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Table of Content
s
ABSTRACT 2
INTRODUCTION 3
1.1 Background of the study 3
1.2 Statement of the Problem 3
1.3 Purpose of the Study 4
1.4 Expected contribution of the Study 4
LITERATURE REVIEW 5
METHODOLOGY 10
FINDINGS AND DISCUSSIONS 11
CONCLUSIONS AND RECOMMENDATIONS 16
Conclusion 16
Recommendations 17
REFERENCES 19
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ABSTRACT
The purpose of this research is to evaluate the benefits of the EMR on quality healthcare in

Ghana hospitals using the structure and outcome to measure the readiness of the EMR. The

introduction of information and Communication Technology (ICT) has brought a significant

delivery change in the healthcare delivery system in Ghana, especially electronic health records.

The current study evaluates how the implementation of the EMR has promoted systems usability

and patient satisfaction (Abdulai & Adam, 2020).

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INTRODUCTION

1.1 Background of the study

Recently, electronic medical records (EMR) have received remarkable attention for optimizing

patient outcomes, sharing patient information, and process improvement in the developing world

(Abdulai & Adam, 2020). Most hospitals, both public and private, are investing heavily in EMR

due to its efficiency. Even with its potential to enhance patient care efficiency, quality, and

safety, most either fail or do not support healthcare. This is even worse in developing countries,

in which medical professionals tend to experience computer anxiety. While readiness assessment

is a significant factor in the adoption and use of EMR, most healthcare institutions in Africa,

including Ghana, have failed to perform an initial assessment of the institution's preparedness

before implementation, leading to a high failure rate (Abdulai & Adam, 2020). In Ghana,

usability is always unattained in the adoption of most ICT systems. Some medical professionals

have discontinued its use due to prolonged working time, insufficient training, and difficulty

using it.

1.2 Statement of the Problem

Like other developing countries, electronic health records (EHR) are gradually replacing paper-

based records. The use of EHR alleviates limitations associated with paper-based records.

Electronic health records are on the rise in the Ghanaian healthcare system as major hospitals

utilize EHRs to enhance healthcare delivery and record-keeping systems. But if care is not taken,

the challenges of EHRs implementation as documented in the literature are likely to be

experienced. Given this, there is a need to evaluate such implemented systems in Ghana to
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uncover the challenges and benefits associated with EHRs and propose measures to ensure

effective implementation of the system in the entire healthcare system.

1.3 Purpose of the Study

In this research, I will seek to answer the following study questions:

1. What factors enable or impede the usability of EHRs in Ghana?

2. What are the uses of EHRs in the Ghanaian healthcare system?

3. What is the impact of EHRs on patient care delivery?

1.4 Expected contribution of the Study

Few studies examine the implementation of large-scale electronic health record infrastructures in

the Ghanaian context. As such, this study will expand the wealth of knowledge by revealing the

benefits, challenges, and impact of implementing electronic health records in healthcare

institutions in Ghana. Secondly, this study's findings will form a foundation upon which

expansive research works can be conducted. Also, the results of this project could guide

managers and leaders (of healthcare institutions), information system developers, and health

professionals in assessing, designing, and implementing electronic health records systems in

their facilities. Lastly, but equally important, the project could guide policy formulation and

implementation of HER while enhancing understanding of its implications in Ghana and other

developing countries.
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LITERATURE REVIEW
Literature Review

Many researchers have investigated the benefits and challenges of electronic health records

within the healthcare setting. Menachemi and Collum (2017) wrote a paper summarizing the

current literature review on the benefits and costs of EHRs. They found that implementing

electronic health records confers societal benefits such as improved population health, reduced

costs, and enhanced ability to conduct research; organizational benefits like financial and

operational benefits; and clinical benefits like improved quality of care and reduced medical

errors. The shortcomings of applying EHRs as cited in the literature included ongoing

maintenance costs, privacy concerns among patients, workflow disruption that contributes to

short-term losses in productivity, and high upfront acquisition costs. It was suggested that

significant benefits to patients and society could only be achieved when EHRs are implemented

and used in meaningful ways.

