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PATIENT RECORD MANAGEMENT SYSTEM
LAILATUL MUNIRAH BINTI PAIRON
This report is submitted in partial fulfillment of the requirements for the Bachelor of Computer Science (Software Development)
FACULTY OF INFORMATION AND COMMUNICATION TECHNOLOGY UNIVERSITI TEKNIKAL MALAYSIA MELAKA 2007
The Patient Record Management System is developing for Unit Rekod Perubatan (URP). This system focused on the patient record management for surgical department which include the patient record and patient admission record. The development of this system is to increase the function of patient record management. Besides that, it also to increase the security of patient record, minimize time in record calculation, and availability of record. The module that included in this system is patient record management, borrowing record, and record calculation. So, this computerized system will solve the problem that faced in the current manual system. The system that will develop is using SDLC (System Development Life Cycle). The SDLC has a similar set of four fundamental phases: planning, analysis, design and implementation. It is using waterfall methodology.
Sistem yang dibangunkan adalah Sistem Pengurusan Rekod Pesakit Jabatan Pembedahan. Sistem ini bakal digunakan di Unit Rekod Perubatan (URP). Sistem ini memfokuskan pengurusan segala data mengenai rekod pesakit bagi Jabatan Pembedahan merangkumi rekod pesakit dan rekod kemasukan wad pesakit. Ia adalah bertujuan bagi menjamin keselamatan rekod pesakit dan memudahkan pengiraan rekod. Sistem ini akan meningkatkan mutu pengurusan URP. Modul yang terlibat adalah pengurusan rekod pesakit, peminjaman rekod dan pengiraan rekod. Sistem yang sedia ada dijalankan secara manual. Kelemahannya adalah berlakunya kehilangan rekod pesakit, tiada maklumat pinjaman rekod dan pembaziran masa. Maka, sistem berkomputer bakal dibangunkan bagi mengatasi segala masalah yang dihadapi. Sistem ini dibangunkan menggunakan kaedah System Development Life Cycle (SDLC) manakala metodologi yang digunakan adalah waterfall.
The surgical department is one of the organizations that provide services for cases that need laparoscopic or open surgery. This department also receives references from nearby districts such as from Jasin, Alor Gajah, Tampin, Tangkak, and Segamat. The services that are given such as inpatient surgical treatment, operation day, endoscopy, clinic day for the SOPD, breast clinic, palliatives care and etc.
This system will use in the healthcare industry which is in the Unit Rekod Perubatan (URP). The existing system is using manual system which is at this time, all the data about patient has key in using Dbase. However, the calculation and some of the task have done manually. Therefore, this is difficult task and sometimes gives a problem. "Putting on the shoes of the people you've created, and looking at their problems and solutions through their eyes" (Kuniavsky 2003). This system that will develop is to improve the current system about the patient information database. There was data redundancy about the patient admission record which one patient takes many storage spaces in the database. For example, if the patient has been admitted six (6) times in the different or same ward, he or she will have six (6) different databases based on their R/N (reference number).
System application that will develop is Patient Record Management System at Unit Rekod Perubatan. This system have different category of user which is administrator (have the password) and user. The administrator can edit or modify, delete and save the record while the user only can view the record. These systems also include the borrowing information such as the person who borrowed the record and duration. This system can print the reminder letter (suratperingatan) and the patient label. At the end of the month, this system will calculate the record to produce the monthly report which includes the appointment information and admission information. Besides that, it also have network sharing which when two computers are using together and run at the same system, all the data are updated automatically. When the administrator updated one record, the record will also update at another computer. This will reduce the data redundancy which different administrator key in the same record. So, using this system will make the data efficiency and work effectively. It will also decrease the record calculation error during using the system. This will change the manually system to the computerized system which are more trustworthy, efficient and effective.
