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Evaluating EHR and Health Care in Jordan According to the International

Health Metrics Network (HMN) Framework and Standards: A Case Study of
Hakeem

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DOI: 10.1109/ACCESS.2019.2911684

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Date of publication xxxx 00, 0000, date of current version xxxx 00, 0000.
Digital Object Identifier 10.1109/ACCESS.2017.Doi Number

Evaluating EHR and Health Care in Jordan

According to the International Health Metrics
Network (HMN) Framework and Standards: A
Case Study of Hakeem
Ahmad F. Klaib 1, and Maryam Nuser 1,2
1
Computer Information Department, Faculty of Information Technology and Computer Science, Yarmouk University, 21163, Irbid, Jordan
2
Computer Science Department, Faculty of Computer & Information Technology, Jordan University of Science and Technology, 22110, Irbid, Jordan
Corresponding author: Ahmad F. Klaib (ahmad.klaib@ yu.edu.jo).

ABSTRACT Hakeem is one of the e-health systems that were implemented in Jordan to support the health
care and services of medical sectors by connecting public health hospitals all around Jordan. This study was
carried out as a unique and first study to investigate the effectiveness of Hakeem health system according to
the international health information systems standards. The Health Metrics Network (HMN) framework and
standards for country health information systems are used to measure the Hakeem system from different
perspectives to ensure that it meets its objectives to maintain the required level of medical services in
Jordan compared to international systems.
The study was conducted on 522 respondents of Hakeem system users from four hospitals and ten health
centers in Jordan. Data were collected by a valid and reliable questionnaire and interviews and analyzed by
SPSS software. The study results indicated that the conformity extent of Hakeem system’s components with
HMN framework and standards are in different agreements percentages. Some components are with
acceptable percentages such as the integration polices and data processing while other components are with
moderate, low and very lower percentages that needed improvements. In the light of the results, the study
introduces some recommendations to improve Hakeem system such as improving the technical support of
entire system as well as the services used in pharmacy unit.

INDEX TERMS E-health, Electronic Health Record, Hakeem System, HMN Framework, Jordan, National
Strategy of Health Sector, World Health Organization

I. INTRODUCTION E-health’s significant growing nowadays due to the

The health sector in any country should be emphasized to many advantages and capabilities are provided. As an
have a healthy community. The historical information about example in a data entry process, it saves the data in small
patients should be stored and retrieved when its needed and spaces, retrieves data quickly, eliminates data redundancy,
easily communicated within the health sector itself and allows data communication, reduces errors and increases the
patients. Therefore, health care should benefit from the rapid data integrity. In addition, EHRs contain the medical history
advances in information and communications technology of patient that can be retrieved and accessed at any time in
forming the concept of e-health. The e-health is “an order to show the patient's illnesses, operations, medications,
emerging field in the intersection of medical informatics, allergies and lab results. The EHR can help doctors to avoid
public health and business, referring to health services and giving the inappropriate medications to patients such as that
information delivered or enhanced through the internet and cause risk or allergy to patient and therefore it might help in
related technologies. In a broader sense, the term saving patients’ life and decreasing morbidity and mortality
characterizes not only a technical development, but also a rates. In addition, it helps in sharing and communicating
state-of-mind, a way of thinking, an attitude, and a data within and among the health service providers that
commitment for networked, global thinking, to improve helps in following the patient’s case, exploring the x-ray and
health care locally, regionally, and worldwide by using laboratory results, eliminating paper work, supporting
information and communication technology” [1]. decision makers by choosing the appropriate medications
and treatment and consulting specialists. Furthermore, some

