article information

Modern Care Journal: Vol.14, issue 3; e65735
published online: July 26, 2017
article type: Research Article
received: June 1, 2017
accepted: July 1, 2017
DOI: https://doi.org/10.5812/modernc.65735
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Information and Communication Technology Requirements for Iran’s Holistic Scientific Map on Health: A Qualitative Study

authors:

avatar Mohammad Dehghani ORCID 1 , avatar Djavad Ghoddoosi-Nejad 2 , avatar Roohallah Khara 3 , avatar Narjes Mirabootalebi 4 , avatar Mohamad Hosein Hayavi Haghighi 5 , *

Ph.D Student of Health Information Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
Ph.D. Student of Health Information Management, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, IR Iran
Master of Science in Health Information Technology, School of Medicine, Maternal and Child Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran
Assistant Professor, Department of Health Information Technology, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran

how to cite: Dehghani M, Ghoddoosi-Nejad D, Khara R, Mirabootalebi N, Hayavi Haghighi M H. Information and Communication Technology Requirements for Iran’s Holistic Scientific Map on Health: A Qualitative Study. Mod Care J. 2017;14(3):e65735. https://doi.org/10.5812/modernc.65735.

Abstract

Background and Aim:

Medical universities need to fulfill many requirements to achieve the goals of the Holistic Scientific Map on Health development based on Iran’s 20-year vision plan. This study aimed to determine information and communication technology requirements for the Holistic Scientific map on health from the perspectives of the administrators of medical universities.

Methods:

This qualitative study was done in 2017 using the Delphi method and the nominal group technique. Sampling was done purposively and heterogeneously to recruit 20 junior, middle, and senior university managers. The MAXQDA software (v. 10.0) was used for qualitative data management and the SPSS software (v. 16.0) for quantitative data analysis.

Results:

Medical universities need to fulfill 20 information and communication technology requirements to achieve the goals of the Holistic Scientific Map on Health. The most important requirements are “creating electronic health record” (score: 691), “increasing internet bandwidth and speed” (score: 668), “establishing a customer relationship management system” (score: 667), “developing telehealth system” (score: 623), and “establishing a disease record system” (score: 586).

Conclusions:

Creating an electronic health record is the most important requirement for reaching the goals of the Holistic Scientific Map on Health. However, there are different barriers and problems in fulfilling this requirement.

1. Background

Iran’s 20-year vision plan is the guide for most micro and macro activities. This plan introduces the attributes of a good society (1, 2). One of the requirements of a good society is to maintain good health and quality of life for all people (3). According to the constitution of Iran, health is the absolute right of all Iranians and the responsibility of the government (4-6). The national 20-year vision plan highly values health and holds that by 2025, Iran should be the healthiest country in the local area (7-9). In order to achieve these goals, Iran’s holistic scientific map on health (HSMH) was developed for the universities of medical sciences. HSMH explains the major goals and the strategic plans of the Iranian ministry of health in the areas of education, research, and technology (4, 10). The aim of developing HSMH was to use collective wisdom to facilitate scientific developments in health-related areas in order to reach the goals of the 20-year vision plan (11, 12).

Globalization, rapid flow and development of information, as well as the emergence of modern technologies have considerably increased humans’ dependence on information and technology (13). Therefore, most activities are directly and indirectly affected by information and technology (14). The development of HSMH also requires processing a huge amount of data as well as information and necessitates determining information requirements and infrastructures (15).

A study in a public university in Iran reported that the 10 challenges in achieving the goals of HSMH were related to policy-making and management, financing and facilitating academic process, staff development, educational development and promotion, conducting research, knowledge advancement, entrepreneurship, service provision, culture and norms, and facilitating communications. The most important challenges in this study were related to policy-making and management, culture and norms, as well as educational development and promotion (2).

In order to reach the goals of HSMH and improve community health, some requirements are needed, including HSMH-related policies and strategies (16), advanced information technology, and wise decision-making based on Islamic values (11). The present study was conducted to determine information and communication technology (ICT) requirements for HSMH from the perspectives of the administrators of medical universities.

