EFFECTIVENESS OF ELECTRONIC HEALTH RECORDS IN EFFECTIVE HEALTH

CARE DELIVERY: A CASE STUDY OF ST. MULUMBA HOSPITAL

DALMAS ABUGA

ICT-G-4-0478-17

A RESEARCH PROJECT SUBMITTED TO THE SCHOOL OF COMPUTING AND

INFORMATICS IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
AWARD OF THE DEGREE OF BACHELOR OF SCIENCE IN COMPUTER SCIENCE
OF GRETSA UNIVERSITY

MARCH 2022
DECLARATION

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 Table of Contents
DECLARATION ........................................................................................................................ ii
REVIATIONS AND ACRONYMS............................................................................................ v
OPERATIONAL DEFINITION OF TERMS ............................................................................ vi
ABSTRACT .............................................................................................................................. vii
CHAPTER ONE: INTRODUCTON ....................................................................................... 1
1.1 INTRODUCTION. ............................................................................................................ 1
1.2 BACKGROUND OF THE STUDY .................................................................................. 1
1.3 PROBLEM STATEMENT................................................................................................ 2
1.4 PURPOSE OF THE STUDY. ........................................................................................... 2
1.5 CONCEPTUAL FRAMEWORK ...................................................................................... 3
1.6 RESEARCH QUESTION ................................................................................................. 4
1.7 OBJECTIVES OF THE STUDY ...................................................................................... 4
1.7.0 General objective ............................................................................................................ 4
1.7.1 Specific objectives .......................................................................................................... 4
1.8 HYPOTHESIS OF THE STUDY...................................................................................... 5
1.9 SIGNIFICANT OF THE STUDY ..................................................................................... 5
1.10 SCOPE OF THE STUDY................................................................................................ 6
1.10 LIMITATIONS OF THE STUDY .................................................................................. 6
CHAPTER TWO: LITERATURE REVIEW ........................................................................ 7
2.1 INTRODUCTION ............................................................................................................. 7
2.2 EFFICIENCY OF THE EXISTING EHR ......................................................................... 7
2.3 EHR SYSTEMS’S INTERGRATION CAPABILITIES .................................................. 7
2.4 UTILIZATION OF EMR SYSTEMS ............................................................................... 8
2.5 THEORETHICAL FRAMEWORK .................................................................................. 8
2.6 SUMMARY OF IDENTIFIED GAPS IN THE REVIEWED LITERATURE. ............... 9
CHAPTER THREE: RESEARCH METHODOLOGY ...................................................... 10
3.1 INTRODUCTION. .......................................................................................................... 10
3.2 RESEARCH DESIGN ..................................................................................................... 10
3.3 STUDY AREA ................................................................................................................ 10

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 3.4 TARGET POPULATION ............................................................................................... 10
3.5 SAMPLING TECHNIQUES ........................................................................................... 11
3.6 SAMPLE SIZE ................................................................................................................ 11
3.7 MEASUREMENT OF VARIABLES. ............................................................................ 11
3.8 RESEARCH INSRUMENTS .......................................................................................... 12
3.9 INSRUMENT VALIDITY .............................................................................................. 13
3.10 INSRUMENT RELIABILITY ...................................................................................... 13
3.11 DATA COLLECTION TECHNIQUES ........................................................................ 13
3.12 DATA ANALYSIS ....................................................................................................... 13
4.1 INTRODUCTION. .......................................................................................................... 14
4.2 DATA PRESENTATION. .............................................................................................. 14
4.3 DISCUSSION OF FINDINGS. ....................................................................................... 16
4.3.1 EHR FUNCTIONALITY. ............................................................................................ 16
4.3.2 SECURITY. .................................................................................................................. 18
4.3.3 EHR INTERGRATION. .............................................................................................. 19
CHAPTER 5: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS. ............... 23
5.1. INTRODUCTION. ......................................................................................................... 23
5.2. SUMMERY OF THE FINDINGS. ................................................................................ 23
5.2.1. Functionality of EHR................................................................................................... 23
5.2.2. Security of EHR........................................................................................................... 23
5.2.3. EHR integration. .......................................................................................................... 24
5.3. CONCLUSION. ............................................................................................................. 24
5.4. RECOMMENDATIONS. ................................................................................................ 24
APPENDICES ....................................................................................................................... 26
Appendix 1: questionnaire. .................................................................................................... 26
Appendix 2: Budget and expenditure. ................................................................................... 30
Appendix 3: Research project schedule................................................................................. 31
REFERENCES. ......................................................................................................................... 32

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 REVIATIONS AND ACRONYMS

1. ICT: Information Communication Technology

2. EHR: Electronic Health Record

3. HIS: Health Information Systems

4. DBMS: Database Management System

5. ESG: EHR Standards and Guidelines

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OPERATIONAL DEFINITION OF TERMS
Electronic Health Record: Is a digitalized version of paper records in hospitals for storing
patients’ records and progress of patient’s treatment.

