IMPACT OF ELECTRONIC HEALTH RECORDS ON QUALITY IMPROVEMENT IN HEALTH CARE SERVICES. (A CASE STUDY OF UNIVERSITY OF UYO TEACHING HOSPITAL, UYO, AKWA IBOM STATE).
This study focuses on the impact of Electronic health records on quality improvement in health care services. A case study of University of Uyo, Teaching Hospital, Uyo. The specific objective of the study was to examine the impacts of Electronic health records (EHRS) on quality improvement in health care services. Other objectives were; to determine the impact on electronic health record on time efficiently in health care services, to access the advantages and disadvantages of electronic health records on care delivery system, to examine the impact of electronic heards over paper based records in health care delivery. To achieved the specific objective of the study and problems raise in the study, some literature were reviewed. A sample size of 166 was used for the study. A purposive sampling technique was adopted to select four departments in the UUTH while simple random sampling technique was used to select the respondents in which 116 questionnaire were retrieved and were valid for the study out of 120 distributed. The questionnaires were reviewed and analyzed using tables and simple percentages. The findings of the study showed the important of electronic health records on improvement of healthcare services that it allow doctors to understand patient medical history better, accurate keeping of patient’s records, it further reveals the impact of electronic health records on time efficiency in healthcare services that; it reduces patients waiting time, enhances timely data transfer among healthcare providers, reduction in duplication of healthcare data during statistical compilation. It was recommended that Electronic health records should be implemented and Utilized in providing healthcare services, also that there should be training and re-training of healthcare provides on the use of electronic health records system.
TABLE OF CONTENTS
Certification - - - - - - - - - i
Acknowledgments - - - - - - - - ii
Dedication - - - - - - - - - iii
Abstract - - - - - - - - - iv
Table of Contents - - - - - - - - v
1.1 Background of the Study - - - - - - 1
1.2 Statement of the Problem - - - - - - 2
1.3 Objective Of the Study - - - - - - 3
1.4 Research Questions - - - - - - - 3
1.5 Scope of the Study - - - - - - - 4
1.6 Significance of the Study - - - - - - 4
1.7 Operational Definition of Terms - - - - - 5
2.1 Introduction - - - - - - - - 6
2.2 Concept of Electronic Health Records (EHRs) - - - 6
2.2.1 Comparison with Paper-based Records - - - - 7
2.2.2 Technical Features of Electronic Health Record - - - 7
2.2.3 Electronic Health Record (EHR) Implementation - - - 7
2.3 Evolution/History of Electronic Health record - - - 10
2.4 Importance of Electronic health Records on Quality
Improvement in Healthcare Services - - - - - 12
2.5 Advantages and Disadvantages of Electronic Health Records - 14
2.5.2 Disadvantages of Electronic Health - - - - - 16
18.104.22.168 Financial Issues - - - - - - - 16
22.214.171.124 Potential Privacy and Security Issues - - - - - 16
126.96.36.199 Inaccurate Information - - - - - - 16
188.8.131.52 Frightening Patients Needlessly - - - - - 17
184.108.40.206 Malpractice Liability Concerns - - - - - 17
2.6 The Impact of Electronic Health Record on Quality health Delivery 17
2.6.1 Application of Electronic Health Record (EHR) in Healthcare System 18
220.127.116.11 Clinical Application of Electronic Healthcare System - - 18
18.104.22.168 Clinical Research Application of Electronic - - - 19
22.214.171.124Application of Electronic Health Record (EHR) in Reporting in
Healthcare System -------20
126.96.36.199 Administrative Application of Electronic Health Record in
Health System - - - - - - - 20
188.8.131.52 Application of Electronic Health Record in Healthcare Financing - 20
2.7 Adoption and Challenges faced in Adoption of Electronic
Health Record in Healthcare System - - - - 21
2.7.1 Challenges of barriers faced in HER Adoption - - - 23
3.1 Introduction - - - - - - - - 24
3.2 Research Design - - - - - - - 24
3.3 Population of the Study - - - - - - 24
3.4 Sampling Size and Sampling Technique - - - - 25
3.5 Data Collection Instrument - - - - - - 25
3.6 Reliability and Validity of Instrument - - - - 25
3.7 Data Collection Procedure - - - - - - 25
3.8 Method of Data Analysis - - - - - - 26
RESULT AND DISCUSSION
4.1 Introduction - - - - - - - - 27
4.2 Analysis of Respondents Socio-Demographic Data - - - 27
4.3 Analysis of Findings - - - - - - - 30
4.4 Discussion of Findings - - - - - - 33 CHAPTER FOUR
