Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Health Foresight and Innovation Research Center, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Health Res Policy Syst. 2021 Dec 11;19(1):146. doi: 10.1186/s12961-021-00795-x.
As a building block of all health systems and a multi-sectoral domain, eHealth has a critical role to accelerate the achievement of sustainable development goals (SDGs), particularly universal health coverage (UHC). Our objective was to provide a better understanding of the recent experiences on eHealth policy, particularly in framing process of the policies and strategies, in an attempt to develop evidence-based recommendations that can inform future eHealth policy formulation, implementation, and development in Iran.
We undertook an exploratory, descriptive, comparative, retrospective and longitudinal analysis of eHealth policies by using content analysis of upstream and other key national policy documents, guided by criteria for reporting qualitative research (COREQ). A systematic and purposive search was conducted to identify publicly-accessible documents related to eHealth policies in Iran, followed by in-depth, semi-structured, open-ended interviews with purposefully identified national key informants in the field of eHealth. MAXQDA 12 was used to assist with qualitative data analysis.
We retrieved and included 13 national policy documents demonstrating 16 years experiences of recorded eHealth policy in Iran, from 2004-2020. Our analysis revealed seven main categories as challenges of eHealth policies in Iran: (1) lack of comprehensive and big picture of all eHealth components; (2) lack of long-term and strategic plans on eHealth; (3) poor consistency among national policy documents; (4) unrealistic and non-operational timing of policy documents; (5) inappropriate identification and lack of involvement of key actors in development and implementation of eHealth policies; (6) low priority of eHealth in the national health system, and (7) unconventional focus and attention to Electronic Health Record (EHR).
The findings reveal almost two decades history of eHealth initiatives at the national and upstream policy level in Iran, with noticeable gaps between desired policies and achieved expectations. The inclusion of eHealth solutions in the policy documents has been controversial and challenging. eHealth seems to have not been meaningfully established in the minds and views of policy makers and senior manager, which might have led to the development of incomplete and contradictory policies. The health system in Iran needs, we advocate, the design of an evidence-informed eHealth roadmap, as well as continuous, systematic, and reasonably time-bounded strategic plans to establish eHealth as the building block of health system along the pathway towards sustainable health development.
作为所有卫生系统的基石和多部门领域，电子卫生在加速实现可持续发展目标（SDGs）方面发挥着关键作用，特别是普及卫生覆盖。我们的目标是更好地了解电子卫生政策的最新经验，特别是在制定政策和战略的框架过程中，试图制定基于证据的建议，为伊朗未来的电子卫生政策制定、实施和发展提供信息。
我们通过内容分析上游和其他关键国家政策文件，对电子卫生政策进行了探索性、描述性、比较性、回顾性和纵向分析，这些文件由报告定性研究的标准（COREQ）指导。我们进行了系统和有目的的搜索，以确定与伊朗电子卫生政策相关的公开可获取文件，然后对电子卫生领域的有目的确定的国家主要知情者进行深入、半结构化、开放式的访谈。MAXQDA 12 用于协助定性数据分析。
我们检索并纳入了 13 份国家政策文件，这些文件展示了 2004-2020 年伊朗 16 年记录的电子卫生政策经验。我们的分析揭示了伊朗电子卫生政策的七个主要挑战：（1）缺乏对所有电子卫生组成部分的全面和整体认识；（2）缺乏电子卫生的长期和战略计划；（3）国家政策文件之间缺乏一致性；（4）政策文件的时间不现实且不可操作；（5）在制定和实施电子卫生政策方面，对关键行为者的识别和参与不适当；（6）电子卫生在国家卫生系统中的优先级较低；（7）对电子健康记录（EHR）的关注不常规。
研究结果揭示了伊朗国家和上游政策层面近二十年来电子卫生倡议的历史，在理想政策和实现预期之间存在明显差距。电子卫生解决方案在政策文件中的纳入一直存在争议和挑战。电子卫生似乎没有在政策制定者和高级管理人员的思想和观点中得到有意义的体现，这可能导致制定不完整和矛盾的政策。我们主张，伊朗卫生系统需要制定一个基于证据的电子卫生路线图，以及持续、系统和合理限时的战略计划，以便将电子卫生作为卫生系统的基石，沿着可持续卫生发展的道路建立起来。
