Assessment of health information system adoption : a case study of Ghana’s health service

Abstract

Globally, health information systems (HISs) have improved healthcare delivery in developed countries, yet despite the proven benefits, their implementation in many developing countries remains fragmented, failing to take into account existing infrastructure or human and logistical resources. This prompted the researcher to assess the benefits of using HISs in state-owned hospitals in Ghana. Using convergent parallel mixed method design, the study aimed to assess the HISs used in Ghana’s teaching, regional, district and quasi-government hospitals, to enhance the delivery of healthcare services in resource-constrained environments. Data were collected using questionnaires, interviews and observation techniques. In total, 80 healthcare workers (doctors, nurses, health information officers and administrative staff) from ten hospitals across the country’s northern, middle and southern geographical zones, were purposively and conveniently selected. The data from the quantitative study were analysed using frequencies and percentages, while thematic analysis guided the qualitative component. The findings showed that although all ten health facilities had different forms of HIS applications in place, minimal related training (mainly focusing on basic computer skills) was being given to healthcare workers. A notable benefit was the confidentiality of patient data, which were password protected. While deemed safe, the respondents acknowledged the need for more stringent user authentication. Another identified concern was that one HIS did not communicate with other internal HISs in the same hospital: the out-patient department, for instance, did not interconnect with systems in the dispensary or oncology, thereby impeding operations. While all hospitals in Ghana are regulated by the Ghana Health Service (GHS), data generated in one hospital cannot be accessed in another, meaning information is not easily transmitted, processed or stored elsewhere than where it is captured. Poor internet connectivity and electricity supply were also deemed to limit the hospital-wide use and adoption of HISs. The researcher proposed a Revised Health Information System Framework (R-HIS-F) to effect the interoperability and integration of health data and services across all hospitals in Ghana, through the GHS cloud service. The proposed R-HIS-F was validated by GHS experts, and certified as benefiting healthcare workers and improving healthcare delivery in Ghana.

Internasionaal het gesondheidsinligtingstelsels (GIS) die lewering van gesondheidsorg in ontwikkelde lande bevorder, maar ten spyte van bewese voordele, bly hul implementering in ontwikkelende lande gefragmenteer en neem nie die bestaande infrastruktuur of menslike en logistieke hulpbronne in ag nie. Dit het daartoe gelei dat die navorser die voordele van GIS's in staatshospitale in Ghana ondersoek het. Deur die gemengde ontwerpmetode van samelopende parallelle te gebruik, het die studie gepoog om die GIS's wat in Ghana se onderrig-, distrik- en kwasi-staatshospitale gebruik word om die lewering van gesondheidsdienste in hulpbronarm-omgewings te bevorder, te ondersoek. Data is deur vraelyste, onderhoude en waarnemingtegnieke versamel. Tagtig gesondheidsorgwerkers (dokters, verpleegsters, gesondheidsinligtingbeamtpes en administratiewe personeel) van 10 hospitale in die land se noordelike, middel en suidelike geografiese sones is doelbewus en geriefshalwe gekies. Die data van die kwantitatiewe studie is deur frekwensies en persentasies ontleed terwyl tematiese ontleding vir die kwalitatiewe komponent gebruik is. Die bevindings het getoon dat alhoewel al tien gesondheidsfasiliteite verskillende vorme van GIS-toepassings het, het gesondheidsorgwerkers minimale verwante opleiding (hoofsaaklik gefokus op rekenaarvaardighede) ontvang. 'n Belangrike voordeel was die vertroulikheid van pasiëntdata wat met 'n wagwoord beskerm is. Alhoewel dit as veilig beskou is, het die respondente erken dat daar strenger gebruikerverifikasie moet wees. Nog 'n geïdentifiseerde kwessie was dat een GIS nie met 'n ander GIS in dieselfde hospitaal gekommunikeer het nie: die afdeling vir buitepasiënte was nie aan die apteek of onkologie-afdeling verbind nie, wat operasies vertraag het. Alhoewel die Ghana Health Service (GHS) al die hospitale in Ghana reguleer, het een hospitaal nie toegang tot die data wat in 'n ander hospitaal gegenereer is nie. Inligting word dus nie maklik oorgedra, verwerk of êrens anders gestoor as waar dit vasgelê is nie. Swak internetverbindings en elektrisiteitsvoorsiening word ook gesien as dat dit die hospitaalwye-gebruik van GIS's beperk. Die navorsers het 'n hersiene raamwerk vir die gesondheidsinligtingstelsel (R-HIS-F) voorgestel vir die samewerking en integrasie van gesondheiddata en -dienste vir alle hospitale in Ghana, deur die GIS-wolkdiens. GIS-kundiges het die voorgestelde R-HIS-F geldig verklaar en gesertifiseer as voordelig vir gesondheidsorgwerkers en bevorderend vir die lewering van gesondheidsorg in Ghana.

