Relevance Of Medical Records Management

Of Health Care Services Delivery. Case Study

Of Jinja Referral Hospital Jinja Municipality.
Boniface Adrinkoa,1 , Fredrick Wandaraa
a
Medical Records Department, St. Francis School of Health Sciences,
Nakifuma County, Nagojje Sub-county – Namataba – Mukono District, Uganda.

Abstract

Background
The study sought to investigate the relevance of medical records management on healthcare service delivery in Jinja
referral hospital Jinja municipality. The objectives of the study were to describe the present records management
practices in Jinja Referral Hospital; find out the existing infrastructure for the management of patient medical records
at the Jinja Referral Hospital; determine the compliance of patient medical records management in Jinja Referral
Hospital with the relevant national legislative and regulatory framework; find out the security of patient medical
records at the Jinja Referral Hospital.
Methodology
Quantitative and qualitative approaches were employed, the sample was drawn from the service providers and from
the healthcare service users. Questionnaires, interviews, and observation were used to collect data.
Results
The findings showed that Jinja Referral Hospital uses manual records management system in the creation, maintenance,
and usage of records. Findings, there were challenges related to misfiling and missing patient folders which sometimes
lead to the creation of new patient folders. Also, the study discovered that the time spent in the retrieval of patient
folders could negatively affect the timely delivery of healthcare services.
Conclusion
The creation, maintenance, use, and disposal of medical records at the jinja referral hospital are currently effective
under control. This is supported by the fact that there is a consistent system of creating records, classification, and
retrieval.
Recommendationsa
The study recommended the adoption of electronic records management system as most public healthcare institutions
in the country are rapidly shifting to electronic management systems. The use of electronic records management
system is believed to be efficiently and effectively promote easy accessibility, retrieval of patient medical records, and
allow easy communication amongst the healthcare service institutions and healthcare practitioners.
a Submitted: 17th /10/2021 Accepted:
1 st /12/2021 Email: [email protected]

documented as a result of processes and activi-

1 Background
ties of a particular business is a vital asset of an
Hospitals, both public and private, create, receive organization as any other vital assets including fi-
and maintain records as evidence of their func- nance and human resources (Delosa and Jr, 2020).
tions, activities, and transaction. Any information
 2 Adrinko and Wandara

Moreover, records in an organization are a unique problematic. In the united states of America (USA),
and irreplaceable source of information about its for example, the amount of patient information
work, achievements, and continuity. The record on paper and the lack of a central storage sys-
serves as a reliable and authentic source of infor- tem led to large volumes of medical records be-
mation that must retain its originality throughout ing stored in various locations .it will be also no-
its use. Dikopoulou et al., (2010) pointed out that or- ticed that the storage often had fragmented, inac-
ganization keeps their records to promote account- curate, incomplete, duplicative, and poorly docu-
ability and also are important in the planning and mented information (Steward, 2005). The paper-
decision-making processes. Kemomi and Ngulube based records had problems communicating es-
(2007) opine that an effective records management sential information necessary for quality and ef-
program is a key component of any public sector ficient patient care. the filing created problems
for efficient and enhanced service delivery. in retrieving medical records. The paper lacked
Service delivery is important to both public and uniformity across departments and patient infor-
private organizations. (Arries, Ebin and Newman, mation will be captured differently. In Hong Kong
2008) assert that service delivery has become an the paper-based medical records posed some chal-
increasingly important concern of public health- lenges of retrieval and sharing of patient medical
care services. The authors maintain that health- information due to lost and misplaced records (Ting
care service delivery can be measured by reliabil- et al., 2011). To overcome problems associated with
ity, responsiveness, courtesy, customer orientation, paper-based records many countries, especially in
and confidentiality and caring. To promote effi- the developed world, adopted the use of informa-
cient healthcare service delivery, healthcare facili- tion technology for better effective use of medical
ties need to create people-driven services that are information to improve health care services deliv-
characterized by quality, equity, timorousness, and ery (Al-azni et al., 2009).
a strong code of ethics (Arries,Ebin and Newman, Admittedly, in developing countries, the manage-
2008). Record management is vital to service deliv- ment of medical records has not been taken as a
ery by any institution or organization. (Kemoni and priority and is generally inadequately supported
Ngulube, 2007) pointed out that misfiled and lost and poorly managed. In Ethiopia, for example,
records are likely to delay the service and hence medical were commonly missing, incomplete and
dent the image of any service provider. inaccessible while in Ghana the management of
Medical records. medical records faced many obstacles including
A medical record is an important document that ineffective filing and retrieving due to poor or un-
is used by healthcare institutions and practition- suitable storage facilities (Williams& Boren 2008).
ers to record patient history, illness, and treat- Health care service delivery
ment (Mogli, 2009). A medical record is created Healthcare service is not a new phenomenon but
as evidence of an interaction between a patient can be traced back to ancient civilizations . the
and health care personnel during a patient’s visit healthcare services delivery will be a contact be-
to a healthcare facility. The interaction may in- tween a healthcare provider and the healthcare
volve, among other things, the recording of infor- consumer. According to the author, the physicians
mation about biographic data as well as tempera- or health service providers obtained vital data from
ture, blood pressure, and diagnostic test results. the patient and retained it for future references.
It also may document operations and forms of Before the invention of paper and eventually com-
treatment. (Steward, 2005) points out that medical munication technologies such data were stored on
records form an integral part of healthcare service various media including clay or wax tablets and an-
delivery as they contain critical information whose imal skins inarguably healthcare services revolved
primary purpose is to facilitate the continuum of around a patient’s record as it still does at present.
care and treatment of patients. In Uganda, healthcare services are categorized
Management of medical records. into three levels; the primary care level, district
The management of medical records has a long Hospitals, and tertiary level hospitals. Jinja Referral
history .for a long time medical records have been hospital falls under the second level, district hospi-
in paper format. However, expansion in the health- tals. The common entry point to healthcare service
care service has seen paper format becoming more is at the primary care level which comprises clin-
Relevance Of Medical Records Management Of Health Care Services Delivery. Case Study Of Jinja
Referral Hospital Jinja Municipality. 3