Zakeri, Bowles, and Chaney hypothesized that the successful implementation of electronic health

records improved workflow and financial and patient outcomes. These views are supported by

Achampong (2012), who found that EHRs can potentially reduce hospital operations costs,

enhance resource utilization, improve interdepartmental communication and collaboration,

provide an opportunity for sharing best practices amongst healthcare professionals, and reduce

waiting times for patients experienced at Ghanaian hospital. Immediate benefits of implementing

EHRs included improved patient quality and safety, reduced waiting time, accurate medication

lists, lower transcription costs, immediately available charts, and reduced chart pulls.
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Hayford (2019) evaluated the effect of electronic health records on quality healthcare at Legon

Hospital, Ghana. He employed a qualitative approach with a cross-sectional explanatory design

by obtaining data via an interview guide from 11 participants, five patients, and six staff. The

study findings revealed that hospital management benefits from using EHRs through attending to

patients simultaneously, the relative cost of using EHRs, avoidance of waste, reduction in

waiting time, more accessible and faster booking of appointments, quality acquisitions, quality of

patient records, and alleviation of harmful delays. However, the system is faced with waiting

time, missing data, end-user inability to procure the hardware infrastructure, billing issues, and

redundancy issues. Hayford concluded that the hospital should consider supporting and

sustaining the EHRs schemes and take measures to address the evolving challenges of using the

EHR system. Ajami and Bagheri-Tadi (2018) suggested that hospitals should integrate EHRs to

reduce medical errors, provide more effective methods of sharing information and

communication, and better manage patient outcomes.

Elsewhere, Afarikumah (2014) noted that, like in other developing countries, access to health

services for remote communities in Ghana is still limited. He provided an overview of the

country's current status of electronic health activities. It was found that although the role of

electronic health is still limited at the moment, it offers many opportunities for improving access

and delivery of services which may stimulate its interest. Owusu-Aduomi Botchwey, Charles,

and Acquah (2021) empirically appraised the impact of EHRs on the performance of two

hospitals in the Greater Accra region of Ghana. They employed a qualitative methodology with a

case study design. A total of 35 respondents were selected through purposeful sampling to

participate in the study because of their role in EHRs implementation. They found that the

introduction of electronic patient record management simplified activities of the different

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departments, led to safer and lasting storage of information, reduced waiting time and increased

speed of healthcare delivery, improved delivery healthcare, improved patient satisfaction, and

enhanced revenue generation of the hospital. The study suggested that parity, responsiveness,

efficiency, and effectiveness should be considered significant building blocks to ensure that

EHRs geared towards efficient quality healthcare delivery flourish.

Seymour, Frantsvog, and Graeber (2012) found that although most healthcare providers have

been slow in adopting electronic health records, organizations that implement EHRs benefit from

lower medical costs for consumers, improved efficiencies, and improved quality and standard of

safety, and make medical records portable. Challenges to using EHRs include unknown future

government regulations, costly software packages, patient confidentiality, and system security.

There is also some evidence pointing to the barriers and facilitators of EHRs implementation.

Achampong (2012) observed that developing countries are slow implementers of new

technologies, especially concerning the healthcare services of these nations. He explored the

challenges experienced in data collection and management in 4 Ghanaian hospitals and proposed

EHRs implementation as a solution to these problems. However, he identified challenges that

could hinder the adequate performance of HER in the hospital: a weak state of information

infrastructure at the hospital, initial substantial startup costs, lack of policy to spearhead the

implementation, poor computer skills of healthcare professionals, and inadequate maintenance

culture.

Taylor (2017) reviewed the literature on the challenges and solutions for the practical application

of EHRs. He used common medical databases such as PubMed to select articles published

between 2005 and 2015. Taylor uncovered that poor EHRs implementation could lead to

inherent abuse or misuse of EHRs, financial problems, and logistical problems. Initial disruption
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to healthcare practices, high costs, and lack of certification of some products are significant

barriers to implementing EHRs. For small independent offices, the disconnect between who is in

charge of the implementation, who pays for it, and who benefits from EHRs presents significant

barriers to complete EHRs implantation. These offices have more problems absorbing the

enormous initial costs, increased costs of hardware and software, reduced revenue during

implementation, and ongoing maintenance costs.

