Journal of Modern Medical

Introduction
Health information systems are computerized systems designed to facilitate the management of health and treatment information and, thus, improve their quality of care and reduce costs. These systems serve as an infrastructure for decision-making. The success of health information systems is subject to careful evaluation and improvement of the quality and effectiveness of health care services. About 4.6% of healthcare companies’ budgets are spent on health information systems, and their failure can have negative effects on patients and medical staff. Evaluation can provide evidence of whether the information system has achieved its expected goals. In addition, it can be useful for policy making and decision-making management and budget allocation. With the increasing effect of information technology in organizations and its costs, it is very important to evaluate the quality of information technology services, especially from the perspective of users. Measuring user satisfaction with information systems is the most effective method for evaluating these systems. 
Integrated health system (SIB) is used in all medical universities of Iran (except for Mashhad University of Medical Sciences and Golestan University of Medical Sciences) to record the health and treatment information of people in health care centers. The present study aims to evaluate this system in Torbat Heydarieh based on different criteria to identify the success and failure factors of this system from the perspective of its users.
Methods
This is a descriptive study with cross-sectional design conducted in 2017. The study population consists of the users of the SIB system (doctors, midwives, nurses, health care providers, nutritionists, psychologists, environmental or occupational health experts, health workers) in rural areas, urban areas, and outskirts of Torbat Heydarieh county. Of these, 100 users were selected using random and convenience sampling methods. The research tool was a questionnaire that was designed by Sadoughi et al. The data were analyzed after collection in SPSS v.18 using descriptive statistics (SD) and statistical tests (Pearson correlation test).
Results
Of 100 participants, 80% were female and 20% were male. Most of them were in the age group of 23-31 years (53%), while 32% were in the age group 32-41 years, 13% in the age group 42-51 years, and only 1% in the age group >52 years. Their mean age was 33± 7.33. The majority of participants had bachelor’s degree (53%), while 17% had professional doctorate, 16% had diploma, had 7% had associate degree or master’s degree. The majority of them were health care providers (36%), while few of them (2%) were nutritionists and psychologists (Table 1).


The results in Table 2 showed that the highest mean scores belonged to economic, political and moral factors, respectively.


The lowest score was related to the cultural factor.
Discussion
This study assessed the factors of success and failure for the SIB system from the perspectives of users in health care centers of Torbat Heydarieh county. A system is successful when it fits the cultural and social conditions of the environment. Due to the different conditions of the regions that use the SIB system, it is recommended to hold meetings with the health managers of each region to get to know each region’s local and cultural issues and consider them in the implementation and development of the SIB system. Workshops should be held for visitors to health centers to explain the capabilities of electronic health records and their advantages over paper-based health records and increase their cooperation and trust in the system. Considering that the participation of users has always had a positive effect on the productivity and effectiveness of a system, it is recommended that the requirements of the users be taken into account by involving them in the design and implementation of the system. By involving users in the development of the system and conducting periodic surveys by managers, their useful and practical opinions can be used. This can help the user friendliness of the system and increase its effectiveness, reduce the resistance to the system adoption, and increase the user motivation to use it. Paying attention to these issues can increase the probability of success and reduce the probability of failure in this system. Finally, according to the participants’ report of the importance of economic factors, it is recommended to evaluate the SIB system in terms of cost-effectiveness using economic evaluation methods in the next studies.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Mashhad University of Medical Sciences. (Code: IR.MUMS.REC.1397.221).

Funding
This study was extracted from a master thesis. It was funded by Mashhad University of Medical Sciences.

Authors' contributions
Conceptualization, investigation: Khalil kimiafar, Masoumeh Sarbaz, Azam Zanganeh, and Nafiseh Jamal; methodology: All authors; Writing: Azam Zanganeh, and Nafiseh Jamal; Editing & review: Khalil Kimiafar and Azam Zanganeh; Supervision and budget acquisition: Khalil Kimiafar and Masoumeh Sarbaz; Data collection: Azam Zanganeh, and Nafiseh Jamal, Mohammad Reza Etesami Rad.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the deputy for research of Mashhad University of Medical Sciences for their support.


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