Nabimara Charles Cit Pgd Report

COMPUTERIZED HEALTH RECORDS MANAGEMENT

SYSTEM

CASE STUDY KITAGATA HOSPITAL

BY

NABIMARA CHARLES

Reg. No. 2005/PGD18/514U

BLIS (MAK)

Email: [email protected];Tel.: +256772618296

A Project Report Submitted to the School of Graduate Studiesin Partial Fulfillment of the Requirements for the award of the

Postgraduate Diploma in Information Technology of

Makerere University

Option: Information Technology

January, 2007

Declaration

I Nabimara Charles do hereby declare that this Project Report is original and has not beenpublished and / or submitted for any other diploma / degree award to any other Universitybefore.

Signed.............................................................. Date..............................................

Nabimara CharlesBLIS (MAK)

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Approval

This Project Report has been submitted for Examination with the approval of the followingsupervisor.

Signed:................................................... Date:...............................................

Emily BagarukayoBSc (Comp. Sc), MSc (Comp.Sc)Department of Information SystemsFacult of Computing and Information Technology

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Dedication

To my Family:My dear wife Dativah, Children: Austine, Angela and Audrey, who have greatly missed my

company during this whole period while pursuing this study.

Good things in life are not easily accomplished,but when accomplished, they will always be reckoned for many generations to come.”

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Acknowledgments

Success in life is never attained single handedly. It is on this note that I express my heartfeltgratitude to God for the strength and wisdom; and to various people who have assisted mein various ways to accomplish this project.

My sincere appreciation goes to Makerere University Faculty of Computing and InformationTechnology staff, more especially so to my supervisor, Emily Bagarukayo, without whosehelp this work would not be as it appears.

Last but not least, I acknowledge all my friends and classmates on the Information Tech-nology post-graduate program for having made my academic and social life comfortable atMakerere University.

MAY GOD BLESS YOU ABUNDANTLY

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Contents

1 INTRODUCTION 1

1.1 Background to the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1.2 Statement of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.3 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.3.1 General Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.3.2 Specific Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.4 Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1.5 Significance of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 Literature Review 5

2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2.1.1 Records Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2.1.2 Information System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2.2 Steps in developing a Health Management Information System . . . . . . . . 6

2.3 Keys to Successfully Adopting Electronic Health Records (EHR) . . . . . . . 7

2.4 Push for Medical Record Computerization . . . . . . . . . . . . . . . . . . . 7

2.5 The Role of IT in Improving Health care Delivery . . . . . . . . . . . . . . . 8

2.6 Data Overload and out dated Technology . . . . . . . . . . . . . . . . . . . . 8

2.7 Health care Challenges Solved Through Networking . . . . . . . . . . . . . . 9

2.8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

3 Methodology 11

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3.1 System Study and Investigation . . . . . . . . . . . . . . . . . . . . . . . . . 11

3.1.1 Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3.1.2 Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

3.1.3 Document Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

3.2 System Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

3.2.1 Existing System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

3.2.2 Problems of Existing System . . . . . . . . . . . . . . . . . . . . . . . 13

3.3 Requirements Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

3.3.1 User Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

3.3.2 Functional Requirements . . . . . . . . . . . . . . . . . . . . . . . . . 14

3.3.3 Non-functional Requirements (NFR) . . . . . . . . . . . . . . . . . . 14

3.3.4 System Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.4 System Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.4.1 Data Flow Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.4.2 Entity Relationship Diagrams . . . . . . . . . . . . . . . . . . . . . . 16

3.4.3 Data Dictionary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.5 System Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

3.5.1 PHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

3.5.2 MySQL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

3.5.3 HTML . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

4 Results / Findings 24

4.1 Patient’s Demographic data, Medical history, Diagnosis, Prescriptions, andTreatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

4.2 Existing Health Records Systems . . . . . . . . . . . . . . . . . . . . . . . . 24

4.3 System Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

4.4 System Implimentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

4.4.1 The Database . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

4.4.2 Graphical User Interface . . . . . . . . . . . . . . . . . . . . . . . . . 25

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4.4.3 Screen Formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

4.4.4 User log on Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

4.4.5 Patient Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

4.4.6 Searching for the Registered Patient . . . . . . . . . . . . . . . . . . 29

4.4.7 Searching a Patient using Patient Name . . . . . . . . . . . . . . . . 30

4.4.8 Search Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

4.4.9 Patient Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

4.4.10 Laboratory Investigation . . . . . . . . . . . . . . . . . . . . . . . . . 33

4.4.11 Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4.4.12 Ward Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

5 Project Discussion, Conclusions and Recommendations 38

5.1 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

5.2 Problems / Constraints Encountered . . . . . . . . . . . . . . . . . . . . . . 39

5.3 Recommendation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

5.4 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

5.5 Interview Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

5.6 Some Codes used for Design . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

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List of Tables

3.1 Software Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.2 Hardware Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.3 Description of user login . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3.4 Description of the doctors identification . . . . . . . . . . . . . . . . . . . . . 18

3.5 Description patient registration . . . . . . . . . . . . . . . . . . . . . . . . . 18

3.6 Description patient treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 18

3.7 Description of Ward information . . . . . . . . . . . . . . . . . . . . . . . . . 19

3.8 User log on information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

3.9 Tracking the doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

3.10 Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

3.11 Treatment information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

3.12 Laboratory Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

3.13 Ward information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

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List of Figures

3.1 Diagram to show information flow in the proposed system . . . . . . . . . . 16

3.2 ERD in the proposed system . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4.1 Logon screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

4.2 Registering the incoming patient . . . . . . . . . . . . . . . . . . . . . . . . . 28

4.3 Searching for the patient in the system . . . . . . . . . . . . . . . . . . . . . 29

4.4 Search for a patient using first name . . . . . . . . . . . . . . . . . . . . . . 30

4.5 Search results displayed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

4.6 Diagnosis and Treatment information entered . . . . . . . . . . . . . . . . . 32

4.7 Laboratory investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

4.8 Daily OPD report / Census . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4.9 Daily OPD report according to age groups . . . . . . . . . . . . . . . . . . . 35

4.10 Daily in-patient report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

4.11 Ward information is entered in the system . . . . . . . . . . . . . . . . . . . 37

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Acronyms

BLIS: Bachelor of Library and Information Science

EHR: Electronic Health Records

ERD: Entity Relationship Diagram

DFD: Data Flow Diagram

HTML: Hypertext Markup Language

ICA: International Committee on Archives

ISO: International Standard Organization

IT: Information Technology

MOH: Ministry of Health

MUK: Makerere University-Kampala

NFRs: Non Functional Requirements

PHP: Hypertext Preprocessor

WHO: World Health Organization

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Abstract

This project is about computerized health records management system. Kitagata Hospitalwas used a case study. The current system was found to be completely manual faced withnumerous problems like duplication, loss of records, huge storage space and time consum-ing. A computerized system was designed using tools like ERDs, DFDs MYSQL, and PHPembedded in HTML. This system is fast, convienient in terms of storage, makes it easy toshare information and it is user friendly. Computerization of health records managementsystem is therefore recommended for use in all hospitals in Uganda.

