Volume 27, Issue 3 (11-2024)
jha 2024, 27(3): 87-102 |
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Bagherian H, Shafinia N, Tavakoli N. Utilization of selected information systems reports for decision making at Isfahan hospitals (2022). jha 2024; 27 (3) :87-102
URL: http://jha.iums.ac.ir/article-1-4489-en.html
URL: http://jha.iums.ac.ir/article-1-4489-en.html
1- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2- Department of Management and Health Information Technology, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
3- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran dBe’sat hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. & Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran dBe’sat hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. ,tavakoli@mng.mui.ac.ir
2- Department of Management and Health Information Technology, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
3- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran dBe’sat hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. & Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran dBe’sat hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. ,
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Introduction
Information technology, as the driving force of transformations in the healthcare systems, is considered the most important factor influencing the increased efficiency and effectiveness of health service provider organizations, reducing medical errors, and increasing hospital revenues [1,2]. The implementation of such systems lays the foundation for every decision-making process aimed at proper management, budget control, and oversight of various hospital resources [3]. The unique impact of health information systems lies in their management of information and production of reports. These reports encompass hospital performance indicators across various dimensions of patients’ health status and serve as valuable tools for planning, monitoring, coordination, and impactful decision-making at all managerial levels, from execution to policymaking, while simultaneously improving patient care [4-8].
The use of efficient information systems by internal and external users of healthcare organizations to improve performance, effectiveness, service quality, and patient satisfaction is an undeniable necessity in the healthcare industry. However, evidence shows that service providers and system users do not have sufficient capacity to utilize many of the reports from these systems, which leads to the storage of large amounts of inaccurate information without using it [9-11].
Mohammadpour et al. [12] declared that hospital information system reports improved physicans’ performance by 64.42%. The study by Saluvan and Ozonoff [13] showed that these reports supported managerial decisions up to 52.2%. Hospital information systems should guide managers in providing high-quality healthcare, reducing costs, and meeting the diverse needs of individuals [14]. In Sinha's study [15], 61.4% of healthcare workers reported being satisfied with the use of hospital information systems. The use of health information systems is considered to be one of the main concerns in the health sector due to the increasing need for these systems due to the ever-growing complexities of health management processes, as well as the remarkable diversity and innovations in this field. Nurses, physicians, and other healthcare providers now spend a significant amount of time each day working with these systems [16, 17]. Sanjuluca's study [4] revealed that more than 50% of users had never used or had rarely used the health information system to support decision making and, 47.2% had never included itin the audits conducted at their institution [4].
In recent years, these information systems have become one of the primary tools for healthcare institutions to communicate and provide services to their customers and stakeholders [18]. Healthcare organizations in Iran increasingly rely on numerous information systems in their daily operations to process, store, and report essential data. Systems such as Avab (Hospital Statistics and Information System), Sepas (Iran’s Electronic Health Record System), and Gasedak (Performance-Based Payment System), are employed at various levels. Avab is a web-based system that records and calculates hospital departments' identification details, statistics of department activities, staff and doctors, medical and capital equipment, and hospital performance indicators. It plays a major role in the fair allocation of resources in the Ministry of Health. Sepas was designed by the Statistics and Information Technology Management Center of the Ministry of Health to integrate citizens' health information at hospital levels. Qasedak was designed to link non-permanent employee income to the income of the department where they work in the form of a memorandum of understanding. In this method, at the first level, accountants calculate the income distributable to non-medical employees working in that department based on the performance of each department, and at the second level, each individual's share is determined based on the performance of each employee and the points earned [19-22].
The purpose of the present study was to identify the prevalence of using reports generated by Avab, Sepas, and Ghasedaksystems by users at Al-Zahra, Kashani, and Farabi teaching hospitals in the city of Isfahan, Iran.
