Introduction
Developing countries such as Nigeria are faced with a wide variety of health-related challenges including the limited resources and capabilities and the health systems that address those challenges, have inevitably moved into maximizing the value of scarce resources and finding ways to make health systems functions as efficiently as possible (Kimaro & Nhampossa, 2007).
Availability of accurate and timely information and understanding of how to use them effectively in the health system are critical components for evidence-informed decision making, which is provided by health information management structure and methods (Hinman, Eichwald & Saarlas, 2005).
Health information management structure and method should be designed according to the service delivery system to ensure that patients’ needs are met in collecting, processing, storing, retrieving, and transferring the required information to improve the processes of data handling in order to extract useful information for health planning, decision-making, and resource allocation through different sources to provide quality services (Reichertz, 2006).
The information management structure defines how activities such as task allocation, coordination and supervision in health information management department are directed toward the achievement of organizational aims. The health information management structure can be structured in many different ways, depending on its objectives. The structure will determine the modes in which it operates and performs by stating the responsibilities for different functions and processes to different entities such as the branch, department, workgroup and individual. The structure affects the role of health information managers in two big ways; first, it provides the foundation on which standard operating procedures and routines rest and secondly, it determines which individuals get to participate in which decision-making processes, and thus to what extent their views shape the activities of health information managers (Mukama, 2013).
Akpan (2011) stated that health information management method highlight the techniques applied my health information practitioners in the keeping patient medical data. The methods use in health information management depends on the healthcare setting; some make use of manual filling methods while others embrace the computerized medical records methods.
Challenges facing health information management structure and methods
According to Brailer (2015), a key challenge to health information management structure and the method applied in health record management is that the environment within which health information professionals work is constantly changing and becoming more demanding. These changes include a number of health reform initiatives, including recent changes to the national healthcare funding model, and an increase in the adoption of e-health and electronic health record (EHR) systems.
Bloomrosen (2013) noted that at an organizational level, health information managers are experiencing an increase in the volume of information to be managed; an increasing uptake of clinical information systems, which is adding to the complexity of managing and providing an integrated medico-legal health record; and increasing competition from the information technology workforce to manage the systems and data within them.
Many healthcare organizations are embarking on implementing EHRs. While there are currently no national incentives or drivers for doing so, the primary driver is enhancing patient safety and enabling greater efficiency and effectiveness of healthcare. There continues to be a focus on producing accurate and timely clinical coded data to represent inpatient care with greater attention on improving clinical documentation in order to optimize revenue as seen through coding and DRG (diagnosis-related group) outputs. The funding models now in place have resulted in increased organizational attention and pressure on healthcare activity data for funding purposes, that is, capturing and reporting all patient activity accurately and promptly (Greeg & Buck, 2007).
Other challenges facing health information management structure and methods as highlighted by Acker, Adair and Sweeny (2008) are:
- Privacy concerns: Medical records and other health information can contain personal data such as health conditions, substance abuse issues, sexual history and psychiatric diagnoses that could prove embarrassing if released to unauthorized users. Therefore, the decisions that determine storage procedures and control the level of access to health information should always include confidentiality and sensitivity considerations. While it may be more convenient to make information available to a large pool of employees and vendors, ethical management limits access regardless of how inconvenient it may be to preserve the privacy and confidentiality of patients.
- Mobile device theft: Security breaches through mobile device theft present a security threat and an ethical challenge in managing health information. For example, on Jan. 9, 2013, a laptop with medical information for approximately 57,000 paediatric patients was stolen from the car of a physician who worked for Lucille Packard Children’s Hospital and Stanford University School of Medicine in Palo Alto, California. The laptop contained names, dates of birth, medical record numbers and other patient data. This incident marked the fourth security breach at Lucille Packard or Stanford Medical Center since 2010. Ethical management of health information includes such measures as encrypting data so unintended parties cannot decipher it. In addition, when laptops or other mobile devices are stolen from medical employees, implementing remote data wipes can delete stolen information.
