Assessment of the Impact of Electronic Health Record and Manual Recording in Ogun State (a Case Study of Ijebu Ode General Hospital, Ogun State)
Chapter One
BROAD OBJECTIVE: –
The general objective of this study is to examine the impact of electronic health record and manual recording in IGH Ijebu Ode, Ogun State, Nigeria.
SPECIFIC OBJECTIVES OF THE STUDY.
The following were the specific objectives that guided this research. They include to:
- Examine the prior assessment made by the IGH Ijebu Ode Hospital Management with manual recording of health information
- Find out the challenges faced in impact of electronic health record and manual recording in IGH Ijebu Ode, Ogun State, Nigeria
- Investigate the solutions on preservation and conservation of information technology in health records management in IGH Ijebu Ode, Ogun State, Nigeria
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
This literature review includes the contextual issues and brief historical overview of available health records management systems in Nigeria. The discussion focused on the infrastructural requirements for using information technology into health record management practice alongside the cost implications. A significant portion of the literature review centered on the Nigerian situation as it relates to the poor implementation of hospital information systems. Issues highlighted about Nigeria include lack of support infrastructure, corruption and lack of technical support services.
The proper management of data storage and retrieval of records are imperative in any organization. In this vein, the system used in keeping records in any healthcare organisation should possess the ability to provide smart search functions, instantaneous and multi-location access, and ability to virtually integrate data elements stored in geographically disperse databases (Berg & Toussaint, 2003), as this is the only sure way to ensure better healthcare delivery. The introduction of EHR in healthcare delivery in recent time is therefore aimed to achieve these functional aims highlighted above. In spite of these functionalities, EHR in the healthcare sector is also aimed to trounce the inherent problems associated with paper-based record management systems that have been used in the healthcare industry for over a century
Bringing information technologies to health record management systems encompasses a variety of applications, in tune with needs, both on an individual basis and on a society level. Information technology increases the efficiency of the administrative processes while optimizing costs by rendering all information flows that were previously based on paper documents and translating it into an electronic form.
Many reviews have been made and published to date on use of information technology into various sectors and different issues in health record management system in Nigeria. The implementation of health information technology has become a major priority in the health care industry due to rising health care costs; escalating concerns for patient safety and reducing medical errors; focus on improving the provision of evidence-based care; and the increasing number of regulatory requirements placed on health care providers (Doebbeling et al, 2006).
The health records in most Nigerian health institutions especially in hospitals has been facing some numbers of problems; these had affected the accessibility and utilization of health information in the treatment of people that have health challenges in those hospitals, as information needed on each patient is not being accessible on time or is not even available.
In this section, a review of other relevant studies relating specifically to the objectivities of this study is presented. This section firstly brings to bear the adoption of Information Technology for the development ofhealth record sector in Nigeria, while considering the challenges and benefits of using Information Technology into health record management system. It then proceeds to a review of record keeping (paper and electronic record keeping) in various health facilities. This section also highlights the benefits and challenges associated with the implementation of EHR as accounted for by other studies. It then concludes with a summary and the rationale for the present study
THEORETICAL FRAMEWORK
Currently, a gap in knowledge exists about the exact number of hospital information systems functionally available in Nigeria, but the subjective data project less than 5% implementation of any form of hospital information technology in a country of more than 150 million people (Idowu et al., 2006). The available literature provides a common position among various authors that disparities exist in the implementation of hospital information systems in developing and developed countries (Williams et al, 2008). Speculated reasons include poor technological and funding support in developing nations, poor management capacity at all levels that ensures seamless workflow, and a complex milieu of health care service delivery. Other possible factors for low implementation include the continual evolution of technology, confidentiality problems with use of hospital information systems, and the poor technological background of the Nigerian society (Krishna et al., 2007).
Holden (2009) posited that much research related to adoption of health care information technology has been a theoretical. In this study, a useful theoretical model is the maturity model to process improvement originally described in software engineering and used in the novice-to-expert approach to competency. The maturity theoretical model describes a modernization framework aimed at the committed use of relevant information technology in a change process (Gillies et al, 2005).
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction: –
Research methodology is a way to systematically solve the research problem. It may be understood as a science of studying how research is done. It refers to the various procedures, methods and instrumentation, which data are sourced, specified, defined, collected, processed and analyzed. It provides scaffolding for the validation, proper interpretation and analysis of research data. It treats issues on the source of data, target population, sampling in terms of research techniques, research population and sample.
Subsequent knowledge of the methodology or technique is quite important while preparing for an academic research work, as it gives credibility to the research. A well-articulated research methodology must be able to provide information on vital issues that can aid the execution of a research. Thus, this section gives a detailed description of methods and procedures that were used to collect, analyzed and interpret relevant data collected for this study.
This chapter discusses the study under the following headings: Study design, study area, study population, sampling techniques, sample size calculation, instrument for data collection, validity and reliability of instrument, method of data collection, method of data analysis, ethical consideration
Research Design: –
Research design is the process of identifying variables and their relationship to one another. Thus, the instrument for this research was well-structured questionnaires which were used in accordance with the objectives of this study. It also involved interviews. The reliability of this method lies in the fact that the verbal and non-verbal responses of the respondents are recorded and questions outside the ones already listed can be asked.
The study adopted descriptive survey design because, it focuses on observation and perception of the existing situation, describes and interprets the issues, conditions, practice or relationship that exist; views, belief and attitude that are held, processes that are going on and trends that are developing. The research approach is purely quantitative with a questionnaire survey method. Quantitative research approach with a questionnaire survey method were used because there is a time limit to gather or collect data for the study.
