ST.

AUGUSTINE UNIVERSITY OF TANZANIA

JORDAN UNIVERSITY COLLEGE

ALICE HYERA

HEALTH RECORDS MANAGEMENT PRACTICES FOR SERVICES

PROVISION AT MOROGORO REFERRAL HOSPITAL

SUPERVISOR

Mr. Ndauka

Morogoro, 2022
 CHAPTER ONE
INTRODUCTION AND BACKGROUND
1.0 Introduction
This chapter presents the background of the study, a statement of the problem,
objectives, and research questions, significance of the study and scope of the
study limitation and definition of key terms.

1.1 Background of the study

Records are important sources of information and knowledge. They assist the
institutions to make timely, relevant and informed decisions hence contribute to
sustainable socio-economic and political development. Health records are
among the vital tools that hospitals require in order to attain the missions and
visions of the respective hospitals. The purpose of health record management is
to ensure quality, accuracy, accessibility, authenticity and security of
information in both paper and electronic systems (The United States
Department of Labour, 2013). Effective medical service delivery does not only
depend on the knowledge of doctors and nurses but also records management
processes in the hospital. Records managed in hospitals include patient case
notes, x-rays, pathological specimens and preparations, patient indexes and
registers, pharmacy and drug records, nursing and ward records. (IRMT, 2010)

International Organization for Standardization (ISO) 15489 (2001) explained

records management as the field of management responsible for the efficient
and systematic control of the creation, receipt, maintenance, use and disposition
of records, including the processes for capturing and maintaining evidence of an
information about business activities and transactions in the form of records.
Information professionals have realized that it is essential that information is
captured, managed and preserved in an organized system that maintains its
integrity, originality and authenticity as well as meeting legal requirements.

Onyenekwe (2015) defined records management as the systematic and

consistent control of all records in which they are held throughout their
lifecycle. Ondieki (2017) acknowledged that proper records management
practices are significant to government realization and achievement of its goals
such as the rule of law, accountability, management of state resources, and
protection of entitlement of its citizens as well as enhancement of foreign
relations. Health records management practices is concerns with statutory and
non-statutory functions such as records classification, filing, security,
confidentiality, staffing, and organization of series of activities that enhance the
protection of vital records.
Most countries in the world have been working effortlessly to deliver quality
health care services to its citizenry through public health facilities. However,
people perceptions of what quality health care service provision connotes vary.
Harrison (2010) stressed quality as the degree of excellence of health care
services delivered or offered to the targeted audience. The Institute of Medicine
(2001) explicated that quality is the degree to which health care services
provision to individual and population increases the livelihood of desired health
outcomes and are consistent with current professional knowledge.

In U.S.A most large public hospitals have their health records automated,
however according to Catherine, (2009) capital requirements and high
maintenance cost are the primary barriers to implementation. The most basic
rules governing access to a medical record dictates that only the health care
providers directly involved in supporting care have the right to view the records.
The patient however may grant consent for any person or entity to evaluate the
record e.g. a family member. In U.S.A medical records are required for the
lifetime of a patient and legally as long as that complaint can be brought.

Leung (2016) on his study of health records management practices in Ghana:

An exploratory study. The findings of his empirical study revealed that
managing health records well is essential to improving health service delivery in
less developed countries such as Ghana. Ondieki (2017) study on records
management on service delivery: A case study of Kisii Teaching and Referral
Hospital, Kenya. The study revealed that records management practices include
the creation/ receipt, maintenance, use, and disposal of records. The study
further showed that health workers in the public health institutions, such as
medical doctors and nurses, pharmacists are usually not able to deliver timely
and effective health services to citizens due to a lack of effective and efficient
records management practices.