2. Methods

This qualitative study was done in 2017 using the Delphi method. The 4 phases of the study were as follows.

In the first phase, HSMH was read and discussed in 4 1-hour sessions by 7 experts in healthcare management and health information management. Then, the nominal group technique was used to create a list of 20 junior, middle, and senior managers who were involved in the implementation of HSMH. Sampling was done purposively and heterogeneously. Managers were recruited from 3 universities of medical sciences in Iran. The eligibility criteria included work experience of more than 5 years, familiarity with HSMH, and involvement in its implementation. In this phase, an ICT requirements questionnaire with 2 open-ended questions was developed based on HSMH and by using the nominal group technique. The validity of this questionnaire was confirmed by 5 experienced faculty members.

In the 2nd phase, participants were provided with the above-mentioned questionnaire, a printed copy of HSMH, and verbal information about the aim of the study. After 1 week, we referred to them and collected the questionnaires. Collected data were qualitatively analyzed and categorized into several themes using the MAXQDA software (v. 10.0). Irrelevant themes were deleted. Then, the generated themes were used to develop a 26-item questionnaire on ICT requirements. Items were scored on a 5-point Likert-type scale (from “Completely agree” to “Completely disagree”). Based on the theoretical underpinnings of the Delphi technique, the questionnaire needed no validity and reliability assessment because it had been developed based on the opinions of a panel of experts.

In the 3rd phase, study participants were invited to complete the 26-item questionnaire. Collected data were entered into the SPSS software (v. 16.0) and the score of each item was calculated. Finally, 30% of the lowest-scored items (6 items in total) were excluded. Therefore, the final questionnaire contained 20 items.

In the 4th phase, participants were provided with a 20-item questionnaire and the results of the 2nd phase; in addition, they were asked to rank the items with respect to their importance. In other words, they were taught to rank the most important item 1 and the least important item 20 and so on. Then, questionnaires were collected and the data were entered into the SPSS software. Item scoring was done reversely to item ranks. For instance, the items that had been ranked 1, 2, and 3 were scored 20, 19, and 18, respectively. Moreover, participants’ opinions were weighted based on their managerial levels. In other words, the responses of junior, middle, and senior managers were weighted by 1, 2, and 3, respectively. Subsequently, the score of each item was calculated through multiplying its raw score by managerial weight and thereby, the importance of each item was determined.

The ethics committee of Hormozgan University of Medical Sciences approved the ethical considerations of the present study under No HUMS.REC.1395.147.

3. Results

This study was done on 20 managers. Participants were 7 females (35%) and 13 males (65%). A total of 6 participants had a work experience of 5 - 10 years, 9 had a work experience of 10 - 20, and 5 had a work experience of more than 20 years. They were 4 university deputies, 3 faculty deans, 3 faculty education deputies, 3 faculty research deputies, and 7 managers in university administrations. There were 7 individuals aged less than 40, 9 aged 40 - 50, and 4 older than 50. They held postdoctoral (3), doctoral (10), master’s (5), or bachelor’s (2) degrees.

Themes deleted in the 2nd phase were the development of an accreditation and evaluation system, interuniversity meetings, and staff management and development. Moreover, the 6 lowest-scored items, which were excluded in the 3rd phase, were the development of fiber-optic communication system (28%), the use of appropriate hardware (19%), equipping workshops with modern technologies, strengthening educational and research systems (24%), developing regulations for health information technology (27%), and using the original copies of software programs (16%).

“Creating electronic health record” was the most important ICT requirement for achieving the goals of HSMH. The score of this item was 691. All managers from different managerial levels had chosen this item as the most important ICT requirement. Moreover, although “increasing internet bandwidth and speed” was the most important ICT requirement in the 2nd phase of the study (with a score of 100), it was the 2nd most important requirement in the 3rd phase (with a score of 668). On the other hand, the least important requirements were “developing and using video conference system” (with a score of 86) and “expanding digital libraries” (with a score of 100). Table 1 shows all 20 ICT requirements for achieving the goals of HSMH.

