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How To Bring Healthcare System In Nigeria Into The Digital Age



The health records in most Nigerian hospitals have been facing some number of problems which have affected the accessibility and utilisation of health information in treatment of patients. But technology solutions may offer a way out. VICTOR OKEKE writes on this.

Kwokoma’s father was at first a visitor to the out-patient department before his condition degenerated. He was later admitted at one of the hospital wards. The man is down with prostate enlargement.

Treatment and medical procedure was just tiring both for the patient and the son who is attending to him as referrals kept pushing them from one department to the other. And the medical records- they were endless. New files and folders are opened for each new department the patient is referred to and even for common things as blood sampling at the laboratory.

Unfortunately, these medical cards are not for free and the last time Nwokoma’s father had a missing file at the OPD, he paid for a new file to be opened for him without which treatment may be avoided.

And for big hospitals like the University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla, Enugu, records are so important but a large chunk of these are kept in books with their attendant difficulties in accessing them.

In fact, the context of healthcare delivery in Nigeria is complex and fraught with myriad of challenges ranging from limited access, poor infrastructure, limited qualified healthcare providers, poor data management, etc. These critical challenges have continually accounted for the abysmal standards witnessed in the Nigerian Health sector, against globally acceptable indices.

According to Dr Abdulrahman Aljumah, Consultant Hepatologist and Gastroenterologist at the King Abdulaziz Medical City, the main problems being faced by hospital authorities in preservation and management of records in most developing countries include: Use of outdated forms: Need of constant revision; Shortage of experienced personnel: Need of trained personnel; Lack of planning in storage of in-active records: Need of effective storage and control of in- active records; Lack of determination of records’ retention period: Need of determination of records’ retention period.

He remarked that there are various types of damage that affect paper documents. These are highlighted as follows: ageing document may become weak, sometimes paper gets so weak that it gets broken into pieces; there may be a colour alteration in it and it may get yellowed; dust and dirt may be present on the surface; insects of various types may have damaged the document; fungi may be actively present, or might have damaged the paper in the past; the document may have got stained by various means e.g water stains, fungus stains, oil stains, ink stains or simply dirt stains; water may have affected the paper at some time, and besides staining, it could make it limp; in prolonged contact with water, it may become soggy; the sizing materials may have deteriorated, making the paper loose or soft; the document may not be complete and some parts may be missing; and if the paper is kept folded, it may become weak or may break at the creases.

Fortunately for the sector, a huge number of private initiatives are advancing efforts in bridging the healthcare delivery gap in the areas of improving healthcare infrastructure across the three healthcare tiers. A lot still needs to be done to further enhance quality of care delivered across the country’s health structure.

According to Chuks Melville Chibundu, the chief executive officer of Wellspring Technologies- an IT solutions firm- healthcare information management is pivotal to quality healthcare and the quality offered depends largely on the process efficiency, accuracy, prompt documentation, information storage and retrieval, as well as content analysis and reporting.

He said “information management is therefore a vital segment in healthcare delivery that requires a strategic intervention to fundamentally enhance quality of healthcare in Nigeria. To support this initiative, we offer the GEMINI advantage.”

The Gemini HIMS is a comprehensive, integrated information system designed to manage all the aspects of a hospital’s operation, such as medical, administrative, financial, and legal issues and the corresponding processing of services. The HIMS systems enhances the ability of health care professionals to coordinate care by providing a patient’s health information and visit history at the place and time that it is needed. Patient’s laboratory test information and also visual results such as X-ray are also accessible through the HIMS.

Tech experts say the Health Information Management system will be a highly resourceful tool for hospitals as it can be used to harmonise the management of health records in multiple locations which can help in the efficient management of health data. The HIMS also provides immediate and easy access to necessary health information by patients, healthcare providers and regulators from anywhere and anytime.

Researches have demonstrated that given right environment and incorporation of health technologies, hospitals can perform much more than they do today.

