1.3.2 OBJECTIVES OF THE STUDY
This project is set:
- To assess the effectiveness of electronic records management at the Eku Baptist Government Hospital, Eku Delta State.
- To examine the level of awareness of electronic records management awareness among the staff of Eku Baptist Government Hospital, Eku Delta State in using electronic records.
- To determine the level of administrative effectiveness.
1.4 RESEARCH QUESTIONS
To carry out this project successfully, the following questions were raised:
- Does Eku Baptist Government Hospital assess their electronic records management?
- What is Eku Baptist Government Hospital staffs level of records management awareness in using electronic records management?
- Does electronic records management improve the level of administrative effectiveness in Eku Baptist Government Hospital?
1.5 RESEARCH HYPOTHESIS
H0: There is no significant effect of awareness of electronic health records management on administrative effectiveness among Eku Baptist Government Hospital staff.
H1: There is no significant effect of awareness of electronic health records management on administrative effectiveness among Eku Baptist Government Hospital staff.
REVIEW OF RELATED LITERATURE
This chapter presents the review of related literature on the awareness and use of electronic health records management among health workers for administrative effectiveness in Eku Baptist Government Hospital, Eku Delta State. Views and opinions of other authors are as follows.
2.2 Electronic Health Records Management
Electronic records management is a subdivision of Information and Communication Technology (ICT), which involves the sophisticated automated method of management of official records in organisations (Ile & Ojowhoh, 2020). Electronic records management system was said by the management of automated and non-electronic records using computer hardware and software (Duranti, 2010). Electronic records system involves “the manufacture, usage, preservation, protection and disposal of automatedly established records for business and evidence-based activities” (Marutha, 2011).
Hence business owners tend to consider the use of electronic records management because of developments in automated office procedures. To denial people of unauthorised usage, modification, theft, or physical destruction to automated data, electronic management protection practices are important to limit user licence to computer systems to achieving control over the information stored on automated records (Ile & Ojowhoh, 2020).
Electronic Health Record continued to gain wide acceptance in Nigeria after the federal government declared it a key measure to facilitate effective and timeless patient management in 2001 (Adeleke, Erinle, Ndana, Anamah, Ogundele & Aliyu, 2014). Electronic health record (EHR) otherwise known as an electronic medical record (EMR), refers to the “systematized collection of patient and population electronically-stored health information in a digital format” (Gunter & Terry, 2005). An individual health record refers to the electronic record of a person’s health information that is in conformation with national standards and guidelines but is under the control of the individual (HealthIT. gov, 2019; Menachemi & Collum, 2011).
The pooled set of information can be transmitted through different hospital settings with network-connected, enterprise-wide information systems or other information networks and exchanges. The information collected is made up of an array of sociodemographics, health history, drug and allergies, vaccination status, results of laboratory test, radiogram, vital signs, billing information (Hamilton et al., 2014; Lupton, 2014), genetic testing results, sexual orientation, psychological details, accumulated hospital visitations records, radiology reports, allergies etc. (Esther, Jantan, Abiodun, Arshad, Dada & Emmanuel, 2020).
2.3 Concept of Electronic Health Information System
In today’s healthcare service delivery, health information is fundamental to continually monitor and appraise health status, to ensure and continually boost the quality of medical care programs and services (WHO, 2015a). Globally, healthcare services have moved from the curative to preventive care system, from precise intervention to a broad-based and inclusive approach, from an integrated to decentralised healthcare system (Nwankwo & Sambo, 2018). This has compelled the need for reformation of uneven health information systems into an all-inclusive but single health information management system (WHO, 2015b). Electronic health is perceived as a general term that denotes any types of digital information associated with and important to healthcare delivery. It is the integration of information supported equipment to aid every aspect of medical care services, literature, research, surveillance, education and knowledge (Umar, 2015). It is also described as an enormous integrated system that aids the wide-ranging information requirement of medical facilities in the areas of patient, ancillary, clinical and financial management; which can also be perceived as a holistic healthcare information system, designed to store, operate and retrieve administrative and clinical information (Ojo & Popoola, 2015).
Considering its function of constant facilitation and enhancing the process of service delivery within medical facilities, eHIS serves as the link between individuals, processes and technology, which firmly supports the administration of essential information operations and availability (Almunawar & Anshari, 2012). Hence, the health sector over time has changed to a dynamic sector from a relatively stable one, of which the prime objective of eHIS is to enhance the efficiency, service delivery quality of the sector (Sockolow, Bowles, Adelsberger, Chittams & Liao, 2014), and also encourage an expansive development of its management, to achieve security, reliability, quality, interoperability standards and timeliness in the processing and storage of data (Jardim, 2013).
