|Year : 2022 | Volume
| Issue : 2 | Page : 187-192
Information communication technology in medical practice: Pattern of usage and knowledge among doctors in a tertiary health institution in Southeastern Nigeria
Jude-kennedy C Emejulu, Sunday Patrick Nkwerem, Mary C Adimekwe
Department of Surgery, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
|Date of Submission||23-Oct-2021|
|Date of Decision||19-Jan-2022|
|Date of Acceptance||23-Feb-2022|
|Date of Web Publication||29-Apr-2022|
Dr. Sunday Patrick Nkwerem
Department of Surgery, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State
Source of Support: None, Conflict of Interest: None
Background: Information communication technology (ICT) is increasingly being used in medicine for teaching and clinical practice. It reduces physical contact and travel time and minimizes the risk of nosocomial infections, including COVID-19. It provides good channels of interaction among medical practitioners as well as between physicians and patients. In Sub-Sahara Africa, the windows of opportunity provided by these platforms, especially WhatsApp, Instagram, electronic mail, are still underused. Reasons include hostile legal atmosphere. Aim: This study aims to review the level of use and awareness of legality of WhatsApp, E-mail, and Instagram in a tertiary hospital in the South Eastern Nigeria. Materials and Methods: This was a cross-sectional study in which a pro forma was generated and sent to the contacts of doctors working in the above institution. The forms willingly filled and turned in were analyzed. Results: About 108 respondents willingly filled and turned in their forms. M: F ratio was 2:1, the modal age group was 20–30 years. About 36.6%, 22.6%, 12.9%, and 8.6% of respondents were in surgery, pediatrics, internal medicine, and family medicine, respectively. About 98.1% of respondents believed in the use of ICT; however, only 10% of respondents used it frequently in the management of patients. Among those respondents that used it, it was mostly for inpatient care. About 43.3% of respondents are convinced that there is no legal backing for ICT in Nigeria. About 86.6% of respondents are waiting to take advantage of ICT when proper law is put in place. Conclusion: There is a need for better advocacy and amendment of relevant law to enhance use of ICT.
Keywords: Communication, information, medical practice, technology
|How to cite this article:|
Emejulu JkC, Nkwerem SP, Adimekwe MC. Information communication technology in medical practice: Pattern of usage and knowledge among doctors in a tertiary health institution in Southeastern Nigeria. Niger J Med 2022;31:187-92
|How to cite this URL:|
Emejulu JkC, Nkwerem SP, Adimekwe MC. Information communication technology in medical practice: Pattern of usage and knowledge among doctors in a tertiary health institution in Southeastern Nigeria. Niger J Med [serial online] 2022 [cited 2022 May 21];31:187-92. Available from: http://www.njmonline.org/text.asp?2022/31/2/187/344379
| Introduction|| |
Information communication technology (ICT) has inarguably become an essential part of our existence; it has a great influence in almost every aspect of modern man's life. It simply refers to technologies that provide access to information through telecommunication. It involves the use of communication devices such as radio, television, cell phones, computer, and network hardware for the purpose of advancing medical practice. Unlike the traditional and conventional method of storing in the mind and passing it to younger generation orally with attendant gradual loss of content due to age, ICT is able to maintain the originality of content from generation to generation. It can be used to store, manipulate, retrieve, and receive information electronically in digital forms.
The global use and access to ICT has continued to grow tremendously with the developed economies maintaining the top spots. The use of ICT is gradually gaining momentum in Africa., It is being used as a tool for sustainable development, increased productivity, and administrative efficiency even at a reduced cost. The use of ICT in Nigeria has continued to increase with tremendous impact on governance, legal system, business, and educational sectors.,,,,
ICT has been very useful in undergraduate and postgraduate medical education where Zoom and Google platforms have conveniently been used for virtual teachings and conferences.,, This is especially important in this period of ravaging COVID-19 pandemic. ICT has also been found to be very useful in medical practice. It enhances information sharing among the health personnel as well as the patients, promotes bonding between the health workers and the patients alike, and enhances education of the medical practitioners.,, The impact on cost reduction is also considerable.
With the recent move by the Federal Government of Nigeria to encourage inflow of resources from diaspora and the need to encourage increased private participation in the health sector, many clinicians and investors overseas now establish hospital in Nigeria. Some of these facilities depend considerably on consultation from experts who are situated far from the hospital. This is made partly possible by ICT. In addition, the recent recurring waves of the coronavirus pandemic have put a lot of strain on available resources in the hospitals. This has led to reprioritization of resources to accommodate the emerging challenges. In some instances, regular clinics are scaled down while people are encouraged to interact with their physicians via phone calls, WhatsApp messages and calls, E-mail messages, etc.
This means of communication is cheap, does not involve physical contacts, reduces travel time, and minimizes the risk of nosocomial infections.