In their study, Ajami and Bagheri-Tadi (2018) examined barriers perceived by healthcare

professionals in adopting EHRs. They found that physicians are reluctant to use EHRs because

they lack autonomy, financial resources, inadequate data exchange, system complexity,

incentives, privacy and security concerns, time, workflow disruption, and lack of computer skills

and interoperability. They concluded that healthcare facilities should train their staff, establish

standards, and cultivate and nurture strong leadership to insulate against these risks. Zeki,

Bowles, and Chaney examined the barriers, enablers, and effects of EHRs implementation in a

homecare environment. They hypothesized that effective performance and utilization of EHRs

could improve workflow, financial, and patient outcomes. The researchers unearthed that some

clinicians did not use the EHRs due to barriers such as mismatch between usability, workflow,

and functionality which lowers efficiency; the need for better first and continuous training; and

constant hardware issues combined with lack of technical support. Enablers of effective EHRs

implementation include support for team communication and enhanced timeliness of data

availability.

Adoption of EHRs requires careful planning and execution for effective implementation and

benefits. Ngugi, Were, and Babic (2018) sought to identify, analyze, and categorize barriers and

facilitators to implementing electronic medical records in low-resource settings to gather

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important insights into effective EMR implementation. A total of 18 articles published between

2007 and 2017 were examined. Content analysis identified four categories of enablers and

barriers: technical (stable electricity, infrastructure or hardware, system complexity, data storage

backup, and availability of standards), organizational (EMR adoption plan, funding,

procurement, leadership), and processes (incentives, training, system champions, technical

support), human (high expectations, workload, patient-staff relationship, experience, staff

turnover). The researchers urged the implementers of electronic medical records in resource-

constrained settings to focus on these issues and embrace a change management approach for

sustainable EHRs. Jakhar and Srivastava (2018) explored the resistors, drivers, and enablers of

EHRs implementation. Barriers to successful implementation include a learning curve to

adequately familiarize with the feature found in EHRs, lack of technical support and perceived

increased workload. Some enablers identified include upskilling and training of all end-users of

EHRs and clinician management in the design and roll-out of the EHRs. There is a need for

continuous support to ensure adequate buy-in from medical staff.

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METHODOLOGY

This study employs secondary analysis of qualitative data to investigate the factors that enable or

impede the usability of electronic health records in Ghana and the benefits that EHRs could bring

to the health care system and care delivery. According to Johnston (2017), using secondary

analysis of qualitative data entails using existing data to answer the research questions. Thus, I

seek to answer the research questions identified earlier by analyzing the already available data

from credible sources, such as the government, reports from hospitals and other health

institutions, relevant magazines, journals, books, and publications from other researchers and

research groups and universities.

According to Johnston (2017), using secondary information is advantageous because it requires

fewer resources in terms of finances and time than primary sources. For instance, collecting

primary data is time-consuming as one has to collect data from the population of interest, which

could take time to prepare and conduct the actual data collection. In addition to time, it may

require other resources and participation gifts. Furthermore, Johnston (2017) finds secondary

data to be an inconspicuous method that could lead to unforeseen discoveries.

However, secondary data may not always match the researcher's objectives, and relevant data is

not always readily accessible. Besides, using secondary data removes the researcher’s control

over data quality. This study's secondary information is the most appropriate because of its fewer

resource requirements. In addition, adequate literature, international and local, could help answer

my research questions.
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FINDINGS AND DISCUSSIONS

The researcher sought to examine the status of electronic health records in Ghanaian healthcare

systems with specific emphasis on the benefits and challenges associated with its

implementation. The findings of this study are discussed based on the research questions outlined

in the introduction section.

Question 1: What are the factors that enable or impede the usability of EHRs in Ghana?

A review of existing literature revealed several themes relating to facilitators of EHRs in Ghana,

namely motivation, logistics, training and capacity building, and human resources. The country

has readily available logistics such as printers, computers, scanners, and servers for initiating

EHRs implementation (Abdulai & Adam, 2020; Zakeri, Bowles, & Chaney). Moral support and

involvement from hospital management and primary implementers were important in making

end-users utilize the technology. Besides, all users were subjected to capacity building and

training prior to EMR implementation even though most of them had prior knowledge of the

technology. It was found that most users were motivated to see the complete implementation of

the EHRs system to allow for quick access to patients' information and ensure data persistency.

The data also identified some things on perceived future facilitators, including motivation,

human resources, and training. Hospitals in Ghana were tipped to hire skilled IT personnel to

deal with all emerging IT emergencies or problems and do data entry very fast. More so, in-

service training was considered important for both new hires and old staff. Users of EMRs were

also found to require individualized rewards and benefits of EMR usage.

