AvailabilityandUtilizationofHealthInformatics SystemamongHealthWorkersinNigerState,Nigeria
1
1DepartmentofNursing,MaryamAbachaAmericanUniversityofNiger,Maradi,Niger 2BayeroUniversity,Kano,Nigeria 3SokotoStateUniversity,Sokoto,Nigeria
ABSTRACT
Withaclearflowofinformationacrossmanymedical subsystems,theadoptionandutilityofelectronichealthrecord systems(EHRs)improvethehealthcaresystemgoingforward. Thestudyisabouttheavailabilityandutilizationofhealth informaticssystemsamonghealthWorkersinNigerState, Nigeria.Inthisstudy,thechannelmodelwasusedtodescribe howtheinformationisflowinthehealthsectors.Thestudy adoptsquantitativeapproachestoinvestigatetheavailabilityand utilityofhealthinformaticsamonghealthworkersinNigerstate, Nigeria.Thepopulationofthestudycomprisedallthehealth workersworkinginpublichealthhospitalsandclinicsinNiger Statetotallingabout3,599healthworkersoutofwhich400were sampledusingappropriatesamplesizedetermination.The returnedrateof320instrumentswasusedfortheanalysis.The studyrevealedthatthehealthinformaticssystemwasnot availableandassuchtheutilisationwasrelativelyverylowin Nigerstate.Thestudyrecommendsamongothersthatthereisa needfortheNigeriangovernmentandhealthmanagerstomake useofhealthinformaticstoimprovethedeliveryofthehealthcare system.
KEYWORDS: Availability, Utilization, Health informatics, Health workers,Nigerstate
INTRODUCTION
Healthinformaticshasbecomeaninevitablepartof modernhealthcare.Duetothevolumesofhealthdata beinggenerated,itisinevitabletodeploycomputers to manage patient data to offer better healthcare delivery. In health informatics systems around the world,massiveamountsofdataarebeingcollected, adoptedandutilisedforbetterpatientdiagnosisand treatment, improving public health systems and assisting government agencies in designing and implementing public health policies, instilling confidenceinfuturegenerationswhowanttoutilise betterpublichealthsystems(Sood,&McNeil,2017).
ThehistoryofhealthinformaticsinNigeriastartedin the late 80s when a collaborative research project betweentheComputingCentreoftheUniversityof Kuopio,FinlandandObafemiAwolowoUniversity, andObafemiAwolowoUniversityTeachingHospital (OAUTHC),Nigeria(Anderson,2012)wasinitiated
3
How to cite this paper: Eucharia Hauwa, Umoru | Dr A. H. Ibrahim | Dr AbdulrahmanM.Sani"Availabilityand UtilizationofHealthInformaticsSystem among Health Workers in Niger State, Nigeria" Published in International Journal of Trend in Scientific Research and Development (ijtsrd),ISSN:24566470, Volume-6 | Issue-7, December 2022, pp.521-528, URL: www.ijtsrd.com/papers/ijtsrd52351.pdf
Copyright © 2022 by author (s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0)
and this initiative was part of INDEHELA Health informatics has several classes and sub-domains, Shortliffe&Blois(2001)classifiedhealthinformatics into seven domains namely, Nursing Informatics, Veterinary Informatics, Dental Informatics, Bioinformatics, Imaging Informatics, public health informaticsandclinicalInformatics.
Itis anobjectiverealitythattheworldischanging with the development of technology and communication; meanwhile, changes in policies, economics, demographic and socio-environmental variables,haveasignificantinfluenceonhealthcare delivery systems. In support of the utilisation of health informatics technology, scholars such as Garde,Harrison,&Hovenga(2015),Watcharasriroj, &Tang,(2014), Hassan (2016), flora(2013), Toochukwu,Achadu&Asogwu(2021),Chaudhry, Wang,Wu,Maglione,Mojica,&Roth,(2016)have
agreed that the introduction of information technology has accompanied with different health informatics strategies adopted and utilised by healthcare workers specifically the to enhance accurate, efficient, effective and managerial data concerning the patients for appropriate action and decision.Theyopinethat,ifthesehealthinformatics areappropriatelyutilised,theycanenhanceeffective healthcaredelivery.