Database Management System (DBMS): is a collection of programs that enables a user to insert,
modify, retrieve data and thus make it easy to design, maintain and access databases.

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ABSTRACT
Despite electronic Health record (EHR) systems being in existence since 1972, it is only recently
that government worldwide have begun to encourage digitalization of medical records (Agency
for Healthcare Research and Quality, n.d.). With EHR systems being the current way of hospital
management and delivering healthcare in St. Mulumba hospital. There is need for a review of their
impact and to understand the challenges faced in their adaptation and use. The objective of the
study was to determine the effectiveness of EHR on healthcare delivery in St. Mulumba. A cross-
sectional qualitative study will be carried out in St. Mulumba hospital among patients and
healthcare professionals. An interview guide will used to collect data, which will coded and
analyzed using content analysis. The study will determine how EHR has led to increase in the
productivity of healthcare delivery, better clinical decision-making and better collaboration
between healthcare providers. The EHR systems in St. Mulumba have had a great impact on health
care delivery system by increasing collaboration between personnel, increased productivity of
health care providers bringing about patient and provider satisfaction. There is need to increase the
amount of funding for the utilization of the systems, to employ more ICT staff and carry out
refresher training to the staff so as to increase the benefits of the EHR systems and tackle the
shortcomings.

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CHAPTER ONE: INTRODUCTON
1.1 INTRODUCTION.
According to 2010 Second International Conference on Multimedia and Technology 1, 60-63,
2010, An Electronic Health Record is a longitudinal collection of electronic health information
about individual patients or populations, and is capable of being shared across different health care
settings, by being embedded in network-connected enterprise-wide information systems. These
electronic health records (EHRs) are been perceived as key to increasing of quality care. Today,
providers are using data from patient records to improve quality outcomes through their care
management programs. Combining multiple types of clinical data from the system's health records
has helped clinicians identify and stratify chronically ill patients. EHR can improve quality care
by using the data and analysis to prevent hospitalizations among high-risk patients. This researcher
will show us how these systems have improved health care delivery and improve their
performance. With this research, the researcher is aiming at creating awareness on the need to
implement and adopt these systems.

1.2 BACKGROUND OF THE STUDY

Electronic Health record (EHR) systems have been in existence since 1972. However, it is only
recently that governments worldwide have begun to encourage digitization of medical records. In
Kenya, the Ministries of Health (MOH), in particular, the Ministry of Medical Services and the
Ministry of Public Health and Sanitation, are actively promoting the standard implementation of
EMR systems with the aim of improving health care delivery, health systems management and
patient health outcomes. Several EHR systems exist in Kenya to collect and manage data, analyze
data, provide administrative/management support, assist in accessing patient records easily,
enhance privacy and security of patient’s data.

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1.3 PROBLEM STATEMENT

Since the adaptation of EHR systems, numerous reviews for example (Ministry of Health Kenya,
2011), have the systems not to address the minimum functional requirement categories which the
EHR Standards and Guidelines for Kenya (ESG) deem important for defining standards for EHR
systems. With EHR being the current system used in ST. Mulumba hospital, there is need to review
their functionality. Therefore, this study will be aiming at reviewing the benefits and functionality
of these systems in good health care delivery

1.4 PURPOSE OF THE STUDY.

The main purpose of this study is to clearly point out the benefits of these systems in the health
sector and look for ways to improve It because however good they may sound; they are not panacea
to all the problems that health care professionals face when trying to locate information about
patients. For example, if too many people access the records, the integrity might be compromised
and unauthorized access, which means that patent information sold to entities that can benefit from
it. This research will cover the roles of EHR systems and how to perfect their effectiveness as far
as good health care is concerned at ST. Mulumba Hospital.

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1.5 CONCEPTUAL FRAMEWORK
Below is a framework that highlights the interrelationship between the implementation of the
systems and the dependent variables; effectiveness, while the independent variable is the adoption
of EHR in hospitals.

Figure 1: Conceptual framework.