Notably, modern electronic health applications, which includes electronic medical records(EMR), health information management systems (HIMS), internet supported telemedicine, among several others are essential information technology tools employed to increase patient safety, enhance care delivery quality, and reduce associated medical costs (Luna, Almerares, Mayan, Bernaldo & Otero, 2014). Other benefits of e-health information systems include access to updated medical records and interrelated information, clinical decision aided systems, electronic prescriptions (Zayyad & Toycan, 2018), well-structured interdepartmental information sharing, convenient maintenance of clinical services and improved health services administrative system (Meier, Fitzgerald & Smith, 2013).
2.4 Medical Records Management
Another prominent term in eHIS is the electronic medical records; which is central to any health information system (Almunawar & Anshari, 2012). The electronic medical record is a digital layout, upon which medical health records are created, used to capture and refer to patient’s medical record in a digital format (Msiska, Kumitawa & Kumwenda, 2017). It coordinates the storage and retrieval of individual records with the aid of installed software accessible on a computer, often through a computer network (Welborn & Winter, 2014).
Highly essential in the healthcare services is information captured in medical records, vital for provision of decent healthcare delivery; while quality medical data is very necessary for planning, improvement and optimal preservation of the healthcare system (Adeleke, 2014). Thus, a timely accessed patient’s historical information via medical record is highly essential in medical care decisions to achieve efficient care delivery within health facilities (Attah, 2017). Also, a patient’s continued care, impact and outcome of healthcare services received are largely determined by the volume and quality of information available to medical professionals (Kabashiki & Moneke, 2014; Melanie, 2016); recalled from a patient’s record, employed to pass information, monitor response to treatment and to confirm treatments made (Nwankwo, 2018).
The electronic medical record has been acknowledged as a facilitator for modern productivity, efficiency and effectiveness in medical care (Sockolow, et al., 2014); premised on the fact that it represents a departure from out-dated paper records keeping to electronic records management in a computerised format (Adeleke, Asiru, Oweghoro, Jimoh & Ndana, 2014), supported with internet network systems and offering versatility in the ability to transfer information and effective communication among medical practitioners and other health facility personnel in enhancing service quality (Weeks, 2013). To optimally serve the purpose for which they are meant to, Msiska, et al., (2017) think that electronic medical record systems are designed to provide solution in some core healthcare functional areas, which includes recording and provision of patient’s basic demographic and clinical information (Akor & John-Mensah, 2016), such as identification information, clinic attendance details, known allergies, test results, weight and height, among others (Waithera, Muhia & Songole, 2017).
It provides clinical decision support, by highlighting abnormal test results, alerting care providers of abnormal vital signs, alerting care providers if a prescription is a recorded allergic drug or a possible reaction if a recorded drug is administered (Melanie, 2016) and provides reminders of recommended tests, medication, or care due (Osundina, Kolawole & Ogunrewo, 2015). The system serves as a platform for order entry and medication prescriptions, which involves electronically recording instructions for treatment of patients’ within and under the care of medical personnel (López, López, Torres & Santiago, 2014); accept prescription orders, capture dose and administer immunisations (Waithera, Muhia & Songole, 2017); manage orders for referrals together with particulars of referring and referred-to providers.
Additionally, electronic medical records serve as an information reporting medium, helps to improve the reportage and use of derived information (Jardim, 2013; Nzuki & Mugo, 2014). Facilitating this task, the systems are pre-programmed to generate reports from treatment data to aid enhancement and create aggregate reports for planning and policy decision making (Zayyad & Toycan, 2018). Central to facilitating these tasks, it supports the confidentiality and security of all medical data, ensuring the maintenance of a patient’s information privacy (Eason & Waterson, 2013).
The system also enables control settings that limit access to health data only to authorized health personnel, premised on documents and outlined functions (Justice, 2012), maintain thorough audit tracks of happenings within the organisation, follow programmed standard practices on passwords and logins (Luna et al., 2014), guarantee data protection by creating data documentation, backup, recovery and integrate technical security mechanisms associated with data encryption and transmission (Sockolow, et al., 2014). Finally, it facilitates the electronic exchange of information with other integrated systems such as medical record, laboratory and pharmaceutical systems within the same medical facility (Walker-Czyz 2014), to promote interoperability between systems.
