FAIZA

EFFECT OF HEALTH INFORMATION MANAGEMENT SYSTEM (HIMS) ON
STAFF PERFORMANCE IN GOMBE SPECIALIST HOSPITAL OF GOMBE STATE
BY
FAIZA IDRIS HAMMA
(17/HIM/01/018)
BEING A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF

THE REQUIRMENTS FOR THE AWARD OF NATIONAL DIPLOMA (ND) IN
HEALTH INFORMATION MANAGEMENT SYSTEM, DEPARTMENT OF HEALTH
MANAGEMENT INFORMATION, GOMBE STATE COLLEGE OF HEALTH
SCIENCE AND TECHNOLOGY, KALTUNGO
AUGUST, 2019
i
DECLARATION
I hereby declare that this project titled Effect of Health Information Management System on
Staff Performance in Gombe Specialist Hospital was carried out by me and is a record of my
research work and has not been presented before to any other Institution for the award of any
degree or certificate. References made to literatures have been duly acknowledged.
FAIZA IDRIS HAMMA DATE

(17/HIM/01/018)
(STUDENT)
ii
DEDICATION
This project is dedicated to my family members.
iii
APPROVAL PAGE
We hereby certify that this project titled Effect of Health Information Management System on
Staff Performance in Gombe Specialist Hospital has met the requirements governing the award
of National Diploma (ND) in Health Information Management System of Gombe State College
of Health Science and Technology and has been approved for its contribution to knowledge and
literary presentation.
MR. ABUBAKAR AHMAD DATE