ics and other healthcare services. Consumers of

2 Methodology.
healthcare services at the primary healthcare level
Study area.
may be referred to the next level of healthcare ser-
Historically, Jinja Regional Referral hospital was
vices. Local clinics of the surrounding communities
started during the 1 st world war of 1914-1618 with
under Jinja County refer their patients to Jinja Refer-
three structures built in 1920 and few British doc-
ral Hospital. (Arries and Newman, 2008) aver that
tors. The health workers had one cardinal duty
healthcare service delivery to the public has been
of treating the wounded kings, African riffles and
made a constitutional right. The importance and
army men.
quality of the healthcare service delivery are guided
by the principles of Batho Pele (Uganda, 2007). After independence in1962, Uganda doctors,
nurses and allied health professionals fully took
Unarguably, the provision of quality healthcare
over the expanded management of the hospital.
service cannot be delinked from, among other
This increasingly expanded the capacity of the hos-
things, sound records management programs. (Ke-
pital and in 1998; it was made one of the eleven
moni and Ngulube, 2008) opine that there is a di-
referral hospitals in Uganda .it is a 500 bed capac-
rect link between effective records management
ity hospital that serves the original Busoga region.
and enhanced service delivery, hence good record
This includes the districts of Jinja,Iganga, Kamuli,
keeping is the key to enhanced public healthcare
Bugiri,Kaliro, Mayuge and Namutumba with a pop-
service delivery. This then suggests that for the
ulation of fur million people .the hospital serves
organization to render quality and efficient service
the districts of Kayunga and Mukono an additional
to its users’ needs to have a good record-keeping
population of two million people.
system. Hospitals just like any other organization
have to adopt an effective records management The hospital supervises seven referral hospitals
system for quality health care service delivery as in the region and over 15 health centers IV. The
the medical records have a direct link to the deliv- hospital has a work force of 365 health workers
ery of healthcare services. According to Aries and and has the department of internal medicine, Nu-
(Newman, 2008), health consumers are placed at trition, General Surgery, Obstetrics and Gynecology,
the center of healthcare service delivery. In tan- Finance and Administration and Health community
dem with the principles of Bath Pele, healthcare which are headed by senior Consultants.
service delivery should be driven by the vision of The hospital is comprised of the following units
transparency, efficiency, effectiveness, accountabil- too, laboratory, radiology, dental, ophthalmic, E.N.T
ity, and responsiveness to the needs of patients. In (Ear, Nose and Throat), pediatrics, orthopedic, anes-
public hospitals, the state is the primary provider thesia and human resources. The hospital receives
of the HealthCare services delivery, and therefore patients through referral from health centers Ivor
quality healthcare services are expected by the the referral hospitals while others come directly to
consumers. According to this author, some hospi- receive health care.
tals use electronic record systems while others use Research methodology
both manual and electronic records systems. Good This study employed both qualitative and quan-
and accurate keeping, as well as the communica- titative approaches. The rationale for using both
tion of clinical information between health practi- qualitative and quantitative approaches was to col-
tioners, is essential for good and quality healthcare lect data to explain the aim of the research. The
practice. use of both approaches helped to gain advantages
In Uganda, there are types of widely used of both qualitative and quantitative approaches
records, the facility held Record (FHR) and the pa- and make up for the disadvantages and weakness
tient held record (PHR). The FHR is kept in the fa- of each. According to Creswell (2003) the use of
cility and remains the product of that facility while both approaches tends to improve the quality of
the PHR is kept by the patient and can be used at research as the weaknesses of one approach is cov-
any healthcare facility to provide the continuum of ered by the strength of the other method. A combi-
healthcare. The FHR is widely used by the hospi- nation of more than one research approach or tri-
tals while the PHR whenever they visit other health angulation in this research gave the researcher the
care facilities as this record contains history patient opportunity to collect numeric data and the feeling,
health information. opinions, and interpretations of both the providers
 4 Adrinko and Wandara

