|Year : 2015 | Volume
| Issue : 2 | Page : 103-108
Toward a framework of statistical information system 1 for Iranian hospitals
Sakineh Saghaeiannejad-Esfahani1, Asghar Ehteshami2, Zohreh Mohammadi-Bertiani2
1 Instractor Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Information Technology, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||12-Feb-2015|
Department of Health Information Technology, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan
Source of Support: This study is a part of a master thesis (approved code:393607) supported by Isfahan University of Medical Sciences, Conflict of Interest: None
Statistical information is a valuable and strategic resource for decision making to each level of the management, especially in disaster and crisis situations. This issue in hospitals as a health care service due to their function (that are directly related to human life) is more significant. The SIS is required at hospital level to promote this need. This study provided a framework of a Statistical Information System for Iranian hospitals. Materials and Methods: The present study was conducted using mixed methods with qualitative approach and Delphi technique during the 2013-14 in four phases: 1. Hospital statistical reports and indicator were identified and collected; 2. Based on the collected reports and indicator, an initial SIS framework was designed; 3. Delphi technique was used to determine the validity of the proposed framework; 4. Each accepted statistical indicator in previous phase was considered as SIS output and then input and process of them were determined. Results: More than 500 reports and indicators identified and about, 85% of them considered in the initial SIS framework; and all Initial SIS framework indicators accepted by the experts in the first round of Delphi. Then a framework of SIS is presented in three major pivots suggested 363 inpatients, emergency and outpatient indicators for the Iranian hospitals. Conclusion: To have timely, accurate, consistent and reliable statistical information for decision making for more and better care in hospital level, a SIS is required. One of the core components of Hospital Information System (HIS) is SIS. In this study, based statistical demand of Iranian hospital and scientific references, a framework of SIS is presented that consists three major pivots. It is clear that statistics in other pivot in hospital like financial, facilities and hospital equipment, human resource indicators and etc. are needed for complete this framework.
Keywords: Emergency/statistics, emergency indicator, hospital information system, inpatient/statistics, inpatient indicator, outpatient/statistics, outpatient indicator, statistical information system
|How to cite this article:|
Saghaeiannejad-Esfahani S, Ehteshami A, Mohammadi-Bertiani Z. Toward a framework of statistical information system 1 for Iranian hospitals. Int J Health Syst Disaster Manage 2015;3:103-8
|How to cite this URL:|
Saghaeiannejad-Esfahani S, Ehteshami A, Mohammadi-Bertiani Z. Toward a framework of statistical information system 1 for Iranian hospitals. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2020 Sep 30];3:103-8. Available from: http://www.ijhsdm.org/text.asp?2015/3/2/103/151327
| Introduction|| |
Timely, accurate, consistent and reliable health information is crucial for policy making, planning, implementation, monitoring and evaluation of all health programs , ; especially in disaster and crisis situations.  In this regard statistical information is a valuable and strategic resource use as input in the decision making process, health sector reviews, planning and resource allocation in management at all health system levels. ,,
A health care service has a wide range of information requirements.  Hospitals as a health care service are a highly diverse information generated  ; they collect data about inpatients and out patients on a daily basis. 
The traditional medical record information statistical method has not been able to satisfy the hospital rapidly expand the information need. 
Hereof information technology is making a significant positive impact on the hospital statistics as well as other part of the healthcare sector. ,, Introduction of comprehensive hospital information system as a means of improving efficiency and, hopefully, revenue collection  and essential hospital performance components  is an instance of this positive impact. Owing to Hospital Information Systems (HIS) are mainly consists of the data and statistics of the professional work performed by doctors, nurses and paramedics who provided services to patients.
Unfortunately consequences of implementing HIS have led to a failure in meeting decision makers' expectations on the one hand and a failure in the successful execution of the process on the other hand.  Current hospital information systems with simple statistical functions cannot meet the increasing demands of hospitals. 
Over the past 10 years it has become obvious that statistical information systems, both official and commercial, need to integrate different statistical information sources and tool-sets to achieve a coherent framework for production, reference and dissemination activities.  The hospital wishes to acquire a Health Statistics Information Module that include all health statistics information. 