The concept of informatics means the use of computerized information systems to address questions, solve problems and make decisions (Kaushal,Shojania,Bates,2015).Basedontheresults ofpaststudieswheninformaticsisusedinnursing tasksandproceduressuchasfinancial,clinical,and otheradministrativetransactions,itcanhelpreduce costsandthetimerequiredtocompletetheprocess (Honey,&Procter,2017).
TheInternetisplayingausefulfunctioninalmostall aspects of modern life. In the health sector, the Internetcanbeausefulwayforaccessingup-to-date informationabouthealth(Ajuwon,2003).Theuseof theInternetforhealthcaresystemssuchasremote neonatalmonitoringsystems,teleradiology,electronic patient record system, and Internet-based patient information system (DG INFSO, 2006) is well documented, though uptake of such systems is variable;regrettably,accesstotheInternetsystemin Nigerian hospitals is rarely available. The Internet initiativeinNigeriastartedin1994withtheeffortsof the Nigerian Internet Group. At this time the only accesstotheInternetwasprovidedbyNITELandit wasextremelyveryexpensive(Olayinka,2000).
ThefirstcomputeremergedinNigeriain1948when the Nigerian Ports Authority bought a ‘Visible Record Computer’ from International Computer Limited(ICL).In1963,IBM(InternationalBusiness Machines) established the IBM African Education Centre at the University of Ibadan in Western Nigeria, enrolling fifty–two students from Nigeria andotherEnglish-speakingAfricancountries(Buntin, Burke,Hoaglin,Blumenthal,2018).Despitethe60yearhistoryofcomputeruseinNigeria,thediffusion andusageofcomputersinNigeriaisstillverylow duetothecostofaComputer(PC)whichisveryhigh foranaverageNigerian.
InNigeria,mostteachinghospitalshavetogenerate moneybybillingpatientsfortheservicesrenderedto them, to augment the money received from the governmenttorunthehospitalandpaystaffsalaries. Meanwhile, it is believed that if the use of ICT is adoptedthecostofrunningthehospital,inthelong run, will be reduced and the healthcare delivery systemmaybeasefficientandeffectiveasitisinthe
developed world (Buntin, Burke, Hoaglin, Blumenthal,2018).
The Electronic Health Record (EHR) has been the ultimategoaloftheinformaticssystemfromitsstart. IntheUnitedStatestoday,only5%ofdoctorshave access to a true HER (Mennemeyer, Menachemi, Rahurkar&Ford,2016).Researchershaveworkedon thedevelopmentofthisforalmost50years(Honey, Procter, 2017; Mennemeyer, Meacham, Rahurkar &Ford, 2016). Over the years “it” has been given many names. It has been called the Automated Medical Record (AMR), the Computerised Patient Record(CPR),theComputer-basedMedicalRecord (CMR),theElectronicMedicalRecord(EMR),the electronichealthcarerecord(EHCR),theelectronic patient record (EPR), the personal medical record information (PMRI) and others. Mennemeyer, Menachemi,Rahurkar&Ford,(2016)foundthatthese healthinformaticsarenotaccessibleinAfrica.
Withaclearflowofinformationacrossmanymedical subsystems, the adoption and utility of electronic healthrecordsystems(EHRs)improvethehealthcare systemgoingforward(Sadeghei,2018).Thedatais frequently employed in the sector of health informatics,asnewdataisconstantlypouringintothe system,requiringanalysisandinterpretationtomake rational and effective decisions (Sadeghei, 2018; Piscotty,Kalisch,&Gracey-Thomas,2015).Thisof course improves decision-making through the comprehensive integration of data from a range of sources,allowingformuchfasterandmoreeffective decision-making(Imani,Khademi,Yusefi,Bahrami, & Naghizadeh, 2016). Within and outside of the medicalbusiness,computationalhealthinformaticsis an emerging study field (Sadeghei, 2018; Imani, Khademi,Yusefi,Bahrami,&Naghizadeh,2016).
The major purpose of Health Informatics is to improvetheunderstandingofmedicineandmedical practice by using real-world medical data. In the subjectofthemedicalsystem,healthinformaticsisa blendofinformationscienceandcomputerscience (Sadoughi,Kimiafar,Ahmadi,&Shakeri,2015).Big datainhealthcareisintimidatingnotonlybecauseof itssheermagnitudebutalsoduetothevarietyofdata typesandthepacewithwhichitmustbemanaged andplanned.Togainpeople'strustandgiveeffective healthcareservices,allhealthserviceprovidersare nowadoptingdifferentstrategiestoutilisethemost up-to-datetechnologiestoprovidehealthservicesand more advanced treatments. Various requirements drive innovation in this industry, such as finding appropriateaccommodationwithstandardizationand coordinatingtheacquisitionandimplementationof newerhealthcaresystemsandservicesatalllevels.
