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Challenges of Professional Management of

Medical Records in Nigerian Public Hospitals.


Victor Chibueze Ijeoma.
Victor Chibueze Ijeoma is a Higher Medical Records Officer with the Health & Human Services Secretariat;
Federal Capital Territory Administration (FCTA), Abuja, Nigeria with current posting at Wuse District Hospital. He
s with the hospital. He studied Health Information Management at the
Ahmadu Bello University Teaching Hospital (ABUTH), Zaria-Nigeria. He also holds a Postgraduate Diploma in
Education and various other diplomas and certificates in different academic disciplines. He is certified by the Health
Registration Council of Nigeria, as a Registered Teacher. He can be reached at: chibuezeijeoma@gmail.com .

Abstract
healthcare facility cannot be overemphasized. However, when professional and effective
management of this record is hampered, it impacts negatively on the generality
This study employed a cross-sectional survey to identify some of the problems which militate
against effective and professional medical records/ health information management practice in
FCT public hospitals. Sample size was one hundred and forty-three (143) constituting ninety-six
percent (96%) of the total one hundred and forty-nine staff population in the Medical Records
departments of three selected FCTA hospitals. Data were collected using self-administered,
structured Questionnaire. Data entry and validation was done on a laptop computer using EPI
info software. Although this survey was conducted on both non-professional and professional
Health Information Management personnel, both group completely agree that the profession, in
their respective hospitals, is dominated by quacks and that there were limited number of skilled
professionals in their various departments. Similarly, 143(100%) of the respondents strongly
agree that lack of Medical Records Management standards & policies in their respective
hospitals, is also one of the problems hindering effective and professional medical records
management practice in Nigeria. Based on research findings, it is recommended, among others,
that there should be prohibition against the practice of Health Information Management by
quacks and this should be grounded on the need of the patient in particular and the profession at
large to maintain integrity and competence among those who undertake to render qualitative
health information services.
Introduction
Health Information Management (HIM), also known as Medical Records Management, is the
scientific practice of acquiring, analyzing and protecting and preserving both digital and
traditional health information/ medical records which are vital to providing quality and timely
1

health care services.


Mogli (2009), as an orderly written report of the patient (that) contains the identification data,
course; when complete, it should contain sufficient data to justify the investigations, diagnosis,
treatment, length of stay and end result. The medical records/health information is a powerful
identify problems or patterns that may help determine the course of health care, (Tomasi et al,
2004).
One of the primary purposes of the medical record is to enable healthcare professionals to
provide quality health care to their patients. It is a living document that tells the story of the
patient and facilitates each encounter they have with health professionals involved in their care.
legal, regulatory and auditing requirements. Most importantly, however, they will contribute to
comprehensive and high quality care for patients by optimizing the use of resources, improving
efficiency and coordination in team-based and inter-professional settings, and facilitating
research. This is achieved through some of the following ways:
Quality of care: Medical records contribute to consistency and quality in patient care by
.
Continuity of care: Medical records may be used by several health practitioners. The record is
not just a personal memory aid for individual physicians; it allows other health care providers to
health status.
Assessment of care: Medical records are fundamental components of external reviews, (such as
those conducted for quality improvement purposes), investigations, billing reviews (records must
be properly maintained to enable third-party
-assessments
(whereby physicians reflect on and assess the care they have provided to patients.
Evidence of care: Medical records are legal documents and may provide significant evidence in
regulatory, civil, criminal, or administrative matters when for example; the patient care provided
by a physician is questioned. There are usually policies that impact on the legal requirements for
medical records. These policies often explain how medical records must be kept; outlining
general requirements and considerations about the collection, use, storage, and disclosure of
example, the Ontario Regulations made under the Medicine Act, 1991 of the Canadian Law,
outlines requirements with regard to access and retention periods to ensure continuity of care for
patients. The policy concludes by listing requirements for the contents of medical records,
explaining what must be included in records and how it must be documented, (Physician
Advisory Service, 2012).

facility is the exclusive responsibility of Health Information Management (HIM) professionals,


HIM professionals are highly trained in the latest information management technology
applications and understand the workflow in any healthcare provider organization from large
hospital systems to the private physician practice. They are vital to the daily operations
management of health information and electronic health records.
2