In this regard and in health sector, YiXin, premise medical record statistical information management system by hospital information system development  ; Xu, noting that the SIS is one of the major components of the Electronic Health Record (EHR)  ; The Medical Statistical Information System (MSIS) is used by the Centers for Medicare and Medicaid Services (CMS) to gather key eligibility, enrollment, program, utilization and expenditure data for the Medicaid and Children's Health Insurance Program (CHIP)  ; Patricia MacTaggart and et al., 2011 examines the feasibility of utilizing MSIS data to identify and analyze the core children's health care quality measures required. 
In Iran, there is not seen any leatreture about SIS. In other studies it has been considered mainly in the national and international level; In addition none of leatretures don't pay attention to the framework of statistical indicators needed in the hospital.
As respects, for designing SIS, having an approved framework of scientific statistical indicators based real demands because of the importance of user requirements , is necessary; Consequently, this study was conducted to develop a framework based users' demands, for designing a statistical information system for Iranian hospitals.
| Materials and Methods|| |
The present study was conducted using mix method , with qualitative approach and Delphi technique during 2013-2014.
Our research has been carried out in four phases.
Phase 1: Identifying and collecting statistical indicators. The study data at this phase were collected based all statistical demand in "raw form" from 1. Teaching hospitals affiliated to Isfahan University of Medical Sciences; 2. Department of statistics and information and 3. statistics unit of Department of Health of Isfahan University of Medical Sciences in 2013; literature review which include studying the documents, articles, books, and journals either in the library or published on the websites, database, and also searches engines available at Google scholar as well as extracting statistical indicators by the content analysis method.
Phase 2: The data obtained from the first phase was incorporated with each other; in this way that, unrelated indicator to the circulation of a patient in a hospital and non-extractable one from the HIS, were deleted and similar and duplicate cases was synthesized. Then statistical indicators obtained were classified in three pivots of inpatient, outpatient and emergency indicators. And thus the Initial framework of SIS for hospitals in Iran was developed.
Phase 3: The Initial framework has become the questionnaire in five-point Likert scale questionnaire, which consists of three main pivot of inpatient, emergency and outpatient indicator.
The validity of the questionnaire was assessed using the viewpoints of academic the professionals, medical records specialists and health information/technology management specialists in Iran. Some items were added to it based on the professionals' opinions and some items were modified. The reliability of the questionnaire was calculated around 0.998 using Cronbach's alpha.
The Delphi study as an iterative consensus building process is a well-known approach to develop health indicators.  Therefore, in third phase, we used Delphi technique to determine the validity of the proposed framework.
Experience, willingness to participate, availability and at least 3 years of professional experience, including experts in the fields of health information management/technology and medical record with adequate knowledge and experience of hospital statistics, were the general and specific criteria for selecting experts.
Finally, 47 potential experts were identified and were invited to participate and questionnaire was sent to them through E-mail. Ultimately, 19 of them consented to freely participate in the study and completed questionnaires were returned. The participants in the Delphi technique had to score the components of the proposed framework using the 5-point Likert scale (1 = Very important, 5 = unimportant) and present their suggestions, as well.
The items with median scores ≥4 could remain in the framework.
Phase 4: Determined input and process of each accepted statistical indicators. These four phases are summarized in [Figure 1].
| Results|| |
In general, about 500 statistical reports and indicators were identified, which nearly one half of them were identified through statistical demands of the centers studied. Among the three main groups of indicators have been identified, the inpatient indicators both in demanded indicators of centers (70%) and of the literature reviewed (55%), have highest numbers.
[Table 1] shows the Initial framework of SIS based on identified indicators which consisted of 269 inpatient indicators, 63 emergency indicators and 28 outpatient indicators as well as three basic information for indicator.
To develop an Iranian SIS framework a Delphi study was performed. The Delphi panel included national experts in the fields of health information technology/management and medical record in different settings including medical sciences universities and hospitals. The demographic characteristics of the experts who participated in Delphi technique are shown in [Table 2].
|Table 2: Demographic characteristics of Iranian experts participated in Delphi technique|
Click here to view
Most of the panelists had a PhD degree and more than 10 years professional experience, most of them were Faculty member and were educated in Health information management.