The main problem that faced are data redundancy. The existing system that use have many databases record for one patient based on their admission. For example, if the patient have admitted for eight (8) times in the different ward although the same ward, she or he will also have eight (8) databases based on their
RN. Therefore, by using this new system it can generate one database record for one patient. That's mean; this will decrease the storage place. Besides that, the lost of the patient record also can be reduced. For the Surgical patient record, currently the patient record is only recorded in the paper. Sometimes, the lost of patient record happened most probably because of the misplaced of the record.
Another problem is about the unmonitored borrowing record. For the URP, there is no system for recording borrowed information of the patient by the doctors. When the doctor wants to borrow the record, the URP Bilik Kad's staff will always spend a lot of time finding the record in the record room as they did not know if the record is available or not. Sometimes, the person who borrowed the record did not return it back personally to the record room after finished using. Therefore, it will contribute to the unavailability of patient record at record room. And the staff at the record room will spend a lot of time to find the unavailable record and this is such a waste less work.
This system has a several objectives to fulfill as below: a. To replaced the current system (manual system) with a flexible, systematic and more reliable record management system. The proposed system will be the system which is will fully using computer to manage the record and patient's file movement. It is more efficient and effective than manual system which is burden the staff in the record room b. To decrease the calculation error about the record amount to produce the monthly analysis report. This include to reduce the lost of data and staff burden c. To decrease the data redundancy of the patient record and avoid opening several file for the same patient d. To decrease the time use to manage, find and calculate records
This system will be developed for Unit Rekod Perubatan in the Surgery department. These system has two level or different user which is administrator and user. For administrator level, it will have their own password which can modify the patient record and has the authority to all the module while the user only can view the data. This system will not replace the note or description stated by the specialist but as a guide to track or monitor the movement of the patient's file. The functions of the system included: a. Patient record management 1. Registration module This feature is for the patient registration. The patient information will insert to the database. 2. Add
This feature is for user to add new data into the database 3. Modify/ Update
This feature is for user to change the existence data in the program 4. Delete This feature is for user to delete any existence data from the program 5. Save This feature is for user to save a new data into the database 6. Find
This feature is for user to searching data in the database
b. Borrowing record All the information will recorded in the database such as the person who borrowed the patient record, the date and the reason. So, the system will automatically calculate the duration. If the record has borrowed more than two weeks, the system will print the reminder letter (suratperingatan). This will reduce the lost or missing record and unknown person who borrowed the record. c. Report calculation At the end of the month, this system will produce a report which calculate the patient record and discharge information. This include the total new record and the borrowing record. d. Database integration This system has network sharing which mean that if one administrator key in or update the patient record, the record at the another computer also updated. So, this will decrease the data redundancy and duplicated.
The management of the Unit Rekod Perubatan can manage all the patients' records for surgical department effectively and clearly by using this system. The data redundancy or lost of the data about patient records also will not happened anymore.
The expected output is the computerized surgical patient record management for Unit Rekod Perubatan in Surgery department is successfully implement and running without problems.
From a proper planning and development, hopefully that this system is going to solve the problems arise in the Patient Record Unit in the Surgery Department. This system will make the staff works much more efficient to give service to the people needed.
LITERATURE REVIEW AND PROJECT METHODOLOGY
Introduction To develop a new effective system, the research about literature review, about
the area and previous development must be done without doubt. Literature review means searching, collecting, analyzing, and drawing conclusion from all debates and issues raised in relevant body of literature. Based on Oxford Advanced Learner's Dictionary, "literature" mean writings that are valued as works of art especially fiction, drama and poetry while "review" means that a survey or report of a subject or of past events. The source that we can get the literature review such as journal articles, books, conference proceedings, government and corporate reports, newspapers, theses and dissertations, technical reports, anonymous reference, publication of international bodies or agencies, internet, CD-ROM,.and magazines. Using a methodology helps with the management of the whole project by breaking down the development process into small tasks, specifying the order in which they should be done and the interdependencies of the tasks. This helps with planning, scheduling and monitoring the progress of the system.
