Investigating the Influence of ICT and Social Media Utilisation in the Performance of Health Information Management Professional (A Case Study of FMC, Asaba)
Chapter One
Objectives
Broad Objective
To determine the effect of ICT and social Media Utilisation on the Health Information management Professional in FMC Clinics, Nigeria.
Specific Objectives
- To determine the use of ICT in administrative tasks, and in clinical record
- To ascertain the turnaround time of record retrieval, placing orders such as labrequests, procedures and that of receiving the same results through
- To determine whether human factors such as age, status of employment, length of employment and duration of ICT system use, determine the quality of clinical
- To determine whether the measures of quality assessed at FMC are in keeping with the benchmark (Tang, 2003) and (MOMS and MOPHS, 2010).
CHAPTER TWO
LITERATURE REVIEW
Use of ICT in healthcare globally
Denmark is the world’s leading country in the use of this technology in healthcare. Approximately 98% of primary care physicians use Health Information management, and with this technology they are able to send and receive patients’ clinical data, to and from specialists, to the pharmacy, hospital, as well as to send patients reminders electronically. (Pretty and Johansen, 2010). From this case study, the critical success factors in the Danish model that can be emulated by developing countries such as Nigeria in their future approach towards scaling up ICT in health care included; The development of a national policy that supports the development of a National Health Information Technology policy which enhances quality, efficiency and patient centeredness, as well as the requirement for all primary care physicians to use Health Information management by 2004. There was also the requirement to use email technology to communicate with patients. Closer home, communication between patients and clinicians can be addressed via email even without an HIM system in Nigeria, whereby patients’ laboratory reports and medical reports could be emailed to reduce back and forth movement between patients and providers.
In Denmark, a non-governmental body- MedCom coordinated and supported the health information technology development and in Nigeria, this would begin with a government policy to support the use of HIMs, such as the standards and guidelines developed for HIM systems developed by the Ministry of Health in 2010.
The presence of every Danish citizen having a national Person Identification Number has enabled the patient’s entire medical history to be accessible to providers, and every Nigerian who is within the system can be given a unique PIN number for the purpose of using HIMs. This number could be attached to medical files, including patient allergies, previous hospitalizations, and other such pertinent medical issues, that could be accessed from any inter-related HIMs, or Electronic Health Records.
Following the United Nations Conference in Bangkok (Thailand) on the 9th to 10th December 2009, on ‘ICT Applications in e-health: Improving Community Healthcare Services towards achieving the MDGs’, a paper was presented on the present situation of ICT use in Indonesia. Indonesia has a population of 230 million, 60% of who live in the rural set up. The use of ICT in this fast developing country that is very similar to Nigeria has been mainly used to improve and streamline the referral system while improving health service delivery to all people in its 33 provinces. The main objectives in this study were mainly to evaluate the competence of healthcare providers, as well as to assess ICT applications in community level recording and reporting, outbreak management system, telemedicine referral systems, use of paperless prescriptions, as well as the use of Local Area Network (LAN) to support the transfer of medical information. The main lesson learnt from this study was the importance of capacity building and competence of healthcare providers in the use of ICTs, the presence of some cultural barriers, the need for more funding towards technology and operational costs, and the widespread availability of telecommunication infrastructure. Conclusions from the study advocated for the promising outcomes of ICT use in healthcare despite the challenges faced, the need for the involvement by the community, institutions, private and public sector to achieve sustainability.
Bangladesh’s national ICT policy was for ICT to be used in Health Information, the referral system through the use of telemedicine especially for rural patient management, as well as in distant medical and health education. This technology was to be used further in the development of mass awareness for prevention of diseases in the management of disease outbreaks. The above were to be implemented after all public hospitals and medical research centers were linked by computer networks (Bangladesh National ICT Policy – 2008).
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CHAPTER THREE
METHODOLOGY OF STUDY
Study Design
This is a cross sectional study, examining a sample of all Health Information management, against the determinants of quality as per the MoH, standards and guidelines of 2010 and Tang, 2003 and an evaluation of the knowledge, attitudes and practices of Health Care Workers using the above mentioned records, by the use of Self-Administered Questionnaires.