Methods
This study was conducted using a descriptive, cross-sectional method in 2022 at Al-Zahra, Kashani, and Farabi teaching hospitals in Isfahan. The participants were all users of the Ghasedak, Avab, and Sepas reports. They were selected by using a purpoufull sampling method. A total of 139 participants with experience working with the selected systems were identified, comprising 63 users from Al-Zahra hospital, 44 users from Kashani hospital, and 27 users from Farabi hospital. Seventy one of them were Avab users, 56 Ghasedak users, and 12 Sepas users. They were divided into two groups: 134 internal users and five external users who worked in the vice-chancellery for health department and vice-chancellery for logistics and personnel affairs department. The inclusion criterion for participants was having at least three years of work experience with the selected systems. Those users who did not use these systems for professional purposes were exluded.
To collect the data, initially, all reports generated by the three selected systems were extracted. Based on these outputs, a questionnaire was designed to assess the extent to which these reports were used. The validity of the questionnaire was confirmed by six experts and specialists in health information management department from Isfahan University of Medical Sciences and five specialists in computer science, medical records, and health information technology at the hospitals mentioned above. Reliability was calculated using Cronbach’s alpha and was found to be 0.85. The questionnaire consisted of three parts: participants' demographic information, the status of the use of selected systems' reports and open-ended questions. The questionnaires were completed in the presence of the researcher at the participants’ workplace, and data were collected accordingly. The collected data were analyzed using descriptive statistics (frequency and percentage) usingSPSS software version 22.
Results
In this study, a total of 139 individuals participated, including 134 internal users (from the hospitals) and five external users (from the university’s vice-chancellor offices). Internal users included hospital managers, nursing managers, head nurses of inpatient wards, and staff from information technology units, health information management departments, human resources, financial affairs, quality improvement, social work, and medical equipments departments. External users included those responsible for the Avab, Sepas, and Ghasedak systems at the university’s central offices. Totally, %83 of participants were female, 79% held a bachelor’s degree, and 61% were from clinical staff, particularly nursing. The average age was 44 years, and the average work experience was 21 years.
The findings showed that among the three selected systems' users, head nurses and health information technology staff used Avab system reports regarding current status more than other users (75.6% and 44%, respectively). The majority of Qasedak system users were head nurses and hospital financial staff. Their most frequently uses were related to personnel reports (51.8% and 75%, respectively).. Avab system was the most frequently used system among hospital usersespecially head nurses. Hospital managers and health information technology staff used reports from all three systems (Avab, Sepas, and Ghasedak). The results showed that head nurses used the Avab system reports most frequently (80.63%) for planning and decision-making while, financial staff used Avab least frequently (0.20%) for planning and decision-making.
Overall, Avab system was the most frequently used (63.63%) and Ghasedak was the least frequently used (13.63%) among external users. Moreover, the statistics and information technology staff mostly use “current status” reports and “performance indicators” anuualy (50% and 33.33%, respectively), and theier lowest use (25%) was three-month and six-month reports. Overall, they most frequently used Avab outputs annually (42.85%) and least frequently on a monthly basis (14.28%). In addition, statistics and information technology staff used all reports from Sepas daily (100%). The financial staff at the university used the “Personnel report” and “physicians’ report” outputs monthly in 100% of cases.
The most common purpose of using Avab system indicators by statistics and information technology staff at the university's treatment deputy (85.72%) was for planning and decision-making. Furthermore, users of the Ghasedak system including financial staff only used the reports of these systems for planning and decision-making, and users of the Sepas system including information technology departmentstaff (affiliated to the university's information and communication technology center) used the reports for evaluation and monitoring purposes.
Discussion
According to this study, hospital nurses were the main users of Avab, Sepas, and Ghasedak systems for their daily activities at work.. Similarly, Afsari [19] also claimed that as nurses are the largest group of healthcare providers, they need these systems to cover their activities. However, the low quality of hospital information systems, due to nurses’ limited access to information leads to dissatisfaction and problems in the decision-making processes for nurses.Users in the present study acknowledged that they did not use certain reports from the studied systems. This suggests that the information needs of users were not considered during the design phase of these systems. Meanwhile, in the current study, some reports had no defined access for users, and their usage rate was zero. In anotherstudy, Maïga [23] evaluated healthcare data from 14 countries in East and Southern Africa and identified the potential of such data to regularly report national health statistics. Continuous efforts by hospitals to improve the recording and reporting of events, regular reviews and feedbacks on data quality issues and effective communication mechanisms between managers, healthcare providers, and health information managers are critical for improving the quality of healthcare and the statistics generated from healthcare facilities data [23].
