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UNIVERSITY OF APPLIED MANAGEMENT

GHANA-CAMPUS

COURSE NAME: IT INFRASTRUCTURE AND STRATEGY

LECTURERS NAME : MR EMMANUEL FON TATA

INDEX NO : UAMM0020

DATE OF SUBMISSION : 20 TH FEBRUARY, 2011


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QUESTION TWO (2)

DISCUSS HOW YOU (AS A HEALTH CARE SERVICEADMINISTRATOR) WILL ENSURE EFFECTIVE

INFORMATION MANAGEMENT IN YOUR HEALTH

CENTRE: HEALTH CARE SERVICE CENTRE USED FORTHE CASE STUDY: RIDGE HOSPITAL


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TABLE OF CONTENT

PAGE NO

EXECUTIVE SUMMARY 4

INTRODUC TION .5

DISCUSSION 11

CONCLUS ION..18

REFEREN CES20

BIBLIOG RAPHY23


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EXECUTIVE SUMMARY

During the last infinitesimal couple of decades , the health sector inGhana has felt incessant exigency to ameliorate and accelerate as faras effective information management is concerned .It is in this vein and context that the research paper in contention through unflinching and relentless efforts and strides trampled upon some criticalparameters that constantly militate against the health care servicecentres in their capacity and quest to live up to their billing as far aseffective information management is concerned.

Nevertheless, the notable ones of grave concerned that cannot beunderestimated are listed as below: (i) Over-reliance on paperdocumentation of recording patients information or data at theRidge Hospital (ii) Language barrier (iii) Non-existence of fulldisclosure of some drugs (iv) Poor quality of information, includinglack of consistency, duplication, and out-of-date facilities for storingdata (v) Lack of data ware house or reservoir (vi) Non-existence ofpatients data or information automation etc.

Irrespective of the fact that the aforementioned debilitating factors appears extremely insurmountable and quite a mission impossible hurdle and task, some few key principles deemed fit and feasible to dothe trick for the Health Information Administrator in decimating orneutralizing the prevalence of the aforementioned challenges anddebilitating characteristics are categorically spelt out as below: (a)Removal or non-existence of language or communication barriers(b) Full disclosure of drugs potency, side-effects and contra-indications etc (c) Minimal indulgence and reliance on paperdocumentation (d) Expedite introduction of data ware house orreservoir (e) Automation of patients data or information just tomention a few.


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INTRODUCTION

By way of preamble, the terminology information refers to anyevent that affects the state of a dynamic system. In its limited

perspective, it is basically a planned series of symbols. As a concept,however, information has different connotations. In addition, theconcept of information is closely related to notions of constraints,communication, control, data, form, instruction, knowledge,meaning, mental stimulus, pattern, perception, and representation.(www.wikipedia.org )

Information as we know it today includes both electronic and physical information. The organizational structure must be capable of managingthis information throughout its life cycle regardless of the source orformat (data, paper and electronic documents, audio, video , etc) fordelivery through multiple channels that may include cell phones andweb interfaces .

INFORMATION MANAGEMENT

Information management (IM) is the collection and management of information from one or more sources and the distribution ofthat information to one or more audiences . This sometimesinvolves those who have a stake in, or a right to that information.Management means the organization of and control over thestructure , processing and delivery of information .(www.wikibooks.org ) In other words, it refers to the sum of all

activities, gathering, processing, organization anddissemination of information in order to assist humanitarianactors (medical practitioners/assistants/attendants) achieve their goals in an effective and timely manner . Typical examples ofsuch goals include improved coordination , early warning
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(premonition), advocacy or transition. (www.reliefweb.int/symposium/docs/conceptpaperweb.doc )