(DEAN)
MR. USMAN MUHAMMAD DATE
(HOD)
MRS. LIATU NBURAK DATE

(SUPERVISOR)
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ACKNOWLEDGEMENTS
I am grateful to Almighty Allah who is the entire source of knowledge and wisdom endowed to
mankind and who bestowed me with the potential ability to accomplish this work. I feel highly
privileged to record my deep sense of gratitude, sincerity and thanks to my Supervisor, Mrs.
Liatu Nburak the motivation of whom enabled me to select such a thought provoking and
striking project for her precious suggestions, personal interest, dedicated efforts, kind
supervision, affectionate criticism, extremely amicable, encouraging behavior and inspiring
guidance provided to me throughout the course of my study and in my social life. Her presence
was always a source of confidence for me; it was indeed an honour to work under her guidance.
It is my utmost pleasure to avail this opportunity to extend my heartiest gratitude to my Dean Mr.
Abubakar Ahmad and my Head of Department Mr. Usman Muhammad for their valuable
suggestions and criticism, useful comments, sympathetic and technical advice in my research
work and in the preparation of this manuscript. I wish to express my deep sense of gratitude to
all other members of this department for their skilful advices, sincere cooperation and learned
guidance, keen interest, help and supervisory suggestions. I have an immense obligation and
special thanks to all members of staff of Gombe State College of Health Science and
Technology, Kaltungo for their contributions in seeing me throughout my study; may Allah the
Almighty bless them and their families too, Amen. I shall be failing in my duty if I do not thank
to my sincere friends and colleagues for their kind assistance; may Allah bless them and their
families too, Amen.
Last but not the least, I also find hard to express my gratitude and appreciations in words to my
affectionate husband and parents who always pray to see me glittering high on the skies of
success. Whatever, I am today is because of their love and prayers. No acknowledgements would
ever adequately express my obligation to my brothers and sisters who always wish me a good
health and success.
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TABLE OF CONTENTS
TITLE PAGE
..........................................................................................................................................................i
DECLARATION............................................................................................................................iii
DEDICATION................................................................................................................................iv
APPROVAL PAGE.........................................................................................................................v
ACKNOWLEDGEMENTS............................................................................................................vi
TABLE OF CONTENTS..............................................................................................................vii
ABSTRACT....................................................................................................................................x
LIST OF TABLES..........................................................................................................................xi
CHAPTER ONE..............................................................................................................................1
1.0 INTRODUCTION.....................................................................................................................1
1.1 Background of the Study...........................................................................................................1
1.2 Statement of the Problem.......................................................................................................3
1.3 Aim of the Study....................................................................................................................3
1.4 Objectives of the Study..........................................................................................................3
1.5 Significance of the Research..................................................................................................4
1.6 Hypotheses.............................................................................................................................4
1.7 Research Questions................................................................................................................4
1.8 Scope/Limitation of the Study................................................................................................4
CHAPTER TWO.............................................................................................................................5
2.0 LITERATURE REVIEW..........................................................................................................5
2.1 Introduction............................................................................................................................5
2.2 Paper Based Record Keeping in Healthcare Delivery............................................................6
2.3 Electronic Health Record in Healthcare Delivery..................................................................6
2.4 Dimensions of Data Quality...................................................................................................7
2.5 Data Quality Measurement.....................................................................................................7
2.6 Factors that Determine Data Quality....................................................................................10
2.7 Health Information Management System in Developed Countries......................................12
2.8 Health Information Management System in Developing Countries....................................13
2.9 Human Capacity and Training on Health Information Management System......................14
2.10 Health Information Management Systems Challenges......................................................15
2.11 Health Information Management System Security Issues.................................................16
CHAPTER THREE.......................................................................................................................18
3.0 MATERIALS AND METHODS...........................................................................................18
3.1 Research Design...................................................................................................................18
3.3 Area of Study........................................................................................................................18
3.4 Target Population.................................................................................................................18
3.5 Sample and Sampling Techniques.......................................................................................19
3.5.1 Sample Size.......................................................................................................................19
3.5.2 Sampling Technique..........................................................................................................19
3.6 Data Collection Methods......................................................................................................20
3.6.1. Questionnaires..................................................................................................................20
3.6.2 Documentary Reviews......................................................................................................20
3.7 Research Instruments...........................................................................................................20
3.7.1 Pilot Study.........................................................................................................................20
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3.7.2 Validity..............................................................................................................................21
3.7.3 Reliability..........................................................................................................................21
3.8 Data Collection Procedures..................................................................................................21
3.9 Data Analysis and Presentation............................................................................................22
3.10 Ethical Considerations........................................................................................................22
CHAPTER FOUR.........................................................................................................................23
DATA PRESENTATION, ANALYSIS AND INTERPRETATION...........................................23
4.0 Introduction..........................................................................................................................23
4.1 Background Information of Respondents.............................................................................23
4.2 Profession of the respondents...............................................................................................23
4.3 Working Experience.............................................................................................................24
4.4 Use of Hospital Management Information System..............................................................24
4.5 System Functionality in Accessing Services........................................................................25
4.6 Systems Enable the Use and Access of in or out Patient Information.................................25
4.7 The Systems Improved Quality of Services.........................................................................26
4.8 The Systems Provide Diseases Notification Data................................................................26
4.9 The Systems Provide Epidemiological Data........................................................................27
4.10 The Systems Manage Financial Imperatives......................................................................27
4.11 The Systems Improved Patients’ Information Security.....................................................28
4.12 The Systems Provided Accuracy and Relevant Information..............................................29
4.13 The Systems Provided Timely Relevant Data....................................................................29
4. 14 Strength of Hospital Information Management System....................................................30
4.15 Perceptions of the Respondents in Gombe Specialist Hospital on Staff Training.............30
4.16 Challenges Encountered in the Use of Hospital Management Information Systems.........31
4.17 Recommendations on How to Improve the Existing Systems...........................................31
CHAPTER FIVE...........................................................................................................................32
5.0 DISCUSSION, CONCLUSION AND RECOMMENDATIONS..........................................32
5.1 Background Information of the Respondents.......................................................................32
5.2 The Use of Hospital Information Management System.......................................................32
5.3 Systems Provided Accurate and Relevant Patient Information............................................32
5.4 Perceptions of the Hospital Staff towards the Systems........................................................33
5.5 Challenges Encountered in the Use of Hospital Information Management System............33
5.6 Conclusion............................................................................................................................33
5.7 Recommendations................................................................................................................34
5.7.1 Evaluation of Systems.......................................................................................................34
5.7.2 Improvement on the System Speed...................................................................................34
5.7.3 Employ More ICT Staff....................................................................................................34
5.7.4 Acquire More Computers..................................................................................................34
5.7.5 Facilitate More Staff Training...........................................................................................34
REFERENCES..............................................................................................................................35
APPENDIX I.................................................................................................................................41
LETTER OF INTRODUCTION...................................................................................................41
APPENDIX 11...............................................................................................................................42
QUESTIONNAIRE FOR GOMBE SPECIALIST HOSPITAL STAFF......................................42
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ABSTRACT
Improved health information management system use, requires improved quality of data and
information products. Decisions on what information system to adopt have often been made
without evidence of effectiveness; or information on implications; or extensive knowledge on
how to maximize benefits of the systems. This study examined the use of the hospital
information management system among healthcare workers in Gombe Specialist Hospital. The
study objectives were to: assess the use of hospital information management system, establish
the extent to which the software systems provide accurate and relevant information of the
patients, established the challenges that are experienced in using the hospital information
management system in the hospital and suggest possible solutions to improve the system. Health
information management system deal with data quality and is characterized by the relevance,
accuracy, timeliness and completeness of data, while health system performance looks at
decision makers explicitly considering information in policymaking, planning, management and
service delivery. Descriptive survey was applied involving both quantitative and qualitative
approaches, structured questionnaire and document reviews were used to gather data of the
respondents of healthcare workers. The findings of this study have established that health
information management system provides accurate and relevant patients’ information and other
useful data needed to effectively manage patients’ care and govern the health facilities. The
study also established that modern and sufficient information communication and
telecommunication equipment are required so as to deliver desired results. Training of healthcare
workers and continuous support is also of paramount importance in sustaining health information
management system in our hospitals and other organizations.
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LIST OF TABLES
Table 1: Profession of the Respondents in Gombe Special Hospital............................................23
Table 2: Work Experience of the Respondents in Gombe Specialist Hospital.............................24
Table 3: Systems are Easy to Use by Respondents in Gombe Specialist Hospital........................24
Table 4: Functionality for Accessing Services by Respondents in Gombe Specialist Hospital....25
Table 5: Systems Enabled the Use and Access of in and out and Patients’ Information..............26
Table 6: Systems Improved Quality of Services...........................................................................26
Table 7: Systems Provided Disease Notification Data..................................................................27
Table 8: Systems Provided Epidemiological Data........................................................................27
Table 9: Systems Managed Financial Imperatives........................................................................28
Table 10: Systems Improved on Patients’ Information Security ..................................................28
Table 11: Systems Provided Accurate and Relevant Information.................................................29
Table 12: Systems Provided Timely Relevant Data......................................................................30
Table 13: Strength of Hospital Management System....................................................................30
Table 14: Perceptions of Respondents in Gombe Specialist Hospital...........................................31
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the Study
A system is a collection of components that work together to achieve a common goal, an
information system is a system that provides information support for decision making process at
each level of an organization. A health information system is a system that integrates data
collection, processing, reporting and use of the information necessary for improving health
service effectiveness and efficiency through a better management at all levels of health services.
A Health Information Management System is an information system specially designed to assist
in the management and planning of health programs, as opposed to care delivery. Health
Information Systems is one of the six building blocks of a Health System (WHO, 2008), while
the other 5 building blocks are health workforce; health services; health financing; governance
and leadership. Health Information Management System building block provides vital
information for effective decision making for the other building blocks (Abou-Zahr and Boerma,
2005). An information system refers to the structures and processes dedicated to the collection,
storage, retrieval and use of information usually within the context of an organization (Callaos
and Callaos, 2002), thus a health information management system consists of data collection,
processing, archiving and use of the information required for the specific aim of improving
health service efficiency and health systems (Lippeveld, 2000).
In a health information management system there are different types of information based on the
frequency of information generation; routine and non-routine information. Routine health
information provides information at regular intervals to meet predictable information needs
(Lippeveld, 2000) whereas non-routine health information like population censuses,
demographic health surveys provide information on an ad-hoc basis and over longer intervals
usually complement what is collected via routine health information (Lippeveld, 2000). Even
though decision making are largely based on surveys and ad-hoc reviews, these methods are
more expensive and provide information intermittently (Wagenaar et al., 2015). In a health
system, the measurement of success is determined by the health system’s performance which
depends on the generation and use of quality routine health data and information extracted from
the health information management system (WHO, 2008). Unfortunately, though routine health
information is important, the poor quality of the routine health information impedes the effective
use of information for decision making in health systems. Despite the pivotal importance of good
quality health data, it has been found that in practice, HIMS data have a number of limitations
and quality problems, such as missing values, bias, and computation errors (WHO, 2008). The
health information system is bedeviled with serious limitations in the value of the health
information of the data provided particularly regarding its availability and usefulness for decision
making processes at local level.
The National Health Information Management System (NHIMS) in Nigeria has over the years
been noted to be specifically in data completeness, reliability and use in supporting the health
system (Anifalaje, 2009). In 2010, an assessment of the data quality of the routine health
information management in some of Nigerian States found poor data quality at health facility and
district levels to consist of missing values, inconsistent data and poor usability (Makinde, 2012).
Furthermore, poor data quality is experienced despite of routine Health Information Management
System being part of international donor investments in health systems strengthening (Wagenaar
et al., 2015). Huge financial and non-financial investments have been made in the data collection
and maintenance of the health information systems but the information is not used for decision
making (Shaw, 2005).
The effects of poor data quality impact several aspects of the health system including planning,
remise financing and management (Mavimbe et al., 2005). Thus, to ensure high quality data in
routine health information systems the root causes of poor data quality and the factors that affect
data quality has to be identified. In Nigeria, the National Health Information Management
System provides a framework on the process for data collection and collation, analysis and use of
health data in the country (WHO, 2008). In the framework, primary health care is at the core of
the Nigerian health system and this is where health service statistics are reported from the health
facilities on a monthly basis to the supervising districts. It is mandatory for each health facility to
report a minimum set of health information data on a monthly basis to the respective supervising
health districts. The minimum set of health information data is collected on a set of data
collection tools at the health facilities. The data collection tools starts with daily registers
collecting data on each individual patient daily which is then aggregated to monthly summary
forms and eventually the data is captured on an electronic database. Thus, there are three (3)
sources of health information integrated to form the National Health Information System: daily
data collection tools, monthly health facility summary form, and finally the data capturing form
on the electronic database.
Data quality is usually assessed through conducting data quality assessment exercises to health
facilities by district and sub national officials. This assessment is typically executed by the
District Monitoring and Evaluation Officer on a quarterly basis. For this data quality assessment
exercise, a nationally approved tool is used to evaluate data quality at the health facility.
However, these exercises are often donor driven and on an ad-hoc basis depending on the
availability of remises to conduct these exercises. In summary, good quality routine health
information system is essential to the success for health information system and the overall
health system. However, information within routine health information systems is often of poor
quality and hindering the use of information.
1.2 Statement of the Problem
In Gombe Specialist Hospital, the use of routine information for decision making at all
administrative levels is limited and this has been ascribed to the poor data quality of routine
health information. However, there is a paucity of research based evidence on the current state of
data quality in Gombe Specialist Hospital as well as the factors that may influence data quality in
routine health information system. It is thus necessary to assess the quality of routine health
information as well as to investigate the factors that affect data quality in Gombe Specialist
Hospital to generate good quality data in routine health information management system for the
use of information in decision making and planning.
1.3 Aim of the Study
The aim of this study is to assess the performance of Gombe Specialist Hospital Staff in using
health information management system and its impact in improving the quality of their service
delivery.
1.4 Objectives of the Study
The objectives of this study are:
1. To assess the level of awareness of Health Information Management System by health Staff in
Gombe Specialist hospital.
2. To identify the challenges faced by health Staff in the implementation of Health Information
Management System in Gombe Specialist Hospital.
3. To offer possible solutions to the health Staff in the implementation of Health Information
Management System in Gombe Specialist Hospital.
1.5 Significance of the Research
The study can guide system developers and healthcare managers in the design and
implementation of Health Information Management System that are sustainable vis-a-vis the
peculiarities of Nigerian hospitals, most of which are in sub-urban towns often plagued by
various infrastructural challenges like inadequate power supply, inadequate qualified medical