Fact and finding Several case studies that are related are picked to be analyzed and studied in
order to get a crystal clear about the system that going to be developed. A comparison table between these case studies is show to see its similarities, advantages and disadvantages.
Case study of Existing Unit Rekod Perubatan (URP) system Based from the review of the existing computerized system that developed, the system is developed using Microsoft Access. Before using this system, the records are key-in using Dbase and the calculation is done manually. Until now, there are no problems that faced with the existing computerized system. However, the problem that they will encounter is when the amount of data increase.
Case study of Healthcare Guarantee System Today there are many people make their long term planning for the family's health treatment. Introducing of Managed Care Organization (MCO) is one of the popular services provided by insurance company. Once you own this medical card, you can enter into private specialist center and get their services. All the services will cover by insurance. The trend (MCO) becomes famous among the Malaysian due to the services provided government hospital is slow. One of the MCO's roles is to facilitate your convenient admission to and discharge from a hospital. It offers you a way to be free from the usual hassle in claims procedures. It has been designed to relieve you of this burden with the issue of a Medical Card. Use this Medical Card for immediate hospital admission and on discharge, you need only settle excess charges, if any. Healthcare guarantee system is an online system, people can access into the system in any place that connect to the internet. It cans quickly processing of large amount of data, with the ability to evaluate, sort and retrieve data and information with great processing speed. This system provided a faster processing ability, it
replace human doing the routine and tedious paper work. All the calculation and paper work will be replacing by the new system. Besides the benefit on behalf of the staff, the new system can enhance company marketing by providing online computerization insurance claim system. By promoting this new system, we can attract other Manage Care Organization joint us develop the new potential market. The slogan been used is "Online Insurance Claim in A Minutes". This system will help company to get more and more customer because we able to provides effective online insurance claim services. Cost reducing is another benefit given by the new system. Previously insurance claim process has to go through few persons, from admission department, the claim for been pass to the clinic assistance to waiting attending doctor filling the medical report. Later on the report has to fax to insurance company and the phone call have to make to confirm insurance company have receives it. All of this process can be reduce by implement healthcare guarantee system. Admission department will register patient in the system and the attending doctor will fill in the medical report immediately. Healthcare guarantee system will make the decision whether this particular case will be cover by insurance company or decline. All this process does not need fax, phone or paper. Besides this it also reduce work force the company. The methodology chosen to develop the Healthcare Guarantee System is categorized under structured design methodology. It is a set of procedure for examining an existing information system and identifying the requirement for any new system (Penny, 1897). It users a formal step-by-step approach to development the system and move logically from one phase to the next phase. This methodology used covers four main phases, namely system analysis, system design, system development, and system testing.
Case study of Improving outpatient clinic efficiency using computer simulation To assess and plan alterations in outpatient clinic structure, produces a computer simulation of an outpatient clinic based on detailed time and role measurements from the authors' clinic. The simulation which used an object
oriented design method is able to indicate the impact of changes in clinic structure using patient and doctor waiting times in clinic as endpoint measures. The effects of changes in clinic size, consultation time, patient mix, appointment scheduling and non-attendance were examined. We found that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals. Clinic mix influences patient waiting time, which was shorter with a 1 in 4 ratio of new to follow-up patients. In mixed clinics, new patient's appointments are optimally spread throughout the clinic to reduce patient waiting time. In all new or all follow-up clinics, waiting time is improved if the appointment interval reflects the consultation time. Computer modeling can help in optimizing clinic management so improving the delivery of care in outpatient services.
