1.1 Introduction
Electronic health records (EHRs) are defined as an electronic version of a patient’s medical history including key administrative clinical data relevant to that person’s care and have emerged as a promising tool to improve health care quality (Bjarnadottir, et al., 2017). Research indicates that EHRs can improve documentation, thereby increasing the accuracy and completeness of patient data. This improves health care providers’ ability to appropriately diagnose and treat their patients. Furthermore, EHRs can facilitate timely and accurate patient risk assessments and quality measurements, allowing for more prompt intervention as needed. Finally, many EHRs include tools that support clinical judgment and decision making, as well as care coordination and health information exchange (Bowles, Dykes, & Demiris, 2016).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
In the past few decades, the healthcare field has had an increasingly global technological advancement. One prime example of this is the Electronic Health Record (EHR). It is an essential platform that evolved rapidly over a short period of time to serve as a way to use and communicate health information (Garcia, 2020). It is used all around the world as a way to communicate health information across various health care professionals, track a patient’s progress, and trend laboratory results to ultimately enhance patient outcomes through safety and quality of care (Garcia, 2020). Serving as a more secure and faster alternative to the traditional handwritten paper charts, the electronic health record is one of the most important advancements in technology with several positive, and some negative, outcomes (Garcia, 2020).
Service delivery is an important activity within any organization. It defines who the organization is and promotes its corporate image. It shows the level of satisfaction the customers within the organization have. According to Ejumudo (2009) service delivery, has become the focus of increasing managerial attention and represents a major portion of economies of the world’s developed countries is at the heart of organizational performance, whether in the public or the private realm. Pyrene (2015), citing Arries, Ebin and Newman (2008) assert that service delivery has become an increasingly important concern of public healthcare services. Service delivery can be seen or is evident in the way the hospital employees respond to their patients, their courtesy, how reliable and confident they are, and even the care they offer to patients. Service delivery in a hospital entails the total health care given to a patients that visits the hospital, right from the time of registration to the time of actual treatment.
Arries and Newman, (2008) define service delivery as the consistent and accurate services provided to patients, it is the performance of the health personnel, and the motivation and assurance a patient derive from a health care treatment. Service delivery is a multiphase interactive action which coincides with the dimensions of excellence, assurance of competence, attentiveness, dissemination of information by staff and flexible helpfulness that add valuable meaning to the users.
Johnston and clark (2005), state that service delivery is all about the customer service and effectiveness. Effectiveness in customer service implies doing the right things which is measured using indicators like customer satisfaction, this can be seen or is evident in speed, service quality, timing and reactions. A service becomes effective when it is valid to its users or consumers, it is also noticed that whenever service providers meet and exceed their customer’s expectations, then the customer is satisfied. Service delivery is a component of a business or any organization which defines the interactions that exist between service providers and clients where the providers offers a service whether it is in form of information or a task and the clients finds value or losses value as a result. Therefore, service delivery is an a continuous act of providing or rendering services to customers, where the customers are either satisfied or dissatisfied with the services rendered, this can be evident in their reactions or expressions.
Good service delivery provides clients with an increase in value. Good service providers work to clearly define the content of services, the roles and responsibilities of the customers and users, the roles and responsibilities of the service providers and set service quality expectations as well as availability and timeliness (Servicefutures.com, 2016). Service delivery can be found in many different professions, company structures and organizations, such as medical hospitals. Each profession has its own set of standard service delivery practices that are followed. Service delivery provides a framework where services are defined and levels of service support are agreed upon.
Pyrene (2015), says that records management is vital to service delivery within any organization and any record that is misfiled or lost is likely to delay the service delivery and hence dent the image of the service provider. In this view, Alexander and Harding (2003) also noted that hospitals in most countries remain an important source of critical health care services, providing both basic and advanced care for the people. Hospitals are often the provider of last resort for those who are critically ill and poor.
In today’s world, information is key; it plays an important or major role in the society and organizations, hence, the need to preserve that information in the form of records. The International Standard Organization (ISO) 15489-1(2001), define records as information created, received, and maintained as evidence, and information by an organization or person, in pursuance of legal obligations or in the transaction of business needed to deliver the right services to their clients. Records on its own has so many definitions but relating to this research it can be defined as a permanent written communication that document information relevant to a client’s health care management. It is also the clinical, scientific and legal document relating to the nursing care given to an individual or patients. These records provide the employees with the right amount of information needed to deliver the right services to their clients Luthuli, (2017).
