KNOWLEDGE, ATTITUDE AND PERCEPTION OF HEALTH

RECORD PRACTITIONERS TOWARDS DIGITAL PRESERVATION

OF PATIENT’S RECORDS

(A CASE STUDY OF UNIVERSITY OF MEDICAL SCIENCES TEACHING

HOSPITAL, ONDO, ONDO STATE)

BY
OMOTAYO OMOLOLA
MATRIC NO: CHTA/HIM/2020/407

A PROJECT SUBMITTED TO THE DEPARTMENT OF HEALTH

INFORMATION MANAGEMENT, ONDO STATE COLLEGE OF

HEALTH TECHNOLOGY AKURE, ONDO STATE, NIGERIA.

March, 2023.

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 CHAPTER ONE
INTRODUCTION
1.1       Background to the Study

Across the world, effective digital preservation has been directly associated with the

attitude and interest of a Health information professionals. The application of computer

technology to information management services has caused significant changes in many

institutions and organizations across the world. Cooper (2018) opined that the advent of the

internet, digitization, e-learning resources and the ability to access information and patient

records from remote locations created dramatic changes in the functionality of health institutions,

organizations and even libraries.

International Records Management Trust (2018) stated that health records management

program is run in diverse ways in different parts of the world, although differences depend on the

needs and scope of service of the specific hospital or health institution. Iron Mountain (2017),

notes that health care provider ensures competent service provision and proper health

information management to keep costs down, secure patient data, and maintain compliance in

rapidly expanding regulatory environment. This means that hospitals determine the priorities

rolled by the record management policy. The role of the health record manager is to develop

policies for health records management and procedures in order to promote better health records

management practice in the hospitals as working together with heads of departments. Today’s

information professionals are faced with the task of preserving digital resources and the related

technology required to make sense of them.

However, Hedstrom (2018) argues that it is not solely the information professional’s

concern. The unique aspects of digital objects require early intervention for successful long-term

preservation. Thus, the traditional preservation roles held by information professionals are

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creeping across professional boundaries. Government agencies, corporations, and research

libraries all hold considerable amounts of digital information that will need to be preserved into

the future and it is the organization’s responsibility to ensure preservation (Hedstrom, 2018). A

discussion of the nature of digital resources helps to explain their increasing ubiquity in

organizations and libraries as well as the unique challenges of digital preservation. Electronic

documents can improve accessibility to heavily used resources, allow users to manipulate and

annotate the information, as well as increase access points to underutilized information.

Certainly, these benefits play a role in organizational decisions to include digital resources in

their holdings (Vicente, and Ruth, 2017). However, electronic documents have unique

preservation needs that cannot be fully met by the implementation of traditional preservation

processes, hence, positive attitude and interest of the information professional is required to

ensure successful digital preservation.

Cook (2017) stated that unlike their paper-based predecessors, digital documents are not

eye-readable. Instead, digital materials are dependent on technology, which is constantly

evolving, for interpretation. Digital preservation is further complicated by the digital material’s

reliance on contextual information and documentation (Ross, 2018). Today’s Health Information

professionals, however, are not facing digital preservation empty handed. The community has

discussed the challenge of preservation of electronic documents through the development of

content preservation strategies: attitude of information professional, migration, emulation, and

digital archeology. Health Information professionals have been involved in the development of

open access digital preservation tools, an online file format registry and the Reference Model for

an Open Information System (OAIS), which provides a framework for long-term digital

preservation and access.

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 In Nigeria nowadays, it is imperative for Health information professionals to actively

participate in a robust digital preservation strategy to preserve both content and access long term,

although there seems to be a large majority of health institutions that are not actively engaged in

or perhaps even concerned with digital preservation. The current researcher is of the opinion that

attitude and interest of the information officer will determine if the traditional preservation

system is going to be overhauled and replaced with modern digital preservation approach.

Bhatnagar (2016) attempt to inform institutions of the benefits and processes of digitization. He

further expresses awareness that obsolescence is a huge threat to digital materials and is careful

to note the high financial cost of digitization. A health information professional or information

specialist is someone who collects, records, organizes, stores, preserves, retrieves, and

disseminates information. The current research is of the assumption that attitude and interest of

information officer is the determinant of effectiveness in the discharge of the duties required of

the office.

1.2 Statement of the Problem

paramedical practitioner as well as the patients. The health record is the who, what, why, where,

when and how of the patient care during hospitalization (Huffman, 2014). Health information

management department and health information managers plan information systems, develop

health policy and identify current and future information needs. They apply the science of

informatics to the collection, storage, use and transmission of information to meet legal,

professional, ethical and administrative record keeping requirements of health care delivery.

Health is wealth and one of the statutory institutions that provides and supports citizenry’s health

is a hospital. According to Yeo (2016, hospitals are those institutions that deal with the life and

health of their patients. Good medical care also relies on good record keeping. Without accurate,

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comprehensive, up-to-date and accessible patient case notes, medical personnel may not offer the

best treatment or may, in fact, misdiagnose a condition, which can have serious consequences.

