ABSTRACT
Introduction: In busy health facilities, substantial Health Information are generated daily, posing a problem for timely retrieval, prompt decision-making, and the possibility of medical errors. ICT promises to help resolve most of these issues but little research exists to demonstrate its efficacy. This study goes to demonstrate the effect of ICT and social Media Utilisation on the Health Information management Professional
Broad objectives: To determine the effect of ICT and social Media Utilisation on the Health Information management Professional in Federal Medical Centre (FMC) Clinics, in Asaba Nigeria.
Methodology: This is a cross sectional study, assessing the effect of ICT and social Media Utilisation on the Health Information management Professional. A sample of all Health Information management within FMC was evaluated against the set standards governing Health Information management Professional. A sample of all HCWs handling these records was also assessed to ascertain whether their knowledge, attitudes and practices affect the quality of these records. Statistical analysis of both the quantitative and qualitative data was performed using SPSS. Results: The HIM in use was able to support administrative tasks such and clinical management functions. There was 100% ability of the system to make lab orders, prescriptions and schedule appointments electronically. 88% of HCWs reported retrieval of records in less than 1 minute, and 73% of HCWs reported that lab results retrieval in less than 5 minutes. Some human factors such as employment status, increased age and previous HIM use of the Health Care Workers had statistical significance on the quality of HIMs.
Conclusion: This study showed that computerization of Health Information does improve their quality by meeting most of the set standards that HIMs must meet to ensure quality of such records, however some human factors do affect the quality of such records.
LIST OF ABBREVIATIONS
FMC Federal Medical Centre
HIM Health Information management
HCW Health Care Workers
HMO Health Maintenance Organization
ICT Information and Communication Technology
ICD Institutional Classification of Diseases
IREC Institutional Research and Ethics Committee
IRB Institutional Review Board
IT Information Technology
PIN Personal Identification Number
PDA Personal Digital Assistant
WHO World Health
PCA Principal Component Analysis
CHAPTER ONE
INTRODUCTION
1.1Â Â Â Background
Information and Communication Technology (ICT), is defined as ‘technologies that facilitate the communication, processing and transmission of information by electronic means’ (Marker et al, 2002) and has been wildly advocated for in different sectors, including in the Health Sector. Even though by late 2003 Nigeria did not have a policy on ICT use in health care, the uptake of ICTs in health service delivery in a few developing countries like Ghana, Bangladesh, Namibia, Indonesia and the Philippines, has led to an ICT revolution, so to speak, in some of the private hospitals, Health Maintenance Organizations (HMOs), as well as in medical insurance companies in Nigeria.
The National Information and Communications Technology Policy of 2006 states that ‘the goal of Information Technologies in Health Services will be to improve equity and quality of life by utilizing IT in health delivery systems’. Its main target was Public health facilities, to train medical staff, as well as setting standards in IT in health care systems as well towards developing legislation for governing of telemedicine. An assessment of the use of ICT systems in Nigerian Hospitals before the Nigeria ICT Healthcare conference of 2003 held in Asaba, estimated that only 10% of the public hospitals were already using some form of ICT in their health systems. Since then Nigeria has come a long way in the use of ICT in Health Service delivery, specifically in the financial and administrative systems, and in some private health institutions, it is now primarily used for clinical record keeping and claims processing, especially among insurance companies.
Though many health facilities in Nigeria have in the last few years begun adopting IT for administrative purposes such as internal and external communications between departments and patient billing, the use of IT in private health facilities in Asaba specifically has widened to include its role in patient medical record-keeping by the use of Health Information management (HIMs). Health facilities such as Gertrude’s Hospital, Asaba Hospital, Aga Khan Hospital and FMC’s network of health facilities have all embraced the use of IT in patient management, including patient identification verification, patient billing, patient scheduling and more importantly, the use of Health Information management (HIM).
