IMPACT OF COMPUTERIZED PHYSICIAN

DOCUMENTATION IN SOME SELECTED

GOVERNMENT AND PRIVATE HOSPITALS IN
KANO STATE

BY

SAKA SHERIFF ALADE

FCEK/PGDE/08/3039

A RESEARCH WORK SUBMITTED TO THE

DEPARTMENT OF EDUCATION, FEDERAL
COLLEGE OF EDUCATION, KANO IN
PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE AWARD OF POST
GRADUATE DIPLOMA IN EDUCATION
(PGDE)
MAY, 2010
APPROVAL PAGE
1

This essay has been read and approved as meeting the requirements for
the award of Post Graduate Diploma in Education (PGDE) of Federal College
of Education, Kano.

__________________________

____________________________

Mrs. E. F. Adeloye

Date

(Project Supervisor)

__________________________

____________________________

External Supervisor

Date

___________________________
Director

______________________________
Date

ACKNOWLEDGEMENT
The praise is to Allah for guiding and protecting me to the successful
completion of my studies and this project. I would like to register my
profound gratitude to my parents Alhaji Saka Bakare Ajibosin and Alahaja
Salamat Saka for their academic and moral support for their academic and
moral support from the beginning of my life to this stage.
Also, I would like to register my profound gratitude to my supervisor
Mrs. E. F. Adeloye for her guidance and assistance offered to me towards the
completion of this project.
I am greatly indepted to my loving brothers and sisters for their
support and contribution to my academic career, not forgetting my guardian
Dr. Mrs. Yussuf Salaudeen Khairat and her husband Dr. Yussuf Salaudeen
Lecturers at the Federal College of Education Kano, Kano state. May
almighty Allah reward and bless you in abundant.
Finnally, my special regard goes to my friends Bakare Waheed Ariyo,
Abdul Jelil Abdul Azeez, Ibrahim and Abeeb Bello Yarda (The Twin
brothers), Nurudeen Jimoh and so on, for being with me through out the
programme.

CERTIFICATION
I certify that this project was prepared and written by me. I also certify
that to the best of my knowledge; this project has never been presented
wholly or partially for the award of my diploma / degree or for publication
else where.

Mrs. E. F. Adeloye

___________________________

(Project Supervisor)

Signature & Date

DEDICATION
This project is dedicated to my parents Alhaji and Alhaja Saka

Bakare Ajibosin without whom all these would not have been possible.

TABLE OF CONTENTS
Title Page

...............................................................

Approval Page

.......................................................

ii

Acknowledgement .....................................................

iii

Certification

.......................................................

iv

Dedication ..................................................................

Table of Contents .......................................................

vi-vii

Abstract

viii

..................................................................
CHAPTER ONE
INTRODUCTION

1.1

Background of the study .......................................

1.2

Purpose of the study

1.3

Statement of the problems

1.4

Research questions

.......................................
............................

.......................................

1.5

Significance of the study .......................................

1.6

Scope of the study

.......................................

1.7

Limitation of the study

.......................................

1.8

Definition of terms

.......................................

CHAPTER TWO
LITERATURE REVIEW
2.1

Introduction

.......................................

2.2

Impact of computers on health workers

.......

9
9

2.2.1 Why general practitioners use computers and hospital

doctors do not

..................................

12

2.2.2 Electronic patient-physician communication ....

12

2.3

13

Why computer are needed

..........................

2.3.1 Impact of computer-based information on society

.................................................................................
6

17

2.3.2 Efficiency in the use of computerized documentation

..................................................................
19
CHAPTER THREE
RESEARCH METHODOLOGY
3.1

Introduction

............................................

21

3.2

Research Design

............................................

21

3.3

Population

............................................

21

3.4

Sample and sampling technique ......................

21

3.5

Instrumentation

............................................

22

3.6

Procedure for data analysis ....................................

23

3.7

Summary

24

................................................
CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION OF RESULT

4.1

Introduction

...................................................

4.2

Data analysis and results

4.3

Discussion

25

.......................................

25

....................................................

35

CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1

Introduction

.....................................................

40

5.2

Summary

.....................................................

40

5.3

Conclusion

.....................................................

41

5.4

Recommendations

.....................................................

42

References
Appendix

ABSTRACT
The objective of this research is to find out the impacts of
computer usage by physicians in Kano State and this is likely to
increasingly replace handwritten documentation in other
institutions. The population consisted of the physicians in Kano
state hospitals. A questionnaire was designed and administered
among 26 physicians using a simple random sampling technique.
Simple percentage was used to analyze the research questions.
The study found out that the physicians in Kano state need to do
more to make for a proper electronic health record keeping in
their hospitals. Training of staff on computer knowledge
explained the reason for using a Personal Digital Assistant
(PDA) to patients and finally, carefully designed and
implementation of any electronic health record system should be
a priority.