and users of the healthcare services based on the Education level of respondents
management of medical records at Jinja Referral As indicated in table 5, out of the total who re-
Hospital. sponded to the questionnaire, 53% had certificate,
Research design. 27% had diploma, 13% had bachelor’s degree ed-
The study employed a cross-sectional study de- ucation and 7% of the respondents had master’s
sign. degree.
Validity and reliability of the study Training received by respondents
The researcher will use triangulation to examine
The researcher sought to know the competences
evidence from the data source to build coherent
of the service providers to perform their duties. Re-
justification for themes.
spondents were asked to indicate if they had been
trained for the tasks and duties they are required
3 Data analysis to perform: 20(67%) respondents indicated to have
The data collected from the field were categorized gone for training while 12(33%) had no training
and coded in preparation for analysis using the as showed in the above table. Implying that the
statistical package for the social sciences (SPSS). majority of the respondents went for training in
Ethical considerations the management of records and other field in the
The nature of the study to be conducted was ex- hospital.
plained to the participant and extend the choice Medical records management practices
of participating or not to participate. In conduct- Record creation
ing the study, the researcher ensured that the re- Hospitals create records on a daily basis to
spondents were free of harm and the information support their activities and transactions. The re-
gathered was strictly used for the purposes. The searcher sought to find out about the creation of
respondents were also be assured that their partic- medical at the hospital. As shown in table 8, major-
ipation in the study as being strictly voluntary and ity of the respondents that is 25(83%) said that the
be requested to sign an informed consent form. medical records at this hospital are manually cre-
The respondents were also assured of anonymity ated using a clean folder to register service users
and confidentiality. and 5(17%) were not sure whether the records are
crated or not. The patient is not required to pay
4 Results and discussion: a registration fee, show his/her identity document
Demographics of the study participants (ID) and a referral letter from a local clinic .the med-
Gender of service providers ical record contains patient’s personal and medical
Gender distribution of service users information. The process is completed by giving
The study had 16(53%) female and 14(47%) male a patient a card which should be produced dur-
participants. More females than males used the ing the next hospital visit. After creating a record,
service during the time the study took place. patient waits to be examined.
Age distribution of the study participants Rate of medical records creation
The age ranges were used to categories the sam- The researcher sought to establish the rate at
ple of the study participants. Table 3 reveals that which records are created on a daily basis .4(4%)
most (83%) of the respondents are between the respondents indicated that medical records that
ages of 21and 40 which is the youthful age in the are created on a daily basis are more than five
life of humankind. The lower percentage (17%) of ,8(9%) ,14(15) respondents indicated that medical
respondents is above age 40.the age range started records that are created on a daily basis are more
at 21-40 years because the study targeted the users than ten,18(19) respondents indicated that medical
who can use healthcare services without the assis- records that are created on a daily basis are more
tance of parents or guardians. than fifteen and the majority of the respondents
Working experience of respondents 50(53%) said that the daily record creation is be-
reveals that most (83%) of the respondents have tween 25 and above medical records . to verify
worked from 5 to 10 years giving them high working the rate of record creation the researcher asked
experience in the facility. the lower percentage the hospital records administrator to shed some
(17%) of respondents worked for above 10 years . light on the matter. The hospital administrator in-
Relevance Of Medical Records Management Of Health Care Services Delivery. Case Study Of Jinja
Referral Hospital Jinja Municipality. 5

Table 1. Shows the gender of service providers.

Responses Frequency Percentage

Male 20 67
Female 12 33
Total 60 100
Source: primary data, 2019

Table 2. shows the gender distribution of service providers

Responses Frequency Percentage

Male 14 53
Female 16 47
Total 30 100
Source: primary data, 2019

Table 3. Shows the age of respondents.

Responses Frequency Percentages

21-30yrs 15 50
31-40yrs 10 33
41-50yrs 3 10
51-60yrs 2 7
Total 30 100
Source: primary data, 2019

Table 4. Shows the distribution of respondents by working experience.

Responses Frequency Percentage

0-5 yrs. 15 50
6-10 yrs. 10 33
11-15yrs 3 10
16-20yrs 2 7
Total 30 100
Source: primary data, 2019

Table 5. Shows the distribution of respondents by academic qualification

Responses Frequency Percentage

Masters 2 7
Degree 4 13
Diploma 8 27
Certificate 16 53
Total 30 100
Source: primary data, 2019
 6 Adrinko and Wandara

Table 6. shows the level of training of respondents.

Responses Frequency Percentage

Yes 20 67
No 12 33
Total 60 100
Source: primary data, 2019

Table 7. shows the medical record creation.

Responses Frequency Percentage

Yes 25 83
No 5 17
Total 30 100
Source: primary data, 2019

Table 8. Shows the daily creation of medical records.

Responses Frequency Percentage

0-5 4 4
5-10 8 9
10-15 14 15
15-20 18 19
25+ 50 53
Total 94 100
Source: primary data, 2019

dicated that the hospital that the hospital creates maintained by filling ,4(13%) indicated records are
more than 25 medical records each day. maintained by using cabinet and 2(7%) indicated
He also stated that on Mondays the hospital re- records are maintained using shelves which implies
ceives more patients than other days of the week that there is improved maintenance of records in
and therefore the number of records created tends the hospital quick service delivery and limited loss
to be more than 25 since it is beginning of the week. of records .
Retrieval of medical records Does the hospital have a records manage-
The researcher sought to determine the system ment system in place?
and tools used for retrieving medical records when
Majority of the respondents 25(83%) agreed with
patients visit the hospital. The respondents were
the statement and the rest the hospital has a
asked to indicate the procedure used to retrieve
records management system and 5(17%) respon-
medical records. 25(73%) respondents indicated
dents were not sure whether has the records man-
that medical records are retrieved manually .5(27%)
agement system or not.
respondents were not sure of the system used for
retrieving records in the system. Which type of records management system
What do you use in the maintenance of med- does the hospital use?
ical records? As shown in table 12,15(50%) responded that
The researcher sought to determine the system the hospital uses a centralized system of records
and tools used for maintaining medical records in management ,10(33%) responded that the hospital
the hospital. 16(53%) respondents indicated that also uses decentralized system of records manage-
medical records are maintained using the comput- ment especially in administration and 5(17%) of the
ers,8(27%) respondents indicated that records are respondents were not sure of whether the hospi-
Relevance Of Medical Records Management Of Health Care Services Delivery. Case Study Of Jinja
Referral Hospital Jinja Municipality. 7

Table 9. Shows the medical records retrieval

Responses Frequency Percentage

Manual 25 87
Not sure 5 17
Total 30 100
Source: primary data, 2019

Table 10. Shows the maintenance medical records retrieval

Responses Frequency Percentage

Filling 8 27
Cabinets 4 13
Shelves 2 7
Computers 16 53
Total 30 100
Source: primary data, 2019

Table 11. Shows the availability of records management system

Responses Frequency percentage

Yes 25 83
No 5 17
Total 30 100
Source: primary data, 2019

Table 12. Shows the type of records management system the hospital has.