Suleiman [6] stated that due to the inefficiency of hospital information systems (HIS) in producing the necessary information for decision making, the available data were not optimal. Additionally, raw and incomplete data, as well as data that were not available in real-time or were inconsistently reported across units, posed significant barriers for decision-makers. Jafari [24] concluded that user opinions had
Information technology, as the driving force of transformations in the healthcare systems, is considered the most important factor influencing the increased efficiency and effectiveness of health service provider organizations, reducing medical errors, and increasing hospital revenues [1,2]. The implementation of such systems lays the foundation for every decision-making process aimed at proper management, budget control, and oversight of various hospital resources [3]. The unique impact of health information systems lies in their management of information and production of reports. These reports encompass hospital performance indicators across various dimensions of patients’ health status and serve as valuable tools for planning, monitoring, coordination, and impactful decision-making at all managerial levels, from execution to policymaking, while simultaneously improving patient care [4-8].
The use of efficient information systems by internal and external users of healthcare organizations to improve performance, effectiveness, service quality, and patient satisfaction is an undeniable necessity in the healthcare industry. However, evidence shows that service providers and system users do not have sufficient capacity to utilize many of the reports from these systems, which leads to the storage of large amounts of inaccurate information without using it [9-11].
Mohammadpour et al. [12] declared that hospital information system reports improved physicans’ performance by 64.42%. The study by Saluvan and Ozonoff [13] showed that these reports supported managerial decisions up to 52.2%. Hospital information systems should guide managers in providing high-quality healthcare, reducing costs, and meeting the diverse needs of individuals [14]. In Sinha's study [15], 61.4% of healthcare workers reported being satisfied with the use of hospital information systems. The use of health information systems is considered to be one of the main concerns in the health sector due to the increasing need for these systems due to the ever-growing complexities of health management processes, as well as the remarkable diversity and innovations in this field. Nurses, physicians, and other healthcare providers now spend a significant amount of time each day working with these systems [16, 17]. Sanjuluca's study [4] revealed that more than 50% of users had never used or had rarely used the health information system to support decision making and, 47.2% had never included itin the audits conducted at their institution [4].
In recent years, these information systems have become one of the primary tools for healthcare institutions to communicate and provide services to their customers and stakeholders [18]. Healthcare organizations in Iran increasingly rely on numerous information systems in their daily operations to process, store, and report essential data. Systems such as Avab (Hospital Statistics and Information System), Sepas (Iran’s Electronic Health Record System), and Gasedak (Performance-Based Payment System), are employed at various levels. Avab is a web-based system that records and calculates hospital departments' identification details, statistics of department activities, staff and doctors, medical and capital equipment, and hospital performance indicators. It plays a major role in the fair allocation of resources in the Ministry of Health. Sepas was designed by the Statistics and Information Technology Management Center of the Ministry of Health to integrate citizens' health information at hospital levels. Qasedak was designed to link non-permanent employee income to the income of the department where they work in the form of a memorandum of understanding. In this method, at the first level, accountants calculate the income distributable to non-medical employees working in that department based on the performance of each department, and at the second level, each individual's share is determined based on the performance of each employee and the points earned [19-22].
The purpose of the present study was to identify the prevalence of using reports generated by Avab, Sepas, and Ghasedaksystems by users at Al-Zahra, Kashani, and Farabi teaching hospitals in the city of Isfahan, Iran.
Methods
This study was conducted using a descriptive, cross-sectional method in 2022 at Al-Zahra, Kashani, and Farabi teaching hospitals in Isfahan. The participants were all users of the Ghasedak, Avab, and Sepas reports. They were selected by using a purpoufull sampling method. A total of 139 participants with experience working with the selected systems were identified, comprising 63 users from Al-Zahra hospital, 44 users from Kashani hospital, and 27 users from Farabi hospital. Seventy one of them were Avab users, 56 Ghasedak users, and 12 Sepas users. They were divided into two groups: 134 internal users and five external users who worked in the vice-chancellery for health department and vice-chancellery for logistics and personnel affairs department. The inclusion criterion for participants was having at least three years of work experience with the selected systems. Those users who did not use these systems for professional purposes were exluded.
