Introduction and Background Information
Healthcare especially in the developed world is characterized by rapidly increasing use of information technology in patient care, increasing documentation, coding and billing, and management. Rise of health information technology worldwide is increasing the efficiency of health service delivery, reducing medical errors, improving quality of care, and providing better information for patients and physicians (Pollak and Lorch, 2007). The overall goal of the information management function is to obtain, manage, and use information to improve health care and medical services, performance, governance and management and support processes.
The importance of healthcare to individuals and governments and its growing costs to the economy have contributed to the emergence of healthcare as an important area of research for scholars in business and other disciplines. Information systems (IS) have much to offer in managing healthcare costs and in improving the quality of care (Kolodner et al. 2008). In additional, Piontek et al., (2010) asserts that healthcare influences the quality of human lives and function in the society. Healthcare mistakes have serious consequences that can affect ability to carry out social and productive endeavors. Recent reports highlight the gravity of adverse events in hospitals and the dangers such events pose to individuals and the public. Healthcare information systems have changed the healthcare industry drastically over the last decade as well as the last few years (Abraham & Junglas, 2011).
The forces of competition and advancements in healthcare technology are pushing hospitals to follow the trend. Paperless healthcare systems have become inevitable and any healthcare institute that doesn't follow this trend will fall behind the rest in the industry. Health information system is a must and the faster this is adopted the more successful the healthcare facility will be. (Swanson et al. 2010). Delone and Mclean (2003) being one of the most cited models in the fields of information systems seeks to provide a comprehensive understanding of information systems success by identifying, describing, and explaining the relationships between six success variables categories: systems quality, information quality, user, user satisfaction, individual impact, and organizational impact. The same author notes the model provides a comprehensive frame work for measuring the performance of the information system and enhances the understanding of information systems success.
World Health Organization (WHO, 2008) cautions that, the goal of a health information system is often narrowly defined as the production of good-quality data. The ultimate goal is to produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions. Health information management system performance should therefore be measured not only on the quality of data produced, but on evidence of the continued use of data to improve health system performance, respond to emergent threats, and improve health (WHO, 2008). Improving health information systems in terms of data availability, quality and use often requires interventions that address a wide range of possible 'determinants of performance'.
Health information systems recognizes that although new developments in technology, including the use of the internet and other modes of communication offer great potential in the flow of information amongst the providers and recipients regarding the provision and management of healthcare services, the Kenyan health sector remains far behind in taking advantage of such developments to improve reporting (HIS, 2008). Despite vast amounts of resources and time invested in the development and implementation of health information systems, health data is barely used by health workers for service delivery planning and decision-making. Performance is grossly under reported with developments to improve information management lagging behind other sectors improvement activities; the whole culture of information generation and use remain under-developed; and mechanisms for validating and assuring reliability are not optimally functional (HIS, 2008).
Research was carried out in two leading private and public hospitals in Kenya. Primary mandate of the public hospital is to provide specialized health-care services to patients on referral from provincial and district level hospitals. The hospital facilitates medical training, research and participates in national health-care planning. In rural areas, health centres and dispensaries offer diagnostic services, obstetric care, and outpatient treatment. The public hospital embarked on the use of a hospital management information system to provide faster documentation, retrieval, and management of patient information. The system did not only provide a reduction in patient waiting time but also enhanced staff accountability and resource management. The electronic medical record system is part of the management initiative towards implementation of fully integrated hospital management information system. The system was implemented at all patient entry points and in the wards. Every item being used on the patients are ordered and charged through the system.
The private hospital mission is to deliver timely and compassionate medical services to the patients and families to the highest possible standard through the provision of qualified staff, most appropriate equipment and staff training programmes. The hospital also seeks to contain its cost of operation such that the cost of medical care charged to patients remain as low and affordable as possible to as many patients as possible and such that the viability of the hospital, employment and investment are maintained in line with the ethos of the founders. Hospitals deal with the life and health of the patients. Good medical care relies on well-trained doctors and nurses, high-quality facilities, modern equipment and also good record keeping practices. Without accurate, comprehensive up-to-date and accessible patient case notes, medical personnel may not offer the best treatment or may in fact misdiagnose a condition, which can have serious consequences. Records, such as X-rays, specimens, drug records and patient registers, must also be well cared for if the patient is to be protected. Effective records care ensures the hospital's administration runs smoothly and saves time and resources. Records also provide evidence of the hospital's accountability for its actions and form the key source of data for medical research, statistical reports and health information systems. Patient care is adversely affected if correct records are not maintained, records are inadequately managed or there is no means of co-coordinating the health care the same patient receives in different departments. Structured and effective records management programme, covering all departments and all resources irrespective of media, is the aim of every hospital. Selected hospitals use integrated hospital management information to be able to handle and support the patient records and all other departments.
Statement of the Research Problem
Reliable and timely health information is the foundation of public health action, it is often unavailable. Consequently, decision-makers cannot identify problems and needs, track progress, evaluate the impact of interventions and make evidence-based decisions on health policy, program design and resource allocation (WHO, 2008).One of the key challenges in the Kenyan health sector (HIS, 2008), identified in the first medium term plan of vision 2030 document, is weak health information systems. Various weaknesses identified in the existing information systems include lack of policy and guidelines, inadequate capacities of health information system, staff, and unskilled personnel handling data, lack of integration, many parallel data collection systems, and poor coordination, amongst others. Overall, the current heath information system provides limited information for monitoring health goals and empowering communities and individuals with timely and understandable information on health (HIS, 2008).
Kenyan health care systems are typically made up of a number of relatively independent health programs and services which all maintain own vertical and uncoordinated reporting systems. Additionally, fragmentation of services, locally within hospitals and between primary, secondary and tertiary health care settings, alongside the use of different information systems in different care settings can make it difficult to safely communicate information. This may lead to miscommunication or missing patient information, ultimately compromising patient safety. The problem of HIS fragmentation and integration of health care information system is consequently a priority that needs to be addressed to realize successful patient centred healthcare delivery in the country (African Development Bank, 2013). Proper computerization of health records is a problem that many countries have had to deal with to ensure patient safety and evidence based care. Most developed countries have managed to come up with arguably workable solutions. However their counterparts in third world countries are yet to get there (Mwangi, 2013). The study has not only indicated insufficient adoption of HIS system in the country but also a major disconnect between adoptions in different heath care facilities, therefore bringing out the need to find out the use of HIS in two Kenya hospitals.
Purpose and Objective of the of the Study
The purpose of the study was to examine the use of hospital information management systems among healthcare workers in two public and private hospitals in Kenya.
Objectives of the Study
Objectives of the study were to:
i. Assess the use of the...