CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The modernization of healthcare facilities is crucial for our technologically advanced nation. However, healthcare records significantly lag behind in adopting technology compared to various other organizations in the U.S. (Levey, 2009). Electronic Medical Records (EMRs) represent the contemporary technology for documenting patient information. EMRs encompass not only a patient's medical history but also tests, results, doctors' notes, insurance information, and more. It's important to note that the specific contents of an EMR can vary as there is no legal standard dictating their exact composition.
Despite the concept of EMRs not being new, it is gaining widespread recognition, and there is a clear push to implement EMRs across all U.S. hospitals. The process of implementing EMRs has been slow due to its cost, which many organizations cannot afford (Levey, 2009). Recognizing the importance of EMRs, the government has taken steps to support their implementation in hospitals nationwide.
It is time to bring healthcare industry records up to the technological standards of other industries. While the idea of a connected EMR system has been around for decades, the development of a functional system is only now taking shape. President Bush's administration was the first to devise a plan for EMR utilization. Dr. David Brailer, former National Coordinator for Health Information Technology during President Bush's administration from 2004 to 2006, emphasized that it's not as simple as placing a computer on every doctor's desk, given the technical challenges involved (Paddock, 2009). During President Bush's tenure, the goal was to transition all hospitals from paper medical records to electronic medical records by 2014. While some remain confident that this goal will be met (Freking, 2009), many analysts are skeptical.
Change is often met with resistance, and the shift to EMRs requires patience and open-mindedness. Training is a time-consuming aspect of the implementation process. President Bush's vision of improving healthcare through EMRs is not the only benefit; it also generates jobs. This aligns with President Obama's stimulus package, as these jobs involve transitioning healthcare workers into Health Information Technology (HIT) roles or training IT professionals in the healthcare field. Job transitions can affect the implementation timeline if not done correctly (Freking, 2009).
The primary hurdle in EMR implementation is funding. President Obama and his administration have committed to realizing President Bush's vision of full EMR implementation. President Obama has pledged $50 billion over five years for Healthcare Information Technology, with a substantial portion of this amount, $17.2 billion, allocated in the economic stimulus package to support healthcare organizations in adopting electronic record systems (Brown, 2009). This stimulus bill has far-reaching effects on various aspects of healthcare, emphasizing the significance of healthcare's digital transformation.
Under the stimulus package, each physician is set to receive more than $40,000 over a five-year period from the Centers for Medicare and Medicaid Services starting in 2011 for the implementation of EMR systems (Japsen, 2009). The expectations for EMRs are high, with President Obama highlighting their potential to reduce errors, lower costs, ensure privacy, and save lives.
A stark contrast exists in the utilization of information technology among different industries. Mann (2005) points out that while we can perform a multitude of tasks online, such as banking, bill payments, booking travel, and even grocery shopping, it remains uncommon for healthcare facilities to share X-rays digitally, even if they are located nearby. The statistics emphasize this contrast: only nine percent of hospitals and about 25 percent of doctor offices have adopted EMRs in the United States. While EMRs are recognized as a trend, not everyone agrees that they will necessarily lead to cost savings and improved patient care (Low, 2009).
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Bottom of Form
1.2 Statement of the Problem
The adoption rate of Electronic Medical Records (EMRs) in healthcare facilities is relatively low. Several factors contributed to this low adoption rate, which align with challenges encountered in the implementation of systems in other industries outside of healthcare. These factors include:
- Cost: Implementing EMR systems typically requires a substantial financial investment, which can be a barrier for many healthcare organizations. The initial setup, software, hardware, and ongoing maintenance expenses can be significant.
- Productivity: Learning and adapting to new EMR systems take time and effort for staff at all levels within the organization. This transition period can impact productivity as healthcare professionals need to familiarize themselves with the new technology.
- Data Security and Privacy: Healthcare facilities must address data security and access control issues to ensure patient privacy, a critical concern due to federal privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA). Ensuring the confidentiality of patient information is of utmost importance to avoid potential legal repercussions.
- Integration: Integrating the new EMR technology with existing systems within the organization can be a complex and time-consuming task. Ensuring that the EMR system seamlessly works with other systems and processes is crucial for efficient healthcare operations.
Additionally, the implementation of EMR systems is a protracted process due to privacy policies such as HIPAA. Enacted by Congress in 1996, HIPAA includes the HIPAA Privacy Rule, which governs the use and disclosure of certain information by "covered entities," including healthcare clearinghouses, employer-sponsored health plans, health insurers, and medical service providers involved in specific transactions. The HIPAA privacy regulations are intricate, and healthcare providers must comply with them to avoid severe penalties, including substantial fines and even potential legal consequences (Terry, 2009).