Independent variables Dependent variable

Functionality of EHR

systems

Risks associated with EHR

systems
Effective health care delivery

 Security concerns

EHR Integration with

other devices.

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1.6 RESEARCH QUESTION

1. How does the functionality of electronic health records affect the delivery of health care
delivery at St. Mulumba hospital?

2. How does security of data in the electronic health records systems affect the delivery of
effective health care at St. Mulumba hospital?

3. How does electronic health record systems integration with other devices affect the health care
delivery at St. Mulumba hospital?

1.7 OBJECTIVES OF THE STUDY

1.7.0 General objective

To determine how effective EHR are as far as good healthcare delivery is a concern at St. Mulumba
hospital.

1.7.1 Specific objectives

1. To investigate how the functionality of electronic health records affect the delivery of health
care delivery at St. Mulumba hospital.

2. To investigate how security of data in the electronic health records systems affect the delivery
of effective health care at St. Mulumba hospital.

3. To investigate how electronic health record systems integration with other devices affect the
health care delivery at St. Mulumba hospital.

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1.8 HYPOTHESIS OF THE STUDY
H0. There are more advantages of EHR systems than disadvantages in St. Mulumba hospital.
H0. There is an integration capability with devices and peripherals (swipe card reader, printer,
monitor and keyboard).
H0. The systems have been found improving the quality of patient care by enabling storage of large
amount data and facilitate quick retrieval, which in turn reduces time pressure on health workers.
H0. The EHR systems at St. Mulumba are very secure from security threats and patient data is safe
from unauthorized access.

1.9 SIGNIFICANT OF THE STUDY

The study researches on how patients and health experts benefit from the system at hand compared
to before it came to operation. The study will cover the following milestones;
a) The reliability of the existing EHR systems
b) Patient’s guarantee that their information about sickness is save.
c) Review the existing laws on medical experts who do not agree to keep patient’s data
confidential. Moreover, this will made known by the patients so that they be aware of their
rights as far as good health care is a concern.
Therefore, this study will be of benefit to:
i. Patients because they will be aware of their legal rights while in medical beds.
ii. The community who will review this research paper as they will be aware of the benefits of
EHR and stop condemning them.
iii. Database administrators (basically ICT personnel) will benefit because they will be aware of
the reliable systems to implement so as to achieve the common goal of good health care within
the facility.
iv. It will also benefit the medical experts who will learn the need to protect the patient's data to
escape the law penalties
v. The administrative personnel also will learn on how to maximize the functionality of the
system to increase the output.

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1.10 SCOPE OF THE STUDY
The researcher will conduct the study at St. Mulumba hospital

1.10 LIMITATIONS OF THE STUDY

 Considering the main respondents of this study will be patients, they will be afraid to offer
confidential information as expected. Also, some of them may be illiterate about the health
information systems (HIS) hence some of the questions may be ambiguous.
 The health experts will be limited to give out all information because they confidential.

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CHAPTER TWO: LITERATURE REVIEW

2.1 INTRODUCTION

This section reviews the literature concerns of good health care in hospitals and how EHR system
implementation in hospitals how has enhanced effectiveness. This research will focus on the
following areas: efficiency of the existing EHR systems, EHR systems’ integration capabilities
and utilization of EHR systems. In addition, this section will highlight the theoretical framework
within the based area of this study.

2.2 EFFICIENCY OF THE EXISTING EHR

According to (joseph, 2016), EHR defines as the legal patient record created in digital format in
hospitals. Most Kenyan medicals facilities including St Mulumba hospital, are implementing these
systems to do away with paper work and enhance proper recording of data, because it is
computerized, EHR reduced errors and they are more effective than paper work.

2.3 EHR SYSTEMS’S INTERGRATION CAPABILITIES

(Shahid shah, 2012) states that, Stage 2 is coming, and the focus of the electronic medical record
(EMR) community is shifting from the capture, to the exchange of health information when it
comes to interoperability.

EMR will need the following to enhance integration capabilities:

a. Interactive Voice Response (IVR), which allows an EMR to interact with users through
phones and other voice systems, such as Skype, will improve collaboration with
patients and other physicians who are not on a computer.
b. Voice recognition. This will help users conduct EHR tasks more efficiently to escape
the task of typing. Instead of that, one can only speak to the device and the information
is stored.

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 c. Natural language understanding. Humans enter EHR data, hence the system should
integrate with systems that can convert the spoken word or typed text to structured data.