CHAPTER ONE
1.0

INTRODUCTION
The effectiveness with which information needed by
organization is generated and transferred is used to
determine the rate of progress of a society. Modern society
is information conscious. Organization and even the
hospitals in the communities are not left behind.
The society depends on information for their smooth
running and survival. For this reason, information must be
well managed.
Generally, the management of patients records and
even that of the clinic staff record (collection of related
fields data) relating to patients and staff such as name,
age, sex, age, sex, origin, health condition, symptoms etc.
which when carefully selected, manipulated, organized and
communicated in some meaningful ways become
information.
The researcher in particular tends to investigate into
the impact that computerized documentation plays in the
selected hospitals in Kano state. The data collected will
reflect the result of clinic staff in the selected hospitals in

Kano state and will be used to generalize and present the

experience of those in that sector.

1.1

BACKGROUND OF THE STUDY

Some years back, Nigeria as a nation has little
number of physicians with the knowledge of computing
documents, all they knew was paper-based (hand-written)
documentation in all their day-to-day activities.
Today, few medical practitioners still find it difficult
to effectively use computer despite the technological
development and the access they have to computer in their
offices.
This study, when completed would encourage both the
resident and faculty health workers including the nurses on
the use of computer in documenting their records. It will
also help to highlight the problematic areas and provide
ways of improving the ability to using computer-based
documentation in hospitals; in this regard it would also help
the students and other researcher on similar research topic
to have insight and guide on the impact of computerized

10

physician documentation in the hospitals with particular

reference to this area of study.

1.2

PURPOSE OF THE STUDY

The purpose of the study is to identify the effects of
computerized documentation in hospitals and the attitudes
of those in that sector towards the use of computer.
The study also further intends to:

i.

Examine whether the hospitals in question employ

physicians who are computer literates and compare them to
those without computer knowledge.

ii.

Find out whether the nature of daily routines carried out in

the hospitals encourages the use of computer in
documenting most records.

iii.

Find out whether the result generated by the computerized

documentation suites the format expected by the health
workers.

iv.

Find out whether the introduction of the computerized

documentation reduces the rate of interpersonal
communication among the health workers.

11

1.3

STATEMENT OF THE PROBLEMS

The absence of complete accurate physician
documentation continues to pose concern for hospital
providers. Being in compliance and ensuring accurate
record keeping (i.e. computerized or manual). However, the
correct application of coded data depends heavily on
physician documentation; which has been shown to be
deficient.
Compliance struggles with physicians documentation
typically stem from physicians who inadvertently do not
understand the methodology behind coding and how
documentation or the lack of it, affect coding and billing.
The key to ensuring appropriate documentation depends on
physicians understanding of coding methodologies and its
clinical interpretation.
The importance of documentation
Proper physician documentation is important many
reasons. It should serve as a means to help physicians
organize their thoughts, justify the treatment, support the
diagnoses, and document patients progress and results of
treatment provide continuity of patient care by serving as a

12

vehicle of communication for care givers to evaluate, plan

and monitor patients care plans.
Because of the potentials for important effects from
the use of computerized physician documentation (CPD),
the likelihood that this technology will proliferate, and the
paucity of research to it use in the inpatient setting, this
study set out to identify the range of clinical and
educational impacts that are perceived to have been caused
by the transfer from manual to computerized record
keeping in hospitals.
1.4

RESEARCH QUESTIONS
The following questions are therefore calling for
answers to ascertain the fact of these propositions:
i.

Is there any difference in the use of computer in

documenting records in the hospital compared to the
conventional paper-based (hand written)?

ii.

Will the introduction of computer in a hospital

consultation rooms increase the interpersonal
relationship between patients and physicians?

iii.

Is there any relationship between the background of

the physicians and the use of computer?

13

1.5

SIGNIFICANCE OF THE STUDY

In daily documentation and maintenance of medical
record and quality is a crucial issue in hospitals. The overall
quality of the health records could be enhanced with the use
of electronic devices (computers).
Therefore, this studys significances are the following:
i.

It is hoped that the findings of this study will help the

hospitals authorities to device the way to change the
trend of the attitude of physicians towards the use of
computer.

ii.

It is hoped that recommendations that emerge from

this study will allow for assessing the effect of
different computer placement in the hospitals.

iii.

