The management of medical records in government hospitals: An agenda for reform

Health sector reforms aimed at addressing fundamental problems in health care delivery, and also at preparing the ground for a National Health Service, are currently underway. The reform programme is crucially dependent on improving information flows and information management to facilitate resource planning, monitoring and evaluation. Medical record systems and their management are central to this process, and are here made the subject of review. The emphasis throughout is upon practical solutions that are appropriate to the Ghanaian situation. My purpose is to outline a framework for the development and management of a standardised, coherent medical record system. The state of the art in the creation, maintenance, use and final disposition of medical records is critically reviewed and evaluated with a view to recommending remedial measures and formulating research proposals that could contribute to the improvement of the existing system. The study is limited to selected government-run regional and teaching hospitals (6 in all). For purposes of data collection, the study relied on survey research and adopted the 'records life cycle' concept for its analysis. The study revealed that the problems inherent in the present record systems are due to the absence of sufficiently formalised policies, guidelines and procedures, and to the fact that those that exist are not properly enforced. It is argued that the causes of these deficiencies lie in a lack of accountability and lack of appropriate organisational and managerial structures. A second problem has been the paucity of essential resources; financial, material and human. The study is organised into three sections, each divided into a number of chapters. Section I outlines the context of the study and has three chapters: Introduction, Overview of the Ghana Health Service, and The Medical Record in Historical Perspective. Section II presents the case study and documents the findings of the research (Chapters 4, 5, 6, and 7). A detailed analysis of existing routines and procedures (making comparisons with working methods elsewhere, chiefly English and Scottish hospitals) is presented, painting a picture of the current condition of the function, and providing essential insights regarding the changes required. Section III has two chapters. Chapter 8 recapitulates in brief the key problems discussed in the case study and for which practical solutions are required in order to substantially improve the medical record function. This chapter further proposes solutions to the problems that require intervention at the institutional or operational level, and also to problems which require a strategic approach. Chapter 9 concludes the study and outlines the proposals for reforms presented in Chapter 8