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Chapter 1

INTRODUCTION

Health records management is such an important area in health care delivery because withoutproper records, planning is rendered difficult. Hospitals and other health units base theirdecisions on records to know which drugs to stock and which services to prioritize. It isimportant therefore to give due attention to health records management to ensure that rightinformation is available at the right time in the right place.

The aim of this study was buid a computerized records management system that would bemore effective and effecient than the existing manual system in Kitagata Hospital.

This was done by looking at the existing health records management system , analysing itsstrong and weak points design and implementation of a new system. Interviews, observationand document reviews were tools used in data collection. MySQL database managementsystem, Apache server, PHP scripting language embaded in HTMl were used for design.

Data flow diagram, relationship diagram and the data dictionary were results of the designand implement5ation saw deffirent interfaces as seen in the last chapter of this project report.

1.1 Background to the Study

Kitagata hospital is a district government Hospital located in Bushenyi District in south west-ern Uganda. It was started in 1967 and like any other district hospitals, according to (MOH,2001) [11], it provides the following services : Clinical services such as Medicine, Surgery, Paediatrics, Obstetrics and gyaenecology, Dentistry, Anaesthesia, Radiology, Clinical lab-oratory, and Community health. Services like Medical records management, finance andadministration, procurement, personnel and security are under administration. Catering,laundry, central stores, domestic hygiene, maintenance and repair, transport and commu-nication plus staff residential housing fall under support services. On average the hospitalhandles about 300 patients / clients per day. Out of the services provided, and the loadof work handled per day, a lot of records are generated which are handled manually. Forexample the clinical writer keeps a register, the laboratory keeps another, the wards andthe theatre also keep theirs. Medical follow up charts are also produced and kept. This

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registration at different levels usually leads to duplication.

Various reports are generated periodically for use at different levels of management.Thehospital is required to make weekly disease surveillance reports, hospital monthly reportsand annual reports plus any situational reports in case of an outbreak. Production of thesereports using manual system is not only difficult but also time consuming. Because all this isdone with pen and paper, sharing of these records among the health professionals is usuallydifficult and time consuming. Health workers spend more time looking for information thanthey spend on caring for the patients therefore patients have to wait for a long time.

There is a lot of paper work which is kept in the records center. This makes it difficult forclinicians to make right decisions which leads to prescription mistakes or mistreatment.

It is the researcher’s considered view that a computerized system that will handle the hugerecords, quicken the generation of reports, ease the sharing of health information and storethe huge amount of data more efficiently and effectively is needed to replace the currentmanual system.

1.2 Statement of the Problem

The current manual system used at Kitagata Hospital generates huge amount of paperwork that is difficult to deal with, in terms of storage, retrieval, maintenance and sharingamong the medical personnel. The personnel spend more time looking for information thanthey would spend on health care delivery. Duplication of records resulting from multipleregistration and misplacement of some of them makes the situation worse. This does notfavor the generation of reports in terms of timeliness and accuracy. This project thereforedevelops a system for computerizing health records management.

1.3 Objectives

1.3.1 General Objective

To build a system for computerizing health records management, that will replace the currentmanual records management.

1.3.2 Specific Objectives

The specific objectives of the research program are to:

(i) To investigate issues related to patient’s demographic data, medical history, diagnosis,prescriptions, and treatment.

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(ii) Analyse existing health records systems

(iii) To design a computerized health records management system.

(iv) To Implement and test the system.

1.4 Scope

The study will be done at Kitagata Hospital in Bushenyi District. Departments that directlydeal with clinical services will be dealt with. Only medical records will be considered andthese include:

1. Patient personal information

2. Laboratory examinations

3. Diagnosis

4. Prescriptions and Treatment

5. Follow up of the patient

1.5 Significance of the Study

1. There has been automation and streamlining of clinicians work flow. This has reducedmedical errors, as there is readily available of necessary information on which to basetheir decisions.

2. Patients records can now be accessed anywhere in the departments of the hospital on acomputer screen. The problem of moving from department to department to get somerecords is no more which has increased time to attend to the patient.

3. Paper work has been considerably reduced with the introduction of computer-assistedmethod of storing the records. Misplacement of records, space for keeping the paperfiles, molding / depreciation of paper and all other problems associated with paperwork have been dealt with accordingly.

4. Paper-based record-keeping system was adding to the expense of health care. Doctorsand nurses used to spend time away from patients attending to a great deal of paper-work. The reliance on paper-based medical records used to add enormous financialburden, with substantial costs for records storage and administrative support staff.

5. Delayed or missing paperwork used to add time to patient hospital stays and couldlead to unnecessary or duplicate clinical tests.

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6. Periodic reports are now easier to make and on time. Since the necessary data isavailable in one place and the computer is able to manipulate it like sorting, stratifying,carry out computations, then the reports are easy to make unlike using the manualsystem where functions like computations were difficult to handle.

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Chapter 2

Literature Review

2.1 Introduction

2.1.1 Records Management

Records Management is the practice of identifying, classifying, archiving, preserving, andsometimes destroying records according (ISO, 2001) [7]. (ISO, 2001) [7] defines records as”information created, received, and maintained as evidence and information by an organi-zation or person, in pursuance of legal obligations or in the transaction of business”.

The International Committee on Archives (CIA) and Electronic Records defines a record as,”a specific piece of recorded information generated, collected or received in the initiation,conduct or completion of an activity and which comprises sufficient content, context andstructure to provide proof or evidence of that activity”.

