THE DEVELOPMENT OF AN HEALTH INFORMATION MANAGEMENT (HIM) SYSTEM TO SUPPORT THE MANAGEMENT OF CHRONIC DISEASES IN NIGERIAN PRIMARY CARE (A CASE STUDY OF HEALTH RECORDS OFFICERS REGISTRATION BOARD OF NIGERIA (HRORBN), ABUJA)

CHAPTER ONE

INTRODUCTION

1.1   Background to the Study

The World Health Organization (WHO) defines chronic diseases, also known as noncommunicable diseases, as diseases that are not transmitted from person to person and typically have a long duration of illness with slow progression (World Health Organization, 2014). The main types of chronic diseases include cardiovascular disease, cancer, chronic respiratory disease and diabetes, with neurological disorders and mental health problems often falling into this category.

 

Annually, chronic diseases are responsible for the deaths of 41 million people worldwide, accounting for approximately 71% of global deaths, with three quarters of these deaths (31.4 million) occurring in low- and middle-income countries, particularly in Africa (World). Healthcare Organization, 2021; Hay et al., 2017; Akinmoladun et al., 2023). Non-communicable diseases, including cardiovascular diseases, diabetes, chronic respiratory diseases and cancer, account for a significant proportion of mortality and morbidity in Nigeria (WHO, 2022).

 

Primary health care (PHC) plays a key role in the country's health system. They form the basis of health setups created to tackle the issue of non-communicable diseases (Kruk et al., 2015). The 2018 Astana Declaration reaffirmed the fundamental role of primary health care in improving people's physical and mental health and social well-being (World Health Organization [WHO], 2018). It is widely recognized that PHC lays the foundation for achieving universal health coverage (UHC) and the health-related Sustainable Development Goals (SDGs). The underlying assumption is that PHC has the quality needed to optimize health. However, this assumption is not always valid, especially in low- and middle-income regions. Studies have shown that there are still widespread gaps in the quality of primary health care, such as: Undertreatment and poor management of non-communicable diseases (Li et al., 2020), overuse of antibiotics (Nguyen et al., 2023) and lack of coordination of services (Yi et al., 2020).

 

The lack of a well-integrated system to manage health information (HIM) stands as a major hurdle to handle chronic diseases in Nigeria's primary care system. The majority of Nigeria's current healthcare system, especially in rural areas, manages patient data and records manually using paper-based systems. As a result, health services become dispersed and inadequately coordinated. Consequently, medical personnels are unable to quickly acquire patient data or make wise decisions (WHO, 2022; BMC Public Health, 2023). Governments in developing countries are increasingly recognizing the value of information and communication technologies (ICT) for healthcare and are taking various steps to address this. These include telemedicine, the use of PDAs for data collection, and the computerization of district-level health information systems (IS) (Bodavala, 2002).

 

HIMS includes a range of technologies for the electronic collection, storage, management and transmission of health information and represents a significant advance in the delivery of healthcare services (Nagbe et al., 2019; Khubone et al., 2020). According to Ghazal (2021), HIMS is a comprehensive framework that integrates a number of components such as:  Decision support systems, health information exchange (HIE) platforms and electronic health records (EHRs). All of these elements work together to maintain the smooth flow of information throughout the healthcare system, enable informed decisions and improve the overall standard of patient care.

 

The integration of HIMS is in line with the broader global trend towards digitalization in healthcare and promotes the efficiency, accuracy and accessibility of healthcare data (Braa et al., 2004). The use of HIS has significantly increased the efficiency of healthcare services globally, reducing medical errors and improving patient outcomes. A systematic analysis of computerized clinical decision support systems, for instance, revealed that HIS can enhance patient outcomes and physician performance, especially in areas like clinical guidelines, diagnostic support, and medication dosing (Garg et al., 2005).

 

Moreso, research indicates that providing digital tools to healthcare teams reduces administrative burdens, facilitates better communication, and allows continuity of care, all of which improve patient outcomes. HIS implementations have simplified healthcare processes in developed countries.

 

The development of a Health Information Management (HIM) system specifically designed for primary care chronic disease management is therefore a crucial innovation needed to address Nigeria's rising non-communicable disease (NCD) burden (PLOS Global Public Health, 2022; BMJ Family Medicine, 2023). Establishing such systems at the primary healthcare level provides a scalable opportunity to address NCDs and is consistent with global goals of universal health coverage (BMJ Family Medicine, 2023; PLOS Global Public Health, 2022). It is based on this background that this study aims to investigate the development of a HIM system to support chronic disease management in Nigerian primary care settings.