personnel, poor road network and poor internet access among other things. As efforts are
currently underway by the Federal Ministry of Health to scale up ICT infrastructure in all health
facilities, findings from this study may be valuable for policy formulation and implementation of
electronic health records. It will also contribute to the existing knowledge on issues associated
with deployment and implementation of electronic health records in developing countries in
enhancing the Health Information Management System.
1.6 Hypotheses
Ho1. There is no significant difference between the paper method of Health Information
Management System and electronic method of Health Information Management System in
Gombe Specialist Hospital.
Ha1. There is a significant difference between the paper method of Health Information
Management System and electronic method of Health Information Management System in
Gombe Specialist Hospital.
1.7 Research Questions
1. How much knowledge of the Health Information Management System do the healthcare
professionals in Gombe Specialist hospital have?
2. What do the health professionals in Gombe Specialist hospital perceive of the challenges to
the implementation of Health Information Management System?
3. What do the health professionals in Gombe Specialist hospital believe of the prospects to the
implementation of Health Information Management System?
1.8 Scope/Limitation of the Study
This research study is limited to Gombe Specialist Hospital of Gombe State.
CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 Introduction
Health Information Management System, like any other software consist of parts which are
interrelated and interdependent which work towards a common goal. The Health Metrics
Network (HMN) describes Health Information Management System as six building blocks;
remises indicators, data sources, data management, information products and dissemination, and
finally the use of information (WHO, 2008). In addition, the HMN states that Health Information
Management System collects data from the health sector and other relevant sectors, analyses the
data and ensures their overall quality, relevance and timeliness, and converts data into
information for health related decision making (WHO, 2008). Routine health information
systems are considered important because it provides information to different levels of the health
system; it is used for the planning of health system interventions and for the effective monitoring
and evaluation of health systems (Abou-Zahr and Boerma, 2005). Planning of the health
interventions cut across several health decisions including remise allocation, monitoring and
evaluation of health program goals, micro and macro planning of health activities and public
health systems research (Abou-Zahr and Boerma, 2005; Bowen et al., 2009).
Data quality is a vital component of Health Information Management System and the importance
of the availability of usable routine health information is central to the use of the information for
planning and decision making (WHO, 2008). However, despite the recognized importance of the
production and use of good quality data for effective Health Information Management Systems
monitoring and evaluation, Health Information Management Systems is ascribed a poor level of
data quality (Ndabarora et al., 2013). Good quality data is said to be when the information
available fits or meets the intended goals of its users (Chen et al., 2014). Unfortunately, Health
Information Management System in developing countries often falls into a vicious cycle of poor
data quality and poor information use (Heywood and Rhode, 2001).
The issue of record keeping in healthcare service delivery is very important as evident in the
evolvement of hospital record management as a core discipline in the area of hospital
management in recent times (Asai and Fernando, 2011). To be useful, the record system must
make it easy to access and display needed data, to analyze them, and to share them among
colleagues and with secondary users of the record who are not involved in direct patient care
(Braa et al., 2012). There are two major means of keeping medical records of patients in any
healthcare delivery facility: the paper-based record keeping system and the electronic health
record (EHR) system.
2.2 Paper Based Record Keeping in Healthcare Delivery
The traditional paper based medical record arose in the nineteenth century as a highly
personalized lab notebook that clinicians could use to record their observations and plans so that
they could be reminded of pertinent details when they next saw the same patient. The traditional
paper based approach to clinical documentation has become overwhelmed by information
exchange demands among health care providers, financial and legal complexities of the modern
health care environment, the increasing rate of biomedical knowledge, growing chronic care
needs from an aging population, and medical errors associated with handwritten notes (Chen et
al., 2014). Furthermore, it comes with other challenges like; inadequate physical space to keep
the cards in case of high number of patients, inconsistency in handwriting of individuals as Ill as
vulnerability to termite attack or other attacks. Retrieval of patient information will take a longer
time and patients may be privy to confidential information in situations where they must take
these paper based records from one unit of the hospital to another (Asai and Fernando, 2011).
Also, there are certain patients that registered with several healthcare providers and these patient
records are never shared with other physicians, laboratories and hospitals. Hence information
becomes fragmented causing disruption, delay and error in patient care (Avgerou, 2008). Patients
most times do not have access to their accurate and reliable information which could be used by
them to meet their need. Studies revealed that patients who understand their condition and are
involved with doctors in making decisions are better able to deal with their illness or diseases
(Gladwin et al., 2000).
2.3 Electronic Health Record in Healthcare Delivery
There are numerous acronyms for system handling patient data: Electronic Medical record
(EMR), Electronic Patient Record (EPR), Computerized Medical Record (CMR), Computer
Based Patient Record (CPR), and Electronic Health record (EHR). There are only minor
differences in the meanings depending on the defining country of origin, health sector,
professional discipline, and period of time (Nicol et al., 2016). The acronym EHR is preferred in
this study. The electronic health record has been acknowledged as an important driving force for
modern organizational productivity, efficiency and performance effectiveness in healthcare
delivery (Love et al., 2015). The EHR can be defined as a longitudinal health record with entries
by healthcare practitioners in multiple sites where care is provided. It is used primarily for the
purpose of setting objectives and planning patient care, documenting the delivery of care and
assessing the outcomes of care. It includes information regarding patient needs during episode of
care provided by different healthcare professionals (Haln et al., 2013).
2.4 Dimensions of Data Quality
In the past, data quality referred to the fitness for use (Tayi and Ballou, 1998; Wang and Strong,
1996). More recently, researchers propose that there are properties of data that determines data
quality and there appears to be an agreement that data quality is a multidimensional concept
(Chen et al., 2014; Wang and Strong, 1996; Zaied, 2012). However, there is no agreement on the
dimensions of data quality, there are cross cutting dimensions identified by the literature:
completeness, timeliness, consistency, accuracy, reliability and precision (Glele-Ahanhanzo et
al., 2014; Ndabarora et al., 2013; Pipino et al., 2002; Wang and Strong, 1996).
Specifically, the dimensions completeness, accuracy, consistency, and timeliness are found in the
most common reviews in the literature (Chen et al., 2014). Completeness is defined as a measure
of the presence of expected data items in a given data set or collection (Wang and Strong, 1996).
Accuracy is described as the closeness of data values to the truth or the veracity of the
information received (Chen et al., 2014). Data consistency and accuracy are considered separate
data quality dimensions but consistency can only be achieved if data is accurate and valid
because the stability of data ensures consistency (Hahn et al., 2013). Timeliness is viewed as the
extent to which a particular set of data is current in relation to a specified time (Zaeid, 2012).
Chahed et al. (2013) used the completeness and accuracy dimensions to evaluate the
immunization data with focus of reported values for DPT3 using daily and monthly PHC
reporting forms.
2.5 Data Quality Measurement
The measurement of data quality in routine Health Information Management System involves the
use of various methodologies typically in one or more of the dimensions of data quality
mentioned above (Chen et al., 2014). However, the measurement of data quality appears to have
focused on identifying poor data quality such as data inconsistencies, data accuracy errors and
misrepresentations (Chen et al., 2014). One particular measurement tool is the Routine Data
Quality Assessment tool (RDQA) developed by Measure Evaluation (Measure Evaluation, 2008)
which has been used in many countries to assess data quality in routine Health Information
Management System (Edgard-Marius et al., 2014). The tool uses a two-pronged approach
looking at data verification and routine data system assessment to evaluate data quality and can
be used either in its original form or adopted to meet specific needs.
The first of the two-pronged approach is the data verification part of the tool. The data
verification recounts reported data values against source documents and uses the values to
calculate a ratio comparing the values obtained. The second approach in the RDQA is the
systems assessment focusing on a qualitative approach to assess the data management and
reporting systems on data administrative levels. The assessment covers the training, indicator
definitions, data requirements, data management and quality control measures in the data
management process (Edgarg-Marius et al., 2014). The RDQA basically combines both
quantitative and qualitative methods to assess data quality.
The RDQA tool has been used in various countries and for different purposes illustrating its
usefulness in assessing data quality. For example, the tool was used in Nigeria, to evaluate the
quality of HIV data to improve grant applications using both approaches; Data Verification and
Systems Assessment (Edgard-Marius et al., 2014). This study found poor quality data in ART
clinics in Nigeria and attributed this to late submission of data from health facilities as well as a
high turnover rate of health facility staff. In another example, the tool was used in a cross
country data quality assessment of Immunization data involving 27 countries (Ronveaux et al.,
2005). Using the verification factor technique, the study found that only about 42% of districts
evaluated fell between the desired range of 0.85 and 1.15 (Ronveaux et al., 2005). The
verification factor was calculated by recounting Diphtheria-Tetanus Pertussis Third Dose (DPT3)
values at health facilities and comparing with values reported at the districts and national levels
(Ronveaux et al., 2005).
Similarly, researchers in Tunisia examine the consistency of immunization data using
verification factors (Chahed et al., 2013). The consistency of the reporting system was
determined by comparing reported Diphtheria-Tetanus Pertussis Third Dose (DPT3) values with
written documentation in health facilities and districts. Chahed et al. (2013) found large
discrepancies between the Diphtheria-Tetanus Pertussis Third Dose (DPT3) values recorded in
the facility registers, facility summary forms as well as district summaries. They found good data
completion rates in their study although this was based on the availability of paper records. In
another case, a process evaluation approach was adopted to assess immunization data (Mavimbe
et al., 2005). In this process evaluation approach facility reports were crosschecked with tally
sheets as well as district reports. Interviews were also conducted with health workers in the
health facilities about data collection methods, quality of feedback on data quality as well as
interactions with their respective district management teams. The study found poor consistency
between values at health facilities and districts in Mozambique although data was complete
(Mavimbe et al., 2005).
Using qualitative methods researchers in Mozambique tried to investigate the data quality of
routine malaria data finding problems with the available malaria data in terms of completeness
and accuracy (Collins, 2003). The results showed a discrepancy of 62% in the number of malaria
cases reported at the district paper based records and electronic provincial records. The
researchers attributed this to human errors in computation. In summary, the illustrations of the
use of the RDQA tool described above provide evidence of the usefulness of the tool in
investigating data quality in routine Health Information Management Systems of vertical
programs. The challenge is applying the tool to all the health programs in the health system.
Furthermore, several research studies in developing countries Ire identified conducting
measurements of data quality in routine Health Information Management Systems at facility and
district levels (Collins, 2003; Ledikwe et al., 2014; Ronveaux et al., 2005). Collins (2003)
conducted a study on malaria data and found marked differences between laboratory registers of
malaria tests and what was recorded in summary forms submitted to district and provincial levels
(Collins, 2013). In this case, large discrepancies in values Ire found comparing the data at
provincial and National levels in Mozambique.
Ledikwe et al. (2014) conducted a qualitative study in Botswana using interviews based on the
routine data quality audit tool. The interviewees were asked questions related to data
management processes, monitoring and evaluation structures, indicator definitions and National
information systems as related to the quality of health information. The study found that there are
generally good monitoring and evaluation systems in place with available human remises at the
district and national levels to ensure the production of good quality health information in
Botswana. There was however challenges reported with the electronic data systems in the
country at the time of the study. These challenges included the presence of multiple systems
lacking the ability to integrate the different health systems making the systems unreliable for
most users in the system.
An example of a study focusing on facility level data is a qualitative study conducted in Tanzania
(Wagenaar et al., 2015). Wagenaar et al. (2015) explored the implementation of National data
collection tools and data quality at one district hospital in Tanzania. The researchers used various
qualitative methods include interviews, direct observations as well as the retrospective inspection
of reporting documents used in the health facility. Findings included pervasive inadequacies in
the completeness and accuracy of health records in the secondary documents used for reporting
outside the health facility. The study also found that the information available from the hospital
was not used for any decision making process.
2.6 Factors that Determine Data Quality
The factors that affect data quality identified in routine Health Information Management Systems
are behavioral, infrastructural and systems based (Glele-Ahanhanzo et al., 2014). The behavioral
factors include health staff motivation, presence of incentives or disincentives; the infrastructural
factors include availability of proper data collection tools and equipment, quantity and quality of
human remises for health information systems and use of technology and the systems factors
include level of data demand and use, feedback mechanisms within health administrative levels,
routine data quality checks and availability of robust routine health information system policies
(Glele-Ahanhanzo et al., 2014). Furthermore, the human remises in routine health information
systems remain a key factor in determining data quality because a strong health information
system is built on well-functioning core building blocks driven by vibrant human remises for
health (Health Metrics Network, 2005).
In Benin, researchers using the RDQA tool and Lot Sampling technique identified human remise
levels, management and planning capacity as well as the state of infrastructure as some of the
factors that influenced the quality of routine health information. Health Facilities with well
trained staff and management capacity were found to have better quality health information
(Glele-Ahanhanzo et al., 2014) confirming their findings that human remises play a major role in
determining the quality of data within a routine Health Information Management System and
identified specifically health workers competence within the scope of their training as a factor.
The Benin study was a cross sectional descriptive study aimed to determine the factors that affect
the quality of data in the routine Health Information Management System. Focus group
discussions were used to collect information from health staff related to the collection of data in
routine Health Information Management Systems. The focus groups gave the following reasons
as responsible for the poor data quality seen in the study; large amount of data required in tools,
format of data collection forms, de-motivation of staff in routine heath management information
systems activities and poor capacity (Glele-Ahanhanzo et al., 2014).
Using mixed methods in a cross sectional study Cheburet and Odhiambo-Otieno., (2016) looked
at organizational factors that influence the quality of routine Health Information Management
Systems in one hospital in Kenya (Cheburet and Odhiambo-Otieno., 2016). This study obtained
data via questionnaires administered to respondents in the health facility asking questions related
to the process of data collection as well as data quality protocols available in the health facility.
Data verification done in the study showed gaps in data completeness and consistency in the
available data in the health facility. The study reported the presence of strong organization
protocols for data quality as a major factor in determining the quality of data in routine health
information systems.
Motivation or lack of motivation has been described in literature as determinants of health staff
performance and remains a major determinant of human remise performance. Since human
remises play a major role in the functioning or routine Health Information Management Systems,
the general issues that affect staff performance and efficiency within health systems will have an
influence on information systems. A literature review of performance based financing in health
systems across several countries showed that financial incentives improved the quality and
efficiency of health staff in health facilities (Sood, 2008).
Although financial incentives were not identified as a factor in most of the reviewed studies, it
has been reported as a possible determinant of human remise performance in health systems and
by extension of health information systems (Ireland et al., 2011; James et al., 2012; Wagenaar et
al., 2015). Reward for good quality data whether by direct inducement or incentives can
contribute to the quality of data produced at health facilities; this is an extension of effects of
performance based on inducement programs for health workers making this a possible factor that
influences data quality in routine Health Information Management Systems (Miller et al., 2014).
Regular data audits often referred to as data quality assessments were identified as contributors
to the level of data quality in Health Information Management Systems as well as investments in
human remise development (Mutale et al., 2013). A study looking at the development of health
information systems in five countries, Mutale et al. (2013) identified engagement at the district
and facility level to institutionalize routine data quality audits as a factor to improve the quality
and subsequent use of data within routine Health Information Management Systems. They
posited that these regular audits accompanied by regular feedback on data quality will improve
the quality of data in the health information systems.
The capacity of the human remise available has also been identified in several studies as
determinants of the quality of data in routine Health Information Management Systems. The
capacity of health staff to understand with specific training for health care workers on the
importance of public health information, monthly data reviews and feedback, regular data audits
(Mutale et al., 2013).
2.7 Health Information Management System in Developed Countries
One notable observation in Europe is that each country has its own distinctive approach in the
journey towards enabling technologies in healthcare. France is developing the concept of digital
hospitals via telemedicine technologies (Polonsky and Weller, 2009). Germany is working on an
electronic health card (EHC) that allows the physicians to check the administrative data of the
patient and write prescriptions on the system. This system will also have voluntary medical
functions like the emergency data record and later the electronic patient record that can be
checked anywhere using appropriate card readers (Sunyaev et al., 2009).
Denmark leads the way in European e-health and patient controlled health records (Cruicksack et
al., 2012) boasts a universal electronic health record system and of national patient health record
(PHR) service available to any Danish citizen that allows the control to accesses and use medical
information. Launched in 2003, the country’s government run patient health record portal is
Sundhed.dk, the website where, citizens view treatments and diagnoses from the hospital patient
record, book appointments with the general practitioner, renew prescription drugs, monitor own
drug compliance, survey shortest waiting lists for operations and quality ratings of hospitals,
register as organ donor, and get access to local disease management systems in out-patient
clinics (Makori et al., 2013). Information system development until recently relied mainly on
technical approaches, from assessing information needs to developing data analysis and
presentation tools, and using information communication and technology, with little recognition
of the effects of contextual issues. Information system is described as the set of related elements
without any consensus on defining and measuring the systems’ performance. Attention is given
neither to how people react to and uses information systems for problem solving or self-
regulating performance behavioral factors, nor organizational processes for creating enabling
environment for using and sustaining routine health information system. When attention is given
to these factors, there is need to put them in a coherent framework to understand the effects on
RHIS processes and not follow their performance only
2.8 Health Information Management System in Developing Countries
Health system strengthening is a global priority and one of the core components is the need to
improve health information systems. World Health Organization describes these components as
integrated efforts to collect, process, report and use health information and knowledge to
influence policy making, program action and research. Most health information systems in
developing countries in practice are complex and fragmented (Abou-Zahr and Boerma 2005).
This is caused by the way systems have been developed and evolved over time, in piecemeal
fashion, in response to donor pressure or requirements of disease specific initiatives (HMN,
2008).
Developing countries are now waking up to the realization that there is need to embrace
information and communication technologies to deal with the problem of access, quality and
costs of healthcare. Adoption of ICT in health sector across developing countries accelerates
knowledge diffusion and increase access to health information (Samy et al., 2011). Video
conferencing tools have been deployed in Tunisia for tele-diagnosing while in Botswana there is
extensive e-learning for AIDS programs by community health workers. In Rwanda, efforts are
on-going to connect the district hospitals with referral hospitals for the transfer of medical
information. This is going to be very important especially in the area of tele-radiology (Makori et
al., 2013). The problems that exist in the health sectors of many developing countries such as