The findings of the study will be used to improve the

reliability of measuring the impact of computer
system in the consultation room for documentation.

14

1.6

SCOPE OF THE STUDY

With regard to the research subject, it will be of
mentioning the extent at which the tentacles of the research
worker will go in the area of study to gather information
and the sections of the hospitals that can be used.
Firstly, as the name or the research topic is based on
the physicians (doctors) this then call for the fact that only
the physicians and very few other health workers will be
consulted for gathering information.
Secondly, the attitude of the physicians towards the
use of computer that will be studied may not be extraneous
due to the factor in the completion of the work.

1.7

LIMITATION OF THE STUDY

This study has some limitations. Data was collected
from few hospitals in Kano state which represent sample of
the numerous variables that can be tested on the subject
matter. The results may not be generalized beyond Kano
state hospital involved, to other specialties or to the
outpatient setting.

15

1.8

DEFINITION OF TERMS
CPD:

means Computerized Physician Documentation

which is the physicians records stored,
processed, analyzed, or generated by computer.

Physician:
EHRs:

This is a licensed medical practitioner.

means Electronic Health Records which is some

how synonymous to CPD an electronic method
of storing records in the health sectors.

CPRs:

mean Computerized Physician Records.

Documentation: Program listings or technical manuals

describing the operation and use of
programs.
Patient: A person who requires medical care.
PDA:

Personal digital assistant is a lightweight

consumer electronic device that looks like a
hand-held computer but instead performs
specific tasks; can serve as a diary or a personal
database or a telephone or an alarm clock etc.

Hospital: A medical institution where sick or injured

people are given medical or surgical care.

16

CHAPTER TWO
LITERATURE REVIEW
2.1

INTRODUCTION
This section entails information sighted from some
selected literatures with points on the research work.
The patient health record serves as the repository for all
information relevant to the care of a patient in a hospital or
health care system, while clinical documentation is the core
of this record. Among the many purposes of todays health
record, communication with patient-related details among
clinicians remains the most important. The traditional
paper record often lacks accessibility, legibility, and
flexibility, reducing its effectiveness as a communication
tool. These limitations have driven many institutions to
adopt electronic health records (EHRs).
Advances in EHRs have made it possible to
computerize many functions of the patient health record.
While the inclusion of physician documentation in EHRs
has traditionally occurred through the use of transcribed
dictation, this is expensive and can produce substantial
delays in document availability. To address these issues,
some EHRs allow for direct entry of physician
17

documentation via a computer keyboard and mouse, a

process we refer to as Computerized Physician
Documentation (CPD).
One EHR that provides CPD capability is the
Veterans Administrations Computerized Patient Record
System (CPRS). In addition to allowing physicians to type
directly into the chart, CPRS provides document templates,
copy-and paste functions, and automated insertion of
clinical data to facilitate the sometimes burdensome task of
documentation. Since the release of CPRS in 1998, most
Veterans Administration Medical Centers (VAMCs) have
mandated that clinicians make the transition from paperbased documentation to CPRS-based CPD.
The creation and review of clinical documentation are
integral not only to the practice of medicine, but also to the
teaching and learning of it. CPD has the potential to
improve these activities through better document
accessibility, increased legibility, and decrease costs.
However, studies of EHRs-based documentation
effects have yielded mixed results. While some have found
that the use of an EHR resulted in more complete and
more understandable documentation when compared
18

with paper-based records, other have noted that EHR-based

documentation may promote the completion of such
information-intensive tasks at the expense of patient
communication.
In addition, earlier research suggests that a transition
from paper to computer-based documentation might have
other unintended impacts. Nygren and Henrikson (1992)
showed that the format, layout, and other textural features
of the paper record are critical to a physicians ability
contained therein. Features such as the ability to manually
tabulate pertinent data and mark up abnormal findings
may be important to the cognitive processing of clinical
information and could be lost with CPD. Indeed, more
recently conducted research by Patel et al (2000) found that
EHR use was associated with changes in physicians
cognitive behaviours such as information gathering,
organization and reasoning strategies. Embi et al (2004).

