UNIVERSITY OF APPLIED MANAGEMENT GHANA-CAMPUS

COURSE NAME: IT INFRASTRUCTURE AND STRATEGY

LECTURERS NAME: MR EMMANUEL FON TATA

INDEX NO: UAMM0020 DATE OF SUBMISSION: 20TH FEBRUARY, 2011

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QUESTION TWO (2)

DISCUSS HOW YOU (AS A HEALTH CARE SERVICE ADMINISTRATOR) WILL ENSURE EFFECTIVE INFORMATION MANAGEMENT IN YOUR HEALTH

CENTRE: HEALTH CARE SERVICE CENTRE USED FOR THE CASE STUDY: RIDGE HOSPITAL

TABLE OF CONTENT

PAGE NO

EXECUTIVE

SUMMARY4

INTRODUCTION.5

DISCUSSION11

CONCLUSION..18

REFERENCES20

BIBLIOGRAPHY23

EXECUTIVE SUMMARY
During the last infinitesimal couple of decades, the health sector in Ghana has felt incessant exigency to ameliorate and accelerate as far as 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 critical parameters that constantly militate against the health care service centres in their capacity and quest to live up to their billing as far as effective information management is concerned. Nevertheless, the notable ones of grave concerned that cannot be underestimated are listed as below: (i) Over-reliance on paper documentation of recording patients information or data at the Ridge Hospital (ii) Language barrier (iii) Non-existence of full disclosure of some drugs (iv) Poor quality of information, including lack of consistency, duplication, and out-of-date facilities for storing data (v) Lack of data ware house or reservoir (vi) Non-existence of patients data or information automation etc.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 do the trick for the Health Information Administrator in decimating or neutralizing the prevalence of the aforementioned challenges and debilitating 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 contraindications etc (c) Minimal indulgence and reliance on paper documentation (d) Expedite introduction of data ware house or reservoir (e) Automation of patients data or information just to mention a few.
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INTRODUCTION
By way of preamble, the terminology information refers to any event 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, the concept 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 managing this information throughout its life cycle regardless of the source or format (data, paper and electronic documents, audio, video, etc) for delivery through multiple channels that may include cell phones and web interfaces. INFORMATION MANAGEMENT Information management (IM) is the collection and management of information from one or more sources and the distribution of that information to one or more audiences. This sometimes involves those who have a stake in, or a right to that information. Management means the organization of and control over the structure, processing and delivery of information. (www.wikibooks.org) In other words, it refers to the sum of all activities, gathering, processing, organization and dissemination of information in order to assist humanitarian actors (medical practitioners/assistants/attendants) achieve their goals in an effective and timely manner. Typical examples of such 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 basically a business discipline that analyses various types of information to use as a resource to improve business operations especially the health 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 and clinics control the amount of information collected or gathered through the use of electronic means. Analysis is typically executed electronically as well. (Abbot et al, 1995). Effective management system can be collected from external or internal business sources. Internal sources of business information may include the accounting, production, executive management or HR departments. External sources of business information often include the economic market place, competitors, national organizations or a local chamber of commerce. (www.wisegeek.com) A vast number of organizations of which medical entities are a part usually nurture the information gathering processes based on their specific operation needs and business environment. During the last few decades, the health sector in Ghana has felt increasing need to improve and accelerate as far as effective
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information is concerned. Also, with the ever-changing medical landscape, challenges and opportunities continue to characterize the 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 a community. One of the essential functions for health effectiveness is information. It is quite unfortunate that the medical experts have been slow to implement standards for communication and sharing 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 or automation of clinical records and computer-assisted input protocols are as effective and capable of promoting and fostering health information management. THE FUNCTIONS OF A HEALTH INFORMATION ADMINISTRATOR The significance of the role that health care service administrators play in ensuring effective information management cannot be over-emphasized. A health information administrator is a degree holder of health information management. Common job title in contemporary job market are related 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 information engineer, chemical information coordinator, data administrator, information security officer) as health care enterprises expand their reliance on information systems and technology. Health administrators have, and will continue to assume roles that directly contribute to the development of computer-based patient record systems and a national health infrastructure. (www.info@promotesolutions.se). The tasks or functions performed by health administrators are diverse and dynamic within the work environment. The health service care administrator in general performs tasks related to the management of health information and the systems used to collect, store, process, retrieve, analyze, disseminate and communicate that information regardless of the physical medium in which it is maintained. In addition, health information administrators assess the uses of information and identify its availability in terms of inconsistencies, gaps, and duplications in health data sources. (Bowns et al, 1999). Furthermore, they are capable of planning and designing systems and serving as pivotal team members in the development of computer-based patient record systems and other enterprise-wide information systems. Their responsibilities also include serving as brokers of information services. (www.ahima.org). Among the information services provided are a design and requirement definition for clinical and administrative systems development, data administration, data quality management, data security management, decision support design and data analyses, and management of informationintensive areas such as clinical quality/ performance