2.4 UTILIZATION OF EMR SYSTEMS

In Kenya, the EMR systems used in various private and public hospitals include Comprehensive
Patient Application Database (CPAD), IQ Care, Care 2000, Fun soft, Compact, Open Medical
Record System etc. EMR systems’ initial purpose was for recording patient information. This was
the case with Larry Weed’s Problem Oriented Medical Record in the 1960’s. According to the
EMR Standards and Guidelines (ESG),

EHR systems must address the following functional areas:

i. Record and provide basic demographic and clinical health information.

ii. Provide a clinical decision support.
iii. Support Security and Confidentiality.
iv. Facilitate exchange of electronic information.
v. To provide health information and reporting.

2.5 THEORETHICAL FRAMEWORK

UTAUT explain how an information system can be accepted and used by users through the users’
intention (behavioral intention) and behaviors (use behavior). The reason to conduct behavior is
that a user has intention or desire to use a system. Intention is a desire and may change over time,
while behavior is actual form of system usage by the use.

In this study, the researcher also adopts the Unified Theory of Acceptance and Use of Technology
(UTAUT) model developed by Morris and Davis to understand the complexity in determining the
acceptance of EHR systems by health professionals and the patients to trust them as far as good
health care is a major concern.

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2.6 SUMMARY OF IDENTIFIED GAPS IN THE REVIEWED LITERATURE.

Most researchers have based their argument on the data privacy threats, EMR initial cost of
implementation and acceptance of these systems by medical experts and the community basically
patients.

This research will cover

1. The benefits of EHR in medical facilities

2. The result of utilizing EHR as far as good health care is concerned.

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CHAPTER THREE: RESEARCH METHODOLOGY
3.1 INTRODUCTION.
The main purpose of this chapter is to describe the methods used to attain the research objectives.
This chapter describes the methodologies and the research designs. The areas covered here include;
Research design, Study area, Target population, Sampling techniques, Sample size, Measurement
of variables, Research instruments, Validity of measurements, Reliability of measurement, Data
collection techniques, Data analysis and the chapter will highlight Logistical and ethical
considerations that will ensure the successful completion of the research.

3.2 RESEARCH DESIGN

According to (Bhat, 2019) a research design is a framework of formulas that researchers use in an
orderly manner so that the research to efficiently handle the problem. The research used a
descriptive research design. Descriptive research design fully describes the case under study.
Moreover, it is theory based created by gathering information, analyzing and presenting the
analyzed data. The research design will enable the researcher to gather data on patients’ data
privacy from St. Mulumba hospital then analyzed it and presented it.

3.3 STUDY AREA

The study location of this research will be restricted to only St. Mulumba Hospital.

3.4 TARGET POPULATION

(Vonk, 2007) Defines a Target Population as the group of people to whom we want our research
results to apply. This describes the specific target of people who this research is targeting. My
research will be restricted to patients, Database administrators and the authorities of St. Mulumba
as stated earlier in the study area section. Patients will be queried to determine the level of
satisfaction on the quality of health care they receive. Database administrators and EHR designers
will be queried on the efficiency and security of the systems whereas the Authority of the hospital
will be asked to fill in questionnaires too, on the laws/rules that exist in the hospitals in relation to
patient’s data privacy. The target population in the hospitals was 80 patients, 3 ICT personnel and
40 health care delivery personnel.

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3.5 SAMPLING TECHNIQUES
Sampling defines as the process of selecting an appropriate number of subjects from the defined
population (Mwangi, 2004) (Vonk P., 2007) A sample, which is a subclass of the entire population,
it is used to give generalized data about the whole population in question. This In research,
convenience-sampling technique will be used because the target population was selected in
accordance to the researcher’s convenience. The hospitals in the sample size will be purposely
selected considering the implementation of EHR systems in these hospitals and their closeness to
the researcher.

3.6 SAMPLE SIZE

The sample size of the study was St. Mulumba hospital, where they have already implemented
EHR systems. Patients will be randomly selected for interviews and questionnaires answering
while administrators and managers also considered for the same. According to (Mugenda, 2003),
sample size should be at least 30% of the general population. Therefore, the sample size of the
patients was 24 patients out of approximately 80 patients admitted in St. Mulumba hospital
translating to 30% of the population, 25 health care delivery personnel out of 40 resulting to 73%
and 3 ICT personnel out 3 resulting to 100%.

