Journal of Modern Medical

Introduction
One of the most important activities of the health information management departments is the coding of diagnoses and measures. In fact, clinical coding is assigning an alphanumeric code to a diagnosis or a disease. The source of the clinical coding standards is the ICD-10 Reference book [1, 2]. Today, there is a high demand for correctly coded clinical data many healthcare settings. Codes are used as a basis for reimbursing treatment costs, tracking workload, allocating resources, checking length of stay, and evaluating the quality of care [3]. One of the important problems related to the coding of diagnoses and treatments is the accuracy of coding. The results of a study reported 18.7% errors among the codes of the main actions assigned to the medical files [4] One of the reasons for the weakness of coding is the lack of skill and ability of clinical coders to extract correct codes. This problem can be due to their non-practical training [5].
Educational technologies and specifically augmented reality (AR) have the potential to provide a suitable learning experience in the field of clinical coding and surgical procedures [6]. For their optimal use, their design and development should be done based on the needs of users. Considering the importance of practical training for clinical coders for reducing the coding errors and given the necessity of using new tools for clinical coding education based on new technologies, this study aims to determine the requirements of AR-based educational applications for teaching clinical coding.

Methods
This is descriptive-comparative study, conducted in 2022 and in two steps. The first step was to determine the presentation format of the content in the form of AR. For this purpose, after the review of similar tools, the features, capabilities and content format of the extracted tools were listed. To extract similar applications, a search was conducted in Google Play store and Cafe Bazaar store using the keywords such as Medical Informatics, Health Informatics, Virtual reality, and Augmented Reality. The inclusion criteria for the applications were being based on AR, being educational, being for the Android operating system, being in Farsi or English, and being free to download. The applications required payment for installation were excluded. 
We found 252 applications in the Google Play store and 841 applications in Cafe Bazaar. After removing duplicates, screening and applying entry and exit criteria, 4 applications from Cafe Bazaar and 8 applications from Google Play remained, which were installed later (Table 1).



Then, their user interface (UI) and functionality were examined and extracted (Table 2). Eight features were related to functionality and 9 features for UI.



In the second step, according to the extracted features and taking into account the nature of the clinical coding course and the opinion of the clinical coding professors of the Faculty of Management and Medical Information, Isfahan University of Medical Sciences, the final features of the AR-based educational applications for disease coding were determined (Table 3).




Results 
As shown in Table 3, the most frequent feature of AR-based educational applications was the scanner feature to display the 3D model (n=11 out of 12). In other words, this feature was introduced as a basic feature in designing and creating an AR-based educational application. The required features of AR-based educational applications for clinical coding are divided into two general groups of functionality and UI. The functionality is divided into two categories of testing and teaching using images (2D, 3D). The UI should have the features of search, scanner, educational content classification, about us section, and audio/text guide.

Conclusion
The AR is a new technology that has a huge potential to create new educational methods and can provide new opportunities for designing educational applications. Paying attention to the functional, technical and content features of educational applications based on AR is one of the basic principles of developing these tools. One of the most important features of AR-based educational applications for clinical coding is to offer a section for tests and quizzes. According to the theoretical and practical nature of the clinical coding course, a test of disease coding knowledge should an inseparable part of these applications. Another most important feature related to functionality is the use of 2D or 3D images for teaching. Due to the nature of the clinical coding course, in which physiological, histological, pathological and anatomical topics are also used, the use of images and videos can have a deeper impact on students’ learning.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Isfahan University of Medical Sciences (Code: IR.MUI.NUREMA.REC.1401.118). 

Funding
The present article was extracted from the master's thesis of Parisa Tavakoli, approved by Department of Management and Health Information Technology, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences.

Authors' contributions
Conceptualization: All authors; Methodology: Hossein Bagherian, Parisa Tavakoli, Sakineh Saghaeiannejad Isfahani; Validation, research and review: All authors; Analysis: Hossein Bagherian, Parisa Tavakoli, Sakineh Saghaeiannejad Isfahani; References: Parisa Tavakoli, Hossein Bagherian.

Conflicts of interest
The authors declared no conflict of interest.



 

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