Case study of Integrating information systems and health care According to J. Griffith (1987), by the middle of the twenty-first century patient care in hospitals will be highly computerized. The doctor will guide an electronic system which suggests a plan of care for each patient based on analysis of both the patient's history and detailed data about specific treatment options. Forecasts of all patients needs will be available to each patient service unit. Systems will optimize schedules, order supplies, and prompt completion of the original assignment and follow-up of any unexpected occurrences. Complete records will be available to establish expectations and monitor performance for the doctor and the nurse (Kovner, 1990). As of 1985 the processing ability of the computer has far exceeded its use in practice. The computer has had a much wider acceptance in finance and billing for services than in patient care. But computers are being used increasingly in analysing treatment in relation to outcome and in developing standards for diagnosis and treatment. The application of computer technology in health care is by no means new. Earlier straightforward applications included text production and editing, data analyses, and adjacent graphics products. Narrow range clinical application involved the use of neurodiagnostic scanners (for example magnetic resonance imaging and CAT scan). What is new in health care is the accelerated pace of innovation, clinical application development, and information management opportunities.
Entire departments of service known as health-care information (a science of information, technology, and knowledge applied to health care) have developed over the last few years. In the 1970s, cost plus reimbursement and financial systems were an information systems priority. During the 1980s, clinical systems were integrated into the landscape with health-care reform while information systems in the 1990s need to focus on operations management. Currently, health-care providers in a variety of settings are using technology to improve the efficiency, effectiveness, and quality of care delivered to their patients. Current technological applications include basic data processing, electronic mail exchanges, computerized medical records, and videolfax transmissions. Additionally, more advanced applications include robotics, first and second generation artificial intelligence products, and completely image based medical records.
Figure 2.1 : Operational information systems The essential ingredient for integrating information is teamwork. There is a dramatic need to bridge the gap between the people, processes, and technology sides of the hospital (see Figure 2). Programmes like patient focused care, re-engineering systems integration, total quality management, and benchmarking have flourished. These programmes allow organizations to adapt to governmental and market changes, help target solutions to specific problems or react to industry trends. The
problem is that there is rarely sufficient communication to link these areas together. Only a hospital-wide mission-driven effort will be effective at managing the coming changes. This approach will require a level of teamwork never before demanded of physicians, administrators, hospital staff, researchers, and teaching institutions.
Case study of Computerized patient record system The last area, computerized patient record system, is fast becoming the most researched area in health care. Arneritech Knowledge Data, Cerner, First Data Corporation, HBO & Co., and SMS are the leaders in this field. The projected plan is to minimize or remove the paperwork of a patient's medical record, and to have systems that will store these data. By having a patient's medical record on the computer screen, the organization has enhanced the ability of the doctor and of the other treating personnel to have a better picture of the patient's current health status. Some of the current developments in this field are fuelled by: The increasing demand concerning cost, quality, and outcome of services; The growth of managed care systems and new reimbursement methodologies in health care; The emergence of more systematic approaches to disease entities such as clinical pathways and guidelines and "disease management" models; An accelerated rate of knowledge development in health care with which it
is impossible to keep pace; The proliferation and availability of high speed, high-powered distributed, and network ready computer technology; A national commitment and plan for use of information highways from the executive office of the government; increasing awareness through accrediting bodies of the need for health care organizations to use information and knowledge more effectively.
Case study of Managing patients with identical names in the same ward Correct patient identification remains one of the most essential steps of safeguarding patient safety in healthcare (Emergency Care Research Institute (ECRI), 2003). Errors in patient identification may lead to the unneeded exposure of a patient to diagnostic or therapeutic procedure, the omission of the needed procedures to another patient, or the failure of linking pathology specimens to the correct patient. The greatest risk concerns acute care hospitals where a wide range of clinical interventions take place in complex settings amidst a rapid turnover of patients and staff who work in shifts. The Joint Commission on Accreditation of Healthcare Organizations has identified the improvement of accuracy of patient identification as the first goal in its National Patient Safety Goals (Joint Commission on Accreditation of Healthcare Organizations, 2004). In particular, the National Patient Safety Goals specify the use of at least two patient identifiers whenever blood samples are taken from a patient, or when medications or blood products are administered to the patient. Among these identifiers, patients' names are probably the most convenient and the most frequent parameter used for patient identification. Table 2.1: Summary of Case study (Managing patients with identical names in the same ward) Purpose
To review the experience of managing two patients with identical names in the same ward during a five-month period.