SUMMARY, CONCLUSION AND RECOMMENDATION
5.1 Introduction - - - - - - - - 36
5.2 Summary - - - - - - - - 36
5.3 Conclusion - - - - - - - - 37
5.4 Recommendations - - - - - - - 37
References - - - - - - - - 39
Appendixes - - - - - - - - 41
1.1 Background of the Study
An electronic health records (EHRs) is a systematic collection of health information about a patient such as the patients’ medical history, medication orders, vital signs, laboratory results, radiology reports, and physician and nurses notes electronically. In health care institutions it automates the medication as well as examination, ordering process ensuring readable and complete orders. (Goodman, 2011).
It is thought that health information technology particularly electronic health records (EHR) will improve quality and efficiency of health care organization from small practices to large groups. Given these potential benefits, the federal Government encourages Electronic Health records (EHRs) adoption under the Health Information Technology for economic and clinical health (HITECH) Act. In response, many hospitals are striving to adopt this system and demonstrate meaningful use.
In 2013, 59% of Hospital had some type of electronic Health Record (EHRs) system. The Federal incentive program defined 3 stages for timely adoption of Electronic Health record uses. Stage 1 is Electronic Health Record adoption (EHR), stage 2 is Electronic Health Record data exchange and stage 3 is Using Electronic Health to improve patient outcome. However despite the widespread adoption of electronic Health Record (EHR) system only about 6% of hospitals met all criteria of stage 2 meaningful use. Thus, implementing and developing meaningful use for Electronic Health Record (EHR) is still on ongoing process in the Nigerian healthcare billing purposes not for research and quality improvement efforts.
Accordingly, the impact of Electronic Health Record (EHR) on quality healthcare delivery has focused on physical performance and billing precision. Electronic Health Records studies often concentrate on process quality metrics.
Electronic Health records have the potential to decrease medical error by providing improved access to necessary information better communication and integration of care between different providers and visits and more efficient documentation and monitoring. Many have used Electronic Health Records (EHRs) to decrease prescribing errors by real time clinical decisions support. Recently different bodies/studies, and department has begun to use Electronic Health Records to tract and also monitor patients outcome such as Catheter associated to urinary tract infection, deep vein thrombosis, or pulmonary embolism, providing criteria data to improve patient safety outcome Research and approved by researcher Ann. Fam. Med (2012).
Therefore, while several studies have looked at changes in quality attributed to Electronic Healthcare system over all improvements in patient outcome associated with Electronic Health Record implementation are still not yet well documented.
In particular, the effect of the implementation of an Electronic Health Record system on inpatient adverse events, Inpatient mortality and 30-days all cause readmission for specific surgical and medical conditions has yet to be explored, we thus sought to determine hospital level of Electronic Health Record (EHR) system with important, that is how it will be important to patient and the outcome of it. Crossom Jc, (2012).
Goodman, (2011). However, make research on how to achieve these goals, he also stated that Electronic Health Record is beneficial and must be use by the clinicians, and this remains as major challenge, Electronic Health Record tends to be beneficial to various factors. Electronic Health Record helps to Maximize the technical characteristics it also support the system such as speed and values added. Also, functionalities such as order entries or automated reports have been document with higher rates of Electronic Health Records (EHRs) use users related characteristics such as training and is also believed to be important. The integration of the Electronic Health Record (EHRs) into clinical workflow must be taken into consideration in the early planning in order to optimize the integrations of the system into routine clinical use. Indeed, the need for a good fit between the electronic Health records and routine clinical practice is also recognized as the essential and time efficiency it is also one of the several factors that is used to access the guality of this integration. Herndon, (1997).
