CHAPTER ONE
INTRODUCTION
1.1  Background of the Study
According to Lisker, (2007) an Electronic Patient Information Management System is any tool used to assist in the delivery of clinical care from point of care initiation to completion. The tools include computer based attendance scheme for patient, payment processing software and information technology systems, blood group and genotype to avoid test result mismatch of data. Electronic based attendance scheme for Patients is used by hospital to create process and record their attendance scheme for patient’s information. This system is used to calculate the nurse punctuate to work. It’s an effective tool in the hands of the hospital management (Lisker, 2007). Duty is a term that conveys a sense of moral commitment to someone or something. The moral commitment is the sort that results in action, and it is not a matter of passive feelings or mere recognition. When someone recognizes a duty, that person commits himself/herself to the cause involved without considering the self-interesting courses of actions that may have been relevant previously. This is not to suggest that living a life of duty precludes one from the best sort of life, but duty does involve some sacrifice of immediate self-interest. Cicero is an early philosopher who acknowledged this possibility. He discusses duty in his work On Duty. He suggests that duties can come from four different sources:       i.           It is a result of being human     ii.           It is a result of one’s personality place in life (your family, country, and job)  iii.           One’s own moral expectations for you can generate duties From the root idea of obligation to serve or give something in return, involved in the conception of duty, have sprung various derivative uses of the word; thus it is used of the services performed by a minister of a church, by a soldier, or by any employee or servant (Arnett, et al. 2006). Nurses today have a broad scope of responsibility as health care providers that require them, under some circumstance, to exercise independent professional judgment. When nurses exercise their judgment negligently, they may be held liable because courts hold them to a correspondingly higher level of accountability. Nurses have been held liable for their failure to monitor and/or promptly respond to patients by informing physicians of significant changes in patient’s condition. Under these types of circumstance, nurses have an affirmative duty to exercise their professional judgment to ensure that all adequate steps are taken to treat patients appropriately (Arnett, et al. 2006). Usage of Information Technology (IT) remained comparatively very less in Health sectors that other sector despite having more potential (Thomas, 2008). Health Institution, which is an important sector, should encourage IT usage resulting in better productivity, effectiveness, efficiency and economics leading to better health care of all. This paper tells a success of implementation of ICT (Information Communication Technology) in monitoring of medicine in health institution. System work on low-end resources and E-mail (Electronic mail) based data transfer from District Head Quarter to State Head Quarter. Implementation of Med-Centre in all the district of Enugu result in checking on pilferage (the act of stealing amounts or small articles) for medicine, increase in availability of medicine at Government institution, increase in attendance of patients/doctor in health institution, optimal utilization of medicine and data capturing at source, resulting in availability of error-free data at Head Quarter (Thomas, 2008). Electronic Patient Management System is a certified automated managerial processing software (Lisker, 2007). It is used by hospitals to input, process and display their patient information. This system is used to manage and maintain electronic medical records, patient information, prescriptions, lab reports etc. It is an effective tool in the hand of the hospital management (Lisker, 2007). Shanahan Hospital, Nsukka, Enugu which is the case study, has patients whose fees are to be collected after treatment. Shanahan Hospital, Nsukka, Enugu is one of the biggest and well equipped hospitals in Nigeria. It has nine (9) training schools/programmers in the hospital. From the studies carried out by the researcher, the hospital’s initial means of recording was manual from automated system to computerized system which lacked some features such as patients and nurses records. Lonabocker, (2003) stated that the Hospital is a very important part of our society and it is imperative for healthcare providers to do their jobs in an efficient and effective manner. Each day hundreds of thousands of patients enter healthcare facilities challenging the administration to run the show smoothly. The employees have to manage and integrate clinical, financial and operational information that grows with the practice. Information technology has made a significant impact on the healthcare sector. The past decade has witnessed the foray of numerous information systems and their resultant products into the hospital scenario. The number of investments in computers and types of hospital systems has increased. This is because paper medical records are cumbersome, bulky to use and difficult to manage. On the other hand digital records are much easier to handle and improve the workflow efficiency by integrating various tasks. The ultimate objective therefore, is to build a network of interdependent centers such as the clinical laboratory, radiology department, pharmacy, and so on in order to effectively meet the needs arising within the hospital. Despite the fact that these individual centers are autonomous, they are interdependent in terms of delivering services and to ensure effectiveness of providing care. All this can be achieved through hospital information systems that have formed the cornerstone of today’s modern hospital (Lonabocker, 2003). A patient is any person who receives medical attention, care or treatment. The person is most often ill or injured and in need of treatment by a physician or any other medical professional whereas an outpatient is a patient who is not hospitalized for 24 hours or more but who visits a hospital, clinic, or associated facility for diagnosis or treatment. Treatment provided in this fashion is called ambulatory care. (Lonabocker, 2003). This Electronic Patient Management System is necessary to ensure the medical practitioner to maintain its operations in an organized and well-coordinated manner. These solutions save time and run the operations using the best mechanisms against liabilities. This system is especially helpful in organizing and keeping patient records up-to-date. Patient names, records of treatment and medicine given records are well maintained. Maintaining patient records is really helpful when you are allowed to refer to the patient’s old history. Say for example, you want to refer your old patients for mouth cancer or jaw piece ulcers and cancers, you may be able to locate such records on the basis of their symptoms or conditions as you had entered in the database in the past. By law hospitals are required to record in the outpatient information register once at the beginning of the morning session and once during the afternoon whether the pupil is present, absent, engaged in an approved, or unable to attend due to exceptional circumstances as defined in regulation. If compulsory hospital patients are absent the register must show whether the absence is authorized or unauthorized. It must also record the nature of any approved activities. By using this Electronic Patient Management Information System, the department will provide the patients with convenience and security of having their payment records been stored automatically into the database for further processing. This automated method is the most advanced and least expensive way to maintain and process patient’s payment records. If a patient’s payment record is not found in the database, definitely that patient’s fees has not yet been paid.