Introduction
According to Gunton (1993) information and communication technologies (ICTs) include a set of effective tools to collect, store, process and exchange health related information. Alvarez (2004) and Romanov (2002) are of the view that information communication technologies (ICTs) could improve safety, quality and cost efficiency of health care services. Amongst the application of ICTs to the health sector is the electronic system which is known as electronic health records which is viewed as the backbone supporting the integration of various tools (e.g. electronic presumption and information management). These can help to improve the uptake of evidence into clinical decision using such evidence in daily clinical practices could engender a safe and more efficient health care system.
In the opinion of Myers (2002), Edworthy (2001) and Feliciana (2003), the development of the computer and evolution of the internet has had a positive impact on the area of information management, disease control, diagnosis, patient management and teaching. According to Oyunyade (2003), Oyibo (2003), Odunsanya (2002) and Bamgbala (2002), electronic health records management has greatly contributed to dissemination of information among health care professionals. Again the adoption of electronic health records system in the keeping of patients Information in the health care system focuses on computer automation to provide services for patient effective care. In an electronic health information environment, software development is used to promote effective services.
The adoption of electronic data processing in health delivery system reduces or wipes out human error as well as ensuring that effective and efficient service delivery are carried out by the health team in the hospital. According to Chuadhry, Wang, Maglione, Morton and Skekelle (2006), health information technology provides a comprehensive management of health care delivery across computerized system and secure exchange between consumers, providers, government and quality entities and insurers. Electronic health information is in general increasing viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.
Ajuwon (2003) wrote that Nigerian with population of approximately 140, knowledge and attitude of health workers towards computer and information is still very low. According to scholar this is because most of the health workers have little or no knowledge of computer and internet use by first clinical and nursing students at the university college Hospital, Ibadan, it was discovered that about 60% of the students had used computer and internet services but only 42% of them could actually use a computer. Ajuwon further stated that little is known about the knowledge and attitude of health workers toward electronic health information management.
In another study carried out by Ogunyade (2003) at Lagos State University Teaching Hospital (LUTH), it was established that 48% of selected 250 health workers in the study have worked with electronic health information system though not fully in use in LUTH. These studies show that the utilization of computer is very low among Nigeria health worked as they mostly rely on manual method of health information management. Bermel (2008) commented that clinical information(s) aims to improve and facilitate patients care by the intelligent application of technology and equally increases the effectiveness and efficiency of care as well as patient safety and reduce pressure on health workers. Electronic information can improve or fulfill its promises in developing countries like Nigeria only if the health workers are trained and motivated in basic computing and information technology. Furthermore, all departments in health care institution should be equipped with good and functional facilities like computers and training manpower. Such training will necessitate an assessment of baseline knowledge and attitude of health workers towards improving quality health care delivery system through the automation of health information in Nigeria as a whole.
The concept of health information
A number of scholars have defined health information in several ways. For instance, Aremu (2008) defines it as “a collection of data compiled on a patient to assist in the clinical care of the present and future illness”. By clinical care, we mean treatment by doctors, nurses and others in the health team in a hospital, and out- patient clinic or primary care by a family doctor. It is also a clinical, scientific, administrative and legal document relating to patient care in which are recorded sufficient data written in the sequence of events to justify the diagnosis and warrant the treatment and end-results.
Another definition has it that health information is not only a repository of information but a continuing record which acts as a means of communication between members of the health team. According to Osundina (2005), health information is a collection of recorded facts concerning a particular patient. It is also a clear, precise and accurate history of a patient’s life and illnesses written from medical point of view. Osundina note that for health information to be completed, it must be completed on time, contain sufficient data to identify the patient, support diagnosis and justify treatment so that health information can serve its purposes which is primarily the patient’s care.
Electronic health information system
Computer has been identified as the major equipment for the operation of health information. This multi-faceted machine has been defined in so ways ranging from the storage, processing to information retrieval. According to Shoddie( 1993), computer is an electronic device operating under the control of instructions stored in its own memory unit which can accept and store data, perform arithmetic and logical operations and produce an output information from the processor. It is also defined as a mechanical device that is designed to process data and at a very fast rate with a high degree of accuracy.
