Achampong, 1:2 http://dx.doi.org/10.4172/scientificreports.164 Open Access Open Access Scientific Reports Scientific Reports Review Article OpenOpen Access Access Electronic Health Record System: A Survey in Ghanaian Hospitals Emmanuel Kusi Achampong* Department of Medical Education and IT, School of Medical Sciences, University of Cape Coast, Ghana Abstract Developing countries are slow adopters of new technologies, particularly with regards to the health services of these countries. This study explores the data collection and management challenges in four Ghanaian hospitals using a survey study approach and proposes implementing an Electronic Health Record (EHR) system as a solution to these challenges. Some challenges that would impede the implementation of EHR in a Ghanaian hospital are the initial huge start up costs, poor computer skills of healthcare professionals, poor maintenance culture, and lack of policy to spearhead the implementation of the system. The weak state of information infrastructure at the hospitals is another challenge in an EHR implementation. EHR could potentially reduce waiting times for patients, reduce the cost of the hospital‘s operations, improve interdepartmental communication and collaboration, provide opportunity for sharing best practices among physicians within Ghanaian hospitals, and enhance better resource allocation. The data an EHR could primarily capture would be patients‘demographics, care plans, laboratory results, billing and NHIS claims information. Keywords: Electronic health record; Information and service provider has implemented a number of policies to improve communication technology care delivery development, unfortunately these policies have not yield the necessary success expected due to lack of accurate and timely Introduction data. On the other hand, most developed countries are experiencing improvements in care delivery by implementing various kinds of health Appropriate information and Health Information Systems (HIS) information systems such as electronic medical record, computerized are seen as crucial to strengthen the health system in developing provider order entry and clinical decision systems. It is therefore the countries [1] and in pursuing the Millennium Development Goals focus of this study to examine the benefits of EHR and its contribution (MDGs) [2]. On the ground, however, HIS and especially hospital to care delivery, development in less developed countries. information systems development in developing countries has proven difficult due to organisational complexity [3], fragmented and Materials and Methods uncoordinated organisational structures all maintaining their own HIS [4], and unrealistic ambitions [5]. Literature and report of on-going electronic health record system projects in Ghana, current health challenges and the quality of the local The important role, influence, and impact of Information and manpower were examined. Communication Technology (ICT) in all sectors of our society have long been recognized [6-12]. In the health sector, ICT-tools are being Information was collected by reviewing documents on current more and more developed, recommended, and used to improve the practices at the various hospitals and by site visits. The following quality of work in administration, patient records, health services, and hospitals were used for the study: Effia Nkwanta Regional Hospital, research [13-15]. During the nineteen-eighties, at the inception of the Takoradi, Western Region, Komfo Anokye Teaching Hospital, use of ICT-tools in most developed countries, the use of ICT-tools Kumasi, Ashanti Region, Korle-Bu Teaching Hospital, Accra, Greater were not an issue or at best a matter of low priority in Less Developed Accra Region and Tamale Teaching Hospital, Tamale, Northern Countries (LDC) [16]. Region. These four major hospitals in Ghana were studied and the type of records system being used at these facilities. National reports on Given the complex nature of healthcare delivery and the numerous health, and national health insurance scheme reports were reviewed. decisions that must be made, sometimes under very challenging circumstances, the need for accurate, reliable and timely information Only public hospitals were involved in this study. becomes very crucial. Paper-based records cannot provide the flexibility Korle-Bu Teaching Hospital (KBTH) and leverage that Electronic Health Record (EHR) presents. The KBTH is a tertiary hospital in Ghana. It is one of the busiest The ministry of health (Ghana) clearly identifies the need for an hospitals in the sub-Sahara. It has the only Cardiothoracic Centre in efficient health information management system. the country. Medical work is a highly complex, distributed, dynamic, regulated, The hospital was founded in 1923 as the Gold Coast Hospital. The knowledge-intensive and often time-critical activity. To make treatment then Governor, Gordon Guggisberg laid the foundation for Korle-Bu of ill and/or injured patients possible in these time-critical, specialised and physically distributed work settings, medical staff constantly needs to cooperate with each other. Cooperation in these distributed *Corresponding author: Emmanuel Kusi Achampong, Department of Medical medical work settings requires extensive coordination between the Education and IT, School of Medical Sciences, University of Cape Coast, Ghana, medical actors involved. To facilitate this coordination medical work is E-mail: [email protected] heavily regulated by procedures and conventions, as well as supported Received May 16, 2012; Published July 30, 2012 by a number of technologies like paper documents and analogue films Citation: Achampong EK (2012) Electronic Health Record System: A Survey in that are used by a large number of medical actors for many different Ghanaian Hospitals. 1: 164. doi:10.4172/scientificreports.164 purposes. These technologies are not isolated artefacts but social and Copyright: © 2012 Achampong EK. This is an open-access article distributed material parts of work. under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the Over the years, the government being the principal health care original author and source are credited. Volume 1 • Issue 2 • 2012 Citation: Achampong EK (2012) Electronic Health Record System: A Survey in Ghanaian Hospitals. 1: 164. doi:10.4172/scientificreports.164 Page 2 of 4 Hospital in 1921, and it was finally opened on th9 October, 1923. The 1993 in three out of the ten administrative regions of Ghana, it focused hospital has expanded in phases and now has 1600 beds. on organized collection of data and reporting at the departmental level [17]. Little is mentioned of the success of this intervention though, and Effia Nkwanta Regional Hospital (ENRH) whether it had been replicated in the remaining seven regions of Ghana. ENRH was established in 1938 as a military hospital by the then The District Health Information Management System (DHIMS) is one British West African Royal Frontier Force (BWARFF) based in of Ghana‘s first attempts of modernizing health information capture Takoradi, Western Region. The hospital is currently the third largest using ICT. It was first piloted in twenty districts across the country and hospital in the country after Korle-bu and Komfo Anokye Teaching then deployed in all district/municipal health hospitals/administrations Hospitals. throughout the country in 2007. The software is used to capture data solely for management and policy development. The data captured is The administration, with the Medical Director as the head, has forwarded to regional Health Administrations for analysis and onward the oversight responsibility of the daily operations of the hospital. The transmission to the National Health Administration (the Ghana Health hospital is organized into an Outpatient Department (OPD) and an Service [GHS] and/or the Ministry of Health). Inpatient Department. The OPD is usually the first point of call for all visiting patients. At the OPD, patients are triaged and referred to the The Ministry of Health has however identified poor human appropriate consulting rooms. Based on the outcome of the consulting, resources, low levels of investment in ICT, and the uncoordinated patients are either admitted as inpatients or outpatients. The hospital nature of Health Information Systems (HIS) deployment as some of is also organized into several wards, namely the Maternity Clinic, the start-up challenges of an effective HIS. Steps have been taken by the Paediatric Ward, Surgical Ward (Male/female), Intensive Care Unit, Ministry of Health to address the human resource challenge through Causality Ward, and the Gynaecology Ward. the development of a curriculum to train health information officers at the Kintampo Rural Health Training School. Some public and private The hospital has a bed capacity of 416 and a total workforce of universities have also started running programmes in health informatics about 572. It offers practical training for health service administrators, to augment what the ministry of health is doing. The University of student nurses and other medical house men and interns. Ghana and Kwame Nkrumah University of Science and Technology have started Master of Science programmes in health informatics Komfo Anokye Teaching Hospital (KATH) whilst the Catholic University College is running a Bachelor of Science KATH is located in Kumasi, the Regional Capital