19

2.2

IMPACT OF COMPUTERS ON HEALTH WORKERS

In every health sector, problem solving is always a

critical issue which if not well managed could jeopardize the
effort of the health workers. As can be seen from some
literatures, there exist different views by health workers
which differs based on their affinity for the use of computer
in record keeping for various purposes to include
administrative purpose.
2.2.1

Why general practitioners use computer

and hospital doctors do not:
Almost all British general practitioners use computer
based patient records, but most hospital doctors do not.
This review (the first of two) focuses on how, over 30 years
incentives led to enthusiastic adoption of computing by the
general practitioners but widespread alienation of hospital
doctors. For the same number of years, leaders of the
general practitioners profession have worked with
government to provide incentives for computerizing
practices and to remove barriers. In hospitals, computing
was treated as a management overhead; and doctors had no
incentives to become involved.
20

2.2.2

Electronic Patient-Physician

Communication:
According to Kenneth et al (2003) a critical mass of
internet users (i.e. computers with the internet connection)
will soon enable wide diffusion of electronic communication
within medical practice. E-mail between physicians and
patients offers important opportunities for better
communication. Linking patients and physicians through email may increase the involvement of patients in supervising
and documenting their own health care, processing that
may activate patients and contribute to improve health.
These new linkage may have profound implications for
patients-physician relationship.

The use of computer for patients by the

doctors and their benefits:
Hospital may be able to significantly reduce the time
it takes to deliver medications to patients and complete Xrays and lab tests by having doctors fill out orders via
computer rather than by hand; a new study suggests.
Results (carried out in 2003) showed computerized
ordering also eliminated prescription drug errors that
21

occurred when doctors handwritten prescriptions were

misread.
The study found that computerizing physician order
cut medication turn around times by 64%, cut turn around
times for X-rays and other radiology procedures by 43%,
and reduced turn-around times for laboratory tests by 25%.
(Science blog February, 2003).
According to Gary McCord et al (May, 2008) in their
research paper titled Assessing the Impact on PatientPhysician Interaction when Physicians use Digital
Assistants. Their findings lead to the conclusion that during
the past few years, the physicians-patient relationship has
evolved from physician assuming principal responsibilities
for patients health care to a situation where patients and
physicians often work together to resolve health care issues.
The manner in which physicians use computers at the
point of care has the potential to profoundly affect the
physician-patient relationship, positively or negatively,
depending on the behaviour of the physician.
Communication issues are one of the most important
aspects of the interaction between the patient and the
patient. Approximately 75% of primary care patients prefer
22

that treatment decisions are made in conjunction with their

physician. Empathy, reassurance, support, providing
explanations, positive reinforcement, and information
sharing all have associated with positive health outcomes.
Compared with their control group, patients of physicians
who completed a program to enhance the communication
skills of health care professionals had shorter hospital stays,
improved outcomes, and rated more highly the quality of
communication with health care providers. At the same
time, it has been shown that computers in the examination
room can affect physician-patient communication
negatively by limiting dialogue.
McCord et al (2008) found that patients rate their
interactions and communications with physicians more
positively when their physician explains why they are using
the PDA. It would seem that what is important is their
patients perceptions of the quality of the interaction with
their physician in terms of patient-perceived bettercommunication and person ability of the interaction.
According to Gary McCord et al (2008) their finding
did not include the years of experience of the physicians

23

that was interviewed during their investigation in relation to

the use of a PDA and the interaction with patients.
The goal of this study was to understand the impact of
computerized physician documentation in hospitals and on
the physician-patient relationship so that we can begin more
effective strategies to enhance physician-patient interactions
while minimizing the pitfalls and maximizing the benefits of
using technological and electronic devices in the
examination room or hospitals.
2.3

Why computers are needed:

Hemish Alles et al (1994) assert that every day of your
life you use a kind of computer your brain. Your brain
tells you when you are hungry. It helps you to move, to work
and to remember things.
Our brains can also solve complicated mathematical
problems, or calculations. But sometimes we need to
calculate far more quickly than our brains can manage and
be sure that the answer is correct. This is when we need
computers which can solve problems and carry out the most
difficult calculations with amazing speed and accuracy.

24

Computers are especially useful for storing a lot of

information. They can keep words, pictures and sounds in
their memory, and give you the information you need within
seconds. Even the most advance computers are often easy to
use. They communicate with you by flashing messages or
pictures into a screen, or sometimes they talk to you. You
can play game with them too.

