DESIGN AND IMPLEMENTATION OF AN ONLINE PATIENT MANAGEMENT SYSTEM

ABSTRACT

The essence of patient management is obtaining the right information about patient, in the right place, in the right order, at the right time for the right person. In order for this to be accomplished, a good efficient and effective patient management system is required. Considering this, a careful analysis of the patient management process that is been implemented by the National Hospital Abuja was conducted. The results revealed that the process or system currently implemented is inefficient. This analysis initiated the need of a patient management system that would facilitate effective and reliable patient management through automated processes and

 

The main objective of the project is to design and develop an Online Patient Management System that would automate and improve patient management in National Hospital Abuja and give direct benefit for the National Hospital Abuja section in terms minimizing cost associated with the management of patient as well as improving the quality of care provided through the minimization of errors during patient diagnosis and increasing efficiency. The OPMS was designed as a server based and web based system and implemented using open source solutions that include PHP as the programming language and MySQL as the database.

 

The system was developed using Iterative Prototyping methodology. A careful research was carried out to understand what is required in order to build the system successfully. The critical evaluation of the project showed that the project achieved most of the predefined objectives.

The documentation further explains the limitations and future enhancements of the system.

CHAPTER 1 – INTRODUCTION TO STUDY

1.1 INTRODUCTION

Computers and information systems have become an essential part of every business nowadays. The use of computers has become very popular that businesses are trying there best to put computers at the reach of their employees. In general, businesses trust that computers will enable their workers to be more productive – eradicating repetitive tasks, minimizing time to do difficult calculations and easing communication and cooperation within a work environment. The introduction of Internet into the business world has even further improved the business processes.

 

The Internet and hospitals seem to be creatures from two distinctive geographical eras. Similar to the automobile factories, hospitals are very much creatures of the old economy. But this is gradually changing due to the change in trends as a result of a new economy, hospitals are now adopting these technologies in their in carrying out their activities.

 

The main research area in this project is Health Informatics. According to the department of health (2002), “Health informatics is the branch of healthcare that focuses on getting the right information to the right person at the right time”. It is one of the fastest growing areas within healthcare. It is basically about improving patient care by improving the management of health information.

 

The main reason why Health informatics is important is because it assists in the exchange of information between patients, healthcare professionals, management, IT services and planner of healthcare. It also offers healthcare professionals with a patient’s complete healthcare picture, to enable them make informed decisions about their treatment.

 

1.1.1 NIGERIA

Nigeria is referred to as a West African “third world” country. According to the business dictionary, a third world country is referred to as a general name for most of the nations of Africa, Asia, Latin America, and the Middle East, many of which once colonized and are usually characterized as developing, less developed, or least developed countries. They support 75 percent of the world’s population but use only 20 percent of their resources, and are generally characterized by:

1. Slow pace of industrialization
2. Low to very low levels of per capita income that is insufficient to generate savings for economic growth
3. High level of population growth but low literacy levels
4. Inadequate health services and transport infrastructure
5. Reliance on agricultural and commodity exports as main foreign exchange earners. Nigeria is a federal constitutional republic comprising of 36 states. Its Federal Capital Territory is Abuja. Nigeria has an approximate population of over 170,123,740 million people. It plays an important part as a beacon of governance and innovation in Africa through technology advancement, cultural heritage, and rich natural endowment. According to Adeyanju and Okwori (2006), 68% of the total populations with ages 15 and above are literates. The total percentage of IT literates amounts up to 48%.

 

1.2 PROBLEM CONTEXT

A significant part of the operation of any hospital involves the attainment, management and timely retrieval of large amount of data. This data usually include; the patient personal information, medical history, appointments and several other facilities. It is important that this data is managed in an efficient and cost-wise manner in order to ensure a successful utilization of organization resources.

