Utilization of Health Information Technology to Enhance Patient Safety Among Healthcare Workers at Mama Lucy Kibaki Hospital
Chapter One
Objective of the study
The main objective of the study is to determine the Health Information Technology utilization in promoting patient safety among healthcare workers at Mama Lucy Kibaki hospital, Nairobi City County, Kenya
- To identify technological factors influencing the utilization of HIT in the promotion of patient safety at MLKH
- To determine HIT organizational factors influencing the utilization of HIT in the promotion of patient safety at MLKH
- To describe individual system components influencing the utilization of HIT in the promotion of patient safety at MLKH
CHAPTER TWO
LITERATURE REVIEW
Utilization of Health Information Technology
Healthcare information technology (HIT) has been defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (Brailer, 2004). Health information technology includes various technologies that span from simple charting, to more advanced decision support and integration with medical technology. Health information technology presents numerous opportunities for improving and transforming healthcare, which includes; reducing human errors, improving clinical outcomes, facilitating care coordination, improving practice efficiencies, and tracking data over time.
Currently, technology development has become one of the strategic elements in organizations, so that the effects of changes in the social, economic, and political systems have been more than the technologies themselves (Esmaeili et.al.,2013).
There are a number of technologies that are used in healthcare setups. The advances progress each day and get even more and more mind-blowing. The health system was not far from the outcomes, but the paper records, because of their own limitations, are not capable of proper communication between health service providers, and the data that are needed may not be available in a timely manner. To solve the problem, moving toward health information systems began about 30 years ago, and the ultimate goal of this movement was to improve the access to electronic health records (Gartee, 2007).
Over the recent years, health information technology (HIT) has been seen as a tool that can be used to improve the quality of health care and patient safety. The critical role of information technology in health care systems is to meet the six aims of care; care that is safe, effective, efficient, timely, equitable and patient-centered (crossing the quality of chasm, 2001). Use of information technology in various sectors of health care, particularly in hospitals, has great potential to improve the quality of services provided and the efficiency and effectiveness of staff, and they reduce some of the organizational costs. Studies have shown that using electronic records in today‟s complex health system faces many challenges that require organizational preparation and workforce readiness. Such technologies can be used in diagnosis of illnesses to improve the accuracy of diagnosis, as well as for measuring precision during drug administration or prescription.
However, several studies identified problematic or inadequate aspects of identifier design, including illegibility (small font, or handwritten bands), ink that degraded with exposure to water, bands too narrow to accommodate the printed ID sticker, and lack of a clear covering to protect information from degradation. Notably, one Canadian study found that during surgery, wristbands were often inaccessible or removed, posing risks for this vulnerable population both intra- and postoperatively. Similarly, specimen labels were often unclear due to small font size along with inadequate demarcation between labels printed for different patients. Notably, the majority of identified design flaws could be addressed with relative ease, and in fact, studies often reported that redesigned wristbands were well received by staff and that increased usability may have contributed to increased adherence to ID protocols. Identification alerts during order entry can decrease wrong-patient orders. A recent report suggested that medical identity theft in the United States is rising, with 2.32 million adult victims in 2014, a 21.7% increase over the prior year. Detection is challenging because victims may not report a theft or may willingly allow another person to use their credentials; institutions may not report discrepancies because of concerns about losing reimbursement. Proper patient ID confirmation at every step of clinical care is vital to patient safety. However, despite the priority placed on addressing this issue by The Joint Commission and others, significant problems persist. Studies have assessed a variety of interventions, aimed at reducing patient ID errors across wide range of clinical contexts. Although the evidence base has significant gaps, we conclude that patient ID errors can be avoided through improving usability of physical, electronic, and assigned patient identifiers; use of well-designed ID alerts during order entry; and technologies and automated algorithms that function as systems-level safety checks (Galanter et al. 2012). Healthcare is at a different place than it once was, over the past few decades, there has been an accelerated revolution with information technology (IT) and how it is used. Electronic Health Record (EHR) systems are a common healthcare IT deemed as a crucial step in advancing healthcare with both positive and negative impacts. Many unintended consequences stem from technical issues and/or sociotechnical issues – workflows, culture and interactions with the EHR system. The complexity of both the healthcare industry and EHR systems demonstrate the criticality to keep investigating and addressing issues with interaction of the two (Harrison et al.,2017).