While the definition of a record is often identified strongly with a document, a record canbe either a tangible object or digital information which has value to an organization. Forexample, birth certificates, medical x-rays, office documents, databases and application data,and e-mail are all examples of records.

2.1.2 Information System

(O’brien, 2002) [13] defines Information System as any organized combination of people,hardware, software, communication networks and data resources, that control, transformand disseminate information in an organization. (O’brien, 2002) [13] further reveals thatthe data resources of information systems are typically organized, stored and accessed by avariety of data resource management technologies into:

1. Databases that hold processed and organized data

2. Knowledge bases that hold knowledge in a variety of forms such as facts, rules, and

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case examples about successful business practices.

According to World Health Organization, (WHO, 2004) [18] the following terms are definedas:

1. Health information System: A system that integrates data collection, processing,reporting and use of information necessary for improving health service effectivenessand efficiency through better management at all levels of health service.

2. Health management information system: This is an Information system speciallydesigned to assist in the management and planning of the health programs as opposedto delivery of care .

2.2 Steps in developing a Health Management Infor-

mation System

World Health Organization regional office for western pacific, (WHO, 2004) [18] recommendsthe following steps while developing health management information system:

(a) Review the existing system

(b) Define the data needs for relevant units within the health system

(c) Determine the most appropriate and effective data flow

(d) Design the data collection and reporting tools

(e) Develop the procedures and mechanisms for data processing

(f) Develop and implement a training program for data providers and data users

(g) Pre-test, and if necessary re-design the system for data collection, data flow, dataprocessing and data utilization

(h) Monitor and evaluate the system

(i) Develop effective data dissemination and feedback mechanisms

(j) Evaluate the system

According to (Chrisanthi and Cornford, 1998) [4], the process of development of an Infor-mation System can be seen as a list of tasks, starting with identification and launching of aninformation system’s project and ending with maintenance of its optional components for aperiod before the system is phased out or replaced. However, they say that this varies fromone organization description to another. On their part they suggest the following steps tobe typical for most organizations:

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(a) Identification of a problem, pressure, or opportunity

(b) Determination of general requirements for change

(c) Feasibility study to explore possible approaches

(d) Systems analysis to model detailed requirements for technical components or organi-zational reform

(e) Systems design to work out how requirements are to be met

(f) Development or acquisition of software and hardware and their configuration

(g) Systems implementation with the organizational settings

(h) Operation and maintenance

(i) Phase out when the system is no longer needed or used.

2.3 Keys to Successfully Adopting Electronic Health

Records (EHR)

(Scott and Rundall, 2005) [15], in a fund-supported study find that the keys to successfuladoption and implementation of EHR include a participatory selection process, flexibilityregarding staff roles and responsibilities, and decisive leadership at critical stages.

EHR systems have great potential to improve health care quality. So far, however, realand perceived barriers from high costs and decreased productivity to staff frustration-haveprevented most providers from implementing them.

2.4 Push for Medical Record Computerization

(Meghan, 2006) [9] reports that advocates say that electronic medical records could save140billion dollars a year in health care expenses on things like file clerks and space for filecabinets, while also saving tens of thousands of lives each year by reducing medical errors.

When Medical Records management is computerized, there are no rooms full of shelves linedwith manila folders stuffed with charts. Instead, patients’ insurance, medication, examina-tion, and treatment records are maintained on eight Dell servers stacked in a large closet,(Meghan, 2006) [9].

The technology dramatically reduces the time between a patient’s initial consultation witha physician and his receiving treatment, allowing physicians to see between 30 to 35 patientsa day. (Meghan, 2006) [9] quotes Dr. Doroshik as saying that doctors ”think outside thebox,” increasing the likelihood that a patient will get an accurate diagnosis sooner. Analystssay that the use of EHR significantly reduces redundant and improper treatments, and cuts

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back on potentially fatal medical errors resulting from incomplete or erroneous informationin a patient’s medical file.

According to (Lucey, 2002) [10], all organizations operations are ever changing. Managementand information systems that support them have to deal with that change and adapt to theiroperations, systems and organizations themselves in order to survive and prosper. (Lucey,2002) [10] reveals the following as factors that lead to these changes:

1. More competition: All types of organizations face greater competitive pressures forexample hospitals competing for business

2. Faster pace: The knowledge and development that people have rapidly become obsoletebecause of changing requirements. Existing work patterns and practices need to beupdated more or less continuously to keep pace. Current information rapidly becomesout of date as technology seems to change month by month

3. Increased globalization

(Ndagire, 2003) [12] reveals the following as some of the problems of manual informationsystems:

1. Paper based systems are generally very bulky both to handle and to store, and officespace is expensive

2. Information manual techniques of processing information are more tedious, laborious,slow and inefficient

3. Labor productivity is low and the process is slower where large volumes of data needto be dealt with.

2.5 The Role of IT in Improving Health care Delivery

(Klein, 2006) [8] states that there is an opportunity to transform health care and improvepatient safety by better leveraging information technology to improve the efficiency, accuracy,and effectiveness of the health care system. However, adoption has been slow and the resultshave been mixed up. If deployed incorrectly, without well-conceived process improvements,IT systems can do just the reverse, leading to critical delays or mistakes.

2.6 Data Overload and out dated Technology

According to (Hendee et al., 2006) [6], the 20th Century had a challenge of a deficit of patientinformation, but the 21st Century is faced with a surplus. Compounding matters is the factthat the human brain, even a physician’s, cannot keep up with the exponential growth inmedical knowledge that will occur in forthcoming years.

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The ability of most humans to memorize things has remained flat, but the medical knowledgethat needs to be assimilated is increasing at a very high rate. Sub-optimal medical care oftenis provided to patients because of the failure to access all the data necessary to make theright decision, (Chaiken et al., 2006) [3].

(Bush, 2004) [2] argues that many Americans die each year from medical errors. Manymore die or have permanent disability because of inappropriate treatments, mistreatment,or missed treatments in ambulatory settings.

All these problems of high costs, uncertain value, medical errors, variable quality, adminis-trative inefficiencies, and poor coordination are closely connected to the failure to use healthinformation technology as an integral part of medical care.

