TABLE OF CONTENTS

TITLE PAGE i

CERTIFICATION ii

DEDICATION iii

ACKNOWLEDGMENT iv

ABSTRACT v

TABLE OF CONTENTS vi

1.1 Background to the study 1

1.2 Statement of the problem 3

1.3 Objectives of the study 4

1.4 Research questions 4

1.5 Research Hypothesis 4

1.6 Justification for the Study 4

1.7 Significance of the study 5

1.8 Operational Definition of Terms 5

LITERATURE REVIEWED

2.1 Introduction 6

2.2 Theoretical Framework 19

2.3 Empirical Review 21

2.4 Appraisal of the Literature Reviewed 23

METHODOLOGY
3.1 Research Design 25

3.2 Population of the study 25

3.3 Sample and Sampling Technique 25

3.4 Research Instrument 25

3.5 Validation of the Research Instrument 25

3.6 Procedure for Data Collection 26

3.7 Data Analysis Techniques 26

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

4.1 Introduction 27
4.2 Questionnaire Administration and Response Rate 27
4.3 Demographic Variable of the Respondents 27
4.4 Answers to Research Questions 28

4.5 Test of Hypothesis 30

4.6 Discussion of finding 30

CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Introduction 31
5.1 Summary 31

5.2 Conclusion 32

5.3 Recommendation 32

5.5 Suggestions for further research 33

References 34
 CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Information and Communication Technology (ICT) is growing rapidly in Nigeria and has
had a great effect on businesses and individuals. We can easily say ICT has not penetrated
everywhere in the society which is understandable due to many reasons. Without any doubt
Internet is the fastest growing communication technology today. Nigeria health sector has being
disintegrating for years and have suffered due to negligence. One can easily say keeping records
of an institution like the health sector is very important and crucial to the development of the
sector as well as the patients. The standardized electronic health record (EHR) is rapidly
replacing paper documentation of health care activities in hospitals.

The use of electronic health records (EHR) in the health care industry especially
secondary health care tier is becoming the standard. A growing number of health care
organisations are introducing and utilizing electronic systems to store patients’ information (De
Veer and Francke, 2010). Thus facilitating communication between health information
professional and other care providers and between health information professional and patients
(Gusen, et,al., 2016). The electronic health record (EHR) is rapidly replacing paper
documentation of health care activities in hospitals across the world (Estes, Johnson and
Harrahill 2010) and its adoption is a major reform component and cost saving tool. The intent of
initiating computerized documentation systems is to improve efficiency, safety and quality of
patient care (Jha et al., 2009).

An electronic health record (EHR) is described as a repository that electronically

maintains an individual’s health information and health care for their lifetime and stores the
information in a manner that it can serve multiple legitimate users of the record (Gusen, et,al.,
2016). Electronic Health Record (EHR) is considered as the backbone integrating various
information tools (e.g. computerized physician order entry, clinical decision-support, clinical
documentation, digital imagery, patient portals, telemedicine) (Adeleke, Lawal, Adio and
Adebisi, 2014). Benefits of EHRs have been well documented in the literature (e.g. optimizing
the documentation of patient encounters, improving the availability and timeliness of
information, reduction of errors) (Adeleke et al., 2015). However, in secondary healthcare, an
EHR has a specific importance. It improves the management of chronic diseases, facilitates
continuity of care, enables reporting of population health, improves preventive care, and allows
for the development of patient portals (e.g. personal health records) and adaptive awareness
programs for patients. Therefore, implementing EHRs in secondary healthcare has the potential
to improve the population health, and to enhance the overall healthcare system of the country.

Nigeria is witnessing continuing advocacy and increase in number of individuals

yearning for computerisation of health information and healthcare processes. On the other hand,
the Government is evolving plans and strategies for the adoption and implementation of health
information technology (Adeleke, et al. 2015). To improve the use of ICT in healthcare
delivery in the country, the Nigerian Government developed a 5-year Strategic plan on health
with health information system taking a strategic position. The goal is to provide an effective
National Health Management Information System (NHMIS) by all the governments of the
Federation to be used as a management tool for informed decision making at all levels and for
improved healthcare (Adeleke, et al. 2015). In furtherance of her efforts to achieve the plan, the
Government recognized the need to have a harmonized health information management through
Health Information Technology (HIT). It was on this premise that the first National Conference
on HIT was organized by the Federal Ministry of Health (FMoH) between November 2 and 4,
2011. The focus of the conference was to have one harmonised health data management system
and the specific objectives were to compile a list of health information system applications in use
in the country, to review the interoperability of the existing systems, to review the Health
Information Technology components of the country’s e-health strategies and to propose
strategies for the establishments of interoperability standards and capacity building.