In most African countries like Nigeria, preservation of hospital documents and records

has posed a serious problem. The worsening of the materials used, non-availability of filling

space and inappropriate record management policies form the basic problems that give rise to

poor preservation of records. Hence, it is on this premise that this project is set to examine the

knowledge, attitude, perception of Health Record Practitioners towards digital preservation of

patient records at the University of Medical Sciences Teaching Hospital, Ondo State.

1.3 Objectives of the Study

The broad objective of the study is to examine the Knowledge, attitude, perception of

Health Record Practitioner towards digital preservation of patients records at University of

Medical Sciences Teaching hospital, Ondo State.

The specific objectives of this study are:

1. to determine the Knowledge of Health Information Management professionals towards

Digital preservation at University of Medical Sciences Teaching Hospital, Ondo State.

2. to determine the attitude and perception of Health Information Management professionals

towards Digital preservation at University of Medical Sciences Teaching Hospital, Ondo

State.

3. to identify the factors militating proper digital preservation of patients records in

University of Medical Sciences Teaching hospital, Ondo State.

1.4 Research Questions

1. What is the Knowledge level of Health Information Management professionals towards

Digital preservation at University of Medical Sciences Teaching Hospital, Ondo State?

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 2. What is the attitude and perception of Health Information Management professionals

towards Digital preservation at University of Medical Sciences Teaching Hospital, Ondo

State?

3. What are the factors militating proper digital preservation of patients records in

University of Medical Sciences Teaching hospital, Ondo State?

1.5 Scope of the Study

The scope of this study was purely designed to examine the Knowledge, attitude,

perception of Health Record Practitioner towards digital preservation of patients records at

University of Medical Sciences Teaching Hospital Ondo state. The study covered majorly Health

Information Management Department staffs.

1.6 Significance of the Study

Outcome of this research would be useful to the government, policy makers, information

professional, researchers, information seekers and the general public as it reveals the attitude and

interest of information professionals towards digital preservation. It would also expose the

factors militating against digital preservation among information professionals therefore bringing

about strategies that will result in the improvement of information management. This research

would contribute to the body of literature in the attitude and interest of health information

professionals towards digital preservation, thereby constituting the empirical literature for future

research in the subject area.

1.7 Operational Definition of Terms

 Health: According to World Health Organization (W.H.O), Health can be defined as the

state of complete physical, mental, and social wellbeing of an individual not merely the

absence of disease nor infirmities.

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 Hospital: A place where people who are ill or injured are treated and taken care of by
doctors and other health practitioners.
 Healthcare: Is the maintenance or improvement of health via the diagnosis, treatment,

and prevention of disease, illness, injuries, and other physical and mental impairments in

human beings. Healthcare is delivered by health professionals

 Preservation: This is the means by which archives and records are protected for both

present and future use. This is an aspect of information management which implies the

survival of the physical medium which contains the information whether printed, hand

written or electronic.

 Digital preservation is a set of processes and activities that maintain information stored

in digital formats in order to ensure continued access to information.

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 CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction

There is need to review what digital preservation records, it's history and benefits with

the aim of identifying its importance as well as methods of preserving, this chapter entails

various theories from numerous scholars or intellectuals in relation to the subject matter. As a

result, a number of relevant literatures have been consulted and quoted from. Therefore, this

literature review shall be approached under the following subtitles.

 The concept of records

Association of Records Managers and Administrators (ARMA) described records as the

evidence of what an organization does. Records capture business activities and transactions, such

as contract negotiations, business correspondences, personnel files, and financial statements of

organizations. Association of Records Managers and Administrators identified two formats of

records in any organization. These are physical paper in our files, such as memos, contracts,

marketing materials and reports. Electronic messages, such as e-mail contents and their

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attachments and instant messages content on the website, as well as the documents that reside on

flash drives, desktops, servers, and document management systems. Information captured in the

organization's various databases (Association of Records Managers and Administrators, 2020).

They further define records as information created, received, and maintained as evidence and

information by an organization or person, in pursuance of legal obligations or in the transaction

of business. A record can be either a tangible object or digital information such as birth

certificates, medical x-rays, office documents, databases, application data, and email

(Association of Records Managers and Administrators, 2020).

The Society for American Archivists (2021) provides a robust definition consisting of

seven elements. These are written or printed works of legal or official nature that may be used as

evidence or proof. Data or information that have been fixed on some medium, that has content,

context, and structure, and that is used as an extension of human memory or to demonstrate

accountability. Data or information in a fixed form that is created or received in the course of

individual or institutional activity and set aside (preserved) as evidence of that activity for future

reference. An instrument filed for public notice (constructive notice), Audio: A phonograph

record. Computing: a collection of related data elements treated as a unit, such as the fields in a

row in a database table. Description: an entry describing a work in a catalog; a catalog record

(Society for American Archivists, 2021).

Health records are very important in the management and treatment of patient, Huffman

(2014) defined health records “as compilation of pertinent fact of a patient life history including

past and present illnesses and treatment written by health practitioners contributing to patient

care” he also states that health record must be compiled in a timely manner and should contain

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sufficient information to identify the support for diagnosis or reason for health care encounter to

justify the treatment and ensure accurate documentation of the result.