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 an unprecedented and simultaneous bulge in demand while there are aggravating deficiencies in skilled workers needed to meet this glaring necessity. Out of the ordinary improvement in productivity will soon be required just to maintain current service levels in a broad spectrum of perspectives. This can only come to fruition if the ingenuity of health care consumers becomes more pro-active and informed participants in health care processes. Effective management and delivery of better health information is crucial to the aforementioned strategies. Better management and availability of health care information is however, increasingly seen as an important tool against disease in its own right and there is undoubtedly incessant evidence that both health outcomes and consumer satisfaction can be augmented by improving the way health information is managed. (www.ehealthera.org). In short to medium term, it is also a tool most likely to enable improvement of the incongruous distribution of health care services which undermines indigenous, rural and poor Ghanaians. Effective information management, I reiterate, is currently recognized as a key 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 information management practices are paramount for many organizations including 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 effectiveness of health processes, the demands of compliance regulations and the 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 of health needs to meet and complex medical issues to address. Nevertheless, this research paper will attempt to accentuate on some critical factors, mechanisms and strategies deemed probable for not only health information administrators in ensuring effective information management but also offer within its jurisdiction, a series of principles that can be imbibed into the health information administrators scheme of things and also as a guide in the planning and implementation of proper information management practices which will irrevocably impact positively on health administration in most medical outfits in Ghana. Also, an effective information management encompasses 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 its billing, each of the aforementioned attributes will also be given the requisite priority and addressed accordingly. Lastly, some unrelenting challenges that militates against better and effective information management such as (i) Little integration or coordination between information, including lack of consistency, duplication, and out-of-date information (ii) No clear strategic direction for the overall medical technology environment just to

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mention a few will also be taken a critical and a thorough scrutiny.

DISCUSSION
A HYPOTHETICAL CASE OF INFORMATION FLOW FROM THE MEDICAL PRACTITIONER TO THE PATIENT AT RIDGE HOSPITAL (ACCRA) The health care service outfit is plagued with a lot of encumbrances as far as the flow of information from the medical expert to the patient is concerned. The storage of information to be used at a later date is purely documented (hard copy storage) making it extremely laborious and arduous a task for not only the average medical assistant but also the patient as well. It is in lieu of this that this research paper attempts to develop mechanisms and strategies with the notion of curtailing these mishaps which will undoubtedly foster and boost effective information management in most medical outfits. THE PROCESS OF INFORMATION FLOW RECORDS SECTION: When an indisposed person visits a health outfit (Clinic or Hospital), his or her details as regards what he or she is suffering from, medical history, allergies just to mention 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 for subsequent visits to the health post. Also, details of the patients BP (Diastolic and Systolic) levels, temperature are recorded in a folder.
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CONSULTING ROOM The health attendant (nurse) then sends the sufferers folder to the 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 is taken notice of in this section. Again, the recorded information is done 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 to make deductions and draws his or her conclusion as regards the actual cause of the patients ailment or disease. This is categorically done on paper. PHARMACEUTICAL/DISPENSARY SECTION It is at this stage that the sufferer hands over the folder/file (hard copy) containing some directives (prescribed drugs) to the medical practitioner intended to provide a panacea to the ailment or malady at stake. WARD SECTION In situations where the patient will have to wait for a couple of days for further examination, he or she is conveyed to the ward with 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 the need crops up.

