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EVALUATION OF ACHIEVEMENT AND CHALLENGES OF HEALTH INFORMATION MANAGEMENT PRACTICE
CHAPTER ONE
1.1 INTRODUCTION
The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any healthcare delivery setting included in this information are patient demographics, vital signs, immunizations, problems, progress notes, medications, past medical history, laboratory data and radiology reports.
EHR has the ability to generate complete record of patient’s clinical encounters as well as supporting other care-related activities directly or indirectly via interface, including evidence-based decision support, quality management and outcomes reporting. Much interaction with HER is less than ideal, system crashes paralyzes clinics, poor system responses time test user patience, multiple system passwords create redundancy and frustration, and overreliance on EHR in lieu of direct inter-specialty communication can impair patient care. Despite these problems, there are advantages to using EHR and its continued existence is as certain as the interest.
The principal benefits identified for the introduction of an electronic health record system are supporting patient care and improving the quality of that care. Accurate and timely health information, which is accessible when needed by both providers/users and consumers has great advantages for the healthcare of all individuals and would enhance the health and welfare of the community. It will also enhance the productivity of healthcare providers in the delivery of care, and be a strong support to clinical and health research. Implementation of EHRs has been said to revolutionize how we collect, store and use health information (Sekoni F.M, 2010).
Patients are expected to become more involved in healthcare decisions when electronic systems provide them with easily accessible and accurate information about their health problems and care. It is often advocated that healthcare practitioners tend to deliver better healthcare by being able to more efficiently provide up-to-date details of a patient’s healthcare to others involved in treating the patient and by having better access to best practice and the latest research findings.
Several possible advantages to EHR over paper records have been proposed, but there is debate about the degree to which these are achieved in practice (Greenhalgh T. et al 2010).
The steep price of EHR and provider uncertainty regarding the value they will derive from adoption in the form of return of investment (ROI) has a significant influence on EHR adoption (RWIF, GWUMC and IHP staff 2006).
In a project initiated by the office of the National Coordinator for Health Information (ONC), surveyors found that hospital administrators and physicians who had adopted EHR noted that any gains in efficiency were offset by reduced productivity as the technology was implemented, as well as the need to increase information technology staff to maintain the systems (Robert Wood Johnson et al, 2008).
A 2010 Board Position Paper by the American Medical Information Association (AMIA) contains recommendations on EHR-related patients safely, transparency, ethics education for purchasers and users, adoption of best practices, and re-examination of regulation of electronic health application (Agency for Healthcare Research and Quality, 2013-06-19 retrieved 9 July, 2013)
1.2 BACKGROUNDS TO THE STUDY
With the many advances in information technology over the years, particularly in healthcare, a number of different forms of electronic healthcare have been developed and implemented. Some countries are currently planning a nationwide electronic record healthcare delivery system (Sekoni F.M, 2010). The type and extent of electronic health vary and what one country calls an electronic health, E/Tele health may not be the same as that of developed countries. Although effort are going on in some countries on some forms of a computerized patient health care information system and yet not many hospitals have successfully introduced an electronic health record with clinical data entry at the point of care (Gailmard, 2009).
Interest in automating the health record is generally high in both developed and developed countries, unfortunately, in some cases the introduction of an EHR system seems overwhelming issue and almost out of research to many health providers and administrators as well as health information managers (Raouf N. et al. 2011).
EHR along this line may encounter obstacles which may not be inadequate technology but technical support and cost of changing to an electronic system coupled with insufficient healthcare funding. In many developing countries cost, available technology, lack of technical expertise and computer skills of staff and lack of processing facilities are in fact major issues which would need to be addressed before implementation is possible (Sekoni F.M, 2010).
1.3 STATEMENT OF THE PROBLEM
Despite the high interest of both developed and developing countries around the world towards implementing EHR, the accuracy of data management and storage, ability to capture state of a patient at all times, and reducing changes of data replication among other benefits of the EHR (Jerry S. et al 2011).
Of 17068 health facilities only 151 (i.e. 0.89%) facilities are owned by the federal government, 1,385 (8.1%) by the state government, 7580 (44.4%) by the local government areas, 579 (3.4%) by the communities and religious organizations while the remaining 7,373 (43.2%) are privately owned (National Bureau of statistics, 2007).
Public expenditure on health is under $10 per capital compared to $34 recommended internationally. Private expenditure is estimated to be over 70% of the total health expenditure with most of it coming from out-of-pocket expenditures in spite of the endemic nature of poverty in Nigeria (Federal Ministry of Health, 2004).