The point being made is, a computer can be identified with the following properties or characteristics:
- Very high skilled operation.
- High accurate result.
- Reduced time of processing.
- Generate the designed information to appropriate quarters.
The introduction of computer cannot be blamed for the concentration of information to individuals. In fact, none of the operations performed by a computer is different from in kind from those which could at least in principle be carried out by traditional methods although the use of computers has undoubtedly enhanced some of the existing problems.
The uses of computers are as follows:
- To facilitate the maintenance of extensive records system.
- They make data easily and readily available from many distant parts.
- They make it possible for data to be transferred quickly from one information system to another.
- They make ii possible for data to be combined in ways which might not otherwise be practicable.
- Because data are stored, processed and often transmitted in a form which is not directly intelligible, few people may know what is in the record.
Trends in health information management
According to the Health information Management Association of Nigeria (HIMAN), health records started from paper which was kept according to wards, forms or departments and these records were usually bound into books. With rapid development, the modern methods adopted in hospital changed from bound books to folders. Traditionally, clinical documentations were handwritten on forms and filed into folders which are kept throughout the period of a patient’s treatment in the hospital.
However, the shortcoming of paper records are well known which includes the fact that handwritten records can be illegible, incomplete and poorly organized, making it difficult to ensure quality of care. With the introduction of technology, health record management has changed as hospitals now compile, organize and store vast amounts of patient’s data in microfilms. This has made it possible to maintain a large amount of information in a small space as opposed to the earlier means. According to Young, Sullivan and Burman (1998), the advent of computer technology which spearheaded electronic health information introduced enormous possibilities for electronic medical information. Electronic records are defined as records or information located on a shared computer network that has both read and written electronically on a relational database through a graphic user interface.
In the words Duman (2000) the potential benefits of electronic health information such as increased communication between users, reduced paper work, fewer errors and cost saving have been widely discussed. Additionally, electronic information allows for just in time access and has led to faster searches and increased efficiency. For Jackie, Sharon and Tracey (2003), electronic health information is the use of electronic services for controlling or processing information. It is a machine that makes industries more and more automatic especially by means of electronic contract or self moving machine on one which moves by machinery.
Burmmel (2008) defined electronic health information as an evolving concept which involves systematic collection of health information about individual patient or population. It is a record in digital format that is capable of being across different health care facility setting by being embedded in network connected enterprise wide information system. Paper based information has been in existence for centuries and their gradual replacement by computer based information has slowly underway for over 20 years. In western health care system, computerized information systems have not achieved the same degree of penetration in health care as that seen in other sectors such as finance, manufacturing and retail industries.
According to Ajuwon (2003), many health care institutions continue to rely on paper- bases medical information as primary source of patient’s medical and demographic information. Medical care decisions are based on the information stored in these charts. Ajuwon (2003) further defined electronic health information as a systematic collection of data about a particular or individual patient or population which assist in the present and future treatment of ailments which are supported by individual mechanical appliances or network or computer systems for data sharing among health care practitioners. McWood (2005), further stated that when electronic health information is adopted in health care industries, there is substantial improvement in the patients waiting time strengthening good human relations among the patients and members of the health’s team and also provides effective monitoring and evaluation of the health care system.
The importance of health information
According to the World Health Organization (WHO), health record is not an end in itself as its design should reflect the uses and importance for which it is made. Such uses include but not limited to the following:
To the hospital: for the hospital, health records are useful in the following ways:
- They are used to protect the hospital against any litigation charged against them.
- They are used to justify the results of treatment.
- They are useful in the evaluation of the effective use of hospital services including use of beds.
- They help the hospitals to deliver proper health services to the people and finally,
- It affords the hospital of easy and timely availability of required information without any delay.
To the patient: Patient’s health or medical records are importance to patient in the following ways:
- It makes follow-up possible and quicker.
- It enable patient to receive quality care.
- It helps derive the respective information in case of necessity as legal evidence.
- It helps patient to be informed of their ailment and plans and procedures adopted in the course of conducting treatment.
- It helps the patient to acquire right and apt treatment.