For example, after it implemented electronic health record-based interventions, Boston Medical Center reduced unnecessary diagnostic testing and increased the use of postoperative order sets, two markers of providing high-value medical care, a new study shows.

The data from the hospital’s efforts demonstrates the impact of deploying multiple interventions simultaneously within the EHR as a way to deliver high-value care -which is defined as delivering the best possible care while simultaneously reducing unnecessary healthcare costs.

At six months following Boston Medical Center’s intervention, which was activated hospital-wide for specific patients using the Epic EHR, the proportion of patients receiving pre-admission chest X-rays showed a decrease of 3.1 per cent, and the proportion of labs ordered at routine times decreased by 4 per cent. Total lab utilisation decreased by 1,009 orders per month.

The researchers found no significant difference in the estimated red blood cell transfusion utilisation rate, or the number of non-ICU urinary catheter days. But the proportion of postoperative patients who received appropriate pain and pneumonia prevention orders showed an increase of 20 per cent.

In Nigeria, Well Spring Technologies Nigeria Limited in collaboration with partners developed the GEMINI solution, which allows point of care analytics for clinicians who need to ask questions about the patients they are caring for.

The system consists of two components: profiling and nnalytics. The profiling component extracts data of each patient from various sources and stores them as information in a patient profile graph. The data sources include structured data, such as, patients’ demographic data (e.g age, gender), laboratory results (e.g HbA1c values), and medications, and unstructured data (e.g free-text from a doctor’s note).

The patient profile graph provides a holistic and unified view of a patient’s clinical data, which simplifies the various routine or daily tasks performed by healthcare professionals and administrators. This graph contains key entities, such as, diseases (e.g Diabetes Mellitus) and medication (e.g Glipizide), identified from unstructured data (doctor’s note) and structured data (e.g dosage regimen of medication), and captures the relationships between these entities (e.g Glipizide is used to treat Diabetes Mellitus).

The analytics component analyses the patient profile graphs to infer implicit information and extract relevant features for the prediction tasks.

Existing knowledge bases lack domain-specific relationships, such as, the relationship between a disease and a laboratory test. The relationships that exist between these two concepts, such as, HbA1c and Diabetes Mellitus (DM), is the use of HbA1c to monitor the control of DM, playing a crucial role in realizing the full potential of semantic computing. For instance, from the laboratory result of HbA1c, we can infer whether the DM condition is well-controlled.

GEMINI adopts an iterative process where the system keeps interacting with the healthcare professionals as part of a feedback loop to gather, infer, ascertain and enhance the self-learning knowledge base.

More specifically, to construct the patient profile graph, GEMINI leverages the information from knowledge base together with the implicit information inherent in the doctor’s notes. Hence, these patterns are captured by GEMINI as information for improving the accuracy of identifying and extracting concepts and enhancing the knowledge base. GEMINI also poses questions to the doctors for verification. Based on the answers from the doctors, GEMINI adjusts its inference results.

The generation of patient profile graphs gets more accurate and complete as the system runs more iterations. Meanwhile, the knowledge base becomes more comprehensive and customised to each organisation’s practice. For the analytics tasks, GEMINI utilises doctor’s input to label a small number of patients with the most informative data and to provide expert rules/hypotheses, by integrating them into the analytics algorithms.

The analytics component analyses the patient profile graphs to infer implicit information and extract relevant features for the prediction tasks.

Indeed, management and preservation of health records is an integral part of medical service delivery as it goes a long way in enhancing better service delivery as well as serving as a basis for following patient health trend overtime. It also serves as a basis for effecting referral service. Hence effort should be made to ensure regular preservation and management of hospital records.


Researchers found no significant difference in the estimated red blood cell transfusion utilisation rate, or the number of non-ICU urinary catheter days. But the proportion of postoperative patients who received appropriate pain and pneumonia prevention orders showed an increase of 20 per cent.





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