[Table 3] shows the panelists' views about the Initial framework indicators. According to this table, all 363 indicators were accepted by panelists in first round of Delphi. To provide the framework of statistical information system, all accepted indicators in the Delphi technique, were considered the output of the SIS and the formula for calculating the outputs that were based on the scientific literature, books and existing guidelines were considered as systems processes and at least, the inputs needed for each process were determined. A Schematic view of SIS framework shown in [Figure 2].
| Discussion|| |
There is increasing agreement that promoting, major directing and coordinating authority, decision making process, planning and resource allocation in management at all health system levels, requires accurate, consistent and reliable health statistics. In this regard SIS is considered a valuable tool to provide statistical information for use as input in the decision making process. ,,,,
Consequently, as this study indicates, despite the importance of SIS at all health system levels, several SIS have been developed and applied in national and international level ,,,,, but it is not seen in hospital level. In Iran, the certain SIS isneither seen in hospital level nor in nationally level.
Use of HIS is one concern in the health sector for management of information  Consequences of implementing HIS have led to a failure in meeting decision makers' expectations  because of inadequate compatibility of hospital information systems with statistics requirements and poor efficiency in this part.  Obviously developing an information system through identifying user needs and other scientific methods is necessary. 
It seemed that a comprehensive framework for designing SIS based on HIS can solved significant part of this problem.
So in this study, for developing the hospital information system to provide statistical reports and information needed in making decisions provided a framework to deal with Iran's Hospital SIS.
Clearly, hospital indicators should be tailored to a country's needs, infrastructure, and hospital information systems. For this purpose a framework was presented in three major categories for designing a statistical information system for Iranian hospitals. This framework was a combination of the demand's indicators of centers studied and indicators were obtained through the literature review and then accepted by experts taking part in the Delphi technique.
From about 500 identified reports and indicators, 85% in initial SIS framework considered; thus the irrelevant indicator with the circulation of a patient in a hospital like staff, facility, equipment and specifications of the physical part of hospital, financial and non-extractable one from the HIS were removed and in this way the initial framework provided.
Because of scientific evidence about the initial framework indicators has been adequately mentioned in literature report and guidelines ,,,,, , and attention to real demands and user needs to provide initial framework indicators, not only all of indicator accepted by panelist but also they hadn't no idea to addition indicator, topic and pivot.
Thereupon in the final framework rendered:
- Two-hundred and sixty-nine inpatient indicators with main topics included: Bed, census, admission, discharge and transfer, readmission, morbidity, surgeries, delivery and childbirth, nosocomial infections, mortality, autopsy and performance indicators of hospital wards;
- Sixty-three emergency indicators with main topics included: Bed, census, admission, discharge and transfer, morbidity, surgeries, Cardiopulmonary resuscitation (CPR), mortality, performance indicators of the emergency ward, triage and time indicators;
- Twenty-eight outpatient indicators with main topics included: Encounter two different services (clinics, par clinics and different paramedical services) and time indicators
- Three basic information about wards and other clinical units properties.
Among the reviewed literature, there was no input or process for identified indicators. Forasmuch as a statistical information system accomplishes its tasks by performing three major functions:
(F1) an input acquisition function, which prepares and stores the observation data obtained; (F2) an aggregation function, which transforms the input acquisition function into "statistics", which are estimated values;
(F3) an output delivery function, which makes statistics available to the users, and which assists the users to interpret and analyze the data further.  We considered accepted indicators as SIS out puts then developing the formula for calculating any indicator, that was based on the scientific literature, books, academic resources and existing guidelines were considered as SIS processes and at least, inputs needed for each processes were determined.
Nevertheless input and process of any indicators require more studies. Additionally, the sensitivity, specificity and priorities of these indicators for SIS design and the useful and effective interface, are other issues that has been investigated.
It is hoped that by using this framework that summarized in [Figure 2] production of useful reports and statistical indicator to disseminate hospital statistics for different users will be improved and the system's objectives will be achieved.
| Conclusion|| |
Although several SIS have been developed worldwide, in national or international level, there is a need for hospital level too. One of the core components of HIS is SIS.
But this component donormation Systemf HIS sufficiently and based statistical demand and user need.
So in this study, based statistical demand of Iranian hospital and scientific references, a framework of SIS is presented that consists three major pivots with 363 inpatients, emergency and outpatient indicators along with basic information as a SIS module. It is clear that statistics in other pivot in hospital like financial indicators, facilities and hospital equipment indicators, human resource indicators etc. are needed for complete this framework. To support these actions more studies to identify indicators other pivot in hospital, to develop input and process indicators, developing any additional input to HIS, establishing calculating formula and pilot testing of this set of indicators, is strongly recommended.
| Acknowledgement|| |
We would like to thank all experts who freely and kindly participated in the study.
