Designing Model for Using Document Imaging to Keep Medical Records

Document Type : Original Article


1 Assistant Professor of Health Information Management.Department of Health Information Management, Paramedical School, Ahvaz Jundishapur University ‎of Medical Science, Ahvaz, Iran.

2 Instructor Medical Record.Department of Health Information Management, Paramedical School, Ahvaz Jundishapur University ‎of Medical Science, Ahvaz, Iran.

3 Assistant Professor Health Information Management.Department of Health Information Management, School of Management and Medical Informatics, ‎Tabriz University of Medical Science, Tabriz, Iran.‎

4 BA of Medical Record.Vice-Chancellor for Treatment, Ahvaz Jundishapur University of Medical Science, ‎Ahvaz, Iran.‎


Background and Objectives:  In the past decade, hospitals in Iran have been heavily interested in electronic storage of paper based medical records using document imaging. But there is no specific guidance or instruction for hospitals in Iran regarding the use of this method. Therefore, the purpose of this study was to design a model for the use of document imaging for paper based medical records keeping in hospitals.
Subjects and Methods: This is cross-sectional and descriptive study was conducted in two phases since 2012 to 2017. In the first phase, the use of document imaging method was investigated in eight hospitals in Khuzestan province. Data were collected using a checklist and on-site visits from hospitals.  In the second stage, a model was proposed for using document imaging to keep medical records in hospital. This model presented as a questionnaire and was distributed to 25 experts. The validity of the proposed model was tested in two steps using the Delphi method. In each stage, descriptive statistics methods were used for data analysis. 
Results: The results of the first phase showed that most hospitals used document imaging as archive for keeping inpatient medical records. All hospitals used document imaging software to index and scan records. In the second phase of the study in two Delphi rounds, overall 129 components for the final model of document imaging implementation were approved by the experts. The final model consists of four main parts, planning for document imaging implementation, the minimum capabilities of document imaging software, the minimum requirements for the process of document imaging, and the implementation of the document imaging in the medical records department.
Conclusion: The model presented in this study can help hospitals, document imaging service providers, document and health information management specialists to use the document imaging method.


1-Ghazi-saidi M, Safdari R, Davarpanah MR‎. health information management. Tehran: Mirmah; 2005.
2-Moghaddasi H, Sheikhtaheri A. Organizational chart of health information management department, presented a new pattern for hospital of Iran. Payesh. 2008;7(2):129-40.
3-Daniali A, Keshtkaran a‎. ‎Health Information Management: From design to operation‎. Shiraz: Publications of Shiraz University of medical sciences‎; 2000.
4-Davis N, LaCour M. Introduction to health information technology: Saunders WB Co; 2001.
5-            Mohammadi A, Kameli ME, Kamkar HM, Amini MK. A survey on the status of the application of document imaging for storage medical records of ‎hospitals in Iran, 2013‎. Journal of clinical research in paramedical sciences. 2015;4(1):63-70.
6-            Kameli ME, Kamkar- haghighi M, Parvan M, Zarei J. The medical records maintenance in hospitals of Iran: A national survey. Journal of healthcare management. 2014;5(2):25-33.
7-            Zarei J. Compare electronic medical record filing with traditional approach in hospitals in ‎selected cities and submit appropriate framework.[Thesis]‎. Isfahan University of Medical‏ ‏Sciences, 2010.
8-Zarei J, Biglar M, Chatrouz A, Nikkhah S, Amini M. Document management in healthcare. Tehran‎: Tabdis; 2013.
9-Ahmadi M, Samadbeik M, Birjandi M. Survey of the medical records filing in the teaching hospitals of Lorestan univercity of medical sciences in 2009. Yafteh. 2009;11(3):73-83.
10-Davari- doulatabadi N, Shahi M. Medical record sections in Hormozgan University of Medical Sciences affiliated Hospitals. 2005.
11-Azizi A, Torabipour A, Safari S, Mohhamadi A, Kheirollahi J, Shojaei Baghini M. Assessment of Medical Records Department Performance in Kermanshah Educational Hospitals 2007 Iran. Journal of Health Administration. 2009;12(37):17-22.
12- Ajami S, Tavakoli-Moghadam O. A Comparative Study on Health Information Management System with Standards in Ayatolah-Kashani Hospital in Isfahan, Iran. Health Information Management. 2006;1(3):63-71.
13-Davari-doulatabadi N, Shahi M, Tavasoli-farahi M. Effects of environmental factors on medical files kept in the hospitals affiliated to Hormozgan University of Medical ‎Sciences, 2004‎. Hormozgan Medical journals ‎. 2006;10(3):279-83.
14-Zarei J, Saghaiannejad-isfahani S, Ajami S, Saidbakhsh S. Electronic Storage as a Step towards Reducing Costs: An Investigation into the Use of Document Imaging in Medical Records Department. Journal of health accounting. 2013;1(2).
15- Zarei J, Mohammadi A, Kameli ME, Kamkar HM, Amini MK. A survey on the status of the application of document imaging for storage medical records of hospitals in Iran, 2013‎. Journal of clinical research in paramedical sciences. 2015;4(1):63-70.
16-Carter JH. Electronic medical records: a guide for clinicians and administrators: ACP Press; 2001.
17-McAuley E, Unnithan C, Karamzalis S. Implementing scanned medical record systems in Australia: a structured case study on envisioned changes to elective admissions process in a Victorian hospital. International Journal of E-Adoption (IJEA). 2012;4(4):29-54.
18-Floyd A. Medical Record Scanning Project, Bathurst Base Hospital, Greater West Area Health Service (NSW): a health information management perspective. Health Information Management Journal. 2010;90(1):56.
19-Waegemann CP. Spotlight on healthcare: document imaging in healthcare: one piece of the puzzle in creating electronic patient record systems. Inform. 2000;14(1):8-10.
20-Liette E, Meyers C, Olenik K. Is document imaging the right choice for your organization? Journal of AHIMA. 2008;79(11):58-60.
21-Schmidt RA, Simmons K, Grimm EE, Middlebrooks M, Changchien R. Integration of Scanned Document Management With the Anatomic Pathology Laboratory Information System: Analysis of Benefits. American Journal of Clinical Pathology. 2006;126(5):678–83.
22-West S. Need versus cost: understanding EHR data migration options. The Journal of medical practice management: MPM. 2013;29(3):181-83.
23-Rhodes HB, Dougherty M. Document imaging as a bridge to the EHR. Journal of AHIMA. 2003;74(6):‎56A-G‎.
24-Rogoski R. Paperless strategies rely on document imaging. Document imaging provides a bridge to the paperless hospital. Healthcare informatics: the business magazine for information and communication systems. 2011;28(1):24.
25-Ngulube P. Cost analysis and the effective management of records throughout their life cycle. Journal of the South African Society of Archivists. 2011;44:3-18.
26-Saghaiannejad-Isfahani S, Zarei J, Ajami S, Saidbakhsh S. The Status of Computerized Medical Records in Selected Hospitals of Ahvaz, Isfahan and Shiraz. Health Information Management. 2012;8(6).
27- Farrell K, Lute J. Document-management technology and acquisitions workflow: A case study in invoice processing. Information technology and libraries. 2005;24(3):117-22.
28-Jangi M, Azizi A, Kamali Yousef Abad M, Tara SM. Systematic Design of the Minimum Data Set Storage: An Essential Need to Create Purposed for Archiving. Journal of Health and Biomedical Informatics. 2015;1(2):113-21. eng.