This mode of review of patients appears not to have garnered enough support in some quarters. Part A, item 22 of the Code of Medical Ethics in Nigeria: rules of professional conducts for medical and dental practitioners recognise the use of ICT to the extent of general practitioners and specialists using ICT in accessing tele-support in their daily practice especially for specialist consultations. It is however silent and opaque on the use of same in the daily review of the patients by the practitioner. An enabling regulatory environment is needed for maximum benefit from the improved access and service delivery these platforms provide.
This study sets out to study the level of use and awareness of the legality of some common ICT platforms (WhatsApp, E-mail, and Instagram) among doctors practicing in a tertiary hospital in the South Eastern Nigeria. The data on the knowledge and pattern of medical use of ICT are not readily available for our environment.
| Materials and Methods|| |
This was a cross-sectional study in which a pro forma was generated via Google Forms [Appendix 1]. This was then transmitted via WhatsApp messages to the respective contacts of the respondents. The willing respondents were encouraged to fill and submit the form electronically and also send to their contacts as many as they could. The results were collected and collated for analysis by the investigators.
| Results|| |
A total of 108 recipients willingly participated and submitted their forms via the Google Forms account of the investigators. The modal age group of the participants was 20–30 years. The mean age was about 32.7 years with standard deviation of 8.4 years. [Table 1] for the age distribution. The male: female ratio was 2:1.
Most respondents have been in medical practice for <20 years [Table 2] while 96% have been in the current cadre for 20 years and below.
About 36.6%, 22.6%, 12.9%, and 8.6% of the respondents were in surgery, paediatrics , internal medicine, and family medicine, respectively. The remaining were in the departments of community medicine, pathology, otorhinolaryngology, obstetrics and gynecology, ophthalmology, and anaesthesia.
About 98.1% of the respondents believed in the use of ICT; however, only 78.3% deploy ICT in the management of their patients.
Of the people that believed and used the ICT, most respondents used the ICT platform occasionally in the management of their patients [Figure 1].
|Figure 1: Most respondents used WhatsApp and Email communication platform. Instagram was rarely used|
Click here to view
Some of the advantages of ICT listed by the respondents included speed and ease of communication, efficiency, seamless interaction between health workers and patients, and regular monitoring of patients. Some of the disadvantages listed include lack of physical contact with patients, need for optimum power supply, occasional poor internet network in our environment, lack of privacy, and additional burden on the doctor uploading the information, unofficial.
About 54.6% of the respondents agreed it is legal to use ICT communication in the follow-up of patients in Nigeria. About 43.3% of the respondents agreed that there is no adequate legal backing for ICT in Nigeria. In general, most respondents (75.9%) agreed there is a need for adequate legislation of ICT use in Nigeria. Most respondents (86.6%) are waiting to take on the advantage of the use of ICT in the management of their patients.
| Discussion|| |
Globally, ICT has revolutionized medical practice. It makes easy control and use of the vast information that has accumulated over the years. Electronic medical archives are easy to access and less expensive to maintain. Documents and important information are better protected unlike in paper archives where those that are seeking for any given information have access to the entire document. Communication platforms like WhatsApp, E-mail, and Instagram can be used as telemedicine platforms to provide a veritable resource for interaction between patients and the attending clinicians as well as between clinicians. It aids quick communication by reducing geographic barrier.
ICT platforms like ZOOM meeting, Google Classroom, Google Meet, and Skype and other platforms appear to have more roles in virtual clinical conferences and meetings, as well as research.,, Communication platforms like WhatsApp have been found to be useful and reproducible in the radiological assessment of patients. It was found to have good inter- and intraobserver agreement.
A total of 108 doctors working in the hospital willingly responded and turned in their filled forms electronically. The modal age group of 20-30 years is likely because the highest number of respondents who willingly returned their forms are interns who were easily ICT savvier than their older colleagues. Some studies have shown that the millennial age group appears to be more favourably disposed to the use of ICT., Though Jegede found the converse among higher education teachers.,
Most respondents agreed that ICT was useful in medical practice. This was in consonance with similar studies in Ilorin and other parts of the country.,, Acceptability appears to reasonably equate with usage; about 80% of respondents who believed in ICT deployed it in the management of their patients. This is similar to the study done by Afolayan and Oyekunle. Only <15% of the respondents used ICT platforms infrequently [Figure 2], further proving acceptability.
|Figure 2: About 74.5% of the respondents had a formal unit group communication platform|
Click here to view
Of the three ICT platforms assessed, WhatsApp was the most patronized by the respondents. Waterloo et al. in the study showed that people generally are more active on WhatsApp in the expression of pains and emotion ahead of other platforms. WhatsApp platform is able to reach the participants in the forum once and by just a click away. Guraya et al. also found that among the medics, WhatsApp communication appears to be preferred in disseminating and sharing information.