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Similarly,Armyetal(2017)intheirstudywereofthe viewthatthemajorityofthehealthworkerswerenot properly trained in the area of health informatics systems and subsequently called for improved awarenessamongthehealthworkers.Itisevidentthat theresearchontheawarenessofhealthinformatics systems is bountiful elsewhere, however, there is lackingworkontheavailabilityandutilityofhealth informatics among health workers in Niger state, Nigeriahencethisstudybecomesrelevanttofillthe void.
Also, in Nigeria, due to the widespread utility of informationtechnologyinotherareas,regrettablyit wasslowertodevelopinthehealthsector.Whilethe use of these technologies will bring more health goals,providebetterservicesandaccessinformation in the shortest time, increase patient satisfaction, increase system efficiency and reduce costs. As a
HealthinformaticsModel
result, Sood, McNeil, (2017), Hassan (2016), Hammond(2016)wereoftheviewthatusingthese technologiesinthefieldofhealthwillacceleratethe transition towards a better future, and healthcare organizations should be prepared to accept these systemsandtoescapethechallengesposedbytheir use. Despite the importance of informatics in the healthsector,therehasnotbeenaspecificstudyon thestatusofinformaticsusedinhealthmanagement. It has been observed that health informatics are availableandhavebeenutilisedelsewhere,however, there is a felt need to know if health informatics systems are available and utilised by the health workers in Nigerstate, Nigeria fordocumentation. The study, therefore, was set up to investigate the availabilityandutilityofhealthinformaticssystems inthearea.
Figure1:theprocessofthehealthcareinformaticssystem
Theoreticalframework
Channelmodels
Thismodelofthechannelcanbemadetodescribehowtheinput(thetransmittedsignal)ismappedtotheoutput (thereceivedsignal).Thereexistvarioustypesandusesofchannelmodelsspecifiedinthefieldofinformation technology.Inparticular,somemodelsareformulatedtodescribeeachpartofacommunicationsystem.A channelcanbemodelledphysicallybytryingtocalculatethephysicalprocesseswhichmodifythetransmitted signal.
Communicationchannelsarealsostudiedinadiscrete-alphabetsetting.Thiscorrespondstoabstractingarealworldcommunicationsysteminwhichtheanalogue→digitalanddigital→analogueblocksareoutofthe controlofthedesigner.Thecommunicationchannelmodelconsistsofatransitionprobabilitythatspecifiesan outputdistributionforeachpossiblesequenceofchannelinputs.Ininformationtheory,itiscommontostart withmemory-lesschannelsinwhichtheoutputprobabilitydistributiononlydependsonthecurrentchannel
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input.Thistheoryisthereforerelevantinthisstudyinthattheuseofhealthinformaticsservicesbythenursesis borneoutofthedesiretokeepaccurateinformationbotheringonthepatientsforeffectiveandefficientservice delivery.Recordinginvolvesdocumentingthesymptomsofillness,whichisusedforcommunicatingbetween doctorsandeveryoneelseinthehealthcareprocess–further,thesamecanbeutilizedfortheteachingand learningprocess.Storingandcommunicatingentailsthatoncethedataisrecordedwithappropriatemeasures–the further stages such as storing, processing and analysing and communicating the data and synthesized informationarecarriedout.Investigating/analysingrecordeddataandutilizingthesameinameaningfulwayto buildtheinformationsystemswhichfacilitatetheexecutionofthehealthcareprocessiscarriedout.Thismodel explainedtheimportanceandvariousmeansthroughwhichinformationispassedfromonepersontoanother.