Responses Frequency Percentage

Centralized 15 50
Decentralized 10 33
Not sure 5 17
Total 30 100
Source: primary data, 2019

tal has any records management system used for that it takes 10 minutes, 2(7%) said that it takes
record keeping in the hospital or not . ten minutes and no responses was registered on
How long does it take to retrieve a patient above fifteen minutes.
file? The researcher observed that the retrieval of fold-
The speed of service is one of the key compo- ers is generally quick except for those users who
nents of any service delivery. Excessive waiting pe- revisit the hospital after a long time. It is probable
riods in hospitals are often caused by the wasteful that their records may have been placed outside
processes before or after treatment .this is often the office holding current records.
caused by the spent in locating the medical records Who is responsible for the overall manage-
of patients . The respondents were asked to de- ment of medical records in this hospital?
termine the length of time spent in retrieving an As shown in table 14, 20(67%) responded that
individual patient folder. Out of 30 respondents the health records clerks are the once in charge
,25(83%) indicated that it takes approximately 5 the overall management of medical records
minutes to retrieve a folder,3(10%) summarized in the hospital, 5(16%) of the respondents in-
 8 Adrinko and Wandara

Table 13. Shows the length of retrieval time records in the hospital

Responses Frequency Percentage

5 minutes 25 83
10minutes 3 10
15minutes 2 7
+15minutes 0 0
Total 30 100
Source: primary data, 2019

Table 14. shows the personnel responsible for the overall management of records.

Responses Frequency Percentage

Doctor 2 7
Health records clerks 20 67
Hospital records administrator 5 16
Nurses and midwives 3 10
Patients (healthcare users ) 0 00
Total 30 100
Source: primary data, 2019

dicated that medical records are managed by The hospital wards may produce large quanti-
hospital records administrator,3(10%) indicated ties of records and may decide to maintain their
that records are managed by nurses and mid- records either centrally or in the wards. Hospitals
wives,2(7%) records are managed by doctors and generally have two types of patients; in-patients
response was recorded on whether the records are and out-patients. The researcher sought to find
managed by patients( health care users ) or not im- out whether the two categories of patients’ records
plying that records are managed by health record were filed and kept separately. 25(83%) respon-
clerks in the hospital quick service delivery. dents asserted that the storage of in-patient and
How frequent are the medical records col- out-patient records is not separate. 5(17%) respon-
lected from other units? dents stated that the storage of these folders is
separate. This was verified by the hospital records
Waiting periods for service.
administrator who indicated that the hospital is
The time factor is important in healthcare deliv-
using a centralized records registry system. The
ery. He maintains that healthcare organizations
in-patients remain in the wards until the patients
must strive to balance customer demands as ex-
are discharged, after which they are collected to be
cessive delays may delay diagnosis and therefore
filled and kept in one central place. The researcher
put the patient’s health at risk. When the service
noted that all folders are kept in one centralized
use study participants were asked if they got their
storage place. When the patient is admitted to the
folders on time when reporting to the registration
hospital wards then the folder will be kept in the
point, 25(83%) indicated that their folders were
ward after the patient is discharged the folder will
retrieved quickly while 5(17%) indicated to have
be taken back to the central storage place.
waited longer for their folders to be retrieved.
Infrastructure for the management of medical
An interview with the hospital records adminis- records
trator revealed that the retrieval of folders should Do you consider the patient registration
take approximately 5 minutes except on very busy space and the waiting are as adequate?
days. The study also sought to establish the type of
Are the in-patient kept separate from the material and tools used for patient identification.
out-patient records? The respondents were asked to state if there
Filing of in-patient and out-patient folders. was proof of registration given to patients to have
Relevance Of Medical Records Management Of Health Care Services Delivery. Case Study Of Jinja
Referral Hospital Jinja Municipality. 9

Table 15. Shows the registration of patients.

