Essay: Development of an electronic medical administration system for Health Care Providers

1.0 Introduction
This document serves to introduce the development of an electronic medical administration system for Health Care Provides. The greater part of Bechr filing concepts` customer base constitute of the doctors and hospitals. This proposed Medical Administration System is aimed at achieving two ends. The first being, helping the better management of patients records and then better management of the patients themselves. The software interface between the patient and the hospital, substitute those conventional and cumbersome datasheets and will definitely lessen the time each patient has to spend at every point in his course. The new system will cover appointment scheduling, billing and a registration module that will integrate all administrative works into one. The details of each patient are posted to the database in the form of “forms” which are simulations of the medical folders that we currently are supplying them. Each patient is therefore given a unique “registration-number” such that when they come into the hospital if their registration number is enter all medical history of that patient is shown.
The system is designed to represent data that accurately captures the state of the patient at all times. It allows for an entire patient history to be viewed without the need to track down the patient’s previous medical record volume and assists in ensuring data is accurate, appropriate and legible. It reduces the chances of data replication as there is only one modifiable file, which means the file is constantly up to date when viewed at a later date and eliminates the issue of lost forms or paperwork. Due to all the information being in a single file, it makes it much more effective when extracting medical data for the examination of possible trends and long term changes in the patient.
1.1 Background Study
Bechr Filing Concepts (Pvt) Ltd is a Limited Company incorporated under the Companies Act [Chapter 24:03] on the 12th of March 2002. It is wholly owned by Dr. Christopher Pasi and wife. Bechr filing concepts offers a full circle of service solution customer`s filing needs. It provides the best filing cabinets with an antitheft locking system that allows proper security of client`s files. Suppliers are mainly Zimbabwean based although some of the raw materials for the filing cabinet are imported to ensure a high quality product. Our customers consist of the corporate world, government institutions, hospitals and medical practitioners. Bechr filing concepts came out as a competitor to Easy file, providing people with a more flexible, easy and organized way of maintaining physical office files. Bechr filing Concepts has managed to withstand the pressures of the economy as well as the changing environment because of its center concentration on customer satisfaction as well as employee satisfaction. It offers a unique selection of filing cabinets and filing solutions that all work together for better, faster retrieval of information and more efficient use of office space.
1.1.1 Management and control
The Head of the management structure, the managing Director, reports directly to a Non-Executive Chairman and is responsible for ensuring the viability of the company. A Managing Director oversees the operation of the whole company. Members of staff include Sales and Administration Officer, Factory Manager, merchandiser and two Cabinet Assemblers.
1.1.2 Products
Filing cabinets
3 Draw 3 Bay Filing Cabinets
4 Draw 3 Bay Filing Cabinets
5 Draw 3 Bay Filing Cabinets
6 Draw 3 Bay Filing Cabinets
Folders
Medical Folders
Business Folders
Government Folders
Numerical Labels
Alphabetical Labels
Absent Cards
Index Cards
Complete Index System
A4 Boxes
The principal aims of the company are:
‘ To increase speed and efficiency in filing
‘ Increase storage capacity
‘ Increase productivity
‘ Improve records security
‘ Improve document management by eliminating misfiling
‘ Enhance office environment
1.1.3 Vision and Mission
‘ To be established as domestic and regional market leaders in the provision of filing cabinets and peripherals.
‘ To excel in the manufacturing of ergonomically designed, space saving and value for money filing cabinets.
‘ To excel in the provision of excellent filing peripherals.
‘ To achieve and maintain long-term sustainable profitability.
With a view to
‘ Satisfy our stakeholders
Through
‘ Efficient operational systems
‘ Provision of quality products and services
‘ Hard working and team spirit
‘ Integrity and professionalism
‘ Leading by example
.
1.1.3 Organisational Structure
Figure 1.1 Organisation structure for Bechr Filing Concepts
1.1.4 Activities
Bechr filing Concepts is a member of the BUY ZIMBABWE Corporation and therefore participate in activities that encourage Zimbabweans to be patriotic. Other functions that have been organised include SMEs Awards, showcasing and road shows. In order to fully capture the medical Practitioners, Bechr filing concepts have participated in activities organised by Physicians by supplying them with business files during their annual meetings. These business files have always been free of charge. Strategy meetings for a starting year are usually done in Nyanga where employees gather and discuss their views and assist in planning for the coming year.
1.2 Problem Statement and Definition
Paper-based records require a significant amount of storage space compared to digital records. Doctors at times have to change or move to other locations and it is always a hassle carrying the cabinets to and from. Bechr filing Concepts maintenance employees have to make numerous trips to go and fix the cabinets after possible mishandling. This project work was also inspired by the immense inconvenience faced by patients whilst hospitals and the reception have to search through their physical files. This brings us to a major problem that affects the efficiency of treatment of patients and the management of the entire hospital with time being consumed in the manual processing of records, which are physical stationery. The assistant has to go through a number of files in a cabinet before he/ she finds the one she wants. Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors. Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input.
Billing and scheduling of appointment are also other problems faced by medical providers. It is tiresome and at times confusing trying to follow up on who is paid up and who still owes. There is need to distinguish between those on medical aid and the cash payers such that when claims come they are easy to follow through. Appointments can get mixed up and as human errors are inevitable, appointment books can get lost or misplaced.
1.3 Aim
To develop an electronic medical administrative system that will allow easier filing and management of patient files as well as better management of the patients themselves.
1.4 Objectives
‘ To convert all patients over to electronic medical records
‘ Develop a database that will store forms and all patient information and generate unique registration numbers for patients
‘ To reduce filing errors by 90%
‘ Increases efficiency, accuracy and flexibility with state-of-the-art medical management software. At a minimum, the system will
o Provide a user-friendly, Windows-based graphical user interface.
o Handle electronic medical records.
o Meet the needs of the medical hospitals and doctors so that costly and time-consuming modifications can be avoided.
‘ Implement authorisation procedures to accept patient data as authentic
‘ To create a system that will allow automatic sharing and updating of information among different offices.