In terms of barriers, the common themes in most sources include human resources, financial

resources, and data entry errors (Taylor, 2017; Ajami & Bagheri-Tadi, 2018). Most hospitals in
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Ghana are constrained in funding for acquiring sufficient logistics and hiring IT personnel

(Zakeri, Bowles, & Chaney). Errors in data entry like multiple registrations and incorrect dates

of birth were also common. The absence of automatic power and data backups led to data loss

that hindered EHRs utilization. Hospital staffs also tend to complain a lot about increased

workload and responded slowly to the change process.

The goal of this research project was to identify barriers and facilitators of EHRs adoption in the

Ghanaian healthcare system. The enablers of EHRs implementation were the health

professionals' desire to enhance emergency medicine practice via data persistency, availability of

logistics and training provided to medical providers. EMR implementation experienced barriers

of automatic power and data backups, full-time IT expertise, and funding problems. The

evaluator noted providing adequate financial and human resources can help alleviate the

challenges and improve EMR adoption. Other research works have supported the fact that staff's

prior exposure to EHRs during induction and their previous technological knowledge facilitates

EMR implementation (Jakhar & Srivastava, 2018; Ngugi, Were, & Babic, 2018). While EHRs

are somewhat inexpensive, some funds must be invested to get them running and for

maintenance. For instance, it has been shown that healthcare facilities with successful EHRs

adoption had invested significantly in EHRs implementation and maintenance (Seymour,

Frantsvog, & Graeber, 2012). In fact, countries like Australia and USA have already allotted

funds for nationwide EHRs implementation (Kologriopus, Baran, & Nimunkar, 2008).

The management at Ghanaian hospitals examined in the literature limited the number of material

and staff resources used for EHRs adoption. This finding is in line with the report by Zandieh et

al (2008) who found that space required for computers can hinder EHRs utilization. On top of

material and financial support, Kamadjeu, Tapang, and Moluh (2005) found that active
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involvement and encouragement by management and facility heads help facilitate EMR

implementation. The data call for support from different agencies like donor countries, hospital

management, and businesses to help the country in EMR adoption. This agrees with the

proposition that developed nations should support developing countries in EMR implementation.

Question 2: What are the uses of EHRs in the Ghanaian healthcare system?

This question sought to examine the behavioral intent of EMR utilization among healthcare

providers in Ghana. Data obtained from both qualitative and quantitative reveal that medical staff

in Ghana saw the need for EMR to continue and demonstrated the fact that it improves patient

satisfaction levels and elicits positive responses from patients concerning its quality. This

outcome is in agreement with the view held by Achampong (2012) that while there are barriers

to effective EMR implementation, improvement in efficiency and quality of care within a

healthcare setting is enough reason to adopt it. Besides, the result supports the idea by

Afarikumah (2014) that benefits healthcare facilities a great deal vial timely records, improved

efficiencies, and improved medical records precision.

Some research works also elicited mixed findings about the sustainability of EMR due to its

complex nature that may require frequent maintenance, internet data, and skilled personnel. This

supports the idea that, from the surface, EHRs adoption is an overwhelming and almost out-of-

reach affair to most administrators and suppliers and executives of medical data (Hayford, 2019).

Both developed and developing countries can face the problem of resistance to shifting from

manual to digital documentation for some medical practitioners and professionals. Afarikumah

(2014) noted that it may take time to change the behavior and attitude held by health

professionals regarding EHRs utilization. In Ghana, the EMR system plays a major role in the re-

engineering of hospital work processes to guarantee a more effective working approach.

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Seymour, Frantsvog, and Graeber (2012) found that EHRs contribute partly to healthcare job

savings by eliminating medical transcriptions.

Question 3: What is the impact of EHRs on patient care delivery?

This question examined the benefits and effects of the EMR system on the quality of medical

care delivered among patients and staff in the Ghanaian healthcare system. Findings from the

literature review uncovered that management benefits greatly from EHRs usage via easier and

faster booking of appointments, quality patient records, better requisitions, and attending to

clients simultaneously. The findings are consistent with the notion that IT in the healthcare

setting should help enhance the efficiency of medical professionals, enhance patient safety when

used properly, and reduce administrative or operational expenses (Manachemi & Collum, 2017).

