The woman looked exhausted and kept fidgeting on her seat at the Gwarinpa District Hospital, Abuja. Each time nurses and attendants come out with a pile of folders to call names, she sat up with expectation, only to sit back in disappointment when her name was not mentioned.
After a while, she dragged herself to one of the attendants and lamented that she has been sitting down for hours, and yet her name has not been called out to enable her see the doctor. The attendant told her they couldn’t locate her folder and have been searching for it since she arrived the hospital that morning.
This and many more are some of the experiences many Nigerians face whenever they go to access treatment in our hospitals because most hospitals, public and private alike still use paper health records instead of Electronic Medical Records (EMR), the computer base system.
An EMR is a digital version of the traditional paper-based medical record for an individual. It is designed to contain and share information from all providers involved in a patient’s care. EMRs data can be created, managed, and consulted by authorized providers and staff from across more than one health care organization.
The problem of finding folders make people spend a long time in the hospital before accessing care. Some patients are made to pay for another folder when theirs is missing, and at other times, they spend the whole day without being attended to. This causes chaos in hospitals sometimes as many patients end up fighting health personnel because of delay in locating their folders, their names being skipped or missing folders.
Patients who do not have doctor’s appointments are often not attended to in some hospital units, even when their condition is critical because the record officers feel it is a herculean task locating their folders. The patients are sent away without the doctor’s knowledge.
At the Gwarinpa District Hospital, our reporters observed that people drop their cards at the records unit, and their folders are then brought out one after the other and directed to their doctors. It was the same story at the Wuse District Hospital .
The reporters also entered the record unit department where folders are arranged in shelves and demarcated to identify the departments like pediatric, female surgical, and emergency among others. The health record officers were also seen sorting out patients folders.
At the Maitama District Hospital, however, patients are registered electronically. They drop their cards at the record units, and the information is sent electronically via computer to the vital signs room and their doctors.
At the Wuse District Hospital, an official who does not want her name in print said e-health is yet to be incorporated but they are hoping it will be done by the end of the year.
According to the Registrar/CEO, Health Records Officers Registration Board of Nigeria, Alhaji Mohammed Ibrahim Mami, no public hospital in Nigeria fully utilizes the electronic medical record, adding that while they may use it for some aspects of documentation, there is zero usage for consultation.
He said some hospitals have started using it for registration of patients, billing and stock taking but in the area of real consultation, only one or two federal establishments are using it.
“For instance Federal Medical Centre, Keffi, has gone a little bit far in the use of electronic medical records, more than any other public hospital so far. The registeration, consultation, laboratory investigation, pharmacy , stock and billing including inpatient consulting services are all electronic.
“But the National Hospital, Abuja only uses electronic medical records for documentation , that is in registering patients. Same with some teaching hospitals like University of Maiduguri Teaching Hospital, and Federal Medical Centre, Nguru. Other hospitals do more of paper work and talking about doing it than putting it into practice. As far as using the system for consultation in public health facilities either at state or federal level is concerned, it is zero,” he explained.
He added that some private hospitals like Abuja Clinics and the Nigerian National Petroleum Corporation (NNPC) hospital have achieved almost 100 percent in electronic medical records.
The Executive Secretary Gwarinpa District Hospital, Mrs. Shade Kolawole said the management of the hospital is trying its best to see that the record keeping process is upgraded from analogue to computer-based, adding that presently they have a very serious challenge keeping files as there is no space anymore in the store.
Acting Head of Unit, Medical Records Department of the hospital, Mrs. Elo Akintonde said all their activities at the unit are done manually and it is a hectic job,
“It is stressful because we have both the primary and secondary storage unit, and the secondary is far away from the main office. To retrieve some patients’ folders, our staff have to be going from one unit to the other and that makes it stressful.”
“The electronic medical records is easier and faster because what we just need is to input the data and post, and as the patients come subsequently, we check the name and attend to them speedily instead of searching for folders especially for those that do not come regularly,” an official at the Wuse District Hospital said.
Alhaji Mohammed Ibrahim Mami, Registrar/CEO Health Records Officers Registration Board of Nigeria said electronic medical record saves time, makes records accurate, reduces multiple investigations, enhances billing and improves quality of medical care.
He said since patients can access medication at any point unlike the paper one, there is no problem of patients wasting time or missing folders.
Mami said there are factors mitigating against the implementation of electronic medical records in Nigeria and they include the management-will to do it, attitudinal change of the attending doctor, the energy/power support and cost implications.
He explained that chief medical directors of hospitals sometimes introduce the method without involving other relevant stakeholders, saying 80 percent of documentation or writing for patients at hospitals are done by doctors, and there will be attitudinal change on their part since they attend to about an average of 50 patients daily.
However, he said there are legal implication in EMR usage when there are litigations because till now, electronic evidence are not admissible in most Nigerian courts . He called on the National Assembly to pass a law to incorporate electronic evidence.
He said there is urgent need to create attitudinal change and provide budgetary allocation because electronic health record for 20 people cost about 15m to put the infrastructure on ground, and cost more where users in a hospital are up to 50 to 100.
He said hospitals can commence the EMR process in stages.