Method
Thestudyusesasurveydesignwiththeapplicationofquantitativeresearchmethods.Thiswasemployedto investigatetheavailabilityandutilisationofhealthinformaticsamonghealthworkersinNigerstate,Nigeria. ThepopulationofthestudycomprisedallthenursesworkinginpublichealthhospitalsandclinicsinNiger State;this includes nurses in primary, secondaryand tertiaryhealthcarefacilities. Theyareabout thirteen thousand,twohundredandtwenty-five(3,599)healthworkers(Nigerstateministryofhealth,2022). Thiswascomputedasfollows: Formula:n= N 1+N(e)2 Where:n=samplesizesought e=levelofsignificance(0.05) N=populationsize Therefore:n= 3,599 1+3,599(0.05)2 n= 3,599 1+3,599(0.0025) n= 3,599 9.9975 n=400Approx Furthermore,thesamplesizeof320wasdistributedproportionally.Theformulaispresentedandcalculatedas follows:
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Twoinstrumentswereusedfordatacollectionforthestudy.TheinstrumentsareaquestionnaireandaKey InformantInterview(KII)Guide.ThequantitativedataanalysiswasdoneusingStatisticalPackageforSocial Sciences(SPSS)forWindows.Descriptiveandinferentialstatisticswereusedfortheinterpretationofthetable.
Result
Table1:Distributionofrespondents'department
Healthworkers
Frequency(N=233) %=100
Nurses 52 22.3 Doctors 46 19.7 Pharmacists 34 14.6
Healthinformation/recordofficers 67 28.8 Laboratoryscientists 18 7.7 Physiotherapists 16 6.9
Source:fieldwork,2022
Thetableshowsthedepartmentoftherespondentsinthestudyarea.Thetableindicatesthat22.3%(52)were nurses,19.7%(46)weredoctors,14.6%(34)werepharmacists,28.8%(67)werehealthinformation/record officers,7.7%(18)werelaboratoryscientistsand6.9%(16)werephysiotherapist.Thisimpliesthatrespondents fromvariousdepartmentsprovideinformationandparticipatedinthestudy.
Table2:Respondents'responsesregardingtheavailabilityofhealthinformationsystemsinNiger state
Healthinformatics
Available Notavailable Total Internet 28.8%(67) 71.2%(166) 233 LCDScreens 9%(21) 91%(212) 233 Intercoms 8.6%(20) 91.6%(213) 233
Electronicmedicalrecords(EMR) 18.5%(43) 81.5%(190) 233 Desktops/computers 32.2%(75) 67.8%(158) 233
Video/teleconferencingfacilities 6.0%(14) 94.0%(219) 233
Source:fieldwork,2022 ThetablepresentsresponsesregardingtheavailabilityofhealthinformationsystemsinNigerstate.Therowdata indicatesthatthemajorityoftherespondents71.2%(166)indicatenon-availabilityoftheinternetsystem,91% (212)indicatenon-availabilityofLCDScreens,91.6%(213)indicatenon-availabilityofintercoms,81.5%(190) saidnon-availabilityofelectronicmedicalrecords(EMR),67.8%(148) saiddesktops/computerswerenot available, and 94.0% (219) pointed out that video/ teleconferencing facilities were not available in their respectivehospitals.
Table3:Respondents'responsesregardingtheuseofhealthinformationtoimproveservicedelivery Items FrequencyN=233
ValidPercent%=100
WedouseIntercomstechnologyhere
SD 144 61.8 D 54 23.2 A 6 2.6 SA 29 12.4
Iusedacomputerformorethanthreeyearsandthisimprovesservicedelivery
SD 81 34.8 D 88 37.8 A 46 19.7 SA 18 7.7
WeusedtheInternetandthisimprovesservicedelivery
SD 89 38.2 D 91 39.1 A 34 14.6
SA 19 8.2
usedVideo/teleconferencingfacilitieshere
SD 104 44.6 D 118 50.6 A 4 1.7 SA 7 3.0
NeverusedtheLCDScreensforservicedeliveryhere
SD 12 5.2 D 38 16.3 A 72 30.9 SA 111 47.6
IPossessalaptopcomputeranditaidsmeindeliveringeffectiveservices
SD 80 34.3 D 110 47.2 A 26 11.2 SA 17 7.3
wedouseElectronicmedicalrecords(EMR)
SD 59 25.3 D 105 45.1 A 68 29.2 SA 1 0.4
Source:fieldwork,2022
Thedataconcerningtheadoptionanduseofhealthinformaticstoimproveservicedeliveryshowsthatthe majorityoftherespondents61.8%(144)stronglydisagreethattheuseofintercomtechnology.Also,37.8%(88) disagreed,34.8%(81)stronglydisagreed,19.7%(46)agreedand7.7%(18)stronglyagreedthattheyhaveused computersformorethanthreeyearsandthisimprovestheirservicedelivery.Inaddition,thetableindicatesthat 39.1%(91)disagreed,38.2%(89)stronglydisagreed,14.6%(34)agreedand8.2%(19)stronglyagreesthatthey haveusedtheinternetandthisimprovestheirrespectiveservicedelivery.Thetableaddsthatthemajorityofthe respondents50.6%(118)disagreed,44.6%(104)stronglydisagreed,1.7%(4)agreedand3.0%(7)strongly agreedthattheyneverusedVideo/teleconferencingfacilitiesintheirrespectivehospitals.Thedataindicatesthat themajorityoftherespondents47.2%(110)disagreed,34.3%(80)stronglydisagreed,11.2%(26)agreedand 7.3%(17)stronglyagreedthatPossessingalaptopcomputeraidsthemindeliveringeffectiveservices.Thetable furtherindicatesthatthemajorityoftherespondents45.1%(105)disagreed,25.5%(104)stronglydisagreed, 29.2%(68)agreedand0.4%(4)stronglyagreedthattheyhadtheydouseElectronicmedicalrecords(EMR)to improvetheirservicesdeliveryintheirrespectivehospital.
