E-Health Implementation Challenges and HIS Evaluation in Accordance with EMRAM in Iran
Abstract
The implementation of electronic health (e-Health) in healthcare organizations consistently encounters numerous challenges. These barriers hinder the widespread adoption of this promising technology within healthcare settings. This study addresses the challenges of implementing e-Health across various hospitals and also aims to evaluate the maturity of hospital information systems (HIS) in Iranian hospitals based on the electronic medical record adoption model (EMRAM). Through two rounds of literature review and case studies,
a comprehensive understanding of these previously unexplored issues has been developed. The findings identify 13 social and technical challenges, including the lack of standard applications, high costs associated with e-Health and training, legal issues, security concerns, inconsistencies and diversities in perceived e-Health benefits and barriers, lack of proficiency, and difficulties healthcare professionals face in integrating e-Health into their daily tasks. There are also negative perceptions among physicians and patients regarding the use of
e-Health software, the lengthy implementation times for HIS systems, technical difficulties due to platform diversity, resistance to change, and the limited use of pilot projects, particularly in Iran. Moreover, the maturity of hospital cases in Iran is at 3 stages, in contrast to the 7 stages of EMRAM. These results underscore the need to develop an effective strategy to address the challenges identified in this research. Additionally, a specific program should be implemented for developers to enhance the maturity of HISs and advance them to higher stages of EMRAM.
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18. Sarbaz M, Mousavi Baigi SF, Marouzi P, Hashemi Hasani SM, Kimiafar K. Type and Number of Errors of the Iranian Electronic Health Record (SEPAS) in Hospitals Affiliated with Mashhad University of Medical Sciences. Stud Health Technol Inform. 2022. [PubMed ID:35773882]. https://doi.org/10.3233/shti220736.
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20. Hashemi Hasani SM, Kimiafar K, Marouzi P, Sadati SM, Banaye Yazdipour A, Sarbaz M. [Views of users on factors affecting data quality of iranian electronic health record (SEPAS) in Hospitals Affiliated to Mashhad University of Medical Sciences: brief report]. Tehran Univ Med J. 2020;78(5):328-32. Persian.
21. Nair DP. The Scope and Functions of Health Information Management in e-Health. ECS Transactions. 2022;107(1):9939-55. https:// doi.org/10.1149/10701.9939ecst.
22. Pandita D. Consumer Health Informatics: Engaging and Empowering Patients and Families. Clinical Informatics Study Guide. Berlin, Heidelberg: Springer; 2022. p. 351-74.
23. Nayak P, Mohapatra SK, Sharma SCM. Privacy and Security Issues in IoT Cloud Convergence of Smart Health Care. Connected e-Health, Integrated IoT and Cloud Computing. Berlin, Heidelberg: Springer International 2022. p. 439-55.
24. Rausch Osthoff A-K, Vliet Vlieland TP, Meichtry A, van BodegomVos L, Topalidis B, Büchi S, et al. Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy. BMC rheumatology. 2022;6(1):12.
25. van Poelgeest R, Heida JP, Pettit L, de Leeuw RJ, Schrijvers G. The Association between eHealth Capabilities and the Quality and Safety of Health Care in the Netherlands: Comparison of HIMSS Analytics EMRAM data with Elsevier’s ‘The Best Hospitals’ data. J Med Syst. 2015;39(9):90. [PubMed ID:26242750]. [PubMed Central ID:PMC4525186]. https://doi.org/10.1007/s10916-015-0274-7.
26. Pramanik PKD, Upadhyaya BK, Pal S, Pal T. Internet of things, smart sensors, and pervasive systems: Enabling connected and pervasive healthcare. Healthcare Data Analytics and Management. Amsterdam, Netherlands: Elsevier; 2019. p. 1-58.
27. Chowdhury SR, Sunna TC, Ahmed S. Telemedicine is an important aspect of healthcare services amid COVID-19 outbreak: Its barriers in Bangladesh and strategies to overcome. Int J Health Plann Manage. 2021;36(1):4-12. [PubMed ID:32857887]. https://doi.org/10.1002/hpm.3064.
