CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

The need for advancement into electronic documentation has arisen and therefore

deserving to do a performance check or appraisal to this effect. Health record as defined in

Segen’s Medical Dictionary (2012) is a collection of clinical information pertaining to a patient’s

physical and mental health complied from different sources. This definition has details that

include primary, secondary and tertiary health record (information). The Medical Dictionary for

the Health Professions and Nursing (2012) also defines health records as a comprehensive

compilation of information traditionally placed in the medical records but also covering aspects of

the patient’s physical, mental and social health that do not necessarily related directly to the

condition under treatment.

However, the definition of health records was given a legal twist by Rouse (2017) who

defined it as the documentation of patient health information that is created by a health care

organization. The Legal Health Records are used within the organization as a business record and

made available upon request from patients or legal services.

Health Records are obtained from various sources which include demographic data,

medical history, results of investigations, alert and warnings, and nursing records.

As contained in Segen’s Medical Dictionary (2012), the contents of health records are categorized

as follows:

Demographic Data: This includes population census, birth and death rates, survival rates,

prevalence rates and endemicity rates, fertility rates, life expectancies and other demographic data

variables.

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Medical History: Examinations, diagnoses, treatment (including surgical procedures and drug

therapy);

Results of investigations: labs e.g biochemistry, haematological, and pathological as well as

imaging e.g. plain films; scans and video.

Alerts and warnings: Allergies, blood group, obligatory drugs, extreme reactions (drug and

behavioural).

Record of preventive measures; immunizations, screenings, breast, cervical, facial, occult blood

Nursing Records: clinical correspondence and referrals for treatment, consent forms for surgical

procedures, theatre reports, discharge letters, post-mortem reports.

Summarily, Marinic` (2017) outlined the importance of health records to include

introduction to treatment, health data in the pat (history), health records today, recording of

documents (documentation) and patient’s rights including the right to access health information,

blocking, erasure and amendment of the right to demand rectification. Others include the

importance of written statements: health certificates, consent to health treatment, legal invitations

to treat in court (subpoena), photocopying health documents leading to unauthorized disclosure,

divulge and abuse of privileged communication, preservation of documents as the basis for

exercising the rights of the patients: right to privacy and confidentiality, transparency: forensic

verification of standards of operation, Increased data sensitivity requires better protection: e.g.

psychiatric data and psychological health records are extremely case sensitive.

In addition Marinic` (2007) concluded her list with these points: Legal definition of

various health data normality, morality, privacy, security, prohibition to remove health records

from hospitals or clinics using civil statements of limitation available in statutes of limitation

available in study location, private practice: with reference to going concern, severance and

transfer of clinical services, discussion: in health advocacy fora, workshops, conferences, talk

2
shows and lectures, considering clinical and parental social responsibilities..

However, the manual method of health records documentation faces myriads of constraints which

include usability constraints, interoperability constraints, traceability constraints, storage

constraints, space constraints, economic constraints, social constraints, political constraints.

Usability constraints: Some records are made using traditional signs and symbols that are

unorthodox and may not be easily transferable without the creator as well as an interpreter.

Interoperability constraints: Some hand written records may have poor legibility and rare

mnemonics which fall short of common empathy across the field of health care practitioners.

Traceability constraints: Manual records have susceptibility to damage, wear and tear from

constant usage. This can lead to loss of vital records, histories and facts.

Storage constraints: Lasting records and health care maintenance usually needs storage immune

to unauthorized entry and divulgence. This may result in destruction of records rather than illegal

expose of medically restricted information.

Space constraints: Manual records demand space and cases where departments are separated

from each other by up to a kilometer. The workers can be short charged in energy as they do the

job.

Economic constraints: The space constraint above may necessitate the use of official trolleys are

tracks within the health care facility. This highlights ambulatory services for patients and records

which can be economically limited.

Social constraints: Perception of the value of the medical records workers may fall short of

standards of health workers leading to neglect of the office practice and the workers themselves.

Political constraint: Health provision may be challenged by other ministries, departments and

agencies such that expectations are no met and working targets are not optimally achieved.

It is in an attempt to remove the foregoing constraints that electronic health record was
3
introduced. The impact of documentation in medical and health records is one that actually

defines the basis for orthodox medical practice all over the world. The next pedestal is one that

redefines the distinction between manual and electronic documentation of medical and health

records.

1.2 Statement of the research problems

This research work is carried out with a view to tackling these problems. The dearth of

global best practice models in electronic health/medical records keeping in minna urban. The

continued use of manual record keeping has persisted with much hospital management

challenging the point that electronic health records is neither safer nor cheaper.

The economic contest of the practice of electronic health/medical records keeping in

Minna. The lack of trained staff and expertise in the use of the EHR/EMR has made the prospect

have the task of training of existing staff to use the electronic equipment and install them as well

with scarce resources.

The persistence of manual medical records keeping in the face of ultra modern electronic

health/medical records equipment in Minna urban. Bearing in mind the cost implications of the

practice of EHR/EMR many health care organizations have preferred to be conservative and

remain with the manual record keeping systems.

The failure rate of the EHR/EMR frameworks already installed in the specified area of

study calls for concerns. At times high spiritual attempts have failed due to sub-optimal hard

waves and software applied leading to glitches in the installation such that make them fail

especially with unwholesome or Island networks or workstations.

1.3 Objectives of the study

4
 The main aim of this study is to appraise the electronic medical/health record principles

and practice in General Hospital Minna. However the specific objectives are;

1. To determine the extent to which the hospital comply with the principles and practice

of electronics health records.

2. To determine whether the hospitals have benefitted from their compliers with the

principles and practice of electronic health/ medical records

3. To determine the challenges faced by the hospitals in their compliance with the

principles and practice of EHR/EMR.

1.4 Significance of the study

The outcome of this study would be beneficial to many stakeholders in the healthcare

management enterprise including health maintenance organizations (HMOs), health insurance

brokers, health care providers, health care professionals, patients as well as ministries,

departments and agencies (MDAs) of government.

To the health maintenance organizations, the result of the study will provide a realistic

standard from which to build operational frameworks and limits of interoperability and usability.

HMOs may decide on intrinsic efficiency benchmarks discernible from this study.

To the health insurance brokers, the result of this study will enable them to ascertain,

determine, and assess healthcare options with a view to brokering for reconciliations in upgrades,

audits, technical inputs, professional standards and healthcare assurance of ethical and legal

compliance.

To the healthcare providers, the result of this study will show pointers to electronic

health/medical records options that are in contemporary use and possible strategies to be applied

5
in their development and awareness campaigns, training and orientation.

To the doctor, the study would help appraise the need, usage and efficiency of EHR/EMR

in the hospitals. This is applicable to health and medical workers.

To other health records professionals, the result of this study will bridge the gap in

understanding the principles of the practice, ethical codes of importance and forensic

applications, tendencies and innovations e.g global best practices in EHR/EMR.

To the ministries, departments and agencies, the supervising and or participatory options to be

used can be assessed for common expectation from healthcare enthusiasts. Feedback information

on development levels on ground and economic possibilities for improvement

and comparative analysis with global best practices.