Asunmo and Yaya (2016), define records as recorded information, irrespective of form or medium, received or created and maintained by establishments in pursuance of their legal or statutory obligations or record keeping of any kind. Records could comprise of paper, books, computer print-out and any other machine readable records. They also noted that efficient and effective records management must begin with the establishment and implementation of records management program.
Electronic health records management involves the management of all patient’s records which are stored electronically or in a digital format. They are repositories of information that concerns the health status of individuals the information contained in these records or patients file have a full or complete information about the client’s health history which includes allergies, surgeries, treatments etc., (Mathai, Shiratudin and Sohel, 2017).
Ojo and Popoola,(2015) define electronic health information management system as a massive and integrated information system that supports the comprehensive information requirements of patient, including clinical ancillary and even financial management, which could be seen as only one instance of a holistic health information system. Furthermore, they stated that electronic health information management system can or will bring about an increase in digitization which makes the management of comprehensive medical records from patient’s information to diagnostic care and prescription less stressful and straight forward process.
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Availability and Utilization of Electronic Health Record using Enugu State University Teaching Hospital as a case study.
1.3 Statement of Problems
Investigation revealed that the service delivery within the Enugu State University Teaching Hospital is important and can affect the rate at which patients visit the hospital. Lack of effective health records management practices affects the retrieval of patient’s records. Ondieki (2017) posited that most often, hospital employees render poor services or struggle to render good and timely services due to lack of effective records management which leads to long waits by patients. In the struggle to retrieve patient records which have been stored using paper based systems, the patients continue to wait for hours without any success. The researcher observed that the service delivery of the employees in the area under study has been relatively slow. This is related to the aspect of managing the health records of their patients.
Danso (2015), state that an effective management of hospital records is a critical factor in providing capacity for hospitals’ efficiency, accountability, transparency, information security and also good governance. As records management becomes more and more demanding and very vital activity within any organization, how to preserve them too becomes a problem, because managing paper based records requires a lot of work. Hence there is a need to investigate how electronic health records management practices can influence service delivery of employees in Enugu State University Teaching Hospital (ESUTH).
1.4 Aim and Objectives of Study
The aim of the study is to examine the Availability and Utilization of Electronic Health Record using Enugu State University Teaching Hospital as a case study. In achieving this aim, the following specific objectives were laid out as follows:
- To find out the availability electronic health records management practices prevalent in the area under study;
- To investigate the factors inhibiting the utilization of electronic health record in the area under study;
- To find out the challenges of health care record service delivery of the employees in the area under study; and
- To investigate the influence of electronic health record management practices on service delivery by employee in the area under study.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Are there any factors inhibiting the utilization of electronic health record in the area under study?
- What are the challenges of health care record service delivery of the employees in the area under study?
- What is the influence of electronic health record management practices on service delivery by employee in the area under study?
- What is the availability level of electronic health records management practices prevalent in the area under study?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: Electronic health records management practices have no significant influence on service delivery of the employees in Enugu State University Teaching Hospital.
- H1: Electronic health records management practices have significant influence on service delivery of the employees in Enugu State University Teaching Hospital.
1.7 Significance of Study
This study is important for many reasons. It will cast more light on the importance of electronic health records management practices in Enugu State University Teaching Hospital. And also come up with a frame work that will provide guidelines for Enugu State University Teaching Hospital on electronic health records management practices.
The study will influence the medical personnel on proper records management practices and also adequate training for records keeping. It will also help to identify the challenges hospital personnel face in use and management of electronic health records management and also help them understand how electronic health records management practices can influence and affect service delivery.
The study will also provide empirical, theoretical and conceptual framework, which will contribute to the existing knowledge in other related fields. The outcome of this research would help to identify ideal methods of managing electronic health records.
1.8 Scope of Study
The scope of the research is focused on the Availability and Utilization of Electronic Health Record using Enugu State University Teaching Hospital as a case study.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Operational Definition of Terms
Electronic Health Records: This is an electronic store of patient’s health records, which are created, stored, managed and controlled by health personnel at Enugu State University Teaching Hospital.
Records: This can be defined as any document or recorded information which is created, received and maintained by health personnel of Enugu State University Teaching Hospital.