Eligibility Criteria
Inclusion criteria
All Health Information management that have been in use within the study period and have been keyed into by at least 4 of the different types of health care workers namely; front office staff, nurses, doctors, lab technicians, and pharmacists.
Health Care workers who come into contact with patient Health Information routinely, as part of their work, and who have signed the consent form.
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
Data Presentation-Descriptive Data
HIM support for administrative and clinical management functions
Below is a summary of HIM ability to perform admin’ tasks and medical record management based on objective one. A random sample of 385 out of all HIMs accessed and utilized between January 2011 and June 2011 was assessed.
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
The study has gone a long way in ascertaining what the definition of quality as pertains to HIMs is, and the standard qualities that any Electronic Medical Record must have in place and that are incorporated into FMC’s Compu Care system. It has however also clearly demonstrated that in addition to system factors, human factors must also be considered as determinants of quality of records within an HIM system.
It can be concluded from this study that computer based HIM systems, such as FMC’s Compu Care system are very useful in improving the Health Information management Professional, so long as the majority of the set standards by both Tang 2003, and the Ministry of Health are met. This study has also fully met the set objectives in determining the effect of ICT and social Media Utilisation on the Health Information management Professional in FMC Clinics, in Asaba Nigeria, by determining the use of ICT in both administrative and clinical tasks.
Recommendations
For, FMC as one of the pioneer health providers in this country to embrace HIMs and use them fully, it is clear that the Compu Care system currently in use has the majority of specifications required by any standard HIM system. The current system however can be upgraded to support some of the specifications that it does not support, such as; patient support systems to offer patients prompts and reminders for refill of medication and review of lab tests and remote patient access to their own Health Information, or at the very least, some parts of their Health Information, such as lab results, vital signs, past prescriptions and so forth. Further training for staff is necessary to sensitize them on areas of the system that they may not be using or updating sufficiently. This includes, completing Health Information as well as entering the ICD10 diagnosis for each patient seen to ensure records retrieved there after are not only complete but accurate.
The underlying system issues that members of the medical staff noted would require to be addressed comprehensively. Network stabilization is necessary to ensure minimal interruptions during utilization of these HIMs. These network fluctuations not only affect the system speed and thus staff speed, but may also be the underlying factor behind other issues arising such as difficulty accessing patient benefits and stock related issues. HIMs may be used to solve the problem created by the numerous numbers of Health Information generated by different health facilities, as they grow. The space required to store the ever increasing number of records for larger institutions can be minimized with a fully HIM systems integrated to other systems such as Radiology Information Systems that are able to store radiological images electronically.
The turnaround time of record retrieval can be greatly reduced by computerizing records to ensure Health Information are retrieved in a timely manner to ensure faster clinician decision. This has been clearly evidenced by the sentiments collected by FMC HCWs concerning the turnaround time of accessing patient records, accessing lab results as well as making orders and prescriptions. Loss of records, as well as manipulation of Health Information are problems unlikely to occur with HIMs since most systems have electronic signatures and cannot be edited once saved. This is the case with the Compu Care system, whereby once saved, records cannot be edited in the future. This must be a consideration of all future HIMs to ensure accuracy, unlikelihood of record loss and manipulation and the reliability of such records for medico legal purposes.
HIMs are the backbone of telemedicine where electronic medical data may be transmitted to other medical practitioners or specialists via email remotely. This would go a long way in easing the congestion in referral facilities such as Nigeriatta National Hospital, where patients occasionally wait months in order to see a specialist. These patients could easily be attended to from their rural homes after consulting a specialist remotely on phone or via video conference or even better after sending electronic medical notes or images such as x-rays done electronically, for the consultant to review and advice accordingly. This set up would require the government’s support in funding start up equipment, including setting up medical ICT hubs within each district or provincial hospital to ensure all referral cases are sorted in this manner. This would not only decongest the referral facilities, but also improve rural patient management without the transport costs that referrals result in.
For FMC this is a worthy cause and a natural development for the current system to interlink the upcountry health facilities with Asaba specialists, to avoid sending such patients to Asaba just for referrals to see specialists. The converse would be creating one telemedicine hub within one of its Asaba facilities, from where consultants might be consulted on specific pre-booked patients. Each facility could have one day a week where also referral type patients would be booked to consult specialists remotely. This would go a long way to serve as a model for the public institutions that would need to do the same in the future.