EFFECTIVE INFORMATION MANAGEMENT

Effective information management on the other hand is basicallya business discipline that analyses various types of information to use as a resource to improve business operations especially thehealth care services such as the Police, Ridge and Thirty-seven(37) military hospitals . The gathering of the information may be

done electronically or manually . Information management (IM)in contemporary world often includes Data Administration,Information Technology or Computer Science and Business departments. These departments usually help hospitals andclinics control the amount of information collected or gatheredthrough the use of electronic means . Analysis is typicallyexecuted electronically as well. (Abbot et al, 1995). Effective

management system can be collected from external or internalbusiness sources . Internal sources of business information mayinclude the accounting, production , executive management orHR departments . External sources of business information ofteninclude the economic market place , competitors, nationalorganizations or a local chamber of commerce .(www.wisegeek.com )

A vast number of organizations of which medical entities are a partusually nurture the information gathering processes based ontheir specific operation needs and business environment.

During the last few decades, the health sector in Ghana has feltincreasing need to improve and accelerate as far as effective
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information is concerned. Also, with the ever-changing medicallandscape, challenges and opportunities continue to characterizethe health fraternitys ability to share, and effectively managed

information.Todays IT offers many solutions but real progress is still only

possible through the willingness of people and their organizations such as the health care service outfits to collaborate in sharing ,managing and communicating information as a reservoir or acommunity .

One of the essential functions for health effectiveness isinformation . It is quite unfortunate that the medical experts have

been slow to implement standards for communication andsharing information . Structured data collection and entry has

been shown to be an effective way of providing decision-support for health practice . (Bossert, 1998) The variety and complexity of medical context is such that only the computerization orautomation of clinical records and computer-assisted input

protocols are as effective and capable of promoting and fosteringhealth information management.

THE FUNCTIONS OF A HEALTH INFORMATIONADMINISTRATOR

The significance of the role that health care serviceadministrators play in ensuring effective information

management cannot be over-emphasized . A health informationadministrator is a degree holder of health informationmanagement . Common job title in contemporary job market arerelated to line, staff, and/ or technical positions such as directors,managers, privacy officer, compliance officer, claim analyst,


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clinical information specialist just to mention a few. (Lajca, 1999).It is anticipated that job titles will change (e.g. health informationengineer, chemical information coordinator, data administrator,

information security officer) as health care enterprises expand theirreliance on information systems and technology. Healthadministrators have, and will continue to assume roles thatdirectly contribute to the development of computer-based patientrecord systems and a national health infrastructure.([email protected]). The tasks or functions

performed by health administrators are diverse and dynamic withinthe work environment. The health service care administrator ingeneral performs tasks related to the management of healthinformation and the systems used to collect, store, process,retrieve, analyze, disseminate and communicate that informationregardless of the physical medium in which it is maintained. Inaddition, health information administrators assess the uses ofinformation and identify its availability in terms ofinconsistencies, gaps, and duplications in health data sources.(Bowns et al, 1999). Furthermore, they are capable of planningand designing systems and serving as pivotal team members inthe development of computer-based patient record systems andother enterprise-wide information systems . Their responsibilitiesalso include serving as brokers of information services .(www.ahima.org ). Among the information services provided are adesign and requirement definition for clinical and administrative

systems development, data administration, data qualitymanagement, data security management, decision supportdesign and data analyses, and management of information-intensive areas such as clinical quality/ performance
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assessment and utilization and case management . (Abbot et al,1995)

Ghana , like the rest of the developing world is confronted with a

looming enigma in its health care and delivery system from anunprecedented and simultaneous bulge in demand while thereare aggravating deficiencies in skilled workers needed to meet

this glaring necessity.

