LIST OF FIGURES AND TABLES
THE PROBLEM AND ITS SCOPE
1.1 Background of the study
1.2 Statement of the problem
1.3 Purpose of the study
1.4 Research objectives
1.5 Research questions
1.7 Scope of the Study
1.8 Significance of the study
1.9 Operational definitions
2.1 Requirements analysis
2.2 System design techniques
2.3 The Role of Physicians and Barriers to Use
2.4 Benefits of the Clinical Information Systems
3.1 Research Design
3.2 Study population
3.3 Target Sample
3.3.1 Sampling procedure
3.4 Data collection tools
3.5 Scoring of the scale
3.6 Validity and reliability of the instrument
3.7 Data Gathering Procedures
3.8 Data Analysis
3.8 Ethical Considerations
3.9 Limitations of the study
LIST OF FIGURES AND TABLES
Figure 3.1: showing the distribution of hospitals in Uganda
Figure 3.2: showing Yamane’s formula for calculating target
Table 3.1: The table below shows Health workers at national level
Table 3.2: Table showing the estimated total population stratified
Clinical information systems offer the possibility to improve healthcare quality by providing clinical task support and clinical decision support by influencing clinical decisions at the time and place that these decisions are made. Unfortunately hospitals in Uganda have for long neglected their use despite mounting pressure from medical workers seeking pay rise which has left most government hospitals understaffed. As a result, patients are not attended to on time and medical trainees who assist in most hospitals sometimes lack the desired skills and do not get adequate guidance from experienced health workers to enable them make more informed decisions. The purpose of this study is to evaluate the use of CIS in improving the quality of health care by providing clinical task support to medical workers. Data will be collected from mainly health workers working regional referral hospitals in Uganda whose populace is estimated to be 9000 and 383 will be sampled and given questionnaires. Depending on the outcome from the study, recommendations will be made on whether the government of Uganda should adopt clinical information systems in Uganda.
THE PROBLEM AND ITS SCOPE
1.1 Background of the study
The health care market is the largest industry in the United States, with expenditures of about $2.6 trillion, or 15.9% of the national GDP in 2010. The rapid increase in health care expenditures, technology has developed to provide support to health care delivery staff. The primary care delivery entity is the physician or the specialist. Throughout the evolution of medical technology, the development of an efficient, useful, and practical clinical information system has become a significant focus in the vendor market. However, the resistance to the implementation of helpful technology that is common within the health care market has limited the maximization of the potential of clinical information systems. Through the satisfaction of aggregate physician needs in conjunction with the needs of health care managers, the implementation of a clinical information system can be advantageous to the health care delivery process.
The school dictionary defines a decision as settlement or conclusion reached based on certain data. According to George, Robert, Brent & Eugene (2001), DSSs are used in the identification of problems or decision making opportunities (similar to exception reporting), identification of possible solutions or decisions, provision of access to information needed to solve a problem or make a decision, analysis of possible decisions or of variances that will affect a decision. Sometimes this is called “what if…..” analysis, and Simulation of possible solutions. Shortliffe, Scott, Bischoff, Campbell &Melle (1981), a CDSS refers to any computer programme that helps health professionals to make clinical decisions. Their definition has a disadvantage that it includes any computer system presenting medical knowledge, including the World Wide Web or electronic textbooks. A better definition should take into account the application to patient care and the intent of the CDSS to give case-specific advice. Thus, A clinical information system is a collection of various information technology applications that provides a centralized repository of information related to patient care across distributed locations. This repository represents the patient's history of illnesses and interactions with providers by encoding knowledge capable of helping clinicians decide about the patient's condition, treatment options, and wellness activities. The repository also encodes the status of decisions, actions underway for those decisions, and relevant information that can help in performing those actions. The database could also hold other information about the patient, including genetic, environmental, and social contexts.
According to Gluud & Nikolova (2007), in the early 1970s the first computerized general practice system was produced in the United States, which resulted in a standard computer-generated prescription form. By 1989, a proportion of general practice information technology (IT) investment became directly remunerable and computer use became widespread.
Kawamoto, Caitlin, Houlihan, Andrew, David & Lobach (2005), define a CDSS as, an application that analyzes data to help healthcare providers make clinical decisions. It is an adaptation of the decision support system commonly used to support business management. Physicians, nurses and other health care professionals use a CDSS to prepare a diagnosis and to review the diagnosis as a means of improving the final result. Data mining may be conducted to examine the patient’s medical history in conjunction with relevant clinical research. Such analysis can help predict potential events, which can range from drug interactions to disease symptoms. They provide clinicians, staff, patients, and other individuals with knowledge and patient specific information, intelligently filtered and presented at appropriate times, to enhance health services. Since 2004, when the Federal Government promoted the importance of electronic medical records there has been a slow but increasing adoption of HIT, to improve the quality of health services. World over, and specifically in the US, Europe, Asia and to a small extent in Africa, HIT is being regarded the cheapest way of boosting human resource especially in the health industry. Germany was the first country to start developing a national HIT network in 1993. In 1997, Canada established the Advisory Council on Health Infrastructure and in 2001 launched Canada Health Infoway, a nonprofit organization. By the end of 2009, Canada Health Infoway had half its population using the EHRs.
