Comparative Investigation of Health Information Networks in Iran and Three Selected Countries: A Review Study

Document Type : Review Article

Authors

1 MSc Student, Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Iran

2 MSc, Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Iran

3 Associate Professor, Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Iran. Applied Biomedical Research Center, Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran

10.22038/nnj.2025.90150.1507

Abstract

Background and Aims: Health Information Networks (HINs) and data-related technologies play a vital role in modern healthcare systems. However, the level of development and maturity of these technologies varies across countries. Iran has made efforts in this area but still faces significant challenges. This article aimed to compare Iran’s health information system with three countries of varying income levels.
 Materials and Methods: This is a comparative review study. Relevant information was collected and analyzed through a systematic review of selected scientific articles and official documents related to HINs and data technologies in Ethiopia (low income), China (middle income), and the United Kingdom (high income).
Results: The results highlight significant differences in policy-making, infrastructure, adopted technologies, and systemic challenges across the four countries. Iran is developing national infrastructures such as the SEPAS Electronic Health Record system but struggles with issues like incomplete integration and low data quality. Ethiopia faces severe resource limitations, China has made major investments but encounters standardization challenges, and the UK, despite its long-standing experience, still deals with integrating its national systems.
Conclusion: The comparative analysis shows that national income level, policy strategies, and the extent of technological emphasis (such as EHR implementation) influence the development of health information systems. Lessons learned for Iran include the importance of a comprehensive national strategy, investments in infrastructure and human resources, adopting user-centered approaches, and establishing continuous performance evaluation mechanisms.