2.2 A Brief History of the Health Records

The main goal of health institutions is the provision of efficient services that enhance

health and prolong life of patients. Achieving this goal therefore requires that there is presence of

reliable and accurate health records. Records are used to hold health institutions accountable for

the service delivery. Mogli (2015) considered health records as documents used by health

institutions and caregivers to record patient history, illness, illness narratives and treatment.

Luthuli and Kalusopa (2017) conceived health records as written account of patients’

examination and treatment that include the patients’ medical history, illness narratives and

complaints; the physician’s findings; and the results of diagnostic tests, procedures, medications

and therapeutic procedures. Connectedly, the World Health Organization (2016a) classified

health records to include doctors’ clinical notes; recording of discussion with patient /next of kin

as regards disease; referral notes to other specialist(s) for consultation; laboratory notes; imaging

reports; clinical photographs; drugs prescriptions; nurses’ reports; consent forms; operation

notes; video recordings; and printouts from monitoring records. Advancing the importance of

health records, Adeleke (2014), stresses that health records are needed for delivery of services in

health institutions. Among other purposes, records management provides availability of reliable

and timely information to various end users.

Luthuli (2017), also notes that records management involves accountability, security,

integrity and comprehensiveness. Records Management is therefore considered as the process of

controlling and governing important records of an institution in a comprehensive and complete

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cycle. The process includes identifying, classifying, prioritizing, storing, securing, archiving,

preserving, retrieving, tracking and destroying of records. Health records management also

involve appraisal, retention and disposal, which eventually eliminate ephemeral records that are

no longer useful to healthcare institutions. The objectives of records management as highlighted

by Feather & Sturges (2013) include cost reduction, improved productivity by quick access to

needed records, enhanced litigation avoidance and support, increased audit compliance. Mogli

(2016) conceives service delivery as activities performed by an organization, in line with its

mandate aimed at satisfying, responding and resolving community or citizen problems. Service

delivery in healthcare therefore, is considered as a contact between service providers and

consumers. Service delivery in healthcare institutions manifests in forms of appropriate illness

diagnosis, accurate laboratory tests, correct medication and follow-up treatment. Connectedly,

Kemoni & Ngulube (2015) opine that effective records management is a key factor in the

delivery of service in health institutions. Thus, achieving service delivery requires that health

organizations develop, promote and implement effective records management philosophy and

ideology.

There are agencies and professional associations saddled with the responsibility of

ensuring that records generated by medical practitioners involved in the provision and delivery

of services to patients are efficiently managed in the best interest of patients and healthcare

institutions. With reference to Nigeria, Osundina et.al, (2016) identify Health Records Officers

Registration Board of Nigeria; Nigeria Medical Council, Nurses and Midwifery Council of

Nigeria, among others as agencies and associations that regulate the practice of medical records

management. Against this background, this article provides proper knowledge and orientation of

the subject matter of health records management in the context of service delivery in healthcare

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institutions. It is divided into six sections: the methodological approach towards understanding

the subject matter, the historical development of medical records, issues of medical records

management and service delivery in health organizations and the challenges associated with

medical records management in healthcare institutions.

2.3 Procedures in medical records.

Hospitals is dependent on its medical records to deliver care efficiently and to account for

its actions. This procedure defines the structure and processes for the management of clinical

records. Records management through the proper control of content, storage, transporting and

access to records reduces the risk of poor medical care, due to missing records, legal challenge

and financial loss (Oromi, 2014). This procedure sets out the way in which organizations will

meet its legal obligations in relation to the Data Protection Act 1998, and Freedom of

Information Act 2000 and standards set by the Care Quality Commission, The Health and Social

Care Information Centre, and the NHSLA in respect of records management. This procedure

should be read in conjunction with the Corporate and DET Records Procedure.

2.3.1 Responsibility and accountability

Responsibility for the maintenance of appropriate health care records must be included in

the terms and conditions of appointment (including position descriptions) for all health care

personnel. Documentation must be included as a standing item in annual performance reviews of

clinicians. Failure to maintain adequate health care records will have grave results on the patient

care (Abdulazeez et.al, 2016).

2.3.2 Individual health care record

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 An individual health care record with a unique identifier (e.g. unique patient identifier,

medical record number) must be created for each patient / client who receives health care (Musa,

2018). Every live or still born baby must be allocated a unique identifier that is different to the

mother. Where multiple patient identifiers exist for the same patient / client must be processes

established for their reconciliation and linkage, with the ability to audit those processes. A

reference notation should be placed on the health care record to identify any relevant other

documents that relate to the patient’s health care. Index or patient administration systems must

reference the existence of satellite / decentralized health care records that address a specific issue

and that are kept separate from the principal health care record. Due to the nature of the

information contained in sexual assault records these must be maintained separately from the

principal health care record and be kept secure at all times; as should child protection / wellbeing

and genetics records. Staff screening and vaccination records are considered as personnel rather

than health care records and must be maintained separately.

