Introduce new paper-based outpatient morbidity recording system to outpatient departments of public hospitals in Sri Lanka: feasibility study

Dimuthu Rathnayake, Champika Wikramasinghe, Chaminda Weerabaddana


Background: Effective evaluation of public health status is reinforced by description of the current health status of the community, ability to detect changes in this status and prediction of trends. Morbidity and mortality are often recorded in patients presenting to hospitals. There are more than 1,100 government owned hospitals in Sri Lanka and these institutions have been providing services to average 50 million out-patients per annum. Morbidity data of patients attending Out Patient Department (OPD) of these health facilities are not routinely recorded. We developed a new paper based OPD morbidity recording system adapted with International Classification of Primary Care (ICPC-2) coding and tested its feasibility in various hospitals.
Methods: We used an intervention study design composed of three phases. Pre-intervention was to develop the new paper based OPD morbidity recording system. During the second phase, new recording system was tested in 3 hospitals, which were selected randomly from each hospital level: a primary care hospital, a divisional hospital and a base hospital located in Colombo district. New recording system implemented for a month period in selected three hospitals. We measured the feasibility over the process and acceptability of participants for the new recording system in various aspects during the post-intervention phase.
Results: New paper based OPD morbidity recording system consisted with an OPD form, an OPD return and a Tally sheet and data flow was outlined in the pre-intervention. Feasibility assessment showed high perceived satisfaction to layout (97%), timeliness (97.5%), technical competency (75%) and training & orientation provided (98%). All hospitals showed more than 90% of overall completeness for the new OPD at registration table. Although overall completeness of entries made at consultation table had shown more than 68% completeness, it is declining when hospital becomes larger. High accuracy (99%) is shown in direct entering ICPC-2 codes and 98% in overall satisfaction of MO/OPD implied that new OPD recording system is acceptable. The preparation of new OPD return and tally sheet was also well accepted by medical record officers (MRO).
Conclusions: New paper based OPD morbidity recording system was accepted as user-friendly and feasible to be implemented in OPD settings and medical record offices in tested hospitals. The readiness of central medical statistic unit for large OPD data flow should be assessed and possibility of incorporating IT solutions in future is recommended.