Table 1.

ICT Requirements for Achieving the Goals of HSMH

RankRequirementsScore in the Second PhaseSenior Managers’ ScoresMiddle Managers’ ScoresJunior Managers’ ScoresFinal ScorePriority (Importance)
3*2*1*
1Creating electronic health record94772311673341261266911
2Increasing internet bandwidth and speed100762281533061341346682
3Establishing a customer relationship management system76752251613221201206673
4Developing telehealth system66661981553101151156234
5Establishing a disease record system67611831452901131135865
6Developing clinical systems78461381442881011015276
7Developing managerial systems825315912625296965077
8Developing knowledge management systems855315911723495954888
9Strengthening information security in cyberspace80561681092181021024888
10Developing national research system82481449819681814219
11Establishing national information network (National Internet)8340120101202676738910
12Developing an information bank for scientific journals53298780160646431111
13Improving intra-university internet networks57309070140505028012
14Improving academic data centers473610858116525227613
15Improving academic email system44319354108404024114
16Using data processing and statistical software5120603876303016615
17Improving university websites and portals3219573468272715216
18Developing an integrated library system3211332346232310217
19Improving digital libraries485153672131310018
20Developing video conference systems40824214220208619

4. Discussion

This qualitative study aimed to determine ICT requirements for HSMH from the perspectives of the administrators of medical universities. Findings revealed that “creating electronic health record” (with a score of 691) was the most important ICT requirement for HSMH. Electronic health record is one of the most important tools for the collection and management of health-related data (17). The United States of America allocated 28 billion dollars to the creation of the electronic health record (18). Physicians in developed countries use patients’ electronic health records for more than 2 hours a day (19). Electronic health record is considered as a way for recording all health-related data of an individual from birth to death. This system facilitates decision-making and guides healthcare universities towards the goals of HSMH. Yet, the creation of electronic health record faces different barriers such as users’ limited information literacy skills and unfavorable attitudes toward its use (17).

The 2nd most important ICT requirement for HSMH from the perspectives of managers was “increasing internet bandwidth and speed”. In the past decade, internet was the most important method used by patients and healthcare providers for accessing health information (20). Currently, most adults in developed countries use the Internet for obtaining health information (21). Moreover, the Internet has turned into the most effective channel for obtaining information in universities and higher education centers in recent years (22), therefore, most researchers and students currently fulfill their informational needs via the internet and without the need to go to the library (23). However, Internet speed in Iran is still very low, even though Iran was the first country in the region to be connected to the Internet. Low Internet speed not only demotivates researchers, but also wastes their time. Therefore, medical universities need to adopt strategies to increase internet speed.

Medical universities provide a wide range of educational, research, and medical services and therefore, have a wide spectrum of clients. One of the most important challenges in healthcare organizations is to fulfill customers’ needs and improve their confidence and satisfaction in the shortest possible amount of time and with the highest possible quality and productivity (24). Study findings showed that the 3rd most important ICT requirement for achieving the goals of HSMH was “establishing a customer relationship management system”. Given the importance and the significant effects of customer satisfaction and loyalty on market share of an organization, healthcare organizations need to consider customer relationship management as an effective instrument (25). Customer relationship management is also an effective strategy for healthcare organizations to improve their status (24). Currently, university hospitals and university healthcare centers in Iran have numerous customers due to the fact that they use governmental resources, are the main referral centers in the national health reform plan, and thereby, have no strong competitors. Accordingly, most public hospitals do not greatly value customer relationship management. Given the high importance of personal and public health in the National 20-year vision plan, public healthcare organizations and medical universities need to make the most from customers’ feedbacks through establishing efficient customer relationship management systems.