28. Jung ML, Loria K. Acceptance of Swedish e-health services. J Multidiscip Healthc. 2010;3:55-63. [PubMed ID:21289860]. [PubMed Central ID:PMC3024889]. https://doi.org/10.2147/jmdh.s9159.
2. Ayat M, Sharifi M, Jahanbakhsh M, Tavakoli N, Mokhtari H, Wan Ismail WK. E-health implementation challenges in Iranian medical centers: a qualitative study in Iran. Telemed J E Health. 2013;19(2):122-8. [PubMed ID:23374035]. https://doi.org/10.1089/tmj.2012.0071.
3. Azevedo LB, Stephenson J, Ells L, Adu-Ntiamoah S, DeSmet A, Giles EL, et al. The effectiveness of e-health interventions for the treatment of overweight or obesity in children and adolescents: A systematic review and meta-analysis. Obes Rev. 2022;23(2):e13373. [PubMed ID:34747118]. https://doi.org/10.1111/obr.13373.
4. Ksibi S, Jaidi F, Bouhoula A. A Comprehensive Study of Security and Cyber-Security Risk Management within e-Health Systems: Synthesis, Analysis and a Novel Quantified Approach. Mob Net Appl. 2023;28(1):107-27. https://doi.org/10.1007/s11036-022-02042-1.
5. Wang C, Wu X, Qi H. A Comprehensive Analysis of E-Health Literacy Research Focuses and Trends. Healthcare (Basel). 2021;10(1). [PubMed ID:35052230]. [PubMed Central ID:PMC8775877]. https://doi.org/10.3390/healthcare10010066.
6. Peng Y. European eHealth programs and smart cards: An enabler for e-health services. Neubiberg, Germany: infineon; 2009. [Cited:2023]. Available from: https://report.nat.gov.tw/ReportFront/ PageSystem/reportFileDownload/C09800886/013.
7. McKinley C, Limbu Y, Ganesan P. Examining the Impact of EHealth Literacy on Indian Adults’ Patient Satisfaction: An Investigation of Intervening Communication Processes. Int J Lang Cult. 2022;10:58-70. https://doi.org/10.22034/ijscl.2022.527739.2149.
8. Sariyildiz AY, Aksoy Y, Samanci M. The Effect of Mobile Health Applications on the Health Literacy of Individuals. Pakistan J Med Health Sci. 2022;16(3):552-5. https://doi.org/10.53350/pjmhs22163552.
9. Hanseth O. When stars align. The rise and fall of e- health infrastructure regimes. Hist Soc Res / Historische Sozialforschung. 2022.
10. Katehakis DG, Kouroubali A. Digital Transformation Challenges for the Development of Quality Electronic Medical Records in Greece. Hershey, Pennsylvania: IGI Global; 2022.
11. Furusa SS, Coleman A. Factors influencing e-health implementation by medical doctors in public hospitals in Zimbabwe. SA J Inf Manag. 2018;20(1). https://doi.org/10.4102/sajim.v20i1.928.
12. Mauco KL, Scott RE, Mars M. Validation of an e-health readiness assessment framework for developing countries. BMC Health Serv Res. 2020;20(1):575. [PubMed ID:32576174]. [PubMed Central ID:PMC7313186]. https://doi.org/10.1186/s12913-020-05448-3.
13. Society HIaMS. Las access Chicago, IL: Healthcare Information and Management Systems Society; 2023. [Cited:22.1.2023]. Available from: https://www.himss.org,.
14. Derakhshan S, Nabiollahi A, Khani N, Khayami SR. [Presenting a capability planning model based on Cobit organizational architecture management process (Case study: Fava management of Isfahan University of Medical Sciences)]. Health Inf Manag. 2022;19(2):60-70. Persian. https://doi.org/10.48305/him.2022.39198.1026.
15. Kharrazi H, Gonzalez CP, Lowe KB, Huerta TR, Ford EW. Forecasting the maturation of electronic health record functions among US hospitals: retrospective analysis and predictive model. J Med Int Res. 2018;20(8):e10458.