1 Multimethodology or multimethod research includes the use of more than one method of data collection or research in a research study or set of related studies and mixed methods research is more specific in that it includes the mixing of qualitative and quantitative data, methods, methodologies, and/or paradigms in a research study or set of related studies.
| References|| |
Htay W. Annual Hospital Statistics Report 2010-2011. Nay Pyi Taw, Myanmar: Ministry of Health; 2013.
Mohammadi Bertiani Z, Jahanbakhsh M. How to speed up and facilitate data collection OF disaster? Health Information Management 2011;spetial 100.
WHO. Intercountry workshop on the use of informatics tools in the health Statistical Information System. Egypt: Regional Office for Eastern Mediterranean-Cairo; 2003.
Lalu AY, Hari K, Rochimul U. Review on Hospital Information System at general hospital, west nusa tenggara province. [Dissertation]. Yogyakarta: Gadjah mada University; 2011.
Roper M, Millar L, EditorS. Managing Public Sector Records: A Study Programme. VoL. 2. Glossary: International Records Management Trust; 1999.
Chen Y. The Implementation and Design of Statistical Information System for Hospital Medical Records; 2012.
Mokhtaripoor M, Siadat S. Information technology in the hospitals of Isfahan: Suggesting a model. Health Information Management; 2008. p. 5.
Muschel J. District health information systems. South African Health Review; 1999. p. 147-59.
Li P, Wu T, Chen M, Zhou B, Xu WG. A study on building data warehouse of hospital information system. Chin Med J (Engl) 2011;15:2372-7.
Rahimi B, Pourreza A, Rashidi A, Jabraeli M, Zare Z, Aghazadeh S. A Survey on Efficiency, Benefits and Complexities of Using Hospital Information Systems from the Perspective of Physicians in hospitals Affiliated to Urmia University of Medical Sciences. J Health Adm 2013;16:16-23.
Xu X. Study and Implementation of Statistical Information System for EHR System: Uppsala University; 2011.
MacTaggart P, Foster A, Markus A. Medicaid Statistical Information System (MSIS): A data source for quality reporting for Medicaid and the Children′s Health Insurance Program (CHIP). Perspectives in health information management/AHIMA, American Health Information Management Association; 2011. p. 8.
Ajami S, Mohammdi-Bertiani Z. Training and its Impact on Hospital Information System (HIS) Success. J Inform Tech Softw Eng 2012;2:2.
Farzandipour M, Sadoughi F, Meidani Z. Hospital information systems user needs analysis: A vendor survey. J Health Inform Dev Ctries 2011;5.
Creswell JW, Klassen AC, Plano Clark VL, Smith KC. Best practices for mixed methods research in the health sciences. Bethesda (Maryland): National Institutes of Health; 2011.
Sheikhtaheri A. Developing Iranian patient safety indicators: An essential approach for improving safety of healthcare. Asian Biomed (Res Rev News) 2013;7.
(OASIS) OASIS. What is OASIS?: Georgia Department of Public Health-Office of Health Indicators for Planning (OHIP); 2014; Available from: http://oasis.state.ga.us/[Last
accessed on 2014 Aug 27].
Samuelson L, Thygesen L. Building OECD′s New Statistical Information System; 2004.
Mehraeen E, Ahmadi M. Evaluation of Hospital Information Systems in Selected Hospitals of Iran. Iran J Med Inform 2013;2.
Ahmadi M, Barabadi M, Kamkar Haghigh M. Evaluation of hospital information systems in the medical records department. Health Inform Manage 2010;7.
Ahmadi M, Ghaderi A, Khorrami F, Zare S. Needs assessment of the information management systems at medical universities based on critical success factors and business system planning. Health Inform Manage 2012;9:41.
WHO. Developing Hospital Information Bulletins. In: Level regional workshop on strengthening use of health information at the district level, editor. Bangkok, Thailand: Regional Office for South-East Asia; 2009.
Horton LA. Calculating and Reporting Healthcare Statistics (AHIMA) American Health Information Management Association; 2004.
Gholamhosseini L, Sadeghi M. Assessment of hospital information system efficiency (SHAFA) in IMAM REZA hospital. J Army Univ Med Sci 2012;10:62-6.
Geneva Un. Guidelines for the Modelling of Statistical Data and Metadata. Conference of European Statisticians of the UN Economic Commission for Europe (UN/ECE); united nations geneva: United nations statistical commission and Economic Commission for Europe; 1995.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]