In Tanzania, Most public and referrals hospitals are not fully automated thus
they are doing their records activities manually compared to the Europe and
U.S.A hospitals which have imposed electronic records management systems
ICT or electronic records management systems can be used to ensure easy and
fast access to treatment and retrieval of information or records. Policies to
manage health records in Tanzania hospitals are not fully implemented.
However, as compared to many years back when health records were managed
by unqualified clerks, nowadays most of the hospitals have trained records
managers from different universities and colleges.
1.2 Statement of the Problem
In Africa, the level of quality health records management practice on services
provision in public health facilities is regarded as being persistently low and
remains a cause of concern to the citizenry. Effective and efficient in health
records management is an important issue that every hospital serving the public
should take into consideration. One of the key contributors to this is the
negligence of good record management in the organizations. This study focused
at Morogoro Referral hospital with the main aim of assessing record
management practices on services provision and to suggest solutions to record
management challenges.
The health unit of Morogoro referral hospital faces a number of challenges such
as: lack of adequate equipment, supplies and facilities (storage space), lack of
records management policy and lack of automated records management
program, with these considerations in mind, the researcher carried out and
evaluative study on the health records management practice at Morogoro
referral Hospital.

1.3 General Objective of the Study

To carry out an assessment of health records management practices for services
provision at Morogoro Referral Hospital.

1.3.1 Specific Objectives

i. To identify mechanism of record storage and retrieval used at Morogoro
Referral hospital
ii. To find out the roles of health records in services provision at Morogoro
Referral Hospital
iii. To identify the challenges associated with the records management at
Morogoro Referral hospital.
iv. Suggest possible challenges…….

1.3.2 Research Questions

To achieve the above objectives, the study will be sought to address the
following questions;
i. What mechanism of record storage and retrieval is used at Morogoro
Referral Hospital?
ii. What are the roles of health records in services provision at Morogoro
Referral Hospital?
iii. What are the challenges experienced in the management of records at
Morogoro Referral hospital?
1.4 Significance of the study
The study will be significant to Morogoro Referral hospital and the country at
large. The study will help management of Morogoro Referral hospital on the
importance of good and proper records management in provision of service, the
need to establish good records management program that includes policies,
procedures and standards that govern records keeping in the hospital and also to
ensure these elements of records management are emphasized to all staff
members.

Again, the study will benefit the management to appreciate the challenges
associated with records management and how to address them. Ahmed (2019)
states that, “Research into records management trends and practices can lead to
a better understanding of records management problems and challenges, as well
as providing solutions to what is to be done, and how resources should be used”.

If the recommendations of the study are implemented, they are likely to lead to
the improvement of records management practices and also serve as a catalyst
for the formulation of records management policies. Therefore the findings of
the study will be expected to help health service provision to help suggest ways
of improving the services it delivers to the public through emphasizing on the
importance of records management as a critical component in promoting and
improving services provision.
Lastly, it will also add to the body of knowledge in the area of records
management.

1.5 Scope of the study

The study will be restricted to health records management practices on services
provision at Morogoro Referral Hospital. Therefore, the conclusion and
generalization may not be readily applicable to other hospitals in the country but
the recommendations may be applied to other hospitals because services in
referral hospitals are almost similar.

1.6 Limitation and delimitation

1.6.1 Limitations of the Study
The study will experience challenges that may hinder its smooth running and
completion. This includes unpredictable weather conditions, unreliable
respondents who may give false information or refuse to cooperate at all and
officials who may not cooperate in giving reliable information.

1.6.2 Delimitation of the Study

The study will be covered only in Morogoro referral hospital. Moreover, the
respondents reporting bias will be minimized significantly by explaining to
them the benefits, and the confidentiality of the research.
1.7 Definition of Key Terms
1.7.1 Records
According to IRMT (1999), a record is a document regardless of form or
medium created, received, maintained and used by an organization (public or
private) or an individual in pursuance of legal obligations or in the transaction
of business, of which it forms a part or provides evidence

1.7.2 Records Management

The ISO Standard on Records Management (2001) defines records management
as the field of management responsible for the efficient and systematic control
of the creation, receipt, maintenance, use and disposition of records, including
the processes for capturing and maintaining evidence of and information about
business activities and transactions in the form of records.

1.7.3 Health Records

Data Protection Act (2017), defined as: "Any electronic or paper information
recorded about a person for the purpose of managing their healthcare". Some
record types that are managed in healthcare are paper records and electronic.