1.5 Justification of the study
The world is moving away from the paper based filing systems to electronic systems which can eliminate human errors as well as bring efficiency. For many years Bechr has been providing its major customer with a physical filing system which has been serving its purpose until customers started asking for a backup filing method in case of emergencies. Mostly it has been the indexing that has been done through the excel sheet to allow faster retrieval of the patient`s file number. Doing everything electronically, that is, from the form generation and filling can save time. It can cost more money using the paper based filing as patients are mainly concerned with efficiency but if they do not get that the move to better pastures. Development of this system will benefit both the medical practitioners and Bechr filing Concepts as both will be satisfied in the end.
1.6 Conclusion
In this chapter the problem has been identified and a system proposed to solve the problem of miss-management of files which in turn lead to poor management of patients. The system is therefore recommended to be approved so that the next stage is approached. The project is in line with company objectives of making the customer the key to business success. It is by keeping abreast to changing technology that we expect to remain in business and this requires us to identify the changing needs of customers as well. The objectives of the system are also clear and outline the brief architecture of the medical administrative system.
Chapter 2: Planning Phase
2.0 Introduction
This chapter focuses on ways of operation of the current paper based system and the proposed system ascertaining the feasibility of developing a new system for the medical doctors and hospitals as a solution to the problems highlighted earlier taking into account technical, economic, social and operational feasibility. It further explains the reasons for building the system and the value such a system is going to bring to Bechr Filing Concepts as the supplier of the new system. Analysing the feasibility of the new system will help to identify benefits and limitations of the new system as compared to the current system. Lastly, the purpose of this chapter is to come up with a work plan to help in developing the system.
2.1 Why build the system
The main thrust of developing a computerised system as opposed to the paper based filing system in place is meant to reduce risks that are associated with the current system. Paper-based records require a significant amount of storage space compared to digital records. The costs of storage media, such as paper and film, per unit of information differ dramatically from that of electronic storage media. When paper records are stored in different locations, collating them to a single location for review by a health care provider is time consuming and complicated, whereas the process can be simplified with electronic records. When paper-based records are required in multiple locations, copying, faxing, and transporting costs are significant compared to duplication and transfer of digital records. Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement and resource management.
At the end of the day, building this system and with its advantages will bring great value to Bechr Filing Concepts as the supplier. A happy and satisfied customer means more business and growth for the organization.
2.2 Identify business value
The business value focuses on the efficiency of the proposed system and its effectiveness in carrying out its intended tasks. If all the proposed objectives are fully met, then there will be remarkable stakeholders and employees’ satisfaction. The benefits expected from the system are categorized into cost, security, speed and convenience, storage reliability and capacity, motivation as well as intangible benefits. These benefits are outlined in detail below;
a. Security
‘ The problem of security will be addressed because of the use of passwords. The use of passwords restricts unintended users to manipulate confidential data in the system. Every user is going to be registered to the system such that at log on it can quickly identify the user. An updates done on the patient information will show the name and times the user updated the information.
‘ The system will offer different levels of access rights to different users. The use of access levels restricts internal stakeholders to their areas of operation. This helps in responsibility and accountability of certain actions undertaken regarding the patient`s information.
b. Speed and convenience
‘ Reduced human error. The use of a computer system compared to manual system reduces errors since computers use a programmed syntax which is structured and procedural avoiding errors and mistakes. Though the computer use garbage in garbage out, commonly referred to as (GIGO), the software to be used works with validation rules and defaults to help users with type of data and information to be used.
‘ Fast retrieval of data and processing services. The use of a computerised system improves retrieval of data due to the centrality characteristics such as data can be obtained from a database through the network.
‘ Better decision making because of more accurate reports and better customer service provided.
‘ Improved processing speeds will ensure that a greater number of members will get service timeously in a very short period of time. This will therefore improve the stakeholder’s service as well as the organisation’s public image.
c. Storage reliability
‘ Safe record keeping and fast tracing reduces the amount of time required to access data or information.
d. Costs
‘ Savings are primarily attributed to automating several time-consuming paper-driven and labour-intensive tasks.
‘ Reduced medical errors through better access to patient data and error prevention alerts
‘ Administrative tasks, such as filling out forms and processing billing requests, represent a significant percentage of health care costs. The administrative system can increase practice efficiencies by streamlining these tasks, significantly decreasing costs.
‘ In addition, electronic administrative systems can deliver more information in additional directions. They can be programmed for easy or even automatic delivery of information that needs to be shared with public health agencies or for the purpose of quality measurement.
e. Intangible benefits
There are benefits, which cannot be quantified in the monetary terms as outlined below:
‘ Improved business image and professionalism to the employees as well as of the whole organisation.
‘ Boredom and overloading of workers is minimised and it results in low labour turnover due to improved working conditions.
‘ Improved employee and customer morale.
‘ Improved management decision making and performance measure through the use of reports produced by the system.
2.3 Feasibility study
Feasibility is a measure of how practical or beneficial information systems will be to the Organisation. The focus feasibility study is there to guide Bechr Filing Concepts in determining whether or not to undertake the project, thus trying to determine how feasible is it to undertake the project in relation to the benefits it will give to the end user. Basically at this stage feasibility deals with the people involved with the system, that is, the system analyst and user of systems. The development team in feasibility analysis should be in a position to address the following what if questions:
‘ Will the following investment pay for itself’? Are there other investments that will return even more on their expenditure?
Planning involves scheduling the tasks, allocating resources in the project in order to kick start the project. Decisions to consider or the project taking into account the costs associated with the project are highly made at this stage. This phase also considers items of System Development life cycle (SDLC) which include:
2.3.1 Technical
Do we have the necessary resources and infrastructure to support the software if it is acquired?
Technical feasibility considers main 3 factors.
‘ Is the proposed solution practical’? Do we currently possess the necessary technology’? Do we have the expertise needed to develop the solution?