Health information management professionals plan healthcare information systems,


develop health policy, and identify current and future health information needs of healthcare
organizations in particular and the nation at large. In addition, they may apply the science
of informatics in the collection, storage, analysis, use, and transmission of information to meet
legal, professional, ethical and administrative records-keeping requirements of health care
delivery. They work with clinical, epidemiological, demographic, financial, reference, and coded
healthcare data. They play very critical role in the delivery of healthcare. For example, Health
information administrators have been described to "play a critical role in the delivery of
healthcare in the United States through their focus on the collection, maintenance and use of
quality data to support the information-intensive and information-reliant healthcare system",
(LaTour, et al 2010).
Health Information Management is a very broad and successful field ofthe healthcare
profession. There are several career opportunities in the field and many different traditional and
non-traditional settings for an HIM professional to work within.
Traditional settings include: Managing an HIM/Medical Records Department, Cancer
Registry, Coding & Indexing, Trauma Registry, Transcription & Translation, Quality
Improvement, Release of Information (ROI), Patient Documentation & Registration,
Medical Audit, and Utilization Review among others.
Non-traditional settings include: Consulting firms, Government agencies, Law firms,
Insurance companies, Managed Care, Health Maintenance Organisations (HMOs),
Correctional facilities, Extended care facilities, Pharmaceutical Research, Information
technology and Medical software companies (for EMR), (Alberta Occupational
Profiles, 2011).
Medical Records/Health Information remains the principal repository of a patient's health care
information, so every health organization needs a Medical Records/Health Information
Management Department that is organized and staffed with only professionals so as effectively
discharge their required responsibilities, (Perspectives on Health Information Management,
2006). Afolabi (1999) asserts that medical records management practice in Nigeria has a number
of problems which may include insufficient skilled and experienced professionals. Other
challenges to effective medical records management have been identified to include the use of
quacks, insufficient storage facilities, lack of clear national policy on medical records
management among others. Accordingly, Utulu (2001) observes that these problems adversely
affect proper healthcare planning for the provision of facilities, adequate funding, proper
formulation and review of healthcare policies, among others, since there would be lack of
accurate and reliable health information to make the required decisions.
th information/medical records to a functional healthcare
facility cannot be overemphasized. It has been identified as the life wire of any level or type of
responsibility of the Health Information Management professionals. Where this very important
responsibility is left in the hands of quacks for example, the healthcare facilities inadvertently
place the lives of patients at risks since quality of healthcare would no doubt be compromised.
3

This research sought to identify the challenges which militate against the professional
Main objective of this study
is to determine these challenges and proffer useful recommendations based on research findings,
on how to address them.
Research Questions
The study sought answers to the following questions:
i.
ii.

What are the main benefits of effective and professional medical records
management practice in public hospitals?
What are the major challenges hindering the effective and professional

Review of Related Literature


The history of Medical Records keeping runs parallel with history of Medicine itself. The first
However, in the 1920s, professionals came to a realization that documenting the provision of
healthcare was of great value to health care providers and to patients themselves, and because
medical records of this day were documented only on paper, the first professional group were
of books because all patient treatment was recorded on
paper (Denise, 2010).
Paper medical records were kept and maintained in steadfast fashion from the 1920s
forward; but as the development and deployment of the computers began in the 1960 and 1970s,
pioneering American Universities began exploring the marriage of computers and medical
records. Health Information Management (HIM) practice which started as a primary way of
ents by
healthcare professionals has now evolved over these years.
Today, the practice has grown beyond bounds and has come to assume global acceptance
equally directs the way in which healthcare is shaped and managed through robust statistics,
case-mix abstracting, intelligent data gathering facilitated by effective medical information
management applications.
In Nigeria, Medical Records keeping is also rapidly developing particularly in the
teaching hospitals and some general hospitals even though many hospitals still continue with
crude method of keeping records, as patient's notes are kept in various ways. The early records
keepers, keeping their records accordin
usually bound into books. Thus, if a patient was admitted several times, his notes were
distributed through a number of large books, and to check for the information about a patient
then becomes a cumbersome task, (HIMAN Journal, 2011). Another practice was to file
4

according to disease and this again meant that records were spread out and very difficult to
collate. Whatever is done with records, the first consideration is the patient. Records are kept for
the benefit of the patient and the attending physician in order to help him to follow the progress
of treatment and the best way to do this is to keep the records in a useful way so that the Doctor
can handle them easily. The modern method in the teaching hospitals is that each patient has a
folder which is kept throughout his or her treatment in the folder this facilitates easy approach to
information and necessary and necessary details.
In early period of orthodox medicine in Nigeria, the numbering system was introduced and the
serial numbering system was adopted. This means that a patient receives a new number each
time he or she is admitted to or treated in the hospital. If he registered five times, he acquires five
different admission numbers. This system made the tracing of case note very difficult.
With the establishment of teaching and comprehensive health care facilities across the
nation, detailed medical records management become a necessity; it is no longer a sketchy
reflection of the patient's chief complaint contained on one line of a log book. Medical record of
this time is now a detailed account of every aspect of a patient's care from the moment he/she
enters a hospital until he/she is treated conclusively.
As the sketchy picture of a patient's care has begun to expand with details, so too has the
role of the medical record responded to the needs of a complex health care system. Information
educational programmes, research activities and the assessment of the quality of patient care,
(HIMAN, 2011). Relevant data moves with patient from one health care provider to another in
response to the needs of a mobile society. Hospital planning activities are often based on trends
in population and patient care needs indicated by available recorded data in patient's records.
In addition, the technological advances have encouraged Nigerian hospitals to compile, organize
and store vast amounts of patient's data. Microfilm storage which hitherto made it possible to
way for the use of the computers. Electronic health records are now the new trend and some
hospitals are gradually expanding their systems to embrace this new challenge. There are no
doubts that as changes occur in the HIM profession, personnel are also expected to develop
themselves to become ready to embrace these changes.
To be considered as a Health Information Management professional in Nigeria, especially
in terms of educational qualifications and for the purpose of registration, the acceptable
minimum qualifications, under the HEALTH RECORDS OFFICERS (REGISTRATION, ETC.)
ACT [1989 No. 39.]; include a National Certificate, National Diploma, and BSc/HND in Health
Registration Board of Nigeria (The Board).
Positioned at the heart of the health care system, health information managers' (HIMs)
professional responsibilities cover the collection, storage, analysis and distribution of healthcare
the information systems and data central for medical decision making and patient care planning.
HIMs coordinate many kinds of healthcare information, from a variety of sources including
paper-based and in the electronic formats.
5