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
In this chapter, we described the research procedure for this study. A research methodology is a research process adopted or employed to systematically and scientifically present the results of a study to the research audience viz. a vis, the study beneficiaries.
Research Design
Research designs are perceived to be an overall strategy adopted by the researcher whereby different components of the study are integrated in a logical manner to effectively address a research problem. In this study, the researcher employed the survey research design. This is due to the nature of the study whereby the opinion and views of people are sampled. According to Singleton & Straits, (2009), Survey research can use quantitative research strategies (e.g., using questionnaires with numerically rated items), qualitative research strategies (e.g., using open-ended questions), or both strategies (i.e. mixed methods). As it is often used to describe and explore human behaviour, surveys are therefore frequently used in social and psychological research.
Population of the Study
According to Udoyen (2019), a study population is a group of elements or individuals, as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitutes individuals or elements that are homogeneous in description.
This study was carried out to examine the Health information Technology utilization in promoting patient safety among healthcare workers at mama Lucy kibaki hospital. Hence, the population of this study comprises of all Health Care workers of Mama Lucy Kibaki Hospital who were from the various departments.
CHAPTER FOUR
PRESENTATION OF DATA AND ANALYSIS
Introduction
This chapter presents the findings of the study on promoting patient safety through effective health information technology risk management at Mama Lucy Kibaki Hospital, Nairobi City County, Kenya. Detailed analysis of the data, interpretation and explanation of the results with regard to objectives and the research questions were given. The findings were based on information from questionnaires for a representative sample of 147 medical and paramedical staff at the study site. The chapter was organized as follows: Socio-demographic characteristics, utilization of HIT in promoting patient safety, organizational factors, technological factors and individual system components affecting patient safety promotion.
CHAPTER FIVE
DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS
Introduction
This chapter presents the discussion, conclusions and recommendations of the study based on the study objectives and findings. The chapter relates the qualitative and quantitative findings of a study and interprets them according to the literature reviewed and according to the researcher‟s observations. The findings are analyzed according to the research questions and objectives. The outcomes are further compared with other similar studies to help highlights similarities and differences in findings.
It also provides the conclusion based on the discussions. Finally, the section presents the recommendations both for professionals in the field as well as for future researchers. The chapter is organized as follows: Social Demographic Characteristics, utilization of HIT in promoting Patient Safety, Organizational factors that influence patient safety, Technological factors influencing patient safety, Individual factors influencing patient safety, Conclusions, Recommendations and Further Research.
Discussions
Socio-demographic Characteristics of the Respondents
From the study findings, most of the respondents were youthful with a mean age of 28, especially considering that the deviation from the mean was six years. This observation could be due to the fact that the study site was a government hospital which benefited mostly from staff as well as young professionals in their respective fields. The female population was greater, which is probably due to the similarly high number of nurses and health information staff – two professions that were dominated by that gender. The fact that those who were single were more than those who had married was shocking mainly owing to the fact that majority of the respondents were female. However, in relation to age, the greater proportion of singles was quite expected. Opinion was divided regarding whether or not age affected the utilization of HIT on patient safety. The questionnaires revealed that age does not influence HIT„s utilization significantly which was contrary to what Henriksen et al. (2005) reported that age influences HIT‟s ability to ensure patient safety. However, the study revealed that the older staff found hard to cope with the new technologies, thereby hindering their effective use of the HITs; and that overworking of younger staff reduced the effect of the HIT on patient safety. Those two reports are concurrent with Chou, (2012)‟s claim that patient safety required maturity and comprehension of circumstances, with or without HIT.