Out of the ordinary improvement in productivity will soon berequired just to maintain current service levels in a broad spectrumof perspectives. This can only come to fruition if the ingenuity ofhealth care consumers becomes more pro-active and informedparticipants in health care processes. Effective management and delivery of better health information is crucial to theaforementioned strategies . Better management and availabilityof health care information is however, increasingly seen as animportant tool against disease in its own right and there isundoubtedly incessant evidence that both health outcomes and

consumer satisfaction can be augmented by improving the wayhealth information is managed . (www.ehealthera.org ). In short tomedium term, it is also a tool most likely to enable improvement ofthe incongruous distribution of health care services whichundermines indigenous, rural and poor Ghanaians. Effectiveinformation management, I reiterate, is currently recognized as akey national priority in most developed countries such as the USA,

Canada and the rest of Europe. (www.connectingforhealth.nhs.uk )Unflinching efforts aimed at ensuring effective informationmanagement practices are paramount for many organizationsincluding the health care-service outfits, across the public and

private sectors. This is being driven by a vast array of factors,
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including an exigency to improve the efficiency and effectivenessof health processes , the demands of compliance regulations andthe desire to deliver new services to clients thereby gaining a

competitive advantage at the expense of radical players in the health industry .

Effective information management is such an arduous task. There exists a vast array of systems to integrate , a huge range ofhealth needs to meet and complex medical issues to address.

Nevertheless , this research paper will attempt to accentuate onsome critical factors , mechanisms and strategies deemed

probable for not only health information administrators inensuring effective information management but also offerwithin its jurisdiction , a series of principles that can be imbibed into the health information administrators scheme of things andalso as a guide in the planning and implementation of properinformation management practices which will irrevocablyimpact positively on health administration in most medical

outfits in Ghana . Also, an effective information managementencompasses issues relating to (a) People (b) Processes (c)Products /Technology and lastly (d) Partners/Suppliers/Content . Hence in order for this research paper to live up to itsbilling, each of the aforementioned attributes will also be giventhe requisite priority and addressed accordingly . Lastly, someunrelenting challenges that militates against better and effective

information management such as (i) Little integration orcoordination between information, including lack of consistency,duplication, and out-of-date information (ii) No clear strategicdirection for the overall medical technology environment just to


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mention a few will also be taken a critical and a thoroughscrutiny .

DISCUSSION

A HYPOTHETICAL CASE OF INFORMATION FLOWFROM THE MEDICAL PRACTITIONER TO THE

PATIENT AT RIDGE HOSPITAL (ACCRA)

The health care service outfit is plagued with a lot ofencumbrances as far as the flow of information from the medicalexpert to the patient is concerned. The storage of information to beused at a later date is purely documented (hard copy storage) making it extremely laborious and arduous a task for not only theaverage medical assistant but also the patient as well.

It is in lieu of this that this research paper attempts to developmechanisms and strategies with the notion of curtailing thesemishaps which will undoubtedly foster and boost effectiveinformation management in most medical outfits.

THE PROCESS OF INFORMATION FLOW

RECORDS SECTION : When an indisposed person visits ahealth outfit (Clinic or Hospital), his or her details as regards whathe or she is suffering from, medical history, allergies just tomention a few are taken notice of by the medical attendant at the

Out Patient Department Section (OPD) and documented on paper .A permanent ID card is issued to the patient to be used forsubsequent visits to the health post . Also, details of the patients BP (Diastolic and Systolic) levels, temperature are recorded in afolder.


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CONSULTING ROOM

The health attendant (nurse) then sends the sufferers folder tothe medical practitioner for tentative scrutiny and diagnosis . The

medical doctor records the patients information or data on a card(hard copy)

LABORATORY SECTION

Information on the patients blood , stool and urine sample istaken notice of in this section. Again, the recorded information isdone on a paper . This is also replicated by the laboratory

technician after carrying out a series of tests on the patient.Feedback is later sent to the medical expert for him or her tomake deductions and draws his or her conclusion as regards theactual cause of the patients ailment or disease. This iscategorically done on paper.

PHARMACEUTICAL/DISPENSARY SECTION

It is at this stage that the sufferer hands over the folder/file (hardcopy) containing some directives (prescribed drugs) to themedical practitioner intended to provide a panacea to theailment or malady at stake .