In south Africa and Libya, CDSS are a point-of-order decision aids, usually through computer order entry systems, that provide real-time feedback to health on which medical workers base to make diagnosis or even to give treatment to patients. In the journal of the American medical association (JAMA), it was published that most hospitals faced pressure cuts in government payments and demand for lower hospital fees and shorter hospital stays. Many have responded by reducing staff or employing few staff and merging with other institutions. Some teaching hospitals especially in the United States have taken these steps, but their problems are compounded by the extra obligations that they have long assumed such as training new physicians and other health care personnel, conducting medical research, and providing free care for the poor. Teaching hospitals shape the future of medicine by providing most of the clinical research in new procedures, technology, treatments, and medications and thus to fully achieve their obligations, there is need to provide enough assistance to both medical trainees and patients. And due to cost pressure, this has seen the introduction of systems like the internist which guide and may act as a virtual trainer to inexperienced medics.
Uganda is a landlocked country located in East Africa, just north of Lake Victoria, astride the equator. The country has a total area of 241,038 square kilometers of which 43 942 square kilometers are swamps and 197 096 square kilometres is land. The figures of 2002 Population and Housing Census indicate that Uganda’s population grew at an average rate of 3.4% per annum between 1991 and 2002. From the National Census Report, Uganda has a projected population of 27.7 million people, and fertility rate of 6.9%. Infant Mortality Rate (IMR) stands at 88 per 1,000 live births while Maternal
Mortality Rate (MMR) is 506 per 100 000 births. The country is divided into 80 districts which are decentralized. Broadly these districts are divided into rural and urban districts.
According to Joseph ,Cissy, Mbasaalaki-Mwaka & Grace (2010), in their study on challenges faced by health workers in providing counseling services to HIV-positive children in Uganda, it was discovered that some of the challenges faced by hospitals include; limited staff leading to heavy workloads; shortage of testing kits and other logistics; lack of, or inadequate protection against occupational hazards like pricking and infections like tuberculosis; lack of comprehensive HIV/AIDS counseling; and lack of sensitization at health facilities prior sending patients to laboratories. For example; Mulago hospital which is a national hospital suffers from lack of enough personnel and so clients often queue for hours. Literary meaning if patients who really need immediate attention and cannot help themselves queue for hours, there is a high possibility of students not getting attention at all. They also found out that, a quarter of the health workers (14 of 59; 24%) were constrained by inadequate knowledge about pediatric HIV care and the lack of pediatric counseling skills. One health worker said “Some of us have never trained or even been trained in counseling.” Many times, it happens that the people we expect to know do not know. This shows that students in teaching hospitals are not only faced by lack of teachers/instructors but they also lack instructors with adequate knowledge and experience.
According to the former minister of Health, Mike (2010), KIU teaching hospital has the highest number of patient beds in Uganda with 1,200; while Mulago Hospital, a national referral hospital has 1,000 and Butabika has 906. Despite the big number of beds at KIU-TH, it was discovered in a pilot study carried out in October of 2011 that the lecturer to student ratio had grown to 1:23 in the departments of health sciences contrary to the world wide accepted ratio of 1:8. Many other hospitals including Mulago that was built to support 906 patients currently support more than 10,000 patients. It is on this ground that a study should be undertaken to evaluate the effects of CIS on the performance of health workers and thereafter draw recommendations on whether CISs should be adopted in Ugandan hospitals.
1.2 Statement of the problem
Clinical information systems offer the possibility to improve healthcare quality by providing clinical task support and clinical decision support by influencing clinical decisions at the time and place that these decisions are made. Unfortunately hospitals in Uganda have for long neglected their use despite mounting pressure from medical workers seeking pay rise which has left most government hospitals understaffed. As a result, patients are not attended to on time and medical trainees who assist in most hospitals sometimes lack the desired skills and do not get adequate guidance from experienced health workers to enable them make more informed decisions. Lack of enough practical skills manifests itself when they fail to correlate signs and symptoms with diseases that cause them. Inadequate staff at Mulago hospital and other hospitals both government and private has significantly contributed to the poor services in hospitals. At KIU, students went on strike over the same issue of inadequate staff to guide them (Wilber, 2010) , at Amana hospital, a child died as the parents waited in the line for treatment (Richard,2006), similar cases are happening in many other small and big hospitals in Uganda and beyond unnoticed. It is common to find hospitals using more of trainees (who in most cases have partial ideas on treatment) than experienced health workers which puts patients’ lives at risk. As a remedy, patients and students alike prefer consulting with experienced doctors who in most cases are not readily available. The time lag created delays patients, students and medical practitioners creating inefficiency in all hospital operations and on several occasions has resulted in loss of lives (Richard, thur Apr 13, 2006) in the IPP newspaper. It is because of the above that clinical information systems should be adopted to supplement the services of medical experts by providing medical trainees with fast access to knowledge acquired from various medical experts at the time and place of diagnosis so as to improve the quality of health care.
1.3 Purpose of the study
The purpose of this study is to evaluate the use of CIS in improving the quality of health care by providing clinical task support to medical workers.