Establishment and Utilization of Electronic Health Records in Iran: A Review of the Policy Documents of the Past Four Decades

Background: This study presents the legal obligations set for the main stakeholders in the establishment and implementation of electronic health (e-health) records in Iran and investigates the fulfillment of these obligations. Methods: This qualitative study was conducted using document analysis. The research population comprised all the documents, laws, reports, and policies of the establishment and utilization of electronic health records in Iran. Sampling was purposive, and all the internal documents of Iran were included until the end of May 2022. A data extraction form was used to collect the data, and Scott's criterion was used to select the documents. Descriptive analysis was used to analyze the data. Results: Based on the documents, 56% of the sentences were implemented, and 22% were not enforced according to the assigned tasks. The status of the execution of tasks by the main players was also extracted. The most important of these included the drafting of the electronic health security and privacy regulations, not providing the conditions for receiving electronic copies in the e-records, creating internal automation for the Ministry of Health and Medical Education instead of the e-health records system, instability of the integrated portal for exchanging health information and disconnection of the majority of service centers, eliminating the extension of the validity of paper booklets, operationalizing the online entitlement system, using the first phase of the electronic prescription project, not inserting nursing notes in the records, recording financial and administrative information instead of clinical ones, refusal of numerous doctors to write electronic prescriptions, using an alternative method of two-step verification instead of electronic signature, the progress of coding and drug authenticity, and the non-implementation of medical equipment coding. Conclusions: Reviewing the status of the enforcement of approvals also revealed that the format of actions since 2018 has ended with a positive result. The main achievement so far has been electronic prescription, while it should be noted that prescription is only part of the electronic health record project.