Integration of health information systems based on a common language is essential to exchange data with the system. The study aimed to eliminate the existing problem in the integration of information system with electronic health records system through providing a conceptual model of laboratory reporting system, using the Unified Modeling Language and enable information system developers to design their services based on this model and connect to Electronic Health Record System to send their laboratory reports.
In this applied-descriptive, cross-sectional study, conducted during the first half of 2015, purposive sampling was used to select 95 employees of Rajaee Heart Center laboratory in Tehran. Data were collected using a questionnaire the validity and reliability of which were measured using content validity and test-retest, respectively. Data analysis was done through descriptive statistics using SPSS software version 21. Visual paradigm was used to design a conceptual model.
Data related to reports such as, demographic, administrative, clinical, insurance, anesthesia and laboratory, observation and interpretation were suggested as minimum data set for radiology report. Identified data needs, based on processes and user description, were used to draw use case diagrams based on which activity, class, state, sequence and collaboration diagrams were designed.
Laboratory reports in Electronic Health Record System have a crucial role in diagnosing and managing clinical problems; therefore, providing a conceptual model for laboratory reporting system can eliminate the current problem of data sharing between these systems and electronic health records system.

The overall objective of a health system is to improve health through reducing disease, disability and death. Accomplishment of this goal depends on the worldwide integrated and coordinated care continuity. Information transmission is a prerequisite to ensure the continuity of care. Widespread acceptance of health information and communication technology (HICT) and developing systems such as Electronic Health Record (EHR), have changed the health care industry. Electronic Health Record is the main part of information management in an integrated health care system. Electronic health record provides access to all health information at organizational, regional, national and international levels and allows for the patient's health data [usually with geographical distribution in several health information systems] to become integrated. Since Electronic health record integrates all care events data, it can make data sharing possible between all care providers to consequently minimize the repeated diagnostic tests, and drug and treatment interactions. Furthermore, Also health care professionals can easily access to patient information at any time and this could lead to improving the quality of care and reduce costs. Accordingly, a productive system is required to provide the electronic health record. Given the significance of the electronic health record and its generating system in improvement of care quality and reducing the health care costs, authors decided to study the needs for developing the national EHR system (NHIN) The main focus of this paper was on selecting material related to the system developing an EHR and it prerequisites. Electronic health record system is a new source of valuable intelligence of real world for the whole health care industry. Electronic health record system includes people, rules, standards, storage and processing equipments, communication and support facilities. To shape this, existence of components and their coordination is necessary. Electronic health record system are established to enhance patient care and its outcome, increase efficiency, improving the availability of information and minimizing the medical errors. With the Europe union formation that in fact was an important step toward globalization, the electronic health record passed the national borders and turned into a global concept to make possible the worldwide integration and sharing of the health data. Therefore international standards are needed to share patient health information between national health systems and across borders. Infrastructure or national information network existence of proper hardware and software and finally participation of all stakeholders are necessary to develop the system. So it is necessary to prepare the infrastructures needed for development of the system in our country. Since EHR has a universal concept, it is needed to create a lifelong health information record for every individual accessible in every point in the world.

The electronic health record system (SPAS in Iran) records information related to the health of individuals in an electronic format. It is the center for collecting health information and data on outpatients and inpatients. This system records information such as the patient's full name, marital status, gender, date of admission, level of education, occupation, type of admission, and other relevant medical data. The core values and ethical requirements of SPAS include safeguarding citizens' rights, respecting individuals, observing justice and fairness, transparency, encouraging participation, and accountability. In this study, the ethical aspects of SPAS were evaluated using the model proposed by the World Health Organization (WHO) for ethical evaluation. This model emphasizes fundamental ethical principles such as human well-being and health, respecting individuals and communities, justice, and fairness. Concerning human well-being and health, SPAS can prevent unnecessary and redundant interventions and provide physicians with quick access to an accurate patient history. Furthermore, the system ensures the confidentiality of information, which is essential to respect individuals and communities. Regarding justice and fairness, the system can improve access to health services for disadvantaged and remote areas. Moreover, SPAS adheres to procedural ethical principles such as solidarity, transparency, participation, and accountability. Therefore, by critically examining the ethical dimensions of the electronic health record system (SPAS), the findings of the present study provide valuable insights for policymakers, health professionals, and regulatory organizations to ensure the ethical and efficient performance of electronic health record systems in Iran.