Unlike other industries, medicine still operates primarily with paper-based records. Thedoctors and nurses have to manage 21st century medical technology and complex medicalinformation with 19th century tools.

(Bush, 2004) [2] further reveals that in the outdated, paper-based system, patient’s vitalmedical information is scattered across medical records kept by many different care giversin many different locations - and all of the patient’s medical information is often unavailableat the time of care. He believes that innovations in electronic health records and the secureexchange of medical information help transform health care in America by improving healthcare quality, preventing medical errors, reducing health care costs, improving administrativeefficiencies, reducing paperwork, and increasing access to affordable health care.

2.7 Health care Challenges Solved Through Network-

ing

According to (Cisco, 2005) [5], managing a clinical environment today involves a largeamount of paper. Clinical information stored in paper charts is difficult to access, takesup costly space dedicated to chart storage, and can impact on quality of care . On the otherhand, networking can be beneficial as:

1. Connected electronic health records provide effective distribution of information to caregivers at the point of care to support higher quality of care with increased efficiency.

2. Care giver productivity and clinical efficiency can be improved by automating commonactivities, including prescribing, ordering labs, viewing results, and taking clinical notesover a network.

3. Clinicians can access patient charts and medical histories without having to search filesor wait for chart pulls.

Connected health care applications, including electronic health records, that streamline in-formation and communications at the point of care are critical to health care organizationsunder pressure to cut costs, increase productivity, and improve patient care, (Cisco, 2005) [5].

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2.8 Conclusion

Although many schoolars have written about computerization of health records as an urgentrequirement and a lot of research has been carried out, implementation is still insufficient.However, according to the literature available, there are numerous benefits that accrue fromEHR when compared with manual systems. For example there will be no duplication ofrecords, sharing of information is made possible, the problem of missing and / or misplacedrecords is reduced and the information is available at the point of care.

In order to continually improve the quality of healthcare, Uganda’s Ministry of Health hasput in place a routine reporting system backed up with electronic databases replacing allpre-existing totally paper-based reporting instructions in districts all over the country.

This system, called the Health Management Information System (HMIS), is designed toproduce relevant and functional information on the health services on a routine basis. Itis kicked off at the grass-roots health units and the information gathered is transferred tohealth sub-districts, then on to the districts and finally to the national level for planning,managing and evaluating healthcare delivery. In other words, from the health unit it goesthrough the districts and straight to the National Health Databank. (Weddi, D.,2005). [17].

Despite the efforts by the ministry of health, hospitals remain completely manual withtraditional pen and paper records management. It is also seen from the above example thatthe efforts are only on reporting systems not minding on how these reports are producedand other processes managed.

Healthcare IT is a sleeping giant. Although healthcare budgets contribute to the bulk ofgovernment spending, healthcare information technology lags far behind other IT businessesincluding banking, telecommunications and the media. Local and countrywide efforts toimplement electronic health record (EHR) systems have been intermittently reported. Thecommon threads, however, that link these efforts and how they contribute to the success,barriers or failure of implementation have not been identified. (Steve, A. et al.2006) [16].

The researcher decided to build on the literature and efforts available to implement a practicalsolution for the problems of the manual system as a way forward. This exploits the benefitsof the new technology as they are widely talked about.

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Chapter 3

Methodology

This section describes the steps and procedures that were followed in order to accomplishthe project. The study was conducted as follows:

3.1 System Study and Investigation

In this section the researcher studied the existing system to establish its weak and strongpoints. The information acquired from this study gave the basis for the design of the newsystem. A number of steps, procedures and tools were employed as shown below:

3.1.1 Interviews

The researcher conducted face-to-face interviews with the stake holders. Doctors, Nurses,Clinicians, Records staff and the patients were interviewed to fully understand their experi-ences. Also an interview guide with open ended questions (Appendix A) was prepared andadministered to the respondents so as to enable them give their views freely. This techniquewas chosen because:

1. It permits clarification of questions

2. Has high response rate than written questionnaires

3. It is suitable for use with both literate and illiterates

4. Get full range and depth of information

5. Develops relationship with client

6. Can be flexible with client

Note that the interview guide is particularly useful in obtaining information that cannot beobtained by other methods according to (Bell, 1992) [1].

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3.1.2 Observation

This technique was used to gather accurate information about how the system actuallyoperates, particularly about processes. This involved the researcher to systematically watchand record the behaviors and characteristics of operations and processes in the hospital.Although the method was time consuming, it had a number of advantages, which include:

• It gives more detailed and context related information

• It permits the collection of information on facts not mentioned in the interview

• It permits tests of the reliability of the responses to the questionnaires

• View operations of a program as they are actually occurring

• Can adapt to events as they occur

3.1.3 Document Review

A thorough review of the documents used in the hospital was done with the intent to studyhow things are done and discover areas where improvement is necessary. A number ofdocuments were reviewed including patient charts, registers, tally sheets, periodic reportsand lab reports among others. This method was used because of its advantages, whichinclude:

1. It is inexpensive because the data is already there

2. It permits examination of trends over the past

3. Doesn’t interrupt program or client’s routine in program

4. There are few biases about information

3.2 System Analysis

3.2.1 Existing System

The existing system was found to be completely manual, i.e. personal (patient) informationis captured in a register at the reception. A medical form is issued to the patient which he/ she takes to the Clinician for prescription and treatment. The Clinician takes the medicalhistory, writes diagnosis and treatment on the form. The Clinician sometimes can refer thepatient to the laboratory for investigation before diagnosis depending on the situation of thepatient. To do this, he fills a form called ”Lab request form.” There is another register inthe Laboratory where they record their finding on the patient.

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When the patient is not very ill, he / she will be recorded in the outpatient register, giventreatment and go home. Otherwise an admission chart will be filled and the patient goes tothe ward where he / she is recorded in the ”inpatient register” and treatment is done thereuntil recovery is realized so that he / she can be discharged.

All the patient charts are collected and kept with the Records department. Filing andorganization of the charts are done in the records department. Summaries and reports arealso generated here.

3.2.2 Problems of Existing System

Considering the previous section, there are many problems associated with the existingmanual system, they include the following:

1. It is evident that there is a lot of duplication in recording of the patients. For examplethere is recording at reception, in the laboratory, and in the ward where differentregisters are kept.