Other major functions of Health Information Managers include:


The design and management of information systems in the healthcare system.
Collection and generation of records and reports about patients who are being treated by
doctors and other clinicians.
HIMs use their clinical knowledge of disease and surgical procedures, technical knowledge
of computer systems and databases and their management skills to set up and monitor these
systems.
HIMs also play a key role in the security and legal use of people's medical records and
health information by establishing appropriate procedures and handling and protecting
personal data, (HIMAA, 2012. Accessed: 13/11/2014).
Medical Records are a clinical, scientific, administrative and legal document relating to
patient care in which sufficient data is recorded by trained professionals as per sequence of
events to justify the diagnosis and therapy, giving the results thereof are in accordance with
reasonable expectation of present day scientific medical care.
It is in other words a performance barometer of the hospital, (Vision 2020 e-Resource, 2013).
Cahill (2014) identifies medical records as an indispensible tool in healthcare. He observes that
care to other healthcare professionals. Another major rationale is that a well-documented medical
Medical Records Management has now become an integral and indispensible activity of the
hospital management. It provides multiple benefits not only to the patients but also to running a
hospital efficiently among other benefits.
However, these benefits cannot be fully harnessed because of the diverse problems and
challenges which militate agai
information/medical records, particularly in most public hospitals. The concept of inadequate
medical records for example, is one very important hindrance to medical records management.
For this purpose, NHS Code of Practice (2006), states that Inadequate medical records will
mean the healthcare professional is unable to defend his/her practice and decisions about patient
care in a legal or professional context. Accurate and complete documentation in the medical
record is essential in facilitating and enhancing communication in collaborative patient care
models.
There are standards governing all aspects of Medical Records management. In Nigeria
and of course in many other countries where Health Information Management practice is still
developing, there is near to complete lack of Medical Records Standards and Policies. According
to Remote Health Atlas (Undated), one major problem to management of medical records in
public hospitals is lack of Medical Records Management standards and policies. This poses a
great hindrance to the effective management of medical records as personnel are unable to
efficiently carry out the core responsibilities of the profession following international best
practices. For instance, according to Roper and Millar (2009); due to lack of standards and
policies, Medical Records professionals would not be able to draw up a Medical Records
6

Management Strategy. The hospital authority must have an agreed strategy for managing all
need to include: a Medical Records Management policy, a clear statement of the responsibilities
of all cadres of the HIM personnel for the purpose of job description, storage media and security
of the records, confidentiality and privacy, Release of Information, Records Retention and
preservation policies, as well as policies bordering on the final destruction of such records.
The menace of quackery seems to be the greatest problem bedeviling the Health
Information Management profession in Nigeria particularly in Federal Capital Territory public
hospitals. Concern for this problem is governed by broad consideration of professional ethics,
social policy a
patients from the hidden dangers of dealing with unqualified or unlicensed practitioners.
Essentially, the process of documentation, analysis, storage and dissemination of patient
information must be effectively controlled in such a manner that will guarantee that operations
conform to standards. Unfortunately the influx of unqualified persons in the practice has posed
dangerous threat to health information practice, Perspective Health Management (2006).
In Nigerian healthcare sector, many reasons can be adduced why some hospitals (private
or public) do engage the services of quacks. The following may subsist:
1. Ignorance: - Cases abound where some hospital proprietors particularly in the private
sector ignorantly engage the services of quacks to perform health information services.
And some take advantage of
enforcement regulatory body which obviously
lack determination to ensure compliance with standards.
2. Cost incentive: - The private sector can hardly (mainly for economic reasons) afford to
engage professional health information officers; they thus ultimately seek out a much
cheaper alternative. Health information services rendered by unqualified persons are
unusually below standard of practice for a much lower cost.
3. Funding: - Lack of fund often time promotes quackery. Typically, the management of a
health facility may be constrained with insufficient fund. In such situation, the health
facility may not even have health information department let alone qualified health
information officer, (HIMSS, 2008).
4. Unemployment: - In this part of the world, with over dependency on oil which price is
dwindling, the level of unemployment thus seems to be on the increase. Therefore
applicants are so desperate to take up job without requisite for any amount.
5. Attitude: - There have been immense improvement in the practice of health information
and medicine in general. It is bewildering of course, to note that some hospital owners in
recent years have shown the tendency towards smugness in engaging unqualified hands.
Most tends to work significantly for self and economic interest much more than for
common good of the patients.
Such unfortunate tendencies aid quackery and often make a caricature of the health information
management profession.