high mortality and morbidity rates, high population and lack of enough medical staff can be
addressed by telemedicine adoption (Samy et al., 2011).
Hospital information systems have enabled faster processing, storage and transfer of medical
information between service providers in developing countries. A health information system
prominently featuring in developing countries’ e-health landscape is the one shared by Southern
African countries including Botswana, South Africa, Mozambique, Tanzania, Ethiopia and
Malawi. In Ghana, adoption of electronic health information technology, (EHIT) has become the
integral part of the national health care delivery system. Reliance on EHIT seems poised to grow
in the years to come due to the myriad of advantages derived from the capture, storage, retrieval
and analysis of large volumes of protected health data, and from multiple sources, which is
spread over a long period of time (Bryman, 2006).
There exists evidence to show that electronic medical records are gaining ground in the health
sector in developing countries. For instance, the Open MRS developed by the Regienstrief
Institute and Partners in Health, provides a user-friendly interface for electronically storing
medical data and has been very successful in Kenya. The Mosoroit Medical Record System
(MMRS), which was implemented at a primary care rural health center in Kenya, provides
patient registration and patient visit records management with capability to handle information of
over 60,000 patients (Sood et al., 2008). Other electronic medical records that have succeeded in
developing countries include the Lilongwe HIS used for wide range of clinical problems in
pediatric department of the Central Hospital in Malawi; Partners in Health (PIH)-HIS, Peru;
HIV-HIS system, Haiti; Careware, Uganda; PEPFAR project, Tanzania; National HIS, project
Zambia (Sood et al., 2008).
These electronic medical records require addressing of confidentiality, privacy and security
issues for maximum acceptability by clinicians. The clinicians must also understand the benefits
and how systems will impact on routines and business processes in hospitals, a challenge that can
be overcome by including ICT in the curriculum of medical courses offered in developing
countries, this is why the study seeks to establish the health information systems effectiveness
among the healthcare workers (Sood et al., 2008).
2.9 Human Capacity and Training on Health Information Management System
Lack of trained human remises for health is a major problem in health care systems in most
developing countries (Chen et al., 2014). The limited human remises and capacity available, both
in terms of technical skills in how to use ICT, as well as high-level technical support skills to
ensure setup and maintenance, have resulted in high reliance on external remises and experts.
Such a reliance on external capacity drives ICT costs upwards, and also produces significant
retention problems and lack of locally-qualified personnel.
However, it is not only the recipient country that needs capacity development and training in the
use of ICT. As demonstrated in Vanuatu (Khazei et al., 2005), international e-Health consultants
must know what local remises are available and have an understanding of the conditions of the
country they are providing information to for example, standard treatment protocols and
availability of various drugs and diagnostics. Overall, while technology can provide a link to
information and knowledge, the critical factor in all ICT initiatives is human remises and
capacity for effectiveness in its use (Keke, 2007).
2.10 Health Information Management Systems Challenges
Given the high failure rate and the very visible and often politically embarrassing failure of many
health ICT projects, there has been substantial academic and industry research on the factors that
cause such systems to fail. Health systems are significantly different from other information
system environments, due to complexity, lack of one single owner, and hyper turbulent and
information sensitive nature (Cheburet and Odhiambo-Otieno, 2014). Lack of senior
management support is often cited as number one cause of project failures in ICT and this is
particularly the case in health ICT projects. Any worthwhile project causes disruption within the
organization and challenges existing interests and practices. If senior management are not
committed to the project and willing to undergo the difficulties involved in overcoming the
internal and external barriers then the project is almost certain to fail. Lack of engagement of
clinicians and other end-users remains the critical factor in the ultimate success or failure of the
ICT project. In research on lessons learned from tele-health projects, English (2014) remarked
that, the fundamental issue pervading the continued failure of ICT projects in health is the lack of
focus on the end-user. The internal dynamics of clinical organizations are quite different from
those of other businesses. In the bank, for example, management can enforce the introduction of
new systems even if the end-users are opposed. In a clinical setting, doctors who have not been
engaged in the introduction of new technology, who feel the systems waste the time or affect
patient safety, can refuse to use the technology and often have the organizational power, even if
informal, to have their wishes implemented.
The introduction of new ICT systems usually requires the introduction of new ways of working,
new staff skills, new roles and may require organizational restructure. In general, people are
resistant to such changes especially if issues of being threatened by the system remain unsolved.
Health Information Management Systems not only deal with complex clinical information
technologies, medical science, research and practices (Connelly, 2008), but are often fragmented,
disorganized and do not operate or progress as a coherent whole (HMN, 2008). Frequently,
technology companies coming into the health domain underestimate its complexity and proceed
on the assumption that if something has worked in another domain then it should be possible to
achieve the same in health.
The under-investment in human remise capacity-building is a critical factor in the continued
failure of ICT projects in health. As discussed by the UN agency on ICT for development
(Hotchkiss et al., 2010), many proponents of ICT mistakenly assume that such projects are only
about hardware, networking, software and applications; however a substantial amount of human
activity is required when dealing with ICT. Challenges with equipment, infrastructure and
connectivity, no online consultations are ever made, and despite the considerable investment
made to the project, no direct benefits to the health of the rural population were observed. One of
the most common causes of ICT failure is the temptation to leapfrog certain aspects of the
development path, in an attempt to decrease the gap between developed and developing countries
(Avgerou, 2008). Technology offers attractive means to bypass some processes in the
accumulation of human or system capabilities, Technology rarely stands independently; rather, it
is embedded in a system of complementary technologies and capabilities and requires three key
elements for success, people, process, and technology (Fernandes et al., 2014; Hotchkiss et al.,
2010).
If ICT is to be used to provide information at the right time and when required, key elements
must be understood including what to collect, where to collect, whom to report to, and how the
information will be used and by whom (Sinha, 2010). Technology needs to be appropriate to the
capacity and maturity of the health system, this includes human and technological maturity, ‘if
you automate a mess, you’ll get an automated mess’ (Thomas and Harden, 2008).
2.11 Health Information Management System Security Issues
In spite of many attempts in providing security in Health Information Management System, data
security breaches in health care organizations have continued to increase and a number of threats
in this area has increased dramatically (Steve and Judy, 2008). Studies show that between 2006
and 2007 in hospitals alone, more than 1.5 million names Ire exposed to data breaches (Steve and
Judy, 2008). In addition, the results of 2010 healthcare information and management systems
society security survey suggests that the reports of more than 110 healthcare organizations have
shown the loss of sensitive protected health information. Personal identifying information
affected over 5,306,000 individuals since January 2008 and damages from patient information
lost top $6 billion per year in 2010 (Norman et al., 2011). The report showed they are received as
theft (stolen laptops, computers, or media), loss or negligence by employees or third parties,
malicious insiders, system hacks, web exposure, and virus attacks (Odhimba-Otieno, 2005).
Some researchers categorized risks to hospitals information as the internal or external threats and
found that employees’ ignorance, curiosity, recklessness, inadequate behavior, using someone
else’s password and giving the password to other employees are some of the internal threats to
health information system.
Viruses and spyware attacks, hackers and intruders are placed as external threat to information
system (Samy et al., 2011). Most organizations however, tend to focus on the vulnerabilities to
external threats and have used technical solutions to improve the security of their information
system (Samy et al., 2011). Most internal security breaches in health information systems
continue to occur by legitimate users. People’s behavior is a major source of threats to the
various information systems so; security cannot be achieved only through technological tools
(Herath and Rao, 2009). According to Sood et al. (2008), information security is more of human
problem than a technical problem. In this kind of scenario non-technological aspects of
information security such as education and awareness must be considered together with technical
aspects. Bakhtiyari and Ismail (2012) identified more than 70 threats to health information
system and have proved that threats caused by human in the role of users’ technology play a big
proportion in many threats to the system. Asai and Fernando (2011) proved that, human factors
are the cause of 80% of privacy breach incidents, and (Cheburet and Odhiambo-Otieno, 2009)
also confirm that human errors have a large proportion in privacy breaches in the United States.
In addition, published academic of Global Security Survey in 2007, found that 91% of
participants are concerned about the employees’ security weaknesses and that human factors
known as the main reason of the information security failures by 79% of participants (Kuhn and
Giuse, 2001). Moreover, most people do not feel hurt nor see any threat as a result health
information systems users need to be informed and educated about the risk perception biases and
understand the magnitude or implications of potential security breaches (Asai and Fernando,
2011).
CHAPTER THREE
3.0 MATERIALS AND METHODS
3.1 Research Design
Research design refers to the way the study was planned and conducted (Polonsky and Weller,
2009). The procedure and techniques employed to answer the research problem explains the
pattern the study intended to follow so as to control variance due to independent variables,
eliminate or reduce influence of extraneous variables, minimize error variance and at the same
time ensure that the findings can be tested for significance. The study was concerned with
assessing the use of hospital information management system in Gombe Specialist Hospital.
Routine information system functioning deal with data quality and is characterized by the
relevance, accuracy, timeliness, and completeness of the data. While health information system
performance looks at decision maker’s use of information in policy making, planning,
management, and service delivery. It thus looks at relationship between availability of data and
its determinants on one hand, outputs or outcomes on the other hand. Such relationship is best
investigated using a case study which gives more insight into what is happening in a larger or
bigger population. This study was conducted through descriptive survey research design
approach. Survey design describes and explains the events in the real life context and occurrence
(Polonsky and Weller, 2009). Qualitative and quantitative research design was used in this study
to explore and understand people’s beliefs, attitude behavior and interaction and to give
systematic empirical investigation of social phenomena using statistical or numerical data or
computation techniques.
3.3 Area of Study
The study was conducted in Gombe Specialist Hospital of Gombe State.
3.4 Target Population
Population is a large collection of all subjects from where a sample is drawn (Zaeid, 2012). The
target population or the unit of observation is a group of individuals, or objects that a sample is
drawn for measurement (Kinfu et al., 2009). The study target population was all healthcare
workers working in Gombe Specialist Hospital, Gombe State. The study population was based
on departments in the hospitals. The departments include outpatients, inpatient, theatre,
laboratory, stores, clinics and administrative. These departments are focal points for decision
making. The target population therefore included the following cadre of staff; doctors, nurses,
health records officers, laboratory and other supporting staff. The target population was chosen
because they are the healthcare workers who are routinely involved with the management of
health system functioning and performance in the country and have regularly contact with
hospital information system. The study involved those who were at work at that time. All the
healthcare workers are eligible to be involved in the study apart from those where on leave
during the study period. The target population was 100 healthcare workers who use health
information system in Gombe Specialist Hospital, Gombe State.
3.5 Sample Size and Sampling Techniques
3.5.1 Sample Size
Sample size entails the number of participants chosen from the whole population to participate in
a research or study (DeLone and McLean, 2003). Purposive sampling was used in the study so as
to focus on particular characteristic of the population that are of interest. The primary
consideration in purposive sampling is to draw on who can provide the best information to
achieve the objectives of the study (Keke, 2007). This method was ideal for this study because of
the small size of target population; this enables the researcher get in depth information rather
than generalized information on the understanding of the research questions. The sample size for
the research was based on healthcare workers using the hospital information system from a total
population of 100 healthcare staff in Gombe Specialist Hospital. Stratified Purposive sampling
technique was adopted to illustrate the characteristics of particular subgroups of interest in the
hospital.
3.5.2 Sampling Technique
To sample 100 interviewees, a stratified random sampling and purposive sampling techniques
was used. The healthcare workers were stratified into the different departments according to their
operations. This was because it provided equal chances to every sample of a given size in the
accessible population. According to Kothari (2013), in stratified sampling, you first divide the
population into sub-population (strata) on the basis of supplementary information, and then draw
samples randomly within the strata so as to achieve a representation from every department. This
study used the stratified random sampling to select the 100 respondents. Cheburet and
Odhiambo-Otieno (2016), support that 30% of the total population is enough to act as
representative sample in a case study. In purposive sampling you decide the purpose you want
respondents to serve and you go out to find some. Purposive sampling relies on the researcher’s
use of good judgment to hand pick those subjects that will satisfy the needs of the research
(Heywood and Rhode, 2001). Purposive sampling was therefore used to select the individual
respondents using the hospital information system in Gombe Specialist Hospital.
3.6 Data Collection Method
Data collection is the process of gathering and measuring information related to the study that
helps in answering the research questions. The methods are varied in terms of time, cost of
money or other remises at disposal of researcher (Connelly, 2008). The methods include
questionnaires, personal interviews that are face to face or through the telephone. This study used
semi structured questionnaire which were self administered to obtain the primary data. The main
tools used for collecting data in this study were questionnaires and documentary reviews. The
study aimed at describing the situation in terms of practices, opinions and attitudes and thus the
questionnaire was deemed the method to collect this kind of data.
3.6.1. Questionnaires
A questionnaire was deemed appropriate for the study as it will give an opportunity to carry out
an inquiry on specific issues on a large sample and make the study findings more dependable and
reliable (Kothari, 2013). The questionnaire was divided into sections, the first part sought to
gather demographic information of the respondents and the other sections aided in responding to
the specific research questions of the study. The questionnaires were self administered by the
researcher so as to collect relevant information relevant for the study. Open ended and closed
ended questions were used on the healthcare workers in Gombe Specialist Hospital, Gombe
State.
3.6.2 Documentary Reviews
The study utilized internet tools such as yahoo, Google scholar and health information data base
and scholarly reviewed Journals to carry out document analysis of literature and content written
on hospital information management system and compare the current trend on other comparative
studies carried out on hospital information management system.
3.7 Research Instruments
3.7.1 Pilot Study
A pilot test was conducted to detect weaknesses in the design, instrumentation and provide proxy
data for probability sample (Kothari, 2013). It helped to validate the instruments consistency
formatting wise and the respondents understanding (Bryman, 2012). The procedures used to pre-
test the questionnaire were identical with those that were used during the actual study; the
sample is usually small 10% of the target population (Connelly, 2008).
3.7.2 Validity
Validity is the degree to which an instrument measures what it is expected to measure (Bryman,
2012). Validity of the study was tested through administering questionnaires to a small group of
respondents who do not form part of the study to validate the information collected. The
questionnaire for this study was carefully prepared to ensure it covers all the research objectives
and address all the issues under investigation.
3.7.3 Reliability
According to Ndabarora et al. (2013) an instrument is considered reliable when it is able to elicit
the same responses each time it is administered. Reliability is the consistency of measurement
(Berman and Rose, 1996) despite the changing conditions. The reliability of the tools of data
collection was conducted during the pilot study to determine where the results produced are
achievable and consistent. This helped to determine whether the questionnaire was capable of
yielding similar results to the same kind of people in a different occasion.
3.8 Data Collection Procedures
The study was based on primary data collected from the field using questionnaire. The main data
collection instrument was the questionnaire administered to the sampled respondents. The
respondents were requested to read the questions and complete the questionnaire and return it at
the end of the activity. According to Gladwin et al. (2000) questionnaires exist in different
formats. They can either be self-administered, online, posted or mail-based, interview administer,
telephonic or interview schedules (James et al., 2012). The most popular are self administered
and researcher administered questionnaires. Researcher administered structured questionnaires
were given to the 100 staff selected as respondents in both hospitals. The researcher was present
to interpret the questions to the respondents and lived with the questionnaires. The administration
of questionnaire was conducted in their units of work with the help of the unit in charge.
Qualitative data was collected from 88 respondents out of the 100 respondents. Questionnaires
are relatively inexpensive and allow a large number of respondents to be surveyed in a relatively
short period of time even if the respondents are widely distributed geographically (Wagenaar et
al., 2015).
3.9 Data Analysis and Presentation
Before processing response data was scrutinized for completeness and consistence. Data was
then coded to enable the responses be grouped into various strata’s. The classified data was
tabulated into tables and columns and rows. Since the study was qualitative, data was
summarized and presented by use of Statistical Package for Social Science (SPSS) in accordance
to the objectives of the study. The Qualitative approach included Tables showing the respective
frequencies and percentages of the respondents. The findings in this study were presented using
Tables, frequencies and percentages. Tables were used to summarize responses for further
analysis. For this study, the researcher was interested in finding out the use of hospital
information management system in Gombe Specialist Hospital.
3.10 Ethical Considerations
Research ethics refers to the appropriateness of researcher’s behavior in relation to the rights of
those who become the subjects of the study work, or are affected by it (Ndabarora et al., 2013).
The appropriateness and acceptability of behavior as researchers affects broader social norms of
behavior. Before the commencement of the study ethical approval was sought and granted by the
Gombe Specialist Hospital, a copy of approval and authority letter from the College guided the
researcher in the study.
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
4.1 Introduction
This chapter outlines the data presentation, data analysis and interpretation of the study. The
study used questionnaires and documentary reviews to obtain the data and information. The
study aimed at assessing the use of hospital information management system among healthcare
workers at Gombe Specialist Hospital, Gombe State. To attain this, the study was grounded on
three objectives; find out the challenges faced in the use of hospital information management
systems in our hospitals and suggest possible solutions to improve the system in them. Therefore,
this chapter presents data collected from primary sources based on three main thematic areas of
the study and also based on the objectives and research questions of this research study. The
study targeted a total of 100 respondents, mainly all healthcare workers in Gombe Specialist
Hospital. From the total population, the study used 100 questionnaires on 100 respondents of
which 88 were responded to and returned. The total returned sample size was 88 respondents: 8
Doctors, 16 nurses, 13 Technicians and 51 other professionals.
4.0 Background Information of the Respondents
The study sought to inquire information on various aspects of the respondents’ background in
terms of professional expertise, educational level and working experience. This is aimed at
testing the appropriateness of respondents in answering the questions regarding the use of
hospital information management system in Gombe Specialist Hospital.
4.1 Profession of the Respondents
The findings indicated that the respondent Doctors in Gombe Specialist Hospital were 8
representing (9.09%), Nurses were 13 representing (14.77%), Technicians were 16 representing
(18.18%) and other supporting staff were 51 representing (57.96%), Table 1 below.
Table 1: Profession of the Respondents in Gombe Specialist Hospital
Profession Frequency Percent
Doctors 8 9.09
Nurses 13 14.77
Technicians 16 18.18
Others 51 57.96
Total 88 100
4.2 Working Experience of the Respondents
A total of 34 respondents have a working experience of between 1-10 years representing
(38.64%), which was followed by 21 respondents with a working experience range of between
11-20 representing (23.86%), followed by 17 respondents with a working experience of between
21-30 years representing (19.32%) and lastly 16 respondents with a working experience of
between 31 years and above representing (18.18%), Table 2 below.
Table 2: Working Experience of the Respondents in Gombe Specialist Hospital
Experience (Years) Frequency Percent
1-10 34 38.64
11-20 21 23.86
21-30 17 19.32
31 and above 16 18.18
Total 88 100
4.3 Use of Hospital Management Information System