The below diagrams show the required hardware and software for the administrative medical system to function well. The system will require the following minimum requirements:
Hardware
Minimum requirements
Recommended
Processor
2 GHz
2.5GHz
Screen Resolution
1024*768
1600*1200
Ram
1 GB
2GB
Internet speed
Cable or DSL, 1Mb/s or higher
3Mb/s or higher
Table 2.1 Hardware Requirements
Platform
Operating system
Browser
Windows
Vista, windows7, windows 8 desktop
Internet Explorer 9+, Firefox, Chrome
Mac
OS X10.6.3 or above
Firefox, Chrome
Table 2.2 Operating Systems and Browsers
Technologies used in the project
For an Internet based system there are lots of available resources today. The form registration is going to be web based and the web development is going to be done using:
‘ Server side scripting : ASP.net
‘ Web servers : Apache
‘ Database management systems : MySQL
‘ Document Preparation Software
a) A word processing application (such as Corel WordPerfect or Microsoft Word) or a forms generation software package will be needed to create documents.
.
b) Portable Document Format (PDF) writer software (such as Adobe Acrobat PDF Writer) is required to convert electronic documents from a word processing format to PDF.
Is the proposed solution practical’? All the technologies mentioned above which have been proposed for the project are open source technologies. Because of their maturity it is enough to build up a stable web system that will serve the best interests of both the supplier and the client.
Do we currently possess the necessary technology’? All the technologies that we proposed to use are free and open source, so they are easily obtainable and available for almost any software platform. Therefore the possession of the technology is not a problem.
Do we have the expertise needed to develop the solution’? All the members to be involved are familiar with these technologies. They share the technical knowledge among each other which will make expertise much less of a problem. Members of the group will employ their effort & time to the project within their maximum capacity.
2.3.2 Economic
Economic feasibility is the measure of the cost effectiveness of an information system solution. Without a doubt, this measure is most often the most important one of the three. This system is going to be viewed as capital investments for the business, and, as such, should be subjected to the same type of investment analyses as other capital investments. Financial analyses such as return on investment (ROI), internal rate of return (IRR), cost/benefit, payback period, and the time value of money are utilized when considering information system development projects but for this project payback period is going to be used.
Cost/benefit analysis identifies the costs of developing the system and operating it over a specified period of time. It also identifies the benefits in financial terms in order to compare them with the costs. Economically speaking, when the benefits exceed the costs, the system has economic value to the business. Costs are categorised as follows:
a. Expected costs
These are costs to be incurred and are divided into intangible and tangible costs:
i. Intangible costs
Are costs which are difficult to quantify in monetary value or terms. They include improved quality of decision making, morale and motivation.
ii. Tangible costs
Costs that can be attached monetary values to them and include reduced operating costs, decrease in processing errors and reduced loss in revenue. These are measurable and hence quantifiable.
2.3.2.1 Development Costs
These costs include all the tools necessary to create or come up with a working solution. These development costs accumulate from the expenses paid to the development team.
These costs include:
‘ Transport fees, which is the money that is to be used by the analyst in carrying out his duties. These are in the form of both public and or private transport.
‘ Stationary costs, which are costs incurred for all the material that the analyst uses in his diagrams, printing such as bond paper used, pens, and charts.
‘ Consultation fees, which are costs that will arise when the analyst seeks, help from stakeholders outside the organisation that is asking for assistance from some experienced professionals.
‘ Team fees, these are the costs that are paid to the development team for their upkeep during the project development.
2.3.2.2 Operational Costs
These are costs, which are incurred from the use of the new system. These costs take into account introduction of the newly developed system to employees, and maintenance. These costs are as follows:
‘ Training- done to familiarise employees on how to use of the new system.
‘ Maintenance- the maintenance and repairing of the system to ensure that it performs up to the expected standards.
‘ Conversion costs- costs derived from updating the system to add some new dynamic functionality. After consultations have taken place in a specific period, then it can be checked to see if the system is performing as expected. If not, then software conversions will have to take place.
‘ Intangible costs, whereby the proposed system development will also seek to lower cost incurred with the use of the current system. Some of these costs are intangible and this impact negatively on the organisation. Though they are difficult to quantify they have been identified to include low staff morale, perpetrated by the amount of time it takes to undertake some other tasks, thus it is time consuming to produce some documents and therefore it puts off the enthusiasm in some of the staff to revisit unfinished cases.
The economic feasibility will be assessed using the following methods:
‘ Cost benefit analysis
‘ Return on investment
‘ Net present value
a) The cost benefit Analysis
This process compares the anticipated costs to the projected benefits. This identifies the initial monetary costs of development, the expected monetary costs of operating and supporting the system as well as the future monetary benefits of using the new system.
BENEFITS AMOUNT $US
Reduced Storage (reduce the amount of prime storage space required by paper.) 1000 1500 1000
Flexible Indexing 1100 1100 100
Improved, faster and more flexible search 900 1000 1000
Increased efficiency 400 600 600
Improved Cash Flow 600 800 5000
Controlled and Improved Document distribution 800 100 100
Improved Security 700 1500 1000
Disaster Recovery 550 1000 1000
Total Benefits 6050 7600 9800
COSTS
Hardware
Computer 600 – 1200
Scanner 550 – 700
Internet 610 700 750
1 HP Laser Jet Pro CP1525 350 – 450
Software
Microsoft SQL Server 400 – –
Other Costs
Training costs 300 300 500
Device Upgrading and maintenance 700 1500 2000
Installation costs 300 – –
Total Costs 3810 2500 5600
(Benefits less Costs) 2240 5100 4200
Table 2.1: Costs and Benefits
a) Return on Investment
This measures the profitability to the period by comparing net monetary benefits to the monetary costs. Not only does the system have to pay for itself, it is also expected to provide a certain level of profitability to make it worthwhile to the organisation.
Return on investment (ROI) = [(Net benefits ‘ Total costs) / Total costs] * 100
Return on investment = 2240 * 100
3810
= 0.58793* 100
= 58.79%
Year 2
= (5100 / 2500)*100
= 2.04*100
= 204%
Year 3
= (4200 / 5600)*100
= 0.75*100
= 75%
A higher return on investment (year 1: 58.79%, year 2:204% and year 3: 75%) is desirable and strongly recommended. However, ROI cannot give the overall decision. The Net Present Value (NPV) has to be considered.
b) Net present value
NPV= total benefits ‘total costs , where r=Interest rate (15%) and n= number of years (3 years)
(1+r) n
NPV after 1 year = 2240 / (1 + 0.15)^1
= $ 1,947.83
NPV after 2 years = 5100 / (1 + (0.15^2))
= $ 4,987.78
NPV after 3 years = 4200 / (1+(0.15^3))
= $ 4,185.87
Note :
If the NPV>0, investment will add value to the firm and the project may be accepted, and if NPV <0 the investment would subtract value from the firm and therefore the project should be rejected, and if the NPV =0 the investment would neither provide gain nor lose value for the firm. In this case the NPV for the first 3 years is greater than 0 meaning the investment still brings value to the company even after 3 years. The net present value needs other factors which are not explicitly included in the formulae like those identified in technical and operational feasibility for the project to be approved.