2.3.1

Impact of Computer-Based Information

on Society:
According to Abdallah Uba Adamu (2001) he stated
that, preoccupation with information and knowledge as an
individual, organizational, and societal resource is stronger
today than at any other time in history. The volume of
books printed in 16th century Europe is estimated to have
doubled approximately every seven years. Interestingly, the
same growth rate has been calculated for global scientific
and technical literature in the 20th century and for business
documents in the United State in 1980s. If these estimates
are reasonably correct, the growth of record information is
a historical phenomenon; not peculiar to modern times.
25

Here in Kano, the vast amount of literary activities

that heralded the 1990s was made possible by the
availability of information processing equipment. From
1990 to 2000, more literature has been provided in Kano
than in all the previous decades because of the synergy
between availability of computers and the desire for literary
expression. The creation of a contemporary literate society
has therefore been made possible as a result of widespread
availability of information technology.
The proliferation of automatic data-logging devices in
scientific laboratories, hospitals, transportation and many
other areas has created a huge body of primary data for
subsequent analysis. Electronic professional workstation
can be programmed to carry out any of a variety of
functions, some of those that handle word processing not
only automatically look for spelling and punctuations errors
but check grammar, diction and styles as well, they are able
to suggest alternative word usage and rephrase sentences to
improve their readability.

26

2.3.2

Efficiency in the use of

computerized documentation

Modern information systems also bring efficiency to the

organization, retrieval and dissemination of recorded
information. Information services provide mechanisms to
locate documents nearly instantaneously and to copy and
move many of them electronically. New digital storage
technology makes it economical for some to obtain for
personal possession those collections equivalent to the
holding of entire libraries and archives.
Alternatively, access to information resources on
electronic networks permits the accumulation of
highly individualized personal or corporate
collections in analog or digital form or a combination
of both.
An equally significant new dimension of modern
information system lies in their ability to manipulate
information automatically. This capability is the result of
representing symbolic information in digital form.
Computer-base information systems are able to perform
calculations, analyses, classifications and corrections at
27

levels of complexity and efficiency far exceeding human

capabilities. They simulate the performance of logical and
mathematical models of physical processes and situation
under diverse conditions. Information systems also have
begun to mimic human cognitive processes: deduction
inference in expert system, contextual analysis in natural
language and analogical and intuitive reasoning in
information retrieval.

28

CHAPTER THREE
RESEARCH METHODOLOGY
3.1

INTRODUCTION
This section deals with details on how the research
work was carried out, the method(s) used in gathering
information, where and when was the information were
collected and the subjects studied and finally the data
analysis techniques that would be used.

3.2

RESEARCH DESIGN
The research was based on the case study of some
selected hospitals physicians in Kano State. Their
perceptions of CPD were gathered through a series of
interviews and the use of designed questionnaire.

3.3

POPULATION
Physicians in some selected hospitals in Kano State
constituted the population under study. In all twenty six (26)
physicians were given the questionnaire and later
interviewed.

3.4

SAMPLE AND SAMPLING TECHNIQUE

Twenty six (26) physicians were selected from the
population defined above using simple random sampling

29

technique from Aminu Kano Teaching Hospital (AKTH),

Gwale Local Government Health Centre, Zenith Clinic and
Federal College of Education (FCE) Kanos National Health
insurance Scheme (NHIS) section.
Using the above mentioned technique, 15 physicians
were selected from the following departments at Aminu
Kano Teaching Hospital (Male medical ward 5 physicians,
Male surgical ward 5 physicians, Emergency and accident
ward 5 physicians), 6 physicians were selected from the
Gwale L.G Health centre, 4 physicians from Zenith Clinic
and 1 physician from the FCE NHIS section.
3.5

INSTRUMENTATION
The instrument to be used for data collection is a
questionnaire designed by the researcher. The questionnaire
measures attitude of physicians towards the use of computer
in record keeping and its effect in discharging their duties.
The questionnaire consisted of two sections A B. the
first section is used to collected personal data of the
respondent while the second section is based on the research
questions of the study consist of fifteen (15) questions.

3.6

ADMINISTRATION OF INSTRUMENT
30

The questionnaire will be administered directly and

personally by the researcher to the physicians, this is to aid
the attainment of validity in the responds they give to the
questions.
The researcher will also have the opportunity of
observing and interviewing some of the physicians on the
reason(s) why they behave the way they do towards the use
of computer (i.e. whether they like to use it or not).
3.7

PROCEDURE FOR DATA ANALYSIS

The data to be collected will be analyzed using the
simple frequency and percentage statistical method. This is
as a result of seeking to tell the rate of progress of the
physicians in Kano State in the near future.

3.8

SUMMARY
This chapter titled research methodology has tried to
explain the methods used in gathering data for the study.
The chapter also attempted to explain the population used
in the study, the sampling technique used; administration
and collection of questionnaires, and the method used in
analyzing the data gathered.

31

Thus the chapter is an attempt to provide a

gateway towards understanding the methods used in
gathering data for the study.

32

CHAPTER FOUR
DATA ANALYSIS AND PRESENTATION OF RESULTS
4.1

INTRODUCTION
In this section, the results of the study will be
analyzed and discussed this will throw more light on the
outcome of the whole research that I carried out.