To collect the data, initially, all reports generated by the three selected systems were extracted. Based on these outputs, a questionnaire was designed to assess the extent to which these reports were used. The validity of the questionnaire was confirmed by six experts and specialists in health information management department from Isfahan University of Medical Sciences and five specialists in computer science, medical records, and health information technology at the hospitals mentioned above. Reliability was calculated using Cronbach’s alpha and was found to be 0.85. The questionnaire consisted of three parts: participants' demographic information, the status of the use of selected systems' reports and open-ended questions. The questionnaires were completed in the presence of the researcher at the participants’ workplace, and data were collected accordingly. The collected data were analyzed using descriptive statistics (frequency and percentage) usingSPSS software version 22.
Results
In this study, a total of 139 individuals participated, including 134 internal users (from the hospitals) and five external users (from the university’s vice-chancellor offices). Internal users included hospital managers, nursing managers, head nurses of inpatient wards, and staff from information technology units, health information management departments, human resources, financial affairs, quality improvement, social work, and medical equipments departments. External users included those responsible for the Avab, Sepas, and Ghasedak systems at the university’s central offices. Totally, %83 of participants were female, 79% held a bachelor’s degree, and 61% were from clinical staff, particularly nursing. The average age was 44 years, and the average work experience was 21 years.
The findings showed that among the three selected systems' users, head nurses and health information technology staff used Avab system reports regarding current status more than other users (75.6% and 44%, respectively). The majority of Qasedak system users were head nurses and hospital financial staff. Their most frequently uses were related to personnel reports (51.8% and 75%, respectively).. Avab system was the most frequently used system among hospital usersespecially head nurses. Hospital managers and health information technology staff used reports from all three systems (Avab, Sepas, and Ghasedak). The results showed that head nurses used the Avab system reports most frequently (80.63%) for planning and decision-making while, financial staff used Avab least frequently (0.20%) for planning and decision-making.
Overall, Avab system was the most frequently used (63.63%) and Ghasedak was the least frequently used (13.63%) among external users. Moreover, the statistics and information technology staff mostly use “current status” reports and “performance indicators” anuualy (50% and 33.33%, respectively), and theier lowest use (25%) was three-month and six-month reports. Overall, they most frequently used Avab outputs annually (42.85%) and least frequently on a monthly basis (14.28%). In addition, statistics and information technology staff used all reports from Sepas daily (100%). The financial staff at the university used the “Personnel report” and “physicians’ report” outputs monthly in 100% of cases.
The most common purpose of using Avab system indicators by statistics and information technology staff at the university's treatment deputy (85.72%) was for planning and decision-making. Furthermore, users of the Ghasedak system including financial staff only used the reports of these systems for planning and decision-making, and users of the Sepas system including information technology departmentstaff (affiliated to the university's information and communication technology center) used the reports for evaluation and monitoring purposes.
Discussion
According to this study, hospital nurses were the main users of Avab, Sepas, and Ghasedak systems for their daily activities at work.. Similarly, Afsari [19] also claimed that as nurses are the largest group of healthcare providers, they need these systems to cover their activities. However, the low quality of hospital information systems, due to nurses’ limited access to information leads to dissatisfaction and problems in the decision-making processes for nurses.Users in the present study acknowledged that they did not use certain reports from the studied systems. This suggests that the information needs of users were not considered during the design phase of these systems. Meanwhile, in the current study, some reports had no defined access for users, and their usage rate was zero. In anotherstudy, Maïga [23] evaluated healthcare data from 14 countries in East and Southern Africa and identified the potential of such data to regularly report national health statistics. Continuous efforts by hospitals to improve the recording and reporting of events, regular reviews and feedbacks on data quality issues and effective communication mechanisms between managers, healthcare providers, and health information managers are critical for improving the quality of healthcare and the statistics generated from healthcare facilities data [23].