2.3.3 Access to Health Records

Health care records should be available at the point of care or service delivery. Health

care records must not be removed from the campus unless prior arrangements have been made

with for example required for a home visit, required under subpoena. Health care records are

only accessible to: a) Health care personnel currently providing care / treatment to the patient /

client, b) Staff involved in patient safety, the investigation of complaints, audit activities or

research (subject to ethics committee approval, as required) consistent with relevant legislation

d) Patient / client to whom the record relates, or their authorized agent, based on a case by case

basis in accordance with health service release of information policies and privacy laws and e)

Other personnel / organizations / individuals in accordance with a court subpoena, statutory

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authority, valid search warrant, coronial summons, or other lawful order authorized by

legislation, common law (Read et. al, 2016). All requests for information, that is contained in a

patient / client’s health care record, from a third/ external party should be handled by

appropriately qualified and experienced health care personnel, such as Health Information

Managers, due to the sensitive nature of health care records; the special terminology used within

them; and regulatory requirements around access to, and disclosure of, information.

2.3.4 Ownership of Health Records

The health care record is the property of the health organization providing care, and not

individual health care personnel or the patient / client. Where shared care models or

arrangements exist for clinicians to treat private patient / clients within health facilities / settings,

responsibility for the management of those health care records must be included in the terms of

the arrangement between the PHO and the clinician (Adeleke, 2014).

2.3.5 Retention and Durability Health Records

Health care records must be maintained in a retrievable and readable state for their

minimum required retention period. Entries should not fade, be erased or deleted over time. The

use of thermal papers, which fade over time, should be restricted to those clinical documents

where no other suitable paper or electronic medium is available e.g. electrocardiographs,

cardiotocographs. Electronic records must be accessible over time, regardless of software or

hardware changes, capable of being reproduced on paper where appropriate, and have regular

adequate backups (Lynn, 2017)

2.3.6 Storage and security Health Records

Cuming & Thompson, (2017) establishes statutory requirements for the storage and

security of health care records, health information, including healthcare records, must have

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appropriate security safeguards in place to prevent unauthorized use, disclosure, loss or other

misuse. For example, all records containing personal health information should be kept in

lockable storage or secure access areas when not in use. Control over the movement of paper-

based health care records is important (Khumalo, 2017). A tracking system is required to

facilitate prompt retrieval to support patient / client care and treatment and to preserve privacy. A

secure physical and electronic environment should be maintained for all data held on computer

systems by the use of authorized passwords, screen savers and audit trails. If left unattended, no

personal health information should be left on the screen. Screen savers and passwords should be

used where possible to reduce the chance of casual observation. Consideration may be given to

providing staff with different levels of access to electronic records where appropriate (i.e. full,

partial or no access).

2.3.7 Disposal of Health Records

The proper disposal of health care records, both paper-based and electronic, to preserve

privacy and confidentiality of any information they contain remains crucial. Disposal of data

records should be done in a manner that renders them unreadable and from which they cannot be

reconstructed in whole or in part. Paper records containing personal health information should be

disposed of by shredding, pulping, or burning. When dealing with large volumes of paper,

specialized services for safe disposal of confidential material should be employed. The disposal

of health care records must be documented in the health organization’s Patient Administration

System and undertaken in accordance with the relevant State General Disposal Authority

(Ginsberg, 2021).

2.4 Digital Preservation

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 Digital preservation refers to the policies, actions, and strategies performed on digital

content over time to ensure its accurate rendering despite media failures and technological

changes (Delaney & Jong, 2021). It involves a digital lifecycle process that includes data

acquisition, ingest, metadata creation, storage, preservation management, and access (Gracy &

Kahn, 2012; Delaney & Jong, 2021). These processes apply to both created and reformatted

digital content.

Standards and guidelines exist for defining levels of digital preservation services, with

the Open Archival Information System (OAIS) serving as a reference model with guiding

principles for long-term digital preservation, developed by the Consultative Committee for Space

Data Systems (Delaney & Jong, 2021). OAIS categorizes information required for preservation

as Packaging Information, Content Information, including Representation Information and

Preservation Description Information (Woodyard, 2015). These categories define how and where

the bits are stored, how to interpret the bits into data, and how to interpret the data as information

(Woodyard, 2015).

Delaney and Jong (2021), there are two key concepts to digital preservation, being

integrity and authenticity. Integrity means that the content is not corrupted over the timespan of

the preservation, and authenticity means that the content is what it claims to be. Integrity and

authenticity are ensured by the strategies, actions, and workflows that the content goes through

as well as the systematic metadata registration of the content during its whole life-cycle (Delaney

& Jong 2021). Metadata provides users a way to manage digital objects and can be used for

auditing in terms of tracking the history of the object and providing proof of the origin of the

source, which is important for the life-span of the object (Qarabolaq, Inallou, Hafezi, & Tabaei,

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2016). Metadata in digital preservation is essentially needed for ensuring accessibility long-term

(Woodyard, 2015).