4.2

DATA ANALYSIS AND RESULTS

Description of the study sample of physicians who
completed the research questionnaire:
Table 4.1: Description of the study sample of physicians who
completed the research questionnaire.
Physicians Sex
Male
Female
Total

Frequency
12
6
26

%
46.15
53.85
100

The above table 4.1 shows that 46.15% of the

physicians who completed the survey are male while
53.85% of them are females. This is an indication that
female physicians accommodate visitor more than their
male counterparts although this was not the primary aim of
the findings, the result shows that majority of those that
were interviewed were females.
Table 4.2: Age range of the physicians.
33

Physicians Age range

25 30
30 35
40 above 40
Total

Frequency
--10
16
26

%
0
38.46
61.54
100

From the above table 4.2 the number of the physicians

whose ages are between 40 years and above 40 years is
61.54% of the total sample size while those ranging between
of 30 to 35 years old are 38.46% and there was no physician
whose age is below the age of 30 were conducted during the
visit a situation which arise due to the fact that for any
individual to be a doctor he/she must be at least 18 years old
before he/she can be admitted into the University to study
medicine, a course that will last for a minimum of six or
seven years, together with houseman-ship and National
Service all these years constituted the reason why it is not
possible for efficient physicians to be below the range of 25 30.
Table 4.3: Religion of the physicians.
Religion
Islam
Christianity
Total

Frequency
16
10
26

%
61.54
38.46
100

From the above table 4.3, the number of the Muslims

out numbered that of the Christian doctors as indicated
34

above. This is as a result of the nature of the state (Kano)

being an Islamic state. Majority of the citizens are Muslims.
The Christian doctors indicated in the table are non
indigenes who are either posted or decided to work in any of
the hospitals.
The tables (4.4 to 4.8) below are description or
analysis of the responses of the physicians who filled and
returned the questionnaire. The numbers under the
response column represents the number of respondent(s)
who gave positive and negative responses to the questions
being asked their percentages respectively.

Table 4.4:
S/N

ITEMS

RESPONSE
YES

NO

Are you a computer

21

80.77

19.23

literate?
Did you lean

19.23

21

80.77

computer from
35

school?
Did you like working

26

100

with computer?

From the above table 4.4 item 1, the response of the

physician on the knowledge of computing was 80.77%
compared to those that are not computer literate with
19.23%. This is an indication that most physicians in Kano
state are computer literate.
The responses as to whether the physicians learn
computer from school as observed in item 2 above showed
that 19.23% of the physicians indicated YES while 80.77%
responded that they had knowledge of computer from
school.
Regarding item 3, this implies that the physicians love
working or documenting their records with computer due to
the following given reasons:
Editing of already completed document is made easier than
the paper based which will require using correcting fluid or
even total abandonment of the original copy and re-writing
of such records is burdensome.
Legibility is another reason, as seen in the hand writing of
some doctors you hardly understand what they write on
36

paper but with a computer anybody can read and

understand their writing especially when they prescribe
drugs to patient.
Transferring and sharing of ideas over a network; when
doctors in a hospital or different hospitals use computer to
document their work they benefit from each other by
sending information on related issues in the hospital
through their computer network without wasting time to
travel for a long distance and time.
Therefore, these reasons justify the results of all the
respondents that responded positively.

Table 4.5
S/N

ITEMS

RESPONSES
%
NO
34.62
17

%
65.38

Can you type very fast using the

YES
9

keyboard?
Do you have a personal computer

17

65.38

34.62

3.

at home?
Do you have a computer in your

17

65.38

34.62

office?

Item 1 of the above table has indicated positive and

negative responses of the respondents. This is an indication
that most of the physicians cannot type very fast using the

37

keyboard. This finding which was traced to the habit of some

of the physicians towards the use of computer such as:
Level of computer literacy: Despite the knowledge of computer
by most of the physicians some of them only use it for accessing
or reading articles of health related documents and not mostly
for editing or recording, a situation that sometimes make them
give the record to a very fast data entry personnel to type for
them while the softcopy is copied into their computer for
accessibility purpose.
Lack of interest: The saying practice make perfection is
applicable to all human endeavour so also in computing the
more you type documents by yourself (practicing) the better
and faster you will be able to type. When they do not type them
self for lack of interest or zeal, they end up not being able to
type very fast.
While items 2 and 3 of table 4.5 shows that most doctors
have computer either at home or in their office for one reason
or the other, this was ascertain their interest on the use of
computer in documentation. The result of 65.38% YES is an
indication that they all love working with computer.

