Journal of Modern Medical

Introduction
Eye health and preventing it from becoming lazy is very important. Lazy eye or amblyopia is a decrease in visual acuity in one or both eyes without a physical cause or specific pathological factors, which is considered as an acquired impairment in childhood. Usually, the quality of life of children with amblyopia is reduced compared to normal children and their academic performance is affected. Visual acuity test is a common method of identifying visual impairments in children, which is performed by doctors and health experts in health care centers. Studies have shown that the Iranian integrated health system (SIB system) is inefficient to meet information needs of users due to reasons such as poor programming and system design, inability to properly use the large amount of collected data, and lack of familiarity of users. Some health care organizations in developed countries have emphasized the use of minimum data set (MDS) for collecting, storing and distributing health data in order to prevent the collection of unnecessary data. Since no study has been conducted in determining the MDS of amblyopia in Iran, the present study aims to determine the MDS of amblyopia in Iran in order to create a suitable platform for facilitating the sharing of patients’ information and improving the quality of documentation in the electronic health records.

Methods
This is an applied study conducted in 2020 using quantitative and qualitative methods in six steps. In the first step, the determination of data for the proposed MDS was done using the Delphi technique and searching in PubMed, Scopus, Google Scholar, Web of Science, Scientific Information Database (SID), Magiran and Barakat knowledge system. In the second step, the records of 150 patients with amblyopia in Farabi Hospital were examined and consultation with ophthalmologists was done. In the third step, a questionnaire including two sections of “demographic information of experts” and “MDS of amblyopia cases” was prepared based on a five-point Likert scale. In the fourth step, the content validity and face validity of the questionnaire were confirmed by 6 experts in ophthalmology, health information management and medical informatics. In the fifth step, the reliability of the questionnaire was examined and confirmed (Cronbach’s α=0.88). In the sixth step, 20 experts from the amblyopia clinic of Farabi Hospital were selected using a convenience sampling method and the questionnaires were provided to them. The criterion for inclusion of each data element was being in the range of 3-5; those with an average score of 3-2.5 were entered into the second round of Delphi. In this study, all the data elements obtained an agreement score above 3; as a result, the Delphi test was performed in one step. Some data elements including language, religion, ethnicity, type of insurance, insurance number, and type of torsional strabismus were removed from the list according to experts’ opinions and finally 92 data elements were approved. There were some corrections regarding the separation of data elements according to the opinion of experts. Data analysis was done using descriptive statistics in SPSS software, version 20.

Results
In this study, 75% of the participants were male, 45% had a work experience <5 years, and 35% were ophthalmology residents. The approved MDS for amblyopia included 6 categories of demographic data, clinical data, strabismus type, sensory tests, doctor’s prescription, and treatment plan. In the category of clinical data, the patient’s medical history had the highest score (4.75). The data element of strabismus type included type of strabismus, deviation pattern, chin position, head tilt towards the left or right, nystagmus, and face turn. The data element of sensory tests included six categories where the Bagolini subtraction test (4.05) and the ability to perceive depth or three-dimensional vision (Stereopsis) obtained the highest scores. The lowest means in the data elements of doctor’s prescription and treatment plan were related to neurology consultation (3.65) and orthoptic practice (3.4), respectively.

Discussion
Determining the MDS of amblyopia cases is an effective step towards the integration of the information of patients in Iran, and can lead to the improvement of information management of patients with amblyopia, increased efficiency in health care, effective communication between health care providers and decision makers, and the possibility of comparing information. By determining the MDS for amblyopia in accordance with the social and health conditions of Iran, it becomes possible to store and retrieve the standard information of these patients for improving the quality of health care and increasing the effectiveness of medical services. Some of the limitations of the study included the doctors’ lack of time to provide us advice and the illegibility of patients’ medical records. Moreover, the determination of the MDS was only limited to patients referred to Farabi Ophthalmology Hospital. To obtain the opinions of doctors, we had to use phone call or email. To solve the problem of illegibility in medical records, we had to ask for help from nurses and some doctors. Further studies are recommended to determine the MDS for amblyopia at the national level.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval of Tehran University of Medical Sciences (TUMS) (Code: IR.TUMS.SPH.REC.1398.290).

Funding
This research was derived from the master's thesis entitled "Design and evaluation of the electronic file on the web of Amblyopia patients to receive the certificate of the master's level empowerment course in the field of health information technology (in the master's degree in the field of health information technology), approved by Tehran University of Medical Sciences (TUMS) with code 5271 in year 2020.

Authors' contributions
Study design, methodology and funding: Leila Shahmoradi; Writing-review and editing: Roya Naemi and Maryam Ebrahimi; Sources: Mina Akbarian and Maryam Ebrahimi; Supervision: Leila Shahmoradi and Roya Naemi; Review of reading and writing of the original draft: all authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We are grateful to all the experts who assisted us in conducting this research.