A total of 31 respondents strongly agreed that the systems in the hospital are easy to use
representing (35.23%), this was then followed by 26 respondents who equally agreed that the
systems are easy to use in Gombe Specialist Hospital representing (29.55%), which was then
followed by 12 respondents who disagree that the systems in the hospital are easy to use
representing (13.64%), which followed by 8 respondents who strongly disagreed that the systems
are easy to use representing (9.09%), while 5 respondents were neutral without ticking any
option representing (5.68%) as whether the systems are easy to use or not, Table 3 below.
Table 3: System was Easy to Use in Gombe Specialist Hospital
Respondents Frequency Percent
Strongly disagree 8 9.09
Disagree 12 13.64
Neutral 5 5.68
Agree 26 29.55
Strongly agree 31 35.23
Total 88 100
4.4 System Functionality in Accessing Services
The study sought to find out whether the hospital information management system in use is
providing more functionality for accessing services. This was important in order to establish
whether the system in use is providing different functions to the users. A total of 33 respondents
strongly agreed that the systems are providing functionality in accessing services representing
(37.50%), which was then followed by 28 respondents who equally agreed that the systems are
providing functionality in accessing services representing (31.82%), which was then followed by
15 respondents who were neutral whether the systems provide functionality in accessing
services or not representing (17.05%), which was then followed by 10 respondents who
disagreed that the systems are providing functionality in accessing services representing
(11.36%) and lastly 2 respondents who strongly disagreed that the system provide functionality
in accessing services representing (2.27%), Table 4 below.
Table 4: Functionality in Accessing Services by respondents of the Hospital
Disagree 10 11.36
Neutral 15 17.05
Agree 28 31.82
Total 88 100
4.5 Systems Enabled the Use and Access of in or out Patient Information
The researcher sought to establish if the systems in use in Gombe Specialist Hospital enable use
and access of in or out patient information. This was an important question in helping to
establish where the systems are integrated and enable access of both in or out patient information
to the users. A total of 45 respondents strongly agreed that the systems enable the use and access
of in or out patients’ information representing (51.14%), which was followed by respondents
who agreed to the same opinion representing (31.82%), which was followed by 7 respondents
each who disagreed and were neutral as whether the systems enable the use in or out patients
information representing (7.96%) each of the two different respondents, while only 1 respondent
strongly disagreed that systems do not enable the use in or out patients’ information representing
(1.14%), Table 5 below.
Table 5: Systems Enabled the Use and Access of in/out Patients’ Information
Disagree 7 7.96
Neutral 7 7.96
Agree 28 31.82
Total 88 100
4.6 The Systems Improved the Quality of Services