On the other hand, medical record keeping in Public health facilities is still done manually, a state that is complicated by the number of patients seen in these institutions, these being the health facilities that are easily accessible as well as affordable to the majority of Nigerians. Nigeriatta National Hospital as a representation of public health institutions is the oldest referral and teaching hospital in Nigeria. It has a bed capacity of 1800 beds, with over 6000 staff members, an average annual outpatient visit of 600,000, and an average annual in-patient attendance of 89,000 patients. Suffice it to say, the number of records required to be maintained is enormous and requires a Health Information department with a work force of 227, consisting of Health Information officers, Health Information Assistants and Clerical Officers. (http://knh.or.ke/index.php)
Following the assessment made on ICT in Healthcare by the Nigeria Private Sector Alliance / AITEC at The Nigeria ICT in Healthcare Conference, Asaba (2003), there were several challenges found in healthcare that could be addressed by ICT.
Nigeria does not have a properly functioning referral system. This has led to the excessive burden on the main national referral hospitals, namely the Nigeria National Hospital, and Moi Teaching and Referral Hospital. A streamlined ICT based referral system would go a long way to decongest these two hospitals and this may be through introduction of e-health solutions through tele-consultations, such as is currently being practiced in Bangladesh. The backbone of these solutions will however require the standardization of Health Information through their computerization.
There were significant losses incurred in the public healthcare system due to inefficient management and logistics. This is especially felt with inefficient management of patient records, which are the back bone of report generation, and eventual decision making regarding administration of these facilities. There is need for improved and better integrated Health Management Information Systems to cater for and improve the uptake of administrative functions of ICT such as in patient identification, as well as in use of standardized coding for medical diagnoses, drugs, tests and to eventually improve the use of referral systems by Nigerians.
Though there is a lot being done by the private sector especially such as FMC Healthcare, there are plenty of opportunities that can be taken up by all players within the health sector. This includes the need to set up regulatory bodies on ICT use in healthcare regarding such issues as standardization of patient records for future retrieval towards improving the quality of these records for timely clinical decision making.
1.2Â Â Â Problem Statement
In busy health facilities, substantial Health Information are generated daily, a state that if not handled properly can result in misfiling, loss and untimely retrieval of records resulting in inability of these records to trigger or prompt decision making, in addition to medical errors resulting from illegibility of clinical notes. ICT promises to help resolve most of these issues but little research exists to demonstrate its efficacy.
1.3Â Â Â Research Question
To what extent does computerization of Health Information improve the Health Information management Professional in FMC Clinics in Asaba?
1.4Â Â Â Hypothesis
The computerization of Health Information does not improve their quality.
1.5Â Â Â 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
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- 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 lab requests, 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).
1.6Â Â Â Significance of study
To date, there has been some improvement in the delivery of health care, resulting from the use of ICT in increasing the access that healthcare workers have to administrative data and patient Health Information. In spite of this, not many studies have been done to assess the effect, if any, of ICT in health care management, and specifically on Health Information especially in the private health institutions that have fully embraced ICT. This study therefore goes to ascertain any positive effects of ICT and social Media Utilisation on HIMs, especially in improving the quality of medical data. This might go a long way in assisting those in the public and private sectors to embrace ICT in the use of Health Information Management Systems, as well as to complement the Private sector in issues related to regulation of the same. Other beneficiaries of this study will include; researchers requiring organized medical data studying disease prevalence, government policy makers, as well as the Ministry of Health, towards eventual standardization of HIMs. In addition health care providers and facilities with intentions to adopt ICT will have an idea of the requirements that most standard systems must have in order to ensure that data meets the criteria for Health Information management Professional.
1.7Â Â Â Study limitations
Due to financial and time constraints, the study was limited to the Nigerian health facilities for an evaluation of the knowledge, attitude and practices of health care workers and how this affects medical record keeping, while the Health Information were pulled from all Nigerian health facilities, but accessed from the FMC Asaba. These records were accessed from the central data base at FMC Asaba. An assumption made was that that the factors pertaining to the Health Information management Professional in Nigeria are similar to those in the region.
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