Public health facilities are many times accused of being run inefficiently. Health Information management would aid in generating accurate reports based on the electronically based records that are usually easier and faster to compile and thus help in making evidence based clinical and managerial decisions. This also affects such reports as those pertaining to notifiable diseases in facilities of all levels. Additional reports that may be useful for managers specifically in running their institutions more effectively would include reports relating to staff efficiency, whereby the system is able to ascertain how many patients a clinician has seen each hour, and administrative tasks such as booking patients to efficiently manage them.
Researchers requiring organized medical data especially on studies such as disease prevalence of certain diseases would benefit from this sort of data due to the ease with which it can be retrieved, as well as the format required, such as based on ICD 10 classification, based on age groups, based on weight and other demographic factors.
From the study, it is clear that the transition from manual records to electronic records for any health facility would require adequate training for all staff likely to handle these records to ensure maximum utilization of all functions of such a system. The completeness of the records would solely depend on the HCWs in the facility. In addition this study has demystified the components of any such HIMs, highlighting on some of the specifications that any health facility manager would require to ensure the HIM in use is robust and up to date.
In addition to the different specifications that have been outlined by Tang,(2003) and MOMS and MOMPHS, (2010), a few areas that would require to be emphasized on would include installing patient reminders and prompts to ensure patients too play a major role in their follow up, by getting system generated reminders sent on their phones on matters such as, refill of chronic medications, review of lab results, recheck of certain parameters such as blood pressure and blood sugar for hypertension and diabetes respectively. These would encourage health promotion in prevention of disease and reduction of disease complications.
The government can play a major role in ensuring regulations are put in place to ensure all HIMs adhere to the standards and guidelines set by the ministries of health according to their 2010 publication on the same. Matters such as confidentiality of records would require special attention to ensure that web based HIMs are protected to ensure patient confidentiality is always maintained.
In addition to regulation, the Ministries of Health in conjunction with other sectors can work together to ensure unique citizen identifiers such as PIN numbers and national identification numbers can be linked to electronic medical data bases to ensure retrieval and provider access regardless of where a patient may be, even far away from their primary physician. This will ensure that any patient connected to this network of HIMs can be treated anywhere in the country.
Lastly, all future Health Information must be modeled to improve medical care. The HIM systems will thus enhance the definition of these HIMs thus, ‘records in digital format that are capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. Such records should include a whole range of data in comprehensive form, including medical history, medication and allergies, immunization status, laboratory test results, radiology images, and billing information’ (Gunter, et al, 2005), to improve the medical care of all patients!
REFERENCES
- Hook, F. & Werner, M. (2003). ICT in Healthcare in Nigeria Assessment. The Nigeria ICT in healthcare Conference, Asaba, 30th Sepember-1st October 2003.
- http://knh.or.ke/index.php, accessed on (5th June, 2010). Nigeriatta National Hospital, Health Information department web page.
- Marker, P., McNamara, K. & Wallace, L. (2002). The Significance of Information and Communication Technologies for Reducing Poverty, The Think! Programme, Development Policy Department, Department of International Development.
- Ministry of Medical Services and Ministry of Public Health and Sanitation (2010), Standards and Guidelines for Electronic Medical Systems in Nigeria.
- O’Malley, A. S, Grossman, J. M. & Cohen G. R. (2009). Are Health Information management Helpful for Care Coordination? Experiences of Physician Practices, Journal of General Internal Medicine.
- Protti, D, Johansen B. & Perez-Torres, F.(2008) Comparing the application of Health Information Technology in primary care in Denmark and Andalucía, Spain 2008 Journal of medical informatics Vol. 78 pp. 270-283.
- Protti, D. & Johanssen, I. (2010). Widespread adoption of Information Technology in primary care physician offices in Denmark: A Case Study, The Commonwealth Fund, Vol. 80, pp. 1-14.
- Tang, P (2003). Key Capabilities of an Electronic Health Record System. Letter Report. Institute of Medicine Committee on Data Standards for Patient Safety. Board on Health Care Services, Washington D.C.: National Academics Press. July 31, 2003.
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