Table 3.6: Sample size

Description Target population Sample size % Sample size

i. Patients 80 24 30%

ii. Health care 40 25 73%

delivery
personnel

iii. ICT personnel 3 3 100%

3.7 MEASUREMENT OF VARIABLES.

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3.8 RESEARCH INSRUMENTS

The instruments of this research were mainly questionnaires, developed by the researcher. These
Variable Measurement Scale Question Number

Dependent variable The number of chosen Nominal 1

patients (24) over the
Effective health care delivery
number of patients
admitted (80) multiplied
by 100 to get 30%

Independent variable Total number of cases Nominal 2

security of EHR systems reported about violation of
patient’s data privacy.

Functionality of EHR systems The average response time Nominal 3

of the EHR systems.

The Memory space

required by these systems.

Integration of EHR system Number of devices that Nominal 4

EHR can integrate with.

questionnaires will be administered to patients, ICT personnel, health care delivery personnel and
administration personnel. The questionnaires contained both closed-ended and open-ended
questions. The questionnaires will be sectioned into four parts: The first part comprises of the
open-ended questions which requires the respondents to express their opinion, the second part is
the functionality section-which entails questions on the functionality of the system, the EHR
security section entailed questions on the security concerns at St. Mulumba hospital and the last

12
part is about integration which comprises of questions that investigate how EHR connects with
other devices to enhance effective health care at the facility.

3.9 INSRUMENT VALIDITY

The validity of the instrument according to (Kothari, 2008) can be defined as the degree to which
a test measures what it is supposed to measure. To enhance validity of these questionnaires, expert
judgment method will be used in that, before being administered to the target population the
questionnaires will be examined by experts, who will give feedback and corrections made where
necessary.

3.10 INSRUMENT RELIABILITY

According to (Mugenda, 2003)the reliability is the measure of degree to which a research
instrument gives consistent results after repeated trials. Reliability of the questionnaires will be
tested by their efficiency. The questionnaires will be given to the patients, doctors, database
administrators and the authority for answering then will be gathered back and skimmed. Only
efficient responded questionnaires will be included in the analysis.

3.11 DATA COLLECTION TECHNIQUES

The researcher will ask for permission from the hospital management to visit their hospitals and
administer the questionnaires to the target population. The researcher will assure maximum
confidentiality of the respondents and their identities. The questionnaires will then be issued to
respondents, filled, gathered back then the data collected will be analyzed.

3.12 DATA ANALYSIS

In this research, the questionnaires will be classified and analyzed whether or not they will be
answered correctly. Descriptive statistics will be used to outline the features of the data. The
numerical/quantitative data will be presented using percentages, tables and charts whereas the
qualitative data will be analyzed through content analysis.

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CHAPTER FOUR: FINDINGS AND DISCUSSION
4.1 INTRODUCTION.
In this chapter, we will cover the findings and discuss the collected data during research. Main
objectives i.e., the reliability of the EHR systems, their functionalities and their benefits were also
covered in this chapter. A five partitioned questionnaire was used in which the first partition
covered the respondent’s profile and the remaining four were specifically meant for patients,
doctors, hospital management and Data administrators respectfully. All the questionnaires
achieved completeness in terms of filling and were collected in time to allow analysis of the
findings.

4.2 DATA PRESENTATION.

4.2.1 Respondent Rate.

The researcher used questionnaires with open ended and closed questions to obtain collect data.
40 forms out of the 52 distributed forms were returned complete while the other 12 were rendered
incomplete. The overall percentage was calculated based on the total completed forms returned
out of the overall number of forms submitted for data collection, which was 76 percent. According
to Mugenda & Mugenda (2003), the number of completed forms returned was enough for analysis
as it exceeds 70 percent.

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Bar graph 4.2.1: Response rate.

250%

200%

150%

Invalid forms
100% Valid forms
forms destributed

50%

0%
patients health care ICT personnel
delivery
personnel

4.2.2 Designation of respondents.

The researcher also collected data on the respondent’s designation. According to the collected data;
health care delivery staff had 20 valid respondents which translates to 50 percent, patients followed
the track with 17 valid respondents- 42 percent and the data admins were 3 valid respondents which
translates to 8 percent of the collected data.

Chart 4.2.2: Designation’s Response Rate

8%

50%
42%

15

Healthcare deliery personnel Patients ICT personnel

4.2.3: Gender of respondents.

The researcher’s investigation considered gender whereby out of the total number of 52 valid
forms viable for analysis, 30 were male translating to 58% while 22 were female- 42%.

Chart 4.2.3: Gender Response Rate.