1.5 Research Questions

This study is academically built to answer these research questions:

4. To what extent do the hospital in possess the requisite the equipment to comply with

the principles and practice of electronic health/medical records?

5. To what extent have the hospital benefitted from their compliance with the principles in

the practice of electronic health/medical records?

6. To what extent are the hospital challenged by their compliance with the principles and

practice of EHR/EMR?

1.6 Scope and Limitation of the study

The scope of the study is a comparative study of operational levels of EHR/EMR in the

hospital. The Limitations of the study are the Hippocratic Oath as applied to health records

professionals, the rules of privileged communication, Confidentiality and legal and ethical

disclosures.

6
1.7 Definition of terms

Conceptual terms applicable to this study have been defined here: Health: An online

encyclopedia Wikipedia (2017) defines health as the level of functional and metabolic

efficiency of a living organism.

The world health organization also defines health as a complete state of physical, social and

mental well being not just the absence of a disease or disorder.

Records in medicine is a chronologic written account in Stedman’s Medical Dictionary (2000)

that includes a patient’s initial complaint(s) and medical history, the physician’s physical

findings, the results of diagnostic test and procedures and any therapeutic medications and/or

procedures.

Electronic health records can be simplified in one definition thus: a construct that use devices,

circuits and systems to control electric flow of information as reviewable collection of data

suitable for storage and use for that maintenance of physical, social and mental well being. This

can be seen in electronic data bases used in health records.

Principle is defined in Stedman’s medical dictionary as a general or fundamental doctrine or

tenet and as the essential ingredient in a substance, especially one that gives it its distinctive

quality or effect.

Appraisal in the researcher’s words means a careful scrutiny of the structure and framework of

an organization, situation or occasion with a view to discerning the operational standards in

comparison with best practice models available in the study sect.

Electronic medical records is a document created, maintained and managed using electronic

gadgets like computers for the purpose of storing clinically significant information medically

7
required for treatment of patient or health statistics.

Practices are tasks, jobs, orders and activities that make knowledge in a field actualized using

tools and instruments as well as principles established in the line of duty.

The principles and practice of electronic medical records are an execution of the record

keeping cycle of records creation; storage, management, retention and disposal using basic

principles encoded practices embodied into the organization or hospital for the basic need of

health care and healthy living.

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 CHAPTER TWO

LITERATURE REVIEW

2.1Introduction

The concept under review is the principle and practice of electronic medical and health

records keeping in designated model hospitals (data models). This review will be built with the

plethora of principles surrounding EMR/EHR i.e. electronic health records. Health and Medical

records keeping are very confidential areas of healthcare usually called the heart of the hospital

which works with dependent principles as the independent variable.

2.2 Types of Health Records

There are two types of health records namely:

1. Personal Health Records

2. Public Health Records

Personal Health Records (PHR)

First, standalone personal health records involve patients filling information from their own

records, and the information is stored on patient’s computers or the internet. In some cases, a

standalone PHR can also accept data from external sources, including providers and laboratories

9
 with a standalone PHR, patients could add diet or exercise information to track progress over

time. Patients can decide whether to share the information with providers, family members, or

anyone else involved in their care. Although this right could be undermined or demeaned by

misplacement, displacement or total annihilation of patients’ rights especially in psychological

medicine.

Tethered/Connected Personal Health Records: A tethered or connected, PHR is linked to a

specific health care organization’s electronic health record (EHR) system or to a health plan’s

information system. With a tethered PHR, patients can access their own records thorough a secure

portal and see, for example, the trend of their lab. Results over the last year, their immunization

history, or due dates for screening. This is an advanced or modern record system which is far

separated from the manual request system is which forms are filled by the patient requesting

official medical certificates that are limited in open access to historical trend unless backed by

legal authorities or courts.

Public Health Records

Public Health records are divided into three sections in this study for the sake of discernible

assertion of obvious health care possibilities on the ground in Nigeria thus primary, secondary

and tertiary health care records.

Primary Healthcare Records include

Health education records, food supply and proper nutrition records, comprehensive maternal

health services including family planning records, immunization delivery records and water

supply and sanitation records.

Secondary Healthcare Records include the five sections of medical records

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 Master name index records, statistical records, medical records library, coding and indexing

records, admission and discharge records…

Tertiary health care records include: Demographic data like vital statistics

Fertility indices, mortality rates, morbidity rates, life expectancies, population (census)

records…

2.3 Conceptual Review

Equipment needed for the Practice of Electronic Health Records Computers: Desktop computers

are computers that are designed to be operated on the desk or table usually having separated

components like monitors, keyboards, speakers and central processing unit or casing. Laptop

Computers are computers designed to be operated on the lap of a person usually light and

compact with all components built into on unit.

Tablet computers are computers designed to be operated on the palm they are at times called

palm top computers.

Health Maintenance organization work stations are computers dedicated for information

services between hospitals, HMOs and patients or clients of the hospital. They serve the

purpose of confirmation of patients as duly insured with relevant deductions. Internet service

network is a closed network system that an organization operates to facilitate business while

keeping customer’s information confidential as seen in banks and hospitals. Hospital website is

an official network center made/design using the name, logo and motto of hospital for the

purpose of public relations, promotion and other essential services to the worldwide web.

Electronic Medical Record Libraries:

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This is an electronic database where clinic based and main clinic based information as well as

the bio data of patients are stored of future references and retrieved.

Medical database management software: These are programmes written to assist health

professionals in the execution of their duties on a general basis.

Patient Biometric registration software: This is a programme designed to capture biological

details of the patients including age, gender, contact details, marital status and finger prints as

well as photograph pictures.

Doctor and nurse- patients’ portals: These are an essential part of clinic based software

designed to capture the clerking sessions between the doctor and patient or nurse and patient.

E – prescription portals and point of sale terminals: Electronic prescription portals enable

distance working relationship between hospital and patients or between HMOs and hospitals to

organize cost management proceedings point of sale terminals are both online and terrestrial in

practice such that credit/debit card information are usually filled into the electronic format for

payments to be made or bills settled. In like manner the credit/debit card can be physically

inserted to into a machine like a table-top POS to settle bills as well.

Cyber Security Network: In surveillance cameras these are a network of video cameras

capturing different parts of the hospital environment with a view to making sure that all entries

are authorized and otherwise detect those that are unauthorized for legal reprimand or correction.

Emergency fire out break controls: These can be physically installed like fire extinguishers

and fire service pipes or automatically operated by

temperature controlled faucets that sprinkle water above certain temperature levels.

Uninterruptible power supply system: This is an electric power supply system that is able to

switch from the national grid to standby generators with minimum interruption of electric power

in the hospitals or organization.

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2.4 Principles for Designing an Electronic Health Records by James Holly

1. Pursue electronic patient management rather that electronic patient records.

2. Bring to bear upon every patient encounter what is known rather than what a particular provider
knows.

3. Make it easier to do it right than not to do it at all.

4. Continually challenge providers to improve their performance.

5. Infuse new knowledge and decision making tools throughout an organization instantly.

6. Establish and promote continuity of care with patient education, information and plans of care.

7. Enlist patients as partners and collaborators in their own health

improvement.

