University of Nairobi

Abstract Medical informatics is very expensive to procure. The impact of ICT on health care delivery in developed countries reveals that despite the many challenges encountered, ICT has improved quality of healthcare. This has not been the case in developing countries. This study undertook a medical computing needs assessment and reviewed current ICT trends in both high-end and low-end medical institutions within Nairobi and it's environs here in Kenya. The role oflCT in the operations of medical institutions was also assessed. The procedures currently used for collection of medical data, processing, storage and security of patient records were reviewed. The study found out that both public and private hospitals have faced ICT -related challenges in the areas of procurement, implementation, maintenance, limited funds, inadequate technical capacity, insecurity, rapid medical innovations, disease coding, government reporting, confidentiality breaches, non-comprehensive systems, record preservation, retention and destruction. The study recommended adoption of electronic medical records (EMR) with carefully crafted security measures. The government should enact a new Act with clear provisions on confidentiality, access rights and ownership of patient records and software. The envisaged Act should set grounds on which electronic records are recognized as legal documents. Greater co-operation between local universities and medical institutions should be cultivated to build local capacity in medical informatics. Hospitals should procure open-systems such that local ICT specialists can customize them in cases where the vendor has withdrawn after-implementation support. Funds should be solicited to finance computerization of patient administration and medical records operations in public hospitals since they serve a large number of patients. For instance, the country's leading referral hospital had a bed capacity of 1800 and some interviewees conceded some cases of over admission have occurred. The government should offer tax waivers on all ICT products (both hardware and software) to accelerate procurement of medical informatics for local hospitals. The study used Medinous, a highly integrated and interoperable HMIS in Europe as a benchmark against which local systems were audited. Abstract, Tables: TOC, List of Figures, List of Abbreviations