2.3.3 Social
It evaluates both positive and negative social implications on the normal running of the organisation. It also considers factors like social ethical issues regarding the proposed system.
a) Positive effects
‘ There would be reduced workload as repetitive and tedious tasks are reduced or eliminated.
‘ Increased morale of the employees and customers.
b) Negative Effects
‘ Computer use is associated with health problems such as eye straining and repetitive strain injuries (RSI).
‘ Information systems normally lead to redundancy thus if the system is down people tend to sit doing nothing without thinking of alternatives.
2.3.4 Operational Feasibility
Do we have properly trained individuals who can operate and use the software? This technique evaluates the proposed system with regards to:
‘ How the users feel about the implementation of such a system’? Are they willing to take part or supports the system in question?
Following the results from the investigations or interviews to both the users and management the proposed system does meet their requirements and expectations. Since the users look forward to a system that reduces their workload and which is not time consuming, the medical administrative system seeks to address such problems. As for the management, they expect a system that reduces the amount of expenditures, which allows fast retrieval of files and finally a system that keeps the audit trail.
The operational feasibility investigations revealed the following:
‘ A few people will need to be trained on how to use the system when it is complete.
‘ Bechr filing has no base of employees who have the skills and expertise and so will outsource some of its expertise from well-known and reputable companies. The support and maintenance that will be required after implementation will be done internally.
‘ There is absolutely no need to retrench any of the staff as some fear. The new system will arrest the tiresome and time consuming elements in the old system.
2.4 Develop work plan
2.4.1 Development of a work plan
It is important to schedule tasks indicating the time frames of each task and sequence of all activities involved in the project. There are a number of ways and tools that are used in scheduling and allocating time to events and activities in system development. The Gantt chart and a table have been used in this project to present scheduling of activities and resources, since the project involved individuals from different minor departments. The use of tables and Gantt charts has been advocated for because they can be easily be understood and have got better information clarity.
Task Project Phase description Start Date Completion Weeks Responsibility
1 Project Proposal 21/01/2014 31/01/2014 1 Project Analyst
2 Project Planning 01/02/2014 21/02/2014 3 Project Analyst
3 Project Analysis 22/02/2014 12/03/2014 3 Project Analyst
4 Project Design 13/03/2014 05/04/2014 3 Project Programmer
5 Implementation and Review 06/04/2014 20/04/2014 2 Project Analyst
6 Maintenance and security 21/04/2014 30/04/2014 2 Project Analyst
7 Documentation 21/01/2014 30/04/2014 14 Project Analyst
Table 2.2: Scheduling table
Total project duration is estimated at 14 weeks.
The above table allocates project resources which include time and individuals to tasks that need to be completed. The project as a whole can be completed in 78 days.
Time(wks)
Task
1
2
3
4
5
6
7
8
9
10
11
12
13
14
1. Documentation
2. Project proposal
3. Planning phase
4. Analysis phase
5. Design phase
6. Implementation
7. Maintenance & security
Gantt chart
Fig 2.1: Work plan
2.5 Conclusion
The above study proves that the development of an electronic administrative system is a viable venture that will result in benefits for the Medical doctors and hospitals as well as Bechr filing concepts as the supplier. The system development team can actually continue with their plan since it has been shown that all the requirements are going to be met and all the constraints have been considered including the risks associated and the plans to mitigate them have been taken into consideration.
Chapter 3: Analysis phase
3.0 Introduction
Systems Analysis is the process of investigation of a system’s operation with a view to changing it to new requirements or improving its current working.
NEED FOR SYSTEMS ANALYSIS
Business systems are usually complex. Making changes to a system without reference to its effects on other subsystems or current working practices could result in a worsening rather than improvement. Systems analysis will identify
‘ Outputs and processing needed.
‘ Data required providing this processing and output.
‘ Role of people in the process.
‘ Security aspects to ensure the efficient continuation of the business.
‘ Costs of providing the system.
This chapter incorporates an in-depth study of the current system determining the complexity of the system and the scope of problems that exists. Major alternatives to the current system are also taken into consideration and evaluated according to their scope and problem solving capability. Data is gathered using various data gathering techniques from internal and external stakeholders to come up with user and client based solution. The functionality of the proposed system is evaluated, analysed and recommended in order to have full understanding of system operations. Constraints underlying the organisation currently and after proposed system installation are also taken into account in this chapter. It is at this stage that determination of procedures and documents flowing through the system are done. This phase is important as it outlines the basis for the proposed system development process. The goal of this phase is to come up with the following information:
‘ A comprehensive detailed functionality of the current (manual) system.
‘ An overview of problems associated with the current system.
‘ Requirements and limitations of current system.
‘ The expectations of the new system.
‘ Evaluation of possible alternatives and establishment of the best possible solution.
3.1 Information gathering methodologies
In order to come up with a detailed, relevant and true analysis of the system, the following methodologies were used:
‘ Questionnaires
‘ Interviews
‘ Documentation analysis
‘ Systems Observation
The data gathering process targets all individuals who interact with the organisation as internal stakeholders and external stakeholders, and the main targeted audience are:
‘ The developers
‘ Management
‘ Medical practitioners and hospitals
‘ Staff
3.1.1 Questionnaires
The aim was to find out about general processes, documents used, document movements, volumes of data, and filing systems that could be identified at an early stage in the investigation. However, questionnaires by their nature may need to be standardised for different areas within the business and are only likely to give an outline for further investigation. Returns were not as low as anticipated as there was a managerial pressure but questions may not have be given full attention and may represent what should be performed rather than what actually happens. The main aim of the questionnaire was to determine what the users felt about the physical filing system. A sample of 5 physicians was used to determine how the new system will assist and how the old system was impacting on their day to day work.