A traditional medical record keeping requires large and secured storage space. In Nigerian
public hospitals particularly those of the Federal Capital Territory Administration, the Medical
Records/Health Information Management Department face the problem of inadequate storage
facilities. Regardless of their formats, Medical records must be stored in a safe and secure
environment to ensure physical and logical integrity and confidentiality. In a similar survey
conducted by Oghenetega and Oghenovo (2008), over 80% of their respondents agreed that
inadequate storage facility was one of the greatest problems militating against the efficient
qualified HIM experts are able to better manage medical record storage and retrieval problems,
inadequate storage has continued to mal their professional practice. Not only can they keep
patient charts more organized and accessible (e.g., through efficient systems for periodic
purging, processing retrieval requests, and training staff on procedures), they fully understand
the importance of meeting record storage and retention mandates but requires the enabling
environment to be able to effectively function, (AHIMA, 2009).
Similar to the problem of inadequate storage facility is that of filing system. Medical records
filing include designing and developing the structure of the health information management
folder. The system must be easily accessible, organized and protects the confidentiality of
many public hospitals where there are insufficient filing shelves and cabinets and as a result,
cked on the floor thereby subjecting them to damages.
Not only that, retrieval in this case becomes a very tedious and time-consuming task which
equally make the job awkward. When Iwhiwhu (2005) conducted a similar research in 2005
with public hospitals in Oyo State, southwest Nigeria as a case study, results of findings was that
66% of these hospitals do not have adequate storage and filing shelves and a result, situations
big draw-back to
professional management of medical records in public hospitals.
Another challenge is the problem of arrangement of the contents of a case folder, after the
discharge of the patient. This is one of the core responsibilities of the HIM/Medical Records
personnel, particularly the technicians. It is common to note that in all FCTA public hospitals,
order. HIMAN (2011) notes that on discharge of the patient, the medical record should be rearranged before it leaves the Nursing Unit; and the pages put in order of filing according to
hospital preference. The medical records of discharged patients are usually sent by a ward
attendant to the Medical Records Department as soon as possible after discharge of the patient,
and certainly not later than 9.00 am the following morning. Thus, they will be available for
prompt processing by the medical records/HIM personnel and for the physician or anyone else
who
may need it for reference.
Arrangement of a source oriented record for permanent filing finds the information falling in
three main sections - Identification, Medical and Nursing. Within each of these sections the
medical records forms are arranged in chronological order.
The following, according to Health Information Managers Association of Nigeria (HIMAN)
2011, is a typical arrangement for permanent filing:8

i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.

Diagnostic summary index


Admission and Discharge Record
Consent forms
Discharge summary
History and physician examination
Consultation Report
Progress Notes
Physician's orders.
Reports - Laboratory, x-ray, special treatment, Anaesthesia, operation.
Graphic Record
Nurses Notes
Autopsy report and authorization for autopsy.

Oghenetega and Oghenovo (2008) identified other problems posing as barriers to


effective medical records management practice in Nigerian public hospitals to include
inadequate funding provision for the day to day running of the department, low morale and lack
of motivation of personnel, among others.
Methodology
The settings are three (3) selected public hospitals of the twelve secondary healthcare facilities of
the Federal Capital Territory Administration (FCTA).
The three (3) selected are Wuse District Hospital (WDH), commissioned in 1991 as a
primary healthcare facility and latter transformed to a secondary facility. It is presently located at
the Wuse district commercial hub and serves the immediate environs of Wuse II, Central Area,
Gwagwa/Karmo, Nyanya, Garki, and even beyond the FCT. The hospital is growing in services
with the provision of modern equipment and existence of professionals in different fields. It
currently has staff strength of forty-eight (48) professional and non-professional personnel at its
Medical Records Department.
The second setting is the Asokoro District Hospital (ADH), commissioned in 2005 with total
staff strength of fifty-three (53) at its Medical Records department. It is presently located at the
Asokoro district of the FCT and serves the immediate environs of Asokoro, Kuruduma, Karu,
Nyanya, Central Area, Garki, and even beyond the FCT. The hospital is growing in services with
the provision of modern equipment and existence of professionals in different fields.
The third is Maitama District Hospital (MDH), also commissioned in 2005 and currently
with forty-eight (48) deployed at its Medical Records department.
Medical Records/Health Information Management is one of the very important departments
of the hospitals and it plays a crucial and inevitable role. It is the first point of call of patients and
their relatives and it is the communication life-wire of the hospital in terms of healthcare
delivery. These three hospitals are located in the heart of the territory and were thus chosen for
this study because of the role models they are expected to play to the other nine hospitals which
are essentially located in more remote locations.
The target population was the sum total of one hundred and forty-nine (149) staff comprising
both professional Health Information Management personnel and other workers who do not have
9