1.7.4 Health Service Provision

A health care service delivery is the organized response of health service
providers to the health problems of its customers. Effective health service
delivery means integrated Primary Health Care services, providing a continuum
of care with effective linkages between different levels of care through
functional referral systems. (Zee, 2004).

1.7.5 Health Records Management

According to IRMT (1999), health records management refers to the planning,
controlling, directing, organizing, training, promoting, and other managerial
activities related to the creation, maintenance and use, and disposition of
medical records to achieve adequate and proper documentation of a health care
organization's policies and transactions. This can include a range of different
records from the multidisciplinary team
 CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter reviews literature related to the study. Marshall (2006) explains
that a literature review is a “thoughtful and logical discussion of related
literature which builds a logical framework for the research and locates it within
a context of related studies”.

2.1 Record storage and retrieval mechanism in referral Hospital

Medical Record Storage is a vital concern for Practices, referral Hospitals of
every size. As the requirements for Medical Records Management continue to
change, practices need to stay updated on the latest Regulations and ensure that
they're in compliance with the latest Records Retention Requirements. With
these additional responsibilities, it's more important than ever that Healthcare
Organizations have a trusted Partner for Medical Records Management.

The available literature is scant. The problem was identified as critical in 1965
by Whetstone (2001) of the Kaiser Foundation, but he provided no discussion of
possible solutions. A year later Chelew, (2003) working at the Mount Zion
Hospital and Medical Center in San Francisco, reported the results of a study of
the utilization of active and inactive records; the age of the record and the
purpose of the retrieval was noted. Records more than 12 years old made up less
than 2 percent of all record retrieval at Mount Zion, and on this basis Chelew
concluded that there was "little economic justification for retaining medical
records beyond the minimum legal requirements." Chelew did not attempt to
define, except by this implication, when records become less active; the legal
limit, of course, varies significantly from state to state.

Recently Lennox 2010 has suggested that records should be culled and only
summary documents (in most cases the discharge letter with a few other items)
be kept available. In this system the bulk of the culled record would be kept in
quite inaccessible storage. The method currently most used to identify and
separate active from inactive records is based on a single variable-the elapsed
time since the patient's last visit to the clinic or hospital. At arbitrary intervals
all records are examined for the length of time since the patient's last visit or the
last use of the record. Records not used during some previous number of months
are sent to the inactive file or, in some hospitals, microfilmed; records that have
been used within this time period are left in active status.
According to Chinyemba, (2005) record storage and retrieval faces myriad
challenges that include included limited qualified staff such as a records
manager and archivist; Lack of records management policies and procedures;
Records management costs that are not immediately apparent. Cost may only
become significant over a period of time and thus not attract management’s
attention and Limited resources to implement a system according to
requirements (legislation).

According to Chavez-borja, (2002) limited guidelines was cited as the major

problem to record storage and retrieval; employees need guidelines to manage
all the information resources on their desktops, in their files, and in the
computer systems with which they interact. Further, they need to determine
which of those information resources are records and how much of that
information is subject to open records laws.

Although mandated by governments (Bigirimana, Jagero, & Chizema, 2015),

records storage has been unevenly implemented with few agencies devoting a
full-time position to the task. Even then, the job of records management has
been driven by the need to destroy vast amounts of paper rather than to
systematically control, manage, and use information and knowledge of the
agency. As budgets have tightened and governments have turned to technology
to “do more with less,” e-mail, Web portals, databases, and other electronic
applications have been typically implemented without regard for managing the
information or for ensuring the creation and preservation of records.

The electronic office poses unique challenges to recordkeeping (Webster, Hare,

& Mcleod, 2007). As noted in a previous section of this paper (Joseph,
Debowski, & Goldschmidt, 2012), the most essential qualities of a record are
that it is authentic and that its content is fixed over time. In other words, people
must have confidence that a record is what it says it is. Electronic records,
unfortunately, do not intrinsically inspire this confidence in the same way that
paper records do. The ease with which electronic documents can be created,
altered, accessed, duplicated, and shared jeopardizes their value as records.
Ironically, the most appealing aspects of creating electronic documents are what
weaken our confidence in electronic records.