Emhlabeni wonke, izinhlelo zolwazi lwezempilo (lwama-HIS) zithuthukise ukulethwa kokunakekelwa kwezempilo emazweni athuthukile, nokho naphezu kwezinzuzo ezifakazelwe, ukuqaliswa kwazo emazweni amaningi asathuthuka kusalokhu kuyizicucu, zehluleka ukucabangela ingqalasizinda ekhona noma izinsiza zabantu nezokusebenza. Lokhu kwenze umcwaningi ahlole izinzuzo zokusebenzisa ama-HIS ezibhedlela zikahulumeni eGhana. Kusetshenziswa ukwakheka kwezindlela ezixubile ezihambisanayo, ucwaningo luhlose ukuhlola ama-HIS asetshenziswa ezibhedlela zaseGhana zokufundisa, zesifunda, zesigodi kanye nezingaphansi kukahulumeni, ukuze kuthuthukiswe izinsizakalo zokunakekelwa kwezempilo ezindaweni ezicindezelayo. Imininingwane yaqoqwa kusetshenziswa uhlu lwemibuzo, izingxoxo kanye namasu okubheka. Sebebonke, abasebenzi bezempilo abangama-80 (odokotela, abahlengikazi, izikhulu zolwazi lwezempilo kanye nabasebenzi bokuphatha) abavela ezibhedlela eziyishumi kuzo zonke izindawo zezwe ezisenyakatho, maphakathi neningizimu, bakhethwe ngendlela efanelekile nenenhloso. Imininingwane yocwaningo lokuqoqa nokuhlaziya iminingwane yezinombolo yahlaziywa kusetshenziswa amaza namaphesenti, kanti ukuhlaziya indikimba kuqondise ingxenye yekhwalithi. Imiphumela ibonise ukuthi nakuba zonke izikhungo zezempilo eziyishumi zinezinhlobo ezahlukene zezicelo ze-HIS, ukuqeqeshwa okuncane okuhlobene (ikakhulukazi okugxile kumakhono ayisisekelo ekhompyutha) kwakunikezwa abasebenzi bezempilo. Inzuzo ephawulekayo kwaba ukugcinwa kuyimfihlo kweminingwane yesiguli, eyayivikelwe yigama eliyimfihlo okumele lisetshenziswe ukuze ungene endaweni. Nakuba kuthathwa njengokuphephile, abaphenduli bavume isidingo sokuqinisekisa okuqinile komsebenzisi. Okunye okukhonjiwe ukuthi i-HIS eyodwa ayizange ixhumane namanye ama-HIS angaphakathi esibhedlela esifanayo: umnyango weziguli ezilaliswa ngaphandle, isibonelo, awuzange uxhumane nezinhlelo egumbini lapho kulungiswa khona futhi kuhlinzekwa imithi, noma ukucwaninga nokwelashwa kwamathumba, ngaleyo ndlela iphazamise ukusebenza. Nakuba zonke izibhedlela zaseGhana zilawulwa Insizakalo Yezempilo YaseGhana (GHS), iminingwane ekhiqizwa kwesinye isibhedlela ayinakufinyelelwa kwesinye, okusho ukuthi ulwazi aludluliswa kalula, alucutshungulwa noma lugcinwe kwenye indawo ngaphandle kwalapho luthathwe khona. Ukungaxhunywa kahle kwe-inthanethi nokuhlinzekwa kukagesi nakho kwathathwa njengokunciphisa ukusetshenziswa esibhedlela sonke kanye nokwamukelwa kwama-HIS. Umcwaningi uphakamise Uhlaka Olubuyekeziwe Lohlelo Lolwazi Lwezempilo (R-HIS-F) ukuze kusebenze ukusebenzisana nokuhlanganiswa kweminingwane yezempilo nezinsizakalo kuzo zonke izibhedlela zaseGhana, ngenhlobonhlobo yezinsizakalo ezilethwa ngokufunwa ezinkampanini nakumakhasimende nge-inthanethi ye-GHS. I-R-HIS-F ehlongozwayo yaqinisekiswa ochwepheshe be-GHS, futhi yaqinisekiswa njengezuzisa abasebenzi bezokunakekelwa kwempilo kanye nokuthuthukisa ukulethwa kokunakekelwa kwezempilo eGhana.