Minimum or no paper trail: Paper workload has been significantly reduced at the level of 6 and no paper trail at the level of 7 certificate public hospitals.
Public: “MoH requires the consent form with the wet signature of the patient and only this document is kept in the patient’s files, the rest are stored in digital archives. Hospital electronic archives should be securely protected against the risk of cyber-attacks. That’s why archive backups are made on a regular basis and were kept in the Provincial Health Directorates in addition to our hospital.” (Pubhosp7)
Private : “ After scanning patient medical records, we store them in our electronic archives. Only the signed consent form was kept as a hard copy in the patient file. However, we are trying to eliminate that hard copy by searching the technology to be able to digitalize the signed consent form as well” (PrivHosp6).
Electronic patient records : Results of all patient examinations were transferred to e-pulse via HMIS in a few days and stored in electronic archives.
Public: Patient records are able to be tracked from admittance to hospital and continue until the patient leaves the hospital. We only get signatures for the consent form. This is controlled by the Ministry of Health. (Pubhosp5).
Private: “Digitalized X-ray images, and results of blood, pathology, or other examinations are transferred directly to e-pulse thru HMIS with in few hours or days depending upon the complexity of X-ray images and the results were also accessed thru hospital web site as well” (Prvhosp7).
Decision support system : It works with a software program to provide a direction to diagnosis and treatment by offering recommendations to healthcare professionals thru alerting system. Decision support system prevents physicians or nurses or any healthcare professional from making a mistake or skipping any important step in the patient care. The HMIS possess a warning system for the doctors and nurses for situations when any changes occurr in patients’ vital signs and the system itself presents various suggestions when the need arises concerning tests or any change in treatment algorithms. For example, the system sends a warning to the nurse about the necessity of changing the patient position to prevent pressure soars and delivery of medicine and other care.
Public: “We have established decision support systems that are triggered by vital signs or laboratory results. This system provides great convenience to doctors and nurses.” (Pubhosp5)
Private: “It is an important system to prevent doctors and nurses from making mistakes. For example, if a patient who has a pacemaker is going to undergo MRI, the system gives a warning to a doctor to check the patient.” (Prvhosp6)
Closed loop medicine system : As soon as the medicine order was entered, the order appeared both on nurse and pharmacist screens simultaneously. When the doctor writes an e-order, he or she can be warned about the possibility of drug to drug and drug to meal interactions with the prescribed medicine by the system. After the approval of the medicine by the pharmacist, the pharmacy prepares unit doses either through automation or manual and delivered in the smart cart allowing the nurse to administer the right medicine at the right dose at the right time to a right patient. Smart cards were expensive; therefore, some hospitals reported using locked medicine cabinets in each service and the medicines which were kept in these cabinets were delivered by the nurse after pairing the medicine with the patient.
Public: “Closed loop medicine system is the most important application in the digital hospital. We as a hospital cannot afford smart carts and for this reason, we designed our own cart and put the PC on it. We also made a packaging device for delivering unit dose medicine. This device can produce 1,200 packages per hour. We are actively using it with the barcode reading system.” (Pubhosp6).
Private: “We don’t have expensive smart carts yet; we use locked medicine cabinets in each service and the daily dose of medicine is delivered in a plastic bag for the patient. Medicines packed in unit doses are delivered on a daily basis by the nurse after the pairing the medicine with the patient. (Privhosp5).
Table 7 displays expected technological advancements mentioned by participants in digital hospitals  in the future.
Table 7: Future technologies