The respondents were asked to indicate whether the systems have improved the quality of
services in their hospital or not. The purpose for this question was to establish the quality of
services the hospital information management system is providing the users. A total of 40
respondents strongly agreed that the systems improved the quality of services in the hospital,
representing (45.46%), which was followed by 35 respondents who agreed that the systems
improved the quality of services representing (39.77%), followed by 6 respondents who
disagreed that the systems improved the quality of services in the hospital representing (6.82%),
followed by 4 respondents who were neutral as whether the systems improved the services of the
hospital or not representing (4.55%) and lastly 3 respondents who strongly disagreed that the
systems improved the services of the hospital representing (3.41%), Table 6 below.
Table 6: The Systems Improved the Quality of Services
Disagree 6 6.82
Neutral 4 4.55
Agree 35 39.77
Total 88 100
4.7 The Systems Provide Diseases Notification Data

A total of 48 respondents strongly agreed that the systems provided disease notification data
representing (54.55%), followed by 32 respondents who agreed that the system provided disease
notification data representing (36.36%), followed by 5 respondents who disagreed that the
systems provided notification data representing (5.68%), followed by 2 respondents who were
neutral as whether the systems provided disease notification data or not representing (2.27%)
and lastly 1 respondent who strongly disagreed that the systems provided disease notification
data representing (1.12%), Table 7 below.
Table 7: The Systems Provided Diseases Notification Data
Disagree 5 5.68
Neutral 2 2.27
Agree 32 36.36
Total 88 100
4.8 The Systems Provided Epidemiological Data