WARD SECTION

In situations where the patient will have to wait for a couple ofdays for further examination , he or she is conveyed to the wardwith his or her information on a detailed folder . This will then be kept by the patient to be utilized at a later date as and when theneed crops up.


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MAJOR CHALLENGES MILITATING AGAINSTEFFECTIVE INFORMATION MANAGEMENT IN THEHEALTH OUTFIT (RIDGE HOSPITAL)

Organizations such as health care service outfits such as theRidge Hospital are confronted with a broad spectrum ofeffective communication and information problems and issues.In most instances, the growth of electronic information (ratherthan paper) has only aggravated these issues of grave concern over the past few decades. (Robertson, 2005). Nevertheless, themost critical and exigent ones that cannot be overlooked are

listed as below : (a) Over-reliance on paper manner/mode ofrecording information or data of patients (b) Language barrier i.e.to say that poor communication and comprehension ability on the

part of the patient in deciphering the actual meaning ofinformation disseminated to him or her by a medical practitioner(c) Non-existence of full disclosure of most drugs respect to itsefficacy or potency, side effects, contra-indications, allergies are

far-fetched and non-existent (d) Prevalence of large number ofdisparate information management systems (e) Little integration orcoordination between information systems across the units in thehospital under scrutiny (www.steptwo.com.au ) (f) Wide range oflegacy systems requiring upgrading or expedite replacement (g) Direct competition between effective information managementsystem (h) Limited and patchy adoption of existing information bystaff at the Ridge Hospital (i) Faint or no clear strategic directionfor the overall information technology environment (j) Poorquality of information, including lack of consistency, duplication,and out-of-date information (k) Little recognition and support ofeffective information management by top-notch medical experts atthe hospital in contention (l) Limited resources for deploying,
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managing or improving information systems (m) Large number ofdiverse medical needs and issues to be addressed (n) Difficulties inchanging working practices and processes of staff (high levels of

resistance to change and new innovations in the medical circles) (o) Internal politics impacting on the ability to coordinate activitieswithin the medical outfits jurisdiction (p) Lack of IT infrastructureto effectively manage the information data base of the facility atthe hospital (q) Non-existence of data ware house or reservoir totake care of patients information or data (r) Rolling out rigid,standardized remedies across a whole health care service centre,even though individual units or departments may have different

pressing needs (s) Coercively forcing the use of a single IT systemin all cases, regardless of whether it is an ideal remedy for asituation or problem at stake (t) Purchasing of a software or

program for life even though medical requirements will constantlychange as time goes on (Stagnation or Inertia mentality) andlastly but not the least (u) Completely centralizing informationmanagement activities, to ensure that every process is closelymonitored and controlled (Lippeveld et al, 2000)

Irrespective of the fact that the aforementioned draw backs lookquite an extremely insurmountable and herculean task , somekey principles can be a dopted and factored into the HealthInformation Administrators scheme of things to ensure thatinformation management activities and practices are effective and successful within the medical jurisdiction and framework atthe Ridge Hospital . A few of these parameters which appearquite feasible and appropriate have been expansiated and addressed a little bit are listed as below:

LANGUAGE OR COMMUNICATION BARRIER


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Addressing the issue of barriers in language at the medicalfraternity in contention through effective communication , propersensitization , and advocacy, mass education campaign etc will

do the trick in ensuring that the accurate information about thedosage and perception of some drugs , individual lifestyles aredisseminated and adhered to by the less privileged ones in oursociety thereby enhancing effective information management which will invariably ameliorate the mortality rate at thehospital and the country as a whole.

FULL DISCLOSURE OF DRUGS

Medical doctors, pharmacists and other attendants/assistants in themedical fraternity and precincts should endeavor to disclose fully ,a particular drugs potency level , contra-indication, side effects ,and correct dosage to the sufferer or patient which more oftenthan not promotes information quality and subsequently fostereffective information management .