Electronic mail has the advantage of being able to achieve a sustainable partnership between physicians and patients especially when personalized doctor–patient relationship is under threat. This is however with the concern for quality consultation, confidentiality, liability, and challenges of recovering fee. The need for further efforts to educate both the patients and physicians has been highlighted., E-mail use has also been described to be with “less urgency.”
Respondents appear to use the ICT platforms mostly for inpatient care while postoperative care has the least usage [Figure 3]. This research involved both physicians and surgeons, as such only the surgeons would ordinarily use it in postoperative care if interested.
Limited number of the respondents (55%) appreciated the extent of legality of the use of ICT platforms in the care of their patients. This is important since the volume of litigation in medical practice is on the increase globally. The effect of unwarranted and avoidable litigations is the preference by practitioners for defensive medicine: The implication of this includes increased healthcare cost, poor care of patients, reduced access to skilled physicians and surgeons, as well as limited use of Information Communication Technology in the care of patients. The role that ICT has played and has continued to play during the pandemic of COVID-19 is still fresh with us. With the aid of ICT platforms, hospital visitation was effectively controlled and limited to deserving patients only. This helps reduce nosocomial infections and also helps in the preservation of hospital space and resources for very ill patients. Continuing medical education will no doubt help resolve this reasonably. This will also help to bring colleagues on board. This is especially those who from this research appear not to have effectively keyed into the opportunities the ICT platform offers.
The limitation placed by Part A, item 22 of the Code of Medical Ethics in Nigeria as appreciated by about 44% of the respondents is also a source of concern. The deafening silence of the Code of Medical Ethics in Nigeria on the day-to-day review of patients, as well as online prescription, may expose the clinicians and management of the hospital to avoidable litigations. The need for proper review and update of this relevant law to reflect the current time may be the needed turning point. The increasing number of litigations worldwide makes this a conscious and desirable step.
First, the developing countries like Nigeria, will have to do more in order to key in and capitalise on the immense opportunity ICT offers in patients' care. Lectures on the importance and use of ICT in medicine should be made a compulsory part of Continued Medical Education. Workshops should be organized from time to time to update members. This will lead to quantum leap in the use of ICT platforms for greater interaction among physicians and patients with attendant benefit to mankind.
Second, If good medical care at a reduced cost and access to experienced clinicians who may be more willing to maintain good interaction in this ICT platforms are to be guaranteed, there is an urgent need for the review of the relevant sections of the Code of Medical ethics in Nigeria to reflect the current time.
| Conclusion|| |
There is a need for better awareness and use of ICT among the doctors for the benefit of the patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mars M, Jack C. Why is telemedicine a challenge to the regulators? S Afr J Bioeth Law 2010;3:55-8.
Hilbert M, López P. The world's technological capacity to store, communicate, and compute information. Science 2011;332:60-5.
Woreta SA, Kebede Y, Zegeye DT. Knowledge and utilization of information communication technology (ICT) among health science students at the University of Gondar, North Western Ethiopia. BMC Med Inform Decis Mak 2013;13:31.
John SN, Itaketo IN, Adewale AA. Automation and Easy Accessibility of Medical Services in Nigeria (ICT and Medicine). International Conference on Managing Current Global Challenges: IT Strategies and Tools. MaCGlobe '09 Nigeria Computer Society, Abuja; 2009.
Agbetuyi PA, Oluwatayo JA. Information and communication technology (ICT) in Nigerian educational system. Mediterranean Journal of Social Sciences 2012;3:41.
Aquilina K. Application of ICT in Legislative Drafting and Law Reform Projects. IJLDLR 2017;6:1.
Berg M, Aarts J, Van Der J. ICT in health care: Sociotechnical approaches. Methods Inf Med 2003;42:297-301.
Sanyal S. ICT, e-health & managing healthcare – Exploring the issues & challenges in Indian railway medical services. Stud Health Technol Inform 2005;114:157-63.
Idowu AI, Esere M. ICT and higher educational system in Nigeria. Educational Research and Reviews 2013;8:2021-5.
Wilcha RJ. Effectiveness of virtual medical teaching during the COVID-19 crisis: Systematic review. JMIR Med Educ 2020;6:e20963.
Guzacheva N. Zoom technology as an effective tool for distance learning in teaching English to medical students. Bull Sci Pract 2020;6:457-60.
Bolster L, Rourke L. The effect of restricting residents' duty hours on patient safety, resident well-being, and resident education: An updated systematic review. J Grad Med Educ 2015;7:349-63.
Vela K. Using Slack to communicate with medical students. J Med Libr Assoc 2018;106:504-7.
Bashshur RL, Shannon GW, Krupinski EA, Grigsby J, Kvedar JC, Weinstein RS, et al.