Subsequently, the National Council on Health in August 2013 approved the deployment
of EHRs in all thirty six states of the federation, including the Federal Capital Territory
(Adeleke, et al. 2015). Furthermore, in pursuance of plans to ensure Universal Health Coverage
for all citizens by the year 2020 through leverage on the vast potentials of ICT, the FMoH
through her National Health ICT Strategic Framework 2015-2020 intends to scale-up ICT
infrastructure in all health facilities across the country to ensure they are in step with Health ICT
and health system priorities (FMoH 2016).

Since documentation plays a major role in delivering health care, and despite the many
benefits of EHR implementation, its results will not be effective unless it is associated with
acceptance from health information manager using the technology. Acceptability of electronic
health records, even in developed countries with very sophisticated health-care systems, has been
uneven. Laramee, et al., (2012) compared inpatient nurses’ attitudes at three different time
periods: before EHR implementation, 6 months after implementation, and 18 months after
implementation. The authors found that preimplementation attitudes were positive, while at 6
months, the attitudes were less positive but became more positive again by 18 months.
Preimplementation, nurses were excited because they had high expectations that the EHR would
make their jobs easier and save time. At 6 months, the nurses went through a period of
frustration due to the gap between their expectations for the EHR and the reality of the actual
experience. By 18 months, the nurses had a longer time to accept the EHR and better appreciated
its advantages and disadvantages.

Ammenwerth, et al. (2003) found similar results after comparing attitudes of nurses
before implementation of the EHR, and at 3 and 9 months after implementation. Kritsonis
(2004–2005) suggested, according to Lewin’s theory, that when nurses had a sufficient amount
of time to learn the EHR, they would eventually accept it. This is exactly what happened in both
Laramee’s and Ammenwerth’s studies. In order for EHR usage to be effective, health
information manager must be aware of all the advantages that come with it to increase their
willingness to use it.

1.2 Statement of the Problem

The introduction of ICT-based initiatives to transform existing paper-based information in

second tier hospitals?
It has been found that attitude of health information manager varies in the acceptability of
electronic health records in most secondary tier hospitals in Nigeria. It is against this background
that this study wants to evaluate the availability and the use of electronic health records in
secondary tier health facilities, a case study of general hospital Ilorin Ilorin, Kwara State.

1.3 Objective of the Study

The main objective of the study is to evaluate the availability and the use of electronic health
records in secondary tier health facilities using General Hospital Ilorin, Ilorin, Kwara State as a
case study. The specific objectives are to:

ascertain knowledge of the EHR system that health information management professionals in a
Nigerian secondary healthcare facility have

To evaluate attitude of health information management professionals on electronic health records

in General Hospital Ilorin, Ilorin, Kwara State.

To assess utilization of electronic health records among health information management

professional in General Hospital Ilorin, Ilorin, Kwara State.

1.4 Research Questions.

How much knowledge of the EHR system do the healthcare professionals in a Nigerian
secondary healthcare facility have?

What are the attitudes of health information management professionals on electronic health
records in General Hospital Ilorin, Ilorin, Kwara State.

How do information management professional in General Hospital Ilorin, Ilorin, Kwara State
utilize electronic health records

1.5 Research Hypothesis

H01 There is no significant relationship between information professional attitude and

utilization of electronic health records General Hospital Ilorin, Ilorin, Kwara State.

1.6 Justification for the Study

 The main reason for the study is from the fact that despite the opportunities inherent in
the use of electronic health records (EHR), several government hospitals in Nigeria are yet to
adopt the system. A previous study indicated that providers and stakeholders of the Nigerian
healthcare system are quite abreast of the benefits of the EHR and are willing to embrace the
technology in their workflow. These healthcare providers exhibited readiness to adopt the
technology and the government as well is positively disposed to the nationwide implementations
of the technology (Adeleke, et al. 2015). General Hospitals was chosen because they are located
mostly in the sub-urban areas of Nigeria often fraught with infrastructural and manpower. This
study will evaluate knowledge, attitude and acceptability of electronic health records among
health information management professional in General Hospital Ilorin, Ilorin, Kwara State.

1.7 Significance of the Study

The study can guide system developers and healthcare managers in the design and
implementation of EHR systems that are sustainable vis-a-vis the peculiarities of Nigerian
Secondary Healthcare facilities, most of which are in sub-urban towns in Nigeria often plagued
by various infrastructural challenges like inadequate power supply, inadequate qualified
medical personnel, poor road network and poor internet access among other things.
As efforts are currently underway by the FMoH to scale-up ICT infrastructure in all health
facilities, findings from this study may be valuable for policy formulation and implementation
of electronic health records. It will also contribute to existing knowledge on issues associated
with deployment and implementation of electronic health records in developing countries.

1.8 DEFINITION OF TERM

KNOWLEDGE: the fact or condition of having information or of being learned

ATTITUDE: a feeling or emotion toward a fact or state.

ACCEPTABILITY: the quality of being accepted

ELECTRONIC HEALTH RECORDS : is the systematized collection of patient and
population electronically stored health information in a digital format