2.5 Electronic Health Records

Electronic Health Records is described by the Centers for Medicare & Medicaid Services

(CMS) as an electronic version of a patient’s medical history that is maintained by the provider

over time (Albert, 2018). Kohli & Tan (2016) refers to as vehicles for improved communication.

Electronic Health Records must have guaranteed availability, integrity and confidentiality and

follow various legislations (Ruotsalainen & Manning, 2022). An Electronic Health Records may

include laboratory tests, diagnostic imaging reports, observations, treatments, therapies, drugs

administered, patient identifying information, legal permissions, and allergies (Eichelberg, Aden,

Riesmeier, Dogac, & Laleci, 2015) (Jardim, 2015). Attention to Electronic Health Records was

increased as soon as information systems deployed automatic functionalities for patient

registration, order of clinical tests, transmission of test results, etc. (Kohli & Tan, 2016).

Furthermore, electronic health records are not simply scanned versions of paper charts. In many

cases, they contain more metadata than data itself (Albert, 2018). Metadata for electronic health

records includes handwritten notes for the specific patient as well as an audit trail of access. One

can also look on metadata for electronic health records as evidence since it provides the record’s

origins, context, authenticity, reliability, and distribution (Albert, 2018).

2.6 Knowledge on Digital Preservation

The information age is characterized by many opportunities as well as challenges

including information explosion which has affected the production of both electronic and print

information sources. Large quantities of information and information sources now exist in digital

forms, including emails, social networking websites, e-journals, e-books and databases, which

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change rapidly in content and forms. This, coupled with other needs and challenges makes the

concept and measures of digital preservation very imperative. Digital preservation (DP)

combines policies, strategies and actions to ensure the accurate rendering of authenticated

content overtime, regardless of the challenges of media failure and technological change. It

documents an organization’s commitment to preserve digital content for future use (ALA, 2017).

Electronic records that are not protected against the challenge of technological change are likely

to be inaccessible with time. As a result of advances in information and communication

technologies (ICTs), digital information management became the trend in health information

services across the world. This is unconnected with the advantages of digital information and

media over physical ones. They guarantee economy of space, timely information access and

management, remote access, diverse form of information (multimedia), ease of information

sharing and distribution, among others. Libraries are now encouraged to adopt digital

information and sources as a result of these benefits and render quality services to users. But

many health records libraries undertake digitalization projects and collection development

without adequate knowledge of digital resource management and careful analysis of their choice.

Giordano (2017) asserted that, knowledge of health information professionals concerning

digital preservation has not made much progress. Therefore, serious considerations are needed to

ensure digital information management and preservation. Health records Libraries as well as

Health information professionals require strong knowledge of digital preservation, management

support, efficient and effective strategy or policy, positive attitude and actions, and adequate

knowledge to manage and preserve information and sources. Nigeria also need to develop robust

model and curriculum to impact on students’ knowledge about digital media management and

preservation. The goal of digital preservation is the accurate rendering of authenticated contents

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over time. Preserving the content of a digital format has become a crucial issue in libraries. There

is a need to preserve information materials that are available in electronic format for future use,

like the printed materials (Adeleke, 2014).

2.7 Attitude towards Digital Preservation

Digital preservation was described by ALA (2017) as combined policies, strategies and

actions to ensure the accurate rendering of authenticated content over time, regardless of the

challenges of media failure and technological change. The Joint Information Systems Committee

(2020) defined digital preservation as “the series of actions and inventions required to ensure

continued and reliable access to authentic digital objects for as long as they are deemed to be

valued. Satish and Umesh (2015) stated that digital preservation means taking steps to ensure the

longevity of electronic documents. It applies to documents that are born digital and stored online

(or on CDROM, diskettes or other) or to the products of analogue-to-digital conversion.

Russell reported in 2017 the results of a survey on health professionals attitude indicated

that (92%) of institutions were already digitizing from source materials, only (29%) had written

policies or plans for digitization. While (59%) of respondents reported that their digital materials

had a need life of 25 years or longer, which was the longest option offered in the questionnaire,

only (13%) had written plans or policies for digital preservation. This data suggested that

institutional planning for digitization lagged far behind creation and confirmed our view that

institutions needed help with policy development. The results of two studies — one in Europe

and one in North America — published in 2011 indicate that progress has been made, but there is

still a gap between preserving digital objects and having articulated policy to govern and manage

the process. A 2009 Planets project survey showed that: Nearly half (48%) of the organizations

surveyed have policies for the long-term management of digital information, where long-term is

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defined as greater than five years. This varies by organization; (64% of archives, and 43% of

libraries, have a digital preservation policy. However, only one-quarter (27%) of government

departments, and the public sector in general, have a digital preservation policy in place.

Similarly, a spring 2010 survey of 72 Association of Research Libraries institutions (ARL is the

nonprofit organization of 126 research libraries at comprehensive research institutions in the

United States and Canada that share similar research missions, aspirations, and achievements)

indicated that (52%) have preservation policies for their institutional repositories.