 

Most of the hospitals in Nigeria operate on manual processes, which generate major problems in managing patient information and excessive delays in a patient’s treatment cycle. The manual processes produce various challenges in conducting supervisory and monitory activities. Such problems in day-to-day hospital environment indicate the essential need to introduce consistent automated procedures and tools for handling the large amount of data in hospital and meet the demands of modern healthcare delivery. Some of the problems that exist within organization that implements these manual processes are discussed below:

 

Cost 

The current patient Management System used in the National Hospital Abuja is completely manual. All the Information’s are controlled manually in folders and other documents. Because the information regarding the patients is paper-based and therefore not stored on computer, maintaining those papers are quite costly. Therefore, as the patients keep increasing, the hospital will have to spend more on managing as well as storing these papers.

 

Security

The paper-based method of keeping patient data is tedious and has a high risk of data loss. In a hospital, the patient’s data are delicate; there is no room for mistakes when it comes to handling patient’s information as a small mistake can cause huge damage. Because all the patient information are written on paper and stacked into a file, a paper can slip out without the nurse noticing because they are busy attending to other patients, in this case, it might affect the next prescription that will be made by the doctor.

 

Time

Lastly, there is an issue of time management; to search for particular information in a paperbased system is very time consuming, as one has to go through a lot of papers before getting to the required information. In the current system, each time a patient arrives, the nurse will have to go and search for the file of each and every patient that arrives and then hand it to the doctor in his office. To keep moving back and forth from their desk to the doctor’s office is time consuming as well as tiring for the nurses.

 

1.3 PROPOSED SOLUTION

Healthcare must always be about people, not about a system. Even though people working in the healthcare system have great concern for patients, there are not always ways built into the system to encourage personalized attention and “second looks” at difficult choices. However, a connected system of health information would make that more possible by creating new and better ways to personalize information and interact with medical information. This can be achieved by making critical information more readily available for review on an individual basis. (Ending the document game, 2005)

 

An online system will make it simpler for physician to review patient data, locate patterns in patient history, offer patients with important information, observe adherence to treatment, reflect on patient enquiries and worries in advance of visit, and plan more carefully for a patient’s appointment.

Electronic networks that functions over the Internet permit a regular and quite easier interchange of data without the unnecessary high-priced and time-consuming office visits or even phone calls. (Ending the document game, 2005)

 

When physicians have an electronic system, they can carefully observe patient’s progress and in most cases develop real, effective partnerships with patients. Furthermore, the fact that the physicians can direct the patients to consistent health information online would offer the patients the chance to review significant and comprehensive information about their condition and use that information to improve their well being. This will result in a making the patient more involved in working with the physicians in order to obtain improved health outcomes, like a better care for serious conditions and improved early diagnosis and treatments. A recent study by The Commission on systematic Interoperability showed that, “CareGroup, a six- hospital integrated delivery system, has saved more than $1 million annually from implementing a web-based electronic medical record system that improves the workflow processes. The group anticipates a 33 percent annual increase in revenues from higher customer retention and attraction rates. CareGroup has seen cost and process time reductions in a range of hospital operations: clinicians need less time to find and retrieve records, the admittance process is quicker, and the average overall stay is shorter”.

 

Also according to Lou and Alshawi (2009), Implementing an online system reduces the reliance on paper transactions and leads to reduced costs and time. Therefore it can be concluded that, the online system can assist in reducing the workload as well as reduces total cost.

Electronic system consumes less time and money in standard business activities, and when applied to healthcare, those benefits will include a decrease in the amount of documents lost in transmission mainly through postal mail and fax, a decrease in spending on printing, transcription, scanning, duplicate data entry and shredding, also a flexible and immediate reporting and tracking abilities.

 

The proposed solution is to replace the manual paper-based system of carrying out the daily activities with an online system. By implementing an online system, the cost of buying and maintaining papers will be eliminated, the chances of data loss will be reduced as well as the time taken to carryout certain business activities will also be eliminated.

 

1.4 RATIONALE

From the problems listed above, an online patient management system could be used to minimize and solve these problems, it well be a web application designed to assist the staff of National Hospital in storing and managing the patient’s information in a more organized manner. By implementing an online patient management system, the National hospital will cut a cost of at least 6% of total revenue (HIT print intelligently, 2010). Another advantage of the online patient management system is that it will store all the patients’ information in one place, which can be accessed from one central location. This will allow an easier management of all patient information, minimize data loss across the whole scope of the system and since the information is now centralized, the staffs do not have to go around searching for files as a result eliminating wastage of time by at least 25%-30% (Lin and Nikita, 2010).

