Document Type : Original Article


1 Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran

2 Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran


BACKGROUND: In their apprenticeship program, health information technology (HIT) students are
deprived of the ample opportunity to work with the hospital information system (HIS). This study
aimed to design an interactive simulator for the HIS training and evaluate its effects on the informatics
skills of HIT students.
MATERIALS AND METHODS: This study was conducted on 16 Bachelor of Science students of
HIT at Kashan University of Medical Sciences in 2019. After the functionalities and features of the
simulator were determined based on similar existing simulators, expert opinions were received to
simulate eight important processes of admission, discharge, and transfer module in HIS. The scores
of students’ skills and time taken to perform the processes were recorded and analyzed before and
after the educational intervention. After they were trained by the simulator, the students filled out a
usability evaluation questionnaire. The data were then analyzed in SPSS version 21.
RESULTS: The simulators of health information systems were characterized by interactivity,
multimedia applications, practice exercises, tests, and feedback. After the students were trained by
the developed simulator, their skills scores improved significantly in 75% (6/8) of the processes, and
the timespans of all processes decreased significantly (P < 0.05). The usability evaluation indicated
the usability of the simulator was at a “good” level.
CONCLUSIONS: According to the study results, using the simulator improves the informatics skills
of HIT students in working with HIS. It is recommended that this method also be used in other
apprenticeship programs to teach health information systems.


1. Jamal A, McKenzie K, Clark M. The impact of health information
technology on the quality of medical and health care: A systematic
review. Health Inf Manag 2009;38:26‑37.
2. Huryk  LA. Factors influencing nurses’ attitudes towards
healthcare information technology. J  Nurs Manag
3. Courtney KL, Demiris G, Alexander GL. Information technology:
Changing nursing processes at the point‑of‑care. Nurs Adm Q
4. Salas E, Burke CS. Simulation for training is effective when. Qual
Saf Health Care 2002;11:119‑20.
5. Medley  CF, Horne  C. Using simulation technology for
undergraduate nursing education. J Nurs Educ 2005;44:31‑4.
6. Durham  CF, Alden  KR. Enhancing Patient Safety in Nursing
Education Through Patient Simulation. In: Hughes RG, editor.
Patient Safety and Quality: An Evidence‑Based Handbook for
Nurses. Rockville  (MD): Agency for Healthcare Research and
Quality (US); 2008 Apr. Chapter 51. PMID: 21328731.
7. Okuda Y, Bryson EO, DeMaria S, Jacobson L, Quinones J, Shen B,
et al. The utility of simulation in medical education: What is the
evidence? Mt. Sinai Schl Med 2009;76:330‑43.
8. Patterson  ES, Zhang  J, Abbott  P, Gibbons  MC, Lowry  SZ,
Quinn MT, et al. Enhancing electronic health record usability in
pediatric patient care: A scenario‑based approach. Jt Comm J Qual
Patient Saf 2013;39:129‑35.
9. SimEMR®. Available from:
Login. [Last accessed on 2019 Mar 05].
10. Simulation at OHSU. Available from:
simulation. [Last accessed on 2019 Feb 25].
11. Smith  JN, Scholtz  JM. Impact of a simulated electronic health
record on pharmacy students’ perceptions of preparedness for
clinical practice. Curr Pharm Teach Learn 2018;10:1624‑30.
12. Haugen  H. The advantages of simulation training: How to
improve EMR adoption. Health Manag Technol 2012;33:10‑2.
13. Mohan  V, Scholl  G, Gold  JA. Intelligent simulation model to
facilitate EHR training. AMIA Annu Symp Proc 2015;2015:925‑32.
14. George  NM, Drahnak  DM, Schroeder  DL, Katrancha  ED.
Enhancing prelicensure nursing students’ Use of an electronic
health record. Clin Simulat Nurs 2016;12:152‑8.
15. Available from:  [Last accessed on
2018 Jul 20].
16. Farrahi  R, Rangraz Jeddi  F, Nabovati  E, Sadeqi Jabali  M,
Khajouei  R. The relationship between user interface problems
of an admission, discharge and transfer module and usability
features: A  usability testing method. BMC Med Inform Decis
Mak 2019;19:172.
17. Chin JP, Diehl VA, Norman KL. (1988). Development of an
instrument measuring user satisfaction of the human‑computer
interface. In CHI ‘88 Conference Proceedings: Human Factors in
Computing Systems, (pp. 213‑218).
18. Kushniruk A, Borycki E, Kuo MH, Parapini E, Wang SL, Ho K.
Requirements for prototyping an educational electronic health
record: Experiences and future directions. Stud Health Technol
Inform 2014;205:833‑7.
19. Waneka  R, Spetz  J. Hospital information technology systems’
impact on nurses and nursing care. J Nurs Adm 2010;40:509‑14.
20. Kushniruk AW, Borycki EM. Human, Social and Organizational
Aspects of Health Information Systems. Pennsylvania, U.S.A:
IDEA Group; 2008.
21. Cronenwett  L, Sherwood  G, Barnsteiner  J, Disch  J, Johnson  J,
Mitchell  P. Quality and Safety Education for Nurses. Nurs
Outlook 2007;55:122‑31.
22. Coons JC, Kobulinsky L, Farkas D, Lutz J, Seybert AL. Virtual
Electronic Health Record Technology with Simulation‑Based
Learning in an Acute Care Pharmacotherapy Course.
Pharmacy (Basel). 2018;6:123.
23. Shachak A, Domb S, Borycki E, Fong N, Skyrme A, Kushniruk A,
et al. A  pilot study of computer‑based simulation training
for enhancing family medicine residents’ competence in
computerized settings. Stud Health Technol Inf 2015;216:506‑10.
24. Borycki  EM, Griffith  J, Reid  P, Kushniruk  AW, Kuo  MH. Do
electronic health records help undergraduate health informatics
students to develop health informatics competencies? Stud Health
Technol Inform 2013;192:1106.
25. Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L,
et al. Ten commandments for effective clinical decision support:
Making the practice of evidence‑based medicine a reality. J Am
Med Inform Assoc 2003;10:523‑30.
26. Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of
electronic health records on time efficiency of physicians and nurses:
A systematic review. J Am Med Inform Assoc 2005;12:505‑16.
27. Boonstra A, Broekhuis M. Barriers to the acceptance of electronic
medical records by physicians from systematic review to
taxonomy and interventions, BMC Health Serv Res 2010;10:231.
28. Hamborg KC, Vehse B, Bludau HB. Questionnaire based usability
evaluation of hospital information systems. Electronic J Inform
Syst Eval 2004;7:21‑30.
29. Elliott K, Marks‑Maran D, Bach R. Teaching student nurses how
to use electronic patient records through simulation: A case study.
Nurse Educ Pract 2018;30:7‑12.