Research Article - International Journal of Medical Research & Health Sciences ( 2023) Volume 12, Issue 1
Awareness, Use of Electronic Records Management System and Administrative Effectiveness of Technological Health Care Services among Teaching Hospitals in NigeriaFarouk Umar Abubakar1, Maduakolam Ijeoma Onyinyechi2*, Agnes Chinyere Onyekachi Chigbu3, Okoroafor Nkiru Loveline3 and Chukwu Ezinwanne Blessing3
2Department of Nursing Sciences, Abia State University, Uturu, Nigeria
3Department of Dental Nursing, Federal College of Dental Technology and Therapy, Enugu, Nigeria
Maduakolam Ijeoma Onyinyechi, Department of Nursing Sciences, Abia State University, Uturu, Nigeria, Email: email@example.com
Received: 30-Aug-2022, Manuscript No. IJMRHS-22-73234; Editor assigned: 02-Sep-2022, Pre QC No. IJMRHS-22-73234; Reviewed: 16-Sep-2022, QC No. IJMRHS-22-73234; Revised: 23-Dec-2022, Manuscript No. IJMRHS-22-73234; Published: 06-Jan-2023
Background: The number of people who are advocating for the computerization of patient information and healthcare procedures is rising. However, little is known regarding the application of computerised records management systems in most teaching hospitals that supply Nigeria's healthcare needs.
Objectives: This study explores “awareness, use of electronic records management system and administrative effectiveness of technological health care services among teaching hospitals in Nigeria’’.
Materials and methods: Descriptive cross sectional questionnaire based method was adopted. A sample of 338 hospital staff was drawn from a total population of 1665 using a convenience sampling technique from the studied healthcare facilities. A validated structured questionnaire developed by the researchers was used for data collection. The instrument yielded a reliability coefficient of 0.78.
Results: Findings revealed that a good number of the staff was aware of the electronic records management in the hospital (90.4%). The use of electronic records management systems was rated very poor (73.7%) and the majority of the staff were positive about the administrative effectiveness of electronic records management systems (87.8%). The use of the electronic records management system was not related to its awareness (p=.357: p>0.005) and the perceived administrative effectiveness of the electronic records management system was not significantly related to awareness of the system (p=1.000: p>0.05) and the perceived administrative effectiveness of the electronic records were not related to the perceived use of it (p=1.000: p>0.05).
Conclusion: Teaching hospitals in Nigeria have very poor use of electronic records in the management and transferring of patients’ information and there is no organized way of assessing patients’ information electronically from the point of admission to the point of discharge. Also, doctors, nurses and administrative staff do not assess and transfer patients’ information electronically except manually. Teaching hospitals should fully utilise electronic records systems to reduce waiting times, retrieve filing, prepare for paperless offices, prevent users from queuing up for a single file, reduce medical errors and costs and provide quick access to information, and accurate data.
Awareness, Use, Electronic record, Management system, Effectiveness, Healthcare, Nigeria
Electronic Management Records (EMRs) have been marketed as crucial to improving good patient outcomes and maintaining healthcare quality. The nature of information being produced, stored, processed and distributed in the healthcare industry has undergone significant changes [1,2]. However, observed that patients hunger for online access to their medical records, including email communication with clinicians while physicians expected to have the right patient information to be able to offer a better healthcare diagnosis and treatment. The exponential growth of information volume in the modern era has fundamentally changed how both public and commercial enterprises conduct their operations [3,4].
The generation and processing of information can be managed by technology, but if it is employed without understanding the principles of records and information management, the results will only be haphazard .
Records management remains significant for the healthcare delivery system as it serves as an imperative tool for the delivery of quality patient care, provides good hospital management, and promotes good governance and efficient healthcare administration. A South African study discovered that records management negatively affected timely and effective health care services, which resulted in long patient waiting times and patients being treated without medical history . Records provide information for improved planning and decision making. To provide an efficient and effective administration that ensures that the business runs as smoothly as possible, there should be proper management of records . Records also provide evidence for health care accountability and transparency and are often subject to specific legal requirements. In government bodies, records document what is done when and why and also provide evidence of communications, decisions and actions. In the process, some of the records the government officers make will be retained as national and provincial archives .