2.4.1 Principles of Documentation for medical Records

According to Center for Medicare and Medicaid services and Trailblazer Health

Enterprises (2016), the ten principles of documentation of medical records are as follows:

1. The medical record should be complete and legible.

2. The documentation of each patient encounter should include; the date; The reason for the

encounter; Appropriate history and physical exam in relationship to the patient’s chief complaint;

Review of lab, x-ray data and other ancillary services, where appropriate; Assessment; and plan

care (including discharge plan, if, appropriate).

3. Past and present diagnoses should be accessible to the treating and/or consulting physician.

4. The reasons for and results of x-rays lab test and other ancillary services should be documented
and included in the medical record.

5. Relevant health risk factors should be identified

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 6. The patient’s progress, including response to treatment, change in treatment, change in diagnosis
and patient non-compliance, should be documented.

7. The written plan for care should include, when appropriate. Treatments and medications,

specifying frequency and dosage; Any referrals and consultations; Patient/family education; and

specific instructions for follow- up.

8. The documentation should support the intensity of patient evaluation and/or the treatment

including thought processes and the complexity of the medical decision – making as it relates to

the patient’s chief complaint for the encounter.

9. All entries to the medical record should be dated and authenticated

10. The CPT/ICD -9-cm codes reported on the CMS-1500 claim form should reflect the
documentation in the medical record.

2.5 Principles of Electronic Health Record Design, Implementation and Policy

There are principles guiding electronic health records design, implementation and policy. These

include as follows:

1. The use of an EHR should add value for the patient.

2. The primary function of an EHR is clinical care

a. Health Care Professionals

1. The use of an EHR should improve, or at a minimum not reduce, the well- being of health care
workers.

2. The use of an EHR should align the work with the training of the worker.

3. The EHR is a shared information plat form for individual and population health.

b. Efficiency

14
 1. The use of an EHR should minimize waste.

2. Electronic work flows should align with clinical work.

3. Various methods of communication including non electronic forms, will be necessary for

optimal patient care.

c.Regulation and payment

1. Sufficient resources should be available for the new work associated with the advanced use of an
EHR.

2. Policies around EHR use should reflect the strength of the evidence base supporting than

3. Regulatory balance between often competing values (i.e clinical quality vs. Security or

efficiency vs performance measurement) should be sought.

2.6 Principles of Record keeping

This pertains to both manual and electronic record keeping with the general principle

stating that whatever you write or enter must be honest, accurate and non-offensive and must not

breach patient confidentiality. Others include:

1. Handwrite legibly and key-in competently to computer systems.

2. Sign all your entries

3. Make sure your entries are dated and timed close to the actual time of the events as possible.

4. Record events accurately and clearly remember that patient/client may wish to see the record at

some point, so make sure you write in language that he or she understands.

2.7 Principles of Form Design (EMR/EHR/)

According to Okoro (2017), the principles of form design both manual and electronic are:

1. Relate the form layout as much as possible to existing standard forms in alignment and
15
 justifications of items positioned in the form, for example form numbers are usually in the top left

hand corner of the form.

2. Make sure that all information asked for serves a specific purpose and not there on habitual

transfer.

3. Select a short title for the form and choose the size of paper to do the draft on.

4. Head the form clearly.

5. Make it as simple as possible

6. Design the layout for clarity and accuracy

7. Design the layout for the user, create sufficient space to accommodate data response for each

field.

Leave room for punch holes of necessary

These principles can be applied using algorithms and programmes sub-routined into EHR

softwares. They are also practical ideas, ideals and ideologies that healthcare professionals have

used, prescribed and standardized with experience from different fields of practice. They

normally enhance the mission of optimal health care depending on the specialty of the health

worker. The basic principle here is healthcare and may not be complete without the traditional

initiators of the modern day orthodox medical and health records, the alchemists.

Alchemy is a form of chemistry and speculative philosophy practiced in the middle Ages

and the Renaissance period according to an online dictionary (dictionary.com). The findings have

an orientation applicable to medical discoveries in records keeping and documentation without

which all information, history and communication would be demeaned. Record keeping and

documentation are therefore the basic building blocks of medical and health data or information

be it manual or electronic.

16
 Based on the foregoing, Hippocrates; who medical historians look to as the founder of

medicine states that science becomes the star bridge linking alchemy to orthodox medicine. He

is regarded as the father of medicine and has strong respects as nominally implied in the

Hippocratic Oath. The Wikipedia 2017 describes the Hippocratic Oath as an oath historically

taken by physicians; it requires a physician to swear, by a number of ‘healing gods’, to uphold

specific ethical standards of historic and traditional value. The oath is considered a rite of passage

for practitioner of medicine in many countries. Wikipedia 2017 indeed affirms that nowadays

various modernized versions are often used; the message delivered is still the same according to

the online encyclopedia, do no harm. This principle is all embracing and could be applied to the

complementary and alternative medical (CAM) that now use electronic virtual

environment/clinics to administer healthcare.

Top Electronic Medical Records Software.

A lot of independent EHR software are available today including: Drchrono:

Drchrono HER is a patient care platform that offers customization at the point of care and

on the go. In addition to EHR it also has scheduling, billing and patient reminders. It is

available on I-pad, I- phone and Apple watch.

Advanced MD: Advanced MD’s EHR is designed for small and mid-sized practices. It is offered

as on-promise or web-based option and has received ONC-ATCB certification. They developed

many specialty – specific templates and workflow tools.

Nue MD: Nue MD from Nuesoft is a web-based EHR system for small practices. As reported by

Nuesoft, the EHR supports nearly 100 specialties and subspecialties with unique features and

templates Nuesoft is 2011/2012 ONC-ATCB certified.

MediTouch: MediTouch EHR is a cloud-based option compatible with I- pad tables, Apple and

window computers known for its ease of use and customization computers. MediTouch EHR is
17
ARRA/HITECH stimulus ready and ONC-ATCB certified.

Athenahealth: Athenahealth is connecting care nationwide with cloud- based services of

electronic health records (EHR), revenue cycle management and medical billing patient

engagement care co-ordination, and population health management as well as Epocrates and other

points-of-care mobile apps. Athena health currently works with a network of more than 87,000

providers. The EHR offers a homepage that allows users to review the daily schedule and patient

information, management orders, and view incoming lab results. The billing module can be

used in tandem with the

EHR or on its own, and features a patented and continuously updated rules engine. Medical

practice management tools include visibility into daily responsibilities, custom bench marking,

pro-active trends analysis.

Compulink: Compulink is a provider with a cloud based EMR software that is ONC certified.

The software has patient portal software, practice management, patient scheduling, medical

billing etc.

Prognosis: Prognosis is a cloud-based ICD-10 complaint and MU certified EMR solution which

helps medical facilities and practitioners to manage patient medical recording. The software

comprises of integrated modules for EHR, practice management, patient portal and revenue cycle

management. PrognoCIS EHR offers customizable EHR workflow and content for clinics and

hospitals. Doctors and hospital staff can quickly generate e-prescriptions with e-signatures to

ensure control.