42%

58%

male

female

4.3 DISCUSSION OF FINDINGS.

4.3.1 EHR FUNCTIONALITY.

This section of research was aimed at querying the respondent a series of questions to achieve this
objective and hence answer the research question. The researcher posed questions like; how easy
is the Electronic Health system is to use? How faster they EHR are? And whether they offer
satisfaction and acceptance in the health care delivery at the facility?

4.3.1.1. Satisfaction and acceptance of EHR systems.

The result on this question based on the respondent’s designation were: The 3 ICT personnel
strongly agreed with the fact that they accept the existence of HER system at St. Mulumba hospital
and that they are satisfied (SA), 18 out of 20 healthcare delivery team strongly agreed translating
16
to 90% while the remaining 2 agreed (A) which corresponds to 10%. 9 of the 17 patients agreed
(A) resulting to 53% while the remaining 8 disagreed (D) which corresponds to 47 %.

Table 4.3.1.1: Satisfaction and acceptance of EHR systems.

Options Result Result (%)

Strongly agree 21 53%

Agree 11 27%

Disagree 8 20%

4.3.1.2. Ease of use.

To solve the objective and also answer the main question of the study, this question was also asked
specifically to the healthcare delivery team and the ICT personnel and the response was as follows;
Turnout was impressive since 18 out of 20 health care delivery personnel strongly agreed (SA)
which translates to 90% while 2 agreed (A) corresponding to 10%. ICT personnel who were 3
selected strongly agree (SA) which corresponds to 100%.

Table 4.3.1.2: Ease of use.

option Result Result (%)

Strongly agree 21 91%

Agree 2 9%

4.3.1.3. Speed.

76% of the patients strongly agreed (SA) that it takes less time to get response from the health care
delivery team about their medical data, 17% agreed (A) while 7% disagreed. The personnel
handling this system in their daily activities in this case referred to health care delivery team and

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ICT personnel provided 80% strong agreement (SA) and 20% agree (A) that the electronic health
system has help them provide timely response to their customers about their health data.

Table 4.3.1.3: Speed.

Option Result Result (%)

Strongly agree 31 78%

Agree 8 20%

Disagree 1 2%

4.3.2 SECURITY.
Security section is one of the research questions of this research whereby the researcher asked the
respondent a series of questions to satisfy the research. The questions were as follows; how secure
is the EHR system is from unauthorized users? What are the measures taken to secure the system
from malicious threats like viruses? Are the patients aware of laws governing the EHR system at
the facility?

4.3.2.1. Secure From Unauthorized Users.

ICT personnel gave the researcher an insight that they have installed software that detects
unauthorized intruders making 97% strongly agreeing percentage (A) while 1 ICT personnel
selected agree option resulting to 3%. Health delivery team accepted that before the start using the
electronic health record system, they are asked to provide the user’s name and corresponding
passwords for verification by giving 70% strongly agree (SA) and 30% agree (A) respectively.

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Table 4.3.2.1: secure from unauthorized users.

option Result Result (%)

Strongly agree 16 70%

Agree 7 30%

4.3.2.2. Patient’s data privacy assurance, Awareness Of the laws governing the EHR Systems
and measures taken to safeguard information.

20% of the patients agreed that they are aware of the laws governing the EHR systems while the
other 80 percentage were not aware what EHR was in the first place meaning they don’t know the
EHR existing laws. ICT personnel clearly stated that they have put measures of safeguarding
patients’ data in place by installing antiviruses and the software that detect and block any unusual
logins to the system, making it 100% strongly agree (SA) according to the question structure. 86%
of health care delivery personnel strongly agreed (SA) that patient’s data is safe while the
corresponding 14 % agreed over the same (A).

Table 4.3.2.2: Patient’s data privacy assurance, Awareness Of the laws governing the EHR
Systems and measures taken to safeguard information.

option Result Result (%)

Strongly agree 26 93%

Agree 2 7%

4.3.3 EHR INTERGRATION.

This variable was measured by through the researcher posing a series of questions i.e. what are the
existing devices that can integrate with EHR system? Whether it’s easy to analyze data with EHR
systems, do the information given out by the system is accurate? And whether the systems promote
employee collaboration and performance improve.
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4.3.3.1: existing devices that can integrate with HER system effectively.

The ICT personnel responded to this question effectively by stating that there exists the patient
website application which is used for various functionalities including booking appointment. Also,
physical peripherals like keyboards, printers, speakers and display devices are already integrated
with the HER system and they are working effectively. Health care delivery personnel i.e.
administrative team accepted that there exist other health information systems like management
information system which fetches its information from the electronic health system.