Many tertiary healthcare facilities (teaching hospitals) in Nigeria are without electronic health records and healthcare delivery is sometimes impaired with the current use of temporary cards. The upsurge in the number of patients seeking health care services requires fast and efficient record keeping. This is one of the driving forces behind the research into awareness and use of electronic records management systems and administrative effectiveness in Nigeria’s technological health care services. The introduction of ICT based initiatives to transform existing paper based information management systems in most tertiary health institutions in developing countries has usually been a difficult process of change, often fraught with several context sensitive challenges and problems such as lack of adequate resources (poor financial resources) and uneven infrastructural development .
Given the high failure rate of EHIMS, successful implementation is imperious to actualize its benefits. An effective EHIMS is one that serves its intended purposes after implementation . The success of the system is achieved through user satisfaction with the system, which is a result of prolonged use, consequently producing the desired benefits. The success of an electronic health information management system or its effectiveness can be measured along with several themes of quality dimension (system quality, information quality, and service quality) as well as usage, however, it has been observed that the use of electronic information systems in health services in tertiary health care setting has been under used or not effectively use to provide the correct and fastest mean of hospital information system. This is especially had to reach targets such as developing countries like Nigeria. Therefore, the study aimed to assess the awareness, use of electronic records management systems and administrative effectiveness of tertiary hospitals in Enugu, Nigeria. The understanding of awareness, use and administrative effectiveness in health information management is responsible for the success of the electronic records management system and is therefore critical to improved healthcare delivery as a whole.
Materials and Methods
This study employed a quantitative, descriptive cross-sectional survey design. The study was conducted at the University of Nigeria Teaching Hospital Ituku-Ozalla (UNTH) and Enugu State University Teaching Hospital Parklane Enugu (ESUTH). A sample size of 338 was drawn from the population of 1665 staff from two selected tertiary hospitals, using the power analysis formula was determined. A purposive was used to select the 2 tertiary hospitals and the 3 departments from each hospital for the study. Convenience samplings was used to select the staff from each department according to the number of staff, staff chosen were medical records staff, doctors and nurses working in the wards and accident and emergency units and are willing to participate in the study inclusion criteria.
The instrument for data collection was a researcher developed questionnaire. The items were generated based on the research objectives and hypotheses and guided by the literature review.
The questionnaire consists of four sections: A, B, C and D. Section A had 5 items to obtain information on the demographic data of respondents and section B was structured to obtain information on awareness. Section cis the level of use while section D is administrative effectiveness. Both open and closed questions ended were constructed to elicit responses from the respondents.
Section B has a total of 4 items of questions and measures awareness. Section c has 8 items measuring the use of electronic records in the hospital while section D has 7 items measuring administrative effectiveness presented on a Likert type scale ranging from strongly agree (4) to strongly disagree (1), making the items a total of (24) items generated.
Ethical approval was obtained from the research and ethical committee of the university of Nigeria teaching hospital and Enugu state university teaching hospital, Enugu while informed consent was obtained from individual respondents before data collection. The principle of anonymity and confidentiality was maintained throughout the study.
Descriptive statistics of frequency and percentage and count were used to analyse the data on sociodemographic variables, awareness of electronic records management, use of electronic records management system and perceived administrative effectiveness. Inferential statistics were used to test the association among variables using the Fisher’s exact test used to test the hypotheses at a 5% level of significance, as data failed to meet the needed assumption for chi square analysis (that not more than 20% of the expected frequency should be less than 5 the Pearson correlation analysis was also employed to empirically ascertain the degree of relationship between awareness and use of electronic record management. Data generated from the study were analysed using the Statistical Package for Social Science (SPSS) version 25 and Microsoft Excel 2016.
The respondents were mostly females (63.5%) and were aged 30-50 years (60.3%). The majority of them had HND/B. Sc. (73.7%) and were registered nurses/midwives (51.9%). Their years of experience were mainly between 0-5 years (23.1%), 5-10 years (25.0%) and 10-15 years (27.6%) (Table 1).
|Years of working experienced|
Table 1: Demographic characteristic of the staff n=156.
