ABSTRACT
The use of technology in healthcare setting is not a new concept, however the use of Information Technology (IT) within health setting was non-existent in most developing countries until recent times. Though developing countries are slow adopters of new technology, however, the use of Health Information System (HIS) including Electronic Health Records system (EHRs) in health service delivery has been gaining prominent in most developing countries and Ghana not exclusive. The need to provide patients with timely quality service in an era when data volume is growing quicker than organisational infrastructure development. Many hospitals today are considering implementing this technology to provide medical information and care in a better way. EHRs, an aspect of HIS, is seen as a powerful tool, which provides a great number of benefits in one of the data intensive industries like the healthcare industry.
This study extends the applicability of Technology Acceptance Model (TAM) to examine user acceptance of EHRs in the hospital within the context of Ghana. The study aims to examine EHRs characteristics/factors which affect EHRs acceptance among health professional, capitalising on their belief perspective in the process of transformation, from paper-based to electronic in the hospital. This EHRs acceptance assessment is to help the health facility estimate how perception of healthcare professions on the usage of EHRs will contribute to the success of the system.
By adopting quantitative research approach, data was gathered from the users of the system and the system administrators using closed-ended questionnaires and observations
Key words: Information Technology (IT), Health Information System (HIS), Electronic Health Record system (EHRs), Technology Acceptance Model (TAM)
CHAPTER ONE
INTRODUCTION
BACKGROUND TO THE STUDY
Health care is dependent on information and to strengthen quality healthcare delivery in any country, is to improve health information system. Healthcare quality extend beyond just meeting client satisfaction, but addresses other components which includes effectiveness, efficiency, equity, safety and timeliness is service delivery (Lohr, 1990). In recent years, aside the need to deliver quality healthcare in a competitive market, managers of health facilities have been overwhelmed with very complex financing, purchasing and provision of health services. This volatile healthcare environment has led to the acknowledgement of the importance of adopting Information Technologies like the Electronic Health Records (EHR) in healthcare management.
Electronic Health Records (EHR) is an electronic version of a patient’s health record that was historically created, used, and stored in a paper chart. This is generated, managed, and kept by a healthcare organisation (Roman, 2009). Electronic Health Records (EHR) are poised to change and revolutionise modern healthcare system in the world. The surge in the development of Information Technologies (ITs) provide various tailor-made innovative applications and systems known as Electronic Health Record system (EHRs). It is assumed to improve cost efficiency, safety, and the quality of healthcare services, however, the adoption of Electronic Health Record systems (EHRs) has been slow to catch on with healthcare providers. Governments have made efforts to promote the digitisation of the health industry by introducing measures or policies to promote what is known as e-health. In developed countries, EHR’s are becoming a necessary component of healthcare. For example, the U.K. and Sweden have national EHRs, the United State passed legislation requesting all healthcare providers to adopt and use EHR by 2015 (Tom , Dean , & Tod , 2014). Other countries like
Australia, Netherlands, New Zealand, Italy and Norway are rate 90% plus, Germany and France rated 72% and 68% respectively, in the coverage of EHRs (Silversides, 2009).
Consequently, the adoption of EHR in sub-Saharan Africa has increased over the last 10 years, initially driven by international efforts at controlling the HIV/AIDS epidemic, although public health institutions in the region appear to be slow adopting EHR and other relevant ITs which are required to improve healthcare (Maxwell, et al., 2012). Acknowledging the potentials of EHR, the World Health Organization (WHO) published a manual on implementing EHRs for developing countries to guide to agencies intend to fund e-health projects. Despite efforts made by these agencies, Sub-Sahara Africa is still faced with many daunting challenges in the adoption of these systems. Among other challenges mentioned include, financing the immense cost of setting up EHR systems or infrastructure, lack of support from government and other stakeholders. In contrast, countries like South Africa, Cameroon among others experienced high failure in the process of adopting EHRs despite support from government and agencies. This on the other hand, failure were attributed to factors such as social influence user perception, system is too difficult to use and lack of training (Arman & Hartati, 2015).
In Ghana, as in most African countries, availability of good quality data for decision making remains a great challenge. The government of Ghana therefore launched the national e-health strategy in in July, 2010 with a list of key strategies to promote the use health information systems, key of which is the EHRs. After the launch of e-health, other different software applications were purchased by some private and large public hospitals to setup EHRs. These EHR systems are tailored towards widening the capacity to support the complete processes in the hospitals – from clinical to purchasing and/ procurement (Achampong E. K., 2012).
Currently about six (6) regional hospitals in Ghana and other tertiary and districts hospitals are in various stages of introducing the HAMS software for the management of their health records.
STATEMENT OF PROBLEM
Considering efforts made to gather the necessary clinical information, strategies over past decades appears not to be sufficient to contain and control current volume of clinical information1in a quick and safe manner (Aydin, 1991). The thinking of applying IT system to overcome this shortfall is fast dominating in recent times. Research has showed that, employing Electronic Health Record system (EHRs) has the potential to improve on efficiency, safety and quality of healthcare services. In many instances in developing countries, such systems do not fully realise the objectives envisaged and have survived partially or fully at the pilot phase (Adjorlolo & Ellingsen, 2013). This statement supported by Arman & Hartati, 2015, claimed that, there are many factors that contribute to the low usage of EHRs some of which included high cost, patient data privacy issues, system too difficult to use, social influence and lack of training. According to Liu & Cheng, 2015, despite the perceived potentials of EHRs, health professionals still finds it difficult to part with the paper-based system in developing countries. On the other hand, most developed countries have recorded improved care delivery since adopting Health Information Systems (HIS) like the EHRs (Achampong E. K., 2012).
The challenge in Sub-Sahara Africa, is ensuring that HIS are effectively set up to better health outcomes and quality of health data for improve health planning and policy formulation. This has become an area where the potential for effective use of the full range of Information Technologies (ITs) can be integrated to enhance service delivery. Consequently, in many instances, such systems do not fully realise the objectives envisaged and have survived partially or fully at the pilot phase (Adjorlolo & Ellingsen, 2013). Record show that
30% or more of the implementation of large scale IT projects like the EHRs fail (More,
19900. It is also recorded that, despite the support of governments and some international agencies to overcome financial challenges that comes with the adoption of EHRs in the Sub- region, many health facilities are still unsuccessful in replacing the paper-based system with EHRs. According to Anderson & Anderson (2010), over the past two decades 70% of all change efforts fail to deliver their intended outcomes. Key reasons of which is attributed to the features of the IT system and health professionals’ impression the IT system in question.
It is empirical therefore that management and project leaders need to make a holistic assessment of its needs (institutional readiness) and make adjustments to organisational systems and processes necessary to create a better environment for a successful implementation of EHR (Lorenzi et al., 2009). Subsequently, studies on the evaluation of health information systems and their implementation have become prominent in the healthcare industry. This ascendancy is to bring to light the achievements and challenges of implemented projects so as to avoid the remodelling of some of the factors contributing to the unsuccessful implementation of these systems (Stoop & Berg, 2003). Similarly, as Ghana embark on the journey achieve a national e-health, studies have been done to explore the feasibility of the introduction of e-health but very few is done to examine or evaluate the factor influencing the intension to use or user acceptance of these EHRs
This study would therefore employ the use of Technology Acceptance Model (TAM) to examine health professionals’ acceptance of EHRs in the hospital. This is more suitable since the EHRs is still at its early stages of implementation by limited number of hospitals in Ghana. As per literature, the success of IT implementation project greatly relies on the cooperation and acceptance of its users.