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e-health systems may grant patients access to healthcare II. RELATED WORK
services which will save their time and money to visit the This section introduces some examples of e-health systems
health service provider and keep them connected especially that were developed to help improving the health care and
in emergency cases [2]. Stored data in EHR can be retrieved health services. Then it presents the conducted health care
and analyzed easily and help in generating medical reports research in Jordan.
that can be used in education and research purposes [3].
A. EXAMPLES OF E-HEALTH SYSTEMS
The Hashemite Kingdom of Jordan is one of the Arab
A disease surveillance system is a real-time detection system
countries that is located in the south-west of Asia and
that monitors group of communicable diseases, such as
considered heart of the Middle East. It is within an easy
Dengue Fever. It was applied in Sri Lanka and India to solve
reach to all major Europeans, Asians and Africans cities.
the problem of manual data processing and sharing between
Many tourists from all over the world visit Jordan to
centers which might take between 15-30 days. It facilitates
discover the Jordanian historical places especially Petra that
the data communication and provides further analysis of data
is considered the capital of Nabataean Arabs and one of the
[8]. Indoor surveillance system was developed to monitor
most famous archaeological sites in the world. Recently,
the oxygen level inside the home and then warn people if the
Jordan is paying much attention to health service providers
safe level of oxygen in the air is decreased [9].
and e-health systems.
A decision support system (DSS) was presented by
The National Strategy of Health Sector in Jordan for
Mohktar et al. in 2013 in order to remotely provide
2015-2019 was created based on the deep analysis of
healthcare services to patients, to assist home tele-health, to
existing situation of Jordanian health sector with the main
reduce visit costs, to enhance the power of multidisciplinary
structure of health system that was adopted by the World
teams and to provide efficient communication between tele-
Health Organization (WHO). The main goal of the strategic
health users. The system showed its advantages in serving
plan as mentioned in the Ministry’s documentation is to
remote patients efficiently especially elderly ones [10].
ensure a high quality of health services for all people in
Jordan. Therefore, health sectors partnership to develop Another decision support system that is used for early
health policies that ensure the excellence and efficiency of recognition and management of acute kidney injury (AKI)
health services through using an excellent e-health system was investigated by Kanagasundaram et al. in [11]. The
[4][5]. study aimed to identify the promoting or inhibiting factors
for using this system for in-patients. They undertake
An EHR called Hakeem was launched by his Majesty
qualitative evaluation of an AKI CCDS system within the
King Abdullah Bin Al-Hussein to improve the health care
National Health Service of England and Wales. It has
and quality of Jordanian medical sectors [4][6]. The program
revealed precisely those themes and a tool was developed in-
aims to improve the efficiency and quality of health care in
house and required experiential learning to meet some user
Jordan through nationwide implementation of an EHR
demands. In addition, it revealed those themes that have
solution. The patient’s medical records are shared between
affected other CCDS implementations. The study results
the health service providers that are connected by Hakeem
concluded that in order for AKI interventions to become
system. The privileged Hakeem system’s users in any health
incorporated into routine clinical practice, a clinician
service provider, use the social security number to access all
approval should be established. In addition, it recommended
patients’ information such as the history visits, allergies,
designing a suitable interaction between technologies,
taken medicines, health images, lab results, etc.
people and organizations.
It is important to evaluate Hakeem system according to Reminder systems were proposed long time ago to alert
the international health systems standards in order to ensure patients and health care professionals for specific health
that it meets its objectives by providing the required level of situations [12][13]. Recently, Sebastián-Viana et al.
services to patients, doctors, physicians, pharmacists, proposed a new reminder system to improve patients follow
accountants, and other users. Therefore, this study aims to up and reduce the risks of developing a bad health situation.
investigate the extent of the conformity of Hakeem e-health The new system alerts healthcare professionals about the
system with the Health Metrics Network (HMN) framework health status of patients who suffer from pressure ulcer [14].
and standards for country health information systems that is The results of the study showed that the system was
hosted by the World Health Organization [7]. effective at reducing the risks of developing a pressure ulcer
[14].
The rest of the paper is organized as follows: the related Another health system is called Appointment System
work is overviewed in Section 2. The HMN framework and was developed by Abisoye et al. as an online outpatient
standards for country health information systems is listed in database system for General Hospital Minna in Nigeria to
Section 3. The study objectives and questions are listed in keep the outpatients records, reduce patients waiting time
Section 4. The study methodology is explained in Section 5. and improve medical service delivery [15]. They
Data analysis and results are reported and discussed in implemented an e-health application with clear
Section 6. Finally, the conclusions of the paper and the study improvements that eliminate the existing obstacles in the
recommendations are presented in Section 7. manual system [15].