The use of an EHR system helps enhance the quality of patient care through the elimination or

reduction of medication errors via e-prescribing. It also can enhance medical documentation,

reduce overall medical costs due to reducing errors, and support decision-making processes.

Besides, EMR can help eliminate patient testing and duplicate testing (Hayford, 2019).

Materials examining the leadership view of the role of EHR in the healthcare environment

unearthed that the effect of EMR on the quality of medical service can be considered positive or

negative. The findings showed that there is no discrimination in EHRs usage as to how clients

are treated, no patient harm, alleviation of harmful delays and time spent, and avoidance of waste

from the use of manual or EMR like getting reminder calls regarding booked appointments. The

findings supported the idea held by Seymour, Frantsvog, and Graeber (2012) that the EMR

system alleviates large volumes of paper produced when manual files are produced and shared.

The system allows easy access to clients' details to be utilized in healthcare delivery.
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Findings from clients' perspectives showed the impact of the EMR system on the relative cost of

its usage, triaging, and system end-user satisfaction. This supports the expectation that an EMR

system can help enhance patient safety, and efficiency of medical providers, and reduce

administrative and operational costs (Manachemi & Collum, 2017). Owusu-Aduomi Botchwey,

Opoku, and Acquah (2021) found other benefits of EHRs to include timely and available records,

improved efficiencies, portable medical records, reduced waiting time, increased speed of

healthcare delivery, and increased revenue generation for the hospitals.

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CONCLUSIONS AND RECOMMENDATIONS

This study examined the status of Electronic health records in the health care system of

Ghana, paying special emphasis on the benefits and challenges associated with adoption. It

sought to achieve this goal by seeking answers to three questions on the enablers and

barriers of EHRs usability in Ghana, uses of EHRs in the Ghanaian healthcare system, and

the impact of EHRs on patient care delivery. Secondary data was obtained by use of a

purposeful sampling approach in which articles that relate to the EHRs were only selected

for the study. This section provides adequate conclusions and makes recommendations for

research and practice based on the study questions.

Conclusion

In healthcare seeking competitive advantage, the implementation and use of EHRs is an

important element of service management. Because of this, the quality of patient care

provided is determined by the full implementation and sustenance of the EMR system. This

relationship between EMR and the quality of care provided is agreed upon by many

stakeholders to be a major concern. Besides, the need to better the quality of medical care

provided is a major factor in the modern healthcare system. All patients expect

uncompromised care. This paper examined the status of EHRs in the Ghanaian healthcare

system. The findings of this study unpacked that hospital management benefits greatly

from the use of EHRs via quality requisitions, easier and faster booking of appointments,

reduction in harmful delays and time wasting, relatively low cost, respectful and

responsive patient care, quality patient records, avoidance of waste, no discrimination,

reduced operational and administrative expenses and attending to clients simultaneously.

The eHealth system is, however, faced with the problem of waiting time, missing
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information or data, hardware infrastructure, end-user inability, trained personnel,

employee resistance, and huge investment and maintenance costs. It was concluded that

hospital management should support EHRs implementation and sustainability, and take

concrete measures to curb the emerging issues accompanying its use.

Recommendations

The researcher made several recommendations for future researchers, practice, and policy

formulation. First, hospitals in Ghana should completely adopt and maintain the EHRs

system because it confers many benefits. While it may be costly to implement the system,

the benefits gained from its use certainly outweigh operational costs. Secondly, hospitals

must take proactive measures to train their personnel on the use of the EMR system. The

training should incorporate activities that enhance the healthcare professionals'

understanding of the system and how to use it in the workplace. Furthermore, Ghanaian

Health service organizations must review the recent technologies employed to improve

care delivery and adopt better programs that would result in increased user satisfaction

with their staff. Such organizations can institute EHRs that are flexible to both internal staff

and external users like customers, patients, or clients. This can help promote staff

contentment and improve care delivery that eventually can lead to increased output and

efficiency for the hospitals.

For researchers, an additional study is warranted to examine the effect of electronic health

records on the quality of care delivery. Besides, the study examined the status of EHRs

within the entire healthcare system of the country. Future studies should consider using

specific hospitals, both private and public hospitals to give a more general and reflective
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picture. Furthermore, the study relied on secondary data published on various websites. An

additional study should consider using both primary and secondary data to elicit different

reactions.
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