It is worthy to note that each EHR software has its own unique features although there are

basic functional requirements like patient portal, patient scheduling, revenue cycle management

E-prescribing and billing; These independent softwares have aesthetic values and principled

inclusions that make them unique and may be specialty based. A great many, however, are
18
 constructed to be independent of specialty influences.

2.8 Empirical Review

Some work has been done in this subject matter of appraisal of the principles and practice

of electronic health/medical records (in private and public hospitals in Minna urban). Four works

have been earmarked for this review thus. The importance of Health Records by Milena Marinic’,

Master of Law, University Psychiatric Clinic, Lyubljana, Slovenia Published in an online Health

journal published in May 2015, 7, 617-624. The Study revealed twelve (12) salient points in the

importance of health records resulting in the conclusion that violation of privacy will stop the

moment the operators are obliged to comply with essential use of computer records, thus enabling

tracking of health data. For legal and professional security, the legibility of records and the

signature of the author are extremely important. Marinic’ has thus emphasized the point of

traceability as a strong concept in EHR/EMR management.

Development of a framework for collaborative Health Services Delivery by Zachaeus Oni

Omogbadegun of Computer and information Sciences Department, Covenant University Ola,

Ogun State Nigeria Published in the International Journal of Advanced computer Science and

Applications vol. xxx No xxx, 2013. The study elucidated the thirteen policy

objectives of Nigeria’s National ICT strategy and the strategic plan for the period 2013-2017 of

Nigeria’s University Service Provision Fund (USPF).

This study resulted in the development of System architecture utilizing new computing

technologies that support collaborative Virtual Environment in complementary and Alternative

Medicine (CAM) as a growing necessity in health care services.

Omogbadegun believes that developing the mobile technology that enables clinical

professionals to remotely share information in real time, and using connected technology to
19
enable access to healthcare would be beneficial to millions from the world poorest communities.

But Marinic’s stand on loyal and professional security checks this generosity.

A study on the usability Framework for Electronic Health Records in Nigerian Healthcare

Sector by Awodele, Kuyoro, and Taiwo (2016), at the Department of computer science Babcock

University, Ileshan-Remo, Ogun State, Nigeria and published in the International Journal of

Computer Science Engineering.

The study reveals four primary functions required to achieve effective and efficient

results. They are memory aid, computational aid, decision support aid, collaboration aid. The

result shows the usability highpoints of EHR which include being learnable, efficient, memorable,

usable, useful and satisfying. Taiwo et al affirms that EHR designs should be flexible and

presented to meet expectations and previous knowledge of the intended user.Thus buttressing

Omogbadegun’s point in CAM usage as historically relevant.

A study was also carried out on the legal Issues in the management of Patient’s Records in

Tertiary Hospitals in Nigeria, by Kayode Sunday Osundina, Joseph Adeniyi Kolawole and Joshua

Adediyi Abolaji of Health Information Management Department, Lead City University Faculty of

Sciences, Oyo State, Nigeria and the Librarian Joseph Ayo Babalola University, Ikeji, Arakeji,

Osun State, Nigeria, Published in the 10SR Journal of Nursing and Health Science Vol. 5 issues

ver 1 Sep-Oct. 2016.

The study reveals the legal practice of regulation of morality or behavior and deals with proper

and adequate legal issues employed in the management of patients records in Nigeria Tertiary

Hospital. Osundina et al assert that violators of rules concerning patient’s records and rights of

privacy should be made to face the wrath of the law, so as to serve as deterrent to others. This

confirms the stand Marinic’ took as afore mentioned as the legal and ethical point of order or

decision.

20
2.9 Summary of Literature Review

This study has exposed source groups of principles of electronic health/medical records

from academics and professional practitioners sources. The metamorphoses witnessed in

medicine and techno-based innovation is aptly evidenced in the current ICD-11 (International

Classification of Diseases) currently being reviewed for release in 2018.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

This Chapter is concerned with research methodology and is discussed under the

following subheadings; research design, description of research population including area of

study, sample and sampling technique, instrumentation, validity and reliability of instrument, data

collection procedure, method of data analysis and ethical considerations.

3.2 Research Design

The researcher adopted the descriptive survey research design in carrying out the study.

According to Otuka (2004), survey design is a data collection technique in which information is

gathered from individuals called respondents. Onuzulike (2016) further asserted that descriptive

research is used to describe characteristics of a population or phenomenon being studied.

The researcher used the descriptive survey research because the study needs the sampling
21
 of opinions of health care professionals in General hospital in minna on the principles and

practice of electronic health/medical records from their own perspectives.

3.3 Description of Research population including area of study

Based on a research-based purposeful contact in General Hospital Minna four hundred and

thirty-six (436) health care professionals were contacted as respondents for this study with their

occupational distribution thus presented.

Table 2: Population distribution of healthcare professionals in the public and private hospitals
under study
Public

HIM Practitioners 75
Clinicians 61

Non Clinicians 47

Private 110
Practitioners
Others 6
Total 299

The purposeful contact was because of the confidentiality of the information as some

hospitals preferred anonymity in this study. However, all selected hospitals are located in Minna

urban as the area of study.

3.4 Sample and Sampling Technique

The sample was drawn from healthcare professionals in General hospital Minna including

clinicians, non clinicians and private practitioners. The purposive sampling method was used in

the research with due respects to the principle of confidentiality. A sample size of four hundred

and thirty-six (436) health professionals was painstakingly and purposively drawn from two

selected model hospitals in minna urban, whose identities remain confidential.

22
3.5 Instrumentation

The instrument for data collection was questionnaire, which involved the list of standard

questions using the Likert type of rating scale of strongly Agree (SA), Agree (A), Undecided

(UD), Disagree (D) and strongly Disagree (SD) with weights of 5, 4, 3, 2 and 1 respectively for

all items.

The instrument has twenty-two (22) items divided into three clusters of thirteen (13), four

(4) and five (5) statements respectively research questions. Their corrections and observations

were incorporated into the final draft of the instrument.

The researcher used the test-retest method to determine the reliability of the instrument

with the three clusters scoring 72 for cluster A, 64 for cluster B and 55 for cluster C, making a

general score of 63.67. This confirmed that the instrument was reliable and fit for the study.

3.6 Method of Data Analysis

Data collected were sorted and subjected to analysis based on a five point Likert scale

format. The researcher’s decision rule was that any response item with a mean value of 3.0

and above was regarded as highly acceptable, while any response with a mean value of 2.99

and below was regarded as low and not acceptable.

23
24
 CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND RESULTS

4.1 Introduction

The researcher did an appraisal of the principles and practice of electronic health/medical

records in General hospital Minna and obtained the following results, with analyses and

discussions.

4.2 Data Presentation and Analysis

Research Question 1: To what extent do General Hospital Minna possess requisite equipment in

compliance with the principles and practice of electronic health medical records?

Table 3: Mean Scores showing the response in respect of possession of requisite equipments
according to the principles and practice of electronic health/medical records.