Changes in the health care system and society along with increase in the power of technology have imposed a mounting pressure on policymakers, healthcare providers, and the health care system to develop electronic medical record systems. Therefore, the aim of this study was to analyze the strengths, weaknesses, opportunities, and threats (SWOT) of implemented electronic health record systems from the perspective of hospital managers of Tehran University of Medical Sciences, Iran, in 2015.
This was a cross-sectional, descriptive, and analytical study. The study population included all managers of hospitals affiliated to Tehran University of Medical Sciences. The research instrument was a questionnaire which gathered information on internal factors (strengths and weaknesses) and external factors (opportunities and threats) of electronic health record systems. Data analysis was performed using descriptive statistics and SWOT analysis.
The most important strength of electronic records was quick and timely access to information (weight rating: 0.147) and the most important weakness was lack of equipment and hardware necessary for the implementation of electronic health records (weight score: 0.094). Moreover, the sharing of information between health service providers and better management of information (weight score: 0.121) were reported as the most important opportunities, and lack of strategic planning in the field of electronic health records (weight score: 0.127) as the most important threat for these record systems.
Politicians and investors in healthcare can use the strategies presented in this research to improve and accelerate the implementation of electronic health records in Iran. Furthermore, drawing a strategic plan, designing standards for security, privacy, and sharing of information, and increasing resources and financing are the steps that can be taken to better implement electronic health records.

, Study Type: Research | Subject: hospital managment | Received: 2014/06/30 - Accepted: 2014/06/30 - Published: 2014/06/30 In order to better design an electronic health record system in the country, determining standardized data elements for creating an integrated information system is important. In this study, the minimum data set of radiology reporting system is determined. In this descriptive cross-sectional study, 13 radiologists, 3 anesthesiologists, 3 general practitioners and 3 insurance experts working in the Imaging Center of Imam Khomeini hospital in Tehran were chosen. The research tool was a questionnaire having 11 parts. Content validity and test-retest method were used to measure the validity and reliability of the questionnaire, respectively. Data analysis was performed using the SPSS software. The highest means reported were radiologist's written explanations and suggestions (9.6), image interpretation (9.5), the name of contrast material (9.4), the name of imaging procedure (9.3) type and date of previous measures (9.1), and the final diagnosis (9); and the lowest averages belonged to referring physician's address (4.8), relationship between patients and the primary individual insured (4.3), and religion (2.2). In an electronic health record system, due to the importance of radiology reports for the diagnosis and future management of a patient's clinical problems, it is necessary to pay attention to the minimum set of data related to these reports such as administrative, insurance, patient identity, and clinical data, and the results of radiological examinations for exchanging with electronic health record system.

The use of electronic health record systems has been developed in the health system, but it is still not clear whether empathy is created in patient visits with this system. The present study aimed to compare patients’ perceptions of physicians’ empathy after the patient viewed standardized and scripted video vignettes of two physicians, which one used the electronic health record system during his visit, and the other one visited the patient without electronic health record system.

This study is a cross-sectional, double-blind, quasi-experimental study with only a post-test, which was conducted in Isfahan Omid Hospital, Isfahan, Iran. 120 eligible patients were selected using convenience sampling method and randomly divided into two groups (each 60 patients) in a cross-over study plan. In group 1, the first arm viewed the electronic health record video, and the second arm viewed video of visit without electronic health record, and in group 2 vice versa. The data were gathered by Jefferson Scale of Patient Perceptions of Physician Empathy, after each intervention.

The video of the visit without the electronic health record system compared to the visit with the electronic health record system had a significantly better empathy score in each arm of the participants (p<0.05).

Cancer patients perceive more empathy in physicians who do not use the electronic health record system during visits and consider this strategy more empathetic.

With huge advances in information technology, in general, and health care services in particular during the past 20 years, various forms of electronic records have been introduced, designed or implemented. This study aimed to review the status of readiness assessment in the implementation process of electronic records with a detailed focus on required and associated areas and to provide a guideline for Electronic Health Records (EHR) directors and executers. Literature review: Although making health records automatically has many advantages, in some cases, the creation of an electronic health records system seems a complicated task. Electronic health readiness assessment, performed prior to implementation, is considered as an essential process. Readiness assessment is a method used for assessing various aspects of an organization and evaluating the preparedness of each component in the organization. The benefits gained from assessment leads to correct decision making. The outcome can be used to identify deficiencies in the existing electronic health records and to provide solutions. Thus identifying factors and requirements of this assessment seems to be essential.