Responses Frequency Percentage

Yes 25 83
No 5 17
Total 30 100
Source: primary data, 2019

a unique identity. The results were that 25(83%) Where are the medical records kept in this
respondents stated that a confirmation of registra- hospital?
tion in the form of a hospital identity card is issued Healthcare facilitates storing and retaining med-
to the patient. Only 5(7%) respondent were not ical records for easy retrieval. The researcher ex-
sure of the statement. plored the storage facilities for medical records at
As the issue of patient identification is a crucial the jinja referral hospital. The respondents were
element in the healthcare service, it was imperative asked to state where the medical records were kept
for the researcher to observe the phenomenon. in the hospital.it turned those 25(83%) respondents
The researcher observed that after registration, stated that medical records were kept in the reg-
each patient is given a card with a number simi- istry ;3(10%) respondents stated records are kept
lar to the number on top of the folder. in administration and 2(7%) of the respondents
The card is used each time the patient visit the stated that records are kept using computers in the
hospital.as some patients are referred to the hos- hospitals.
pital by their local clinics. They are expected to Are all medical records kept in one place?
bring along their small books from their clinics. The Healthcare facilities store and retain medical
folder number written on the card will also be writ- records for easy retrieval. the researcher explored
ten on that small book or patient held record used the storage facilities for medical records at the jinja
in the clinic .each card number is unique to each referral hospital. the respondents were asked to
patient, which fast tracks retrieval of the folder. state where the medical records were kept in the
Which of the following equipment does the hospital.it turned out that 28(93%) respondents
hospital used to keep the patient folders? stated that medical records were kept in one place
In an ideal hospital, a well-organized filing system while 2(7%) respondents were not sure of the stor-
is essential for the effective storage and retrieval age place.
of patient records. An effective filing system is re- In which format are they?
quired for the facilitation of continuity of patient Most hospitals, especially in developing coun-
care among healthcare providers. A ‘’paper-based tries, generate large quantities of paper-based data
medical records requires filing equipment for stor- which results in the increase of volumes and poten-
age of records and enable easy location of folders” tial difficulties in retrieving information.
it was, therefore, essential to find out the type of Globally, the healthcare sector has embraced
filing equipment used at the Jinja referral hospital the benefits of maintaining electronic medical
for the storage of medical records. Consequently, records for faster retrieval and flow of informa-
16(64%) respondents answered that the hospital tion. The respondents were asked to indicate the
uses shelves, 8(27%) answered that the hospital recording medium used by their hospital.25 (83%)
uses filing cabinets and 6(20%) indicated the hos- stated that the hospital uses paper-based medi-
pital uses computers for keeping records. The re- cal records, 3(10%) uses electronic-based medical
searcher verified that from the hospital records records and 2(7%) asserted that both paper-based
administrator who then confirmed that the hospi- and computer-based records are created at the
tal uses shelves, computers, and filing cabinets to hospital. The hospital records administrator said
store medical records in a file room .same as the that jinja referral hospital, like other hospitals, uses
observation in which the researcher noted that the paper-based medical records. Through observa-
hospital uses shelves, computers, and filing cabi- tion, the researcher observed that new folders are
nets which are situated behind the clerk’s desk. created manually using paper-based folders, and
 10 Adrinko and Wandara

Table 16. Shows the equipment used for patient folders.

Responses Frequency Percentage

Filing cabinets 8 27
Shelves 16 53
Computers 6 20
Total 30 100
Source: primary data, 2019

Table 17. Shows the storage place of medical records.

Responses Frequency Percentage

Registry 25 83
Administration Clerk’s Offices. 3 10
Computers 2 7
Total 30 100
Source: primary data, 2019

Table 18. Shows the medium of medical records

Respondents Frequency Percentage

Paper 25 83
Electronic 3 10
Both formats 2 7
Total 30 100
Source: primary data, 2019

the clerk records each coming patient in the regis- dents were not sure whether the hospitals’ hard
tration logbook available at the registration desk. policies or not. Policies should be approved and
The records were also retrieved manually by using widely publicized to create awareness about their
the folder number which is available on the hos- availability. The proper use of these policies pre-
pital visiting card. The clerks search for the folder vents possible shortcomings in the management
manually in the shelves which are filed in numerical of medical records. The hospital records adminis-
order until it is retrieved. trator
Legal and regulatory framework.
Pointed out that those managing and using med-
Does the hospital follow any existing legisla- ical records are quite aware and conversant with
tion and guidelines that regulate the creation the policy regulating the management of medical
of medical records? records.
Policy awareness
Ngope and Van Der Walt (2009) insist that the
As much as the government departments are re-
policy should be communicated to the officials to
quired to establish policies that regulate records
manage records accordingly. The hospital records
management activities, the policies should be com-
administrator confirmed that the policies are com-
municated and implemented. The researcher
municated to healthcare workers and profession-
wanted to establish if the respondents were aware
als. There is in-service training to ensure that staff
of the policy that regulates the management of
is acquainted with the stipulated policies governing
records in the hospital. The response showed
records management.
that respondents were conversant with the policy.
25(83%) respondents were aware of the policy.3 Nengomasha (2009) observes that training all
(10%) did not respond and 2(7%) of the respon- officials on record-keeping would prevent unaware-
Relevance Of Medical Records Management Of Health Care Services Delivery. Case Study Of Jinja
Referral Hospital Jinja Municipality. 11

