Integrated Health Management System, Archival Data Generation and Research in Ghana

Health information management systems are undoubtedly a major area of concern for research, policy, and accurate decision-making. Imagine a country aiming for growth and development without a proper healthcare database system for collecting, reporting, and analyzing health data for policy and vital decision-making. Such countries will make suboptimal health policy decisions, leading to inefficiencies, slack outcomes, high mortality rates, and the inability to meet development objectives.

Here, I discuss the health information system in Ghana, a developing country, and recent policy reforms aiming to develop a nationwide digital record of health information for both private and public actors. I also address the implications for the research community.

Problems of Siloed Health Information Management

Ghana, like most developing countries, has a history of poor health information management. Owing to structural and institutional weaknesses, there has not been a single database or system containing accurate data on the health conditions of the country's people, treatment procedures or interventions, costs, or related bio-information.

Moreover, there is a wide divide between public and private health providers in terms of health information. When coupled with the low level of health insurance penetration, this means that there is no one-stop shop for health information. To a large extent, it is possible to track health information if a patient visits only a single hospital, but if multiple facilities are involved, this becomes much more difficult. 

Paper-based systems of accessing healthcare brought with them numerous challenges—not just limited to delays in retrieving patient folders in times of emergency, inadequate storage, mishandling, and misplaced patient folders—from both healthcare professionals and patients themselves. Other potential challenges include the possibility of selecting the wrong patient folder because of name similarities, challenges associated with patient medical data security, long queues (with reports of patients passing out in the process), illegible handwriting in patient folders, etc.These challenges, which have created policy bottlenecks over the years, have also negatively affected research and development.

Unlike developed countries like the United Kingdom or the United States where it is possible to analyze large data sets of health information at scale, this is not possible in many developing countries. In this sense, the introduction and implementation of digitization in all hospitals in Ghana by the Ministry of Health is a step in the right direction.

Towards an Integrated Health Information System

In the recent past, there have been some efforts at hospital level or through donor support toward digitalization of all hospitals to improve the quality of healthcare in Ghana. Some of these included the use of national electronic health record systems through local technologies such as the Hospital Availability Management System (HAMS) and the ZenMedic Hospital Management Information System.

These software solutions are privately owned by IT companies, and many hospitals that were ready to adopt e-health policies had to pre-finance their implementation. That requirement included bearing all costs incurred, from buying the software, implementation, logistics, and training to post-implementation management. Many hospitals could not afford these software applications, resulting in limited nationwide uptake and the inability to compile a comprehensive national health record.

For researchers, this siloed health information system management approach has negative implications for how archival health records are sourced. It also affects our ability to collect long-term data about a single patient and to develop various health economic policy analyses that could shape policies and future training. The different customized health information management toolkits come with loopholes and are difficult to integrate. Without a single comprehensive data policy, it is hard for researchers to source, merge,  and use them at the country level for any meaningful predictive analysis, such as those provided by the U.S. Department of Health & Human Services.

Against this background, Ghana's government could not achieve its policy of linking health records to all hospitals, hence the introduction of a single database system called the Lightwave Health Information Management System (LHIMS) and the District Health Information Management System (DHIMS).

E-Health and Health Record Management Reforms in Ghana

LHIMS implementation commenced in 2017 with a focus at the district level, across the country, and encompassing all government-run and religious mission-operated hospitals. This means that all hospitals are being enrolled on one basic platform, not only to ensure patient data continuity and improved healthcare delivery but also to provide a good data resource for researchers for quality health policy generation and development.

Others may argue that the reason LHIMS has displaced all other solutions in the Electronic Health Record system is ministerial fiat, but that is not the case. One should be concerned with whether or not the LHIMS application has indeed eliminated the shortcomings of the paper folder system and other software applications, how effective and efficient the implementation has been, the impact to date, whether or not it is providing the digital solutions needed to improve healthcare quality, stand the test of time, and be the best data resource system for researchers in Ghana as far as health policy is concerned. 

The LHIMS implementation has the potential to significantly improve healthcare service delivery across the country. In the deployment process,  hospitals were provided with the resources they needed, not limited to servers, switches, Access Points (APs), desktop computers, Chromebooks, laptop computers, tablets, and well-trained ToTs (Trainers of Trainees). All staff, including biostatisticians, record officers, nurses, laboratory technicians and managers, pharmacists, accountants, doctors, administrators, midwives, physicians, and store managers, are trained on the use of the software—not just didactic training, but hands-on practice, videos, written steps, support platforms, and trainers who stay to provide support in person until these facilities are up to speed with the system.

Implications for Researchers and Health Data Analysts

With data records of health events trickling into the LHIMS databases, there are avenues for practitioners, policymakers, and researchers to use the data, both currently and in the near future. Without prejudice, LHIMS has not only proven to be the best information management system but it is also a significant health policy research tool:

• As regards practitioners involved in health service provision and data entry, the meticulous nature with which the new system is being implemented means that good and stratified data is generated. Proper implementation will also result in reliable data that can be compared easily, making it a useful resource for inferential research.
• For policymakers in developing countries like Ghana, the trickling in of these new data sets will create new responsibilities, ethical concerns, and the need for stronger data protection mechanisms. Health authorities operating on the efficiency frontier in developing countries are examples from which other developing countries can learn as to the ways to store such sensitive data and share them with researchers in their quest to address pressing research problems.
• For researchers, the new data sets provide a means to conduct predictive analysis capturing a large population. They could also, through their research or research needs, provide guidance leading to new changes that can be made to the information systems to collect disaggregated data that can be used for micro-level analyses.
• This reform also serves as a resource from which researchers focusing more on National Health Insurance Scheme (NHIS) data can obtain, analyze, and generate meaningful research outcomes for NHIS policies.

Beatrice Sebbie Akweley is a member of the AuthorAID Ghana Hub and an information technology trainer supporting the roll-out of the new health record system in Ghana. She holds a Bachelor of Business Administration (Banking and Finance) and was previously a program manager at the Dataking Research Lab.