any qualification in the Health Information Management profession, but are currently working to
the Medical Records Department of these three FCTA public hospitals. Categories of the
professionals included Senior Medical Records Officers (SMRO), Higher Medical Records
Officers (HMRO), Medical Records Officers (MRO), Senior Medical Records Technicians
(SMRT), Higher Medical Records Technicians (HMRT), and Medical Records Technicians
(MRT), while those without any HIM qualification included Senior Administrative Officers,
NYSC Corps members, and other Casual workers.
The research design used in the study is a cross-sectional survey method to obtain
effective and professional medical records/ health information management practice in FCT
public hospitals.
A total sample size of one hundred and forty-three (143) constituting ninety-six percent
(96%) of the total one hundred and forty-nine staff population was drawn using Sample Size
Determination by Decision Analyst STATSTM 2.0 with a maximum acceptable percentage point
of error of 5% and 95% confidence level, (Table3.2). Of this total sample size, fifty-one (51) was
drawn from Asokoro District Hospital; while equal sizes of forty-six (46) were drawn from Wuse
and Maitama District hospitals, respectively; (Fig. 3.1).
Hospital
No. of MRD Staff
No. of Respondents
ADH
53
51
WDH
48
46
MDH
48
46
TOTAL
149
143
Fig. 3.1: Number of Respondents drawn from each of the hospitals.
Sampling technique was the Stratified Random Sampling by considering the different
hospitals and various ranks/categories of the personnel as the strata. The method ensured that
sample sizes were drawn from each hospital and category in proportion to the number of
personnel in them. Number of respondents represents certain percentages of the number of staff
in their respective ranks/categories.

S/N

Rank/Category

No. of Staff

No. of
Respondents

Senior Medical Records Officers

Higher Medical Records Officers

Medical Records Officers

13

13

Senior Medical Records Technicians,

13

13

Higher Medical Records Technicians,

19

18

Medical Records Technicians

21

20

Senior Administrative Officers

29

27
10

8
9

NYSC Corps members


Casual workers.

18
21

17
20

Total
149
143
Table3.2: Sample size determination using Decision Analyst STATS 2.0 software.

Data were collected using Questionnaires. The type made use of here is the selfadministered, structured Questionnaire. This is in cognizance of the level of the academic
departments of the selected hospitals.
A total of one hundred and forty-three (143) structured questionnaires were prepared and
validated by a Chief Medical Records Officer of the Federal Capital Territory Administration.
Fifty-one (51) of the questionnaires were administered randomly to the staff of the nine different
ranks/categories in the Medical Records Department of Asokoro District Hospital; equal sizes of
forty-six (46) were administered each at Wuse and Maitama district hospitals respectively.
Respondents were allowed up to three days to carefully study the questions properly for better
understanding to enable them answer them to the best of their knowledge. The questionnaires
were all duly completed and returned within same time frame with no attritions. All the returned
questionnaires had no errors in them, hence were all usable.

Questionnaires were checked for completeness, and thereafter coded for data entry. Data entry
and validation was done on a laptop computer using EPI info software. The data was presented
in form of frequency tables, charts and cross tabulations. The quantitative data generated from
the study are presented in form of tables and charts, and analyzed as descriptive frequencies and
percentages.

Results and Discussion of Findings


A number of tables and charts were used to present data findings. Data collected was analyzed
according to the nature of Responses. Once the coding were completed, the Responses and
Results were cumulated and converted to Totals, Averages, and Percentages .The chapter also
dwelled on the discussion of the results of analyses table by table after each analysis. These
discussions were used in drawing the conclusion at the end of the report.
Analysis of Respondents with respect to being professional or non-professional Health
Information Managers.
Table4.1 below shows that out of the one hundred and forty-three respondents, only
seventy-eight of them representing about fifty-five percent (55%), are professional Health
Information Managers, while a commanding 45% are non-professionals. Breakdown of this
11

figure reveals that out of 51(100) respondents at Asokoro District Hospital, only 28(55) were
professionals; out of 46(100) at Wuse District Hospital, only 28(61) were professionals while
Maitama District Hospital had the least number of 22(48) professionals out of the forty-six
respondents.
Professionalism is something every branch of healthcare must present to their patients in
particular, and the public and colleagues in general. A successful and well-respected profession
is one which integrates professionalism into all aspects of its operations, especially in
recruitment and training. Having even one quack, to do any part of the works of professionals in
the healthcare
the lives and
of patients,
patients, (Rasmussen,
healthcare sector,
sector, can
can only
only endanger
endanger the
and well-being
well-being of
2014).