ness, but without proper training, the set policies act 2001 and the promotion of freedom of access
are of no importance. to information (2005). The management of med-
Do you have rules governing access to medi- ical records is subject to the stipulations of the
cal records in this hospital? Uganda public health act (1935). The act requires
Availability of records management policy. that any person who is in charge of a health estab-
The medical protection society (South Africa, lishment must create and maintain a health record
2012) states that the management of medical for every user of the health service. Respondents
records facilitates continuity of care for patients were asked if they were aware of the national leg-
and reduces risks of adverse incidents that might islation that governs the management of patient
be caused by lost, untraceable, or misplaced medi- health information: 25(83%) respondents indicated
cal records. Chachage and Nhulube(2006) under- that the hospital is aware of the national legisla-
score the fact that many countries pass legisla- tion that regulates the management of health in-
tion that requires businesses and organizations to formation, 3(10%) respondents indicated that the
manage their records to ensure easy access when hospital staff was not aware of the policy and 2(7%)
needed. The results showed that the hospital does respondents were not sure if they were aware of
abide by national standards on medical records all the national legislation about the management
management. the majority (83%) of respondents of medical records.
stated that there is a policy for the management of How are medical records disposed of?
medical records and this was also confirmed by the Disposal of medical records
hospital records administrator .3(10%) did not re- By the guidelines of the Uganda Public Health
spond and 2(7%) of the respondents were not sure Act (1935), a health record should be stored in a
about the availability of such a policy .as regards safe place for not less than 6 years from the time
the mode of implementation of this policy, the hos- the record becomes dormant. The national records
pital records administrator indicated that the policy and archives act 2001 states that no public record
is implemented by the hospital management and under the control of the government’s body may
supervisors. be transferred to the archives’ repository, nor de-
Is access to medical records open to every- stroyed, erased, or disposed of without a written
one? disposal authority. this study further sought to es-
Rules for accessing records tablish if the hospital had disposal schedules for
The Uganda Public Health Act (1935) asserts that non-current medical records. 20(67%) respondents
everyone who is in charge of a user’s healthcare maintained that the hospital preserves medical
record must set up control measures to restrict records for a specified time,2(7%) respondents said
unauthorized access to health records and storage the hospital does not preserve records while 8(26%)
facilities. the act makes it an offense for anyone to respondents were not sure whether the hospital
access or copy patient information without autho- preserved medical records or not.
rization. The study sought to establish if the hospi- The hospital records administrator indicated that
tal does have rules that govern access to medical the medical records are preserved for a specific
records. The respondents were asked to indicate period in line with the requirement of the Uganda
if there were rules that govern access to medical public health act (1935).
records; 3(10%) respondents maintained that there Are all hospital staff conversant with such a
were no rules for preventing access while 2(7%) re- policy?
spondents were not sure about such regulations. Compliance with medical records manage-
hospital records administrator was interviewed on ment policy
this matter, it was established that regulations were The research sought to examine if the manage-
restricting unauthorized access to medical records. ment of medical records in the hospital complied
Does the hospital have a records manage- with existing requirements for the management
ment policy for managing medical records? of medical records. All respondents indicated that
The management of records in the public sector the hospital uses only one records management
in Uganda is impacted by various legislations includ- program for all types of hospital records.
ing the Bill of Rights as enshrined in the constitu- This was confirmed during an interview with
tion of Uganda. The national records and archives the hospital‘s records administrator. The hospital
 12 Adrinko and Wandara

records administrator explained that, although the Shepherd and Yeo (2003) contend that records
medical records were not managed separately, spe- must be protected against long-term loss and mis-
cific procedures were governing their filing, storage, placement, and safeguarded against malicious acts
and retrieval or carelessness on the part of the staff that has
Does the hospital aware of the national leg- legitimate access to them. The paper-based fold-
islations that regulate the management of pa- ers are protected from temporary misplacement
tient health information. or long-term loss through the use of signatures,
Records management program. whoever has borrowed a folder must sign in the
Dikopoulou et al. (2010) stipulate that to achieve borrower’s register to ensure the return of the bor-
efficient use of recorded information, there must rowed folders. The researcher asked about the
be control production, transfer, retention, use, and system the hospital employs to track the medical
disposal .all respondents agreed that jinja’s referral records issued out to other
hospital has a records management program in Hospitals units .25(83%) respondents indicated
place. that there were tracked and traced through a reg-
The hospital records administrator confirmed ister housed at the medical records department.
that the hospital does have a records management when the folder is issued out, it is indicated in the
program responsible for the management of hos- register. If it is issued to a patient, the patient goes
pital records. to the examination room, and after collecting med-
Security of medical records show, are medi- ication at the dispensary. The record is left there
cal records secured? to be collected by hospital staff for filing at the
The world health organization (2006) considers medical records department.5 (17%) respondents
information in a medical record as privileged com- explained that there was no system for tracking
munication between a patient and a healthcare and tracing records.
professional hence it requires guaranteed security. How is the patient health information pro-
The respondents were asked to specify how medi- tected from unauthorized alteration?
cal records were secured in the hospital.25 (83%)
The authenticity of medical records
of the respondents indicated that medical records
The national records and archives act (2001) stip-
were kept in strong rooms,3( 10%) responded that
ulate that an original medical record must always
records were kept in Burglar proofed rooms while
remain intact and fully legible. The medical pro-
2(7%) said they were kept in the special rooms.
tection society (Uganda, 1892) rules that an entry
How is the movement of patient folders
made to a medical record neither be deleted nor
within the hospital units regulated?
obliterated. The study further probed the authen-
Movement of patient folders
ticity of medical records at the jinja referral hospital.
The study also investigated if there were any
All 30(100%) of the respondents stated that unau-
measures to control the movement of patient fold-
thorized officials were not given any information
ers within the hospital. The discussions with re-
contained in medical records thus the door leading
spondents revealed that patient folders are left at
to the folders was always blocked to prevent such
the dispensary after consultation .in some cases,
access .in the event of an investigation, clerks or
users get their treatment at the dispensary and
nurses safeguard medical records by making pho-
leave their folders there .all folders left at a dispen-
tocopies of the originals before the investigation.
sary are sent to the medical records department
The interviews with the key informant, the hospi-
for filing .when the folder is not found from where
tal records administrator, revealed that medical
it is supposed to be, it is tracked through the daily
records cannot be tampered with because medical
register which is normally kept by the clerks. The re-
records are protected by color-coded paper.
spondents also pointed out that should the folder
be borrowed by another unit, that unit should sign
and return that folder to the file area. If not yet re-
turned, the nurses should search for it and return
5 Conclusion and
it to the medical records department for filing.
Is there any system to keep borrowed pa- recommendation.
tient folders by other hospital units? Summary of the findings.
Relevance Of Medical Records Management Of Health Care Services Delivery. Case Study Of Jinja
Referral Hospital Jinja Municipality. 13

Table 19. Shows the security of medical records

Responses Frequency Percentage

Strong rooms 25 83
Burglar proofed rooms 3 10
Special rooms 2 7
Total 30 100
Source: primary data, 2019

Table 20. Shows tracking and tracing of medical records.