National telemedicine initiatives: Essential to healthcare reform. Telemed J E Health 2009;15:600-10.
Eysenbach G. What is e-health? J Med Internet Res 2001;3:E20.
Yao K, Iwashita A, Tanabe H, Nagahama T, Matsui T, Ueki T, et al.
Novel zoom endoscopy technique for diagnosis of small flat gastric cancer: A prospective, blind study. Clin Gastroenterol Hepatol 2007;5:869-78.
Alechenu, B. E. Economic Impact of Diaspora Remittance on Nigerian Economy. London Journal of Social Sciences 2021:1;79–87.
Tahir MY, Mars M, Scott RE. A review of teleradiology in Africa – Towards mobile teleradiology in Nigeria. SA J Radiol 2022;26:2257.
Medical and Dental Council of Nigeria. Code of Medical Ethics in Nigeria: Rules of Professional Conducts for Medical and Dental Practitioners [internet]. Nigeria: Medical and Dental Council of Nigeria; 2004. Available from: http://www.mdcnigeria.org/Downloads/Code%20OF%20CONDUCTS.pdf
. [Last accessed on 2021 Jun 28].
Rucker J, Steele S, Zumwalt J, Bray N. Utilizing zoom breakout rooms to expose preclerkship medical students to TeleMedicine encounters. Med Sci Educ 2020;30:1359-60.
Archibald MM, Ambagtsheer RC, Casey MG, Lawless M. Using zoom videoconferencing for qualitative data collection: Perceptions and experiences of researchers and participants. Int J Qual Methods 2019;18:1609406919874596.
Chang TY, Hong G, Paganelli C, Phantumvanit P, Chang WJ, Shieh YS, et al.
Innovation of dental education during COVID-19 pandemic. J Dent Sci 2021;16:15-20.
Giordano V, Koch HA, Mendes CH, Bergamin A, de Souza FS, do Amaral NP. WhatsApp Messenger is useful and reproducible in the assessment of tibial plateau fractures: Inter-and intra-observer agreement study. Int J Med Inform 2015;84:141-8.
Igbo HI, Egbe-Okpenge EG, Awopetu RG. Influence of information and communication technology on behavioral problems of Nigerian youths. Procedential Soc Behav Sci 2013;84:97-106.
Kubiatko M. The comparison of different age groups on the attitude toward and the use of ICT. Educ Sci Theory Pract 2013;13:1263-72.
Jegede PO. Age and ICT related behaviors of higher education teachers in Nigeria. Issues Inf Sci Inf Technol 2009;6:771-4.
Afolayan OT, Oyekunle RA. Availability, accessibility and frequency of use of ICT tools by health professionals in Ilorin metropolis. Convenant J Inf Commun Technol (CJICT) 2014;2:1-27.
Ceo O, In A, Yi E, Pa A, Dambo I, Ma I. Assessment of ICT usage in healthcare service systems: A case study of the Federal Medical Centre (FMC) Yenogoa in Bayelsa State, Nigeria. Int J Comput Trends Technol 2013;6.
Iyanuoluwa OO, Ololade R, Odinaka A, Adedeji P. Factors influencing adoption and use of ICT among nurses in selected hospital in Ibadan. J Health Inf Dev Ctries 2021;15.
Waterloo SF, Baumgartner SE, Peter J, Valkenburg PM. Norms of online expressions of emotion: Comparing Facebook, Twitter, Instagram, and WhatsApp. New Media Soc 2018;20:1813-31.
Guraya SY, Al-Qahtani MF, Bilal B, Guraya SS, Almaramhy H. Comparing the extent and pattern of use of social networking sites by medical and non medical university students: A multi-center study. Psychol Res Behav Manag 2019;12:575-84.
Car J, Sheikh A. Email consultations in health care: 2 – Acceptability and safe application. BMJ 2004;329:439-42.
Brooks RG, Menachemi N. Physicians' use of email with patients: Factors influencing electronic communication and adherence to best practices. J Med Internet Res 2006;8:e2.
Menachemi N, Prickett CT, Brooks RG. The use of physician-patient email: A follow-up examination of adoption and best-practice adherence 2005-2008. J Med Internet Res 2011;13:e23.
Kane B, Sands DZ. Guidelines for the clinical use of electronic mail with patients. The AMIA internet working group, task force on guidelines for the use of clinic-patient electronic mail. J Am Med Inform Assoc 1998;5:104-11.
Wood C. The misplace of litigation in medical practice. Aust N Z J Obstet Gynaecol 1998;38:365-76.
Roytowski D, Smith TR, Fieggen AG, Taylor A. Impressions of defensive medical practice and medical litigation among South African neurosurgeons. S Afr Med J 2014;104:736-8.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]