OVER-RELIANCE ON PAPER DOCUMENTATIONThe over-reliance on paper documentation at the hospital under scrutiny should be considered a nip in the bud . Instead, theeffective utilization of state-of-the-art mode of storing data or information is given the requisite precedence as well as theusage of skilled workers to effectively manage those facilities ,equipments and tools so as to boost their longevity and shelf-life .

REDUCTION IN THE NUMBER OF DISPARATEINFORMATION SYSTEMS

The number of disparate information systems in somedepartments/units at the hospital should also be reduced


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drastically to the barest minimum thereby boosting informationor data in the hospital .

REVITALIZATION OF THE LEGACY SYSTEM

Candidly and categorically speaking, the legacy system thatthrives in some departments or units such as the OPD, X-Ray,Dispensary, Archival, Administration, Finance etc need to beupgraded or replaced with modern and sophisticated medical paraphernalias, facilities, equipments which as it stands now

will irrevocably accelerate the rate at which information iseffectively managed and harnessed across most of the units at thehealth care service centre in contention .

IINTRODUCTION OF DATA WARE HOUSE ORRESERVOIR

In dealing with the enigma or debilitating information situation at the OPD or Reception Centre and other units/departments atthe hospital , the ushering and the introduction of data warehouse or reservoir to take care of patients information or data will be a more likely option to foster effective informationmanagement at the health post as this initiative will beyondreasonable doubt boost the transmission of data from one part ofthe hospital to the other . The deployment of data ware house will make it easy to work with the quality of information andanalysis across the hospitals processes, which can be extremelydifficult to do in the transactional system . A data ware housetypically supports key areas in the outfit such as the Dispensary,Surgical, Wards, Dental, Emergency units just to mention a few.Furthermore, a well-equipped data base outfit should be made


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available to the medical practitioner at the consulting room andlinked to the health care centres local network to ensure that thedoctor fully scrutinizes the patient for a tentative diagnosis to be

arrived at in order to come up with the appropriate remedy forthe sufferer through the use of the patient electronic file orfolder.

AUTOMATION OF PATIENTS DATA

It is also very exigent that the patients data or information should be completely automated so as to ensure that all otherunits benefits from such innovation or service as and when the need arises.

EFFECTIVE UTILIZATION OF THE BARCODE SYSTEM

More so, the effective utilization of a unique barcode system from the patient available data (electronically) at the laboratory can also play a pivotal role in ensuring that accurate results of a

patients blood sample is drawn . This will invariably promote

information management to a varying degree or significantextent.

Once a well equipped data ware or reservoir is instituted aswell as strict adherence to the issues discussed earlier , the flowof information from the dispensary, ward, administration,accounts (finance), HR, operations, maintenance units etc will

be effective, successful, productive and of the highest quality or premium.

Again, information management systems need the activeinvolvement of medical attendants throughout the hospital. Forinstance, medical attendants must endeavor to save all key files


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and folders into the document/records management system . Inthis scenario , the challenge is to gain sufficient adoption toensure that the required information of a patient is recorded in

the existing system . Without a critical mass of usage, corporaterepositories will not contain enough information deemed to bebeneficial or useful .

It is indeed imperative and quite laudable that the systems such asthe introduction of data base facility in all the units that aredeployed should as a matter of fact be usable and useful for not only the medical practitioner but also the assistants/attendants

and the patients in its entirety . (Hurtubise, 1984)

CONCLUSION

In my candid opinion , it appears as if about ninety-five percent

(95%) of data or information stored i s done paper (hard copy )which presupposes that a sizable room should be deemed fit toharbor and contain all these voluminous files and folders ofpatients. The mind-boggling and intriguing question that will be posed to the Health Care Service Administrator is how theselarge quantities of files/folders will be kept for a lengthynumber of days without falling prey/victim to rodents, insectattack or damage as well as the vagaries of the weather (erratic and unpredictable weather pattern s prevailing in the country ).