“Developing telehealth system” was the 4th most important ICT requirement for achieving the goals of HSMH. Telehealth is to assess patients’ health conditions and provide healthcare services via communication equipment such as telephone, radio, and visual contacts (26). It was first established in the 1993 in the United States and was used mainly in emergencies and natural disasters. However, it is currently used in all areas of healthcare delivery such as counseling, self-care, geriatric care, and mental illnesses and is covered by insurance organizations. Telehealth was also established in Canada in 2000 for psychological and oncologic services (27), while this technology in European countries is mainly used for home care (28). Medical universities in Iran can use telehealth to provide care services and make use of specialists’ services in distant areas. Telehealth can significantly reduce healthcare costs.

The 5th most important ICT requirement for achieving the goals of HSMH was “establishing a disease record system”. This system is an electronic system for recording the data related to diseases or medical interventions. It uses secondary data and includes more extensive and structured data compared with conventional medical records (29). The aim of this system is the purposeful collection and provision of health-related data (30), mainly for care quality improvement (28).

One limitation of the present study was that we could not find any similar study in Iran and hence, could not compare our findings with the findings of other studies.

4.1. Conclusions

One of the most important ICT requirements for HSMH is easy access to high-speed internet. It can facilitate effective telehealth service provision, which is another main ICT requirement for HSMH. It is noteworthy that National Internet can overcome some Internet-related problems in Iran, while it may restrict access to international databases. Governmental authorities need to develop exclusive policies in order to provide medical universities with high-speed internet.

Acknowledgements

References

  • 1.

    Research and development center for university policies. Scientific road map of Tehran University of medical sciences. 2009. Available from: http://education.tums.ac.ir/IPPWebV1C037/Persian_WebUI/Templates/WebSiteTemplate1/WebSiteFile1068.aspx.

  • 2.

    Esmailzadeh H, Majdzadeh SR, Ibrahimipoor H, Dehnavieh R. Assessment of the Iran health innovation system and provide corrective suggestions. Payesh. 2013;12(1):5-16.

  • 3.

    Arshadi M, Rahkarfarshi M. Conformity of Nursing Researches with Comprehensive Health Plan of Iran: Case Study. Nursing of Tabriz University of Medical Sciences; 2015.

  • 4.

    Bucky SF, Callan JE, Stricker G. Ethical and legal issues for mental health professionals: A comprehensive handbook of principles and standards. Routledge; 2013.

  • 5.

    Mehar A. From knowledge creation to economic development: Missing links in muslim world. J Manag Soc Sci. 2005;1(1):24-47.

  • 6.

    NADERI AAGH. Economics of Education and its Status in Iranian Educational System. J Manag Soc Sci. 2002;1(1):24-47.

  • 7.

    Haghdoost A. Qualitative study of Ph. D. student scholarship systems in developing and developed countries. Strides Dev Med Educ. 2015;1(2):73-84.

  • 8.

    Haghdoust AA, Sadeghirad B, FASIHI HM, ROUH AA. Ph. D. Education model in medical fields in iran and the application of research based curriculum. Hakim Med J. 2009;11(4):8-15.

  • 9.

    Malekzadeh R, Mokri A, Azarmina P. Medical science and research in Iran. Arch Iran Med. 2001;4(1):27-39.

  • 10.

    Majd Rahim Abadi A, Fathallahi A. Forecasting introduction: a glance at the early experiences of Japan, Germany and Iran. Growth And Technology Magazine (Roshd -e- Fanavari). 2009;17:63-5.

  • 11.

    Policy making council of Ministry of Health and Medical Education. Health Scientific Road Map. Tehran; 2002.

  • 12.

    Haghdoost AA, Sadeghirad B, Dehghani MR, Eslaminejad T, Shafian H, Alizadeh M, et al. Strategies in development of Iranian medical sciences universities for dynamic presence in the international arena. Strides Dev Med Educ. 2013;10(2):120-9.

  • 13.

    Aguilar J. Dynamic random fuzzy cognitive maps. Computacion y Sistemas. 2004;7(4):260-70.