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MAJOR CHALLENGES MILITATING AGAINST EFFECTIVE INFORMATION MANAGEMENT IN THE HEALTH OUTFIT (RIDGE HOSPITAL) Organizations such as health care service outfits such as the Ridge Hospital are confronted with a broad spectrum of effective communication and information problems and issues. In most instances, the growth of electronic information (rather than paper) has only aggravated these issues of grave concern over the past few decades. (Robertson, 2005). Nevertheless, the most critical and exigent ones that cannot be overlooked are listed as below: (a) Over-reliance on paper manner/mode of recording 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 of information disseminated to him or her by a medical practitioner (c) Non-existence of full disclosure of most drugs respect to its efficacy or potency, side effects, contra-indications, allergies are far-fetched and non-existent (d) Prevalence of large number of disparate information management systems (e) Little integration or coordination between information systems across the units in the hospital under scrutiny (www.steptwo.com.au) (f) Wide range of legacy systems requiring upgrading or expedite replacement (g) Direct competition between effective information management system (h) Limited and patchy adoption of existing information by staff at the Ridge Hospital (i) Faint or no clear strategic direction for the overall information technology environment (j) Poor quality of information, including lack of consistency, duplication, and out-of-date information (k) Little recognition and support of effective information management by top-notch medical experts at the hospital in contention (l) Limited resources for deploying,
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managing or improving information systems (m) Large number of diverse medical needs and issues to be addressed (n) Difficulties in changing 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 activities within the medical outfits jurisdiction (p) Lack of IT infrastructure to effectively manage the information data base of the facility at the hospital (q) Non-existence of data ware house or reservoir to take 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 system in all cases, regardless of whether it is an ideal remedy for a situation or problem at stake (t) Purchasing of a software or program for life even though medical requirements will constantly change as time goes on (Stagnation or Inertia mentality) and lastly but not the least (u) Completely centralizing information management activities, to ensure that every process is closely monitored and controlled (Lippeveld et al, 2000) Irrespective of the fact that the aforementioned draw backs look quite an extremely insurmountable and herculean task, some key principles can be adopted and factored into the Health Information Administrators scheme of things to ensure that information management activities and practices are effective and successful within the medical jurisdiction and framework at the Ridge Hospital. A few of these parameters which appear quite 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 medical fraternity in contention through effective communication, proper sensitization, and advocacy, mass education campaign etc will do the trick in ensuring that the accurate information about the dosage and perception of some drugs, individual lifestyles are disseminated and adhered to by the less privileged ones in our society thereby enhancing effective information management which will invariably ameliorate the mortality rate at the hospital and the country as a whole. FULL DISCLOSURE OF DRUGS Medical doctors, pharmacists and other attendants/assistants in the medical 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 often than not promotes information quality and subsequently foster effective information management. OVER-RELIANCE ON PAPER DOCUMENTATION The over-reliance on paper documentation at the hospital under scrutiny should be considered a nip in the bud. Instead, the effective utilization of state-of-the-art mode of storing data or information is given the requisite precedence as well as the usage 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 DISPARATE INFORMATION SYSTEMS The number of disparate information systems in some departments/units at the hospital should also be reduced
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drastically to the barest minimum thereby boosting information or data in the hospital.