In every organisation, the healthcare sector inclusive, information serves as the lifeblood, which is core to the healthcare delivery system globally (Qureshi, 2016). The medical records in automated or manual form, stores the medical information that labels all features of patient care, which makes it an essential tool in the daily operations of healthcare organisations within the private and public sector (Ondieki, 2017). The introduction of information technologies into health institutions has resulted in an information explosion, stimulating an increase in the volume of accessible records (Osundina et al., 2015), enhancing healthcare service delivery.
Medical records are clear, brief and precise information containing patient’s health history, illness and medical occurrences recorded from a medical perspective, which represents the primary source of clinic materials and health statistics (Lungile & Trywell, 2017). They are a recorded version of a patient’s medical history, containing patient’s complaints, examination and medical treatments (Vesna, 2014); diagnostic laboratory test results, doctor’s opinions, medical procedures adhered to, therapeutic procedures and medications (Asunmo & Yaya, 2016). It represents the only historical documentation of the extent of work done and achievements by the medical and nursing staff, the only record showing patients’ recovery progress and source of information for diverse purposes (Garba, 2016).
Records management encompasses the administration of digital or paper records, irrespective of its layout. Its activities involve receipt, creation, use, maintenance and eventual disposal of records (Aljumah, Ahamad & Siddiqui, 2013). The central purpose of records management among others include to provide timely, complete and accurate information whenever needed to manage and operate the organisation efficiently (Callen, 2014); process recorded information as efficiently as possible, provide information and records at minimal costs (Ajala, 2015); offer quality service to customers (Park, 2015) and support organisational decision making and control (Anyika, 2014; Akhtar, 2016).
2.4 Medical Records Management in Public Healthcare Institutions
In public healthcare institutions, medical information and related records are collected, created, disseminated and utilised daily in vary large volumes than any other organisation (Weiskopf & Weng, 2013). These records are fundamental to the well-being of the public and employed to ensure service delivery accountability of such public health facilities (Ondieki, 2017). Over the years, medical records have served and still serve multiple purposes in both private and public healthcare institutions; from purposes of births to the recoding of deaths of individuals; while also serving as data for equipping and provision of needed medical facilities by visionary governments (Garba, 2016).
The significance of records management to public healthcare facilities and institutions includes operational cost reduction and elimination of duplicated overhead costs; eliminates the creation of irrelevant records (Milena, 2015); reduces future costs by ensuring that expensive new equipment are only purchased for upgrading information management (Marinič, 2014); saves spaces by transferring inactive records to storage areas from busy offices and also ensure the timely destruction of expired records (Vesna, 2014). Also, health records management saves time by ensuring proper organisation and maintenance of records (Aljumah, et al., 2013); promotes effective public service delivery via access to needed information for programme monitoring, guarantee administrative stability and ensure informed policy decisions are made; upholds history by identifying and preserving vital research records and evidential information (Asunmo & Yaya, 2016).
2.5 Electronic Medical Records Management and Public Healthcare Delivery
The multifaceted benefits of health information system and associated information technologies in public healthcare delivery cannot be overemphasised. Management Information Systems are essential tools in public healthcare institutions deployed to aid in monitoring and combating the outbreak of diseases, among others (Knobler, Mahmoud, Lemon, Mack, Sivitiz & Oberholtzer 2004 in Umezuruike, et al., 2017). The benefits of adopting and implementing electronic health information system in records management within public healthcare institutions are enormous, some of which include, decrease inpatient waiting time, reduced duplication of laboratory tests, reduction in medical errors (Open Clinical, 2013).
Studies have shown that adoption of electronic health information system will cause an upsurge in digitization, enabling broad management of medical records, from patient information to prescription data and diagnostic care, achieving a straight, effortlessly and seamless process (Yoon, Chang, Kang, Bae & Park, 2014). The electronic health information system also enables healthcare service providers to get multiple opinions on diagnostic treatment and care; evaluates results of research and clinical trials against preventive measures adopted for different illnesses (Ojo & Popoola, 2015); limiting redundant workflow, enhancing the standard of healthcare, increased employee productivity (Chao, Hu, Ung & Cai, 2013). It also has vast potentials to promote patient safety, satisfaction and efficiency of the organisation, thus, enhancing medical outcomes for patients (Postema Peeters & Friele, 2012).
