ABSTRACT
The study investigated ICT- led hospital information system in the management of health services with particular reference to University of Ghana Hospital, Legon. The study utilized the qualitative method. Through the purposive sampling technique, 12 participants were selected for the study. The participants included 1 medical director, 1 administrator and 10 departments and unit heads of the Hospital. The qualitative instrument used for primary data collection was an interview guide. The findings of the study revealed that the Hospital has over a decade implemented two Hospital Information System (HIS) namely: System Consult (SC) (old software) and Equipment Business Frame (EBF) (New Software). It was found that the SC was implemented alongside the manual system using the parallel implementation approach, whilst the EBF was implemented using the direct conversion and hybrid implementation approaches. It was discovered that the process of implementation of the SC was difficult, expensive and the existence of the manual process did not motivate employees or staff to use the software as compared to the EBF which was found to be easier. The effect of the EBF on service delivery was found to be positive and reliable as compared to the SC which was negative and non- reliable. The basic elements underpinning the utilization of the HIS were access and use. Significant factors that propelled the effective implementation and use of the EBF were effective collaboration between staff and service providers, and the cost saving nature of the EBF, adequate training and education, easier use of the software, and the role of the medical director. Moreover, with regards to use, it was found that the SC had significant number of constraints including fewer staff that could use it, expensive nature of the SC, not getting value for money, poor records keeping, inability to do follow up, slower pace of work, unable to raise proper bill, delay in reporting, delay in laboratory result and frequent folder misplacement. In conclusion, the study suggests that the implementation of the HIS in the University of Ghana Hospital focused critically on stakeholders integration of the Hospital whilst exploiting recent development within cloud technologies. On the basis of the constraints, the following recommendations were made. The Hospital should liaise effectively with the University of Ghana Computing Systems so that technical challenges such as network issues and computers are working adequately. Further, the Hospital must also continually ensure that HIS are upgraded, most especially the modules. This will help meet the changing demands of patients and the university community
CHAPTER ONE
INTRODUCTION
Background of the Study
In today’s world of technological advancement, the implementation and use of Information and Communication Technology (ICT) has permeated almost all aspects of life due to its significant effect on productivity and organisational management (Ranta, 2010; Oshikoya & Hussein, 2007). In recent times, the need to improve quality healthcare service delivery has challenged healthcare institutions and professionals to implement and use ICT to enhance their operational activities (Tossy, 2014; Oliveira, et al., 2011; WHO, 2007). This has led to the advancement of Hospital Information System (HIS) in almost every hospital both in developed and developing countries (Tossy, 2014).
Health Information Systems and Hospital Information System (HIS) are two different concepts. According to Aghajari (2013), any system that captures or collects, stores, manages or transmits information related to the individuals’ health or the activities of organisations that work within the health sector is termed health information systems. Moreover, studies on hospital information system, define the concept as an integrated electronic system that collects, stores, retrieves and displays the patients’ overall data and information such as the patients’ information, laboratory test results, diagnoses, billing and other procedures used in several departments in hospitals (Ismail et al., 2010; Hamid, 2010; Ariffin, 2008). Based on the size and mission of the hospital, components of a hospital information system may include clinical information system, financial information system, laboratory information system, nursing information system, pharmacy
information system, and radiology information system (Ismail & Abdullah, 2010). This suggests that HIS is limited to a specific hospital aimed at enhancing the delivery of quality healthcare service.
Currently, the demand for HIS is high in order to help handle the ever-growing population health needs and also assist health practitioners with timely services and quality in healthcare delivery (Joe-Rodrigues, 2010). According to Joe-Rodrigues (2010), the implementation and use of HIS is very critical to health services management, as it aids the improvement of communication between health professionals and ensures confidentiality of patients’ data and records. Adding to this, HIS improves quality of healthcare service delivery and facilitates the standardization of medical procedures (Cline & Luiz, 2013; Feijooa, Fernandeza, Olverab & Calveta, 2010). This may lead to better access to healthcare facilities and improve the quality of healthcare delivery, which subsequently will translate into productive labor and the country’s development as a whole (Khan, Shahid, Hedstrom & Anderson, 2012; Oyeyemi & Wynn, 2014).
Although, HIS presents several prospective benefits to patients and hospitals, its implementation is quite demanding (Hamid, 2010). There are several factors that serve as constraints to the implementation and use of a hospital information system (Sadoughi, Kimiafar, Alhmadi, & Shakeri, 2013). These factors include among others; high initial costs (Boonstra & Brockhuis, 2010; Smelcer, et al., 2009); time needed (Tossy, 2014); technology and technical problems such as complex system and integration problems (Farzandipur, Jeddi, & Azimi, 2016; Kimiafar et al. 2015); basic problems such as lack or inadequate computer skills, complex tasks, complex functions (Ajami & Bertiani; 2012; Khalifa, 2013) and ethical issues such as certification, security, privacy, and confidentiality (Ahmadian, et al., 2014; Ahani, Nilashi & Ahmad, 2016).
Given the above background, the intended interest of this study is to investigate ICT-led hospital information system in the management of health services with particular reference to the University of Ghana hospital.