Equipments Agreed Disagreed

Mean Mean
(%) (%)
The hospital has 3.12 (62.4) 3.81(76.2)
desktops, laptops, and
other computer devices
The hospital has health 3.18 (63.6) 3.85 (77.0)
maintenance organization
work stations
There is intranet service 2.32(46.4) 3.30(66.0)
network sharing
The hospital has its own 2.33(46.6) 3.31(66.2)
website
There is electronic 2.09(41.8) 2.79(55.8)
medical record libraries
in the hospital
There is medical database 2.39(47.8) 3.35(67.0)
management software
There is patient biometric 2.24(44.8) 3.14(62.8)
registration software in
the hospital
There is presence of 2.62(52.4) 2.94(58.8)
doctor and nurse-patient
portals
There is e-prescription 2.09(41.8) 2.79(55.8)
portals
25
 There is point of sale 2.14(42.8) 3.46(69.2)
(POS) terminals in the
hospital
There is cyber security 2.84(56.8) 3.27(65.4)
network system like
surveillance cameras
There is emergency fire 2.23(44.6) 2.88(57.6)
outbreak controls
There is provision for 2.23(44.6) 2.88(57.6)
uninterruptible power
supply system
Grand Mean 2.48(49.6) 3.23(64.6)

In table 3 above, for yes response, it can be seen that items 1 and 2 have mean scores

above the bench mark of 3.0 all other items have mean scores below 3.0 These other items have

a mean score ranging from 2.09-

2.84. They include items 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13. The grand mean score of this cluster

is 2.48 for yes which is below the benchmark of 3.0. This indicates low and insignificant level of

compliance which is not acceptable. Therefore, the respondent agreed that they do possess the

requisite equipments in compliance with the principles and practice of electronic Health/Medical

records in General Hospital Minna.

In table 3 above, for disagreed, it is clearly shown with the exception of items 5, 8, 9,

12 and 13 whose means are below the bench mark of 3.0; all other items have a mean above

3.0. Items, 5, 8, 9, 12 and 13 have means ranging from 2.99 – 294; the means of items 1, 2, 3, 4,

6, 7, 10 and 11 ranged from 3.14 to 3.85. The grand mean of the cluster which is

3.23 for the respondent that disagree is above the benchmark of 3.0. Therefore, they disagree that

they do not possess the requisite equipment in compliance with the principle and practice of

electronic health records in Minna urban. The result shows a high have of significance and is

acceptable.

Item 1 of cluster A revealed a mean score of 3.12 and 3.81 agree and disagree

26
respectively which are above the benchmark of 3.0.

Therefore both have desktops, laptops and other computer devices. Omogbadegun (2013)

agreed with the above thus, information and communication technologies (ICTs) are needed in

addressing the global challenges of healthcare worldwide. He further elucidated that we require

technology-based strategies that would assist in determining specific health care scenarios where

mobile health and tele- health can add value, improve access to high quality care and reduce the

cost of healthcare delivery. The utility value of computers and related devices are increasingly

becoming pertinent in today’s healthcare principles, even though they come with stringent

challenges.

Item 2 of cluster A showed a mean score of 3.18 and 3.85 for agree and disagree

respectively which are above the benchmark of 3.0. Therefore have health maintenance

organization work stations. The Health Insurance Portability and Accountability Act HIPAA

(2013) agree with the above in stating that compliance is just one aspect of security. The HIPAA

(2013) described Health Information Technology (HIT) as one specifically designed for

healthcare; it includes solutions meant to insure HIPAA compliance.

The basic point of possession clears the point of computer literacy but not exactly

electronic health records compliance.

Item 3 of Cluster A unveiled a mean score of 2.32 and 3.30 for agree and disagree

respectively. Therefore public hospitals do not have internet service network sharing but can

outsource this service from the private hospitals that do have it. Omogbadegun (2013) agrees with

the above where he stated that a health information system architecture that places emphasis on

supporting collaboration and coordination among various health care services can also fulfill

the requirements to support mobility of health care professionals that may lead to a pervasive

computing infrastructure. In addition, some public hospitals possess skeletal set ups that either

27
perform below installed capacities or are totally dysfunctional especially the wireless

technological options.

Item 4 of Cluster A: indicated mean scores of 3.33 and 3.31 for agree and disagree

respectively, which are above the benchmark of 3.0. Therefore, they have website for both

clinical and non-clinical purposes and services.

The Nigeria’s National ICT Strategy in Omogbadegun (2013) quoted an item of the 13

policy directives thus: to promote widespread access to high quality advanced communications

technologies and services, in particular the Internet. This buttresses the point of compliance made

by the HIPAA Act of 2013.

Item 5 of cluster A showed mean scores of 2.09 and 2.79 for agree and disagree

respectively which are below the benchmark of 3.0. Therefore do not have electronic medical

record libraries.

The Nigeria’s ICT strategy as cited in Omogbadegun (2013) agrees with the above in

asserting that 70% of Nigerians live in rural areas and do not therefore have access to ICT

services and that some living in urban areas are unserved or underserved.

Item 6 of cluster A showed mean scores of 2.39 and 3.35 for agree and disagree

respectively which are below and above the benchmark of 3.0. Therefore do not have medical

database management software (MDMS). Rao et al as cited in Ajami and Bagheri Tadi (2013)

agreed that by listing challenges to the acquisition, use and management of MDMS thus: capital

needed to acquire and implement, uncertainty about return on investment, resistance to adoption

from practice physicians and capacity to select, contract and install the EHR. Other points hinted

by Rao et al include concern about loss of productivity during transition, concern about

inappropriate disclosure of patient information, concern about illegal record tampering/hacking

and concern about the legality of accepting the EHR from a hospital. Rao et al rounded off their

28
list with concern about physician’s legal liability, finding an EHR that meets your needs and

concern that the system will become obsolete.

These veritable going concerns are not insurmountable are proved by the private hospitals as

seen in the mean scores above, Omogbadegun (2013) agrees with an extract from the strategic

plan from the period 2013 – 2017 of Nigeria’s Universal Service Provision Fund (USPF) with the

objective supporting the development of local content and application (i.e m- health, m-learning,

m-banking, m-government applications) which stimulate demand for internet services and

provide sustained socio-economic benefits for recipients of these services. The fact of life science

makes the point that the motivation may be sub threshold in certain health facilities and may

require more human capital investments and development to get the optimal threshold for EHR

installations, management and development.

Item, 7 of cluster A: This revealed mean scores of 2.24 and 3.14 for agree and disagree

respectively which are below and above the benchmark of 3.0. Therefore the respondent agree

that do not have patient biometric registration software. The Health Information Portability and

Accountability Act 2013 of the U.S Department of Health and Human, services (HHS) disagreed

in stating hospitals must have a security incidence response plan, this is in order to secure patient

identity and peculiarities of biometric significance like thumbprint, physiognomy, color of eye,

skin and hairs, height, weight and full finger prints. The HIPAA tip affirmed that the security

incidence response plan details and documents what will be done in the case of security breach

or other security event.

Item 8 of cluster A: indicates mean score of 2.62 and 2.94 for agree and disagree

respectively which are below the benchmark of 3.0.

Therefore, do not have doctor and nurse-patient portals. This can be due to the face-to-face
29
contact basically required for clinic clerking and ward observations, patients may be physically

inhibited due to ill-health to balance the EHR standpoints of the doctors and nurses electronically.

