…made by Ghana’s electronic medical record system
By Ernest Bako WUBONTO
Lightwave Health Information Management System (LHIMS) an integrated electronic medical record (EHR) system designed to deliver efficient and effective healthcare in the country for both patients and health institutions, has however become exhausting to some healthcare workers and patients across the country.
Hospitals operating the LHIMS have migrated from using manual folders to a digital software, a move that has simplified data management more safely and securely.
The LHIMS has been widely accepted and touted as a game-changer because the key challenges in the health management system such as missing patient records or patients forgetting their folders at home during emergencies have been addressed. Similarly, the days when records of patients and case histories existed in silos are no more.
However, the erratic system failures and network downtime challenges are rather prolonging turnover time and creating duplication of work for healthcare workers instead of reducing it significantly. On days that the system is running efficiently, waiting time is indeed reduced by about 50 percent and operations proceed smoothly, but the opposite also happens between two to three days a week in some health facilities, especially those outside the regional capitals.
An IT expert and LHIMS technician at the Korle-Bu Teaching Hospital stressed that the LHIMS has shown some form of weakness and challenges that seek to undermine the delivery of improved healthcare services in other parts of the country. The periodic network downtime encountered at the implementation end has resulted in delays and long queues sometimes at the outpatient Departments (OPD) Pharmacies and account desks of the implementing hospitals.
These factors combine to defeat one of the main purposes for which the system was introduced, ease of data collection and faster service delivery.
Nonetheless, testimonials from facilities that use the LHIMS indicated that it has enhanced patient information data management, and revenue collection among other operations of these hospitals. Subsequently, it has fostered ease and timeliness in accessing patients’ health records, having patients’ records follow them from service point to service point seamlessly, tracking the revenue generation process, and addressing reporting needs, all in a secured system.
With the LHIMS platform, a patient’s mobile phone number, LHIMS ID number, or National Health Insurance Scheme (NHIS) number, once captured into the system can be used to access the person’s health information for treatment without any requirement of a folder. This is not limited to the patient’s primary hospital but to any other facility that uses the system across the country.
Piloted in 2018, the LHIMS was approved in 2019 for implementation and has since been deployed in all six teaching hospitals, 10 regional hospitals, 243 district hospitals, three psychiatric hospitals, and 50 polyclinics as well as other health centres across the 16 regions of Ghana.
As of November 2024, just five years into the project, it was estimated that 21 million patients have been captured into the system, and work is ongoing to enroll other health centres and Community-Based Health Planning and Services (CHPS) compounds across the country.
Minister of Health, at the time of LHIMS inauguration in 2024, Dr Bernard Okoe-Boye, highlighted some key achievements of the system, which included improved clinical decision-making, revenue leakage brokerage, tracking of hospital operations by administrators, enhanced supervision and monitoring from the regional health directorate, and reduction in patient waiting time at outpatient wards by about 50 percent.
That notwithstanding, the erratic system failure and network downtime as mentioned earlier has become a bane of the existence for LHIMS end users, especially the nurses who are the first point of call within the patient data collecting and records verification process at health facilities. In some health facilities away from the regional capitals, patients are sometimes turned down and asked to report the next day due to a system breakdown.
The B&FT’s checks with some of the top hospitals in Accra such as Korle-Bu Teaching Hospital, the Accra Regional Hospital -Ridge, and Ledzokuku Municipal Assembly (LeKMA) Hospital showed that LHIMS is working quite smoothly with almost non-existent system challenges. The few experiences are usually addressed by the LHIMS sub-team of the IT department within a few minutes to hours in some circumstances to restore service.
But checks with health facilities outside the capitals revealed a different trend. The situation at facilities including Ankafu Leprosy and General Hospital, Anfoega Catholic Hospital, and Sunyani Municipal Hospital shows that outside the national capital, the network challenge is more erratic and problematic.
The Korle-Bu Situation
An accountant at the Korle-Bu Teaching Hospital, Belinda Padi, shared her experience with LHIMS stating that her department interacts with the platform from the revenue generation angle where billing is done on the LHIMS platform. A fee is generated for the client and the receipt of payment from the client at the in-house banks is imputed into the system to reflect in the patient’s records and for accounting purposes.
She added that network challenges are rarely recorded and it takes between 30 minutes to about three hours maximum and it happens a few times in a whole year. She recalled that only on about three to four occasions did it take almost a whole day.
“At Korle-Bu, when there is a network failure, the LHIMS team informs the various departments about the challenge and if possible, how long it will take for restoration. In case it will take less than three hours patients are made to wait for the system to be restored, however, if it will take longer than that, departments are made to go ahead with manual processes and later transferred onto the platform.
