Impact of EHR on healthcare delivery

Data generated from the questionnaires pointed to a variation in the benefits or relevance of the EHR across the various user departments. Some users perceive the system to have increased their work practices and as they perceive it to entail more work. Others however view the system to have reduced their work practices and errors associated with their use of paper records. However, the respondents in general see the system as supportive to their task and have higher expectations of its benefit to the staff, patients and the hospital at large.

4.3.4.1 Benefits of the EHR to the users

The respondents identified some benefits of the system, which is discussed under the various headings below;

Facilitated work task

Some of the respondents indicated that, the introduction of the EHR has made their work easier and cited some of these reasons;

very satified 17%

moderately satisfied 43%

satisfied 31%

less satisfied 9%

Levels of Users satisfaction with EHR

very satified moderately satisfied satisfied less satisfied

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“…it has reduced the manual documentation of the NHIS claims forms which was tedious to do” (Respondent XVIII)

“…it has made it easy to locate patients’ folder and I believe it would reduce waiting time if implemented properly” (Respondent XIX)

“….the computer has reduced the overcrowding of patient at the revenue point since patients information is recorded at the Records Unit making my work easier for me..” (Respondent XX)

“… It has reduced the time spent on costing the patients drugs now it is all done by the system”

(Respondent XXI)

“..Since we are no longer using the claims, it has made documentation easier and faster”

(Respondent XXII)

Although respondents from the records units perceive the system to have enhanced their folder arrangement and filing, my observations indicated a less improvement in folder arrangement since one out of four folders searched, seem to be misplaced or found in a different cell and not the original cell assigned to it. However, it was worth noticing that the system has helped in the easy tracking of the folder.

Reduced errors

Some respondents indicated that the introduction of the system has reduced the errors made in the paper records.

“…the system has reduced errors and redundancy in patient information” (Respondent XXIII)

“…smooth working, there is about 90% reduction in folder lost at the pharmacy hence the good relationship between patient and the pharmacy staff” (Respondent XXIV)

Easy retrieval of patient information

A respondent also mentioned that the introduction of the system has made it easy to retrieve patient information, which would not have been possible with the paper records and cited an example as;

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“a patient came to the hospital and reported of his missing folder ID card, so we just asked for his health insurance card, type the number, then we search for his details and brought out every information needed about the patient and his number from the system…” (Respondent XXV) 4.3.4.2 Benefit of the EHR to the hospital

Although most of the respondents pointed out that the system is at its early stages and hence it little impact or benefit to the entire hospital. Some respondents indicated that, the system has help improved the storage of patients folder and reduced the storage space due to the less issue of double folders to the patients. Other respondents also indicated that the hospital has benefited from not printing claims forms and believe it has save the hospital some money. Another respondent indicated that absconded patients are easily traced with the system thus contributing to the further saving of the hospital, a lot of money.

4.3.4.3 Challenges of the system

Majority of the respondents identified inadequate computers and training as the major challenge with the system as identified in the interviews. However, some other challenges were identified to include; poor network connections, unstable power supply, increased work task and illegibility of doctors’ handwriting.

Poor network connections

Some of the respondents indicated that, there are often breaks in the network connections of the system, which makes working with the system difficult. One respondent mentioned,

“the system is sometimes not working. There is often breaks in connections especially when there is rain or sometimes when the cables comes into contact with water which makes it impossible for me to prepare patient bills” (Respondent XXVI).

In such situations the users are forced to document the proceeds in their books and transfer it to the system when the connection is restored. This according to the respondent is a lot of work for them, which has resulted in a lot of backlog data to be entered into the system.

95 Illegibility of doctors’ handwritings

Another challenge identified by the respondent to inhibit their use of the system is the illegibility of some doctors’ handwriting. This challenge was particularly cited by the officers from the Records Unit and the Transcribing Office. One respondent indicated that;

“one out of the four folders received from the consulting room is sent back for clarification because we do not see what the doctors have written. I sometimes try to guess what is written or show it to my other colleagues to see if they know the diagnose, in cases where no one knows we either take the folder back or ask the patient to go for the nurse with the doctor to rewrite it which I think is a lot of work for us and the patient” (Respondent XXVII).

Unstable power supply

The respondents identified unstable power supply as one of the challenges faced by the system.

It was mentioned that although the hospital has a secondary power supply, not all the units were connected to the source, which indicate the non-use of the system when there is power outage.

Even with the departments that have access to the secondary power supply, respondents complained about the frequent interruption in the power supply for various reasons unknown to them. This according to them also interrupts the use of the system

“the system relies greatly on electricity so when there is erratic power supply as we have here in Ghana, the system suffers too” (Respondent XXVIII).

Increased work task

Some respondents identified the system to have increased their workload since double entries are made both in their books and on the system. They however indicated that should they stop entering the patients’ records in their books, their workload would decrease immensely.

“.. it is time consuming compare to the using our books and folders. We have to key every information about the patient into the computer after you are done with the paper work.”

(Respondent XXIX).

96 4.3.4.4 Overall no difference between user departments

Overall the questionnaires generated similar responses from the different users of the system.

Inadequate training, insufficient computers, poor network connections and increased workload were identified by the users to be the main challenges to the effective use of the system.

However, it was asserted by the users that the system supported their work task and its full implementation in the hospital would reduce their work task and its benefits realised. They cited the reduction in workload as well as improve access to patient information as some of the benefits to be realised on the full implementation of the system.