References

1. Mostafaie A, Ghojazadeh M, Hosseinifard H, Manaflouyan H, Farhadi F, Taheri N, et al. A systematic review of amblyopia prevalence among the children of the world. Rom J Ophthalmol. 2020; 64(4):342-55.  [DOI:10.22336/rjo.2020.56] [PMID] [PMCID]
2. Aghazadeh-Amiri M, Ghorbanian N, Ghasemi-Broumand M, Akbarzadeh-Baghban A. [Comparison of the effect of full time and part time patch (in nonstrabismic & moderate amblyopia) in 3-7 years old children (Persian)]. J Rehab Med. 2013; 2(4):15-21 [DOI:10.22037/JRM.2013.1100129]
3. Mohammadi M, Vaisi Raiegan A, Jalali R, Salimpour S, Ghobadi A, Abbasi P. Prevalence of amblyopia in Iranian children. J Babol Univ Med Sci. 2018; 20(9):72-80. [Link]
4. Hosainian H, Hatamizadeh N, Vameghi R, Bakhshi E. [Process evaluation of therapy in children with amblyopia detected in ‘amblyopia prevention program-2012’, Mashhad city (Persian)]. J Rehab Med. 2016; 5(1):109-18. [DOI:10.22037/JRM.2016.1100171]
5. Darabi M, Delpisheh A, Gholamiparizad E, Nematollahi M, Sharifian R. Designing the minimum data set for Iranian children’health records. sjimu. 2016; 24(1):114-25. [DOI:10.18869/acadpub.sjimu.24.1.114]
6. Kabir MJ, Ashrafian Amiri H, Rabiee SM, Keshavarzi A, Hosseini S, Nasrollahpour SSD. [Satisfaction of urban family physicians and health care providers in Fars and Mazandaran provinces from integrated health system (Persian)]. J Health Biomed Inform. 2018; 4(4):244-52. [Link]
7. Jafari H, Ranjbar M, Amini-Rarani M, Hashemi FS, Bidoki SS. [Experiences and views of users about delivering services through the integrated health system: A qualitative study (Persian)]. J Toloo-e-behdasht. 2020; 19(2):57-71. [DOI:10.18502/tbj.v19i2.3396]
8. Hazhir F, Jahanbakhsh M, Peikari H, Saghaeiannejad-Isfahani S. [Investigating the realization of the consequences of using the integrated health system (SIB) from users’ point of view in primary healthcare centers in Isfahan, Iran (Persian)]. J Health syst Res. 2020; 16(2):136-42. [DOI:10.22122/jhsr.v16i2.3544]
9. Sadoughi F, Yazdanian A, Hamedan F. Provision of the minimum dataset of asthma for electronic health record. J Family Med Prim Care. 2018; 7(6):1309-13. [DOI:10.4103/jfmpc.jfmpc_46_18] [PMID] [PMCID]
10. Abbasi R, Khajouei R, Mirzaee M. Evaluating the demographic and clinical minimum data sets of Iranian national electronic health record. BMC Health Serv Res. 2019; 19(1):450. [DOI:10.1186/s12913-019-4284-x] [PMID] [PMCID]
11. Khajouei R, Abbasi R, Mirzaee M. Errors and causes of communication failures from hospital information systems to electronic health record: A record-review study. Int J Med Inform. 2018; 119:47-53. [DOI:10.1016/j.ijmedinf.2018.09.004] [PMID]
12. Spigolon DN, Moro CM. Nursing minimum data set based on EHR archetypes approach. Paper presented at: The 11th International Congress in Nursing Informatics. 23-27 June 2012; Montreal, Canada. [PMID] [PMCID]
13. Kooner KS, Joseph A, Shar A, Marquardt FA, AlBdoor M, Cho BJ, et al. Dallas glaucoma registry: Preliminary results. J Clin Exp Ophthalmol. 2011; 2(6):164. [DOI:10.4172/2155-9570.1000164] [PMID] [PMCID]
14. G W Aylward AL, N Patton, D Steel, T Williamson, D Yorston. Retinal detachment data set. London: The Royal College of Ophthalmologists; 2011. [Link]
15. Shahbazi M, Safdari R, Zarei M. [Determining the minimum data set for uveitis patients’ electronic health records in Iran (Persian)]. Payavard. 2018; 12(2):120-7. [Link]
16. Ghazi Saeidi M, Moghimi Araghi S, Babadi S. [Determining the required minimum data set and data elements to create a web-based electronic record for glaucoma patients (Persian)]. Payavard. 2018; 11(6):675-84. [Link]
17. Sabbaghi H, Daftarian N, Suri F, Mirrahimi M, Madani S, Sheikhtaheri A, et al. The first inherited retinal disease registry in Iran: Research protocol and results of a pilot study. Arch Iran Med. 2020; 23(7):445-54.   [DOI:10.34172/aim.2020.41] [PMID]
18. Mahmud I, Kelley T, Stowell C, Haripriya A, Boman A, Kossler I, et al. A proposed minimum standard set of outcome measures for cataract surgery. JAMA Ophthalmol. 2015; 133(11):1247-52. [DOI:10.1001/jamaophthalmol.2015.2810] [PMID]