Suleiman [6] stated that due to the inefficiency of hospital information systems (HIS) in producing the necessary information for decision making, the available data were not optimal. Additionally, raw and incomplete data, as well as data that were not available in real-time or were inconsistently reported across units, posed significant barriers for decision-makers. Jafari [24] concluded that user opinions had
not been considered in the design of the SIB system.
Consequently, when users are not sufficiently involved in the design phase, interacting with the system later may seem illogical to them. They may lack a sense of ownership and motivation towards the system, identifying this lack of involvement as the biggest reason for the systems failure to achieve its objectives.
Salahuddin et al. [25] showed that knowledge, system quality, teamwork, and task stressors are prerequisites for the safe use of HIS and therefore, are predictors of HIS utilization. Thus, hospital managers should facilitate safe HIS implementation strategies and also create policies and regulations for safe HIS adoption by considering socio-technical aspects. The present study showed that senior managers primarily use the selected information systems reports for planning and managerial decision-making. In another study, Balaghafari [8] concluded that HIS often does not adequately provide the information required by hospital managers. Moreover, the data received often do not play an effective role in assisting managers’ decision-making. Instead of being used as tools for planning and decision-making by managers they end up functioning as obstacles within the management system, due to factors such as data collection from multiple systems, duplication of efforts, and lack of timely and appropriate reporting and feedback
External users mainly used selected information system reports for achieving evaluation and monitoring goals, while internal users primarily use them to achieving decision-making and planning goals. Sanjuluca’s study [4] in five public hospitals showed that at least two-thirds of the participants reported being dissatisfied or only somewhat satisfied with each of the evaluated hospital information system features. More than 50% rarely or never used the health information system to support decision-making. Using hospital information systems is undeniable due to technological advances, massive data volumes, and managerial needs. Although the number of systems with similar functions may be large—resulting in duplication of work and wasted time and energy—considering users’ information needs can enhance the quality of information provided to managers and users. This leads to improved managerial performance in planning and decision-making. Edhie [26] studied the effects of IT usage, the implementation of a regional financial management information system, and the execution of internal control systems on the integration of financial reports produced by regional governments.The results indicated that the simultaneous implementation of these systems helps improve the quality of financial reports generated by local governments.
Limitation
Only three systems in three hospitals in one city were included in this study. Therefore, the results obtained cannot be generalized to other systems, hospitals and users.
Conclusion
Although head nurses use system outputs indirectly but they are not familiar with system features either. Hospital managers and the statistics units should be prioterized as the main report users, with the statistics unit handling data collection, analysis, and presentation. Accurate, timely data recording, and improved report accessibility are key to enhancing report utilization. Barriers include lack of demand from managers and users, incomplete reports, and inadequate system supports. Recommendations include tailoring reports to managers’ needs for better decision-making, providing user training programs, and ensuring supervision in data collection processes. Additionally, the ministry of health and hospital managers should support vendor contracts to improve system effectiveness and report quality.
Declerations
Ethical considerations: This article was conducted under the ethics code IR.MUI.RESEARCH.REC.1398.585 issued by the Ethics Committee for Biomedical Research of Isfahan University of Medical Sciences. The information from the questionnaires was analyzed without the names of the participants.
Funding: This study was funded by Isfahan University of Medical Sciences. The funder had no role in data collection, analysis, or writing of the article.
Conflicts of interests: The authors declare that they have no conflicts of interest.
Authors’ contribution: NT: Conceptualizing, Study design, Methodology, Data analysis, Validation, Writing- original draft, Writing- review and editing, Study supervision, Final approval; HB: Conceptualizing, Study design, Methodology, Data analysis, Validation, Writing- original draft, Writing- review and editing, Study supervision, Final Approval; NSh: Conceptualizing, Study design, Methodology, Data gathering, Writing- original draft. All the authors approved the final version of paper.
Consent for publication: Not applicable.
Data availability: All completed questionnaires can be available by the corresponding author via email if needed.
AI Deceleration: Artificial intelligence was not used in writing this article.