- Digital security breaches: In addition to physical thefts, some medical security breaches are digital and are the result of computer viruses. In December 2012, Froedtert Health, a three-hospital system in Milwaukee, reported that a computer virus might have allowed hackers to access an employee’s computer and obtain 43,000 patient records. The virus may have been a result of lax security measures. Ethical management of health information must include defensive measures, such as scanning for viruses and malware, to ensure the privacy and security of health information.
- Accuracy issues: While health information can provide valuable data to improve patient care, inaccurate information can potentially harm patients. According to the Agency for Healthcare Research and Quality, in November 2011, at least 1 in 10 outpatient computerized prescriptions contained at least one error. Researchers analyzed 3,850 prescriptions over a four-week period and found 452 errors; more than 33 percent of these mistakes could have produced an adverse drug reaction. Most of the errors were a result of omitting dose, frequency and duration information. In this instance, ethical health-care management can be achieved by implementing computer design functions, known as “forcing functions,” that will not allow the user to skip data fields.
Solutions to challenges facing health information structure and method
Blumenthal (2010) stated that health information method can be improved by improving data capture, transfer, and feedback systems to strengthen the delivery of health programmes by improving the quality of information used to plan national, district, and facility-level programmes. Applying best practices that are effective within one health program to the data management and reporting systems of other health programmes is practical, feasible, and effective in strengthening health information systems.
Acker et al. (2008) also added that health information management structure can be improved by examining staffing patterns to streamline data-related tasks to strengthen health management systems by improving data demand, use, and quality assurance. This would include decentralization of training and mentoring initiatives from the national to the district level for health workers delivering services at health facilities, which would allow for support at the point of data generation. On-the-job training and mentoring has been shown to be an effective approach for strengthening measurement and evaluation capacity and ensuring data quality within a health information management department.
Resource intensive investments that can improve data quality include strengthening electronic health information systems, investing in tertiary education programs, and harmonizing data collection systems. Computerized point-of-care health information systems, particularly web-based systems, have the potential to dramatically reduce the data collection burden by automating data aggregation and reporting. These systems would also allow for real-time access to data (Wager et al., 2015).
Types of health information management structure
Bratschat (2016) classified health information management structure into three, which are: functional, divisional and matrix structure. Functional structure is set up so that each portion of the department is grouped according to its purpose. This type of structure works very well for small departments in which each department can rely on the talent and knowledge of its workers and support itself. However, one of the drawbacks to a functional structure is that the coordination and communication between departments can be restricted by the organizational boundaries of having the various people working separately.
Divisional structure typically is used in larger departments that operate in a wide geographic area or that have separate groups in the department. The benefit of this structure is that needs can be met more rapidly and more specifically; however, communication is inhibited because people in different divisions are not working together. Divisional structure is costly because of its size and scope.
The third main type of health information management structure, called the matrix structure, is a hybrid of divisional and functional structure. The matrix structure allows for the benefits of functional and divisional structures to exist in one. This can create power struggles because most areas of the department will have a dual management.
Acker et al. (2008) highlighted methods of health information management as computerised and manual record methods. There are a number of issues to consider when before setting up a computerised or manual records system, as each has certain advantages and limitations.
Computerised records method: Computerized records method use software programmes in health record keeping. According to Diamond and Shirky (2008), there are many other advantages to using electronic record keeping, as listed below:
- Helps in keeping patients health records in real time.
- Efficient way to keep patients’ health records and requires less storage space.
- Easy to generate and share patients’ health
- Automatically tallies health records and provides reporting functions.
- Allows back up for health records and keep them in a safe place in case of fire or theft.
Manual health records method: Manual health records method makes use a simple, paper-based record keeping system. Robert (2008) stated that there are certain advantages to using manual health records method, as listed below.
- It is less expensive to set up.
- Correcting entries may be easier with manual systems, as opposed to computerised ones that can leave complicated audit trails.
- The risk of corrupted data is much less.
- Data loss is less of a risk, particularly if records are stored in a fire-proof environment.
- Problems with duplicate copies of the same records are generally avoided.
- The process is simplified as you don’t need to be familiar with how software calculates and treats information.
References
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