1.3 Objectives of the Study
The main objective of the study is to examine the factors militating against the implementation of Electronic Medical Records (EMR) in Nigeria. Specific objectives of the study are:
- 1. To identify the key factors that hinder the implementation of Electronic Medical Records (EMR) in Nigeria.
- 2. To assess the relative importance of these factors in influencing the adoption and utilization of EMRs in Nigerian healthcare facilities.
- 3. To provide recommendations for policymakers, healthcare administrators, and technology providers to address the identified barriers and promote the successful implementation of EMRs in Nigeria.
1.4 Research Questions
To guide the study and achieve the objectives of the study, the following research questions were formulated:
- 1. What are the key factors that hinder the implementation of Electronic Medical Records (EMR) in Nigeria?
- 2. How do these factors in influencing the adoption and utilization of EMRs in Nigerian healthcare facilities?
- 3. What recommendations for policymakers, healthcare administrators, and technology providers to address the identified barriers and promote the successful implementation of EMRs in Nigeria?
1.5 Research Hypothesis
The following research hypothesis was developed and tested for the study:
- Ho: There is no statistical significant relationship between EMR and Hospital Performance.
- Hi: There is a statistical significant relationship between EMR and Hospital Performance.
1.6 Significance of the Study
The study is important for many reasons. The following are the major stakeholders this paper through its practical and theoretical implications and findings will be of great significance:
Firstly, the paper will benefit major stakeholders and policy makers in the health sector. The various analysis, findings and discussions outlined in this paper will serve as a guide in enabling major positive changes in the industry and sub-sectors.
Secondly, the paper is also beneficial to the organizations used for the research. Since first hand data was gotten and analysed from the organization, they stand a chance to benefit directly from the findings of the study in respect to their various organizations. These findings will fast track growth and enable productivity in the organisations used as a case study.
Finally, the paper will serve as a guide to other researchers willing to research further into the subject matter. Through the conclusions, limitations and gaps identified in the subject matter, other student and independent researchers can have a well laid foundation to conduct further studies.
1.7 Scope of the Study
The study is delimited to First Line Hospital in Uyo Local Government Area, Akwa Ibom State. Findings and recommendations from the study reflects the views and opinions of respondents sampled in the area. It may not reflect the entire picture in the population.
1.8 Limitations of the Study
The major limitations of the research study are time, financial constraints and delays from respondents. The researcher had difficulties combining lectures with field work. Financial constraints in form of getting adequate funds and sponsors to print questionnaires, hold Focus group discussions and logistics was recorded. Finally, respondents were a bit reluctant in filling questionnaires and submitting them on time. This delayed the project work a bit.
1.9 Organization of the Study
The study is made up of five (5) Chapters. Chapter one of the study gives a general introduction to the subject matter, background to the problem as well as a detailed problem statement of the research. This chapter also sets the objectives of the paper in motion detailing out the significance and scope of the paper.
Chapter Two of the paper entails the review of related literature with regards to corporate governance and integrated reporting. This chapter outlines the conceptual reviews, theoretical reviews and empirical reviews of the study.
Chapter Three centers on the methodologies applied in the study. A more detailed explanation of the research design, population of the study, sample size and technique, data collection method and analysis is discussed in this chapter.
Chapter Four highlights data analysis and interpretation giving the readers a thorough room for the discussion of the practical and theoretical implications of data analyzed in the study.
Chapter Five outlines the findings, conclusions and recommendations of the study. Based on objectives set out, the researcher concludes the paper by answering all research questions set out in the study.
1.10 Definition of Terms
- Cost: The financial expenditure required to acquire, set up, maintain, and operate an EMR system. It includes expenses for hardware, software, training, and ongoing support.
- Productivity: The measure of how efficiently an organization or its staff can carry out tasks and achieve goals. In the context of EMR implementation, reduced productivity refers to the initial dip in efficiency as staff adapts to the new system.
- Data Security: The protection of sensitive and confidential information from unauthorized access, disclosure, alteration, or destruction. In the context of EMRs, data security ensures that patient health information remains confidential and is only accessible by authorized individuals.
- Access Control: The process of managing who can access specific data or systems within an organization. In healthcare, access control mechanisms are used to limit and monitor access to patient records within an EMR system.
- Privacy: The right of individuals to control their personal information and decide how it is collected, used, and shared. In healthcare, privacy regulations like HIPAA aim to safeguard patients' privacy by setting standards for the handling of their health information.
- Health Insurance Portability and Accountability Act (HIPAA): A federal law enacted in 1996 that establishes regulations and standards for the protection of patient health information. HIPAA includes the HIPAA Privacy Rule, which governs the use and disclosure of protected health information by covered entities.
- Integration: The process of combining different systems, applications, or technologies to work together seamlessly. In the context of EMR implementation, integration refers to making sure that the EMR system can exchange information with other existing healthcare systems and processes.