2. There is a problem of storage of these registers and forms / charts which are producedat different levels.

3. Information retrieval from these sources is not easy

4. Some charts get lost or misplaced. This is a problem in decision making as there isinadequate information.

5. Patients have to wait for a long time as health workers are looking for their charts.

3.3 Requirements Analysis

3.3.1 User Requirements

It is very important to get users of the system fully involved such that the problem ofchange management does not arise. The stake holders, who will use the system thereforewere approached during the study and were asked what they expected of the proposed systemand the following were the findings:

1. A system that is easy to learn and use

2. A system that improves on the efficiency of information storage and retrieval

3. A system that is fast in producing results which will be ready at the point of caretherefore reducing on waiting time and increasing on time to attend to the patients.

4. A system that has an element of error validation, i.e. one that prompts the user onentering unusual command or data format inconsistent with the database.

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5. A system that provides attractive interfaces with easy navigation throughout the sys-tem

6. A system that is faster, flexible and convienient.

7. A system that stores data and produces reports timely and accurately

8. A system that restricts access to information to only authorized personnel

3.3.2 Functional Requirements

Functional requirements capture the intended behavior of the system. This behavior maybe expressed as services, tasks or functions the system is required to perform. Therefore theproposed system is able to:

1. Capture the patient information, store it and make it available at the time of need.

2. Present the users with a real-time display of the number of records in a database.

3. Allow the sharing of the data by the users

4. Generate reports accurately and timely

5. Search and display patient information details

3.3.3 Non-functional Requirements (NFR)

Non-functional requirements are requirements which specify criteria that can be used tojudge the operation of a system, rather than specific behaviors. This is contrasted withfunctional requirements that specify specific behavior or functions. Systems must exhibitsoftware quality attributes, such as accuracy, performance, cost, security and modifiabilityplus usability, i.e. easy to use for the intended users. NFRs help to achieve the functionalrequirement of a system. Thus the proposed system does the following:

1. The system has high performance and reliability level. The mean time between failures,mean time to repair, and accuracy are very high.

2. The system has user-friendly interfaces. This ensures the ease with which the systemcan be learned or used. The system can allow users to install and operate it with littleor no training.

3. Handles growing amounts of work in a graceful manner as can be readily enlarged i.e.the ease with which the system can be modified to handle a large increase in users,workload or transactions .

4. The system prevents unauthorized access to the system with user authentication vialog-on system.

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3.3.4 System Requirements

1. Software Requirements

Software Component System RequirementOperating System for the server Windows NT, 2000 or aboveOperating system for the client PC Windows XP/NTWeb Server Apache Web Server Version 1.3Web Browser MS Internet Explorer 6.0 or aboveDatabase Management System Mysql server version 3:23.48

Table 3.1: Software Requirements

2. Hardware Requirements

Hardware Component System RequirementProcessor Intel Pentium III or aboveProcessor Speed 800MHZ or aboveWeb Browser 128MB RAM or above depending on the Operating SystemDisk Space 50 GB or aboveBandwidth 100MBps

Table 3.2: Hardware Requirements

3.4 System Design

3.4.1 Data Flow Diagram

Data flow diagrams (DFDs) were used to illustrate the flow of information in a system.They are hardware independent and do not reflect decision points. They demonstrate theinformation and how it flows between specific processes in a system. They provide onekind of documentation for reports. These diagrams help to show how data moves andchanges through the system in a graphical top-down fashion. They also help to give graphicalrepresentation of the system’s components, processes and the interfaces between them.

When it came to conveying how data flows through systems (and how that data was trans-formed in the process), DFDs were the method of choice over technical descriptions for threeprincipal reasons:

1. DFDs are easier to understand by technical and non-technical audiences.

2. They provide a high-level system overview, complete with boundaries and connectionsto other systems.

3. They provide a detailed representation of the system components.

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The diagram below shows the flow of data through the proposed system. It depicts the flowthe of information and the transformation that are applied as data moves from input tooutput.

Figure 3.1: Diagram to show information flow in the proposed system

3.4.2 Entity Relationship Diagrams

These were used to identify the data to be captured, stored and retrieved in order to sup-port the activities performed. The diagrams were used to show the relationships between theentities involved in the system together with their attributes and indicate the number of oc-currences an entity can exist for a single occurrence of the related entity. Entity RelationshipDiagrams (ERDs) illustrate the logical structure of databases.

Entity relationship diagrams were used because they are relatively simple, user friendly andcan provide a unified view of data, which is independent of any data model. The diagrambelow shows the ERD for the new system

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Figure 3.2: ERD in the proposed system

3.4.3 Data Dictionary

This contains all data definitions for cross-referencing and for managing and controllingaccess to the information repository / database. It provides a very thorough interface de-scription (comparable to Interface Control Documents) that is independent of the modelitself. Changes made to a model may be applied to the data dictionary to determine if thechanges have affected the model’s interface to other systems.

Data dictionaries do not contain any actual data from the database, only book keepinginformation for managing it. Without a data dictionary, however, a database managementsystem cannot access data from the database. Below are the illustrations:

User

Attribute Data Type and Length DescriptionUsername varchar(30) user identification by namePassword varchar(30) user security identification

Table 3.3: Description of user login

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Doctor

Attribute Data Type and Length DescriptiondocId varchar(20) Unique identification of the Doctors

who attends to the patientfname varchar(50) Identification of the doctor by first namelname varchar(50) Identification of the doctor by first namecontact varchar(30) Telephone contact of the doctor

Table 3.4: Description of the doctors identification

Patient

Attribute Data Type and Length DescriptionpatNo varchar(20) Unique serial number given to the patientfname varchar(50) Patient first namelname varchar(50) Patient last nameaddress varchar(100) Physical address of the patientsex varchar(10) Patient’s sex

Table 3.5: Description patient registration

Treatment

Attribute Data Type and Length DescriptionpatNo varchar(10) Patient’s serial numberwardNo varchar(11) ward number in case a patient is admittedbedNo varchar(11) bed number where the patient is admitteddiagnosis varchar(100) Diagnosis by the doctortreatment varchar(500) Treatment given to the patientdocId varchar(10) Identification of the doctornotes varchar(500) Clinical notes of the medical history

Table 3.6: Description patient treatment

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Ward

Attribute Data Type and Length DescriptionwardNo int(11) Identification of ward by numbername varchar(50) Ward identification by namebed-capacity int(11) Number of beds in the ward

Table 3.7: Description of Ward information

Basing on the above illastrations, the following describe the system’s database togather withits corresponding tables which keep records or data and respond to querries.