Responses Frequency Percentage

yes 25 83
No 5 17
Total 30 100
Source: primary data, 2019

This sub-section provides the summary of the registration. Personnel dealing with registration
findings of the study are based on the research have sufficient working space and are situated in
objectives which sought to: an area that is easily noticeable and approachable
1) Describe the present records management by outpatients.
practices in a jinja referral hospital. 9) The records are centrally filed and kept in well-
2) Find out the existing infrastructure for the maintained filling equipment and storage place.
management in jinja referral hospital with the rele- 10) The entire records management program of
vant legal and regulatory framework. the hospital is under the supervision of the hospital
3) Find out the security of medical records in a records administrator. the staff working on the
jinja referral hospital. records unit have been exposed to basic training
4) Creation and management of medical records on records keeping and seem to be conversant and
5) The study established that jinja referral hos- regulations governing the management of records
pital uses a paper-based manual medical records in general and medical records in particular. No
management system which is centralized. At the mention was of unique training on medical records
time of the study, this system was serving the hos- management or use of information technology in
pital without any problems. The few notable prob- medical records keeping.
lems included the loss or misplacement of patient Legal and regulatory requirements.
files which necessitated the opening of temporary
1) The study established that the hospital com-
files. The use of temporary files carried the risk
plied with the relevant legal and regulatory require-
of compromising the quality of healthcare services
ments for the management of medical records.
given since the health professionals were unable to
benefit from the previous healthcare history with a 2) The policies and regulations are appropriately
temporary file. communicated to staff from time to raise their
6) The accrual of medical records creation at the awareness as well as the importance of complying
hospital was found to be moderate with Mondays with and implementing such policies and regula-
identified to be the most notable peak periods cre- tions.
ation. Security of medical records
7) Infrastructure for the management of medical The results of the study indicated that the hos-
records. pital keeps all medical records in secured and safe
8) The study that the hospital has adequate space and lockable storage rooms. The security is aimed
for the registration area which is also used for in- at safeguarding the originality and authenticity of
teracting with patients on any other issue besides the records against any possible alteration or theft.
 14 Adrinko and Wandara

The study findings also established that the hos- in general and medical records in particular. No
pital controls the movement of medical records mention was of unique training on medical records
by making sure that borrowed medical record is management or use of information technology in
indicated in a register .this is used as an attack- medical records keeping.
ing system to ensure that medical records are not Legal and regulatory requirements.
easily misplaced and are properly accounted for. The study established that the hospital complied
This sub-section provides the summary of the with the relevant legal and regulatory requirements
findings of the study are based on the research for the management of medical records.
objectives which sought to: The policies and regulations are appropriately
Describe the present records management prac- communicated to staff from time to raise their
tices in a jinja referral hospital. awareness as well as the importance of complying
Find out the existing infrastructure for the man- with and implementing such policies and regula-
agement in jinja referral hospital with the relevant tions.
legal and regulatory framework. Security of medical records
Find out the security of medical records in a jinja The results of the study indicated that the hos-
referral hospital. pital keeps all medical records in secured and safe
Creation and management of medical and lockable storage rooms. The security is aimed
records at safeguarding the originality and authenticity of
The study established that jinja referral hospital the records against any possible alteration or theft.
uses a paper-based manual medical records man- The study findings also established that the hos-
agement system which is centralized. At the time pital controls the movement of medical records
of the study, this system was serving the hospital by making sure that borrowed medical record is
without any problems. The few notable problems indicated in a register .this is used as an attack-
included the loss or misplacement of patient files ing system to ensure that medical records are not
which necessitated the opening of temporary files. easily misplaced and are properly accounted for.
The use of temporary files carried the risk of com-
promising the quality of healthcare services given
since the health professionals were unable to ben- 6 Conclusion
efit from the previous healthcare history with a From the summary of the findings, the follow-
temporary file. ing conclusion can be made.
The accrual of medical records creation at the The creation, maintenance, use, and disposal of
hospital was found to be moderate with Mondays medical records at the jinja referral hospital are
identified to be the most notable peak periods cre- currently effective under control. This is supported
ation. by the fact that there is a consistent system of cre-
Infrastructure for the management of medi- ating records, classification, and retrieval. This has
cal records. resulted in a few missing or lost records. Medi-
The study that the hospital has adequate space cal records are directly related to quality healthcare
for the registration area which is also used for in- service delivery. A failure to retrieve a patient folder
teracting with patients on any other issue besides that contains a medical record of that particular
registration. Personnel dealing with registration patient may have implications on the medical pre-
have sufficient working space and are situated in scription, reordering of diagnostic tests which are
an area that is easily noticeable and approachable sometimes expensive to reproduce, and the loss of
by outpatients. precious health information history. Jinja referral
The records are centrally filed and kept in well- hospital falls under the first level of health service
maintained filling equipment and storage place. in the district hospitals. The district hospitals use
The entire records management program of the manual records management system which has its
hospital is under the supervision of the hospital flaws of access, an increase of paper files, retrieval,
records administrator. The staff working on the and lost or missing files.
records unit have been exposed to basic training There is adequate infrastructure for the manage-
on records keeping and seem to be conversant and ment of medical records at the hospital at least
regulations governing the management of records at present. The recent refurbishing of the hospi-
Relevance Of Medical Records Management Of Health Care Services Delivery. Case Study Of Jinja
Referral Hospital Jinja Municipality. 15