The questionnaires maintained anonymity to allow respondents to give a more true opinion. Allowing the respondents not to disclose their names was a decision taken to help maintain good relations with customers just in case the human nature of wanting to mention names decides to cripple in.
Advantages of questionnaires
‘ It allowed anonymous input and therefore the respondents gave precise answers without restraint or fear of uncertainties emanating thereof.
‘ Cheaper than personal interviews
‘ There was no need for the Interviewer to be present
‘ Can be used repeatedly to track things over time;
‘ Respondents could decide the optimal time to complete the Questionnaire. The respondents completed the questionnaires in their own spare time allowing maximum concentration during responding process.
‘ The questionnaires were categorised into structured and non-structured to allow flexible responding according to level of respondent expertise.
Disadvantages of using questionnaires
‘ Tend to be slower than other methods of collecting data
‘ It is not known who actually completed the Questionnaire and this may lead to misunderstandings. For example a questionnaire can be given to non-relevant staff to fill in.
‘ Respondents may interpret the Questionnaire in a way that differs from the one who is gathering the data and hence the respondents may intentionally mislead by giving false information.
‘ Not all questions were answered properly, some of the questionnaires could show the respondent filled in as an afterthought.
FIG 3.1 PIE CHART SHOWING RESPONSE RATE
3.1.2 INTERVIEWS
Interviews, which entail face to face communication with key stakeholders in the system, were the next method used. Rowland Square of Cimas Medical Aid Society, HMMAS Clinic and T & M Clinic were used as the major interviewees since there are the major customers of Bechr Filing Concepts and any change in the systems would require their input. Not having their opinion meant risking losing the cash cow of the business.
Advantages of interviews
The main advantages of interviews were:
‘ they were useful to obtain detailed information about personal feelings, perceptions and opinions
‘ they allowed more detailed questions to be asked
‘ respondents’ own words were recorded
‘ ambiguities could be clarified and incomplete answers followed up
‘ precise wording could be tailored to respondent and precise meaning of questions clarified even in local languages
‘ interviewees were not influenced by others during the interview
Disadvantages of interviews
The following were some of the disadvantages realised by virtue of using interviews:
‘ Due to the fact that the respondents had their own perceptions on the initiative, some answers were tainted with bias. However, by asking more than one respondent a balance was easy to reach
‘ They involved a significant amount of dedicated time as the interview had to start and be taken until the end with full involvement unlike other options like questionnaires which are left then collected later.
‘ Some interviewees were reluctant to give information.
Findings
The interviews allowed us to make a great realisation which was that the physical filing system was reducing clinic space and eventually the cabinets were going to be discarded. This system could not have come at a better time, we realised it has been a growing need in our customer`s hearts. Most of the people interviewed showed much appreciation of the electronic administrative system though some were afraid it being computer based would bring trouble to them as they are not computer people. The good thing with interviews is that all misunderstandings were able to be cleared with clients being assured of proper training and step by step guidance of the new system. Some were not sure of what they want as they needed change but were not sure of the change they need is to go software.
3.1.3 Documentation Analysis
Document analysis is a social research method and is an important research tool in its own right and is an invaluable part of most schemes of triangulation. Documentary work involves reading lots of written material. A document is something that we can read and which relates to some aspect of the social world. Official documents are intended to be read as objective statements of fact but they are themselves socially produced.
Forms, documents (invoices) are studied such that where possible, these are replicated in the new system to enhance familiarity. Filing systems, ledgers and procedure manuals, where available, are collected.
Why do document analysis’? documents reveal what people do or did and what they value
‘ behaviour occurred in a natural setting
‘ data has strong validity
Advantages
‘ get comprehensive and historical information
‘ information already exists
‘ few biases about information
‘ can provide insight into what people think and do
‘ can be collected from different time periods (historical data)
‘ provides useful background data
‘ useful for corroboration
‘ grounded in local setting
‘ use for exploration
‘ inexpensive
‘ often are reliable and valid
‘ can study trends
‘ easy to analyse data
‘ often based on high quality or large probability samples
‘ can utilize qualitative or quantitative analysis
Disadvantages
‘ time consuming
‘ info might be incomplete
‘ need to be clear in what you are looking for
‘ data restricted to what already exists
‘ may be representative on only one perspective
‘ access to some content might be limited
‘ may not provide insight into participants’ personal thinking
‘ may not be generalized to all populations
‘ may not be available to population of interest
‘ may not be available for research question of interest
‘ data may be dated
‘ many of most important findings have already been mined from the data
Documentation analysis was a more informal way of attaining literature and allowed a better and more fun way of getting data.
3.2 Analysis of existing system
3.2.1 Description of current system
Alphabetical Filing
‘ With alphabetical filing, medical records are organized using the last and first name. This makes it easy for you to locate medical records for appointments. This filing system expedites the information retrieval process but lacks confidentiality; a patient can be easily identified this way, but the name must be visible to do so.
Numeric Filing
‘ Numeric filing systems arrange files in sequential order. By assigning numbers to each file, you alleviate the problem of duplicate headings. Numeric systems work well with organizations that handle a large number of files. They also help with file confidentiality, which is why many doctors and legal institutions use this filing method. Fewer filing errors occur with numeric filing systems, since numbers are easier to put in order than letters.
‘ Both the alphabetic and numeric system uses the indexing system where by the identity information is written on the file folder. This allows the faster retrieval of files .
1. Select the correct grammage file for the content to be housed.
2. Use the scale to design a system so that every label on every file is visible opening a drawer.
3. Affix the label to the selected file.
4. Load into A4 boxes inside the cabinet.
Relax as we put order in your workplace ‘ BECHR CONSULTING
S ERVICES will design and organize your live documents
After the filing system has been set up patients can be assigned different numbers depending on who comes first if they are going to be using the numerical system or according to the first or last name if they are going to be using the alphabetical system. Below is the flow chart of how the system works in the clinic hospital or doctors` rooms;
The flow chart for the existing system
3.2.2 Process analysis
3.2.2.1 Activity Diagram of current system
The diagram below shows an activity diagram and how data moves from the patient through to the doctor.