1.5 AIM

The aim of this project is to develop an online system that will replace the traditional way of maintaining and managing patient’s information, as a result simplifying the work of the staff as well as providing better service to patients.

1.6 OBJECTIVES

• To produce a viable and economic system to deal with problems faced by the National Hospital Abuja.
• To investigate the quality and compliance requirement for systems built to serve health informatics systems.
• To investigate and understand the security policies that affects the use of medical information (such as for medical research and patient diagnosis).
• To investigate the National Hospital work process in aspects relating to managing patient information.
• To investigate the current cost expenditure of the National Hospital associated with patient management
• To understand the process of managing appointment in the National Hospital Abuja.
• To investigate aspects of Human Computer Interaction (HCI) that could enhance user experience.
• To investigate and formulate more efficient ways of handling patient diagnosing in the National Hospital.

 

1.7 TANGIBLE BENEFITS

• The reduction in cost by at least 6% through eliminating the use of papers as well as space needed to store all the information.
• Minimizing the rate of data loss.
• Increasing the speed in carrying out the daily patient related activities by at least 25%30%.
• Increased security of medical records by monitoring and restricting access to only authorized personnel.
• Minimizing the workload of the nurses. The nurses don’t have to go around and search manually for files and move back and forth from their desk to the doctors office to give the file, they can just send a notification to the doctor.

 

 

1.8 INTANGIBLE BENEFITS

• Increase in patient satisfaction as a result of a quicker and more convenient service.
• Increased mobility i.e. by implementing an online system, the information can be accessed at anytime or anywhere through a computer that will be very convenient especially for patients that need their medical records when they travel else where for medical checkup.
• A better work process as well as an improvement in the staff morale Also offering an improved service to the community.

 

1.9 NATURE OF CHALLENGE

Some of the challenges that will be faced during the development of this project include;  Data collection:

Firstly, there is an issue of data collection. In a country like Nigeria, collecting data relevant for understanding the current problems and finding solutions to that problem is going to be an issue as they hardly document such records or keep them up to date, therefore in this case, information like how much resources are used up for performing daily activities or information about procedures will have to be obtained from organizations that are similar to the National Hospital Abuja.

Another challenge will be finding out information on data retention policies of Nigeria. This is an issue because Nigeria is still behind in technology as such issues pertaining to technology are discussed in small and otherwise new organizations set up by the government, which are not commonly known, therefore identifying such information will be an issue.

Policy:

Secondly, there is an issue of understanding the information about the policy, i.e. understanding the code of conduct, the rules and regulation of the medical field and also how to translate these processes to software will be a challenge. This challenge refers to translating rules that where originally designed for a paper-based system which cannot necessary or be easily applied to an electronic system, for example, in a paper-based system, there can a policy that prohibits taking patient record out of the hospital facility, in order to prevent copying or theft of data, this will be difficult to implement in electronic system with the advancement in technology that allows screenshots and instant messaging. Therefore, in such cases, the author will try to gain as much information as possible on hospital policies through previous research papers as well as other online resources and also try to understand how to interpret this information and implement in the software.

Obtaining and selection of relevant Information:

Also, some of the technical challenge for the author is understanding;

• What information is relevant for a medical practitioner in order to include in the system,
• What infrastructure will permit the hospital to use the proposed system,
• Also the expertise of the people, whether the system will be usable by the target users. Therefore, the author will have to design a system that will be easy to use for both novice and expert users as will as find out the relevant information needed during the primary research.

 

1.10 SCOPE

The scope will cover only activities related to management of patient information. It will cover only out – patients. No billing, accounting or any other aspects of the hospital will be included. The system will provide information in the best and most efficient way for doctors, nurses and patients, it does not emphasize on security and the system will not be fully functional only parts of the system will function.

 

1.11 DELIVERABLES

There are three main deliverables for this project, which are; the documentation, a software system and a user manual.