Problem Statement
Players in the healthcare market in both developed and developing countries have invested substantial amount of resources in information systems to gain competitive edge, reduce operational cost and improve quality healthcare service delivery to its clients. Given this, the success and failure of information systems implementation will largely depend on how well hospitals handle this stage (Ahani, Nilashi & Ahmad, 2016). Although the challenges faced in implementation of information systems are enormous, hospitals today see information systems as necessary for their survival (Ahani, Nilashi & Ahmad, 2016).
Literature review shows that significant number of studies have been carried out within the area of Health Information Systems in the developed world. However, most of the studies concentrated on the acceptance of health information systems (Sagiroglu, 2006; Yusof, 2007; Ahani, Nilashi & Ahmad, 2016). It is clear that these studies focused on understanding health information systems within the broader context. The researchers’ aim was to develop models to help improve health information systems for Hospitals in both developed and developing countries. The challenges are the failure to acknowledge cultural indicators as well as specific needs and function of specific hospitals. These show that these previous studies were conducted on a broader perspective. Therefore, it is important that this study focuses on hospital information system rather than health information systems as studied by previous researchers. A
hospital information system is unique to a specific hospital and has the propensity of revealing the vital information regarding specific hospitals, their needs and functions.
In addition, some studies in developed countries also concentrated on user role in the success of information systems (Yusof, 2007; Mahmoudi, 2010); health information systems (Sagiroglu, 2006; Sam-Zadeh, 2011); health information technology (Morton, 2008; Ping et al., 2008; Koivunen, 2009; Sam-Zadeh, 2011) and clinical information systems (Pare et al., 2008; Anderson, 2010). Further, in Africa most of the studies also concentrated on health information systems and technology adoption (Ojo and Popoola, 2015; Farzandipur et al., 2016). This clearly shows that the aim of these researchers was to provide critical understanding to specific aspects of health information systems.
Further, previous studies concentrated on single viewpoint either on clinical, or single user groups such as doctors, nurses, laboratory technicians (Chau & Hu 2002; Croteau & Vieru 2002; England & Stewart 2007; Schaper & Pervan 2007) or organisational factors only (Hamer and Schwarts 2000; Ping et al.,2008). Even though, their concentration was specific, their focus was to develop models to support health information systems. Although, concentrating on specific aspects of health information systems is good, it does not reveal specific issues regarding specific hospitals, their needs, technology adaptation and operational effectiveness. In addition, the previous studies ignored the human and system interaction within the hospital milieu and how this influences implementation and use of hospital information system. These shortcomings also underscore the need to study specific hospitals and the implementation and use of a hospital information system.
In light of these, the researcher decided to concentrate on a specific Hospital (i.e. the University of Ghana Hospital). The University of Ghana Hospital is one of the reputable hospitals in Accra, the capital city of Ghana. Despite its role in providing quality healthcare service to the University Community, critical observation has revealed that implementation and use of HIS at the Hospital has not been empirically studied, although some studies have covered health information systems (Ahani, Nilashi & Ahmad, 2016). According to Ahani et al., (2016) health information systems have been given critical attention by researchers within the health sector in Ghana. However, researchers have not given such attention to hospital information system, even though some hospitals have adopted such systems in Ghana. This makes the study unique as it narrows its scope to the implementation and use of HIS with reference to a specific hospital (University of Ghana Hospital).
The study aimed to answer the following three questions: How is the hospital information system implemented and used at the University of Ghana Hospital? What are the factors enabling or constraining the implementation and use of the hospital information system at the University of Ghana Hospital? and What is the impact of the implementation and use of the HIS on service delivery by the hospital?
In view of this, it is clear that most of the studies did not concentrate on hospital information system implementation and use. It is important to indicate that significant number of studies conducted were carried out in the developed worlds with limited studies in Africa, especially Ghana. This study would unearth specific hospital information system used by the University of Ghana Hospital, reasons underpinning the choice of such information system and its implementation processes and use. It would reveal unique implementation strategy by University of Ghana Hospital which previous studies failed to unearth because of their broad concentration
on health information systems. It is therefore, justified on the premise that studying health information systems reveal specific challenges prior to the introduction of hospital information system. Based on the literature gaps in literature, the study seeks to investigate ICT-led hospital information system in the management of health services with particular reference to University of Ghana Hospital.
Research Objectives
The purpose of this study is to investigate ICT-led hospital information system in the management of health services with particular reference to University of Ghana Hospital. The specific objectives are as follows;
- To investigate how hospital information system was implemented and used at the University of Ghana Hospital.
- To examine the factors enabling or constraining the implementation and use of hospital information system at the University of Ghana Hospital.
- To examine the impact of the implementation and use of hospital information system on service delivery by the University of Ghana Hospital.
Research Questions
Based on the objectives, the study seeks to find answers to the following research questions:
- How is the hospital information system implemented and used at the University of Ghana Hospital?
- What are the factors enabling or constraining the implementation and use of hospital information system at the University of Ghana Hospital?
- What is the impact of the implementation and use of hospital information system on service delivery by the University of Ghana Hospital?