A survey research studies a small sample from a large population from where inferences would be drawn about the characteristics of the defined population. This research design conforms to the characteristics of the survey research described above. Therefore, the survey research provides conceptual and methodological design for investigating the problem of the study.
Population of the Study: –
The population for the study comprised of all the registered and licensed health/medical practitioners (i.e Health Information Managers, Nurses, Doctors and Others health/medical practitioners ) in University of Ijebu Ode Teaching Hospital, Ijebu Ode, Ogun State. The targeted population of this study was the entire Health/Medical practitioners of the surveyed institution. In order to ensure efficiency in the level of work done, the method used and all the detailed acquired are limited as a result of time and capital in addition to other constraints. The study was limited to health/medical practitioners (i.e. Health Information Managers, Nurses, Doctors and Others health/medical practitioners) in University of Ijebu Ode Teaching Hospital, Ijebu Ode, Ogun State.
CHAPTER FOUR
DATA PRESENTATION ANALYSIS FINDINGS AND DISCUSSION
INTRODUCTION
This chapter contains the findings obtained from the field survey. The data for the study were collected through the use of questionnaire which was distributed to the respondents and analyzed in order to have insight information on the impact of electronic health record and manual recording in IGH Ijebu Ode, Ogun State, Nigeria.
The collected data were analyzed so as to obtain and discuss its findings especially as it relates to the researcher′s questions and objective using descriptive statistics. This analysis involves the collation of data received from administered questionnaires and conducted interviews. Raw data is inputted and transformed into statistical figures for graphical manipulation and the opinion of each personnel involved in the data gathering process. It was illustrated by means of tables and charts using Statistical Packages for Social Scientist (SPSS).
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Introduction
The rapid advance of IT in healthcare settings has accentuated the importance of addressing the shortcomings of current health record integration practices. This matter is made worse by the regulatory gap between implementing new and emerging ICT, and managing the security risk the latter represents. Other problems include poor data quality and fragmentation, budgetary constraints, irreconcilable systems architecture, a history of incompatible data standards, confusing privacy jurisdictions and a lack of access to proven evaluation results. This research argues that it is of crucial importance that technology innovation in health is associated with the incorporation of Information Technology (IT) for establishing secure health record integration.
Summary
The analysis of mechanism put in place for use of Information Technology (IT) in health records management in IGH, Ijebu Ode revealed that care in handling hospital health records, confidentiality of health records, security of health records and avoidance of water contact/bad weather are major mechanism employed in the hospital. The major challenges faced in use of IT in health records managements in surveyed hospital are poor funding, inadequate computer and other ICT devices, poor skill in computing, harsh environmental conditions, lack of preservation and conservation policy.
Conclusion
Use of Information Technology (IT) in health records management is an integral part of medical/ healthcare service delivery as it goes a long way in enhancing better service delivery as well as serving as a basis for following patient health trend overtime. It also serves as a basis for effecting referral service. Hence effort should be made to ensure regular preservation and management of records in medical centers/hospital.
The knowledge and skill of IT should be used on the hospital staff through training and re-training, formulation of health record management policies, infrastructural development, proper funding, computer skill training, etc as these would help in ameliorating the problem of poor hospital record preservation and management and its attendant’s negative impact on health care delivery.
Recommendations
In view of the above findings, the following recommendations were made for management of the institutions and to the entire health institutions in Ogun and Nigeria at large. The following aspects should be improved for better operation of health information management in the future:
- Management of health institutions should inject more financial resources into the organization in order to solve the problem of inadequate funding of the health records management. It takes real money to acquire and maintain good health records management.
- Capital should be injected into provision of infrastructure and acquisition of modern equipment that would facilitate and sustain the general health condition of their patients. These could help in saving cost and manpower on the long run.
- Management of health institutions should intensify their efforts in encouraging their health workers to maintain good handling care of records; while some of the paper based records should be microfilmed in order to sustain their durability.
- Management of the health institution need to training the health/medical practitioners
Limitation of The Study
During the processing of the project, the researcher faced with a lot of physical problems. These problems includes:
The researcher seriously faced with the problem of data collection, which helps in building the manuscript. Because information is the tool of business for solid data collection or material. So, inability to get materials on time really set my project back. Actually, it took me more than five months to gather enough information needed for this project.
Also for collection of data from my case study a lot of money is spent on transportation (Ibadan to Ijebu Ode and Ijebu Ode to Ibadan). Hence for one to be effective in this project, money must be involved.
Finally, the major limitations of this study were time, financial constraints and poor response by some health/medical practitioners fearing that computers may take over the practice of medicine which in advance, they may lose their jobs. For this reason the researcher is recommending compulsory information technology training for all the medical practitioners to enable them cope with the current trend in information technology.
Area of Further Studies
It is recommended for further studies to examine country specific policies and its effect on the implementation of EHR especially in the context of developing countries such as Nigeria. This would help unearth the limitations and barriers created by national policies and regulations on ICT systems’ implementation in both developed and developing countries. It would also help to determine the national readiness for EHR in developing countries.
It is also recommended that future studies evaluate the impact of EHR from the patients’ perceptive. This would help reveal whether or not the intended benefits of the implemented EHRs to patients are actually realized.
From the identified limitations to the adopted study approach, it is recommended for further studies to adopt both quantitative and qualitative research approaches in similar studies to generate diversified responses from participants.
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