The Medical Record System at Okhaldhunga Community Hospital in Rural Nepal

Abstract

Background

Okhaldhunga Community Hospital (OCH) lies in a rural area in the east of Nepal. In this area there is no reliable power supply so it is still not possible for this hospital to use a computer based medical record system (MRS) like we do in most western hospitals today. Therefore they have developed their own system, where the patients themselves are responsible for taking care of their own medical record (MR) and bringing it at their next visit to the hospital. We wanted to look at how this medical record system at OCH works today.

Method

We chose to use a dual strategy to achieve this goal, a quantitative and a qualitative design. In the quantitative part, we developed a questionnaire concerning the MRS and analyzed factors we assumed could influence the patients’ compliance in bringing their medical record to the hospital. We hired one of the staff at OCH to interview all the patients coming to the hospital for three different months: January 2010, April 2010 and October 2010. In the qualitative part we did 10 semi-structured interviews with patients at the hospital. To analyze the interviews, we used the principles of systematic text condensation as modified by Malterud.

Main Results

Most of the patients bring their own Medical Record (MR) to the hospital (89,7 %). Factors increasing this compliance are short travel time to the hospital, many previous visits and short time since last visit. The patients state that the main reason to bring the MR is to get the consultation cheaper. The patients with less education, the patients that have been to the hospital several times before and patients that have visited the hospital a short time ago are significantly more concerned about the price of the consultation. The patients keep their MR at a safe place in their homes together with other important documents. They have a lack of knowledge concerning the content of the MR, and they want to know more about the content.

Conclusions

OCH has a MRS that challenges our regular way of thinking about MRs due to the fact that they give the patients the full responsibility to take care of their own MR. The study reveals that the MRS has a high functionality concerning the compliance of the patients in bringing their MR to the hospital and it seems like the main motivation for bringing the MR to OCH is to get the consultation cheaper. The study also reveals a lack of knowledge concerning the content of the patients` own MR, and that they hunger for more information. This result may indicate that by giving the patients easy access to their own MR, it could make the patients more concerned about their own health situation.