HOSPITAL

NO. OF
PROFESSIONALS (%)

NO. OF NON- TOTAL NO. OF STAFF


PROFESSIONALS (%) AT THE MRD (%)

ADH

28( 55 )

23( 45 )

51(100)

WDH

28(61 )

18( 39 )

46(100)

MDH

22( 48 )

24( 52 )

46(100)

TOTAL
78(55 )
65(45)
143(100)
Table4.1: Numbers of professional & non-professional Health Information Managers at the
Medical Records Departments of the three hospitals that responded to the survey. ADH-Asokoro
District Hospital; WDH-Wuse District Hospital; MDH-Maitama District Hospital; MRDMedical Records Department.

Analysis of Professional Responsibilities of Respondents by Gender.


s/n

1
2
3
4

Rank/Category

Senior Medical
Records Officers
Higher Medical
Records Officers
Medical Records
Officers
Senior Medical

No. of Staff
M (%) F (%)

2(33)

Total
(%)

4(67)

No. of Respondents
M (%)
F (%)
Total
(% )
2(33)

4(67)

6(100)
3(33)

6(67)

6(100)
3(33)

6(67)

9(100)
5(38)
9(69)

8(62)
4(31)

9(100)
5(38)

13(100)
13(100)

9(69)

8(62)
4((31)

13(100)
13(100)
12

Records Technicians,
Higher Medical
Records Technicians,
Medical Records
Technicians
Senior Administrative
Officers
NYSC Corps members
Casual workers.

5
6
7
8
9

Total (%)

9(47)

10(53)

8((38)

13(62)

9(31)

20(69)

8(44)
8(38)

10(56)
13(62)

29(100)
18(100)
21(100)

61(41)

88(59)

149(100)

9(50)

9(50)

8(40)

12(60)

8(30)

19(70)

8(47)
8(40)

9(53)
12(60)

27(100)
17(100)
20(100)

83(58)

143(100)

19(100)

18(100)

21(100)

20(100)

60(42)
Table4.2a: Percentage of Respondents by gender. M=Male; F=Female
From Table4.2a, six (6) of the respondents were Senior Medical Records Officers; nine (9) are
Higher Medical Records Officers; thirteen (13) were Medical Records Officers, thirteen 913)
were Senior Medical Records Technicians, eighteen (18) were Higher Medical Records
Technicians while twenty (20) of them were Medical Records Technicians. Results show that
among the respondents, professional officers made up 51.3% while the Technicians constituted
48.7% of the Health Information Management professionals
Among the non-professional respondents, twenty-seven (27) were Senior Administrative
Officers, seventeen (17) were NYSC Corps members while twenty (20) of them were Casual
workers.

Analysis of Socio-demographic Characteristics of Respondents by Gender.

Variable (n=143)
A. Age of Respondents (Yrs)
20-24

Male (%)

Female (%)

Total (%)

7(39)

11(61)

18(100)

25-29

9(39)

14(61)

23(100)

30-34
35-39
>40
Total

10(53)
14(37)
20(44)
60(42)

9(47)
24(63)
25(56)
83(58)

19(100)
38(100)
45(100)
143(100)

B. Years in Service

13

1-5
6-10
11-15

24(36.4)
17(65.4)
4(40.0)
15(36.6)
60(42)

42(63.6)
9(34.6)
6(60.0)
26(63.4)
83(58)

66(100)
26(100)
10(100)
41(100)
143(100)

MSc/MHIM

2(66.7)

1(33.3)

3(100)

BSc/HND
ND

17(32.7)
3(60.0)

35(67.3)
2(40.0)

52(100)
5(100)

Cert. in HIM
11(61.1)
Totals
33(42.3)
D. Highest Qualifications for Non-professionals

7(38.9)
45(57.7)

18(100)
78(100)

MSc
BSc/HND
ND
WASSCE
Totals

0(0)
8(53.3)
6(75.0)
24(57.1)
38(58.5)

0(0)
15(100)
8(100)
42(100)
65(100)

Totals
C. Highest Qualification in HIM

0(0)
7(46.7)
2(25.0)
18(42.9)
27(41.5)

Table4.2b: Demographic characteristics of respondents by gender.


Table4.2b shows the demographic characteristics of respondents by gender. Eighteen (18) of the
respondents, representing 13% of them, fell within the age bracket of 20-24years, twenty-three
(23), that is, 16% of respondents, were between 25 and 29years, nineteen (19) were in the age
range of 30 to 34years, while about 32% of them were more than 40years of age.
In terms of years in service, sixty-six (66) of the respondents had worked at the Medical Records
Departments for between 1-5years; twenty-six(26) of them had worked for between 6-10years,
while forty-one(41) which represents 29% of the respondents said they had worked for more than
fifteen years at the department.
Only three (3) that is, 2% of the professional-respondents, had either an MSc or a Masters
in Health Information Management. No one among the non-professionals had MSc/MHIM.
Fifty-two (52) professionals, representing 36% of total respondents had BSc/HND. Among the
non-professionals, only fifteen (15) of them, representing just 10% of total respondents had
either a BSc or HND in disciplines other than Health Information Management. As much as
fortynon-professionals can be considered just too much for a healthcare field whose functions help
determine the overall quality of healthcare. Having this large number of what has been described
as quacks in this very important field is surely a factor militating against effective Health
Information Management Practice in Nigerian Public Hospitals.
Analysis of Responses on the Benefits of effective and professional medical records
management practice
Benefits of effective and professional
medical records management practice

1.