38

Table 4.6
S/N

ITEMS

RESPONSES
NO
13

Is your hospital having a

YES
13

%
50

centralized computer room?

Are other doctors and nurses in

19

73.08

26.92

3.

your hospital computer literates?

Is your hospital billing system

23.08

20

76.92

computerized?

The results from the above table 4.6 are as follows:

Item 1:

responses from the physicians indicated that on

the average the hospital in Kano state have centralized

computer rooms which they put to use for performing task
that is aimed at collating what-ever has been inputted from
other departments of the hospital This will help reduce
physicians workload of attending to patients or a situation
where the doctor is not around, the centralized computer
can be used to by an authorized doctor to access the other
doctor record to check information that is needed urgently
in his absence.
Regarding item 2 of table 4.6, 73.08% responded YES
to the item while 26.92% said NO. This is an confirmation
from the physicians are computer literates.
Regarding item 3, 23.08% of the respondents
affirmed YES and 76.92% stated NO which is an indication
39

%
50

that very few hospitals in Kano state have centralized

billing system and majority do not have. The reason for this
was traced to the embezzlement of funds by those in charge
of department.
According to some of the interviewed doctors it was
revealed that when the departments account for their
incomes separately the account can be easily audited, than
when the transaction fees goes to just one department or
section alone.

Table 4.7
S/N

ITEMS

Does your management give

YES
17

RESPONSES
%
NO
65.38
9

computer training to its staff?

Does computer usage diminish

11.54

23

patients confidence in you?

Result from the above tables item 1 showed that

majority of the hospitals mostly government owned
hospitals give computer training to their staff members as
indicated in the table with 65.38% positive responses and
the percentage of those that go for NO was 34.62%.
The above result is justified by the fact that in most
federal and state government sectors staff members are
40

%
34.62
88.46

sometimes sent abroad to learn or acquire more skills on

their area of specialization in order to improve their sector
and nation at large. Therefore, when doctors are well
trained on computing, they will be able to meet up with
international standard and development globally.
The result of item 2 on table 4.7 showed that the use
of computer within the hospital by physicians does not
diminish patients confidence in them. This was ascertained
from the result of the responses from the respondents to this
question with majority 88.46% said NO and the remaining
11.54% who said YES.
This result really depicts what is in practice in the
states health sector by the physicians on the use of
computerized devices or machine in performing their
patients health related tasks.
Table 4.8
S/N

ITEMS

Does computer usage threaten

YES
5

your credibility with patients?

Does computer usage decrease

patients satisfaction with the

quality of their health care?

41

RESPONSES
%
NO
19.23
21

%
80.77

11.54

88.46

23

Item 1 of the above table reports on the credibility of

physicians with their patients on the use of computer and
the result was 80.77% which represents the majority that
said NO meaning that it does not threaten their credibility
with patients.
Item 2 of the table 4.8 had a result of 88.46% YES
responses from the respondents which is an indication that
despite the use of computer, the health care services to
patients is still intact and this is giving the physicians an
assurance that their patients feel satisfied with their
services.
More over, the level of understanding of what the
doctors use as a computerized device to treat a patient for
will go a long way in giving the patient more confidence and
satisfaction in the doctor as being a credible doctor who
knows what the health care of patient is and how to manage
them.
4.3

DISCUSSION
To make the discussion very clear and to the point,
issues involved (the research questions) will be taken one
after the other.

42

a.

Transition from conventional paper-based (handwritten) to computerized documentation:

It was found in this study that there is a great
difference in the use of computer in documenting
records of patients by physicians in the hospitals in
Kano State compared to the conventional paper-based
as it is clearly seen from the results of questions 1 and
5 of questions in the table 4 (which are questions from
the questionnaire) with 80% and 60% respectively to
show that computer usage in medical practice is
widespread, and in parallel with the adoption
computer technology in the general community.
This studys findings suggest that CPD may
substantially affect several important aspect of
clinical and physicians education.
Positive Impacts
The impacts of CPD on documentation were noted to
be of great importance to the physicians and were
largely positive given that improvements in
accessibility and legibility are often cited among major
factors calling for the deployment of EHRs in
hospital.
43

 Access to electronic records

With the use of computers doctors at any time
can easily make changes to their records without
having to go through rigorous tasks.
For any doctor who wants to check the details
of his/her patient, their will be a provision of
username and password for each doctor in the
situation whereby the hospital is operating a serverbased system in which all the data of patients are
entered for centralized repository of data. And this is
a kind of security on the records that is been kept in
the computer.
Access to hospital records over the internet
The trend in which people use the internet
today is an indication that even the doctors love to get
access to information about their patients at a remote
site without even sitting in front of their computer in
the office.
The internet through the computer provides
access which the paper-based record keeping cannot
provide.
44

b.