This is a facility that is supra-optimally expressed in the web MD consultations and

investigations which the hospitals visited by the researcher discouraged. Jha et al as cited in

Ajami and Baghari-Tadi (2013) agreed with the above in listing the challenges it portends thus,

computer skills of you and/or colleagues/staff, computer technical support, lack of time to acquire

knowledge about system, start-up financial costs, on-going financial cost, training and

productivity loss. Jha et al also mentioned physician skepticism and privacy or security concern

as reasons worth reckoning within the doctor/nurse – patient portal computer EHR initiative.

Item 9 of Cluster A showed mean scores of 2.09 and 2.79 for agree and disagree

respectively which are below the benchmark of 3.0. Therefore, do not use e- prescription portals

however, the average mean of private hospitals is closer to the bench mark but due to privacy

concerns more details cannot be revealed.

Item 10 of Cluster A showed mean score of 3.14 and 2.46 for agree and disagree

respectively which are above a n d b e l o w the benchmark of 3.0. Therefore, the hospital do

use point of sale (POS) terminals

Item 11 of Cluster A revealed mean scores of 2.84 and 3.27 agree and disagree

respectively which are below and above the benchmark of 3.0. Therefore, the hospital do not

have cyber security network system. Drako (2017) agrees with a best practices list for cyber

security camera system. Thus; camera passwords, port forwarding, firewalls, network topology

(separate cameras), operating systems, operating systems passwords and video surveillance

system passwords. Others include connection encryption, video encryption, mobile access,

physical access to equipment and storage and video recording software. These are best practice

expectations of any ultramodern hospital cyber security surveillance system. The basic operation

30
system run in many brands including Microsoft Windows, Linux and Unix.

Item 12 of Cluster A showed exposed mean scores of 2.23 and 2.88 for agree and disagree

respectively which are below the benchmark of 3.0. Therefore, hospitaldo not have emergency

fire outbreak controls. The HIPAA (2013) disagreed with the above in stating a tip for

information Technology thus HIPAA requires administrative safeguards and policies.

Administrative safeguards are procedures and policies to make sure security violations or

breaches don’t occur. It also involves detaching incursions, containing attacks and correcting

problems including fire outbreaks.

Item 13 of Cluster A: This unveiled mean scores of 2.23 and 2.88 for agree and disagree

respectively which are both below the benchmark of 3.0. Therefore, do not have uninterruptible

power supply systems.

Holden as cited by Ajami and Bagheri-Tadi (2013) agreed with the above in including

electricity and social environment as barriers to adopting electronic health records (EHRs) by

physicians.

Cluster A showed grand means of 2.48 and 3.23 for disagree and agree respectively

which are below and above the benchmark of 3.0.

Therefore agree do have the required equipment in compliance with EHR principles and

practice.

31
Research Question 2: To what extent have the hospital benefitted from their compliance with the

principles in the practice of electronic health/medical records?

Table 4 showing means scores of agree and disagree in cluster B measuring the extent of

compliance with EHR principles and practice.

CLUSTER B: Extent of compliance with the principles and practices of electronic health records

ITEMS Disagree Agree

Mean (%) Mean
(%)
The hospital is friendly to 3.88 4.28
all visitors and patients and (77.6) (85.6)
always open.
The registration process of 4.06 4.40
both first comers and (81.2) (88.0)
appointees are quick, smart
and caring.
All patient records are well 4.27 4.54
respected and kept very (85.4) (90.8)
private and confidential.
Clinic times per patient are 3.68 3.79
short and devoid of long (73.6) (75.8)
waiting periods.
Grand Mean 3.97 4.26
(79.4) (85.2)

Item 1 of Cluster B indicated mean scores of 3.88 and 4.28 for disagree and agree

respectively which are above the benchmark of 3.0. Therefore the hospital are friendly to all

visitors and patients and always open.

Taiwo, Awodele and Kuyoro agreed with the above in elucidating usability or user-

friendly points of the EHR thus: they serve as memory aid, computational aid, decision support

aid and collaboration and which are all veritable standpoints on hospital friendliness to all visitors

and patients. Common courtesy and discipline are also good points of observation in this social

32
direction.

Item 2 of Cluster B revealed mean scores of 4.06 and 4.40 for disagree and agree which

are both above the benchmark of 3.0. Therefore, agree the hospital have quick, smart and

caring registration process for both first comers and appointees. An EHR facility Patient Now

(2017) agreed with above in revealing that doctors and hospitals around the world are

experiencing the benefits of moving away from paper-based systems. The advantages of EMR far

exceeded any disadvantages that one can present. Consequently machines are becoming safer and

more efficient. Patients receive better care and the National Health Insurance Scheme (NHIS) is

now in place and doing very well. The National Health Insurance Scheme is a fact and testimony

to many people accessing health care with professional help.

Item 3 of Cluster B showed mean scores of 4.27 and 4.54 disagree and agree respectively

which are above the benchmark of 3.0.

Therefore the hospital respect all patients’ records and keep them private and confidential.

Wikipedia (2017) disagreed with the above in stating that one of the most controversial issues for

Personal Health records is how the technology could threaten the privacy of patient information.

Network computer break- ins are becoming more common, thus storing medical information

online can cause fear of exposure of health information to unauthorized individuals. Threats like

accidental disclosure, insider curiosity, insider subordination, uncontrolled secondary usage and

outsider intrusion. The privacy and confidentiality stand tall as principles of both manual and

electronic health/medical records. Marinic’ (2015) also supports Wikipedia (2017) in stating that

health records in private practice, especially under storage are problematic in having difficulty in

restricting unauthorized access, in monitoring the handling of personal data and in the event of

termination of the contractor’s activities. The skepticism thus elucidated may then be the reason

33
why manual record keeping still thrives in many public and private hospitals in Minna urban.

Item 4 of cluster B revealed mean scores of 3.68 and 3.79 for disagree and agree

respectively which are above the benchmark of 3.0. Therefore clinic times per patient are short

and devoid of long waiting periods in the hospital.

Research Question 3: To what extent is the hospital challenged by their compliance with the

principles and practice of EHR/EMR?

Table 5: Cluster C showing the mean scores of public and private hospitals in response to
challenges faced in compliance with EHR/EMR.

CLUSTER C: Challenges faced in compliance with electronic health records

ITEMS Agree Disagree
Mean
(%) Mean
(%)
The hospital is influenced 3.44 (68.8) 3.27(65.4)
by artificial intelligence
There is existence of 3.40 (68.0) 2.52(50.4)
unwholesome sharp
practices
Multiple registration of 3.27(65.4) 4.27(85.4)
patients is experienced in
the hospital
There is the existence of 2.34(46.8) 2.58(51.6)
identify transfer in the
hospital
Divulgence of patient’s 2.41(48.2) 1.89(37.8)
confidential information
is being witnessed
Grand Mean 2.97(59.4) 2.45(49.0)

Item 1 of Cluster C revealed mean scores of 3.44 and 3.27 for agree and disagree

respectively which are above the benchmark of 3.0. Therefore, the hospital is influenced by

artificial intelligence. Zieger (2016) agreed with the above in the statement that most scientists
34
and researchers don’t seem as worried as Gates and Hawking and contend that while machines

and software may do an increasingly better job of imitating human intelligence, there’s no

foreseeable way in which they could become a self conscious threat to humanity Zieger (2016)

argues that Artificial Intelligence (AI) could help in improving healthcare in these ways;

diagnosing disease, medication management, virtual clinicians, drug creation and precision

medicine others include patient scheduling and strategic data management. The effort made by

Information Technology (IT) experts becomes the leverage upon which AI is set up to assist

human and physical healthcare efforts in and out of the clinics and out of the clinics and hospitals.