Table 4.3.3.1: existing devices that can integrate with HER system effectively.

Designation Existing components and software

Patients Website application

Health care delivery personnel & ICT MIS, keyboard, printers, display screen,
personnel Ethernet, USB, Website application.

4.3.3.2: How easy it’s to analyze data with EHR system.

To achieve this objective and also answer the corresponding research question, the researcher
engaged both ICT personnel and the health care delivery team and the response rate was as follows:
Out of 20 valid health care delivery personnel respondents, 14 of them strongly agreed (SA) giving
a 70%, 4 of them agreed (A) which corresponds to 20%while the remaining 2 disagreed (D)
resulting to 10%. Out of the 3 ICT personnel 2 of them strongly agreed (SA) which represents 67%
while the other 1 agreed (A) -23%.

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Table 4.3.3.2: It’s to analyze data with EHR system.

option Result Result (%)

Strongly agree 16 70%

Agree 5 21%

Disagree 2 9%

4.3.3.3: Whether the information given out by EHR is accurate.

This question was staged to all respondents whereby the researcher wanted to investigate
whether the information given out by this system was accurate and able to solve problems at
hand. The responses were as follows: 8 of the 17 patients strongly agreed (SA) - 47%, 8 agreed
(A) resulting to 47 % and 1 disagreed (D) which is 6%. Out of the 20-health care delivery team,
16 of them strongly agreed (SA) which corresponds to 80%, one of the 20 agreed (A)
corresponding to 5% while the remaining 3 disagreed resulting to 15%. 2 out of the 3 ICT
strongly agreed (SA) while the remaining one agreed (A) which corresponds to 67% and 33%
respectively.

Table 4.3.3.3: The information given out by EHR is accurate.

option Result Result (%)

Strongly agree 26 65%

Agree 10 25%

Disagree 4 10%

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4.3.3.4: Whether the EHR enable employee to collaborate and improve performance.

This question was only directed to ICT personnel and health care delivery personnel where the
response rate was as follows: Out of the 20-health care delivery team, 17 strongly agreed (SA)
which corresponds to 85% while the other 3 agreed (A) which corresponds to 15%. 2 out of the 3
ICT strongly agreed (SA) while the remaining one agreed (A) which corresponds to 67% and
33% respectively.

Table 4.3.3.4: The EHR enables employee to collaborate and improve performance.

option Result Result (%)

Strongly agree 19 83%

Agree 4 17%

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CHAPTER 5: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS.

5.1. INTRODUCTION.

The purpose of this chapter is to summarize and present the finding of data analysis. This chapter
will also incorporate conclusions and suggestions for the future research.

5.2. SUMMERY OF THE FINDINGS.

The research findings were met and the research question was answered because out of the 50
forms distributed, 38 of them were considered valid for research translating to 76% hence valid
for analysis.

5.2.1. Functionality of EHR.

Functionality of EHR was evaluated whereby the health delivery team, basically doctors and
nurses who interacts with the systems in their day-to-day activities, agreed that it enhances speed,
it’s easy to use and they totally accept the deployment of the system. This was true because they
added that speed of serving their customers has improved by 60% since the deployment of EHR
system.

5.2.2. Security of EHR.

This section helped the researcher to satisfy the main objective of the research since it’s very
difficult to mention effective health care delivery using software like Electronic Health record
system without mentioning security constraints. The database administrators- ICT personnel
satisfied the researcher by mentioning about installation of antiviruses, installation of intrusion
detection-based software and use of strong passwords. Also, they mentioned about patients’
education on awareness of laws that govern the EHR at their organization whereby they stated that
they do it use posters around the facility. 80% Patients disagreed when asked whether they are
aware of the laws governing the system simply because some of them did not know the existence
of the EHR in the facility plus the fact that many of them didn’t know that they were in hospital

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either because they were in critical conditions upon admission hence they couldn’t have time to
read the posters.

5.2.3. EHR integration.

The main benefits of integration of any system are; employee collaboration and performance
improvement, easy data analysis and security and accuracy improvement. The responses for this
question helped the researcher to measure that integration of EHR systems at St. Mulumba hospital
has been enhanced because an average of 72% of the respondents strongly agreed that EHR system
integration is enhanced at their facility.