“So, we in the accounting department write down in our books payment details when the system is down and later reconcile the figures then transfer them onto the LHIMS platform. During these periods wait time becomes longer for patients and we also do double work by transferring the data unto the system when the system is restored, but this is not frequent,” she said.
Health Facilities Outside the Capital
At the Ankaful Leprosy and General Hospital, Cape Coast-Central Region, for instance, despite the ease of operationalising the LHIMS according to the nurses, they are sometimes left frustrated with the frequent system shutdowns because this means double work for them.
“At Ankafu, we have what is called the Admission and Discharge (A&D) book. So, whenever we experience system failure, we use the A&D book to take the patient records then we transfer them into the system when it is restored. Sometimes the system can be off for the whole day or two,” a nurse said on anonymity.
She explained further that booking clients on the LHIMS platform is like typing on the computer. When the computer goes off without saving the work everything might go off depending on the backup capacity of the device.
“Unfortunately, with the LHIMS, you can only save when you are done taking the required information for a patient, so, when the network goes off in the process you lose everything for that particular case and have to start again, so instead of saving time, it’s rather prolonging the operational time,” she added.
Elsewhere, at the Anfoega Catholic Hospital, Volta Region, an administrator mentioned that almost daily some level of network challenge is experienced and in worst situations, it goes off for about two to three days continuously.
Touching on mitigative factors put in place to ensure the operation is not disrupted, she said, “We improvise to attend to emergencies irrespective of the system challenges but other patients coming in for regular check-ups have to wait. We use the old manual paper folders to take records for emergencies and other necessary cases. Later this data is transferred onto the LHIMS when the system is back to normalcy,” she stated.
A nurse at the same facility, Clara Ibrahim, also mentioned that when the network is down for like a whole day, the workload becomes stressful as the next day staff has to juxtapose between attending to new clients and entering the previous day’s records into the system which could also be time-consuming.
The advantage of the system is that client data once saved is safe as issues of clients misplacing their folders or mistakenly forgetting their data in the house in times of emergency are solved.
Also, in case one travels to a different city, and needs to access healthcare, the data can be easily accessed.
“We prefer the LHIMS to the manual because it makes our work easier however, the frequent network issues are rather prolonging turnover time on such days instead of reducing it significantly like we experience on good days,” she said.
A Senior Officer of the Ghana Immigration Service (GIS), who spoke on anonymity at the Sunyani Municipal Hospital in the Bono Region, shared that within the year 2024, she has experienced a system breakdown on about three different occasions when she visited the hospital and have to wait for hours.
“On one particular instance, I was asked to go home and come the next day but I didn’t because I spoke to a doctor friend who prescribed some drugs for me to buy from the pharmacy,” she said.
The Vision for LHIMS
Former Vice President of Ghana, November 2024, Dr. Mahamudu Bawumia, at the official launch of the Ministry of Health (MoH) Electronic-Project initiative reiterated that LHIMS had helped for easy patient record portability, eliminated manual record keeping, improved revenue accruals, and accurate submission of NHIS claims, reduced waiting time, improved access to actionable epidemic information promptly and enabled early detection of disease outbreaks among others.
He also mentioned the government’s plan to integrate the records of the patients with the national identification system, but that is yet to take effect.
The Core Network Downtime Challenge
At the heart of LHIMS operation is a dedicated network independent of internet services provided by the telcos but unfortunately, the network also experiences some challenges periodically.
The factors responsible for this, according to the LHIMS expert, include power supply failure to the network devices, damaged cables, and cable connectors, as well as physical damage to network devices.
To address these issues, he suggested continuous infrastructural support to ensure advanced or state-of-the-art network support equipment usage, and secondly, to improve the remuneration of dedicated staff to provide 24-hour support to the network, especially hardware and power supply.
Extend LHIMS to low-tier health facilities.
Former Health Minister, Dr. Okoe-Boye, in November 2024, mentioned that work is ongoing to deploy the LHIMS to other Health Centres and CHPS Compounds across the country but checks indicate that this is yet to take effect.
Considering the benefits and advantages outlined by the health facilities using the system, such as quick and easy access to patient medical records at all levels of treatment, reduction of human errors in data acquisition, and improved revenue collection accuracy, extending it to these facilities will stand to benefit their operations significantly, improving the efficiency of operations.
However, considering that these low-tier centres are even more deprived in terms of technology and advanced digital infrastructure, the challenges identified by the existing users must be addressed appropriately to avoid extreme impact on these smaller facilities.
Having said that, as a digital public good (DPG), LHIMS must be made accessible to all citizens irrespective of location. This will enable people in remote communities that only have access to CHPS compound to also escape the trouble of missing health records in case of emergencies and they find themselves at a bigger facility.
This report is produced as part of the DPI Africa Journalism Fellowship Programme, a collaboration between the Media Foundation for West Africa and Co-Develop.