Item 2 of Cluster C showed mean scores of 3.40 and 2.52 for agree and disagree

respectively which are above and below the benchmark of 3.0. Therefore, the hospital have

unwholesome sharp practices. Ford et al as cited by Ajami and Bagheri-Tadi (2013) agreed with

the above in history challenges to EHR/EMR thus:

uncertainty about implementation costs, causes and effects, uncertainty about shifting standards,

uncertainty about potential policy interventions. It is factually observable that private hospital

professionals enjoy longer years of tenure in office at times lifetime tenures if it is a family set up

health facility. Administrative interruptions are less in the private hospitals and thus justified the

results of item 2 of Cluster C.

Item 3 of Cluster C unveiled mean scores of 3.27 and 4.27 for agree and disagree

respective which are above the benchmark of 3.0. Therefore, multiple registrations of patients is

experienced in the hospitals. (2016) agreed with the above in stating three standard numbering

systems usable in hospitals unit numbering, serial numbering and serial-unit numbering systems.

Unit numbering allocates one number to the patient to be used for all other entries. Serial number

allocates a new number per entry and all entries have different numbers of registration. The

serial-unit numbering allocates numbers for every entry but is able to make the files traceable by
35
filing all files on one person under the latest number registered. This means that multiple

registration is possible in single clinic specialty hospitals and in multiple clinic specialty

hospitals.

Item 4 of Cluster C showed mean scores mean scores of 2.34 for agree which is below
the
benchmark of 3.0. Therefore do not indulge in identity transfers. Taiwo et al (2016) agreed

with the above in stating the needs for usability of the EHR as being learnable, efficient,

memorable, usable, useful and satisfying. With these needs optimally attained then identity

transfers would be out of context, erroneous and legally implicating.

Item 5 of Cluster C showed mean scores of 2.41 for agree which is below the benchmark

of 3.0. Therefore, do not divulge patient’s confidential information in Minna urban. Patients do

have rights according to Marinic’ (2015) to information about who was acquainted with his/her

health records, the right to rectification, blocking or erasure of data i.e the removal and revision of

health records in the process of health data which Marinic (2015) asserts is relatively unknown in

contemporary health records processing especially when the records are not accurate.

In the event of a subpoena, the hospital is mandated to divulge patient’s information for

court proceeding to take place and possible rectification to be made, ordered and executed in the

light of fairness and justice as contained in article 33 of the Personal Data Protection Act of the

Slovenian legislation as cited by Marinic (2015).

The grand mean scores of Cluster C are 2.97 and 2.45 for agree and disagree’ hospitals

respectively which are below the benchmark of 3.0. Therefore the hospital have managerially

overcome the challenges faced in compliance with electronic health records in Minna urban.

36
4.3 Summary of Results

Table 7: Showing summary of Results

Questionnaire Agree : Grand Disagree :

Items Mean (%) Grand Mean
(%)
Cluster A 2.48(49.6) 3.23(64.6)

Cluster B 3.97 (79.4) 4.26 (85.2)

Cluster C 2.97 (59.4) 2.45(49.0)

Cumulative 3.14 (62.8) 3.31(66.2)

Grand Mean

The cumulative grand means of clusters A,B and C are 3.14 and 3.31 which are above the

benchmark of 3.0. Therefore, comply with the principles and practice of Electronic Health

Records (EHR) in General Hospital Minna. Although, some equipments may be obsolete and

needed upgrade and maintenance, the challenges are more organizational and technical than

behavioral.

37
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Introduction

This chapter summarized the study using these sub headings, summary, conclusion,

limitations, recommendations and suggestions for further studies. The appraisal of the principles

and practice of electronic medical/health records is one that needs professional ethical codes of

practice to be more respected in the ranks of order, discipline and competence.

5.2 Summary

The advent of the electronic health records has come to stay in healthcare delivery in

General Hospital Minna. The study has made a discovery which shows that private hospitals are

the up and doing in the area of EHR installations and maintenance. The public hospitals are more

inclined to EHR at secondary and tertiary levels of health care management since the teaching

hospitals are becoming equipped with specialized electronic gadgets for diagnostic purposes and

investigations.

5.3 Conclusion

The basic components of EHR has been found wanting in the public hospitals in Minna

urban and this is attributable to a myriad of reasons, factors, determinants and constraints which

can be organizational, technical and behavioral. Organizational constraints include administrative

insufficiency, lack of qualified personnel to do the job, lack of sufficient office time and space,

high cost of basic equipment and inputs.

Technical Constraints include lack of training of already employed staff, lack of skill and

38
 expertise in advanced levels of technical knowledge, lack of maintenance culture for few installed

equipments.

Behavioral constraints include disinterestedness in techno-based health practice by

clinicians, aversion to computer based registration and documentation, ease of data loss due to

poor data security. These constraints have, however, been overcome to a large extent by the

private hospitals and practitioners.

5.4 Recommendations

Based on the research findings these recommendations were made.

1. Adoption of both the AHIMA and HIMAN codes of ethics stated in the appendices V and VI.

2. Utilization and application of the 10 principles for designing an EHR by James Holly, 10

principles of documentation for medical records, principles of EHR design, implementation and

policy, principles of record keeping and principles of form design all stated in chapter two of this

study.

3. Use of outsourcing techniques in areas where cost and management constraints are high.

4. Personal education and skills development to increase competence.

5. Staff development through in-service training, workshops and seminars to introduce and learn
cosmopolitan EHR instruments.

6. An industrial training course for students including training tour of tertiary hospitals and
specialist hospitals and clinics. A maintenance culture that sustains installations with a view

to adding upgrades without total replacement of basic equipment.

7. Biometric identification of all patient entries as well as a detailed security and surveillance
reference data for investigations.

39
 8. Health insurance coverage for all eligible patients, citizens and visitors/tourists in Nigeria.

9. Promotion of all HIM professionals as and when due to avoid anti-social inclinations as well as

statutory recognition of relevant qualifications, certifications and licenses.

10. Ensure patient consent in all HIM professional activities except where stipulated by the Health

Information Patient Privacy Act (HIPPA) of 1996.

11. Avoid all forms of negligence in the performance of all professional duty of care.

40
 REFERENCES

Ajami S, Bagheri-Tadi T. (2013). Barriers for Adopting Electronic Health Records ACTA

INFORM MED, 2013 Jun;21 (2): 129-134.