  • 14.

    Maniy R, Carolux A, Frostock M. Investigating the relationship between ICT and scientific development using cognitive map. J Res Plan High Educ. 2009;15(1):73-97.

  • 15.

    Farajzadegan Z, Javadi AA, Asgari GHR, Manzouri L. Indicators of utilization as a means for assessment of health information management systems. Health Inf Manag. 2007;4(31):23-31.

  • 16.

    Policy making council of MOHME. IslamicRepublic of Iran's health in Thfifthprogram of economic, social and culturaldevelopment. 2009.

  • 17.

    Beglaryan M, Petrosyan V, Bunker E. Development of a tripolar model of technology acceptance: Hospital-based physicians' perspective on EHR. Int J Med Inform. 2017;102:50-61. [PubMed ID: 28495348]. https://doi.org/10.1016/j.ijmedinf.2017.02.013.

  • 18.

    Sendak MP, Balu S, Schulman KA. Barriers to Achieving Economies of Scale in Analysis of EHR Data. A Cautionary Tale. Appl Clin Inform. 2017;8(3):826-31. [PubMed ID: 28837212]. https://doi.org/10.4338/ACI-2017-03-CR-0046.

  • 19.

    Arndt BG, Beasley JW, Watkinson MD, Temte JL, Tuan WJ, Sinsky CA, et al. Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. Ann Fam Med. 2017;15(5):419-26. [PubMed ID: 28893811]. https://doi.org/10.1370/afm.2121.

  • 20.

    Roehr B. Trend for US patients to seek health information from media and internet is stalling. BMJ. 2011;343:d7738. [PubMed ID: 22127143]. https://doi.org/10.1136/bmj.d7738.

  • 21.

    Les consequences des usages d'internetsur les relations patients-medecins. Ipsos Public Affairs. The Social Research and Corporate Reputation Specialists. 8. 2019.

  • 22.

    Jookar A, Naeemi S. Use the Internet to compare the information needs of graduate students at the University of Isfahan and Shiraz. Nat Studies Lib Inf Organiz. 2008;75:223-38.

  • 23.

    Norouzi Y, Talkhabi M, Alipour HM. Evaluation of information seeking behavior of Arak university faculty members in using the internet. J Epistemol. 2010;3(10):81-91.

  • 24.

    Yaghoubi M, Asgari H, Javadi M. The impact of the customer relationship management on organizational productivity, customer trust and satisfaction by using the structural equation model: A study in the Iranian hospitals. J Educ Health Promot. 2017;6.

  • 25.

    Sayedi M, Mousavi A. Heidari Sh. Factors affecting the performance of customer relationship management and new measurement model fit (case study in the electronics industry). J Educ Manag. 2009;2:79-112.

  • 26.

    Lee HY, Lee JS, Kim J. Prerequisites for Effective Implementation of Telemedicine: Focusing on Current Situations in Korea. Healthc Inform Res. 2015;21(4):251-4. [PubMed ID: 26618031]. https://doi.org/10.4258/hir.2015.21.4.251.

  • 27.

    Organisation for Economic Co-operation and Development. OECD Internet economy outlook. Paris: Organisation for Economic Co-operation and Development; 2012. Available from: http://www.oecd.org/sti/ieconomy/oecd-interneteconomy-outlook-2012-9789264086463-en.htm.

  • 28.

    Korea Medical Device Policy Development Institute. The u-Healthcare industrial market and company analysis. Seoul, Korea; 2012.

  • 29.

    Taherian A, Mohammadi F, Hosseini MA, Rahgozar M, Falahi KM. The effectiveness of patient education and home-based follow up on knowledge and health behaviors in patients with myocardial infarction. Iran J Nurs Res. 2007;2(5):7-13.

  • 30.

    McCain ME, Quinet RJ, Davis WE. Etanercept and infliximab associated with cutaneous vasculitis. Rheumatology (Oxford). 2002;41(1):116-7. [PubMed ID: 11792895].