REVITALIZATION OF THE LEGACY SYSTEM Candidly and categorically speaking, the legacy system that thrives in some departments or units such as the OPD, X-Ray, Dispensary, Archival, Administration, Finance etc need to be upgraded or replaced with modern and sophisticated medical paraphernalias, facilities, equipments which as it stands now will irrevocably accelerate the rate at which information is effectively managed and harnessed across most of the units at the health care service centre in contention. IINTRODUCTION OF DATA WARE HOUSE OR RESERVOIR In dealing with the enigma or debilitating information situation at the OPD or Reception Centre and other units/departments at the hospital, the ushering and the introduction of data ware house or reservoir to take care of patients information or data will be a more likely option to foster effective information management at the health post as this initiative will beyond reasonable doubt boost the transmission of data from one part of the hospital to the other. The deployment of data ware house will make it easy to work with the quality of information and analysis across the hospitals processes, which can be extremely difficult to do in the transactional system. A data ware house typically 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 and linked to the health care centres local network to ensure that the doctor fully scrutinizes the patient for a tentative diagnosis to be arrived at in order to come up with the appropriate remedy for the sufferer through the use of the patient electronic file or folder. 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 other units 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 significant extent. Once a well equipped data ware or reservoir is instituted as well as strict adherence to the issues discussed earlier, the flow of 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 active involvement of medical attendants throughout the hospital. For instance, medical attendants must endeavor to save all key files
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and folders into the document/records management system. In this scenario, the challenge is to gain sufficient adoption to ensure that the required information of a patient is recorded in the existing system. Without a critical mass of usage, corporate repositories will not contain enough information deemed to be beneficial or useful. It is indeed imperative and quite laudable that the systems such as the introduction of data base facility in all the units that are deployed 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 is done paper (hard copy) which presupposes that a sizable room should be deemed fit to harbor and contain all these voluminous files and folders of patients. The mind-boggling and intriguing question that will be posed to the Health Care Service Administrator is how these large quantities of files/folders will be kept for a lengthy number of days without falling prey/victim to rodents, insect attack or damage as well as the vagaries of the weather (erratic and unpredictable weather patterns prevailing in the country). Effective and strong information management carried out in support of coordinated processes will undoubtedly ensure that relevant actors (medical practitioners, laboratory technicians and
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assistants/attendants) are working with the same or complementary relevant, accurate and timely information and baseline 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. Properly analyzing the information gathered can help hospitals and clinics 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 involves continual communication between medical experts and their subordinates, and periodic reviews of the implementation process 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 and foster optimum performance and profitability in the long run. Of course, much more can be written on how to ensure effective information management as a health care service administrator at the Ridge Hospital. Nevertheless, I am of the opinion that future research work carried out will explore, exploit and dichotomize this topic which will undoubtedly provide additional impetus, guidance, insight and also outline concrete strategies and mechanisms that can be resorted 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) Information Management in Health Care, Handbook A-Introductory Themes. Trowbridge: Redwood Books

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

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

Bowns, I., Rotherham, G. & Paisley, S. (1999) Factors associated with success in the implementation of information management and technology in the NHS. Health Informatics Journal, 5, pp 136-145. 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 Health Information Systems, Geneva, World Health Organization.

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

UNHCR, (2007) Handbook for Emergencies. www.reliefweb.int/rw/lib.nsf/db 900SID/AMMF-75TFLQ? Open Document www.ahima.org

www.connectingforhealth.nhs.uk

www.ehealth-era.org/database.html

www.health.nsw.gov.au

www.health.qld.gov.au

www.info@promotesolutions.se

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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 in Health Information Management. Chicago: AHIMA; 2007. Available at www.ahima.org

Galliers, B. & Swan, J. (1999) Information Systems and Strategic Change: A Critical Review of Business Process Reengineering, in: Currie W.L & Galliers B. (Eds). Rethinking Management Information Systems: An Interdisciplinary Perspective, pp 361387. Oxford University Press.

Kimaro, H, & Nhampossa, J. (2005) Analyzing the Problem of Unsustainable Health Information Systems in Less-Developed Economies: 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: A Critical Appraisal, Methods, Inf. Med, 4, pp 428-432 (http: www.idi.ntnu.no/~ericm/37 Monteiro. Pdf.

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