A total of 46 respondents strongly agreed that the systems provided epidemiological data
representing (52.27%), which was followed by 30 respondents who agreed that the systems
provided epidemiological data representing (30.09%), followed by 6 respondents who were
neutral as whether the systems provided epidemiological data or not representing (6.82%),
followed by 2 respondents each who disagreed and strongly disagreed, respectively that the
systems provided epidemiological data representing (2.27%), Table 8 below.
Table 8: The Systems Provided Epidemiological Data
Disagree 2 2.27
Neutral 6 6.82
Agree 30 30.09
Total 88 100
4.9 The Systems Managed Financial Imperatives

A total of 53 respondents strongly agreed that the systems managed financial imperatives very
well representing (60.23%) which was then followed by 31 respondents who agreed that the
systems managed financial imperatives representing (35.23%), followed by 2 respondents who
were neutral whether the systems managed financial imperatives or not representing (2.27%),
followed by 1 respondent each who disagreed and strongly disagreed that the systems manged
financial imperatives representing (1.14%), Table 9 below.
Table 9: The Systems Managed Financial Imperatives
Disagree 1 1.14
Neutral 2 2.27
Agree 31 35.23
Total 88 100
4.10 The Systems Improved Patients’ Information Security

The study also sought to find the extent which the hospital information management systems
have improved on the patient information security in the hospital. The purpose of this question
was to establish the security of patients’ information in the systems. It was noted that 54
respondents strongly agreed that the systems improved patients’ information security
representing (61.36%), which was followed by 32 respondents who also agreed that the systems
have improved on the patients’ information security representing (36.36%), followed by 2
respondents who were neutral as whether the systems have improved the patients’ information
security or not representing (2.27%), followed by 0 respondents each who strongly disagreed and
disagreed that the systems have improved the patients’ information security representing (0.00%)
each respectively, Table 10 below.
Table 10: The Systems Improved Patients’ Information Security
Disagree 0 0.00
Neutral 2 2.27
Agree 32 36.36
Total 88 100
4.11 The Systems Provided Accuracy and Relevant Information

One of the objectives of the study was to establish the accuracy and relevancy of the information
the hospital information management systems provide in the hospital. The purpose of this
question was to establish the accuracy and relevancy of the information provided by the systems.
55 respondents strongly agreed that the systems provided accurate and relevant information
representing (62.50%), followed by 30 respondents who also agreed that the systems provided
accurate and relevant information representing (34.09%), followed by 3 respondents who were
neutral as whether the systems have provided accurate and relevant information representing
(3.41%), followed by 0 respondents each who strongly disagreed and disagreed that the systems
have provided accurate and relevant information representing (0.00%), Table 11 below.
Table 11: The Systems Provided Accurate and Relevant Information
Disagree 0 0.00
Neutral 3 3.41
Agree 30 34.09
Total 88 100
4.12 The Systems Provided Timely Relevant Data

The study sought to establish the timeliness and relevancy of data the system provided. This
question was important in finding out how relevant and timely data provided by the systems
were to the system users. As a result, 50 respondents strongly agreed that the systems provided
timely relevant data representing (56.82%), followed by 31 respondents who also agreed that
the systems provided timely relevant data representing (35.23%), followed by 5 respondents
who were neutral as whether the systems provided timely relevant data or not representing
(5.68%) followed by 1 respondent each from the strongly disagreed and disagreed that the
systems provided timely relevant data representing (1.13%), Table 12 below.
Table 12: The Systems Provided Timely Relevant Data
Disagree 1 1.13
Neutral 5 5.68
Agree 31 35.23
Total 88 100
4. 13 Strength of Hospital Information Management System
The analysis showed 48 respondents representing (54.55%) who found that the systems to be
user friendly than paper based system, affirming that the availability of centralized remise
planning, indicating that the systems are easier and quick in accessing patients’ information.
They also strongly agreed that the hospital information management system has stronger
functionalities in managing patients’ health information. From the study it could be affirmed that
the hospital information management system is necessary in improving the efficiency and service
delivery in the hospital. Though not all respondents agreed to these attribute of the system, Table
13 below.
Table 13: Strength of Hospital Information Management System
Disagree 3 3.41
Neutral 3 3.41
Agree 32 36.36
Total 88 100
4.14 Perceptions of the Respondents in Gombe Specialist Hospital on Staff Training

The study sought to find out the perceptions of healthcare workers towards information
transactions. The results reveal that 39 respondents strongly agreed that they are given training
on the various aspect of the hospital representing (44.32%), followed by 24 respondents who
agreed also that they are given adequate training in their fields of study, representing (27.27%),
followed by 11 and 10 respondents who disagreed and strongly disagreed, respectively that they
are given normal training on regular basis representing (12.50 and 11.36%), respectively, while 4
respondents were neutral as whether they are given regular training or not representing (4.55%),
Table 14 below.
Table 14: Perceptions of the Respondents in Gombe Specialist Hospital on Staff Training
Disagree 11 12.50
Neutral 4 4.55
Agree 24 27.27
Total 88 100
4.15 Challenges Encountered in the Use of Hospital Management Information System