1.2 Statement of the Problem
Electronic Health Records (EHRs) system have the potential to improve the quality of healthcare services, it is a tool which assist healthcare providers in delivering higher quality of healthcare services. The problem that lead to this study is that electronic health record is not fully utilizing in providing healthcare services to achieve it projected benefits and cost effectiveness. Hence, the quality of services can never be improved or be transform if the healthcare services is not computerized, in that, paper record can be easily lost, misplaced, expensive to easy to destroy, difficult to analyze and determine who has seen it or are often illegible. The use of electronic health record (EHR) would eliminate many of this issues and leads to major improvement in the quality of healthcare services and safety of a patient in the healthcare sectors.
It was in light of the above that the researcher has highlight the potentials of Electronic Health Records on quality improvement in healthcare services.
1.3 Objective Of the Study
The broad objective of the study is to examine the impacts of Electronic Health Record on quality improvement in healthcare services. The specifics objective includes;
i. To determine the important of electronic health records on healthcare services.
ii. To examine the impact of electronic health record on time efficiency in healthcare services.
iii. To access the advantages and disadvantages of electronic health record on healthcare delivery system.
iv. To examine the impact of electronic health records paper in healthcare delivery.
1.4 Research Questions
i. What are the important of electronic health records on improved healthcare services.
ii. What are impacts of Electronic Health Records on time efficiency in healthcare services.
iii. What are the advantages and disadvantages of electronic health record in healthcare delivery system.
iv. What are the impact of electronic health records in healthcare delivery system.
1.5 Scope of the Study
This study is conducted in University of Uyo Teaching Hospital, Uyo. A tertiary health institution in Akwa Ibom State. The research concentrates on the impact of Electronic Health Record on quality improvement in healthcare services.
University of Uyo Teaching hospital is bounded by Ediene Ikot Obio Imo village by the South, Ikot Ntuen Nsit by the North use Ikot Ebio by the West, Ikot Oku Ikono by the East. All along Abak road, Uyo. The hospital lies along latitude 16.45 North of equator and longitude 22. 20 East.
University of Uyo Teaching Hospital, Uyo was established and commissioned officially by the president late, General Sanni Abacha commander in chief of armed force of Nigeria on 1st November, 1996. The hospital then was called Sanni Abracha Hospital, but was later Metamorphous to Teaching Hospital in June, 2000.
The Hospital has been headed by chief medical Director, but presently headed is by Dr. EmemAbasi Bassey.
1.6 Significance of the Study
The outcome of this study will be signify and benefit to various people and department as follows;
To the Hospital:
This study will ensure that the hospital productivity is increase and efficient when the health workers have a conducing working environment which will go along in promoting the hospital.
To the Health Information Managers:
This study will serve as significance to the health information managers it will ensure that health information managers will increase their performance as adequate working flow. This will lead to reduction of stress and occupational hazard to workers.
To the Government:
The study will be of great significance to the government as it will encourage them to provide technical assistance to all the hospital for a computerize healthcare services.
For Researchers and Student:
The result of this study will serve, as a reference materials to anyone who want to research on related field.
To The Patient:
The findings from the study will help the patient to support electronic healthcare services as it will help in reducing healthcare cost.
1.7 Operational Definition of Terms
⦁ Impact: To have a strong effect on someone or something.
⦁ Electronic health record: An electronic health record or electronic medical record is the systematized collection of patient and population electronically-stored health information in a digital format.
⦁ Quality Improvement: Quality improvement is anything which causes a beneficial change in quality performance.
⦁ Healthcare: Healthcare is the organized provision of medical care to individuals or a community.
⦁ Healthcare Services: The finishing of medicine, medical or surgical treatment, Nursing, hospital services, dental services optometric services, complementary health services to a person or community (Wikipedia)..