Usage of computer in consulting rooms by doctors

and interpersonal relationship with patient:
During the past years physicians do perform
consultations without computers and to them it is
satisfactory, but they cannot dispute the fact that the
introduction of computer in hospitals for record
keeping aids their record keeping. But the big deal
here is on the fact that whether computers affect their
relationship with patients when they use it.
According to the result from this study, it is an
indication that majority of the physicians felt that
their patients are comfortable with their use of
computer and does not decrease their interpersonal
relationship. From the face-to-face interview of one
doctor she said since her documentation or the use of
computer is not immediately as she is treating a
patient, she only use it to transfer the records from
the paper form into the computer at a later time and
this has nothing to do with her patients feeling of
dissatisfaction .
In a situation where a doctor use a
computerized device to treat a patient, the level of
45

understanding of the patient on what device is will go

along way to giving the patient more confidence in the
doctor as being a credible doctor who knows what the
health care of a patient is and how to manage it and
not to the detriment of his patient while wasting time
on his computer entering record while neglecting the
patients. So, if a doctor can explain to the patients
what he uses the device (computerized) to do, it will
increase the interpersonal relationship between
doctors and their patients.

c.

The background of doctors and the use of computer:

It is possible that the rate at which a doctor use
computer or has knowledge of computing is a factor
of many different levels of practice experience.
Most of the doctors interviewed, from their
response on the questionnaire showed that they did
not learn computer from their primary or secondary
school, 80% of the subject learn computer after
secondary school while very few learn it from school.
Concern has been expressed that benefits of the
use of electronic medical devices will not be
46

distributed equally across demographic and socioeconomic groups i.e. the more well-to-do may be
expected to receive more benefits.

47

CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1

INTRODUCTION
This section of the report is to dwell on the future direction
to those in the health sector towards the use of computer in
documenting their records and finally to summarize the whole
report of the study.

5.2

SUMMARY
Chapter one being the first section of this report elaborated
the background of the study, purpose of carrying out the research,
it went further to stating the statements of the problems while also
posing some research questions precisely three (3) questions were
used to serve as a guide towards arriving at the result of the
findings, the chapter also included the importance or significant,
scope and limitation of the study.
Chapter two of this research basically entails some related
literatures of some scholars which are in relation with this study.
It consists of the benefits, impacts and reasons for the use of
computers for documentation by physicians.
Chapter three was based on the methods used in carrying
out the research such as the design, population studied, the

48

instrument used, how the instrument was administered and

finally how the result was analyzed or interpreted.
Chapter four presented the results of all the data that were
gathered using the methods and instruments mentioned in
chapter three. The results were not only presented but also been
analyzed in order to make it more meaningful. The chapter was
culminated with discussion on the research questions as it relates
to the research under study.
5.3

CONCLUSION
This study looked at the Impact of Computerized Physician

Documentation (CPD) of some selected private and government

hospitals in Kano state.
This study has shown that the health sectors really need the
use of computerized health records. All the research questions
posed have showed that the physicians all agreed to the positive
impact of computerized record keeping as a welcome idea. The
most important areas that the physicians will need to address
quickly have been suggested in order to improve on their
performances in record keeping and accessing.
Finally, this research also suggests ways to future direction
for further researchers on this type of research work for the sake
of ensuring effectiveness in physicians assignment.
49

5.4

RECOMMENDATION
As anticipated, the findings revealed clearly that
many physicians love to use computer in documenting their
record, and this is an indication that it is a helping tool to
their profession.
Therefore, the recommends that hospital doctors
should adopt the habit of computerizing their record to aid
easy access from virtually any location with the aid of
internet facility due to the fact that a paper-based file
cannot be accessed from virtually many different location at
the same time the a computerized one will.
The doctors should also in their use of any electronic
device for treating a patient , explain to any patient who
wishes to know what and why they are using that device.
Doing this will increase the interpersonal relationship and
confidence in the physicians.
The governing body of the Nigerian doctors both
resident and Faculty practitioners should be compelled to
learn computer or better still, introduce it into their
education curriculum from school, this will give most
physicians the basic knowledge of computerized record
keeping.
50

In the case of further studies, it is suggested that any

research on this same topic, software can be designed with
all the specifications required by the physician in mind. And
extra care should be taken during designing and
implementing such system (software) to avoid or minimize
any potentially harmful impact from the use of computer.

51