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B. HEALTH CARE RESEARCH IN JORDAN [22]. Rasmi et al. proposed a model that concentrates on the
The Hashemite Kingdom of Jordan keeps up with the role of the behavior of health care professionals in using
development in all areas especially the health sector. Several EHR system in Jordan [23].
studies of e-health in Jordan were proposed. One of the El-Jardali and Fadlallah emphasized the existence of a
earliest studies was proposed by Rawabdeh that examined common standards and policies to improve the health care
the potential of implementing an e-health strategy that serves quality and safety in Jordan and Lebanon [24]. Their
patients and health facilities in Jordan [16]. He used research was based on interviews, survey, and
qualitative data collection approach and made interviews. documentation review. The study concluded an
He concluded that an e-health in Jordan is a long way to go improvement in health care quality and accreditation
and insurmountable challenges faces e-health in Jordan [16]. policies fulfillment and highlights the importance of
Several other studies investigated the challenges of e- unifying policies and strategies in order to improve the
health in Jordan. Nassar et al. divided the challenges into health quality care and patient safety [24].
general challenges such as: financial, technological, policy Alsobeh et al. proposed a framework for health data
and legislative challenges and into specific challenges such collection and integration for the Jordanian health sector.
as: stakeholder and organizational challenges [17]. Jalghoum The study was based on analyzing cancer and diabetes
and Khasawneh presented that most of the challenges due to health data. The analysis focused in integration and
human and cultural issues [18]. Both studies presented some collection features. As a result, they suggested a common
suggestions to managers in order to overcome these mechanism for data collection to reduce incompatibility and
limitations such as the mission and vision of the health integration problems. In addition, they recommended a
program should be clearly mentioned in the strategic plan, common framework between all Jordanian health
financial support should be considered and stakeholders organizations that should improve the quality of the health
should be involved in all phases and promoted for their use service provided [25].
of the system [17][18].
C. THE IMPORTANCE OF THE STUDY
Additional barriers to EHR in Jordan were mentioned by
Matar and Alnabhan in 2014. They used two surveys: one Previous studies in Jordan presented the barriers of
was distributed to hospital managers and the other one to implementing the e-health systems and recommended a
patients. Additional investigation was done to hospitals’ development of new e-health system. Accordingly, Hakeem
websites. The study concluded several barriers such as the system was launched as a pilot deployment that presents the
lack of hospital administration awareness and expertise e-health system for public hospitals in Jordan and will be
towards e-health, limited financial resources, and restrictive deployed in future for other public and private health service
hospitals policies. Patients showed the importance of e- providers. Few studies investigated the Hakeem system such
health services to fulfill their needs [19]. as Nassar et al. in 2015 and Alsobeh et al. in 2019. Nassar et
al. evaluated five internal factors of Hakeem system in one
Jordan has lunched Hakeem system as an e-health public hospital in Jordan while Alsobeh et al. suggested a
system that aims to solve the mentioned faced challenges. It common mechanism for data collection to reduce
was a tremendous change that aims to connect all public incompatibility and integration problems [20][25].
health service providers in Jordan. Several researchers
studied Hakeem system such as Nassar et al. in [20]. Their This study was carried out as a unique and first study
study aimed to assess five internal factors: financial, that aims to investigate the effectiveness of Hakeem health
customer, internal process, medical information quality, and system according to the international health information
growth perspective. The study was based on an interview in systems standards. The HMN framework and standards for
addition to a questionnaire that was distributed to Prince country health information systems are used to measure the
Hamzah Hospital. The results showed that all the above Hakeem system from different perspectives to ensure that it
mentioned factors are affected by each other and significant meets its objectives to maintain the required level of medical
to the success of Hakeem system [20]. services in Jordan compared to international systems.

AlZghoul et al. studied e-health in Jordan and found that III. HMN FRAMEWORK AND STANDARDS FOR
there is a lack of an appropriate middleware in e-health that HEALTH INFORMATION SYSTEMS
causes the electronic health records to be inaccessible on the The Health Metrics Network (HMN) was started in 2005
national level [21]. They suggested a new middleware and funded by Bill and Melinda Gates Foundation, the UK
architecture that facilitates secure data exchange and allows Department for International Development (DFID), the
access to the database server regardless of the time or Danish International Development Agency (DANIDA), the
location [21]. Tubaishat and Alrawajfah measured the level Netherlands Ministry of Foreign Affairs, the United States
of use of e-health records in Jordanian hospitals based on the Agency for International Development (USAID), the
American Hospital Association annual survey that measures European Commission (EC) and by the host of the World
the level of adoption of e-health services [22]. They Health Organization (WHO). It aims to help countries and
concluded that the level is relatively low. A very low percent other partners improve global health by strengthening the
of hospitals uses EHR in all hospital’s divisions; some uses systems that generate health-related information for
EHR in one division and most hospitals don’t use the EHR evidence-based decision-making [7].
Identify applicable sponsor/s here. If no sponsors, delete this text box
(sponsors).
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HMN is the first global health partnership that focuses To achieve the above objective, the study contains three
on enhancing entire health information and statistical questions:
systems and strengthening country leadership for health
information production and use in low and low-middle 1. What is the extent of the conformity of Hakeem e-
income countries such as Jordan. The HMN Framework and health system’s input with the Health Metrics
Standards for Country Health Information Systems was Network (HMN) framework and standards
coordinated and launched in 2012 to be a standard for regarding input components?
developing countries and global agencies that unifies data
collection, reporting and use of health information. It divides 2. What is the extent of the conformity of Hakeem e-
the components and standards of a health information health system’s processing with the Health
system into six components under the input, processing and Metrics Network (HMN) framework and
output phases as shown in Fig. 1 [7]. standards regarding processing components?