The study showed many respondents indicate their highest level of education as College. However, with nearly 40% of the respondents indicating their level of education as university, the overall level of education in the hospital was found to be fairly good. Since the chi-square test for independence also revealed significant differences across the various levels of education; there was even greater credibility of the education level results.
Education on the other hand also had mixed responses regarding the effect on HIT‟s utilization in promoting patient safety with sentiments that training can always supplement education. Others also felt that education margins in the health sector were also quite small. That observation was consistent with what Koppel et al. (2005) reported that training can be used by institutions to mitigate patient safety risks as well as cover up for challenges inherent in staff.
Utilization of HIT in promoting Patient Safety
The study findings revealed that EMRs have hugely helped in solving most storage and automation issues, the processes are faster and report generation was made easier and that the HIT systems were less tedious and provided for the reproducibility of the patient records. The systems also detected errors automatically. These observations were consistent with (Podean & Benta, 2012) who indicated that each health IT initiative involves transition from the old mode of operations to a new one, often there is need for proper change management. However, with the emergence of Big Data, all sectors were slowly transitioning into a world of endless bounds through Cloud functionalities. Cloud services as well as maintenance of storage as the world was revolutionized may be helpful so as to ensure scalability. The two statements above provided affirmations of the functions of HIT in the facility. Auto-detection of errors improved accuracy whereas reproducibility of the HIT output proved its reliability thereby contributing to the patient safety (Henriksen et al., 2005).
Summary of Findings
To lay the groundwork for defining, measuring, and analyzing HIT-related safety hazards, there are Health Information Technology-related error occurring anytime; HIT is unavailable for use, malfunctions during use, is used incorrectly by someone, or when HIT interacts with another system component incorrectly, resulting in data being lost or incorrectly entered, displayed, or transmitted. These errors, or the decisions that result from them, significantly increase the risk of adverse events and patient harm.
The benefits of health information technology (IT) include its ability to store and retrieve data; the ability to efficiently communicate patient information in a legible format; improved medication safety through increased legibility, which potentially decreases the risk of medication errors; and the ease of retrieval of patient information. The potential to improve patient safety existed through the use of medication alerts, clinical flags and reminders, better tracking and reporting of consultations and diagnostic testing, clinical decision support, and the availability of complete patient data. Data gathered using health IT could be used to evaluate the efficacy of therapeutic interventions and have demonstrated to lead to improvements in the practice of medicine (1). Alerts can optimize adherence to guidelines and evidence-based care (2).
Record uniformity could be designed to reduce practice variations, conduct systematic audits for quality assurance, and optimize evidenced-based care for common conditions (3).
HIT can increase patient engagement as consumers of health care. It allows patients access to their medical records, which helps them to feel more knowledgeable about their conditions and encourages them to actively participate in shared decision-making.
Outside the patient encounter, it can improve follow-up for missed appointments, consultations, and diagnostic testing. A health care provider can search for specific cohorts of patients within a practice to monitor and improve adherence to indicated health care such as mammograms, Pap tests, or measurement of hemoglobin A1c levels. There are no HIT-specific policies that were identified. Policies were however found not to be organizational-wide. Lack of HIT code of conduct was identified as an ethical issue globally. Storage and Antivirus update are the greatest technological issues that the study identified, with EMR, DSS and CPOE all found to be present and actively in use by the facility. Finally, system update and backup of the patient information were also identified by the study as useful components of HIT to promote patient safety. The lack of complete agreement between the various statements by the staff also implied that the structures were not uniform across the hospital.
Conclusions
Based on themes derived from study objectives the researcher found out that Health IT has become an integral part of the practice of medicine. As with any new technology, HIT brings many potential benefits. Health information technology (IT) facilitates communication between health care providers; improves medication safety, tracking, and reporting; and promotes quality of care through optimized access to and adherence to guidelines. The current literature to date reflects outcomes at single sites or institutions. National estimates are extrapolations from these single-site studies. As the implementation and use of health IT systems increases, it is important to keep patient safety and quality as a major focus.
