Challenges of Professional Management of PDF
Challenges of Professional Management of PDF
Challenges of Professional Management of PDF
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
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
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
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.
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
13
13
13
13
19
18
21
20
29
27
10
8
9
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.
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 (%)
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.
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.
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)
1.
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)
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)
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.
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