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ICT and National Health Insurance; Challenges and Impact on Performance of Nurses and Mid-wives
6/05/ 2014


Rita Wurapa, Public Health Nurse doing her presentation  

The ICT and Health forum is a knowledge sharing forum organised by GINKS with support from IICD to educate students of 37 Military Hospital Nurses Training College on the challenges affecting ICT and National Health Insurance in Ghana.

The resource person, Madam Rita Wurapa, a practicing Public Health Nurse at the Afajato South Health Directorate in the Volta and also Masters Student at the School of Public Health of the University of Ghana said the main role of nurses and mid-wives is observation, reflection, analysis, evaluation and planning of cure.

This she said can be done through studying facial expressions of patients to be analyzed and evaluated to help plan appropriate care for the patient.


Rita mentioned that all these activities point to good documentation but with ICT it is easy to do compared with the old paper based documentation. She added that ICT has really come to stay and it is being used across all sectors of life. Information technology has revolutionized everyday life from the way we manage our finances to how we watch movies. Technology advancement is changing the way we address health of our communities thereby making big impact and changing how healthcare is being addressed.


Rita stressed that as an up-and-coming nurses and mid-wives, she encouraged all to embrace the use of ICT in healthcare delivery. She observed that documentation becomes even more challenging when Doctors scribble prescriptions on paper which is difficult to read but with the use of ICT it is easy.


Participants at the health forum

Information technology has revolutionized everyday life from the way we manage our finances to how we watch movies. Technology advancement is changing the way we address health of our communities thereby making big impact and changing how healthcare is being addressed.

Rita stressed that as an up-and-coming nurses and mid-wives, she encouraged all to embrace the use of ICT in healthcare delivery. She observed that documentation becomes even more challenging when Doctors scribble prescriptions on paper which is difficult to read but with the use of ICT it is easy.


Problems with Paper Records

  1. Handwritten notes and typed reports
  2. Stored in a paper file system
  3. Cryptic abbreviations
  4. Difficult to search
  5. Difficult to share with other facilities

Current Situation (Documentation)


Workflow in a medical office using paper charts.

Manual documentation by far is not transferable and searching for patients' medical file can be a tedious task and take time to be able to locate a particular file but with ICT it is easy. Appointments can be done through phone or using email communication to maximize time as well as hand held devices e.g. mobile phone, tablets can be used for transferring information which is vital in health care delivery.  If files are well documented through the computer, it is safer and in case of disaster, information can be retrieved from emails or cloud online.

Structure of Paper Record Workflow

  1. Appointment scheduled by phone, No appointment in most cases
  2. Folder/Chart pulled from filing system
  3. Insurance confirmed and paperwork completed
  4. Vitals noted
  5. Assessment by clinician
  6. Prescription written
  7. Lab samples obtained
  8. Follow-up scheduled
  9. Exam notes transcribed
  10. Diagnostics received
  11. Chart re-filed

As much as ICT is very important in health care delivery, it has some challenges especially in rural areas. In these areas, there is less network coverage making connectivity with other health facilities very difficult. Most health workers in the rural areas also lack ICT skills and may not be able to operate computers if they should have them.

Paper Workflow Points

  1. All information documented during patient visit entered by hand
  2. Records accessible to one person at a time
  3. Records must be physically “handed off” from one person to the next

Fragmented and Disconnected Care*

  1. Multiple Records
  2. Incomplete Information for Providers
  3. Unavailable data in 81% cases.
  4. 4 missing elements per case.
  5. Unwired System

*Blackford Middleton, MD, MPH, MSc   - Chairman, Center for IT Leadership - Harvard


Section of participants at seated at the forum listening attentively

Ultimately, the vision of government in instituting a health insurance scheme in the country is to assure equitable and universal access for all residents of Ghana to an acceptable quality package of essential healthcare. Every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against the need to pay out of pocket at the point of service use in order to obtain access to a defined package of acceptable quality of health service.
The National Health Insurance Scheme(NHIS) has come for all of us to get equal quality healthcare in Ghana but is the NHI performing the exact task. There are constraints mainly with the ICT system.

  1. NHIS is useful in accessing  health care
  2. Slowness of the system
  3. Large numbers of subscribers and low numbers of scheme staff

"National Health has come to stay, it is therefore our duties as nurses and mid-wives to ensure that scheme managers pay for insurance on time" Rita

National health infrastructure  is therefore needed to;

  • Provide immediate access to complete patient information and decision support tools for clinicians and their patients
  • Capture patient safety information as a by-product of care and use of this information to design even safer delivery systems

Health Information Technology
HIT is the use of information and communication technology in health care and includes;

- Electronic Health Records (HER)
- Personal Health Records (PHR)
- E-mail communication
- Clinical alerts and reminders
- Hand held devices
- Other technologies that transfer clinical, administrative and financial information within health care settings


Benefits of HIT includes, better information means safer care, faster, more accurate prescriptions, E prescribing systems automatically send orders to pharmacy, reduces error in medical care, improves quality, efficiency, ccost benefits, patient centred care, secure access to information. In the event of natural disasters your health information can be transferred and accessed electronically.

The major functions of IT System are;

  1. C-Clinical care, communication
  2. A-Administration
  3. R-Research
  4. E-Education, Evaluation

Challenge for Nurses and Mid-wives

There is work overload for health workers.

-Service abuse by the insured

-Data-driven system shift focus from main work


With National Health Insurance, when a form is submitted, a nurse must fill the form which consumes time. Every nurse needs in-service training to build capacity. These are static because of delay in disbursement of funds to pay casual workers, procurement of consumables and non-consumables, motivation for Nurses, improving standards of health facility, inability to implement planned program on time.

Nurses and mid-wives are technologically challenged as they are not familiar with the use of ICT tools which means the computers can be available but nurses are afraid to use them. They are also resistance to change.

Challenges specific to Rural

  1. Access to information on various health IT vendors
  2. Suitability of vendors products for rural settings
  3. Interoperability requirements
  4. Connectivity issues
  5. Difficulty in collaborating and forming partnerships in rural settings
  6. Workforce

Quotes
Newt Gingrich: “Paper kills!”
Hilary Clinton: “Using a 20th-century health care system to deal with 21st-century problems is nowhere more true than in the failure to use information technology.”
Bill Frist: “Information is the most cross-cutting force in health care to bring about bold transformation”

Summary/Conclusion

  • Science is dynamic
  • Change is inevitable
  • Nursing is evolving
  • Health insurance has come to stay in-spite of challenges
  • Need to build capacity to fit into current trend


 


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