Discussionofthefindings
The study is set to investigate the availability of healthinformaticsinNigerstatehospitals.Thestudy foundthatinternetsystems,LCDScreens,intercoms, electronic medical records (EMR), desktops/computers, and video/ teleconferencing facilities were not available in Niger state. This finding tally with Ajuwon, (2003), DG INFSO, (2006),PeterandLucy(2008)whopointedoutthat theInternetisplayingausefulfunctioninalmostall aspects of modern life. In the health sector, the Internetcanbeausefulwayforaccessingup-to-date healthinformation.TheuseoftheInternetforhealth care systems such as remote neonatal monitoring systems, teleradiology, electronic patient record system, and Internet-based patient information systemsiswelldocumented,thoughuptakeofsuch systemsisvariable;regrettably,accesstotheInternet systeminNigerianhospitalsisrarelyavailable.Inthe
United States today, only 5% of physicians have access to a true HER (Mennemeyer, Menachemi, Rahurkar&Ford,2016).
Second, the responses regarding the use of health informationtoimproveservicedeliveryrevealedthat theusageofthehealthinformaticssystemsinNiger stateisrelativelyverylow.Thiswasbecauseofthe non-availability and adaptability of the health informatics system by the health managers. This study tallies with Garde, Harrison, & Hovenga (2015), Watcharasriroj, &Tang,(2014), Hassan (2016),flora(2013),Toochukwu,Achadu&Asogwu (2021),Chaudhry,Wang,Wu,Maglione,Mojica,& Roth,(2016)whohaveagreedthattheintroductionof information technology has accompanied with different health informatics strategies adopted and utilised by healthcare workers specifically the to
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enhanceaccurate,efficient,effectiveandmanagerial data concerning the patients for appropriate action and decision. They opine that, if these health informatics are appropriately utilised, they can enhance effective health care delivery. However, therewaslowusageofhealthinformaticsinAfrica.
Conclusion/Recommendations
In Nigeria, the health sector has suffered due to negligence.Itcanbesaidthatkeepingrecordsofthe healthsectorisimportanttothedevelopmentofthe sector as well as the patients. Generally, Nigeria's health sector has not fully utilized the dividend of healthinformaticsinthehealthsectorandcanbeseen as backward development for a country that is adoptinghealthinformaticsspeedily.InNigeria,the patients’recordsarenormallystoredonpaperwhich standsachanceofbeingmisplacedoruselesswhen visitinganotherhealthcarefacility.Theutilisationof electronichealthrecordsystems(EHRs)improvesthe healthcaresystem.
Thereistheadagethat“healthiswealth”,therefore thereiseveryneedfortheNigeriangovernmentand healthmanagerstomakeuseofICTtoimprovethe delivery of healthcare to get out of poverty. To coordinate this initiative and tackle some of the problemshighlighted,theNigeriangovernmentcould establish an agency, different from the ministry of health and empower this agency financially to administerandfundICTequipmentandpersonnelin government hospitals, while also overseeing the deployment of ICT at different levels, from state hospitalstoruralclinics,this,ofcourse,willenhance efficienthealthcareservicedelivery.
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