ABSTRACT
Incorporation of Information and Communication Technology into healthcare system has electronically transformed the approaches to medical data collection, storage, retrieval and its management across all health institutions in the world. However, there has been a drift of focus from core issues pertaining to the preparation processes, benefits, challenges, and prospects of such transformative innovation in the health sector. This study therefore sought to examine such fundamental shift by focusing on the electronic health management information system at the University of Ghana Hospital at East Legon in Accra after two and half years of its implementation. The purpose was to examine the effectiveness of the implementation of the eHMIS adopted as a new EHR system for providing healthcare at the university hospital. The specific objectives were to evaluate prior assessment made before implementation, the benefits, and challenges of the eHMIS. To achieve these specified objectives, the study adopted interpretive design combined with qualitative methods to collate and analyze the primary data from 27 sampled health professionals who use the eHMIS system to render healthcare services.
Findings revealed that the participants possess a general knowledge about health information system (HIS). Also, the university policy makers made well planned preparation towards the purchase and adoption of the eHMIS system at the University’s hospital at East Legon but there were some lapses. In spite of that, the use of the system has brought enormous benefits such as easiness, quickness, and simplicity to the accessibility of patients’ health records. Nonetheless, resolvable challenges identified included unstable internet service, intermittent power outages, and inadequate training. It was conclude that, the implementation of the eHMIS has been tremendously successful, which has brought benefits such as easiness, quickness, and simplistic accessibility to patients’ health records hence the prospects of the eHMIS is very optimistic when the recommendations that target the lapses and challenges are considered in the further review and use of the system. Recommendations made included the installation of uninterruptible power supply, and engagement of more ICT superintendents to offer assistantship to the health professionals who have no or limited ICT or computer skills and knowledge to use the system effectively and efficiently.
CHAPTER ONE INTRODUCTION TO THE STUDY
Background
The infusion of modern information technology into the medical records keeping has made electronic healthcare (i.e. eHealth) gained much prominence in the healthcare sector across the globe. This owing to the concerted effort at national, regional, and international levels to make the management of patients’ health information more enhanced, efficient, and effective for quality medication.
Generically, the World Health Organization (WHO) defines eHealth in its broad scope as the cost-effective and secure adoption of information and communication technologies (ICTs) to assist health and health-related fields, comprising healthcare services, and health surveillance, education, knowledge, literature, and research (WHO, 2019). In a narrowly construed manner, it is described as the healthcare practice assisted by electronic processes (Talking Medicines, 2017) or the use of ICTs for healthcare practice (WHO, 2019). It therefore comprises technology such as patient administration systems, lab systems, and electronic health records (Talking Medicines, 2017).
Since the introduction of the electronic health records (EHR) in the health sector, there has been a great total transformation of paper-based health record keeping and transmittal systems to an electronic system (Routine Health Information Network [RHINO], 2019). Before the introduction of eHealth, patients’ health records were kept manually in large volumes of printed folders, which demanded appropriate records management practices in order to ease storage and retrieval of records. The Center for Medicare and Medicaid (2012) defines EHR as “an electronic version of a patient’s medical history that is maintained by the provider over time, and may include all of the key administrative clinical data, relevant to that person’s care under
a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports”. That is, the invention of EHR systems were designed as a clinical and administrative tool to stock and retrieve patients’ medical history. Today, EHR system is one of the eHealth techniques to effectively handle patients’ health information and records.
It is generally known that health information or records is one of the important blocks of the EHR system strengthening because health policies and planning mostly depend on the accurate and timely information on various health issues which improves the overall health status of a country. That notwithstanding, it as well serves as a vital element for individual health organization in managing and improving healthcare delivery (WHO, 2019).
One of the great ICT innovations to organize and manage health information or records to strengthening any EHR system is Electronic Health Management Information Systems (eHMIS). This eHMIS is a facility-based data aggregation system designed purposely to automate accurate and timely collection, aggregation, store, analyze, and evaluate medical data for health-related decisions (RHINO, 2019; para. 2). It is best referred as an automated health information management system composed of a set of interrelated procedures and components that function together to generate health information and intelligence to monitor and manage peoples’ health status and healthcare services to advance healthcare decisions at all levels (RHINO, 2019; para. 4).
The WHO recognizes the potential benefits of integrating information communication and management technology into healthcare administration (WHO, 1998). In its Health-For-All Strategy, the organization recommended member states to incorporate the appropriate usage of health telematics in the overall health policy framework for the realization of quality healthcare delivery for all and sundry in the 21st century (Dawson, 2011; WHO, 1998). Thus, ensuring
the global vision of equitable distribution of the diverse benefits of science, technology and public health development is achieved for all and sundry around the globe (Dawson, 2011).
As part of this modernization vision, in December 2015, the University of Ghana (UG) Health Services (hereinafter called UG Health Services) implemented an eHMIS, as a new EHR system, into their mainstream service delivery framework to receive and retrieve medical records of patients at one of its long built health facility, popularly called ‘University of Ghana Hospital’ (hereinafter called UG Hospital). The installation of the eHMIS was to facilitate services delivered by the university’s healthcare professionals and to promote quality medical services to patients mostly students and staff of the university. The new electronic healthcare system also automates access to information and has the potential to streamline the clinician’s workflow (University of Ghana-Health Services, 2019: para. 3).
The eHMIS implementation agenda was laudable and met with high expectation and full institutional and administrative support. Since its inception, the system has been serving over 30,000 students and over 1000 staffs of the university and it environ inhabitants. However, for time being nothing has been heard about the progress of the implemented eHealth system let alone whether it is meeting its expectations. For this, the study seeks to assess how the implementation of the new EHR system in the university’s health facility has been, particularly in terms of its pre-implementation preparation, relevance and challenges in the healthcare delivery framework at the health facility. Such an assessment sought the best way(s) to strengthen the system and help in providing an implementation plan for future similar initiatives.
