Introduction
The WHO considers health information systems to be one of the six essential building blocks of any health system because they provide reliable information to aid in decision-making throughout the health system.1 2 Relatedly, the recent global development agenda also sees health information systems as one of the critical health delivery components that contribute to achieving goal 3 (good health and well-being) and goal 9 (industry, innovation and infrastructure) of the Sustainable Development Goals.3–6
In Africa, medical information recording has evolved over the years; from the period of cave recordings, where records were stored on tablets of stone to an age where the paper system was introduced.7 Until the latter part of the 20th century, a paper-based record management system was the primary method of storing health records and other documents.8 Although it can be tailored to the needs of each hospital and healthcare provider without requiring any technical changes, the introduction of the electronic health record (EHR) system has made paper-based records less effective in healthcare delivery. The limitations associated with the use of the paper-based system now make the EHR system the appropriate option.9–11
Even though EHR systems have evolved into a viable option, there are major drawbacks to their implementation in Africa. For instance, there are lower adoption and utilisation rates in lower-middle and low-income countries.12 13 The implemented EHR systems in Africa focus on only a few health conditions such as HIV care, home-based care, injury surveillance, tertiary care, and maternal and reproductive health.14–17
To improve healthcare quality and accelerate the health service delivery processes in Ghana, the Ministry of Health (MoH) published the Health Sector Information and Communication Technology (ICT) Policy and Strategy charts in 2005. It was guided by the Ghana ICT for Accelerated Development policy to increase the adoption of ICT in the health sector.18 Due to this, some health facilities implemented an EMR system meant for solo practice. The health facilities that used the EMR systems have frequently changed systems due to challenges such as poor report generation, the inability of the system to mimic the daily transactions performed during service delivery (work domain saturation) and clinicians’ inability to type on a keyboard while attending to patients. Even though the information generated by the EMR could be shared across departments within one health facility, it was not able to share patient information across multiple providers. As a result of the challenge, some facilities used the system together with paper records as they couldn’t fully implement a paperless system.
Due to these challenges, the MoH developed a new policy document in 2009 to aid in the implementation of a national EHR system, a common platform to be used by all health professionals in health facilities across the country. This new implementation was expected to streamline admission, discharge and transfer processes, and be integrated into the claims management system of the National Health Insurance Scheme for billing.19
Lightwave health information management system (LHIMS) is a web-based software platform that is capable of transmitting health information for use by authorised health service providers and supporting administrative functions such as managing records, making clinical orders, inputting information, storing and retrieval to assist in decision-making during and after the time of care in Ghana.20 It is a comprehensive system with several components including National Health Insurance Authority (NHIA) claims, patient records, administrator, antenatal care, laboratory management, alerts and communication, appointment and scheduling, and radiology. The implementation of LHIMS started in 2017 in the Central Region of Ghana. Adoption is still in the early stages, and it is only about 10% of healthcare facilities have adopted the use of LHIMS.
It has been theorised by Davis21 in the Technology Acceptance Model that external factors such as age, gender, organisational factors, etc influence the perceived usefulness of EHR Systems. Also, Al-Rayes et al22 hypothesised that physicians' use of the EHR system is significantly influenced by their age, work experience and medical specialty. This paper, therefore, assesses health professionals’ capacity to use LHIMS-EHR efficiently for health service delivery in Ghana.