The respondents were asked to respond to various challenges they have encountered using the
hospital information management system. The findings indicated that the main challenges
encountered were poor change over between the new and old systems, few ICT staff to assist
when need arises, systems keep going on and off and incapability between the old and the new
systems, inadequate software coverage, systems being slow and lack of training of users.
4.16 Recommendations on How to Improve the Existing Systems
The respondents were further asked to give recommendations on how to improve the existing
hospital information management system. Most of the respondents wanted complete overhaul of
the systems and the development of electronic remise planning system for the hospital and
development of specific tools to the current structure.
CHAPTER FIVE
5.0 DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1 Background Information of the Respondents
The study generated information on respondents, this was considered necessary in validating the
responses as this helped the researcher to understand the level of experience by the respondents
who answered the questions. The study analysis indicated that the respondent’s rate was 88
(100%) which was very adequate for this analysis, this implied that the respondents willingly
participated. The study also showed that both Doctors, Nurses, Technologists and other
supporting staff in the hospital participated in answering questions using the questionnaires from
the researcher from the sample population drawn.
5.2 The Use of Hospital Information Management System
The first objective of the study was to find out the use of hospital information management
system of the hospital. The researcher also sought to find out the functionality of the systems in
accessing more services, most of the respondents strongly agreed that the system is providing
more functionality for accessing services and other respondents agreed on the same though not as
strongly agreed. The results showed that the systems are well integrated and most services could
be accessed via the systems. Respondents also indicated that some areas are not yet be connected
to the systems meaning that some of the systems were not well integrated. On the use and access
to in and out patients’ information, the respondents said that the systems enable more access to
patients’ information. In disease notification function, results also showed that most of the
respondents indicated the systems providing disease notification data. On the provision of
epidemiology data, they equally agreed that the systems provided this kind of data as well.
Whether the systems managed financial imperatives; most respondents agreed strongly that the
systems are managing financial imperatives of the hospital. On the improvement on patients’
information security, majority of the respondents agreed strongly that the systems manage the
patients’ information security. Information systems in healthcare allow the capture and
dissemination of information to decision makers for better coordination of healthcare and
population levels as reported by the following researchers (Anifalaje et al., 2009; Berman and
Rose, 1996; Braa et al., 2012; Bryman 2006; Chen et al., 2014; Collins, 2003 and Connelly,
2008).
5.3 Systems Provided Accurate and Relevant Patients’ Information
The second objective of the study was to establish the extent to which the hospital information
system provides accurate and relevant patient information. The study findings revealed that most
respondents agreed that the systems in use are providing accurate and relevant patients’
information. The results implied that the systems provide accurate and relevant patient’s
information for users. The study has established that the systems in use are fully integrated while
some sections are yet to be automated and this could be hampering the provision of accurate and
relevant patients’ information. Well integrated hospital information management system would
help to improve operational efficiency, care quality and more informed decision making as
observed by the following (Fernandes et al., 2014; Hahn et al., 2013; Keke, 2007; Kinfu et al.,
2009; Ledikwe et al., 2014; Mavimbe et al., 2005 and Ndabarora et al., 2013).
5.4 Perceptions of the Hospital Staff towards the System
The third objective was to establish the perceptions of healthcare workers towards the systems,
most of the respondents’ agreed that the systems are easy to use, majority of the respondents
indicated that they are competent on the use of the systems, others believe that the systems
provide meaningful patients’ information. A number of the respondents strongly agreed that the
systems are slow and keep going on and off implying that users keep experiencing problems
from time to time. The respondents expressed the need for more training so that they can utilize
the systems better. The under investment in human remise capacity building is a critical factor in
the continued failure of ICT projects in health the sector. As discussed by the UN agency on ICT
for development, many proponents of ICT mistakenly assume that such projects are only about
hardware, networking, software and applications; however a substantial amount of human
activity is required when dealing with ICT projects.
5.5 Challenges Encountered in the Use of Hospital Management Information System
The fourth objective of this study was to establish challenges of healthcare workers encountered
in the use of hospital information management systems. The study established that the main
challenges encountered; are systems being slow, poor change over between the new and old
systems, Few ICT staff to assist when needed, system keep going on and off and incapability
between the old and new systems. Other challenges in the hospital were systems providing
inaccurate information, some of the respondents are not knowledgeable with the use of the
systems, systems are not user friendly and employees having negative attitude towards the use of
systems. Most respondents want complete overhauls of the systems, some respondents want the
development of electronic remise planning system for the hospital and development of specific
tools to the current structure and more training on the use of the systems.
5.6 Conclusion
Well integrated hospital information management system can be able to manage effectively all
the information and data needs of any hospital and in return provide quality service to the
patients. Financial imperatives are well managed with this kind of system and can greatly curb
financial malpractices. Hospital information management system is able to provide timely,
accurate and relevant data whether on the patient, disease notification or epidemiological data
very easily. Security on patients’ information can well be managed effectively with the help of
the hospital information management system. Training on the use of healthcare workers is
required from the time of implementation to enable effective utilization, without which the
system will not achieve their purposes.
5.7 Recommendations
5.7.1 Evaluation of the Systems
There is the need to evaluate the functions of the old and new upgraded software currently in use
and harmonize the changes.
5.7.2 Improvement on the System Speed
Hospital administrators can explore ways of improving on the speed of the systems or acquire
new servers to improve on the speed for improved efficiency.
5.7.3 Employ More ICT Staff in Gombe Specialist Hospital
Respondents have indicated the need for more ICT staff to be employed; this would translate
quicker and improved responses for staff whenever assistance with the system is required.
5.7.4 Acquire More Computers in Gombe Specialist Hospital
The study has shown that the respondents require more computers for effective utilization of the
system and improved quality of services.
5.7.5 Facilitate More Staff Training in Gombe Specialist Hospital
There is the need for continuous training on the systems’ use for old and new healthcare workers
which would help in providing relevant and accurate information and data from the systems.
Continuous training would also help in changing the negative attitude of healthcare workers on
the systems and improved hospital service delivery.
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APPENDIX I
LETTER OF INTRODUCTION
Faiza Idris Hamma
Department of Health Information and Management
Gombe State College of Health Science and Technology
Kaltungo, Gombe State.
Dear Respondent,
LETTER OF INTRODUCTION
I am a Higher National Diploma Student of the Department of Health Information and
Management. Presently, I am conducting a research titled Effect of Health Information
and Management System on Staff Performance at Gombe Specialist Hospital. The
purpose of this study is to collect data and information from healthcare workers of the
hospital.
You have been selected to participate in this study. The information and opinions you
provide are purely for academic purposes of the study and shall remain strictly
confidential.
Thank you in anticipation of your cooperation.
Yours faithfully,
Faiza Idris Hamma

(17/HIM/01/018)
APPENDIX 11
QUESTIONNAIRE FOR GOMBE SPECIALIST HOSPITAL STAFF
INSTRUCTIONS
Please indicate your response by ticking (√) in the provided box. For questions that
require suggestions or comments, please use the space provided.
Background Information
1. Organization:
2. Profession
(i) Doctor [ ]
(ii) Nurse [ ]
(iii) Technician [ ]
(iv) Any other (specify)……………………………………………………………….
3. Highest educational level..................................................................................................
4. Working experience:
(1) 10 years [ ]
(ii) 11 – 20 years [ ]
(iii) 21 – 30 years [ ]
(iv) 31 – 40 years [ ]
Use of the Hospital Information Management Systems
5. To what extent do you agree or disagree with the following statements regarding the use of the
hospital information management systems. Use the following scale:
Strongly agree = 5, Agree = 4, Neutral = 3, Disagree = 2, Strongly disagree = 1.
USE OF HOSPITAL INFORMATION MANAGEMENT SYSTEM
S/N STATEMENT 5 4 3 2 1
1. System has become easier or harder to use
System provide more functionality for accessing
2. services
System enables excellent use and access of in/out
3. patient
Information
4. System has improved quality of service
5. Provides disease notification data
6. System provide epidemiological data
7. Manages financial imperatives
System has improved on patient information
security
6. Select from the list the statement that highlights the strengths of hospital information management
system.
(i) User friendly than paper based system [ ]
(ii) Availability of a centralized planning system [ ]
(iii) Easier and quick access to patient information [ ]
7. Relevance and accuracy of patient information provided by System.
(i) System provides accurate and relevant information Yes No
(ii) Data provided by the system is accurate and relevant Yes No

Perceptions of Healthcare workers on Information Collection
8. To what extent do you agree or disagree with the following statements regarding the
Perceptions of the healthcare workers on information collection. Use the following
scale: Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, strongly Disagree = 1
Perception of information collection through HIMS 1 2 3 4 5
1. Collecting information which is not used for decision

making discourages me
2. Collecting information makes me feel bored
3. Collecting information is meaningful and makes work

Easier
4. Collecting information gives me the feeling that data is
needed for monitoring facility performance
5. Collecting information is appreciated by co-workers and
Superiors
Gombe Specialist Staff Training Perceptions
9. Please tick (√) statement that applies to the perception on training in the use of the Hospital
Information Management System
STATEMENT Yes No
Competent on system use
Hospital system is easy to use
You encounter problem when using the system
Training was conducted on how to use the system
You feel you need more training to adequately use the system
Challenges in the use of hospital information management systems

10. To what extent do you agree or disagree with the following statements regarding the
challenges encountered using the Hospital Management information system: Use the following
scale: 5 = strongly agree, 4 = Agree, 3= Neutral, 2=Disagree, 1= Strongly Disagree.
No. STATEMENT 5 4 3 2 1
1. Incorrect information
2. Computers not enough for users
3. Not fully knowledgeable with the system
4. System keeps going on and off
5. Lack of comprehensive coverage of the system
6. System is slow
7. Users’ needs not fully captured by the system
8. Not user friendly
9. Employees have negative attitudes towards changes
10. Lack of system testing
11. Lack of training of users
12. Poor changeover between the new and old software
13. Inadequate software coverage for the whole hospital
14. Few ICT Staff to assist when in need
15. Incompatibility between the new and old system
3. State the recommendation to improve the existing hospital information system
(i) Complete overhaul of the system [ ]
(ii) Development of a framework based on hospital requirements [ ]
(iii) Development of specific functional tools with minor reforms
to the existing structure [ ]
(iv) Any other (specify)
………………………………………………………………………………………………

FAIZA

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EFFECT OF HEALTH INFORMATION MANAGEMENT SYSTEM (HIMS) ON

STAFF PERFORMANCE IN GOMBE SPECIALIST HOSPITAL OF GOMBE STATE

BEING A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF

FAIZA IDRIS HAMMA DATE

MR. ABUBAKAR AHMAD DATE

MRS. LIATU NBURAK DATE

4.3 Use of Hospital Management Information System

4.6 The Systems Improved the Quality of Services

4.7 The Systems Provide Diseases Notification Data

4.8 The Systems Provided Epidemiological Data

4.9 The Systems Managed Financial Imperatives

4.10 The Systems Improved Patients’ Information Security

4.11 The Systems Provided Accuracy and Relevant Information

4.12 The Systems Provided Timely Relevant Data

4.14 Perceptions of the Respondents in Gombe Specialist Hospital on Staff Training

4.15 Challenges Encountered in the Use of Hospital Management Information System

Faiza Idris Hamma

(ii) Data provided by the system is accurate and relevant Yes No

Perception of information collection through HIMS 1 2 3 4 5

1. Collecting information which is not used for decision

3. Collecting information is meaningful and makes work

Hospital system is easy to use

You encounter problem when using the system

Training was conducted on how to use the system

Challenges in the use of hospital information management systems

5. Lack of comprehensive coverage of the system

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