The summary of the responses on awareness revealed that the staffs were aware of the electronic records management system in the hospital (3.50 ± 0.70). They also indicated the staff awareness of using the records management system to be high (2.83 ± 0.96); also, that staff made more research on the system (2.61 ± 0.97) (Table 2). It also revealed the majority of the staff was aware of the electronic records management in the hospital (90.4%) (Table 3).
|Electronic records management systems||SD||D||A||SA||N||M ± SD|
|I am aware of the electronic records management system used in the hospital.||5||3||57||90||1||3.50 ± 0.70*|
|I am not aware of the electronic records management system used in the hospital.||65||72||5||9||5||1.72 ± 0.79|
|The level of hospital staff awareness of using electronic records management systems is high.||19||26||64||39||8||2.83 ± 0.96*|
|The level of hospital staff awareness of using electronic records management systems is low.||48||58||32||12||6||2.05 ± 0.93|
|The staffs of the hospital make more research on electronic records management systems.||26||27||65||24||14||2.61 ± 0.97*|
|An item with M>2.5 was accepted to be true; *indicates an item with M>2.5|
Table 2: Awareness of electronic records management system.
|-Aware (rated awareness >2.5)||141||90.40%|
|-Not aware (rated awareness <2.5)||15||9.60%|
Table 3: Summary of awareness of electronic records management system n=156.
Use of electronic records management system: Findings show that there is a poor use of the electronic records management systems by many of the respondents 115 (73.7%) only 41 (26.3%) had good use. The use was mainly such that records were stored both manually and electronically (3.39 ± 0.72) and patients’ information was stored electronically at the point to the hospital (3.03 ± 0.88). There was also the storing of patients’ information electronically and manually after treatment of patients (2.75 ± 1.02) and staff use of the system as one of their knowledge practices (2.64 ± 1.02), which were rated slightly above average. Annual organizing of a record management training program to ensure that quality records were kept was rated about average (2.51 ± 0.90) (Tables 4 and 5).
|Electronic records management systems||SD||D||A||SA||N||M ± SD|
|Patients’/clients’ information’s often stored electronically only.||58||61||25||11||1||1.93 ± 0.91|
|Hospital has policies and procedures for creating and storing records electronically only.||35||45||52||24||-||2.42 ± 1.00|
|Hospital stores record both manually and electronically.||5||7||66||78||-||3.39 ± 0.72*|
|Patients’ information is stored electronically at the point to the hospital.||11||23||69||50||3||3.03 ± 0.88*|
|Patients’ information is stored electronically and manually after the treatment of patient.||22||37||52||43||2||2.75 ± 1.02*|
|Patient’s information can be transferred electronically from administrative to doctors’ or nurses’ desk.||81||37||31||7||-||1.77 ± 0.92|
|The staff of the hospital uses an electronic management system as one of their knowledge practices.||28||29||59||32||8||2.64 ± 1.02*|
|A record management training program is organized annually to ensure that quality records are kept.||20||47||53||19||17||2.51 ± 0.90*|
|An item with M>2.5 was accepted to be true; *indicates an item with M<2.5|
Table 4: Use of electronic records management system.
|Overall rating on level of use|
|Good use (rated use >2.5)||41||26.3|
|Poor use (rated use ≤ 2.5)||115||73.7|
Table 5: Summary on use of electronic records management n=156.
Respondent’s perceived administrative effectiveness of the electronic records management system included: fostering faster operation of hospital activities (3.66 ± 0.47), deriving positive benefits (3.46 ± 0.62) and a mode of knowledge update (3.43 ± 0.63) (Table 6). In general, the majority of the staff was positive about the administrative effectiveness of the electronic records management system (87.8%) (Table 7).
|Electronic records management systems||SD||D||A||SA||N||M ± SD|
|Electronic records management system helps hospital activities to operate faster.||-||-||51||100||5||3.66 ± 0.47*|
|The benefit derived by hospitals from using electronic records management systems is always positive.||-||10||61||80||5||3.46 ± 0.62*|
|Electronic records management system reduces the length of patient stay in the hospital.||43||30||41||30||12||2.40 ± 1.12|
|The benefit derived by the hospital from using electronic records management is always negative.||78||67||1||3||7||1.52 ± 0.62|
|Electronic records management systems slow down hospitals’ activities.||85||51||5||2||13||1.47 ± 0.64|
|The use of electronic records should be discouraged in the hospital.||110||37||1||1||7||1.28 ± 0.51|
|The electronic records management system is one of the tools hospital staff uses as a mode of knowledge update.||2||5||67||71||11||3.43 ± 0.63*|
|An item with M>2.5 was accepted to be true; *indicates an item with M>2.5|
Table 6: Perceived administrative effectiveness of electronic records management system n=156.
|The overall perception of the effectiveness||Frequency||Per cent|
|-Positive (rated effectiveness >2.5)||137||87.80%|
|-Negative (rated effectiveness ≤ 2.5)||14||9.00%|
Table 7: Summary of administrative effectiveness of electronic records management system.