Design/methodology The records of the patients were reviewed to look for /approach
incorrect entries, errors in specimens sampling, administration of blood products and chemotherapy, and misplacement of clinical notes. Doctors and nurses involved were also invited to complete a questionnaire study to comment on the usefulness of the measures implemented for correct patient identification. A random sample of 60 patients was also selected to see if their full names were shared with other patients attending the same hospital.
Among the 1,442 sheets of hospital records from the two patients, no errors pertaining to the clinical activities were found. However, 13 (0.9 per cent) sheets of the hospital records were misplaced. The 21 doctors and nurses participating in the questionnaire study gave positive support to all the additional measures implemented for safeguarding patient identification, of which the automated alerting feature in the electronic clinical management system received the highest scores. A total of 32 (53 per cent) of the 60 sampled patients shared a common full name with one to 101 other patients attending the same hospital.
Patients with identical names staying in the same ward present a unique challenge to acute health-care settings. The situation is especially relevant in communities where most people's names are not unique. Specific guidelines and measures are needed to prevent patient misidentification. Errors in filing of patient notes and laboratory reports to the hospital record deserve further attention.
Project Methodology With reference to Britton and Doake (1996), a methodology will prescribe in
great detail what tasks are involved in each step, the nature of each task, the order in which the tasks need to be done, what documents are produced at each stage and what documents are required as input to each stage. In fact, it provides a detailed plan for producing a system. Methodology is a collection of processes, methods and tools for accomplishing an objective. Methodologies provide a checklist of key deliverables and activities to avoid missing key tasks.
- "anaae bnange or acol ltlvely
v Quallty Assurance Throughout
Figure 2.2: SDLC summary
Proposed system Systems Development Life Cycle (SDLC)
Figure 2.3: SDLC diagram
The system that will be developed is using SDLC (System Development Life Cycle) approach. The SDLC approach has a similar set of four fundamental phases: planning, analysis, design and implementation. Different projects may emphasize different part of the SDLC or approach the SDLC phases in different ways, but all projects have elements of these four phases.
Table 2.2: System Development Life Cycle Phase
Task Identification Work Breakdown Structure Pert Chart
GAN'TT Chart Scope Management Staff project
Project Charter Control and Direct Project
Documentation Risk Management
Business Process Improvement Business Process Reengineering Interview, Determine Business
Create Use Case
Use Case Analysis
Data Model Alternative
Design Physical Design
Matrix Physical Process
Models Physical Data
Architecture Design Report Hardware and Software
Design Database and
Transform Analysis Program Design
There are several models under the SDLC approach and the model that will be used to develop this system is waterfall model. The waterfall model has many attractive features: Clearly defined deliverables at the end of each phase, so that the client can take decisions on continuing the project. Incremental resource commitment. The client does not have to make a full commitment on the project at the beginning. Isolation of the problem early in the process.
The advantages of waterfall development are that it identifies system requirements long before programming begins and that it minimizes changes to the requirements as the project proceed.
Fe a s i b n l ~ A
3 Kmplemenl7 Test
Figure 2.4: classic Waterfall model methodology
Feasibility The feasibility study is used to determine if the project should get the go-ahead. If the project is to proceed, the feasibility study will produce a project plan and budget estimates for the future stages of development.
Requirement Analysis and Design Analysis gathers the requirements for the system. This stage includes a detailed study of the business needs of the organization. Options for changing the business process may be considered. Design focuses on high level design like, what programs are needed and how are they going to interact, low-level design (how the individual programs are going to work), interface design (what are the interfaces going to look like) and data design (what data will be required). During these phases, the software's overall structure is defined. Analysis and Design are very crucial in the whole development cycle. Any glitch in the design phase could be very expensive to solve in the later stage of the software development. Much care is taken during this phase. The logical system of the product is developed in this phase.