User Log on Information

Field Type Null Key Default ExtraUsername varchar(30) no nullPassword varchar(30) no PRI null

Table 3.8: User log on information

In the table above the user name and the password are kept. They both have a maximumof 30 characters and the primary key is the password.

Doctor’s Information Table

Field Type Null Key Default Extradoc id varchar(20) no PRI nullname varchar(50) no nulllname varchar(50) no nullcontact varchar(30) no null

Table 3.9: Tracking the doctor

The doctor who treats the patient is also recorded by the system and the information kept.The doctors ID, his first and last names and his telephone contact are captured for thepurposes of tracking the doctors who works on a patient.

Patient Registration

At reception, a patient is registered by capturing his / her demographic data. This includesfull names, address and sex. A unique patient number is issued and all this is stored in the

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patient information table. The primary key here is the patient number (patNo). This is seenin the table below.

Field Type Null Key Default ExtrapatNo varchar(20) no PRI nullfname varchar(50) no nulllname varchar(50) no nulladdress varchar(100) no nullsex varchar(0.8) no null

Table 3.10: Patient Information

When the patient goes to doctor, more information is captured in the system. This includesdiagnosis, treatment, and clinical notes. In case the patient is admitted, the ward numberand the bed number are captured. This is stored in the treatment table as shown below.

Treatment Information

Field Type Null Key Default ExtrapatNo varchar(10) no PRI nullwardNo varchar(11) nullbedNo varchar(11) nulldiagnosis varchar(100) no nulltreatment varchar(500) no nulldocId varchar(10) no nullnotes varchar(500) no null

Table 3.11: Treatment information

Laboratory Investigations

Some patients go for laboratory investigation. In the laboratory information like specimen,tests done, and laboratory results are captured and is stored in the laboratory investigationtable as given below:

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Field Type Null Key Default Extravdate date no PRI 0000-00-00patNo varchar(10) no PRI nullwardNo varchar(11) yes nullspecimen varchar(200) no nulltest varchar(200) no nullresults varchar(300) no null

Table 3.12: Laboratory Investigation

Ward Information

Other information captured by the system is the ward information. The ward number, bednumber and the bed capacity are captured and stored in the ward information table.

Field Type Null Key Default ExtrawardNo int(11) no PRI nullname varchar(50) no nullbed-capacity int(11) no null

Table 3.13: Ward information

3.5 System Implementation

System implementation was achieved using MySQL for database design. PHP scriptinglanguage and HTML were used to develop the codes that link up the system interfaces andthe database.

3.5.1 PHP

PHP scripting language is famous for the four S’s, Pushman (2000) [14], i.e. Speed, Stability,Security and Simplicity a reason that justifies its choice for this project. Below is thedescription for the four S’s and more advantages of PHP language:

1. Speed: not only is the speed of execution important, but also that it does not slowdown the rest of the machine. So it does not demand a lot of system resources. PHPis a thin wrapper around many operating system calls, so can be very fast.

2. Stability: it’s no good being fast if the system crashes every few thousand pages. Noapplication is bug free, but having a community of PHP developers and users makesit much harder for bugs to survive for long.

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3. Security : With PHP, the system is protected from malicious attacks from users, bothas programmers and as surfers because it provides many levels of security which canbe set in the individual file to the desired level.

4. Simplicity : With PHP, even HTML coders can start integrating PHP into their pagesstraight away.

5. PHP is available for MS Windows, provides interface for many different database sys-tem, has high performance capability and is extendible.

6. PHP will run on (almost) any platform.

7. It has lots of HTTP server interfaces. PHP currently will load into Apache, IIS,AOLServer, Roxen and THTTPD.

3.5.2 MySQL

MySQL, a popular database with Web developers,was chosen because of the following ad-vantages:

1. It is faster.

2. It is inexpensive. MySQL is free under the open source GPL license, and the fee for acommercial license is very reasonable.

3. It is easy to use. A few simple statements in the SQL language are needed to buildand interact with a MySQL database.

4. It can run on many operating systems. MySQL runs on a wide variety of operatingsystems - Windows, Linux, Mac OS, most varieties of UNIX and others.

5. Strong Data Protection: MySQL offers exceptional security features that ensure abso-lute data protection. In terms of database authentication, MySQL provides powerfulmechanisms for ensuring only authorized users have entry to the database server, withthe ability to block users down to the client machine level being possible.

6. It supports large databases. MySQL handles databases up to 50 million rows or more.

7. It is customizable. The open source GPL license allows programmers to modify theMySQL software to fit their own specific environments.

3.5.3 HTML

HTML was used as the web template because of the following advantages:

1. HTML web templates can be easily edited with a minimum knowledge of HTML.

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2. The codes of HTML templates are easy to understand and change in order to convertthe template into the unique web site

3. As HTML is a widely spread format, there are many materials on it.

4. HTML is available for MS Windows

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Chapter 4

Results / Findings

This charpter explains in summary, the outputs or findings as per specific objectives of thestudy.

4.1 Patient’s Demographic data, Medical history, Di-

agnosis, Prescriptions, and Treatment

At the reception, a patient’s demographic data would be captured on a chart and in a register.Medical history, diagnosis precicription and treatment would be taken by a clinician on thechart. The data on the chart would again be recorded in the register when the patient wasrecieving drugs in case of outpatient department patients. The patient would required tocome with the chart on subsquent visits. In case of admission, the chart would be retainedin the records centre and the patient would be issued with discharge form. This was foundwith the following problems:

1. Patients would forget to bring the charts at their second visit

2. Some charts would be misplaced or got lost in the records centre

3. There was duplication in registration of patients

4.2 Existing Health Records Systems

1. The existing system was found to be completely manual, i.e. all data was capturedwith pen on paper (registers and patient charts). A lot of duplication in registrationpatients was found to be common. For example there was registration at reception, inthe laboratory, in the wards and so on as these places manage their own registers.

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2. It was very slow and time wasting as personnel would send time looking for informationin charts and registers before they could attend to the patients. This increased patienthospital stay.

