Implementation Of Electronic Health Records System on Quality of Care / Patient Satisfaction at the 37 Military Hospital

Abstract

Background: Electronic health records system was introduced as part of Health Management Information System and a replacement of the paper-based health records system to facilitate smooth delivery of healthcare services. In Ghana, the 37 Military Hospital had been acknowledged as one of the quasi-government hospitals leading in the implementation of electronic health records system with the aim of providing quality healthcare services. Objective: The general objective of this study was to assess the implementation of the electronic health records system on quality of care/patient satisfaction at the 37 Military Hospital in Ghana. Methods: The study adopted a positivist philosophical approach with a case study research design to collect data through the use of questionnaires from three hundred and thirty-six (336) health workers and two hundred and twenty-eight (228) patients; giving a total sample size of five hundred and sixty-four (564) respondents for the study. Health workers and patients were recruited through purposive and simple random sampling methods respectively. Two sets of questionnaires were designed and answered by the participants using both self-administered strategy and interviewer-administered strategy depending on the background of the participants. The returned questionnaires were cleaned and entered into STATA version 14.0 for analysis. Descriptive statistics, chi square test and logistic regression analysis were applied to establish the needed associations between the dependent and independent variables. The level of significance was accepted at p<0.05 at a 95% confidence interval. Results: The results showed that experiences of health workers of the electronic health records system was significantly associated with quality of care (x 2= 19.8814, p=0.011). On the part of the patients, the frequency of patients’ visit to the health facility (x 2= 12.6290, p=0.049) was significantly associated with quality of care/patient satisfaction. The study indicated that the 37 Military Hospital was assessed by patients to be very good in respect of attention to patients’ need (M=3.68, SD=0.525), responsiveness of health providers to emergencies (M=3.81, SD=0.651), efficiency of services rendered (M=3.78, SD=0.576), timeliness of healthcare (M=3.78, SD=0.576), general patients’ care (M=3.86, SD=0.528) and overall level of quality of care (M=4.02, SD=0.636). In addition, the hospital was assessed by health workers to be good in terms of adequate staffing (M=2.94, SD=1.007), effective administration structure to deliver quality of care (M=2.88, SD=0.919), serene hospital environment (M=3.34, SD=1.04), adequate medical equipment to provide quality of care (M=2.88, SD=1.02) and overall level of quality of care (M=3.36, SD=0.898). The results indicated an association between perceived usefulness (t=0.57, p=0.570), perceived ease of use (t=0.48, p=0.629) and behaviour control (t=0.40, p=0.687) of the electronic health records system and quality of care (t=5.18, p=0.000). Additionally, the results revealed that 71% of patients (M=3.73, SD=0.86) and 36.9% of health workers (M=3.23, SD=0.98) confirmed overall level of satisfaction with the implementation of the electronic health records system (EHRs) at the 37 Military Hospital. Additionally, the results indicated that a unit increase in attention to patients’ health needs (t=1.15, p=0.259), in responsiveness of health providers to emergencies (t=0.10, p=0.922), in patient-provider communication (t=0.10, p=0.917), in efficiency of health services rendered (t=2.57, p=0.015), in timeliness of healthcare (t=3.20, p=0.003) and general patients’ care (t=2.46, p=0.020) would increase patients’ satisfaction at the 37 Military Hospital. However, the study showed that the listed challenges with the implementation of the EHRs at the 37 Military Hospital included: poor network (41%), lack of backup power to run the system during power outages (28.5%), difficulty in retrieving saved patients’ medical records (9.5%), limited availability of electronic devices to run EHR software (7.6%), difficulty in displaying patients’ medical/laboratory reports (5.7%), difficulty in correcting saved patients’ medical records (4.8%) and delay in the transmission of medical results across units (2.9%). Conclusion / Recommendations: The study established an association between perceived usefulness (p<0.05), perceived ease of use (p<0.05) and behaviour control (p<0.05) of the electronic health records system (EHRs) and quality of care. Moreover, there were listed challenges confronting staff in the implementation of the electronic health records system at the hospital. Therefore, the study recommends that the Ministry of Health/Ghana Health Service should reshape its information, communication and technology (ICT) policy and strategy for the health sector to ensure adequate ICT infrastructure and human resource to drive the implementation of electronic health records system (EHRs) in health institutions. The study further recommends that the Management of the 37 Military Hospital should consider an alternative network infrastructure and procurement of electronic devices for all units at the hospital to ensure smooth transmission of records across units and initiate training programmes for health workers operating the electronic health records system (EHRs) to enhance their understanding and knowledge of the system. Additionally, the study recommends that patients and communities should exercise patience while the hospital tries to improve on the electronic health records system to deliver quality healthcare services to enhance their satisfaction.