Implementation In this phase, the designs are translated into code. Computer programs are written using a conventional programming language or an application generator. Programming tools like Compilers, Interpreters, Debuggers are used to generate the code. Different high level programming languages like C, C++, Pascal, Java are used for coding. With respect to the type of application, the right programming language is chosen.
Testing In this phase the system is tested. Normally programs are written as a series of individual modules, these subjects to separate and detailed test. The system is then tested as a whole. The separate modules are brought together and tested as a complete system. The system is tested to ensure that interfaces between modules work (integration testing), the system works on the intended-platformand with the expected volume of data (volume testing) and that the system does what the user requires (acceptancebeta testing).
Maintenance Inevitably the system will need maintenance. Software will definitely undergo change once it is delivered to the customer. There are many reasons for the change. Change could happen because of some unexpected input values into the system. In addition, the changes in the system could directly affect the software operations. The software should be developed to accommodate changes that could happen during the post implementation period. Table 2.3: System Development Life Cycle Phase- waterfall model Phase
Problem definition :
Deliverables Problem statement
On receiving a request from the user for systems development, an investigation is conducted to state the problem to be solved.
Feasibility study: The objective here Feasibility report. is to clearly define the scope and objectives of the systems project, and to identify alternative solutions to the problem defined earlier.
Systems analysis phase: The present Specifications of the present system. system is investigated and its specifications documented. They should contain our understanding of
HOW the present system works and W4AT it does.
Systems design phase: The specifications of the present system are studied to determine what changes will be needed to incorporate
Specifications of the proposed system.
the user needs not met by the system presently. The output of this phase will consist of the specifications, which must describe both JWAT the proposed system will do and HOW it will work of the proposed system. Systems construction: Programming Programs, their documentation, and user the system, and development of user
documentation for the system as well as the programs System testing & evaluation:
Test and evaluation results and the
Testing, verification and validation of system ready to be delivered to the userlclient.
the system just built.
Software Requirement Table 2.4: Software Requirement
Visual Studio 2005 Used to create and design the web pages' interface.
Adobe Photoshop CS 7.0
Used to create buttons, borders and altering images in the web page iii.
Microsoft Project 2003
Used to design the schedule and the milestone of the project development. iv.
A tool that used for develop an animation image, banner, and so on. . Web-server
Internet Information Services (11s)
This web-server will act as a server for this system. .Inorder to make the ASP.Net codes execute with 11s. The ASP file will be saving at the 'wwwroot' folder of the 11s. IIS is a program that includes Web and FTP support, along with support Frontpage transactions, Active Server Page (ASP) and database connections. Database
SQL Server 2000
The software that will develop the database of the system. Programming
Active Server Pages.Net (ASP.Net) ASP.Net is a specification that enables database-
driven Web sites. Web pages that have an .asp extension (instead of an .html or .htm extension) are rendered on the spot using updated information from the database. This enables "on the fly" updating and easier content management, but it can also present security problems because it opens "holes" in security to enable information to be accessed and viewed in real time.
2.4.2 Hardware Requirement Following are the hardware that we used in developing the proposed system. They are:
a. Computer set such as CPU, monitor, keyboard, and mouse.
b. Memory: 128 MI3 RAM RAM is perhaps the most important of the input/output devices.
c. Processor: Pentium 4 The Pentium 4 processor - Intel's "next generation" of processor to succeed the Pentium III and Celeron processors. It is the most powerful processor available for PC.
2.4.3 Other requirements
126.96.36.199 Network Requirement Internet line LAN (Local Area Network)
Project Schedule and Milestones Table 2.5: Project Schedule and Milestones
Define a project Inception
- Project title /
Prepare project proposal
- Background, scope and objective
- Project proposal
- Find the requirement of the project
- Prepare architecture and presentation of the project. Project estimation - Create task
duration task list and milestones in schedule
- Project Proposal
Project scheduling Planning
- Specify the
resource of the
- Milestone of project
Resource allocation - Planning of
resource and task cost of the project
Project monitoring Project control Project risk management
Analysis and Design
- Business Process
16/6/2006 - Use Cases