2.8 Factors affecting Digital preservation in Health Record System

Digital projects are expensive. Many health practitioners understand the benefits of

hospital information and communication technologies, but they do not find easy justification for

the cost (Thielst, 2017). Digitization of records requires enormous funding due to frequent

hardware and software upgrades, and increasing cost of subscription to electronic databases, this

makes them to be easily by information seekers globally (Jain, 2016). The upgrade and running

cost burden is remarkable and outside the reach of small hospitals and health care trusts.

Compounding the cost issues, the lack of interoperability of information systems marketed by

different vendors is a significant concern (Brailer, 2015).

Management of electronic health record systems is constantly evolving with different

systems currently available to service various clinical applications, facilitate strategic decision

making and improve administrative workflow (Hikmet et al., 2017). Due to inadequate skills in

information technology, many traditional librarians, record keepers and archivists are

conservatives and have phobia for computers. Because of generation gaps between the new and

old professionals, computers are perceived as a threat to their status as experts (Ayoku et al,

2018). Problems with interoperability continue to hamper the seamless retrieval of patient

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information across different operating systems, limiting easy and universal access to patient data

that the technology is intended to support (Arrow et al., 2017). Hospital information technologies

face additional limitations such as wrong identification, incomplete or inaccurate information

documented in hospital systems, and the possibility of unauthorized changes to patient

information (Fuji et al., 2015).

One of the challenges in preserving and conserving hospital records in developing

countries is the lack of education among record keepers on the best practices for handling

hospital records. This challenge is exacerbated by the fact that preservation of records is not a

central focus in most medical science curricula, and specialized education in the preservation and

conservation of archives and records is not widely available (Adeyemi, 2017).

There is a shortage of human capital, and few librarians possess the necessary basic

knowledge of computer science and its applications. Those who do often work in archives and

record units, leading to frequent breakdowns of ICT facilities and disruption of services in

digitized record units. The lack of human resources with appropriate skills, competencies, and

attitudes presents a challenge to initiating, implementing, and sustaining digitization projects

(Chinyemba et al., 2014). Additionally, frequent power outages in Africa make the cost of

running digitization projects prohibitive (Zulu, 2016).

According to Benham-Hutchins (2018) because of challenges involved in integrating new

hospital information systems with old paper documentation and record systems, clinicians, and

other health care practitioners may become encumbered with multiple and conflicting sources of

patient information. Multiples of paper and electronic documentation may disrupt a seamless

workflow and influence the quality and efficiency of service delivery. These circumstances also

have the potential to cause new types of medical errors resulting from poor harmonization of

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patient information. Understanding these concerns requires examination of human factors in the

design of technology that is able to adapt to the way health care providers do their job. The

delivery of patient-friendly services demands that health care providers continue to work toward

improvement in the method of care pathways and processes.

Every innovation and creativity that made impact and advances the cause of humanity

has its inherent challenges. Such challenges are not surmountable if there are dedicated personnel

to study and implement procedures and policies. The challenges of digital information

management and preservation which include machine dependency, technological obsolescence,

and tranquility of storage media, integrity, authenticity and history of digital materials (Satish &

Umesh, 2015) and human errors could be improved upon with dedicated professionals. Hedstrom

(2014) stated that absence of established standards, protocols, and proven method for preserving

digital information are a challenge to digital information preservation.

Wilson (2019) has noted that computer systems and software applications change so

rapidly that there is no guarantee that existing data sources will be accessible and usable on

future computing platform software versions. Strategies to avert impending unforeseen

circumstances need to be put in place by librarians. Gladney (2018) also posited that the software

currently available does not include good tools for saving digital originals in the face of rapid

hardware and software obsolescence.

2.9 Digital Preservation Strategies

A large number of materials or resources exist in digital forms: e-mails, blogs, social network

websites, national websites, etc. Electronic information includes a variety of object types such as

electronic journals, e-books, databases, data sorts, reference works, and websites (Hodge, 2016).

Hedstrom (2014) stated that digital preservation should be examined in two perspectives: users

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hoping to get satisfaction from access and the use of digital materials; and the library satisfying

the immediate needs of the users. According to him the mechanisms that will enable users to

establish authenticity require libraries to store much more than the content of digital documents.

Digital information in libraries can be preserved by copying, refreshing, or migration,

transferring from less stable magnetic and optical media by printing on paper or microfilm, and

preservation in simple digital formats in order to minimize the requirements for sophisticated

retrieval software. Digital preservation programmes include preparing materials along with

associated documentation or metadata into an archival digital storage system where they can be

managed to deal with the threats of data loss or technology change. It involved:

 Controlling the material sufficiently to support its long-term preservation.

 Ensuring that the material will remain understandable to this defined community of

expected users.

 Making the preserved material available to the designated community of users as

appropriate.

 Advocating good practice in the creation of digital resources (National Library of

Austria, 2014).

 Negotiating for and accepting appropriate digital materials from producers

 Working out for whom the material is being kept and who will need to be able to

understand it

 Ensuring that the materials is protected against all likely threats, and enabling the

material to be accessed and its authenticity trusted

23
 Gbaje (2014) posited that digital preservation strategy is a method for keeping stored digital

objects permanently accessible for long-term use. He also pointed out that strategy is a

crucial part of managing the risk associated with rapid hardware and software obsolescence.