3. The bulky charts and registers were kept in the records centre in the custody of recordsstaff. This was found to be expensive and risky as these charts would be attacked bymolds and sometimes misplaced.

4. Reports were generated manually, for example computations where necessary weredone with a calculator and information fed in forms to make reports. This was foundrelatively difficult and time consuming. Timing and accuracy of these reports wouldnot be guaranteed.

4.3 System Design

The system was designed on Microsoft windows platform, using Apache server, MySQL fordatabase design and PHP scripting language i.e. WAMP5 1.6.4 version. It is web-based andtherefore can be installed on a computer (server) on a Local Area Network (LAN) or WideArea Network (WAN) depending on the environment being used.

Once the application is installed, any authenticated user can access it from any work stationby using hypertext protocol, servername, and port number. For example, the system islocated at the address http://localhost/home.php.

The system is composed of two sections; the database server and the graphic user interfaces(GUI) i.e. a two tier architecture.

4.4 System Implimentation

4.4.1 The Database

The database was designed using MySQL database management system. The database wasnamed ”chals” and it contains six tables which keep records or data as entered by the user.Itis this database that is consulted to answer querries

4.4.2 Graphical User Interface

The user interfaces consist of various windows that enable different categories of users tointeract with the system. The forms were developed using HTML and PHP. Different formswere developed to enable the users perform the following tasks:

1. Login to the system

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2. Register the patients by capturing personal information

3. Searching for the registered patient in the system

4. Capturing patient’s information i.e. medical history, entering diagnosis and treatment

5. Entering the laboratory investigation results

6. Viewing reports generated.

4.4.3 Screen Formats

The information that is managed by the system is captured on different screens at differ-ent stages. This section shows these screen shots and how they are used to capture theinformation managed by the system.

The user logs in the system by entering his / her username and password in order to accessthe system. For example in the form below, the user is logging in using ”gilbert” as username.

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4.4.4 User log on Screen

Figure 4.1: Logon screen

After logging in the system, the user can register the incoming patient by capturing thepersonal information as in the following screen format. Here the user means the one whoregisters the patient at reception by capturing the demographic data only. Details of thepatient’s demographic data is captured including first and last names, sex, age and address.He / she is assigned a unique patient number. The screen shot below shows demographicdata being captured:

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4.4.5 Patient Registration

Figure 4.2: Registering the incoming patient

The system allows to search for the patient who is registered . I.e. if he / she is a re-attendance case or has moved from one stage to another. For example, when a patient isregistered at reception and goes to the clinician. On presenting his / her patient number ornames, the Clinician will use search facility in the system to get the details of the patient asin the screen below:

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4.4.6 Searching for the Registered Patient

Figure 4.3: Searching for the patient in the system

In the above form, the patient number was used to search for the patient in the system.Since the patient number is unique, only that patient will be displayed when the it is used.

Patient name can be used to search for the registered patient as well. In the following screena patient whose first name is Bob is being searched in the system.

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4.4.7 Searching a Patient using Patient Name

Figure 4.4: Search for a patient using first name

When patient name is used, details of similar names will display allowing the user to identifythe very patient. The form below therefore shows the results that display when a patientfirst name ”Bob” is used. All the registered patients whose first name is Bob will display.

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4.4.8 Search Results

Figure 4.5: Search results displayed

The user now can pick the patient he is looking for since the details are displayed on thescreen above.

On consultation, the doctor / clinician will enter diagnosis and treatment information in thesystem as shown in the screen below:

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4.4.9 Patient Treatment

Figure 4.6: Diagnosis and Treatment information entered

If the patient is admitted, he / she will be assigned a bed in a ward and therefore the needfor ward number and bed number. In the example above the patient is admitted in wardnumber 4 at the bed number 34.

Where it needs to have laboratory investigations, the systems captures the laboratory infor-mation as in the following screen:

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4.4.10 Laboratory Investigation

In the laboratory, specimen and the tests done are entered and results submitted in thesystem. This is shown in the following screen.

Figure 4.7: Laboratory investigation

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4.4.11 Reports

The system is able to generate a number of reports which can be used in planning. Thefollowing examples of reports show the census of daily outpatient, in-patients and diagnosisaccording to age groups.

OPD Report

Figure 4.8: Daily OPD report / Census

In the following example, patients are grouped according to age and a report of those diag-nosed that day can be generated as shown in the screen shot.

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Age Group Report

Figure 4.9: Daily OPD report according to age groups

Another report that is generated is that of in-patients. The system is able to show how manypatients have been admitted and in which ward. This is shown in the following screen.

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In-patient Report

Figure 4.10: Daily in-patient report

4.4.12 Ward Information

Once the patient is admitted, the information on the ward can be captured and entered inthe system as in the following screen:

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Figure 4.11: Ward information is entered in the system

The next of kin, patient complaint, and whether he / she has been referred from anotherhospital will be captured.

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Chapter 5

Project Discussion, Conclusions andRecommendations

This chapter discusses the work carried out in this project. It examines how the objec-tives of the project were achieved using Kitagata Hospital as the case study. The design,implementation, conclusions and recommendations are discussed.

5.1 Discussion

The purpose of the study was to build a computerized health records management system toreplace the existing manual system. The case study was Kitagata hospital in southwesternUganda. To achieve the objectives of study, the existing systems was studied and analyzed,by comparing the strong and weak points of the system. Stake holders were interviewed,documents reviewed and observation techniques were employed. Existing literature was alsoanalyzed.

Implementation was done using PHP scripting language embedded in HTML for the userinterfaces and MYSQL for database design. PHP enabled Apache web server to effect theconnections between the database and the web browser. The new system is therefore ableto do the following:

1. Capturing of Personal / bio data is done once; on reception as opposed to the manualsystem where the patient would be recorded at every level in different registers. Thisavoids duplication and saves time.

2. Retrieve Information from the database as quickly as one searches on the screen com-pared to the old system which involved paper files which were vulnerable to displace-ment and damage.

3. Authenticate the users with the access control facility to prevent unauthorized usersfrom accessing the data.

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4. Validate the entries by prompting the user whenever a wrong command is entered toavoid unnecessary errors that can distort information.