Keywords


[1] Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, et al. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med. 2011;8(1):e1000387.
[2] Adler-Milstein J, Jha AK. Sharing clinical data electronically: a critical challenge for fixing the health care system. JAMA. 2012;307(16):1695-6.
[3] Budd J, Miller BS, Manning EM, Lampos V, Zhuang M, Edelstein M, et al. Digital technologies in the public-health response to COVID-19. Nat Med. 2020;26(8):1183-92.
[4] Tabatabaei SM, Kasrineh MR, Sharifzadeh N, Soodejani MT. COVID-19: an Alarm to Move Faster towards "Smart Hospitals". Online J Public Health Inform. 2021;13(1):e7.
[5] Metreau E, Young KE, Eapen SG. Understanding country income: World Bank Group country classifications 2025 [updated July 1. Available from: https://blogs.worldbank.org/en/opendata/understanding-country-income--world-bank-group-income-classifica.
[6] Mousavi SM, Takian A, Tara M. Sixteen years of eHealth experiences in Iran: a qualitative content analysis of national policies. Health Res Policy Syst. 2021;19(1):146.
[7] Asadi F, Moghaddasi H, Rabiei R, Rahimi F, Mirshekarlou SJ. The Evaluation of SEPAS National Project Based on Electronic Health Record System (EHRS) Coordinates in Iran. Acta Inform Med. 2015;23(6):369-73.
[8] Samadbeik M, Ahmadi M, Hosseini Asanjan SM. A theoretical approach to electronic prescription system: lesson learned from literature review. Iran Red Crescent Med J. 2013;15(10):e8436.
[9] Woldemariam MT, Jimma W. Adoption of electronic health record systems to enhance the quality of healthcare in low-income countries: a systematic review. BMJ Health Care Inform. 2023;30(1).
[10] Tegegne MD, Tilahun B, Mamuye A, Kerie H, Nurhussien F, Zemen E, et al. Digital literacy level and associated factors among health professionals in a referral and teaching hospital: An implication for future digital health systems implementation. Front Public Health. 2023;11:1130894.
[11] Li C, Xu X, Zhou G, He K, Qi T, Zhang W, et al. Implementation of National Health Informatization in China: Survey About the Status Quo. JMIR Med Inform. 2019;7(1):e12238.
[12] Meng H, Mao H, Chi C, Zhao D. Analysis of HL7 EHRS Functional Model and Suggested Applications in China. Stud Health Technol Inform. 2017;245:174-7.
[13] Takian A, Petrakaki D, Cornford T, Sheikh A, Barber N, National NHSCRSET. Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems. BMC Health Serv Res. 2012;12:105.
[14] Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V, et al. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in "early adopter" hospitals. BMJ. 2011;343:d6054.
[15] Tabatabaei SM, Asadi F, Moghaddasi H, Khayami SR, Niroomand M. A Study of Population based Diabetes Registry in Developed Countries. JOJ Nursing & Health Care. 2018;8(2):555732.
[16] Shahmoradi L, Darrudi A, Arji G, Farzaneh Nejad A. Electronic Health Record Implementation: A SWOT Analysis. Acta Med Iran. 2017;55(10):642-9.
[17] Syzdykova A, Malta A, Zolfo M, Diro E, Oliveira JL. Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review. JMIR Med Inform. 2017;5(4):e44.
[18] Bekele TA, Gezie LD, Willems H, Metzger J, Abere B, Seyoum B, Abraham L, Wendrad N, Meressa S, Desta B, Bogale TN. Barriers and facilitators of the electronic medical record adoption among healthcare providers in Addis Ababa, Ethiopia. Digit Health. 2024 10;10:20552076241301946.
[19] Huang J, Pang WS, Wong YY, Ko S, Yip SS, Chan FS, et al. Evaluation on the adoption of eHealth App for electronic health record sharing system in Hong Kong. Ann Acad Med Singap. 2023;52(8):440-1.
[20] Ser G, Robertson A, Sheikh A. A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals. PLoS One. 2014;9(1):e77669.
[21] Cresswell KM, Worth A, Sheikh A. Integration of a nationally procured electronic health record system into user work practices. BMC Med Inform Decis Mak. 2012;12:15.
[22] Sheikhtaheri A, Tabatabaee Jabali SM, Bitaraf E, TehraniYazdi A, Kabir A. A near real-time electronic health record-based COVID-19 surveillance system: An experience from a developing country. Health Inf Manag. 2024;53(2):145-54.
[23] Tilahun B, Fritz F. Comprehensive evaluation of electronic medical record system use and user satisfaction at five low-resource setting hospitals in ethiopia. JMIR Med Inform. 2015;3(2):e22.
[24] Mohammed AS, Wudu D, Minda Z, Diress GM. Attitudes toward implementation of electronic medical record and its associated factors among health professional workers in selected public hospitals in Addis Ababa, Ethiopia, 2023: A multi-center cross-sectional study. Digit Health. 2024;10:20552076241277034.
[25] Kontopantelis E, Stevens RJ, Helms PJ, Edwards D, Doran T, Ashcroft DM. Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study. BMJ Open. 2018;8(2):e020738.
[26] Slight SP, Quinn C, Avery AJ, Bates DW, Sheikh A. A qualitative study identifying the cost categories associated with electronic health record implementation in the UK. J Am Med Inform Assoc. 2014;21(e2):e226-31.
[27] Greenhalgh T, Hinder S, Stramer K, Bratan T, Russell J. Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace. BMJ. 2010;341:c5814.
[28] Ghazisaeidi M, Ahmadi M, Sadoughi F, Safdari R. An assessment of readiness for pre-implementation of electronic health record in Iran: a practical approach to implementation in general and teaching hospitals. Acta Med Iran. 2014;52(7):532-44.
[29] Bisrat A, Minda D, Assamnew B, Abebe B, Abegaz T. Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul's and Ayder Hospitals, Ethiopia. BMC Med Inform Decis Mak. 2021;21(1):306.
[30] Cresswell KM, Worth A, Sheikh A. Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak. 2010;10:67.
[31] Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nat Med. 2019;25(1):44-56.
[32] Davenport T, Kalakota R. The potential for artificial intelligence in healthcare. Future Healthc J. 2019;6(2):94-8.
[33] Yu KH, Beam AL, Kohane IS. Artificial intelligence in healthcare. Nat Biomed Eng. 2018;2(10):719-31.