5.3. CONCLUSION.
The researcher found out that the Electronic Health records systems came with a lot of benefits
i.e., helping the employee to improve health care delivery in terms of the efficiency and accuracy,
easy patient’s data analysis, reduce work load on the health care delivery team and reduce keeping
the patient waiting for the results for long. On the other hand, the system came with disadvantages
though in a small scale whereby the health delivery team tends to manipulate charges and favor
patients from their ethnicity hence no balance to both parties. Also the health care delivery team
happened to disclose data to unauthorized personnel as claimed by patients and data
administrators. Say for example the patient and the nurse happen to come from the same area and
the patient is diagnosed of cancer, the nurse is the one recording the lab results. He/she carries the
information back to family members about their neighbor or relative in this case. 2 cases of this
type were recorded according to the question posed concerning the same by the researcher.

5.4. RECOMMENDATIONS.
5.4.1. To data administrators.

In adherence to the research blueprint, the researcher identified the following recommendations to
the data administrators of St. Mulumba hospital.

The data administrators should:

a) Report any case of security breaches to the managers and for the law to take its course.

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 b) Create awareness of patient’s rights and laws governing the EHR system not only through
posters within the facility but also in various online platforms or roadshows because
anybody can be a patient.
c) Update the EHR system every month so as to enjoy maximum benefit of the system.
d) Enhance confidentiality of the EHR system so as any modification of the system is verified
and if unauthorized should be detected and reported- through a relevant software.

5.4.2. To health care delivery team.

According to the collected data about the effectiveness of EHR systems at St. Mulumba hospital,
the researcher came up with the following recommendations to the health care delivery team i.e
the doctors and nurses.

Health care delivery team should;

a) Adhere to the institutional rules and regulations about keeping the patient’s data
confidential.
b) Report any response failure of the system to database administrators so as immediate action
to recover the usual functionality is enhanced.

5.4.3. To patients.

In this research the patients seem to be the reference point such that if their needs are well catered
for then the EHR system effectiveness is a success. The following recommendations were
proposed by the researcher to the patients.

Patients should;

a) Always verify before giving out their information because it’s their right and stop being
ignorant of their rights by reporting any privacy cases about their medical data.
b) Seek information about Electronic Health Records always before getting to hospital beds.

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 APPENDICES
Appendix 1: questionnaire.
This questionnaire is purposed at identifying how the EHR system has enhanced effective health
care at St. Mulumba hospital. Please respond by either filling the blank spaces or select the
response among the multiple choices that best suits your opinion.

RESPONDENT PROFILE.

I. DESIGNATION.

Patient Health Care Personnel Data Admin

1. General questions.
a) How often do you update the EHR systems?
Yearly More Than Once a Year Never
b) How many cases of data privacy has been reported since the deployment of EHR
systems……………….?
c) What are the existing devices that EHR can integrate with?
i. ……………………… iv. ………………………
ii. ………………………. v. ……………………….
iii. ……….………………. vi. ………………………

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 2. Functionality.

Table 5.1.1: To Determine How Functionality Of EHR Has Affected The Health Care
Delivery At St. Mulumba Hospital.

To what extent does the functionality of the existing EHR system has improved health care in
your facility. (SA- Strongly agrees, A- agree, N- neutral, D- disagree, SD- strongly disagree).

SA A N D SD

i. EHR system is easy to use.

ii. Am satisfied about the EHR system.

iii. EHR system helps me to offer compressive Health care.

iv. It is easy to enter data using EHR than handwriting.

v. It takes less time to retrieve data from the EHR system.

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 3. Security

Table 5.1.2: To examine the extent at which EHR security has affected health care delivery
at St. Mulumba hospital.

SA A N D SD

i. EHR is protected from unauthorized access using strong

passwords.

ii. Antivirus software is installed to protect the system from

malicious threats.

iii. Patients are assured the confidentiality of their personal

data

iv. Patients are aware of the laws that govern the HER system.

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 4. EHR integration.

Table 5.1.3: To measure how EHR integration with the existing electronic devices affected
the health care delivery at the facility.

SA A N D SD
i. EHR integration with other devices is effective

ii. EHR system integration enhances easy data analysis.

iii. HER integration provides accurate information.

iv. It is easy to deliver and collaborate with my colleagues with

the help of EHR integration with other devices.

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Appendix 2: Budget and expenditure.

Particulars Ksh.

1. Travelling 1000

2. Meals 1500

3. Pens And Pencils 500

4. Printing 1000

5. Miscellaneous 500

Total 4500

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Appendix 3: Research project schedule.

Activities No. of weeks

1. Feasibility study 2

2. Requirements, specification and system analysis 3

3. Methodology 2

4. problem specification 4

5. research results 3

6. recommendation 1

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