Supports patient treatment and


care

SA

SD

n(%)

n(%)

n(%)

n(%)

Response
Count
N(%)

140(98)

3(2)

0(0)

0(0)

143(100)

14

2.

3.
4.
5.
6.

Serves as a means of
communication between
physicians and other health
professionals
For research purposes
For Legal purposes
For Billing purposes
Serves as corporate memory
for the hospitals

141(99)

2(1)

0(0)

0(0)

143(100)

120(84)
100(70)
100(70)
140(98)

10(7)
15(10)
20(14)
3(2)

13(9)
28(20)
20(14)
0(0)

0(0)
0(0)
3(2)
0(0)

143(100)
143(100)
143(100)
143(100)

Table4.3a: Analysis of responses on the Benefits of effective and professional medical


records management practice.
Table4.3a shows the analysis of responses on the benefits of effective and professional
medical records management practice, based on the Likert Scale. One of the fundamental
benefits of effective and professional medical records management practice is that it supports
effective patient treatment and care. This was highly acknowledged by a majority of the
respondents in which 140(98%) of them strongly agree. Similarly, 141(99%) strongly agree that
such professional practice would surely make available a high quality medical records which
would serve as a means of effective communication between physicians and other health
professionals. This is in support of HIMAN Journal, 2011 which stated that one of the uses of
medical records is its use as communication between the physician and other professions
contributing to patient care.
In fact, results show that almost all the respondents strongly agree to the core benefits of
effective and professional medical records management practice in Nigerian public hospitals.
There was no doubt among respondents that such benefits and uses included for research, legal
and billing purposes as well as its use as corporate memory for the hospitals.

Analysis of Responses on the Factors militating against effective health information


management practice in Nigeria public hospitals.
Factors militating against effective health
information management practice in Nigeria
public hospitals.
1. Lack of Medical Records Management
standards & policy
2. Not well-organized Medical Records
Departments
3. Dominance of Quacks in the HIM
profession
4. Inadequate storage facilities.

SA
n(%)

A
n(%)

D
n(%)

SD
n(%)

Total
N(%)

143(100)

0(0)

0(0)

0(0)

143(100)

28(20)

2(1)

3(2)

110(77)

143(100)

143(100)

0(0)

0(0)

0(0)

143(100)

20(14)

13(9)

10(7)

100(70)

143(100)
15

5.

140(98)

3(2)

0(0)

0(0)

143(100)

records by other professionals


6. Insufficient skilled professionals
20(14)
13(9)
10(7)
100(70)
143(100)
7. Lack of motivation of professionals
15(10)
10(7)
8(6)
110(77)
143(100)
Table4.3b: Analysis of responses on the factors militating against effective health information
management practice in Nigeria public hospitals.
Table4.3b shows the analysis of responses on the factors militating against effective
health information management practice in Nigeria public hospitals. Results show that all the
respondents strongly agree that lack of Medical Records Management standards & policies in
their respective hospitals, is one of the problems hindering effective and professional medical
definitions in Health Information Management, the American Health Information Management
Association (AHIMA) frequently include the word in tandem with such terms as Interoperability,
Standardization, SNOMED, ICD-10-CM/PCS, HIM Practice Standards, Accreditation Standards,
etc. As a result, if one were to ask a Health Information Management professional about
standards used in their daily work, the results would obviously be variable.
While some of these aforementioned standards are even globally recognized, there is no
doubt that they were yet to be domesticated in Nigeria or if in existence, were not wellcommunicated to members of staff of the Medical Records Management department of Nigeria
public hospitals, hence, the 100% strong agreement to that effect.
Only 20% of respondents strongly agree that not well-organized Medical Records
Departments is a factor militating against effective health information management practice in
Nigeria public hospitals. In effect, this same percentage might have argued that there was no
organized Medical Records department in their respective hospitals. However, 77% of them
strongly disagreed and would argue that Nigerian public hospitals do have well-organized
Medical Records departments, as a result, this might not actually be identified as a major factor
militating against effective health information management practice in Nigeria public hospitals.
In fact, Oghenetega and Oghenovo (2008), over 80% of their respondents agreed that Nigerian
public hospitals had functional Medical Records department even though the same percentage
argued that inadequate storage facility was one of the greatest problems militating against the