Alakija W. (2000) Essentials of Community Primary Health Care and Management Ambik Press
Edo Nigeria.

American Hospitals Association (AHA) (2013). Hospitals Face Challenges Using Clinic Quality
Measures. Washington D.C. www.aha.org

Churchill’s Medical Dictionary, Churchill Livingstone Inc. (1989) New York USA.

ELmansy R. (2017). Characteristics of Human Centered Design. www.designorate.com Accessed

4/17/2017.

Eze, A. I. (2016) Health Information Management HIM 111: School of Health Information Management
(SHIM) University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla Minna.

Google mobile phone search bookmarks: MTN 08068071602

i Ten principles for designing an EHR by James Holly

ii Ten principles of Documentation for medical records sourced from Centers for Medicare and
Medicaid and Trail Blazer Ent. LLC.
iii Principles of Electronic Health Records design. Implementation and policy
iv principles of record keeping
i AHIMA ethical codes (2011) ethics.iit.edu/ecodes/node/6469 vi Top Electronic
Medical Records Software

Health IT.gov. The Basics of Personal Health Records (PHRs)

https://www.halthit.gov/providers.professionals/faqs/are-there-diff...

Kaseya White Paper (2016) Health Information Portability and Accountability Act Compliance: IT
Automation Make it Almost Simple. www.kaseya.com

Lagoon Hospitals Victoria Island Lagos websites http://www.lagoonhospitals.com

Marinic, M. (2015). The Importance of Health Records. Science Research Publishing Journal of Health
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 7, pp, 617-624.
Httpdx.doi.org/10.4236/health.2015.75073

Omogbadegun Z.O. (2013) Development of a framework for Collaborative Healthcare services Delivery.
International Journal of Advanced Computer Science and Applications (IJACSA) Vol.XXX, No
XXX.

Online Dictionary (Dictionary.com,) www.dictionary.com/browse/dictionary

Online Medical Dictionary (2017) http://medical.dictionary.thefreedictionary.com/health-records.

Onuzulike K.O. (2016) Lecture Notes on GNS228: Research Methods School of Health
Information Management (SHIM) University fo Nigeria Teaching Hospital (UNTH) Minna
Okoro O. (2013) HIMAN Code of ethics 2013. The HIMAN Journal August 2013.

Okoro O. (2016) Principle of form Design HIM 211 School of Health Information Management (SHIM)
University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla Minna.

Osundina, K.S, Kolawole J.A and Abolaji J.A (2016) Legal Issues in the Management of Patients
Records in tertiary hospitals in Nigeria. Journal of Nursing and Health Science (IOSR-JNHS)
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Otuka J.O.(2004) Educational Research Methods. Lagos. National OpenUniversity of Nigeira

(NOUN)

Other citations from Drako (2013), Rouse (2017) and Zieger (2016) PatientNow Health records

software. www.patientnow.com

Segen J. C.(2012) The Concise Dictionary of Modern Medicine Online version

https://www.amazon.com/Dictionary-Modern-Medicine/dp/1850703213

Stedman’s Medical Dictionary (2006) 28th Edition. Baltimore, Maryland USA Lippincott Williams &
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Stedman’s Medical Dictionary for the Health Professions and Nursing Illustrated Seventh Edition
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Taiwo, O.O., Awodele O. and Kuyoro S.O. (2016) A Usability Framework for Electronic Health Records
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Wikipedia, the free online encyclopedia:

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 ii https://en.wikipedia.org/wiki/personal_health_record iii
https://en.wikipedia.org/wiki/social_cognitive_ theory
iv https://en.wikipedia.org/wiki/Sustainable_Development_Goals

World Health Organization (2017) International Classification of Diseases ICD- update details on
http://who.int/classifications/network/meeting2016/ICD-
11RevisionConferenceReportTokyo.pdf?ua-1

Introductory Letter

Health Information Management,

Al-asas health foundation school of health technology

kpakungu,
Minna State. 13th January 2021,

Request for Filling of Questionnaire

I am a student of the above institution conducting a research on “Appraisal of the

Principles and Practices of Electronic Health Records in Public and Private Hospitals in Minna
Urban”

The research work is in partial fulfillment of the requirements for the award of
Professional Diploma (PD) in Health Information Management.

You are therefore kindly requested to respond to the attached questionnaire so as to

facilitate the successful completion of this study.
Be assured that information provided will be used purely for academic purposes while
promising to treat such information with the utmost confidentiality it deserves.

Yours faithfully,

Andrew Judith

43
 APPENDIX 2 QUESTIONNAIRE

Questionnaire for healthcare professionals in An Appraisal of the Principles and Practice of

Electronic Health/ Medical Records in General Hospital Minna
The questionnaire is divided into two sections: Personal data of the respondents and the
questionnaire items. Please fill and tick as applicable.
SECTION A: PERSONAL DATA
Instruction: Fill in the blank spaces and tick [ ] inside the box beside the option that best
represents your answer to the questions.
1. Name of Institution:………………………
2. Indicate your age:……………………
3. No of years of experience:…………………………………….
4. Area of specialization…………………………
5. Indicate your gender: (a) Male (b) Female
6. Indicate your marital status
(a) Single (b) Married (c) Divorced/separated
7. Highest educational qualification
(a) National Diploma (b) Higher National Diploma
(c) Postgraduate Diploma (d) Bachelor of Science
(e) Registered Nurse (f) M.Sc./MBA
(g) MBBS (h) Others, specify……………..
SECTION: PSYCHOGRAPHIC DATA
Instruction: Please carefully read the instruction before responding to the statements that follow.
You are required to indicate the extent to which you agree with the items contained in this part of
the questionnaire by ticking [ √ ] in the column with the following options:
SA=Strongly Agree A=Agree

44
 D=Disagree SD=Strongly Disagree

Extent of possession requisite equipment in compliance with the principles and practice of
Electronic Health Record.
S Equipments S A U D S

1 The hospital has desktops, laptops, and other

computer devices
2 The hospital has health maintenance organization
work stations
3 There is intranet service network sharing

4 The hospital has its own website

5 There is electronic medical record libraries in the
Hospital
6 There is medical database management software

7 There is patient biometric registration software in

the
Hospital
8 There is presence of doctor and nurse-patient portals

9 There is e-prescription portals

1 There is point of sale (POS) terminals in the

hospital
1 There is cyber security network system like
surveillance cameras
1 There is emergency fire outbreak controls

1 There is provision for uninterruptible power supply

system

Extent of compliance with the principles and practices of electronic health records
ITEMS S A U D S
45
 A D D
1 The hospital is friendly to all visitors and patients and
always open.
2 The registration process of both first comers andM
appointees are quick, smart and caring.
3 All patient records are well respected and kept very
private and confidential.
4 Clinic times per patient are short and devoid of long
waiting periods.
Challenges faced in compliance with electronic health records
4. S A U D S
A D D
1. The hospital is influenced by artificial
intelligence
2. There is existence of unwholesome sharp
practices
3. Multiple registration of patients is experienced
in the
Hospital
4. There is the existence of identify transfer in
the hospital
5. Divulgence of patient’s confidential
information is
being witnessed
6.

46
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