Acknowledgments: The authors would like to appreciate the teaching hospitals' managers and staff to participate in this research.
Consequently, when users are not sufficiently involved in the design phase, interacting with the system later may seem illogical to them. They may lack a sense of ownership and motivation towards the system, identifying this lack of involvement as the biggest reason for the systems failure to achieve its objectives.
Salahuddin et al. [25] showed that knowledge, system quality, teamwork, and task stressors are prerequisites for the safe use of HIS and therefore, are predictors of HIS utilization. Thus, hospital managers should facilitate safe HIS implementation strategies and also create policies and regulations for safe HIS adoption by considering socio-technical aspects. The present study showed that senior managers primarily use the selected information systems reports for planning and managerial decision-making. In another study, Balaghafari [8] concluded that HIS often does not adequately provide the information required by hospital managers. Moreover, the data received often do not play an effective role in assisting managers’ decision-making. Instead of being used as tools for planning and decision-making by managers they end up functioning as obstacles within the management system, due to factors such as data collection from multiple systems, duplication of efforts, and lack of timely and appropriate reporting and feedback
External users mainly used selected information system reports for achieving evaluation and monitoring goals, while internal users primarily use them to achieving decision-making and planning goals. Sanjuluca’s study [4] in five public hospitals showed that at least two-thirds of the participants reported being dissatisfied or only somewhat satisfied with each of the evaluated hospital information system features. More than 50% rarely or never used the health information system to support decision-making. Using hospital information systems is undeniable due to technological advances, massive data volumes, and managerial needs. Although the number of systems with similar functions may be large—resulting in duplication of work and wasted time and energy—considering users’ information needs can enhance the quality of information provided to managers and users. This leads to improved managerial performance in planning and decision-making. Edhie [26] studied the effects of IT usage, the implementation of a regional financial management information system, and the execution of internal control systems on the integration of financial reports produced by regional governments.The results indicated that the simultaneous implementation of these systems helps improve the quality of financial reports generated by local governments.
Limitation
Only three systems in three hospitals in one city were included in this study. Therefore, the results obtained cannot be generalized to other systems, hospitals and users.
Conclusion
Although head nurses use system outputs indirectly but they are not familiar with system features either. Hospital managers and the statistics units should be prioterized as the main report users, with the statistics unit handling data collection, analysis, and presentation. Accurate, timely data recording, and improved report accessibility are key to enhancing report utilization. Barriers include lack of demand from managers and users, incomplete reports, and inadequate system supports. Recommendations include tailoring reports to managers’ needs for better decision-making, providing user training programs, and ensuring supervision in data collection processes. Additionally, the ministry of health and hospital managers should support vendor contracts to improve system effectiveness and report quality.
Declerations
Ethical considerations: This article was conducted under the ethics code IR.MUI.RESEARCH.REC.1398.585 issued by the Ethics Committee for Biomedical Research of Isfahan University of Medical Sciences. The information from the questionnaires was analyzed without the names of the participants.
Funding: This study was funded by Isfahan University of Medical Sciences. The funder had no role in data collection, analysis, or writing of the article.
Conflicts of interests: The authors declare that they have no conflicts of interest.
Authors’ contribution: NT: Conceptualizing, Study design, Methodology, Data analysis, Validation, Writing- original draft, Writing- review and editing, Study supervision, Final approval; HB: Conceptualizing, Study design, Methodology, Data analysis, Validation, Writing- original draft, Writing- review and editing, Study supervision, Final Approval; NSh: Conceptualizing, Study design, Methodology, Data gathering, Writing- original draft. All the authors approved the final version of paper.
Consent for publication: Not applicable.
Data availability: All completed questionnaires can be available by the corresponding author via email if needed.
AI Deceleration: Artificial intelligence was not used in writing this article.
Acknowledgments: The authors would like to appreciate the teaching hospitals' managers and staff to participate in this research.
Type of Study: Research |
Subject:
Health Information Management
Received: 2024/07/1 | Accepted: 2025/05/21 | Published: 2025/06/7
Received: 2024/07/1 | Accepted: 2025/05/21 | Published: 2025/06/7
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