5. Update the database whenever new information is entered

6. Reports are generated quickly and correctly, unlike in the old system where informationwould be scattered in charts

5.2 Problems / Constraints Encountered

During the study the researcher encountered a number of problems which to some extentseemed to stand in the way of success of the study. These among others include:

1. Financial constraints: The study being a self sponsored venture, the researcher wouldsometimes face problems to finance some of the activities involved in the study. How-ever, through hard and thin, it has come to an end successfully.

2. Time constraints: The time allocated to the study looked not friendly given that thesame period involved the class work where there are a lot of course works ,tests andlectures.

3. Busy schedules: The people working with current system were most of the time busyand this made the work of the researcher difficult especially during data collection.Nevertheless, they proved very cooperative despite their busy schedule which madethe successful at the end of the day.

4. Fear for retrenchment: Some of the members staff at the hospital, especially the recordsstaff, feared for their jobs with the introduction of the computerized system. Theyexpressed fear that they would be left with no work and risk being retrenched.

5. Throughout the whole study, electric power was never on the researcher’s side. Itwould go off at critical times and this hindered smooth progress and planning wasmade difficult

5.3 Recommendation

A more comprehensive study to exploit the full benefits of the new technology in this field ofhealth records management is highly recommended. This may be able to unveil more gapsand therefore improve on the system more than this study has been able to do.

The ministry of Health should step in to have all hospitals and health units computerizetheir records management systems by providing the necessary funds for such projects.

Given the current power situation in Uganda, the system would be rendered useless if mea-sures are not put in place to avert power problem. The researcher therefore recommends

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that a standby generator be considered such that when power goes off the system does notstop working.

Training of the hospital staff in minimum computer skills is paramount. It was found outthat most staff are computer illiterate. Without these skills system implementation will bedifficult therefore it is recommended that a training program be made a priority.

5.4 Conclusions

Basing on the findings and analysis, computerization of health records management is ventureworth to invest in. Once taken seriously and embraced, there are alot of benefits that canbe realized therein. Both the hospital and the community it is serving will benefit from it.For example patients will no longer wait for long hours to be attended to because the timethat would be spent looking for information would be saved.

Medical errors that were resulting from lack of information for proper decision making onthe part of doctors / clinicians will be minimized. Records which were stored in the recordscenter, in form of charts and sometimes get lost there, will now be stored electronically andwill be more safe. Therefore there will be the right information at the point of care.

Periodic reports which are generated with the help of a computer are more accurate andquick. Therefore with the introduction of computerization, the problem of late reportingand errors in the reports will be no more.

It is important to note that this system is based on a local area network. This facilitatesthe sharing of data in different departments. This helps personnel access the data at theirdepartments instead of moving from department to department looking for information whichis time consuming.

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References

1. Bell, J.(1992). Doing your research project,Milton Keynes:open University Press,UK

2. Bush, G.W. (2004). President George W. Bush, Transforming Health Care throughHealth Information Technology: State of the Union Address, January 20, 2004 , re-trieved June 10,2006 fromhttp://www.whitehouse.gov/infocus/technology/

3. Chaiken, B. P., Edward, B., Bevan, K. B.,and Seth, F. (2006). Clear and Lasting Dan-ger: Pandemic Flu, and How IT Can Help:Proceedings of the WTN Media’s 2006 Dig-ital Health care Conference, retrieved June 15, 2006 from http://wistechnology.com/

4. Chrisanthi, A. and Tony, C. (1998). Developing Information systems: Concepts, Issuesand Practices. Palgrave,Newyork.

5. Cisco (2005). Health care Industry Influencers of Change:Cisco Systems, Inc.:OverviewBrochure, retrieved June 8,2006 from http://www.cisco.com/web/strategy/docs/healthcare/ ehr-connected.pdf

6. Hendee, W., Gary, W., Prekop, J. , Traxler, J. , and Melski, J. W. (2006) Data Over-load: The Quest to Deliver Knowledge.Proceedings of the WTN Media’s 2006 DigitalHealth care Conference, retrieved June 15, 2006 from http://wistechnology.com/

7. International Standard Organization,15489 (2001).Wikipedia: The free encyclopedia,retrieved June 2,2006 from [http://en.wikipedia.org/wiki/Records-management]

8. Klein, M. (2006). Will Technology improve health care delivery.Wisconsin technologyNetwork Journal article [online],retrieved June 12th 2006 from http://wistechnology.com/

9. Meghan, C. (2006).President to Push Medical Record Computerization The New YorkSun article January 6, 2006, retrieved June 8,2006 from www.nysun.com/

10. Lucey, T. 2002. Management Information Systems.Continuum, 11 York Road, London.

11. MOH (2001). Uganda Health Bulletin Volume 7 - No 4

12. Ndagire, Mary Lucy (2003). An inventory management system: Case study RubagaHospital

13. O’brien, J. A. (2002). Management Information Systems: Management informationTechnology in the e-business enterprise. Tata McGraw-Hill,New Delhi.

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14. Pushman, J. (2000) , Tips on web page design,HTML and Graphics, Web Developer’sJournal, Retrieved October 5 2006, 2002, from ABI/INFORM Global database.

15. Scott J. T., Rundall T. G., Vogt T. M. (2005). Kaiser Permanente’s Experience ofImplementing an Electronic Medical Records: A Qualitative Study, (BMJ, December3,2005), vol.29 Retrieved May 20,2006 from http://www.cmwf.org/publications

16. Steve, A.,Joseph, W, Susan, J. H.,Gary, M. K. (2006).Electronic Health Records: AGlobal Perspective Overview Retrieved Sep 12 2006 from

17. Weddi, D. (2005). Using information systems to manage health in Uganda: 2004-2005Annual Health Sector Performance report.Retrieved Sep 12 2006 from www.iconnect-online.org

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Appendix A

5.5 Interview Guide

1. What is your job title?

2. How many patients do you see daily?

3. What role do you play in the health records management?

4. How do you find the existing system of health records management?

5. What problems do you face with the existing system?

6. Do you recommend to continue with the existing system, if yes why?

7. Are you a computer literate?

8. Suppose the existing system were replaced with a computerized one, how would thishelp to improve health records management?

9. What would you expect from the new system (if introduced) as a person going to useit?

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Appendix B

5.6 Some Codes used for Design

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