Utilization of HIT
From the study, most respondents, 66 (56%) felt that HIT utilization promoted patient safety.
Organizational factors
From the results, similarity of access passwords (OR=1.2 [95% CI 1.075-1.600]); periodic trainings on HIT (OR =2 [95% CI 1.456-2.027]); and involvement of HIT users (OR=1.5 [95% CI 1.180-1.654]) had sufficient evidence to back their association with the utilization of HIT in patient safety promotion.
Technological factors
There was sufficient evidence to conclude that auto logout of users (OR=0.2 [95% CI 0.052-0.801]), and the knowledge and use of EMR (OR=0.4 [95% CI 0.195-0.877]) promoted patient safety.
Individual System components
Finally, the results also showed that there was sufficient evidence to suggest that notification on patients‟ identification number similarity and presence of backups to the systems contributed to the use of health IT in promoting patient safety (OR=3.6 [CI 0.072-0.572] and OR=0.2 [95% CI 1.306-9.916]). There were also cadre specific results worth noting that doctors were more likely to perceive the utility of HIT in promoting patient safety compared to pharmacists (OR= 0.56 [95% CI 0.131-2.135]). However, analysis of medication errors leads to system improvement and reduced risk only if the errors were detected, reported, and used to design better patient-care practices and systems. Voluntary medication error reporting systems rely on the ability and willingness of individual physicians, pharmacists, and nurses to detect and report errors as part of their routine practice.
Recommendations
The study recommended the following:
- Further training of Health care workers on the use of HIT by Nairobi City County Health Services.
- Continuous evaluation and monitoring of patient safety outcomes by promotion and modification of HIT in the healthcare delivery by MLKH.
- Dissemination of policies and Guidelines on HIT by the Ministry of Health for promoting patient safety.
- MLKH should regularly update, modify and fine tune implemented technology based on user feedback and patient safety outcomes.
REFERENCES
- Adelman, J. S., Kalkut, G. E., Schechter, C. B., Weiss, J. M., Berger, M. A., Reissman,
- H., & Southern, W. N. (2013). Understanding and preventing wrong-patient electronic orders: a randomized controlled trial. Journal of the American Medical Informatics Association, 20(2), 305-310.
- AHIMA. (2011). American Health Information Management Association Code of Ethics: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024277. hcsp?dDocName=bok1_024277
- Bahlol R., Reza S., Mohamad, J. (2014 ). Acta Inform Med. Dec; 22(6): 398– 401. Published online 2014 Dec 19. doi: 10.5455/aim.2014.22.398-401 PMCID: PMC4315630
- Ballard, K. (September 30, 2003). “Patient Safety: A Shared Responsibility”.Online Journal of Issues in Nursing.Vol. 8 No. 3, Manuscript 4.
- Available:www.nursingworld.org/MainMenuCategories/ANAMarketplace/AN APeriodicals/OJIN/TableofContents/Volume82003/No3Sept2003/PatientSafet y.aspx
- Barnet, S., Green, M., and Punke, H. (2016). 10 top patient safety issues for 2016.
- Infection Control & Clinical Quality
- Battles, J. B., Dixon, N. M., Borotkanics, R. J., Rabin Fastmen, B., & Kaplan, H. S. (2006). Sensemaking of patient safety risks and hazards.Health services research, 41(4p2), 1555-1575.
- Black, G., Publicity Rights and Image (Oxford: Hart Publishing, 2011), page 61-62.
- Blumenthal, D. (2009). Stimulating the adoption of health information technology. New England journal of medicine, 360(15), 1477-1479.
- Blumenthal, D., &Tavenner, M. (2010). The “meaningful use” regulation for electronic health records.New England Journal of Medicine, 363(6), 501-504.
- Brailer D. The decade of health information technology, Framework for Strategic Action [Internet] [[cited 2004]]. Available from: http://www.providersedge.com/ehdocs/ehr_articles/the_decade_of_hit- delivering_customer-centric_and_info-rich_hc.pdf .