tal’s physical infrastructure has provided adequate ing physicians and therefore the missing medical
equipment, and working outpatient space for the records break that communication and make it dif-
management of records. The current staff comple- ficult to decide on the diagnosis and treatment of
ment seems adequate for the task of managing the a patient. Time spent in the retrieval of patient
records. Medical records are created daily increas- folders affects the quality of service .it is against
ing volumes of the image, the files stored on the the problems mentioned above that the developed
shelves which in the future could be a hindrance countries invested in the use and integration of
to timeous healthcare service delivery. On a tightly health information technology in hospitals. In the
packed shelf the paper files get easily damaged, future, the study recommends the implementation
the spine of the file becomes soft and brittle and and the use of electronic medical records in jinja
that could shorten the life span of a record. referral hospital .electronic medical records pro-
The hospital complies with all the legislative and motes the delivery of quality service, enhanced
regulatory requirements about medical records service, and timeous healthcare service. Efficient
keeping. Healthcare workers in jinja referral hospi- and effective healthcare services delivery is the en-
tals sound quite conversant with the policies and visaged service for the citizens.
procedures that govern the creation, use, and main- Infrastructure
tenance of medical records. The disposal of medi- In terms of infrastructure, jinja’s referral hospital
cal records needs to be worked on by the hospital has been recently refurbished. The study found
as the creation of paper medical increases daily. A that the space where the records clerk desk is sit-
sound disposal policy ensures adequate records uated is adequate .registration area or reception
storage. area where patients first report when coming to
The security and storage of medical records are the hospital and the records storage place is sat-
adequate. medical records are stored and locked in isfactory. The infrastructure that is currently in
a safe place that is far from the reach of an autho- use by the jinja referral hospital is adequate but
rized person, however, strict measures in the wards needs to be reconsidered shortly. the hospital uses
should be exercised to prevent the folders from shelves and filing cabinets in the storage of medi-
unauthorized access, the paper medical records cal records and consumes a lot of space that could
can only be found in one place at a time, the collec- have been used in other hospital business oper-
tion of these records from various hospitals units ations. The study recommends that the movable
depending from where the patient left it can harm shelves be used instead of the files that are cur-
service delivery. The folder tracking and system rently in use. The movable shelves consume less
could also affect and impact the healthcare service space and are manually controlled and power con-
delivery as all the systems are done manually. trolled. Also, the study recommends the use of an
Recommendations. electronic medical record management system as
An effective and efficient records management all the records management systems, the patient
program is important to an organization. health information history will always be available
According to Kemoni and Ngulube (2008) records when needed by the physicians. One of the bene-
management is an important component to the fits of electronic medical records is their ability in
survival of any public sector .this study aimed at information sharing: portability, patient health in-
finding out the management of medical records at formation is accessible in any of the health sectors.
the jinja referral hospital. Following the findings Security of medical records
and the conclusions, the following recommenda- The hospital must keep the medical records safe
tions are made. and secured. Security and confidentiality is always
The findings of the study established that jinja the biggest question in keeping medical records.
referral hospital is using manual records manage- Presently, the hospital keeps the medical records
ment system. The manual record-managed system under control but the issue of security needs to
has its flaws which jinja referral hospital is not im- be strengthened by protecting the records against
mune to them. The problem of patient folder re- lost and missing folders. To protect the content of
trieval, missing or lost files were reported in other patient health information, the study recommends
countries in chapter two. Medical records serve the use of cryptography, steganography and cryp-
as a communication medium amongst the treat- tography, steganography, and encryption against
 16 Adrinko and Wandara

unauthorized access. in terms of confidentiality is- and related services for ill and injured patients 24
sues, the study recommends the use of a password hours per day, seven days per week.
to authenticate the right person for the health in- Record management program:
formation. Above all, the use of electronic medical Records management program as described by
records is more secure and confidential than its Shepherd and Yeo (2003) is a strategic function that
counterpart. is effective in setting, monitoring policies and stan-
Area of further research dards for records management by designing and
This study focused on the management of medi- implementing records management system used
cal records only at the jinja referral hospital. Jinja to unify a set of resources, responsibilities, proce-
referral hospitals do produce other records either dures, and equipment and provide easy access to
than medical records, the study recommends that records.
another study that will focus on other records be
Service delivery:
conducted. Since the hospital is currently using the
Arries and Newman, (2008) describe service de-
manual records management system, the study
livery as a multiphase interactive action that coin-
recommends another study that will look at the
cides with the dimensions of excellence, assurance
feasibility of the implementation of the electronic
of competence, attentiveness, dissemination of in-
medical records system
formation by staff, and flexible helpfulness that
add valuable meaning to the users.
7 Acknowledgement.
My special word of appreciation goes to Mr.Okechi
Mathius my beloved father and Mr.Yosia Ikomo
8 References:
who gave me the approval to conduct the research
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