Implementation of Electronic Medical Records for Service Delivery in Selected Southwest Nigeria State University Teaching Hospitals
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Date
2022
Authors
Ajayi, Stephen Adekunle
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Electronic Medical Records (EMR) is an essential communications channel relating
to patient health conditions. Unfortunately, many hospitals in Africa, including
Nigeria, have not implemented EMR. The few hospitals with some level of EMR are
still struggling with the use of paper and hybrid medical records, which has led to
poor medical follow-up, medical error and long waiting times for patients. The study
is anchored on five main objectives: determining the existing types of EMRS, level
of readiness, usefulness, and the relationship between user readiness EMR
usefulness, among others. A sample size of three hundred and forty-one (341) was
determined using krejcie and morgan models, comprising strategic managers and the
operational staff drawn from a population of 2889 in the selected hospitals.
Weighted sampling was used to determine the respondent to pick from each
hospital. The study chooses 108 from LAUTECH, UNIMEDTH 79; EKSTH 104
and LSUTH 106. The purposive sampling technique was applied at the hospital
level in selecting strategic managers, while operational health workers were
determined using a stratified random sampling technique. Questionnaires were used
for data collection. A pilot study was conducted at Olabisi Onobanjo University
teaching hospital Ogun state Nigeria, where 45 questionnaires were administered to
strategic healthcare managers (20) and operational healthcare workers (25) in a
similar secondary healthcare hospital to determine the instrument's validity. This
study adopted the Cronbach alpha reliability procedure. The result indicates the
reliability of .789 for operational healthcare staff and .878 for strategic managers,
respectively. The study used a descriptive statistical analysis technique to describe
the present medical record systems in the hospitals under study. The data from the
quantitative method was presented in tables and figures. The finding indicated that
the systems in the hospitals are mainly paper-based. The hospitals also use a hybrid
system with a few treatment areas having fully electronic medical records systems.
The findings indicated that management readiness, which covers financial (ability to
provide funds for implementation) and political readiness (wiliness of the strategic
managers and government to implement EMR), was very low. In the area of
readiness, which covers the availability of electronic record managers, ICT support
staff, computer compatible medical devices, among others, was low. In the area
where EMR has been implemented, the finding indicates poor penetration of the
EMR system in treatment areas, limited modules and poor staff readiness. The study
concluded that hospitals in Nigeria are not taking an adequate preparatory step in
implementing EMR. In hospitals that have implemented, EMR is not serving the
classical purpose of the medical record of supporting treatment and follow up.
Before embarking on the implementation of EMR, the study recommended that the
selected hospitals ensure the availability of funds by liaising with international
donors and prioritising their budget on the implementation of EMR. There should be
staff training on how to troubleshoot and operate the EMR system and its usefulness,
and technical infrastructures like electronic record managers, ICT support staff, and
computer compatible medical devices, among others.
Description
A Thesis Submitted in Fulfillment of the Requirement for the Award of the Degree of Doctor of Philosophy (Information Science) in the School of Education, Kenyatta University, March, 2022
Keywords
Implementation, Electronic Medical Records, Service Delivery, Selected Southwest, Nigeria State, University Teaching Hospitals