IMPLEMENTING EHR IN NIGERIA:

POTENTIAL CHALLENGES AND BENEFITS

Hameed M.A, Oni E.K, Ateko B.C. and Babafemi O.F.
Department of Computer Science,
The Federal Polytechnic Ede,
PMB 231, Ede, Nigeria

rhameed2001@yahoo.com, tunbestoluwakemi@gmail.com, ayclara16@gmail.com, olusolababafemi100@gmail.com

Abstract
Nigeria as a developing economy is slow in adopting new technologies, especially in her health services delivery
systems. This research work explores the health service delivery system in the country, the collection of data
and its management and x-rays the challenges inherent in the system using an interpretative case study approach
on the primarily captured such as care plans, NHIS claims information. patients‘ demographics, laboratory
results and billing. It proposes the implementation of an ICT based system -Electronic Medical Record (EMR)
system as a panacea to mitigating these challenges and enhance better resource allocation. The data an EHR
could primarily capture would be patients‘ demographics, care plans, laboratory results, billing and NHIS claims
information.

Keywords: NHIS, Information EMR, Infrastructure, patients

1.0 Introduction
The role which a healthy population plays in the sustainability and the rapid development of a nation and her
socio-economic activities can never be over emphasized. The indisputability of this fact in Nigeria
notwithstanding, the country, like most of her peers in Africa have made the provision of effective, affordable
and accessible healthcare to be a terrifying experience (Adams and Nelson. 2019)

Hannan and Rotich (2000) posited that the rapid need progression experienced in the healthcare sector most
especially during pandemic presents a major challenge for the African health sector because the usual capacity
for the healthcare service system is often overstretched thus forcing governments and the healthcare
professionals to be on their toes and struggle to discharge their duties optimally. They concluded that a viable
strategy to reduce and mitigate these challenges is the implementation of telemedicine and this is where
Information and Communication Technology (ICT) comes in.

The introduction and use of computers and ICT in medical service delivery are fast becoming a new normal in
Nigeria. Most findings revealed that there is no serious deployment of Telemedical applications in most
Nigerian hospitals except for the social media computing based medical service delivery, phone call amongst
medical practitioners (Osei 2000).

This research work explores the pre-cursors for the successful establishment and implementation of Electronic
Medical Records systems in Nigeria. It focuses mainly on the study of workflows in the laboratory and records
departments in the University Teaching Hospital Ibadan Nigeria. It has always been a herculean task to collect
and manage data in hospitals

Akor O, Jimoh A, John-Mensah O, Ramoni R, and Oke J. 2020) observed that most of the records are paper-
based, with only a small percentage of the record stored in a computer system for processing, reuse and for
onward transmission to other agencies that interoperate with the data and health directorates amongst which are
NHIS.HMOs etc

Electronic Medical Records Systems has so many benefits when put into use. Some of the benefits are time-
saving. cost savings, enhanced and better data management, qualitative service delivery (Agba, A., Ogaboh, M.,
Ushie, E.M. and Osuchukwu C. 2010).

Given the above, it is worrisome to note that with these overt and covert advantages and benefits of Electronic
Medical Record System coupled with its ability to solve most of the data management problems experienced in
most hospitals in Nigeria, one begins to wonder and puzzled why no effort is consciously being made to
implement Electronic Medical Record.

Probable clogs that could hinder the implementation of the Electronic Medical Record system in Nigerian
hospitals could be traceable to organizational restructuring, adaptability of the users and funding(Ashish, David,
Daniel, Tim,,and David. 2018) one can conveniently say that interactions with some actors revealed that a
greater part of the interactor’s time in the hospitals is spent in the outpatient departments and laboratories
waiting for reports and a lot of time is used to carry out clerical duties.
.
Suffice to say that not much literature abounds regarding the implementation of Electronic Medical Records
Systems in Nigeria but a lot of work has been done on Electronic Medical Record systems in advanced
economies of the world Nir and Robert 2019). The laboratories and other units could benefit tremendously from
electronic record keeping.

PROBLEM STATEMENT
Information that aids evidenced-based and prompt decision oh health matters will be of little value if it is not
made available in a form that is perceived to meet the needs of multiple users in the health care industry. A
cursory look at the underpinnings of the existing health delivery systems in Nigeria reveals that it is
characterised by lack of communications and access to health information that meets the demands of 21st
century health care delivery system.

The time it takes to contact and refer critical issues to the most appropriate hospital is unduly long and this is
attributable to administrative bottlenecks.

The problem of integrating the new systems with the other disparate systems as being witnessed by most of the
existing electronic medical record systems is also an issue of concern. It is expected that the adoption and
implementation of telemedicine would enable health decisions that are evidence-based on matters relating to the
health service delivery system and health policy-makers in the allocation of resources optimally.

It will also help in Nigeria because of the following:

Non-availability of health information has hindered the generation of up to date information on diseases thus
making it difficult to carry out continuous monitoring especially for diseases that are epidemic in nature..

Non-implementation of a Personal Identification Number system that issues unique identifiers to outpatients in
the Nigeria hospitals that will be used throughout the care process

The problem of missing laboratory reports is also an issue of concern. All these would be a thing of the past if
the Electronic Medical Record System is put in place.

Research Questions
This research sought to find answers to the following questions:
What is the present state of data capturing and infrastructural development in Nigerian hospitals?