In 2006, the Online Computer Library Center developed a four-point strategy for the long-

term preservation of digital objects. They include:

 Determining the appropriate metadata needed for each object type and how it is

associated with the objects.

 Providing access to the contents.

 Assessing the risks for loss of content posed by technology variables such as

commonly used proprietary file formats and software applications.

 Evaluating the digital content objects to determine what type and degree of format

conversion or other preservation actions should be applied.

There are different kinds of strategies that can be adopted by libraries and information centers to

preserve digital information. Some of the digital preservation strategies are described thus:

Technology Preservation: A method for ensuring ongoing access to digital objects. It involves

keeping the old technology, that is, hardware and software that were used to create and access

the digital information in their original form and environment.

Technology Emulation: It refers to creating new software that mimics the operations of older

software and hardware in order to reproduce its performance. It helps to maintain integrity of the

original look and feel of the material.

Metadata Management: It is required to track lineage of digital objects. Metadata is needed to

preserve the object and for users in future to find and access it.

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Printing/Output to Paper: This is sometimes referred to as change media. It involves printing

of digital materials and preserving the paper copy. The advantage of outputting or printing on

paper could be preservation of content and to some extent layout (Hodge, 2016).

Digital Archaeology: It denotes method and procedure to rescue content from damaged media

or from obsolete or damaged hardware and software environments, the recovery of digital

materials at risk.

Migration: It covers a wide range of activities to periodically copy, convert, and transfer original

information from one generation of technology to subsequent ones.

2.10 Need for Digital Preservation

The need for digital information can be considered from the benefits and challenges of

digital information resources. Libraries can preserve them in order to ensure continuous

rendering of better services and the attendant benefits. Again, library can also preserve them to

guard against threat to digital resources and services (Beafrie, 2016). Digital information has a

lot of benefits to libraries and users. Hence, it is important for libraries to give adequate

consideration for the preservation of the resources. Beafrie (2016) identified information growth,

information explosion, e-research and collection-based science, the relative short life span of

digital storage media, the ephemeral nature of web documents and links, and the need for

regulatory compliance and retention as factors that have necessitated digital preservation.

Hedstrom (2014) in her paper identified vulnerability to deterioration, catastrophic loss, short life

span of digital media relative to traditional format materials and obsolescence in retrieval and

play back technologies as factors that make preservation of digital information imperative.

2.11 Empirical Review

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 Based on the literature consulted, preservation and conservation policy vary from one

institution to another depending on the nature of their collections and nature of their institutions,

as well as their goals. According to City of Westminster Archives Centre (2017) preservation

and conservation policy sets out appropriate practice for the care and management of the

collection and guidance for the preparation of master plans and detailed management plans.

Similarly, Gbaje (2014) submitted that preservation policy should explain how preservation can

serve the major needs of an institution and state some principles and rules on specific aspects

which then laid the basis of implementation.

Gray (2016) is of the view that any institutional policy should be directly connected to

the aims and goals of the institution and the preservation policy is no exception. Clearly

establishing the benefits of a preservation strategy at an early stage will allow these benefits to be

measured and will spell out the need for organizational commitment in preservation measures. It

further posited that it is important that a preservation policy is implemented as soon as possible.

It is best practice to have a preservation strategy in place even before any material is preserved,

so that everything can be captured to standards spelled out in the policy.

Similarly, Public Record Office of Northern Ireland (2015) submitted that the

formulation of a preservation policy for information centres is therefore an essential step in

fulfilling all their responsibilities and gives them the direction it requires to initiate measures

which are necessary for the protection of its information resources. The policy also enables staff

to meet, or extend, nationally and internationally agreed standards for the preservation of

archival materials. Sharing this view, Forde as cited in Ngulube (2015) described preservation

policies for cultural materials as indispensable tools for organizations that are committed to

facilitating the survival of materials in their custody. Policies are important because they set out

26
goals to be achieved as well as guidelines for implementing them. While Feather & Eden (2018),

on the other hand, codified and stipulated or prescriptive policies facilitate a creative allocation

of funds and staff, and specify other aspects of implementation and monitoring.

However, Wamukoya & Mutula (2016) stated that most African countries do not have a national

information policy which makes the formulation of preservation and conservation policies in the

libraries and information centers out of the question. Although the existence of preservation

policies does not guarantee their implementation, so without funding and personnel with

expertise, the implementation of preservation policies would be extremely difficult, but all the

same efforts must be made to formulate policies that encompass all activities that are

fundamental to the preservation of documentary materials into the future.

27
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0. Introduction

This chapter explains the means by which the researcher used in conducting the research. The

chapter gives the detailed information about the following sub-headings:

 Research design

 Population of the study

 Sample and sampling techniques

 Data collection instrument

 Reliability and validity of instrument

 Data collection procedure

 Methods of data analysis

3.1. Research design

Abdu (2015) described Research design as an outline or a scheme “Blue print” that serves as a

useful guard to the researcher in his effort to generate data for his study. Descriptive survey

design was employed to carry out the study through the administration of questionnaires because,

this type of research design is for developing theory, identifying problems with current practice,

justifying current practice, making judgment or determine what others in similar situation are

doing (Bamgboye, 2016). This research design was considered appropriate to answer the

research questions of the study.