In a study that examined the challenges of Record storage and retrieval in two
Health Institutions in Lagos State Abdulazeez et al., (2015), Nigeria where the
specific objectives include: to investigate the challenges being faced in handling
health records by the surveyed health institutions in Lagos State; and to suggest
some solutions on the preservation and conservation of health records in the
surveyed health institutions in 16 the State, the findings showed that the major
challenges faced in handling health records in the surveyed hospitals include:
poor funding, inadequate computer and other ICT devices, poor skill in
computing, harsh environmental conditions, lack of preservation and
conservation policy.

2.2 Roles of Health Records in Services Provision

Records are a vital asset in ensuring that the health unit is governed effectively
and efficiently, and is accountable to its staff, students (active records users) and
the community that it serves. Records support decision-making, document
general operational activities, provide evidence of policies, decisions,
transactions and activities, and support the dispensary in cases of litigation. The
records are central to the university’s dispensary operation, and managing them
effectively is an important responsibility that involves all members of health
sector staff. Marutha (2011), Proper records management provides a route to
ensuring that the university dispensary adheres to its legal, professional and
ethical responsibilities. Records management improves efficiency by cutting
down retrieval time and maintaining control over what is held, how and why.
University health sector department costs are reduced because resources are not
wasted on retaining unnecessary records. Good records management ensures
that historically significant records are preserved for permanent use.

Besides their administrative value, records are managed in hospitals to support

healthcare providers with patients’ medical history. According to Marutha
(2011), ‘medical records assist the organization with information about the
treatment history and individual care experience that is regularly updated as the
patient consults further. They are used for decision-making in the future course
of treatment’. Therefore, these records need to be protected against destruction
to ensure that they can be retrieved when needed. Several types of records
created in hospitals include ‘bed statistics, daily returns, day and night
handover, nursing records and medical records’ (Booyens, 2001)

Information is every organization’s most fundamental and necessary advantage,

and in familiar with any other business asset, recorded information demands
effective management. Records management ensures information can be
accessed easily, can be destroyed routinely when no longer needed, and enables
organizations not only to function on a day to day basis, but also to fulfill legal
and financial requirements. The safeguarding of the records of government for
instance ensures it can be held accountable for its actions, that society can trace
the evolution of policy in historical terms, and allows access to an important
resource for future decision making.

In the opinion of the importance of records management is increasingly being

recognized in organizations. It is therefore the responsibility of records
managers to ensure that they gain the attention of decision-makers in their
organizations. Gaining recognition is all about convincing management of the
role of records management as enabling unit in an organization. Employees
require information in order to carry out their official duties and responsibilities
efficiently and effectively in a transparent manner. Records represent major
sources of information and are almost the only reliable and legally verifiable
source of data that can serve as evidence of decisions, actions and transactions
in an organization (Tagbotor, 2015). Northwest Territories (2002) stated that the
role of records management is to ensure that members of staff involved in
different operations have the information they need, when necessary and an
organization creates and keeps records so that it can keep track of what its
members have done and what was decided.

Medical record completeness is a key performance indicator that is related with

delivery of healthcare services in the hospital (Tola, 2017). Wong (2009) rated a
medical record complete if it included the following items: medical record
number on each page, patient information in the record, physician note, nursing
note for inpatient, medication record if ordered, lab result if ordered and
radiology result if ordered. Every entry in the medical record should be dated,
timed (24H clock) and legible. Each should be signed by the person making the
entry and should be made as soon as possible after the event to be documented
(e.g. change in clinical state, ward round, investigation etc) and before the
relevant staff member goes off duty (Mathioudakis, 2016).