How can the implementation of Electronic Medical Record Systems improve the situation?

What likely challenges can the users face in the Health service delivery system of Nigeria with the introduction
of Electronic Medical Record Systems.

1.3 Research Approaches Employed

To address the above research questions, interpretative case study, documentary analysis and interviews were
employed. The study included a two-week field study at two hospitals in Nigeria. Detailed descriptive analysis
of the methods employed in carrying out the research is presented hereunder.

3.0 Methodology
The researcher employs a combination of interviews, observations and interpretative case studies to elicit data at
some hospitals in Nigeria. The study included a two week field study at both the Federal Polytechnic Ede
Clinics, Ede Nigeria and The University Teaching Hospital Ibadan, Nigeria respectively. Relevant publications
about health care delivery in Nigeria were also studied based on their level of importance to the study.
3.1 Observation

Observation is fundamental to understanding another culture(Silverman, 2005). The researcher observed the
participants, the interaction between them, their routines, interpretations, temporal elements, and social
organization. This was informed by the suggestion of Denzin (1989) as to what to observe in a field study.

3.2 Interviews

Most of the interviews were semi-structured and the questions were open-ended. The researcher also used
informal talk to clarify issues that require clarification. The researcher conducted a total of ten interviews; three
over the phone and seven face to face. Six of the interviewees were males and the remaining were females. The
oldest was 45years of age and the youngest was around 25 years of age. All the interviews were recorded using
the traditional note-taking system.

The conducted interview and the time it took me to conduct it was stated hereunder.

Table 4.3 Interviews and durations Interviewee

Department Interaction Duration
Laboratory technologist 1 Laboratory 25 minutes
Laboratory technologist 2 Laboratory 10 minutes
Laboratory technologist 3 Laboratory 17 minutes
Laboratory technologist 4 Laboratory 45 minutes
Laboratory technologist 5 Laboratory 22 minutes
Statistician 1 Records 9 minutes
Statistician 2 Records 28 minutes
Statistician 3 Records 12 minutes
Statistician 4 Records 39 minutes
Administrator 1 Administration 55 minutes

4.0 Findings
Nigeria, a third world economy in sub-Sahara Africa is working assiduously to cater for the medical service
need of her teeming population. The country has been spending about 13.5% of its GDP over the last seven
years in the development of infrastructure and human resources in the health service (WHO 2017), there are still
infrastructure and human resources deficits in many parts of the country, especially in the northern part of the
country.

We have had reported cases of significant progress in some institutions amongst which are; The Nigerian
Medical schools, Nigerian Nursing schools and some universities established for the development and training
of medical professionals. Concerted efforts have also been made to reduce brain drains in the country by paying
them fat salaries. Provision of physical infrastructure and the training of more health service delivery
professionals are some of the efforts made to provide accessible and affordable medical services

The research work observed that emphasis on the development, adoption and implementation of modern
techniques and approaches to the health service delivery system is not much. It was also discovered that
expenditure on ICT in the health service sector is small and even when funds are budgeted, released and
expended on Information and Communication Technologies projects, it is usually for administrative purposes.
Data and information communication at the UCH is still at the rudimentary level, therefore most of the
interactions are physical.

There are no computerized systems that are networked for information and data interchange in the hospital.
Findings also revealed that none of the consulting rooms in the hospital is equipped with a computer system. All
the stakeholders in the delivery of medical services which include the hospital, the NHIS, The Government, the
services consumers, the HMOs and all well-meaning and philanthropic Nigerians need to do a lot of work to
strengthen the healthcare service systems in the country if the desires to address the hydra-headed challenges of
data collection, information processing and its management is the big picture.

DISCUSSION
The challenges of implementing the Electronic Health Record systems in Nigeria will require a lot to be put in
place otherwise it will be meaningless and eventually turn out to be a mirage. Reorganization, recalibration and
a lot restructuring will have to be done in order to effectively implement a meaningful Electronic Health Record
system.

90% of the hospitals in Nigeria are faced with the challenges of weak data collection and management system.
They are also faced with the challenges of interoperable and heterogeneous Information Systems that find it
difficult to do ‘hand-shaking’. These challenges pose a serious clog and can impede the implementation of a
meaningful and successful Electronic Health Record System. Human resources, procurement cost and the
sustainability of all these co-factors are issues of concern as far as the implementation of an electronic health
record system is concerned

Conclusion
It is novel to have Electronic Health Record systems in place for medical care delivery system in the country
because it will enhance the quality of health service delivery, however, the Nigerian government has not been
giving the desired attention to it. This research work is carried out in a Nigerian hospital to among other things,
x-ray the challenges of information interchange among the actors in the medical service system with a view to
implementing an Electronic Health Record system that would reduce the problem to the barest minimum.
It has been able to identify the political problem, cost, poor maintenance culture and the huge start-up costs as
being some of the challenges that militate against the implementation of Electronic Health Record Systems in
Nigeria. The foregoing notwithstanding, the research work has been able to discover that implementation of
Electronic Medical Record system would improve interdepartmental communication, reduce the waiting time it
takes to serve patients, and also provide opportunities that would make it easy to share best practices
information among the medical practitioners in Nigerian hospitals. Nigerian government need to take a cursory
look at Internet connectivity system in all the hospitals with a view to overhauling it and promote general
awareness among the medical caregivers on the need to embrace the implementation of electronic health record
systems in Nigeria

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