Registration of information obtained from laboratory findings, is an important method of transferring the results by laboratory professionals and can be of great help to diagnosis patient's clinical problems. Determination of data elements of this part has an important role in designing an electronic health records system. This study, aimed to determine the minimum data set of laboratory reporting system.
The participants of this cross-sectional, descriptive applied study, conducted in the first half of 2015, consisted of 95 laboratory staff working in Shahid Rajaee Cardiovascular, Medical and Research Center in Tehran. Data was collected using a researcher made questionnaire consisting of 11 parts the validity and reliability of which were determined through content validity and test_ retest method, respectively. The data were analyzed using SPSS software.
According to the findings, the highest mean scores were related to final diagnosis (9/6), test result (9/4), test date (9), insurance credit date (8/4), and kind of anesthesia (8/7) while the lowest mean scores were related to referring physician's address (3/8), test tools (3/3) and Social History (5/3).
Considering the significance of laboratory data and information in the diagnosis and treatment of patients and the role of information systems in collecting, processing and distributing this information, it is crucial to pay attention to the minimum set of data related to these reports such as demographic, administrative, clinical, insurance, anesthesia and laboratory, observation and interpretation for exchanging with electronic health record system.

Registration of information obtained from laboratory findings, is an important method of transferring the results by laboratory professionals and can be of great help to diagnosis patient's clinical problems. Determination of data elements of this part has an important role in designing an electronic health records system. This study, aimed to determine the minimum data set of laboratory reporting system.
The participants of this cross-sectional, descriptive applied study, conducted in the first half of 2015, consisted of 95 laboratory staff working in Shahid Rajaee Cardiovascular, Medical and Research Center in Tehran. Data was collected using a researcher made questionnaire consisting of 11 parts the validity and reliability of which were determined through content validity and test_ retest method, respectively. The data were analyzed using SPSS software.
According to the findings, the highest mean scores were related to final diagnosis (9/6), test result (9/4), test date (9), insurance credit date (8/4), and kind of anesthesia (8/7) while the lowest mean scores were related to referring physician's address (3/8), test tools (3/3) and Social History (5/3).
Considering the significance of laboratory data and information in the diagnosis and treatment of patients and the role of information systems in collecting, processing and distributing this information, it is crucial to pay attention to the minimum set of data related to these reports such as demographic, administrative, clinical, insurance, anesthesia and laboratory, observation and interpretation for exchanging with electronic health record system.

Corrently any institute that does not benefit from information technology and communicationnetworks, will gradually fall away from global communication. Therefore, various industries haveshifted towards applying information technology in order to increas their quality and productivity intoday’s competitive world. The health industry has also experienced such change. The health systemhas been constantly taking effective steps towards benefitting from the latest technologies to increasehealth and improve clinical anf financial results.In an announcement made in the 55th public session of the United Nations in Sepptember, 2000, andaccepted by 189 member countries, information and communication technology was introduced as animportant tool for achieving all the goals of this organization such as reducing poverty, correctingeducational and health services, easy access to governmental services and improving the society’shealth level. Considering the importance of medical records as the most important information sourcein healthcare, we can claim that one of the best aspects of the application of information technology inthe health system which has an key role in increasing the effectiveness of the health system, is thecreation of electronic medical records.The electronic health record tool is an electronic health record system that enables the healthcarepersonnel save time and money and improve the health condition of patients by organizing theirrecords. Moreover, the diagnosis and treatment process will also be simplified. This tool combinestraditional paper records with modern technological facilities for increasing the accuracy and speed ofcompleting healthcare records. Using paper records has certain problems such as mistakes related tobad handwriting, prescriptions, and mistakes in writing words, icreased costs for copying forms,cards, and files, and most importantly the place needed for filing the records and the human resourcesneeded for this task. Therefore, for overcoming these problems, electronic health records aresuggested. However, considering the sensitivity of the information, the confidentiality of the records is very important. Therefore, many countries have set policies int his regard. Maintaing the confidentiality of the records differs between societies considering their social, economical, scientific, political and cultural conditions.