Introduction
Today, increasing developments in technology, economics and social fields have affected all domains. One of the rapid centers of developments in today’s world is “Health” [1]. Gradually, with increasing environmental concerns, the importance of foresight and the need to be prepared to deal with risky conditions, the health and medical education have become the priorities of societies [2]. One of the important systems in the field of health information technology is the electronic health record (EHR). This system is widely used to improve the quality of health care in the community. Therefore, paying attention to this system and promoting its performance in order to prevent and treat the diseases in the community seems necessary [3]. In this regard, this study aims to investigate the main factors affecting the development of EHR system in Iran.
Methods
This descriptive study, 35 managers and information technology experts of hospitals and medical universities in Guilan and Qazvin provinces participated. The participation rate was 95% (33 questionnaires returned). In order to finalize the conceptual model (consisting of three dimensions and six criteria) and design future scenarios, meetings were held with the presence of eight experts in the field of health and information technology. In order to rank the main dimensions of the EHR system, hierarchical analysis with pairwise comparisons were conducted. The structure of problem tree was designed in three levels of objectives, dimensions and criteria; the experts compared the dimensions and ranked the criteria according to each dimension. The preference weight was scaled from 1 to 9 (Equal preference, equal to relatively preferred, relatively preferred, relatively to strongly preferred, strongly preferred, almost strong to very strongly preferred, very strongly preference, very strongly to extremely preferred, and extremely preferred). Descriptive statistics were used in SPSS v. 22 software, and ranking and analysis of dimensions and criteria of EHR system were done in Expert Choice v. 11 software.
Results
Participants were 17 males (51.5%) and 16 females (48.5%); 3% aged <30 years, 69.7%  were at the age of 31-40 years, and 3.27% aged 41-50 years; 36.4% had a bachelor degree, 57.6% had a master’s degree and 6.1% had a PhD; 21.2% had a work experience of <10 years, 39.4% had an experience of 11-20 years, and 39.4% had an experience of 21-30 years.
The ranking results indicated the importance and emphasis on the role of information content (45.8%), information architecture (34.9%), and information security (19.3%). Putting the three dimensions of content, architecture and security under three axes (x, y and z) as the drivers of development in the EHR system and their intersection, created eight scenarios for the future of this system. These eight scenarios represented different modes of the operation of the system’s dimensions and criteria. The different weights of the dimensions and criteria had a key role in prioritizing the scenarios, such that in scenarios 2 to 7, the weight of dimensions caused the geometry of the scenario layout (the quality of EHR levels) (Figure 1). Discussion
In this study, a hierarchical and leveled structure of combining the dimensions and criteria of the EHR system was presented. The results of the present study indicated that “information content” was the most preferred dimension in designing a comprehensive EHR system. Other important dimensions were information architecture and information security. This can be due to the vital role of health indicators that shape the information content and their importance in adopting effective diagnostic and therapeutic strategies. Assessing and improving the health status requires to receive and record extensive, complete and accurate data, which leads to the production of mass data. This data can be used technologically under the guidance of health information management by designing an appropriate system for data collection, storage and retrieval. Based on this view, the electronic health approach and the use of  electronic medical records at the national and international levels have been recommended. Due to its value and importance, this project is a priority in the implementation of health programs, and its successful implementation requires governmental support, organizational coordination and accountable trustee [4]. EHR topics can be discussed from a cost-benefit point of view. Hillstead et al. [5], Wang et al. [6], and Buntin et al. [7] conducted the cost-benefit analysis of EHRs whose results are consistent with our results. A study by Zhou et al. in China on identifying the barriers to EHR implementation, reported that, despite issues such as the technology level, resistance of patients and physicians, and lack of financial support, the issues related to information structure and security were among the most important barriers [8].
It can be concluded that information content, information architecture and information security play a strategic role in the EHR system development. This system with the proposed design can provide a framework for determining levels of access, organization and information validation.

Ethical Considerations
Compliance with ethical guidelines
The ethical approval was obtained from the Research Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1398.396).

Funding
This article is taken from the thesis of Sara Jalali, Master of Technology Management, Faculty of Information Management, Department of Information Resources, Islamic Azad University, Lahijan Branch, and has not received any financial support from any specific organization or institution.

Authors' contributions
Conceptualization, methodology, and data analysis, writing and editing: Sareh Jalali and Alireza Nosrati; gathering information: Sareh Jalali. 

Conflicts of interest
The authors declare no conflict of interest

Acknowledgements
The authors would like to thank the participants for their cooperation. 

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