3. What is the extent of the conformity of Hakeem e-

health system’s output with the Health Metrics
Network (HMN) framework and standards
regarding output components?

V. Study Methodology
This study uses survey research method through two tools; a
questionnaire and an interview to achieve its purposes. An
interview was conducted with different users of the
following units: doctor, nurse, dentist, pharmacy, maternity,
radiology, medical lab and reception. The interview helped
in reviewing the Hakeem system interfaces and components
and understanding its use, advantages and barriers.
A structured questionnaire with five pages was
developed based on the collected information from an
earlier reviewed literature, interview, Jordanian Ministry of
FIGURE 1. Health information system components based on HMN Health strategic plan as well as the HMN standards and
standards and framework
framework. It is consisted of two main sections: one
containing three questions related to demographic
1. HIS resources: include financial and human information, and the other containing 37 questions that aim
resources, infrastructure, policies, and coordination. to investigate the extent of the conformity of Hakeem e-
health system with the HMN framework and standards. A 3-
2. Indicators: are needed to assess changes in three point Likert scale with (1) representing ‘disagree’, (2)
major domains; the determinants of health, health representing ‘neutral’ and (3) representing ‘agree’ was used.
system and health status.
Before sending the questionnaire to health service
3. Data sources: include health information data providers, it was checked by four IT specialist reviewers in
sources and are divided into population-based and order to obtain their feedback, add questions, if any, missing
institution-based. from the questionnaire, delete any irrelevant questions; and
4. Data management: consists of data storage, ensuring refine/rephrase the language and the flow of the existing
data quality and data processing. questions. Their comments were applied to the
questionnaire to validate its content and to bring more clarity
5. Information products: involve transforming data into to it.
information.
To assess the content validity of original questionnaire,
6. Dissemination and use: contains use of information the four judges reviewed the modified questionnaire to
for decision-making, institutionalizing information solicit their opinions on the clarity and the extent to which
use and demand. the study could meet the intended objectives. The content
validity index (CVI) as well as the internal consistency by
IV. STUDY OBJECTIVES AND QUESTIONS Cronbach’s alpha were used. In the phase of CVI
This study aims to investigate the extent of the conformity of assessment, 5 questions obtained a score of less than 0.61,
Hakeem e-health system with the Health Metrics Network and were omitted while the rest 40 questions obtained a
(HMN) framework and standards for country health score of more than 0.79. The Cronbach’s alpha coefficient of
information systems that are hosted by the World Health the whole questionnaire was 0.916.
Organization [7].

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Gender System Using Period

50.6 %
264 300 51.7%
262
250
260 49.4 %
200
258 26.4% <1
Male 150 21.8%
256 1-2
254 Female
100 >2
252
50
250
0
Male
Female <1 1-2 >2

FIGURE 2. Distribution of respondents based on gender FIGURE 3. Distribution of respondents based on system using period