Effective and strong information management carried out in support of coordinated processes will undoubtedly ensure thatrelevant actors (medical practitioners, laboratory technicians and


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assistants/attendants) are working with the same orcomplementary relevant , accurate and timely information andbaseline data . Properly collected and managed data during

emergencies at the hospital can benefit early recovery ,subsequent development and disaster preparedness activities. (www.reliefweb.int/rw/lib.nsf/db )

It is also very important to prioritize the information or data according to the pressing needs of the health outfit . Properlyanalyzing the information gathered can help hospitals andclinics immensely in choosing the proper medical practitioners

to implement health decisions and limit the amount of risk associated with the information.

Furthermore , effective information management also involvescontinual communication between medical experts and theirsubordinates , and periodic reviews of the implementationprocess taken by the health centre based on the information .These principles can help ensure that the outfit judiciously

utilizes the information gathered to maximize its operations andfoster optimum performance and profitability in the long run .

Of course , much more can be written on how to ensure effectiveinformation management as a health care serviceadministrator at the Ridge Hospital .

Nevertheless, I am of the opinion that future research work

carried out will explore, exploit and dichotomize this topic whichwill undoubtedly provide additional impetus, guidance, insight and also outline concrete strategies and mechanisms that can beresorted to so as to foster and promote effective information
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managements in our vast array of health outfits of which the hospital in contention is a part and the country as a whole .

REFERENCES

Abbot, W., Bryant, J.R & Barber, B. (1995) InformationManagement in Health Care, Handbook A-Introductory Themes.Trowbridge: Redwood Books

Avison, D. E, (1992) Information Systems Development: A BataBase Approach. 2 nd Ed. London: Blackwell Scientific Publications.

Bossert, T. (1998) Analyzing the Decentralization of HealthSystems in Developing Countries: Decision Space, Innovation andPerformance, Social Science and Medicine, 47, 10, pp 1513-1527.

Bowns, I., Rother ham, G. & Paisley, S. (1999) Factors associatedwith success in the implementation of information managementand technology in the NHS . Health Informatics Journal , 5, pp136-145.

Hurtubise, R. (1984) Managing Information Systems: Concepts &

Tools. West Hartford, CT, Kumarian Press.

Lajca, S. (1999) British Journal of Health Care Computing &Information Management 16/1, pp 20-28.


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Lippeveld, T, et al, ( 2000) Design & Implementation of HealthInformation Systems, Geneva, World Health Organization.

Robertson, J. (2005) Ten (10) Principles of Effective InformationManagement: A Journal of Information Management

UNHCR, (2007) Handbook for Emergencies.

www.reliefweb.int/rw/lib.nsf/db 900SID/AMMF-75TFLQ? OpenDocument

www.ahima.org

www.connectingforhealth.nhs.uk

www.ehealth-era.org/database.html

www.health.nsw.gov.au

www.health.qld.gov.au

[email protected]
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www.nhhrc.org.au

www.steptwo.com

www.wikibooks.org

www.wikipedia.com

BIBLIOGRAPHY

AHIMA Vision, (2006) A Blueprint for Quality Education inHealth Information Management. Chicago: AHIMA; 2007.Available at www.ahima.org

Galliers, B. & Swan , J. (1999) Information Systems and StrategicChange: A Critical Review of Business Process Reengineering, in:Currie W.L & Galliers B . (Eds). Rethinking ManagementInformation Systems: An Interdisciplinary Perspective, pp 361-387. Oxford University Press.

Kimaro, H, & Nhampossa, J. (2005) Analyzing the Problem ofUnsustainable Health Information Systems in Less-DevelopedEconomies: Case Studies from Tanzania and Mozambique,Information Technology for Development, 11, 3, pp 273-298.
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Monteiro, E. (2003) Integrating Health Information Systems: ACritical Appraisal, Methods, Inf. Med, 4, pp 428-432 (http:www.idi.ntnu.no/~ericm/37 Monteiro. Pdf.
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