers.

Results

Forty mothers were assessed for primary outcomes in each group. At three months, the mothers’ knowledge, attitude, and practice (KAP) had meaningful differences in the intervention group compared to the control group. In the intervention group, the degree of changes in knowledge and attitude were 5.67 ± 0.94 and 8.75 ± 1.37 respectively more than the control group (p < 0.001, p < 0.001). However, this amount for the practice score was 0.8 ± 0.49 which is considered to be marginally significant (p = 0.063). During the study, the mothers’ breastfeeding self-efficacy showed significant progress in favor of the intervention group. The score enhancement was 26.85 ± 7.13 for the intervention group and only 0.40 ± 5.17 for the control group that was confirmed to be significant (p < 0.001).

Conclusion

The smartphone-based app for educating new mothers on breastfeeding had a significantly positive effect on breastfeeding self-efficacy and maternal KAP. In future studies, the intervention can be tested in both prenatal and postpartum periods.

Evaluation of performance at Palestinian public hospitals using Pabón Lasso model

BACKGROUND

Hospitals have a paramount role in provision of health care services, which in turn significantly impacts the performance of any health system, especially in developing countries.

AIM

This study aimed to evaluate the performance of the Ministry of Health general hospitals in Gaza according to their surgical and internal medicine departments during a 3-year period (2016, 2017 and 2018) using Pabón Lasso model.

METHOD

This descriptive study includes the overall public general hospitals in Gaza Strip (7). Data have been collected from the officially disseminated reports, mainly about average length of stay, bed occupancy rate, and bed turnover ratio in the surgical and internal medicine departments for the study period. Pabón Lasso charts have been drawn using MS Excel 2013.

RESULTS AND CONCLUSION

For surgical departments, about 42.8% were efficient (zone 3) during the 3 years, while, 42.8% were inefficient (zone 1). Only one hospital was relatively efficient (zone 4) in 2017 and 2018. Regarding internal medicine departments, 28.6%-42.8% of hospitals were efficient during the study period, 14.3%-42.8% were inefficient, and 28.6%-42.8% were relatively efficient (zone 2 and 4). It is recommended to count on such type of analysis in decision-making and identify obstacles for best utilization of the available resources. Inefficiency in hospitals serves as a good opportunity for resources mobilization or innovation in demand-creating interventions, thereby, regular evaluation of resources' distribution. Further research is required by applying frontier techniques of efficiency measurement.

Preconceived Stakeholders' Attitude Toward Telepathology: Implications for Successful Implementation

Introduction

Telepathology is a subdiscipline of telemedicine. It has opened new horizons to pathology, especially to the field of organizing consultations. This study aims to determine the capabilities and equipment required for the implementation of telepathology from the viewpoints of managers, IT professionals, and pathologists of the hospitals of West Azerbaijan, Iran.

Methods

This is a descriptive-analytical study conducted as a cross-sectional study in 2015. All public and private hospitals of West Azerbaijan were selected as the study sites. The population of the study was the managers, directors, pathologists, and IT professionals of the hospitals. The study population was considered as the study sample. Data were collected using questionnaires. The validity and reliability of the questionnaires were assessed, and data were analyzed using SPSS (Statistical Product and Services Solutions, version 16.0, SPSS Inc, Chicago, IL, USA).

Results

The mean awareness of the study population of telepathology in the studied hospitals was 2.43 with a standard deviation of 0.89. According to analysis results (F = 7.211 and P = 0.001), in the studied hospitals, the mean awareness of pathologists, managers, directors, and IT professionals' of telepathology is significant. In addition, the mean awareness of pathologists is higher than that of managers, directors, and IT professionals, and this relation is significant (P = 0.001). According to IT professionals, among the influential dimensions of the implementation of telepathology in the studied hospitals, the effect of all dimensions, except hardware capabilities, was above moderate level.

Conclusion

According to our findings, stakeholders believe that the implementation of telepathology promotes the quality of health-care services and caring patients on the one hand and decreases health-care costs on the other hand. Therefore, it crucial and important to consider users' viewpoints into the process of implementing such systems as they play a vital role in the success or failure, and the accurate estimation of required sources, of the systems.