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3.2 Population of the study

The research work was conducted at University of Medical Sciences Teaching Hospital,

Ondo town, Ondo State. The study population consists 128 Health Information Management

Staffs working in University of Medical Sciences Teaching Hospital, Ondo State.

3.3 Sample Size and Sampling Techniques

Instead of using a sample size, the study employed total enumeration as the research

subject population was minimal, and sampling methods were not practical. Complete

enumeration involves examining the entire population of interest rather than a subset or sample.

This method of data collection ensures that all units of the population are accounted for,

providing a more comprehensive understanding of the subject being studied. However, it can be

time-consuming and resource-intensive, especially in studies with large populations.

3.4. Data Collection Instrument

The ultimate aim of conducting research is to generate data that will be useful for the

analysis and interpretation of a study, regardless of whatever research method and instrument

used. The instrument that was used for this study is a well structed questionnaire. The

questionnaire was structured to consist mostly of closed ended type of questions. The

questionnaire is divided into sections:

Section A deals with the demographic information of the respondents

Section B: deals with Knowledge Health Information Management professionals towards Digital

preservation,

29
Section C: examined the attitude of Health Information Management professionals towards

Digital preservation,

Section D: examined the factors militating against proper digital preservation of records.

3.5 Reliability and Validity of the Instrument

To ensure the reliability of the instrument, the instrument was subjected to pre-test in

order to ascertain the consistence of the instrument. The instrument was also reviewed by an

expert for thorough scrutiny, as well as the project supervisor and other experts in the medical

field. The corrections and suggestions of these people helped in the modification of some of the

items in the questionnaire and validation of the instrument.

3.6 Data Collection Procedure

A verbal introduction was done at the point of administering the questionnaire. An

opening statement was written at the beginning of the questionnaire; the respondents were

briefed about the purpose of the study and were guided on how to fill the questionnaire correctly.

The respondents were assured about confidentiality of their information given. A total number of

92 questionnaires were designed and administered. Analysis was made based on the total number

of 90 questionnaires retrieved from the respondents.

3.7 Method of Data Analysis

The data from the questionnaire was edited to detect and correct possible errors and

omissions that were likely to occur and to ensure consistency across respondents. Data was

presented in frequency table and simple percentage.

30
 ONDO STATE COLLEGE OF HEALTH TECHNOLOGY AKURE.
KNOWLEDGE, ATTITUDE AND PERCEPTION OF HEALTH RECORD

PRACTITIONERS TOWARDS DIGITAL PRESERVATION OF PATIENT’S RECORDS

(A CASE STUDY OF UNIVERSITY OF MEDICAL SCIENCES TEACHING

Dear Respondents,
I am a final year student of the above-named institution. I am collecting information on the
above subject for my research project in partial fulfilment of the award of Professional Diploma
in Health Information Management. The questionnaire is meant for academic purpose only,
hence, your response shall be treated with uttermost confidentiality. Therefore, you are
encouraged to answer the questions as honest as you can.
Thank you.
Instruction: Please, tick (√) the correct options as it applies

Section A: Demographic Data

1. Age: (a) Less than 24yrs (b) 24 – 28 (c) 29 – 33 (d) 34 – 39 (e) 40 – 45 (f) 46 above

2. Sex: (a) Male (b) Female

3. Designation: (a) Technician (b) Officer

Section B: What is the Knowledge level of Health Information Management professionals

towards Digital preservation?

4. Have you heard about digital preservation of records before? Yes [ ] No [ ]

5. If yes, do you practice digital preservation of health records in your hospital?

Yes [ ] No [ ]

31
6. Does your health institution have a preservation policy? Yes [ ] No [ ]

7. Are you aware of the importance of digital preservation of health records? Yes [ ] No [ ]

Section C: What is the attitude and perception of Health Information Management

professionals towards Digital preservation?

8. Is it important to ensure proper safeguarding of digital materials? Yes ( ) No ( )

9. Do you find it easy copying data to more stable media and making back up? Yes ( ) No ( )

10. Are digital records of patients important to preserve? Yes ( ) No ( )

11. If yes, do you think digital preservation of medical records enhances retention of patient

records, prompt retrieval of patient’s records and also enhance continuity of care? Yes ( )

No ( )

Section D: What are the factors militating proper digital preservation of patients records?

12. Does your hospital accept digital preservation? Yes [ ] No [ ]

13. Does inadequate skills in information technology affects digital preservation of health record

in your hospital? Yes [ ] No [ ]

14. Does lack proper training on digital preservation affects its proper functionality?

Yes [ ] No [ ]

15. Does your health institution have the adequate and qualified staff to support digital preserva-

tion of health records? Yes [ ] No [ ]

32
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