Relationship between awareness and use of electronic records management system: Findings revealed there is no significant relationship existed between awareness and use of electronic records management systems (p=.357). Perceived poor use was not associated only with those who were unaware (86.7%) but also with those who were aware of the system in the hospital (72.3%). In other words, perceived poor use was not associated with nonawareness (Table 8).
|Awareness||Perceived Use||Fisher exact|
|Good use||Poor use||Total||p-value|
|Aware||39 (27.7)||102 (72.3)||141||0.357|
|Not aware||2 (13.3)||13 (86.7)||15|
Table 8: Relationship between awareness and use of electronic records management.
The significant relationship between awareness and administrative effectiveness of electronic records management system: Table 9 shows that there was no significant relationship between awareness of the electronic records management system and its perceived administrative effectiveness (p=1.000). Both those who were aware (99.3%) and those unaware of the system in the hospital (100.0%) positively perceived its administrative effectiveness.
|Awareness||Administrative effectiveness||Fishers exact|
|Aware||137 (99.3)||1 (0.7)||138||1.000|
|Not aware||13 (100.0)||0 (0.0)||13|
Table 9: Relationship between Awareness and Administrative Effectiveness of Electronic Records Management System.
Significant relationship between Use and administrative effectiveness of electronic records management system: Table 10 revealed that there was no significant relationship between the use of an electronic records management system and its administrative effectiveness (p=1.000). Those who perceived good use of the system (100.0%) and likewise those that perceived poor use (99.1%) were positive about the administrative effectiveness of the records management system.
Table 10: Relationship between use and administrative effectiveness of electronic records management system.
|Perceived use||Administrative effectiveness||Fishers exact|
|Good use||38 (100.0)||0 (0.0)||38||1.000|
|Poor use||112 (99.1)||1 (0.9)||113|
Demography: The respondent studied were mostly female while very few were male, they are between the ages of 30-50 years respectively, however, more than half had university basic education (BNSC and HND), mostly registered nurse midwives with up to five to ten years of experience. The findings correspond with the age of the working class in the medical field in many institutions in Nigeria was mostly between 30 to 50 yrs, these age brackets are in line with professional age in both developed and developing nations. The findings are in line with the Northern Uganda study that reported similar ages of the respondents . Nonetheless, the findings also disagree with the same findings on gender differences, as the formal showed more males than females and most medical doctors. The outcome of the present study is expected as more than 80% of nurses both in developed and developing nations are mostly female.
Awareness of electronic record management: Findings revealed that the majority of the respondents were aware of the use of electronic records in the hospitals, except very few of the respondents claimed not to be aware of electronic records used in the hospital. The high awareness may perhaps be due to the recent increase in digital technology and the need for computerization, it could also be attributed to the fact that most of the respondents get information from social media on the information on the use of electronic records systems in hospitals in developed nations and that the staff made more research on the system. The present findings agree with the findings of the studies done in Western Canada and Northern Uganda  which showed good awareness of electronic record management in institutions. However, the results were at odds with those of the authors from the Columbia study , who found that members of the care team had poor communication skills and little awareness of electronic record management, which led to numerous hospital errors in patient care. An overall evaluation of the results of our study shows the respondents were cognisant of the existence of electronic records used in hospitals.