A. Characteristics of Study Respondents equally distributed between a period of less than a year
A total of 800 questionnaires were distributed to four (26.45%) and between one and two years (21.8%) as shown
hospitals; Prince Rahma, Prince Badeeaa, Yarmouk and in Fig. 3.
Raya hospitals and ten medical centers; Kufuryoba, Fig. 4 shows that the respondents are distributed over ten
Yarmouk University, Al Farooq, Houwara, Ibn Sina, units, 72 (13.8%) in reception unit, 198 (37.9%) in doctors
AlRazi, Bayt Ras, Al Tatweer Alhathary, Bishra and Altwal unit, 30 (5.7%) in radiology unit, 25 (4.8%) in medical lab
health centers. Only 522 (65.3%) of distributed unit, 72 (13.8%) in pharmacy unit, 15 (2.9%) in accounting
questionnaires were returned. unit, 38 (7.3%) in accident and emergency unit (A&E), 2
Demographic characteristics of respondents illustrate (0.4%) in endoscopy unit, 54 (10.3%) in nursing unit, 16
their gender, duration of the use, and the working units. Fig. (3.1%) in maternity unit.
2 shows 258 (49.4%) of the respondents were male and 264
(50.6%) were female. VI. DISCUSSION AND RESULTS

Almost half of the respondents (51.7%) used the system The study contains three questions, they are:
for more than two years, while the other half is almost

Working Units

200 38%
180 Endoscopic
160
140 Accounting
120
Maternity
100
80 Laboratory
60 14% 14%
40 10% X-Ray
0.4% 3% 3% 5% 6% 7%
20
0 A&E
Nursing
Reception
Pharmacy
Doctor

FIGURE 4. Distribution of respondents based on working uints

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 This article has been accepted for publication in a future issue of this journal, but has not been fully edited. Content may change prior to final publication. Citation information: DOI
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IT Resources Data Sources

80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
30% 30% Agree
20% Agree 20%
10% 10%
0% N/A 0% N/A

Disagree Disagree

FIGURE 5. Respondents answers about IT resources in Hakeem FIGURE 7. Respondents answers about data sources in Hakeem

1. What is the extent of the conformity of Hakeem e- According to the HMN framework and standards the
health system’s input with the Health Metrics Network processing component includes three sub-components; the
(HMN) framework and standards regarding input indicators, data sources and data management. The
components? indicators include determinants of health, health system and
health status. The data sources include population-based and
According to the HMN framework and standards the input institution-based data. The data management includes data
component includes the IT recourses which contain the storage, ensuring data quality and data processing.
financial and human resources, infrastructure, policies, and Fig. 6 identifies the percentages of Hakeem system’s
coordination. Fig. 5 identifies the percentages of Hakeem indicators conformity with HMN framework and standards
system’s IT recourses conformity with HMN framework and as following: (54%) to determinants of health, (44%) to
standards as following: (45%) to Human resources, (29%) health system and (23%) to health status.
to financial recourses, (42%) to infrastructure, (70%) to Fig. 7 identifies the percentages of Hakeem system’s
integration polices and (43%) to coordination. data sources conformity with HMN framework and
standards as following: (79%) to institution-based data
2. What is the extent of the conformity of Hakeem e- source and (20%) to population-based data source.
health system’s processing with the Health Metrics Fig. 8 identifies the percentages of Hakeem system’s
Network (HMN) framework and standards regarding data management conformity with HMN framework and
processing components? standards as following: (56%) to data storage, (42%) to
ensuring data quality and (63%) to data processing.

System Indicators Data Management

60% 70%
50% 60%
40% 50%
40%
30% 30%
20% Agree 20% Agree
10% 10%
0% N/A 0% N/A
Disagree Disagree

FIGURE 6. Respondents answers about indicators in Hakeem FIGURE 8. Respondents answers about data management in Hakeem

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According to the results in Figures 5 – 10, Table 1