 

1.2   Statement of the Problem

The management of chronic diseases in Nigeria’s primary healthcare (PHC) system faces significant challenges due to insufficient infrastructure, lack of skilled healthcare personnel, and inadequate technological support. Despite the growing burden of non-communicable diseases (NCDs) like hypertension, diabetes, and cardiovascular diseases, the country’s PHC system remains under-resourced, with a shortage of essential diagnostic tools, medications, and trained staff (PLOS Global Public Health, 2022). The lack of effective Health Information Management (HIM) systems further exacerbates these issues by hindering efficient patient monitoring, follow-up care, and the integration of care across different levels of the health system. As a result, many patients experience fragmented care, contributing to poor health outcomes and elevated costs.

Developing an HIM system that can support chronic disease management in Nigeria’s primary care sector is essential for improving healthcare delivery and outcomes. Current PHC facilities are often ill-equipped to provide comprehensive and continuous care for individuals with chronic conditions, and there is limited access to integrated digital tools that could streamline patient care and enhance decision-making (World Health Organization, 2022). A robust HIM system would enable better data collection, patient tracking, and clinical decision support, which are crucial for addressing the long-term care needs of individuals with NCDs. However, the widespread adoption of such systems faces barriers, including financial constraints, inadequate technological infrastructure, and resistance to change among healthcare providers (BMC Public Health, 2023).Top of Form

 

 

1.3 Objectives of the Study

The main objective of the study is to examine the development of an HIM system to support the management of chronic diseases in Nigerian primary care. Specific objectives of the study are:

1.   Identify the key information needs of healthcare providers and patients in the management of chronic diseases in Nigerian primary care settings.
2. Design and develop an HIM system that effectively captures, stores, retrieves, and analyzes patient data relevant to chronic disease management.
   1.  Evaluate the usability, acceptability, and impact of the developed HIM system on the quality of care, patient outcomes, and efficiency of healthcare delivery in primary care settings.

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 specific information needs of healthcare providers and patients in managing chronic diseases in primary care settings in Nigeria?
2. How can an HIM system be designed and implemented to effectively support the management of chronic diseases in primary care settings, considering the unique context of Nigeria?
3. What are the potential benefits and challenges of implementing an HIM system in terms of improving patient outcomes, enhancing healthcare provider efficiency, and reducing healthcare costs in Nigerian primary care settings?

1.5 Research Hypothesis

The following research hypothesis was developed and tested for the study:

Ho1: The implementation of a Health Information Management (HIM) system in Nigerian primary care settings does not significantly improve the management and outcomes of chronic diseases, such as hypertension, diabetes, and cardiovascular diseases, when compared to the current manual or traditional methods of management.

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 Information Management 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 Health Records Officers Registration Board of Nigeria (HRORBN), Abuja. 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

1. Health Information Management (HIM) System

 A digital platform designed to manage, store, and exchange healthcare information, ensuring the efficient processing of patient data, clinical records, and administrative activities within healthcare settings, particularly in primary care facilities.

1. Chronic Diseases

Long-lasting health conditions that require ongoing medical attention or management, such as diabetes, hypertension, asthma, and cardiovascular diseases. These diseases are often prevalent in Nigerian communities and require continuous monitoring and treatment to prevent complications.

1. Primary Care

The first level of contact in the healthcare system, typically delivered by general practitioners or community health workers. It involves the prevention, treatment, and management of common health issues, including chronic diseases, with an emphasis on accessibility and continuity of care.

1. Electronic Health Record (EHR)

 A digital version of a patient’s paper chart that provides real-time, patient-centered records accessible to authorized users. EHRs support the documentation of patient history, diagnoses, treatments, and outcomes, facilitating improved healthcare delivery and management.

1. Telemedicine

The use of telecommunications technology to provide healthcare services remotely. In the context of managing chronic diseases in Nigeria, telemedicine can enable regular monitoring, consultations, and treatment adjustments for patients in rural or underserved areas.

1. Data Interoperability

 The ability of different healthcare systems and technologies to exchange, interpret, and use data seamlessly. In an HIM system, interoperability ensures that patient data can be shared between primary care centers, hospitals, and specialists, promoting coordinated care for chronic disease management.

1. Patient-Generated Health Data (PGHD)

Health information collected directly from patients, often through wearable devices or mobile health apps. PGHD can provide valuable insights into a patient’s condition, lifestyle, and adherence to treatment, especially in managing chronic diseases in remote Nigerian communities.

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