 

DOCUMENTATION 

The project documentation will consist of;

• A deeper look into the Nigerian healthcare information
• A broader look into the general healthcare systems and its importance
• A deeper look into the issues with this systems
• A closer look into the National Hospital current managerial issues

 

 

 

 

USER MANUAL

The user manual will consist of a detailed explanation on how to go about using the software system. It will provide information for the users on how to navigate in the system and also help guide the users to successfully carryout their respective tasks within the system.

 

 

 SOFTWARE SYSTEM

The online patient management system allows the administration to add and delete users. Allow the nurses to register new patients and manage all their information online. They do not have to get a new file and record all the details of patient. They can also receive notification about upcoming patients appointments and inform the patients in advance. The doctors can view the patient’s detail such as their medical history, write diagnosis and prescriptions and update the patient’s data. The patients can also book appointment online without having to come to the hospital or call the hospital. Below are the core functions of the system:

• Allows the administration to add and delete users
• Allow end-user to login and logout of the system
• Allow nurses to register new patients
• Allow doctors to view patient details and record of previous encounters
• Allow doctors to write diagnosis
• Allow doctors to update the patient record

       

1.12 RESOURCES NEEDED FOR PROPOSAL

Hardware 

The minimum hardware required to successful complete this project are as follows:

• Random Access Memory (RAM) – 512MB
• Keyboard & Mouse
• Internet
• Processor- 2.4 GHz Intel i5

 

Software

The minimum software requirements for a successful complete of this project are as follows:

• XAMPP
• Adobe Dreamweaver
• MySQL

Documentation and planning

• Microsoft project
• Microsoft Word
• Microsoft Visio

 

Access to information / expertise

When developing the system, several IT related, programming and web design books are available online which can assist in providing information, but sometimes, the information is not very clear or quite complex to understand, in this case, the lecturers in APU which teach such fields can assist in clarifying such information. Also, information can be gathered from questionnaires and interviews that will be conducted.

 

User Involvement

The people involved are the administrators, doctors, nurses and patients. Several kinds of users with different level of expertise such as novice, intermediate and expert users will be using the system. An interview will be conducted with both the nurses and doctor in order to obtain their opinions of the current manual method they are using. Also, some of the patients will as well be given questionnaires so as to obtain their opinions with regards to the current system the hospital is using.   

1.13 PROJECT WORKPLAN

The project work plan for the proposed Online Patient Management System is given below.

S/N	ACTIVITY	Detail	Duration (days)	Start date	End date
1	Initiation	An introduction of the proposed system, problem statement, objectives, and scope will be explained.	5	14/01/2013	21/01/2013
2	Planning	Deep research will be conducted in this stage to gain more understanding of problems and solution as well as other important requirements. Also, the most suitable methodology will be chosen.	28	21/01/2013	18/02/2013
3	Data gathering	Interviews will be conducted and questionnaires will be distributed	21	18/02/2013	11/03/2013
4	Analysis	Results from the interviews and questionnaires will be analyzed in this stage	14	11/03/2013	25/03/2013
5	System Design	The architectural design of the system will be carried out in this part	28	25/03/2013	22/04/2013
6	System Impleme ntation and Testing	Implementation of the proposed system will be described, system testing will be done as well as an explanation of the strength and weaknesses of the system	56	22/04/2013	17/06/2013

 

7	Conclusi on	Summary of what have been achieved will be provided here.	14	17/06/2013	01/07/2012

 

Table 1.1: Activity Workflow

 

Methodology

System development methodologies can be referred to as a means of improving the management and control of the software development process, structuring and simplifying the process, and standardizing the development process and product by specifying activities to be done and techniques to be used (Russo N.L et al 1995).

During the developing of this project, the author will divide the work into different stages; after completing each stage the author will proceed to the next stage.

 

             

The First/ Planning Stage – 28days (21/01/2013 – 18/02/2013)

The first Stage is the planning stage, i.e. in this stage, the author will strive to find information to have a better understanding of the problems and solution to the problem as well as identify the requirements such as the hardware and software needed to successfully complete the project.