Information Products illustrates a summary of the respondents’ agreements levels
on the conformity of Hakeem system’s components with
HMN framework and standards.
60% TABLE I
RESPONDENTS’ AGREEMENTS LEVELS ON THE CONFORMITY OF HAKEEM
50% SYSTEM’S COMPONENTS WITH HMN FRAMEWORK AND STANDARDS
40% Agreements with acceptable percentage
Agree
30% Components Percentage
N/A Institution-based data source 79%
20%
Disagree Integration polices 70%
10% Data processing 63%
0% Agreements with moderate percentage
Transforming data Determinants of health 54%
into information. Data storage 56%
Transforming data into information 52%
Agreements with low percentage
FIGURE 9. Respondents answers about information products in Hakeem Decision making 49%
Human resources 45%
Health system 44%
3. What is the extent of the conformity of Hakeem e-
Coordination 43%
health system’s output with the Health Metrics
Network (HMN) framework and standards regarding Ensuring data quality 42%
output components? Infrastructure 42%
Agreements with very low percentage
According to the HMN framework and standards the output The use of information 38%
component includes two sub-components; the information Financial recourses 29%
products and information dissemination and use. The Health status 23%
information products include transforming data into Population-based data source 20%
information while the information dissemination and use
include the decision making and the use of this information.
As shown in Table 1, the conformity extent of Hakeem
Fig. 9 identifies the percentages of Hakeem system’s system’s components; the institution-based data, integration
information products conformity with HMN framework and polices and data processing with HMN framework and
standards as (52%) to transforming the input data into useful standards is acceptable with percentages between 60-79%.
information. Most data of clinical services or health status at the time of
Fig. 10 identifies the percentages of Hakeem system’s clinical encounters are generated routinely during the
information dissemination and use conformity with HMN recording and reporting of delivered services to present the
framework and standards as (49%) to evidence-based institution-based data. The integration process in Hakeem
decision making and (38%) to the use of information to system is referred to the integration between the Hakeem
prioritize and allocate resources. system, the Jordanian Health Ministry and the Jordanian
Ministry of Information and Communications Technology
which is responsible on designing, strengthening and
Dissemination and Use supporting data collection, transmission, analysis, reporting
and dissemination. The data processing in Hakeem system
includes data extraction, data usability and data validity.
60%
50% The conformity extent of Hakeem system’s components;
40% the determinants of health, data storage and transforming
Agree data into information with HMN framework and standards is
30%
moderate with percentages between 50-59%. It might be due
20% N/A
to the fact that much of these indicators come from other
10%
Disagree sectors than the health sectors and the interrelationship
0% between them is not very strong. In addition, the
Decision Use Of connectivity to data storage is not very stable and there is a
Making Information delay in recovering the failed connection or in the required
maintenance that might affect transforming the input data
FIGURE 10. Respondents answers about information dissemination and
into useful information.
use in Hakeem

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 This article has been accepted for publication in a future issue of this journal, but has not been fully edited. Content may change prior to final publication. Citation information: DOI
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The conformity extent of Hakeem system’s components; • Connect the public health sector with private health
the decision making, human resources, health system, sectors and other government sectors.
coordination, ensuring data quality and infrastructure with
HMN framework and standards is low with percentages • Improve the communication between all shared
between 40-49%.The data is used in decision making sectors.
immediately without using analysis and knowledge • Use analysis and knowledge management tools that
management tools that could help in decision making could help in decision making process.
process. The training and educational schemes that are
provided to human resources and the coordination of health • Connect patients with the Hakeem system to allow
information system components are not enough. Many of them to check their examination or lab results
health service providers’ infrastructures are not very suitable anywhere and anytime.
due to the lack of financial budget that uses old buildings
• Security and privacy issues should be emphasized,
and obsolete technology and computers that effect health
especially when allowing patients to access the
system utilization, service coverage, data quality and prevent
system.
appropriate communications.
The conformity extent of Hakeem system’s components; • Transforming patients from one health center to
the use of information, financial recourses, health status and another one should be implemented electronically in
population-based data with HMN framework and standards order to eliminate all paper work.
is very low with percentages between 20-39%. The use of • Speed up the data entry processes to help doctors
information to prioritize and allocate resources is very low entering the patients’ information quickly and serve
due to the fact that there are no clear policies that help in more patients.
allocating data to actual resources. In addition, the lack of
budget and funds for health sectors is presenting the low • Add statistical reports to the system that measure the
percentage of financial resources. Responses indicated a health status in the Jordan such as morbidity and
very low adherence to the health status component and this mortality ratios.
might due to the absence of statistical information such as • Strengthen the system in pharmacy unit to reduce
the level of mortality, morbidity and disability. The the time needed for dispensing medical prescription
generated data from censuses, civil registration or population for patients as well as providing a mechanism to
surveys are not used in Hakeem system which causing the determine the number of remaining medicines in the
system to use individual-based data sources rather than the pharmacy with its expiry dates and its alternative
population-data sources. choices.
VII. CONCLUSION AND RECOMMENDATIONS • Connect the accounting system with pharmacy to
Jordan is concentrating on having good health services and help in counting the medicines prices.
e-health system that improve the efficiency and quality of
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 This article has been accepted for publication in a future issue of this journal, but has not been fully edited. Content may change prior to final publication. Citation information: DOI
10.1109/ACCESS.2019.2911684, IEEE Access

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