Level of use of electronic record management system: The study revealed the very poor level of use of electronic records in the study’s hospital. The respondents described the poor use as records were stored both manually and electronically. This finding is in line with a study conducted by Adu who reported that administrative documents are stored in both manual and electronic forms. The result of this subclass can be attributed to the fact that the use of electronic record management systems can only be motivated through the hospital policy and by the provision of computers within the hospital for easy accessibility and transferring of patient information that will promote effective care of the patient. In situations where the hospital management system did not promote the use of electronic record management, it becomes impairing for staff to use electronic record management within the hospital. The results were found to be opposing to the submissions of the Northern Ethiopia study that revealed the high use of ERM systems in their study and further showed that more than half of the respondents have a good attitude towards the use of electronic records management. The similarity of the present study’s findings with the Ghana study showed very poor use of electronic records systems in hospitals in developing countries; this could be that the teaching hospitals in these places do not institute policies that ensure mandatory use of electronic records to transport patients’ information. These findings become worrisome when looking at the Nigeria health care system indices that reflected a weak health system whose performance is lower than other African countries in the world . To this end, the use of electronic records especially in the tertiary hospital should make an emergency response by the policymakers. This as it reported to reduce long hours cue, reduces staff workloads, endorse fast medical response and promote access to good health care management . Importantly, the differences in the findings from previous studies results could mean that more efforts are needed to promote the use of electronic records in hospitals in Nigeria.
Perceived administrative effectiveness: The majority of hospital staff had a positive perception of the administrative effectiveness of electronic record management systems in teaching hospitals. Their positive perception was motivated and ascribed to fostering faster hospital operation activities and deriving perceived positive benefits of electronic records. The present study findings showed that the respondent understands the benefits of using electronic records as it reduces the length of hospital cueing time and promotes faster health care services. The findings are similar to the results of Olok and Yagos, which reported a positive attitude of medical staff towards the use of electronic records in hospitals. The positive perceptions show that the staff yearning for the enforced use of electronic records and will probably manifest a positive attitude towards its use. The similarity in the findings revealed that most hospital staff in developing countries desires the use of electronic records for the smooth running of patient care.
Relationship between awareness and use of electronic record management: The finding showed no significant relationship between awareness and use of the electronic records management system (P>0.05), this implies that poor use of electronic records was not associated with awareness of electronic records management. Findings further suggest that perceived bad use was not just related to individuals who were unaware of the system in the hospital but also to those who were aware of electronic records used in the hospital.
Findings are in agreement with work by Kyobe which revealed several incidents of poor records management and lack of compliance with the regulation . Findings are contrary to the study done in the United Kingdom which explains the need for adaptability, distributed leadership and end user involvement and demonstrates how understanding can significantly affect how care is delivered . The similarity of the result with some African studies showed the need to improve electronic records use in hospitals in developing countries.
Relationship between awareness and perceived administrative effectiveness: The perception of the administrative effectiveness of the electronic records management system did not significantly correlate with awareness of the system (p=1.000, P>0.05).
This is further demonstrated by the fact that both those familiar with and those unfamiliar with the hospital's system had a favourable opinion of its administrative performance. The present study finding demonstrates that being aware of electronic records was not related to the perceived administrative effectiveness of technology health care; however, awareness has no effect on hospital staff’s perceived benefits of electronic records use in the hospitals.
The results are in contrast to those of Arain, who found a substantial positive link between employees' perceptions of the effectiveness of IT security educational materials and their contentment with IT security in the workplace. The discrepancies in the findings studies from the previous Uganda result could be differences in the cultural background of each country and acceptability towards a change of new innovations.
Relationship between use of electronic records and perceived administrative Effectiveness: There was no statistically significant relationship between the use of the electronic records management system and its perceived administrative effectiveness (p>0.05). According to the findings of the current study, those who perceived good use of the system and those who perceived poor use both expressed a positive opinion about the administrative effectiveness of the records management system .
Findings are in line with the findings of Marutha and Ngulube that discovered that records management negatively affects timely and effective health care services. Findings are in divergence with the master thesis by Ndeso, which indicated a strong positive nonlinear correction between the use of electronic records management and its administrative effectiveness. Findings are in line with the findings of a South African study that discovered that records management negatively affects timely and effective health care services.
The findings conclude that most of the hospital staff was aware of the electronic records management in the hospital. There was a very poor use of electronic records management systems in tertiary hospitals. Respondent’s positive perceived the administrative effectiveness of the electronic records management system. However, the use of the electronic records management system perceived administrative effectiveness of the electronic records management system and perceived positive administrative effectiveness of the electronic records management system were not related to the perceived use of electronic records. Hence, the study suggested an urgent need for the hospitals in Nigeria and other developing countries develop compulsory policies specifically focused on patient’s records administration and management systems.
We thank the staff of the University of Nigeria Teaching Hospital Ituku (UNTH) and Esut Teaching Hospital Parklane (ESUTH).
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