 

The Second/ Data Gathering Stage – 21days (18/02/2013 – 11/03/2013) 

In order to select appropriate solutions to the problem, the author will then proceed to the data gathering stage, i.e. in order to fully understand the problems and to propose the best solution, some techniques to gather information will be used, the two techniques are through questionnaires and interviews. The questionnaires will be given to the staff in the hospital like the doctors and nurses as well as soon of patients. Also, some of the doctors and nurses will be interviewed in order to gain a better understanding of the hospital activities and the problems they face.

 

The Third/Analysis Stage – 14days (11/03/2013 – 25/03/2013)

After the data gathering stage, the author will proceed to the Analysis stage, in this stage; the results and feedbacks that have been obtained from the questionnaires and interviews conducted in the previous stage will be carefully analyzed in order to propose a suitable solution, this result will assist in designing the system.

 

The Fourth/ System Design Stage – 28 days (25/03/2013 – 22/04/2013)

After the Analysis stage, the author will proceed to the system design stage. In this stage, the software development methodology that has been chosen for the software development process is the iterative prototyping Methodology.

The iterative prototyping methodology requires building a working prototype of a system before carrying the development of the actual software. It is basically a toy implementation of a system through different phases such as:

The requirement phase i.e. in this phase information like analyses of the end-user needs, operation of the intended application is generated.

Then the design phase i.e. in this phase, the intended features, screen layouts, business rules, process diagrams of the hospital management system are generated.

The implementation phase i.e. in this stage, the real coding is performed, that is all the codes is written here.

The integration and testing phase i.e. several testing’s will be so as to check for errors or bugs, testing like unit testing, user acceptance testing and integration testing will be performed.  And lastly maintenance phase i.e. this consists of the future addition, changed or correction that could me made to the hospital management system,

 

The advantages of using this methodology is that it is easy to use and understand, also each stage has a well defined deliverable which makes the project more organized as well as confirm the quality, consistency, and maintainability of the software that is developed.

1.14 EVALUATION AND TEST PLAN

Success Criteria

The main objective of the online patient management system is to develop a system that will perform the operation of registering new patients, saving patient information, updating patient’s information, deleting patients, providing notification of upcoming appointments. Therefore, in order to confirm that this system is functionally perfectly as expected, different testing methods will be carried out by certain number of people.

 

Unit Testing  

For this testing, all the modules will be tested differently to confirm that they perform properly and efficiently with no errors and also meets the user expectation. The programmer will carry out this testing. If by any chance an error is encountered during the testing, then correction can be made instantly.

 

User Acceptance Testing

In user acceptance testing, a minimum of 5 users will be chosen to test the system. They will explore the system and give their feedback. For this testing, the users approval and feedback are important for finding out the level of acceptance of the users that are associated to the system. The testing will involve human computer interaction and the graphical user interface.

 

 

             

Integration Testing

This testing includes integrating more than two units of the system into a component and testing the interface between them. The purpose of this is to test a combination of units and eventually expand the process to test the modules making up a process. This assists in finding out problems that may occur when the units are combined, therefore minimizing the number of error that might occur later on.

 

1.15 COMPANY BACKGROUND

The National hospital Abuja is a government owned hospital in West Africa, Nigeria. It was originally founded by the former First Lady Hajia Mariam Abacha, which was later, commissioned by the former Head of state, His Excellency General Abdusalami Abubakar, and established in 1999. It was originally intended to cater for the needs of women and children in Nigeria and the West African sub- region with the purpose of minimizing morbidity and mortality rates, and to perform extensive research into peculiar causes of women and children- related diseases in Africa.

 

Later on, the range of its operation was increased to accommodate male patients so that the majority of Nigerians can gain from the services in the hospital. The hospital consist of more than 26 different departments, and more than 200 staff. It is situated in Abuja the capital of Nigeria.

 

Due to the vast number of departments and other sub divisions presently in the hospital, and also the limited amount of time, the hierarchy of company shown below is of the departments that are mainly related to the Project.

DESIGN AND IMPLEMENTATION OF AN ONLINE PATIENT MANAGEMENT SYSTEM

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