Full Project – Barriers to effective use of electronic health record system

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ABSTRACT

This research work empirically explored barriers to effective use of electronic health record system. The objectives of this study were to examine the facilitators of electronic health record (EHR) usage, examine the barriers to electronic health record (EHR) usage, identify factors to help implement facilitators of electronic health record (EHR) usage, identify means to overcome barriers of electronic health record (EHR) usage. The scope of the study is Federal Medical Center Owerri, innovation diffusion theory was used as a framework. The research design used for this study is descriptive cross-sectional design using a semi-structured interview guide, the population targeted for this study consists of implementors and end-users of EHR in Federal Medical Center Owerri. 4 implementors and 20 end-users of EHR were used as sample size and cluster sampling technique was applied. Instrument used for this study is interview. Data collected were collected from primary sources. From the analysis of the data, the findings show that available equipment, training and supervision were the major facilitators of EHR usage, poor software, lack of funds and technicians were the major barriers to EHR usage, availability of funds and training of staffs will help facilitate the implementation of HER, provision of equipment and motivation will help overcome the barriers. Following the findings, it was recommended that equipment needed should be adequately provided, staffs should undergo training, software should be updated, staffs should be motivated and properly supervised. The study concludes that implementation of electronic health record system will bring positive impact on the population.

Keywords: electronic health record system (EHR), barriers, Federal Medical Center Owerri.

CHAPTER ONE

INTRODUCTION

1.1. Background to the Study

The electronic health record (EHR) has been regarded as a key component in the advancement of a given health care system. The EHR has the potential to reduce health care costs, reduce medical and drug errors, enhance the flow of information between health care providers, increase communication between patients and health care providers, and improve overall quality and efficiency of patient care (Gardner et al., 2010). The EHR not only has clinical benefits, but also offers the potential for public health benefits. However, despite the stated benefits from the implementation and adoption of EHR systems in Nigeria, their implementation has been slow and lags behind that of other developed nations. Technological, financial, human, and security barriers have all contributed to the slow implementation and adoption of EHR.

Health information technology professionals and governmental leaders are promoting the EHRs. Many organizations are working to develop initiatives and goals to help meet the needs of the healthcare industry. Health information technology (HIT) and the use of electronic health records (EHRs) has increased substantially through efforts to achieve the following: reduce medical errors, provide more effective methods of communicating and sharing information among clinicians, lower national health care costs, better manage patient medical records, and improve coordination of care and health care quality (Ajami and Bagheri-Tadi, 2013; Grinspan, Banerjee and Kaushal et al., 2013). With the growing emphasis on providing the right information to the right person anywhere at any time in today’s globally interconnected world, countries of the world have been moving toward the EHRs system. It has become obvious that the paper record system is incapable of supplying caregivers with all the patient information they need in a way that they can utilize it. This problem, as well as concerns for better quality and reduced costs, is being realized more and more.

The implementation of Electronic Health Record (EHR) system seem to still elude most developing countries including Nigeria. As Identified by the World Health Organization (WHO), part of the challenges facing the Nigerian health system is inadequate health information system for monitoring and analysis of health indicators (Levingston, 2012). Indeed, the functionality of a well-designed EHR system can bridge this gap. Apparently, this is yet to manifest in present day Nigeria as most health facilities are still living in the manual era of health records documentation.

Nigeria e-Health policy has been published since 2007, it includes a three-year strategic plan to reform Nigeria’s National Health Management Information System. Emphasis is placed on improving data collection capabilities and systems integration in order to support planning, monitoring and evaluation of health services. This includes the Public Health Care information system, which monitors health indicators such as infectious disease prevalence, maternal and child health outcomes, and rates of immunization (WHO, 2010). However, Nigeria was not in the list of countries having e-Health profile for 2015. This indicates that close to nothing has been achieved in this direction.

1.2. Statement of the Research Problem

The human health state is considered the most critical to any country survival of a truism that healthy population bring about the desired goals. The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted. Despite broad agreement on the benefits of electronic health records and other forms of health information technology, health care providers have moved so slowly to adopt these technologies.

Numerous healthcare facilities from across the globe have implemented EHR systems to improve the information recording process but only a few have been successful (Hasanain and Cooper, 2014). The percentages of failures are alarmingly higher in adoption and meeting the desired benefits from the implementation. More than 50% of EHR systems either fail or fail to be properly utilized (Biruk, Yilma, Andualem and Tilahun, 2014; Willyard, 2010; Miller and Sim, 2004). Resistance and opposition in changing from the paper-based systems to electronic systems may create some problems (World Health Organization, 2006). Some other issues contributing to the stats include the lack of pre-implementation activities (Biruk, Yilma, Andualem and Tilahun, 2014), lack of organizational readiness (Ventures, 2008; Khoja, et al., 2007; Brender, 2006), unavailability of technology, funding and lack of technical and computer skills of personnel (Ajami, et al., 2011).

In Nigeria, the ability to ensure efficiency in its health system also lie within the adoption of electronic health record system. It is against this backdrop that the researcher considered the study of barriers to effective use of electronic health record system.

1.3. Objectives of the study

The aim of this study was to examine the barriers to effective use of electronic health record system. The specific objectives are to:

examine the facilitators of electronic health record (EHR) usage.
examine the barriers to electronic health record (EHR) usage.
identify factors to help implement facilitators of electronic health record (EHR) usage.
identify means to overcome barriers of electronic health record (EHR) usage.

1.4. Research Questions

This study will be guided by the following research questions:

What are the facilitators of electronic health record (EHR) usage?
What are the barriers to electronic health record (EHR) usage?
What factors will help implement facilitators of electronic health record (EHR) usage?
What are the means to overcome barriers of electronic health record (EHR) usage?

1.5. Significance of the Study

The study will enable relevant agencies concerned with ensuring efficiency and effectiveness the Nigeria health system. The study exposes the performance of health system and highlight the potency of electronic health record system as an instrument of eradicating ineffectiveness. Empirically, this study is carried out to appraise the barriers to effective use of electronic health record system. The changing character of the health sector has affected the industry in recent times and will push studies on barriers to effective use of electronic health record system to new evidence(s). It will contribute to existing literature on the subject matter. This study will be of benefit to;

The Academia: members of the academia will find the study relevant as it will also form basis for further research and a reference tool for academic works.

Government: this study will reveal to the government happenings in the health sector. Formulation and implementation of policies based on this finding would ensure development in the sector.

Investors: this study shall also be valuable to the investors especially those who may have research interest as it shall guide their private investment decisions.

1.6. Scope of the Study

This study is intended to appraise the barriers to effective use of electronic health record system with particular emphasis on Federal Medical Center Owerri.

1.7. Organization of the Study

This study is divided into five chapters. Chapter one is introduction which consists of the background to the study, statement of problem, research questions, research hypotheses, objectives of the study, the significance of the study, the scope and limitations of the study and finally the organization of the study. Chapter two deals with the literature review which consists of the conceptual literature, theoretical literature, empirical literature, theoretical framework. Chapter three gives the research methodology including research design, population of study, sample size, sampling technique, method of data collection, instrument of data analysis, method of data analysis, validity/reliability of instrument. Chapter four is presentation and analysis of data, discussion of findings. Chapter five gives the summary, conclusion and recommendations.

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