Activity Diagram of the Current System
Fig 3.2: Activity diagram of current system
3.2.2.2 Context Diagram for the Current system
PERSONAL RECEIPTS PAYMENT
INFORMATION DETAILS
APPOINTMENT
DETAILS
PRESCRIPTIONS PATIENT
PATIENT SCHEDULES PATIENT HISTORY EVALUATIONS
Fig 3.3 context diagram for the existing system
3.2.2.3 DFD of the current system
Fig 3.4 Data flow diagram for existing system
Weaknesses of current system
A manual-based information system is one that does not rely on any computerised systems and a computer-based information system does. A manual-based system sees information being recorded and kept in files in paper form. Whereas a computer based information system will see data stored on various computer programs including on databases, Word documents, Excel etc.
Both types of information system are designed to help a business carry out its day-to-day running and operations. In recent times, computer-based systems are generally considered to be more popular as more businesses are choosing to keep up with the developments in information technology. There are still those who continue to use manual systems though, perhaps as a matter of financial constraints or it may simply be more suitable for their type of business.
A manual-based information system is generally considered to be cheaper than a computer-based system; however it contribute to lower levels of staff productivity. In addition, having data stores manually in boxes or files is not very environmentally-friendly and this could lead company documentation at risk if a fire broke out for example as there would be no back up.
An information system does not only refer to the way in which business data is stored by a company. It also refers to the way in which the business interacts with clients or associates, processes orders and advertises. In the case of the Bechr Filing Concepts clients, a manual processing framework is greatly reducing the pace at which applications are being received, processed and results produced. With the anticipated volumes of work this would require the Doctors and hospitals to recruit a higher number of staff members on a permanent basis thereby increasing the running costs of the project. Furthermore, activities like filing, backup and redundancy key in today’s environment would prove to be near-impossible tasks.
The today world is now championing the issue of going green in ICTs, a concept which advocates for the removal of environmentally harmful activities like the paper trail, printing, driving to access a service etc. Remaining manual would definitely not be a good option.
In being manual it takes time to produce result reports that the management need in decisions making. Valuable time is lost trying to verify results. It is slow to retrieve and update records. The reports are cumbersome to produce. Any malicious users can manipulate the information whenever they get access to the files and records.
Information is under the danger of being misfiled or misplaced since these are copies handled by human beings. Some may end up forgetting to whom they gave the patient files. Without back up that is computer based as you cannot have two hard copies per patient unlike computer based files that can have backup files.
Lack of security levels to individuals accessing records leading to lack of responsibility and accountability
Too many resources are wasted due to use of bulky storage, for example space and stationery.
3.3 Evaluate Alternatives
3.3.1 Outsource
Outsourcing is an arrangement in which one company provides services for another company that could also be or usually have been provided in-house. Outsourcing is a trend that is becoming more common in information technology and other industries for services that have usually been regarded as intrinsic to managing a business. In some cases, the entire information management of a company is outsourced, including planning and business analysis as well as the installation, management, and servicing of the network and workstations.
The Advantages of Outsourcing
‘ Swiftness and Expertise: Most of the times tasks are outsourced to vendors who specialize in their field. The outsourced vendors also have specific equipment and technical expertise, most of the times better than the ones at the outsourcing organization. Effectively the tasks can be completed faster and with better quality output
‘ Concentrating on core process rather than the supporting ones: Outsourcing the supporting processes gives the organization more time to strengthen their core business process.
‘ Risk-sharing: one of the most crucial factors determining the outcome of a campaign is risk-analysis. Outsourcing certain components of your business process helps the organization to shift certain responsibilities to the outsourced vendor. Since the outsourced vendor is a specialist, they plan your risk-mitigating factors better.
‘ Reduced Operational and Recruitment costs: Outsourcing eludes the need to hire individuals in-house; hence recruitment and operational costs can be minimized to a great extent. This is one of the prime advantages of offshore outsourcing.
The Disadvantages of Outsourcing
‘ Risk of exposing confidential data: When an organization outsources HR, Payroll and Recruitment services, it involves a risk if exposing confidential company information to a third-party.
‘ Synchronizing the deliverables: In case you do not choose a right partner for outsourcing, some of the common problem areas include stretched delivery time frames, sub-standard quality output and inappropriate categorization of responsibilities. At times it is easier to regulate these factors inside an organization rather than with an outsourced partner.
‘ Hidden costs: Although outsourcing most of the times is cost-effective at times the hidden costs involved in signing a contract while signing a contract across international boundaries may pose a serious threat.
‘ Lack of customer focus: An outsourced vendor may be catering to the expertise-needs of multiple organizations at a time. In such situations vendors may lack complete focus on your organization’s tasks.
3.3.2 Improvement
Improvement refers to the upgrading of the current system in order to accommodate new functionalities required by the new project. This has the following advantages:
– No new system has to be developed
– Current system will already have been integrated with other existing systems
– There may not be need for data migration
– It is cheaper than developing a new system
– Current agreements, arrangements and contracts will still apply after the exercise.
There are new cabinet structures that have been introduced by Bechr Filing Concepts` competitors in order to try and overcome the problem of the current cabinets being average and carrying a limited number of files and boxes. A single doctor would need two or more cabinets to have his or her patients all in the file but with this cabinet all patients would fit in one moveable cabinet. The only challenge is that these are being imported from South Africa and may pose challenges such as transportation from supplier to Zimbabwe can be both costly and time consuming.
3.3.3 Development
This option allows the Bechr filing to have an own system developed specifically for the project. There are several benefits to this and some of them are:
‘ The software is designed to meet the requirements and function to match the way the client wishes to operate.
‘ Software is built to your specification it can do whatever you want it to. It could help solve an existing problem or introduce a brand new product / service.
‘ Software can be customized to integrate into your existing systems in use today and future systems.
‘ It can be changed as the framework changes or is altered to further improve its performance.
‘ Software is inherently intuitive, as it has been designed for you, and so easier for your staff to use and get the most from.
‘ The Client will enjoy a much higher quality of support for the software as they will be dealing directly with the developers of the software who not only have time for them but understand how important the software is to the cause.