Part of the challenges facing the Nigerian Health System as identified by World Health organization (WHO) is an inadequate Health Information System for monitoring and analysis of Health indicators (WHO, 2009). Many developed countries have either implemented or are in the process of implementing an Integrated Electronic Health Record system because of its potential benefits. Pilot project in many developing countries like Kenya, Malawi, Peru and Haiti are demonstrating the viability of EHR in resource constrained areas. However, the rate of EHR adoption is generally considered very low, partly because of dearth of reliable evidence on its benefits, few success stories of large scale implementation and the associated cost. With the viability of such project in developing economies now being demonstrated (Fraser et al, 2005, William Boren, 2008), the rapid growing coverage of mobile telecom services (pyramid Research, 2010) the emerging low cost of information and communication technologies, perhaps Nigeria should begin to look to a Nationwide Electronic Health Record to help integrate the health data for research, budgeting and allocation of resources as well as monitoring and evaluation of intervention options. The time has come to set up health care services from the local content by making health a must component for good health services delivery (Professor Odunsanya, 2014).
In summation of the aforementioned factors that hinder the effectiveness of Nigerian Healthcare Delivery System, health information system in particular, interest is exerted upon the mind of the researcher to undergo this research topic.
1.4 AIMS AND OBJECTIVES OF THE RESEARCH
Research aim
- To identify and assess the problems and prospects towards implementing Electronic Health Record (EHR) in Health Information Management System in Shehu Idris College of Health Sciences and Technology, Makarfi Kaduna state, Nigeria.
Research objectives
- To identify the hindrances of implementing EHR in the healthcare delivery system, health information management system in particular
- To provide possible solutions to the identified problems for EHR implementation
- To determine the possible ways of improving the quality standard of health record system in an event that the identified hindrances are inevitable.
1.5 RESEARCH QUESTION
1. What are the challenges to be experienced when implementing EHR
2. What are the possible measures to be applied for addressing the identified challenges?
3. If EHR implementation fails, could health information be reliable?
1.6 SIGNIFICANCE OF THE STUDY
1. The findings of this research work will be of great importance to the Health Record Officers’ Registration Board of Nigeria (HRORBN) for its commitment towards EHR implementation and for addressing issues relating to in capabilities of higher institutions of learning in training qualified and skillful professionals.
2. To contribute to the available literature concerning the electronic health record system, for students and other referral bodies
3. This research finding would serve as a basis on which further research work would be conducted especially where it’s limited.
1.7 SCOPE OF THE RESEARCH
This research has been restricted to the department of health information management, Shehu Idirs College of Health Sciences and Technology, Makarfi, Kaduna state Nigeria to identify the problems and prospects of Electronic Health Record in the health information management system. Other procedures such as general study, field study (hospital), are beyond the scope of this research work.
1.8 RESEARCH LIMITATION
There are number of hurdles arrived at in the course of this study. Most of which are intimately associated with the limitations of the study. They are:
1. Financial instability: inadequate funding is a major factor that hinders the efficiency and sufficiency of the research that it encompasses a broader study area.
2. For reliability of the study findings-there is need for the study to cover both hospitals and institutions of learning who practice and train health information management professionals. This wasn’t met in the case of this study. So therefore, only one institution of learning was studied.
3. The time-bound: the time for the study is not enough for the researcher to thoroughly investigate the subject matter to meet up the high standard.
1.9 DEFINITION OF TERMS
ABUTH Ahmadu Bello University Teaching Hospital
DMRS-Donalk an electronic medical record system
E-HEALTH Healthcare delivery that involves the use of electronic information communication technology
EHR Electronic Health Record
HIM Health Information Management
HIMSS Health Information and Management System Society
HIT Health Information Technician
HITECH Health Information Technology for Economic and Clinical Health Act
HITs Health Information Technicians
JUTH Jos University Teaching Hospital
Medistem an electronic medical record system
MedPro an electronic medical record system
NHIS National Health Insurance Scheme
NHMIS National Health Management Information System
NNPC Nigerian National Petroleum Corporation
PEPFAR presidential emergency plan for AIDS relief, United State of America
SICHST Shehu Idris College of Health Science and Technology
SIWES Students’ Industrial Work Experience Scheme
TELE HEALTH: healthcare delivery system involving information communication at different distances, electronic devices among different users (i.e. patients, physicians, health information officers, health related organizations and other lawful third parties).
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