Furthermore, there abound financial and clinical benefits associated with the adoption of electronic health information system in public health institutions. The financial benefits include a reduction in the cost of medical care, efficient documentation process; avoidance of improper filing, damage or loss of patient records, efficient utilisation of resources, and decrease in repetitive laboratory tests and other related services (Yoon, et al., 2014).
Implementation of electronic health information system in the public healthcare also supports core management functions of initiating, planning, controlling and organising operations of the subsystems of hospitals; therefore, providing synergy among the various units and departments of the organisation (Open Clinical, 2013); reduction of work-related errors and enabling accurate and timely communication among all practitioners involved in healthcare provision (Uluc & Ferman, 2016).
Clinical benefits of the electronic health information system include uninterrupted access to patient records by authorised personnel, all through the day; medical practitioners’ duty reminders and alerts; constant learning for healthcare specialists; improved decision support system via electronic connections to the body of scientific knowledge and other external medical and related sources; prompt, effective and smooth follow-up of patient care (Postema Peeters & Friele, 2012). Also, it ensures quality patient care, enables hospitals to move from an out-dated position to a contemporary and appropriate care management. Furthermore, it shows an objective connection between the extent of implementation of eHIS in medical facilities and reduced health complications and mortality rates in hospitals (Yoon, et al., 2014).
2.6 Empirical Review
Empirical pieces of literature abound on adoption and application of eHIS in Nigeria’s public healthcare institutions. In a recent study, Adedeji, et al., (2018) examined factors influencing the use of electronic medical records by nurses in one of Nigeria’s teaching hospitals, indicating that Nurses are willing to use the system, but require practical hands-on training, necessary technological devices and enabling environment are not supportive of their interest. Also, Zayyad and Toycan (2018) investigated factors affecting the sustainable implementation of e-health technology in Nigeria: The study indicated that belief, attitude, supposed usefulness and willingness of healthcare specialists significantly influence their intent to embrace and use e-health technology applications. However, in another study on the effect of training healthcare workers on data management practice in health management information systems in primary health care (PHC) centres in Kaduna State by Nwankwo and Sambo (2018), the result revealed that health management information system training achieved a significant improvement in the management of data of primary healthcare workers.
In another study, Ojo and Popoola (2015) explored factors in Nigerian teaching hospitals likely to contribute to the success of electronic Health Information System. The results indicated a positive and close relationship between all the identified factors and eHIS success, the factors which include technical, social, organisational, financial and political factors. Adeleke, et al., (2014) examined the usage of internet-supported computers among tertiary healthcare practitioners, focusing on a Nigerian public hospital, as a means of enhancing healthcare delivery process. The result indicated that healthcare practitioners and trainees at the federally owned Medical Centre in Bida have a favourable outlook towards the use of internet-supported computers, to improve their professional practice and enhance the quality of patient care.
This chapter is concerned with the presentation of method used in this study to accomplish its purpose on “awareness and use of electronic health records management among health workers for administrative effectiveness in Eku Baptist Government Hospital, Eku Delta State”. The following areas were taken into consideration, design of the study, area of the study, population of the study, sample size and sampling techniques, research instrument, validation of research instrument, reliability of research instrument, administration of the instrument and method of data analysis.
3.2 Research Design
This study adopted survey research design. According to Ekott & Nseyen (2006), a survey research is one in which a group of people or items is studied by collecting and analyzing data from only a few people or items considered to be representative of the entire group. Thus, in this study, the researcher collected data from the respondents in the final year students in the Department of Business Education, University of Lagos.
- Adedeji, P. Irinoye, O. Ikono, R. and Komolafe, A. (2018) Factors influencing the use of electronic health records among nurses in a teaching hospital in Nigeria: Journal of Health Informatics in Developing Countries; 12(2), pp, 1-20.
- Adefolaju, T. (2014). “Repositioning Health Insurance in Nigeria: Prospects and Challenges: International Journal of Health Sciences; 2(2), pp. 151-162.
- Adeleke, I.T, Asiru, M.A. Oweghoro, B.M. Jimoh, A.B. and Ndana, A.M. (2014) Computer and internet use among tertiary healthcare providers and trainees in a Nigerian public hospital; American Journal of Health Research, 3(1-1), pp. 1-10
- Adeleke, I.T. (2014). “Relevance of health information management (HIM) and the roles of HIM professionals in healthcare delivery systems.
- Ajala, F. (2015). Development of an Electronic Medical Record (EMR) System For A Typical Nigerian Hospital: Journal of Multidisciplinary Engineering Science and Technology (JMEST). 2015; 2 (6): pp. 1253-1259.