‘ The investment of a custom application is unique to your business and the property of the business so it is also an asset of your business adding value to the company.
‘ The costs are reasonable as indicated in the cost-benefit analysis in Chapter 2 of this report.
A few disadvantages were also considered and these are:
‘ Bechr filing Concepts will be the sole entity funding the development of the application and so the investment required is much higher than if outsourced. However considering no suitable application was identified this had to be contained.
‘ Selecting the appropriate developers is extremely difficult but for Bechr filing concepts, the selection will be from current employees, who abide by a code of ethics and conduct and are answerable to the company.
‘ If you do not have a copy of the source code for your application you are dependent on the developers and should they become unavailable your business could be exposed to significant risk.
Recommend one for this system
– A custom application is better solution than a standard, off the shelf, software application. Off the shelf software is designed for a wide range of businesses and may not be ideally suited to the way Bechr filing concepts want to appeal to its customer`s needs.
– Costs can be deceptive as off the shelf software may not include setup, data import, customisation of reports, support nor learning time.
– Off-the-shelf software caters for a wide range of organisations and may include many functions that will never be used. Generic screens, not specific to you’re the framework, will be much slower, harder to user than a bespoke software screen built.
The recommended option therefore is to develop a system specifically for the project. This will save the Bechr filing concepts in terms of costs while allowing the flexibility to fully comply with the proposed grading framework. The requirement for high availability and redundancy as well as integration with the existing systems also calls for the use of an automated in-house system.
3.4 Analysis of the proposed system
The weaknesses of the current manual system have led to the proposal of a computerized system which meets the stated objectives as well as incorporating the functional and non-functional requirements of the stakeholders. The new system should ensure safe record keeping and storing of records appropriately as well as retrieving of information accordingly. However, the new system should address the current technologies that exist within the electronic filing industry and should conform to the required standards.
The new proposed system will incorporate a database for storage and retrieval of information and this database will be sitting on a server. Additionally, it will be a web based application where the users only require internet connectivity and they can send update and maintain. Web application services will be created on the server to allow users to connect to the server from wherever they are.
3.4.1 Process analysis
3.4.1.1 Activity Diagram of the Proposed System
No
Refer to doctor
3.4.2 Data Analysis
3.4.2.1 Context Diagrams and DFDs
Personal info Update
Evaluations
Claim form System
Appointments status
Patient history &
Appointment times
Appointment prescriptions
Schedule
Payment status diagnosis
Claim form submission
Fig 3.4: The context diagram of the proposed system
3.4.2.2 Dfd diagram of the proposed system
Fig 3.4.1 DFD for the proposed system
3.4.3 Weaknesses of proposed system
The increased portability and accessibility of electronic medical records may also increase the ease with which they can be accessed and stolen by unauthorized persons or unscrupulous users versus paper medical records, as acknowledged by the increased security requirements for electronic medical records. Concerns about security contribute to the resistance shown to their widespread adoption.
3.5 Requirements Analysis
FIG 3.5 USE CASE FOR THE PROPOSED SYSTEM
3.5.1 Functional Requirements
This refers to the required behavior of the system to be built, as reported by a hypothetical observer envisioning the inputs that the future system will accept and the outputs it will produce in response to those inputs.
MODULES
PATIENT
This module facilitates of capturing Patients related data at different entry points, enables queries at different workstation and generates reports at required frequency. The following details are part of this module:
a. Patient Registration
This function of the Medical Administrative System deals with registering the new Patient either and giving unique Identification Number to the Patient. This number is unique throughout the System for identifying the patient.
b. Financial transactions
Advances and the deposits accepted by the Billing/Cash counter are directly posted into Accounts.
If patient is to be given Discounts then the authorized person authorizes the Amount and the discount is processed. The discount categories are flexible and can be changed by the administrator. This facilitates easy way to keep track on the discounts and concession.
c. Patient inquiries
d. Appointment schedules
e. Reports
‘ appointment lists
The appointments for consultants are maintained on the system.
‘ patient follow up reports
‘ Prescriptions Discharge Card
‘ Patient list
f. Claim form submission
3.5.2 Non-functional requirements
‘ Reliability
The system should be dependable and with simplicity without any difficulties in form languages.
‘ System Performance
o Response time
The system must give responses in 2seconds after checking patient information
o Capacity
System must be able to support 1000 people at a time
o User interface
The user screen must respond in 6 seconds
o Conformity
System must conform to the Microsoft Accessibility
‘ Security
o Patient identification
Patient must identify themselves using a system identity number provided on registration
o Log on ID
Every user must have a log on ID and password
o Modification
Every modification such as (update, delete, insert) shall be done by the administrator. Administrative assistants shall be able to view all information and add new patients but will not be able to perform any modification
‘ Safety
The system shall be able to control common human errors by allowing such commands such as: are you sure you want to delete or are you sure you want to cancel.
‘ Maintainability
o Back up
The system shall provide capability to back up data
‘ Errors
The system shall keep a record of all errors
‘ Availability
The system shall be available at all times
3.6 Outline constraints
Constraints that may affect the implementation of the project can be classified into the following types of constraints which include technical, operational and economic constraints.
Technical Environment
‘ The agreement has been reached that the system to be developed in-house, however some of the project members may not possess the required technical expertise in the development of the system.
‘ Rapid changes in technology may result in obsolete hardware in the long run, the speed at which technology is moving can quickly phase out the available hardware leading to compatibility issues.
Economic Environment
‘ The instability of the economy and economic policies may affect the development of the system.
Operational Environment
‘ Resistance to change from the Staff may result if proper training is not conducted for them to allow all users to be well familiarised with the new system. This will also reduce the fear that the system may eliminate their job.
‘ The project will have to be completed within the set time limits and this will reduce the amount of creativity that can be displayed by the analyst.
3.7 Conclusion
This chapter looked at the different ways of information gathering in relation with how the system is going to be accepted. It also looked at the analysis of the current system as well as the proposed system. Activity diagrams and flow charts of the current and proposed system are clearly shown in order to give clear comparison of the two. It has therefore been seen that the proposed system is a better option to adopt and this is going to be done through in house development. The analysis of the functional and non-functional requirements helps us to go to the next stage of system designing with an idea of how the system is going to operate like as well as what the user should expect in terms of the system functionality.