Shekelle, Morton & Keeler, (2006); Thompson & Brailer (2004) concur that
accurate and comprehensive hospital records lead to quality patient care,
increase in efficiency of care, reduce medical errors, improve access to patient
data, confidentiality of patients and quality decision making. Furthermore, the
National Archives of Malaysia (2003) declares that the phase provides a
suitable environment for easy access to timely, accurate and available
information in a record. Furthermore medical records must be securely
maintained to prevent unauthorized access, alteration, damage or removal. An
efficient management of hospital records also expedite decision making, inform
future decisions, increase accountability of decision makers, produce evidence
in medico-legal issues, support perpetuity of the facility and improve service
delivery (Akor & Udensi, 2013). Palmer & Marlize (2000) viewed
accountability as a particularly crucial governance element and refers to holding
officials of organizations responsible for their actions. Without records, there
can be no accountability and no rule of law. A good records management
system is essential for supporting financial management, accountability and
transparency. Proper health records management is significant to government
realization and achievement of their goals such Adu Freda (2014), as the rule of
law, accountability, management of state resources, and protection of
entitlements of its citizens as well as enhancing foreign relations (Kemoni &
Ngulube, 2008).

2.3 Challenges in the Management of Health Records

Brendan (2012) observed the following as the challenges associated with
records management; First of all, he noted weak legislative and organizational
infrastructures as a major challenge. Studies by Kemoni and Wamukoya (2000),
and Egwunyenga (2009) confirmed that African records keepers lack the basic
skills and competences for handling records and archives in the public sector.
There is a serious problem of technophobia in most offices in Africa especially
among the older employees. Due to inadequate skills in information technology,
many traditional librarians, records managers, and archivists are very
conservative and have phobia for computers. This may be due to generation
gaps between the new and old professionals which led analogue information
managers to perceive computers as a threat to their status as experts.

Lawal (2007) attributed the challenges associated with records management in

most organizations to corruption or inadequate finance. According to him,
corrupt leaders in Africa do not provide adequate funds, facilities, and
infrastructure for proper and efficient electronic record management. Instead,
corrupt bureaucrats intentionally distort public policies, public records,
decision-making apparatuses, and sometimes go to a length to transfer
experienced records managers in a bid to create opportunities for
embezzlement.
Otuama (2010) mentioned the following as the problems associated with
records management in most organizations: absence of an archival institution;
the problem of oral traditions; inadequate skills and high staff turn-over;
inadequate funding; poor housing and equipment; absence of an archival law;
high levels of illiteracy; poor transport and communication network.

Brendan (2012) opined that, growing use of information technologies in record

management creates a lot of problems in the management of records in both
public and private organizations. He added that in Africa and many developing
countries governments are looking forward to computerizing their core
functions and compelled most African countries to use ICTs in their public
services by adopting e-government. Regrettably these projects fail to succeed
because governments neither assess the available information framework
suitable for electronic records management, nor consult the records mangers to
determine how the process of automation will not affect the role of records
managers in providing reliable and authentic evidence.

In the case of manual records, it is established that the greatest issue is lack
space for the increasing number of health records. With concern to physical
space for storage of paper health records, Dollar (2002) notes that it is a
challenge many institutions will keep battling with. Hospitals producing
hundreds to thousands of records each day means that after a given period of
time the records accumulate huge volumes of paper records. This may bring
about difficulty in locating some records and also lack of sufficient space to
carry all the records before they are disposed. This becomes the major challenge
for paper records. For electronic records many challenges have been identified.
These challenges include high costs of installation, system failure, cyber-crime,
lack computers operational skill of the record management staff. The study
focused on the aspect of legal requirement and technological obsolescence, in
electronic records management. Unlike paper, loss of electronic records is
guaranteed unless actively managed. Paper can be ignored for years, and when
it is opened the information is perfectly readable.

If the state ignores electronic records for 10 years, the fragility of the media and
technological obsolescence will make access difficult. The longer one waits to
manage these records, the less likely the data will be recoverable. Therefore, the
condition poses a challenge of obsolescence of electronic records management
systems, hence the record therein. The Department of Technology Services,
Philippines (2012), also points out that like the floppy disc, the CD, or its
operating system, may become obsolete in the future, requiring State Archives
to either maintain obsolete technology or to upgrade or convert information to
newer technology formats. All the options mentioned above will be costly. This
means that there is need to always keep up to date with the new technologies to
make sure that the information available in the current formats can be accessed
even in future when technology has changed.

