# Exploring the Health Information Management System of Kuwait: Lessons and Opportunities
## 1 Introduction  
In the present medical environment comprising a multidisciplinary team that provides care to a single patient, medical records or health information (paper or electronic) have become an indispensable part of clinical decision making [1]. Medical records are vital communication tools that include but are not limited to, data on laboratory or diagnostic tests, treatment plans, pre- and post-operative care, consent forms, discharge records, etc. [2]. Along with facilitating uninterrupted and smooth patient-centered care, medical records serve other equally imperative purposes, such as litigation cases that, for instance, may arise due to malpractice allegations, and reimbursement by third-party payers [2; 3; 4]. Despite health records being a crucial aspect of healthcare, poor clinical documentation practices have been reported in certain countries [5; 6]. As stated by the World Health Organization (WHO), to boost the quality of any healthcare system, it is of paramount importance to ensure that a robust system for medical records management is in place [7]. The State of Kuwait comprises six goverronates that are composed of primary, secondary, and tertiary healthcare centers [8]. Although medical records are maintained in allhealthcare settings, their quality is poor, despite national standards established by the Ministry of Health (MoH) [9; 10], and is further exacerbated by inadequate regulatory bodies overseen by the MoH. A case in point is a study conducted in 1985 to assess the medical records in Kuwait hospitals, which revealed significant deficiencies in the quality of the medical records system, such as incomplete documentation, lost patient records, misified diagnostic reports, and unskilled workforces [10]. A later study conducted by [PERSON] confirmed that the identified gaps in the medical records system were still persisting in Kuwait hospitals [11]. Other factors contributing towards a weak medical record system include an inadequate workforce and a decentralized medical records management, leading to the development of certain units, offices, and taskforce teams that are not officially processed by the MoH. In a 2015 evaluation of the quality of the health information system (HIS) of Kuwait, the MoH deemed this system 'inadequate', highlighting the need for further improvement. Although significant steps have now been taken, such as the introduction of electronic health records (EHRs) across all primary healthcare centers, there remain several gaps in the EHR system in Kuwait's healthcare settings. For instance, of the six secondary care centers, only three have employed an EHR system, despite EHRs receiving unprecedented global attention [8; 9]. The benchmark for measuring the quality of medical records systems is set by professional organizations belonging to the health information management discipline. A national strategic plan that aims to transform the State of Kuwait by 2035 is underway [12; 13], which identifies 'high quality healthcare' as one of its seven pillars [13; 14]. This strategic plan, along with establishing new healthcare centers, is focused on promoting interdisciplinary research to create and disseminate research-oriented knowledge. To achieve this, Kuwait urgently requires an integrated and ubiquitous platform to allow access to health information and render benefits for research, policymaking, and evidence-based decision-making [9; 15]. Thus, it is indispensable that Kuwait's healthcare centers not only improve their HIS but also undergo a complete transition from paper-based records to EHRs [9; 16; 17]. The literature on the medical record systems in Kuwait is extremely scarce [10]. While one study focused on specific aspects of medical records in a healthcare setting [18], another concentrated on patient satisfaction before and after the implementation of EHR [19]. In Karnataka, a large state in India, a systematic analysis was performed to study the health record management system in private hospitals.