‘
CHAPTER 4
4 Introduction
This chapter comes after a thorough analysis of the existing system, and full understanding of how it operates which helped in defining the requirements of the new system thus helping the next step of designing the proposed system. The design stage gives an outline of the Physical Design, System Architecture, Database Design, Interface Design, Program Design, Test Design, security design and the backup design.
4.1 System Design
System design is the process of defining the components, modules, interfaces, and data for a system to satisfy specified requirements.
4.1.1 Overview of the proposed system
a. Inputs of proposed system
Inputs of the system include:
‘ Password
‘ Patient details
‘ Payments details
‘ Employees details
‘ Medical aid details
‘ Patient Evaluations
b. Processes of proposed system
‘ Registration
‘ Scheduling
‘ Billing
‘ Claim processing
‘ Analysis of patient symptoms
c. Outputs of proposed system
‘ Reports
‘ Diagnosis
4.2 Architectural Design
4.2.1 Network Architecture
Fig 4.2 Network architecture for the AMS
4.2.2 Design Security
Hardware
Insurance, memory, Burglar bars, access control
User privileges
There is a 2 level of users in the system to allow control and security of the system.
‘ Administrator level- database administrator
Maintains exclusive privileges which are: granting, revoking access rights and updating of the system.
‘ User level data entry operator
Include the Administrative assistant, assistant nurse, Doctor and Patient.
Will do the general data entry and are able to add and delete data but cannot truncate any record.
4.2.3 Logical Design
The logical design describes the representation of the database in terms of its entities in the form of tables and existing relationships. The below system logic design was generated using MYSQL design tool.
Fig 4.4.1 database logical design
4.3 Physical Design
This section details the physical design of the system with regards to the hardware and software component illustrating how the specifications will be like and the corresponding software that will be used to implement the system.
Hardware
Minimum requirements
Recommended
Processor
2 GHz
2.5GHz
Screen Resolution
1024*768
1600*1200
Ram
1 GB
2GB
Internet speed
Cable or DSL, 1Mb/s or higher
3Mb/s or higher
Table 4.3 Hardware Requirements
Package Version
Operating system (Client) Windows 7
Office Automation Microsoft Office 2010
Antivirus McAfee Antivirus
Database Management System MS SQL
Platform
Browser
Windows
Internet Explorer 9+, Firefox, Chrome
Table 4.3.1 Software Requirements
4.4 Database Design
4.4.1 Database Server
‘ Server side scripting : ASP.net
‘ Web servers : Apache
‘ Database management systems : MySQL
4.4.2 Database Architecture Design
A database consists of two parts: (1) the database schema describes the structure of the database and (2) the database instance is the actual content of one particular database.
A database schema is the same irrespective of the contents of the database. A database instance changes depending on the data in the database. For example, a database instance changes as new data is added to the database. In designing a database, the database designer constructs a database schema by selecting the data items to be stored in the database.
The architecture of a database management system refers to the design of the major components of the system and how they are related to each other.
Fig 4.4 database schema design
4.4.3 Entity relationship diagram
FIG 4.4.3 Entity relationship diagram
4.5 Program Design
This stage will have the system flow chart which sees to show the sequence of the system.
4.5.1 System Flow chart
NO
NO
YES
FIG 4.5.1 System flow chart for AMS
4.5.2 Class diagram
This is a structure that contains both variables and methods. It shows a set of classes, interfaces and collaborations and their relationships. Below is a class diagram for the propose system.
Fig 4.5.2 Class diagram for the proposed system
4.6 Interface Design
4.6.1 Input Design
Fig 4.6 Login form
Fig 4.6.1 Password changing form
Data entry and manipulation form
Fig 4.6.1.1 Data Entry and Manipulation Form
4.6.2 Output Design
The Data entry and manipulation form shown in (fig 4.6.1.1) act as both an input and output form in the system. When user details have been entered on all fields the user saves and the form will populate the data.
The below diagram shows how an example of how data will be enabled for editing and deletion to users with the rights.
Fig 4.62 Snap shot of an output form
4.7 Test data design
Testing is very crucial in the development of a system. It allows for error checking and to see if the system is performing to standard. There many different ways of doing system checking but for the medical administrative system i used three types and these are:
a. UNIT TESTING
This is where the system is tested individually, component by component to ensure that each module is working as required or expected. This test was used by the researcher to verify that every input of data was assigned to the appropriate tables and forms. There was also crucial verification o the administrator`s module to ensure that user privileges did not overlap. A situation of all users accessing administrator`s rights wanted to be avoided at all costs.
b. Integration testing
Here the individual units are integrated into sub units and tested to see if they are working well. This is done sequentially to allow the developer to see if all certain components are able to work together. This then led to the system testing.
c. System Testing
This is where all components that make up the system are tested. System testing allows the identification of system errors that may hinder the proper flow of the system. It is important to see if the whole system is in sync by using the technical and functional tests. The technical test looks at system`s compatibility with the hardware, operating system, data integrity in the database and user authorization access rights. The functional test looks at how the system will operate or function in its intended working environment.
d. User acceptance testing
This was unable to be done due to time constraints but will be conducted fully before the implementation of the system. User acceptance test is very important as the user has the right to reject or accept the system. Acceptance means the user is willing to work with your system and that it means the required standards with the right requirements.
4.9 Back- up design
Data mirroring
As a backup design this project there used the application of data mirroring. Database mirroring is a primarily software solution for increasing database availability. Mirroring is implemented on a per-database basis and works only with databases that use the full recovery model. Database mirroring maintains two copies of the database and will reside on different server instances of SQL Server Database Engine. One server instance will be serving as the database to clients (the principal server) whilst the other instance acts as a hot standby server (the mirror server). When a database mirroring session is synchronized, database mirroring provides a hot standby server that supports rapid failover without a loss of data from committed transactions.
4.10 Conclusion
This chapter looked at the design of the system, whereby issues of the network design, database design and structure, input and output forms development, the testing of the system and back up designs were discussed. The design stage will help in the implementation phase that will follow.