# Exploring the Health Information Management System of Kuwait: Lessons and Opportunities
## 4 Discussion  
This study aimed to determine the existing functions of the medical records system of Kuwait and provide recommendations for reforming and strengthening the health information management system (HIMS). The following four main aspects of Kuwait's HIMS were assessed: (1) Characteristics of the medical records management system; (2) Medical records policies and procedures; (3) Storage, retention, and disposal of the medical records; and (4) Existing problems in the HIMS. The results of this study reveal that the policies and procedures of the HIMS in Kuwait's healthcare settings are nonuniform and withhold major gaps, additionally lacking sufficiently trained staff for managing health information. The manual, paper-based method of medical record keeping is the traditional method that poses serious limitations, a few of which are challenges with accessibility, accuracy, storage, and retrieval of data [2; 18]. Paper-based medical records cause additional issues, such as lost charts, ineffective record management, and writing errors, raising serious challenges in collecting, validating, and analyzing data [18]. EHRs are tools that enable healthcare practitioners to collect, manage, store, and retrieve health-related information of patients in an electronic format, thereby enabling easy access and sharing of records between different authorized individuals at any given location. EHRs can thus enable healthcare personnel to improve coordination in providing care, further eliminating duplication of patient records and diagnostic tests, by efficiently making the previous results of laboratory tests and interventions available to different points of care [26]. In regard to the format of patient records (Table 2), our study showed that patient records were predominantly stored as both paper and EHRs (53%) and as paper records alone (43%). Although all primary healthcare centers in Kuwait have implemented an EHR system, there seems to be a great gap between the maturity and adoption of this system across different facilities [28]; these statements are consistent with our results as we found that almost half of the hospitals still use paper records alone. HIS is an integrated system that enables the effective management of clinical, administrative, and financial information in healthcare settings, including the management of healthcare data, such as collecting, storing, and transferring EHRs. According to [PERSON] [29] and [PERSON] [30], there are several technical functions within the scope of HIS practice, such as coding, abstracting, releasing information, and analyzing the documents qualitatively and quantitatively. Based on our results, most hospitals (70%) in Kuwait have employed a hybrid system, comprising both manual and HIS, while 20% and 10% of the hospitals use a manual system and the HIS, respectively, to process and manage the technical functions of HIS. The MoH is the guiding force of the medical records standards, policies, and procedures represented by the National Center for Health Information (NCHI), which follows the WHO standards for quality of services in the medical records departments in developing countries; its role is similar to that of The American Health Information Management Association, The Healthcare Information and Management Systems Society, The American Medical Informatics Association, and many more [31]. However, the lack of uniform standards is reportedly a major barrier that affects the implementation of EHRs in Kuwait, as stated by [PERSON] [18]. Although this report [18], which examined and identified measures for improving the adoption of EHRs in Kuwait, stated that the quality and delivery of patient care can be enhanced by increasing access to patient information, a HIS that is not efficiently managed can be counterproductive. Health information that is not appropriately maintained, managed, updated, and secured can have an opposing effect; rather than being beneficial to healthcare reforms, inadequately managed health information can create problems and barriers [26].