Although this survey was conducted on both non-professional and professional Health
Information Management personnel, both group completely agree that the profession, in their
respective hospitals, is dominated by quacks and that there were limited number of skilled
professionals in their various departments. This finding is in agreement with Remote Health
Atlas (Undated), which noted that one major problem militating against effective management
of medical records in public hospitals is the insufficient number of medical record professionals
and the dominance of quacks in the system.
Lack of motivation of professionals did not seem to be a renowned factor against
effective and professional medical records management as only 10% of respondents strongly
agree to its effect. This contradicts Oghenetega and Oghenovo (2008) who identified other
16

problems posing as barriers to effective medical records management practice in Nigerian public
hospitals to include inadequate funding provision for the day to day running of the department,
low morale and lack of motivation of personnel, among others.
Summary and Conclusion
One of the primary purposes of medical record is to enable healthcare professionals to provide
prompt quality health care to their patients. This purpose would be defeated if the quality of the
medical records itself is in doubt. Results of findings of this survey have revealed multiple
factors which militate against Effective Health Information Management Practice in Nigerian
Public Hospitals.
Prominent among these factors are the dominance of quacks in the HIM profession,
insufficient skilled professionals, lack of Medical Records Management standards & policy,
facilities.
The 45% dominance of non-professionals in the practice of Health Information
Management is clear evidence that quackery is a major factor impeding effective medical records
Quackery has immense
hazards on the quality of services to the patient, the hospital and the society at large and indeed
an insult to the integrity of the Health Information Management profession. Quacks are not
ethically bound and are not committed to high standard of ethical conducts. Little wonder this
noble profession is yet to attain its rightful position as the blood vessel of the healthcare
professions.

Recommendations
Based on survey findings, the researcher makes the following recommendations and suggestions:
1. There should be a clear policy and standard of medical records practice which
must also be widely communicated to and adhered to by professionals nationwide.
This will enable a professional and effective practice of the profession.
2. Because
in HIM practice, more efforts should be made by public hospitals to embrace the
Electronic Medical Records system currently been adopted by some hospitals.
This would hopefully take care of the space problem and would even have the
ability to store records of larger number of patients.

17

3.
identified as one of the factors. While these professionals may be excused for
their seeming ignorance on the value of the medical records, it is the duty of the
HIM professionals to impress it on them and make them see reason why they
must fill all relevant fields on the forms.
4. The dominance of Quacks in the HIM profession may be as a result of many other
factors which discussion is outside the scope of this work. However, the
researcher sees no justification for compromising quality since this act places
millions of lives on the line. There should therefore, be the prohibition against the
practice of Health Information by quacks and this should be grounded on the need
of the patient in particular and the profession at large to maintain integrity and
competence among those who undertake to render qualitative health information
services.

all stakeholders, the challenges which hinder professional and effective medical records practice
in Nigerian public hospitals would be adequately minimized.
References
Afolabi, M. (1999): Educational training archivists and record managers in Africa: Annual conference procedure
of the Society of Nigerian Archivists, Lagos: SNA, pp. 61-67.
Oghenetega, I. and K.O. Oghenovo (2008): Problems Associated with the Management of Medical Records in
Public Hospitals in Delta State, Nigeria; PNL Quarterly Journal, Volume 76, number 4.
Iwhiwhu, E.B. (2005). Management of records in Nigerian universities: Problems and prospects. Journal of
Electronic Library, 23(3).
Perspective Health Management (2006):Health information management. Pub Med Central Journal List.
Available: http://www.medicaldocoment/record/000/324.pdf.
Roper, M., & Millar, L. (2009): Managing hospital records: managing public sector records. International
Records Management Trust Council on Archives. Available:
http://www.irmt.org/documents/educ_training/public_sector_rec/IRMT_hospital_recs.pdf.
Utulu, C.C. (2001): Quality of university education in Nigeria: Problems and solution. Journal of the
Commonwealth Council for Educational Administration and Management 29(1).
Remote Health Atlas (n.d.). Records management includes ILM. Asus Extimates on Everything. Available:
http://www.asus.net/basics.html.
Cahill, S. (2014). Structuring information and incentives to improve health. Bulletin of the World Health
Organization, 83(8).
Wikipedia (2012):
Health Information Management. Available at:
http//Wikipedia.org/health_information_management. Accessed: October, 2014.
Mogli, G.D., (2009): Medical Records Role in Healthcare Delivery in 21
st Century. Acta Informatica Medica, 17(4).

18

La Tour, H.S., Florax, C., Porsius, A. J. & De Boer, A., (2010): The
completeness of medication histories in hospital medical records of
patients admitted to general internal medicine wards. Pharmaceutical
Sciences..
Tomasi ,H., Yusof, M.M. & J.W. Creswel, (2004): Towards a Framework for Health Information Systems
Evaluation: Proceedings of the 39th Hawaii International Conference on Systems Sciences.
AHIMA, (2009): Development of Medical Records in Kingdom of Saudi Arabia. published in USA.
National Health Survey, (2006): NHS Confidentiality Code of Practice. Department of Health Confidentiality Unit, IPU,
Leeds.

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