Another challenge of electronic health records management, according to the

International Record Management Trust (2006) is that of legal requirement. The
Trust argues that, in hospitals where the introduction of a patient administration
system is feasible, it may be possible to dispense with certain types of records
needed in a paper based environment. In particular, the patient registers are
likely to be deemed irrelevant or less necessary. Where the registers above
constitute duplicate records of the same information in different formats, their
use can be discontinued where appropriate computer systems are in place.
Nevertheless, where the content of paper registers may be needed for legal or
archival purposes, appropriate measures must be taken before any decision is
made to rely solely on the electronic system and to abandon paper altogether.
These legal requirements may include the need to sign, by hand, a document to
authorize for instance a medical operation on a patient.

2.4 Suggest possible solution……………….

2.4 Research Gap
Notably From many researcher very little have been discussed on the effects of
health records management on service delivery in public hospitals. Again little
has been done on determining adequacy of records managers in hospitals and
their qualifications. To fill the gap the research was covered out.

2.5 Conclusion
In summary, this chapter gave an overview of related literature in health records
management practices. It covered the contextual overview of records
management and services provision. It gives an overview of what has already
been researched in the field of study and the opinions and findings from other
researchers and scholars in the field.
 REFERENCES
CIA/ICA, & Trust, I. R. M. (2016). Managing Metadata to Protect the Integrity
of Records. Digital Preservation in Lower Resource Environments from
http://www.ica.org/sites/default/files/Metadata Module.pdf
Abdulazeez, J., Abimbola, A., Timothy, S., & Linda, N. (2015). Challenges of
Record Management in two Health Institutions in Lagos State , Nigeria.
Records Management Systems.
Bigirimana, S., Jagero, N., & Chizema, P. (2015). An Assessment of the
Effectiveness of Electronic Records Management at Africa University ,
Mutare , Zimbabwe https://doi.org/10.9734/BJEMT/2015/15460
Chinyemba, A. (2005). Managing records at higher education institutions : a
case study of the University of KwaZulu-Natal, Pietermaritzburg
Campus.
Wong, R., & Bradley, E. H. (2009). Developing patient registration and medical
records management system in Ethiopia. International Journal for Quality
in Health Care, 21(4), 253–258. https://doi.org/10.1093/intqhc/mzp026
Unegbo. (2018). Health Care Records -Documentation and Management
Applies to Health Care Records Retrieved from
http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2012_069.
pdf
Ngulube, P., & Tafor, V. F. (2006). The Management of Public Records and
Archives in the Member Countries of ESARBICA. International Records
Management Trust, 27(1), 57–83.
https://doi.org/10.1080/00039810600691288
Lynn, F. (2012). Health Records Management. Trust Governance Commitee.
Mampe, G. (2008). Records management and service delivery : the case of
Department of Corporate Services in the Ministry of Health in Location
of the study : The Ministry of Health.
Fahad, D., Hanifa, B., Joseph, S., Kubra, N., Musah, K. C., Anyango, O. D., …
Richard, N. (2009). An Automated System for Patient Record
Management.
Marutha, S. N. (2011). Records Management in support of Service Delivery in
the Public Health Sector of the Limpopo Province in South Africa
(Master of Information Science). University of South Africa.
Marutha, N. S. (2017). A framework to embed medical records management
into the healthcare service delivery in Limpopo Province of South Africa,
PhD Thesis, University of South Africa
Kemoni, H. N., Ngulube, P., & Stilwell, C. (2007). Public Records and
Archives as Tools for Good Governance: Reflections Within the
Recordkeeping Scholarly and Practitioner Communities. ESARBICA
Journal
Kemoni, H., & Ngulube, P. (2008). Relationship between Records
Management, Public Service Delivery and the Attainment of the United
Nations Millennium Development Goals in Kenya.
Adu Freda. (2014). Assessment Of Records Management Practices Among The
Administrative Staff Of University Of Education. Retrieved from
http://ir.knust.edu.gh/bitstream/123456789/7540/1/Adu%20Freda.pdf