Smart Healthcare System: A Prerequisite for the Optimal Implementation of the Referral System and Family Physician Program

Document Type : Letters to the Minister/Policymakers

Authors

1 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

3 Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

4 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

5 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

6 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

10.34172/jhad.1204

Abstract

Over the past decades, Iran’s health system has faced challenges such as rising costs, inequities in access, imbalances in the quality of health services, weak data management, and the lack of integration among diverse information systems. The implementation of the referral system and the family physician program, considered the main strategy for reforms and achieving universal health coverage, has encountered difficulties in urban and metropolitan areas. These difficulties include inadequate continuity and coordination of care, limitations in recording and tracking patient histories, resistance from some service providers, and an underdeveloped information infrastructure. International experiences demonstrate that the development of smart healthcare systems through technologies such as electronic health records, telehealth and telemedicine, mobile health (M-health), the Internet of Things (IoT), big data, and decision-support systems can enhance need-based access, equity, efficiency, and patient satisfaction, while reducing costs.
For Iran, a comprehensive leap toward digital health is imperative by establishing a dedicated organizational structure for smartification, ensuring people-centered platforms, developing a national data exchange infrastructure, harnessing the domestic innovation ecosystem, and expanding telehealth, telemedicine, and the Internet of Medical Things. Such a smart healthcare system, by optimizing human and financial resources, strengthening the referral system and family physician program, and revitalizing the healthcare network, can address existing challenges and effectively achieve universal health coverage.

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Main Subjects


Akhavan S. Iranian healthcare system and raising wave of privatization: a literature review. Health Scope. 2021;10(3):e111545. doi: 10.5812/jhealthscope.111545.
Khankeh HR, Bagheri Lankarani K, Zarei N, Joulaei H. Three decades of healthcare system reform in Iran from the perspective of universal health coverage: a macro-qualitative study. Iran J Med Sci. 2021;46(3):198-206. doi: 10.30476/ijms.2020.84023.1342.
Askarzade E, Nabizade Z, Goharinezhad S, Mostaghim S. Universal health coverage in Iran: a review of strengths, weaknesses, opportunities, and threats. Med J Islam Repub Iran. 2023;37:6. doi: 10.47176/mjiri.37.6.
Dehghan Bonadaki M. Studying the Status of Aging in Future Iran and its Challenges. Tehran: Research Center of the Islamic Consultative Assembly; 2023.
Heshmati B, Joulaei H. Iran’s health-care system in transition. Lancet. 2016;387(10013):29-30. doi: 10.1016/s0140-6736(15)01297-0.
Yazdi Feyzabadi V, Mehrolhassani MH, Baneshi MR, Mirzaei S, Oroomiei N. Association between pilot urban family physician program and health financial protection measures in Fars and Mazandaran provinces. Iran J Epidemiol. 2018;13(5):48-58.
Takian A, Doshmangir L, Rashidian A. Implementing family physician programme in rural Iran: exploring the role of an existing primary health care network. Fam Pract. 2013;30(5):551-9. doi: 10.1093/fampra/cmt025.
World Health Organization (WHO). Universal Health Coverage. Geneva: WHO; 2021.
Kabir MJ, Malekafzali H, Mohagheghi MA, Heidari A, Jafari N, Tabrizchi N, et al. Effective implementation of family medicine program in Iran: requirements and implementation of strategies. Iranian Journal of Culture and Health Promotion. 2021;5(3):353-60.
Heidarzadeh A, Hedayati B, Alvandi M, Rezaei M, Farrokhi B, Dadgaran I, et al. Referral system challenges of the family physician program in Iran: a systematic review. Med J Islam Repub Iran. 2023;37:49. doi: 10.47176/mjiri.37.49.
Kohpeima Jahromi V, Mehrolhassani MH, Dehnavieh R, Saberi Anari H. Continuity of care evaluation: the view of patients and professionals about urban family physician program. Int J Prev Med. 2017;8:7. doi: 10.4103/2008-7802.200525.
Kohpeima Jahromi V, Dehnavieh R, Mehrolhassani MH. Evaluation of urban family physician program in Iran using primary care evaluation tool. Iran J Epidemiol. 2018;13(5):134-44.
Mehrolhassani MH, Kohpeima Jahromi V, Dehnavieh R, Iranmanesh M. Underlying factors and challenges of implementing the urban family physician program in Iran. BMC Health Serv Res. 2021;21(1):1336. doi: 10.1186/s12913-021-07367-3.
Shams L, Nasiri T, Amiri MM, Abdolahi Z. Challenges of rural family physician policy in Iran. Int J Prev Med. 2023;14:43. doi: 10.4103/ijpvm.ijpvm_24_22.
Mohammadibakhsh R, Aryankhesal A, Sohrabi R, Alihosseini S, Behzadifar M. Implementation challenges of family physician program: a systematic review on global evidence. Med J Islam Repub Iran. 2023;37:21. doi: 10.47176/mjiri.37.21.
Heidarzadeh A, Hedayati B, Sirous S, Huntington MK, Alvandi M, Arabi A, et al. Financial challenges in the family physician programme in Iran: a systematic review of qualitative research. Malays Fam Physician. 2023;18:59. doi: 10.51866/rv.254.
World Health Organization (WHO). Global Strategy on Digital Health 2020-2025. WHO; 2021.
Tiik M, Ross P. Patient opportunities in the Estonian electronic health record system. Stud Health Technol Inform. 2010;156:171-7.
Oja M, Tamm S, Mooses K, Pajusalu M, Talvik HA, Ott A, et al. Transforming Estonian health data to the Observational Medical Outcomes Partnership (OMOP) common data model: lessons learned. JAMIA Open. 2023;6(4):ooad100. doi: 10.1093/jamiaopen/ooad100.
Dastidar BG, Jani AR, Suri S, Nagaraja VH. Reimagining India’s National Telemedicine Service to improve access to care. Lancet Reg Health Southeast Asia. 2024;30:100480. doi: 10.1016/j.lansea.2024.100480.
Imison C, Castle-Clarke S, Watson R, Edwards N. Delivering the Benefits of Digital Health Care. London: Nuffield Trust; 2016.
Hafner M, Yerushalmi E, Dufresne E, Gkousis E. The potential socio-economic impact of telemedicine in Canada. Rand Health Q. 2022;9(3):6.
OECD. The Digital Transformation of SMEs, OECD Studies on SMEs and Entrepreneurship. Paris: OECD Publishing; 2021. doi: 10.1787/bdb9256a-en.
Bitomsky L, Pfitzer E, Nißen M, Kowatsch T. Advancing health equity and the role of digital health technologies: a scoping review. BMJ Open. 2025;15(6):e099306. doi: 10.1136/bmjopen-2025-099306.
Badr J, Motulsky A, Denis JL. Digital health technologies and inequalities: a scoping review of potential impacts and policy recommendations. Health Policy. 2024;146:105122. doi: 10.1016/j.healthpol.2024.105122.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Implementing High-Quality Primary Care; Robinson SK, Meisnere M, Phillips RL Jr, et al, eds. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. Washington, DC: National Academies Press (US); 2021. 7, Digital Health and Primary Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK571817/