To the doctor: Health or medical records of patients are important to doctor in the following ways:
- It helps in treating patient as well as in education and research.
- It helps to protect doctors in any legal tussle.
- It helps to prevent repetition of treatment or duplication of tests and allied findings.
- It is used by doctors to communicate with others colleagues
To medical researchers: The importance of health information to medical researchers cannot be over emphasized. This is because in scientific research the health information is indispensible as case study supply a practical and reliable source of material for the advancement of medical science. It is a source document for medical facts relative to disease, treatment, care and results.
To the nation: To the nation in general health information helps to know the rate of morbidity and mortality prevalent in the country as well as used in planning and budgeting.
In summary, the importance of health information can be enumerated as follows:
- To communicate the physicians and other professionals contributing to patient’s care.
- For the review, study and evaluation of patients care by hospital or medical staff committees.
- For the provision of date for third parties concerned with the patient –other physicians and hospital, insurance companies or prepayment agencies.
- Provides continuity of patients care on subsequent admission of the patient.
- It provides data to assist in protecting the legal interest of patients, hospital and medical staff.
- It provides clinical data for research for research study and education.
Qualities of health information
Osundina (2005) elaborating on the features of health information enumerates the following as the qualities of information:
- It must clearly identify the person about whom it is written.
- It must be legible and able to be understood by anyone who is likely to use it.
- It must be consistent in layout and in the size of papers used in it.
- It must be able to identify the people contributing to the record so that they can be asked for further information if necessary.
- It must be promptly retrieved when required or needed.
Manual system of health information versus electronic health information
While the usual burden and heavy workload of manual system in the administration of health care information keeping, the new system has reduced the workload in the administration of minimum. This is true with the words of Sitting (2010), that an electronic based medical information system is much more beneficial than paper based medical information which include simultaneous remote access of patient’s data legibility of records, safer data storage, patients data confidentiality, flexible data layout, contains data processing, tailored paper and always been up to date.
The opportunity that a computer based medical information system gives is that several doctors may access a patient’s data at the same time which increases efficiently for both the patient and the doctor treating the patient. The legibility of medical records in a computerized format is much more than that of handwritten records which could cause misinterpretation of information due to lack of readability. According to Beverly (2010), in her article titled “paper versus electronic medical records”, the use of paper based medical information increases the risk of grammatical errors, invalid data entries and other record inaccuracies.
Osedola (2009) further stated that the staff catches an average of eight potential medication errors a month due to the imperfection associated with paper work. However, with a good backup system for disaster recovery, a computer based or electronic information system is more reliable than the conventional paper record, the reason being that they can easily pull data out when needed. This would be beneficial instead of having piles of documentation which could be prone to being misplaced.
In a study carried out by Mole, Fox and Napolitano (2010) on how important it is to have patient’s information confidentially hidden from people who should not be allowed to view them, it was also discovered that in a paper-based system anyone could obtain the documentation such as the receptionist dealing with passing document onto the doctor, but if there was an electronic system, it could be restricted and monitored automatically. This could also flag any abnormalities which may signal an authorized information access. Furthermore, flexible data layout could be very convenient for doctors when using the computer-based medical information. This is because they can quickly find specially targeted data with search system, multiple sorts (data can be viewed in ascending, descending by columns in head wings) and validated so that no error would be caused.
Barriers of electronic health information
Though a number of advantages have been associated with the computer-based health information system, a number of barriers have equally been attributed to this germane system.
According to the American Medical Association (AMA) the following barriers constitute impediments to the computer-based system:
- Cost: The cost of electronic system is very high and is often not a reasonable expense for hospitals and physicians facing a declining patient load. In addition, there are costs of update and maintenance of the software and hardware associated with the system.
- Privacy: Moving personal health information online can increase its vulnerability and patients and physicians have expressed concern over inappropriate access and use of health information.
- Implementation: Health Information managers, physicians, nurses and other medical staff spend majority of their time focusing on direct patients care. This group people have no time to learn new technologies especially when it is expensive. There are also the concern that electronic information will not be successful as medical staff may be unable or unwilling to take the time to train in the use and application of this new technology.
References
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