16. Filabadi ZR, Estebsari F, Milani AS, Feizi S, Nasiri M. Relationship between electronic health literacy, quality of life, and selfefficacy in Tehran, Iran: A community-based study. J Educ Health Promot. 2020;9:175. [PubMed ID:32953904]. [PubMed Central ID:PMC7482644]. https://doi.org/10.4103/jehp.jehp_63_20.
17. Bahmani F, Hashemi A, Noroozi M. New National Legislation on Electronic Prescription in Iran: A Severe Breach of Medical Confidentiality. J Iran Med Council. 2022. https://doi.org/10.18502/jimc. v5i4.11347.
18. Sarbaz M, Mousavi Baigi SF, Marouzi P, Hashemi Hasani SM, Kimiafar K. Type and Number of Errors of the Iranian Electronic Health Record (SEPAS) in Hospitals Affiliated with Mashhad University of Medical Sciences. Stud Health Technol Inform. 2022. [PubMed ID:35773882]. https://doi.org/10.3233/shti220736.
19. Khajouei R, Abbasi R, Mirzaee M. Errors and causes of communication failures from hospital information systems to electronic health record: A record-review study. Int J Med Inform. 2018;119:47-53. [PubMed ID:30342685]. https://doi.org/10.1016/j. ijmedinf.2018.09.004.
20. Hashemi Hasani SM, Kimiafar K, Marouzi P, Sadati SM, Banaye Yazdipour A, Sarbaz M. [Views of users on factors affecting data quality of iranian electronic health record (SEPAS) in Hospitals Affiliated to Mashhad University of Medical Sciences: brief report]. Tehran Univ Med J. 2020;78(5):328-32. Persian.
21. Nair DP. The Scope and Functions of Health Information Management in e-Health. ECS Transactions. 2022;107(1):9939-55. https:// doi.org/10.1149/10701.9939ecst.
22. Pandita D. Consumer Health Informatics: Engaging and Empowering Patients and Families. Clinical Informatics Study Guide. Berlin, Heidelberg: Springer; 2022. p. 351-74.
23. Nayak P, Mohapatra SK, Sharma SCM. Privacy and Security Issues in IoT Cloud Convergence of Smart Health Care. Connected e-Health, Integrated IoT and Cloud Computing. Berlin, Heidelberg: Springer International 2022. p. 439-55.
24. Rausch Osthoff A-K, Vliet Vlieland TP, Meichtry A, van BodegomVos L, Topalidis B, Büchi S, et al. Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy. BMC rheumatology. 2022;6(1):12.
25. van Poelgeest R, Heida JP, Pettit L, de Leeuw RJ, Schrijvers G. The Association between eHealth Capabilities and the Quality and Safety of Health Care in the Netherlands: Comparison of HIMSS Analytics EMRAM data with Elsevier’s ‘The Best Hospitals’ data. J Med Syst. 2015;39(9):90. [PubMed ID:26242750]. [PubMed Central ID:PMC4525186]. https://doi.org/10.1007/s10916-015-0274-7.
26. Pramanik PKD, Upadhyaya BK, Pal S, Pal T. Internet of things, smart sensors, and pervasive systems: Enabling connected and pervasive healthcare. Healthcare Data Analytics and Management. Amsterdam, Netherlands: Elsevier; 2019. p. 1-58.
27. Chowdhury SR, Sunna TC, Ahmed S. Telemedicine is an important aspect of healthcare services amid COVID-19 outbreak: Its barriers in Bangladesh and strategies to overcome. Int J Health Plann Manage. 2021;36(1):4-12. [PubMed ID:32857887]. https://doi.org/10.1002/hpm.3064.
28. Jung ML, Loria K. Acceptance of Swedish e-health services. J Multidiscip Healthc. 2010;3:55-63. [PubMed ID:21289860]. [PubMed Central ID:PMC3024889]. https://doi.org/10.2147/jmdh.s9159.
| Files | ||
| Issue | Vol 8 No 2 (2024) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v8i2.15628 | |
| Keywords | ||
| Medical Informatics Quality Assurance Hospital Information System Information System Electronic Medical Records Iran | ||
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How to Cite
1.
Ayat M. E-Health Implementation Challenges and HIS Evaluation in Accordance with EMRAM in Iran. Health Tech Ass Act. 2024;8(2).
