Introduction
The Irosin District Hospital is the only public hospital in Irosin that presides in the
province of Sorsogon. It was developed by provincial Government of Sorsogon by the
virtue of the full implementation of the Local Government code 1991 with the full
responsibility of a good health service to the people.
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. Digitization of forms facilitates the collection of data just
like any other record keeping, moving patients' records from paper and physical filing
systems to computers and their super storage capabilities creates great efficiencies for
patients and their providers but efficiency isn't the only benefit. For individual patients,
access to good care becomes easier and safer when records can easily be shared by
monitoring, handling, manipulating, organizing, storing and updating of patients
information’s also by automatically monitor clinical events, by analyzing patient data
this can include admitting and discharging transferring to the other hospital and other
aspects of our patients medical history can be accounted for much more quickly.
Furthermore, computerized medical record created in an organization that delivers
care, such as a hospital and doctor's surgery. Electronic medical records tend to be a part
of a local stand-alone health information system that allows storage, retrieval and
modification of records in contrast with paper-based record also the reason why federal
and state governments, insurance companies and other large medical institutions are
heavily promoting the adoption of electronic medical records. Like medical records,
must be kept in unaltered form and authenticated by the creator under data protection
legislation, responsibility for patient records irrespective of the form they are kept in is
always on the creator and custodian of the record, usually a health care practice or
facility. The physical medical records are the property of the medical provider (or
facility) that prepares them.
PURPOSE AND DESCRIPTION
Administrator level – the Administrator level are the one who have the total root
Power or privileges to access for all the information or transaction within the
system.
User level – the user level only have a limited access for the information.
Recording personal information about the Patients that come both indoor/outdoor
patient
Monitoring Admitting and Discharging of Patient
Recording patient’s information about diagnostic result, remarks and other
advised tests to be done.
Secondary facilities:
Planned approach towards working - The working in the organization will be well
planned and organized. The data will be stored properly in data stores, which will help in
retrieval of information as well as its storage.
Accuracy - The level of accuracy in the proposed system will be higher. All operation
would be done correctly and it ensures that whatever information is coming from the
center is accurate.
Reliability - The reliability of the proposed system will be high due to the above stated
reasons. The reason for the increased reliability of the system is that now there would be
proper storage of information.
Immediate storage of information - In manual system there are many problems to store
the largest amount of information.
Easy to Operate - The system should be easy to operate and should be such that it can be
developed within a short period of time and fit in the limited budget of the user.
The result of this study will enhance the process of manual operation of into an
automated system that would make the flow of operation faster and easier.
The system would hopefully be of value to the management of Irosin District Hospital
upon organizing their data and information. Using this system it would allow the Irosin
District Hospital of providing additional health services in terms of organizing
collecting, manipulating, handling, sorting, and securing the patient’s information easily
and time-reducing. in the Irosin District Hospital (IDH).
Hopefully, the benefits of this project will also serve as an inspiration for other
businesses to require having their own systems to maximize efficiency and business
performance. This system will also be beneficial for the researcher that will serve as a
guide and reference for them to develop, make and execute computer a program that will
enable them to make a new process.
OBJECTIVES OF THE STUDY
This study will focuses on the automated procedure of transaction between the
IDH management and their patients for the enhancement of the operations of Irosin
District Hospital in terms of recording and storing patient’s medical records
systematically and orderly also by monitoring the admitting and discharging of patients
faster and easier it focuses on the difficulties encountered by Irosin District Hospital and
the possible solution that we can be proposed to solve and eliminate or even can lessen
such problems by substituting the Manual operation- Computerized System that will
upgrade the operation of the said Hospital.
This system is limited only for the Patients Information such as collecting, storing,
updating and recording patient’s medical records, monitoring Admitting and discharging
of patient and strictly not for Computing and recording their total Expenses or patient
bills and not by the entire Hospital records such as monitoring attendance of nurses,
doctors, staffs and administration.
REVIEW OF RELATED LITERATURE/SYSTEM
This chapter will provide a literature review that was designed to identify related
research, to set the current research project within a conceptual and theoretical context.
Related Literature
Instead of documenting patient information on paper and creating a need for filing
and extra space, electronic medical records are stored on a computer server. In contrast
to their traditional counterparts, computerized medical records can be accessed quickly
and efficiently, eliminating the need for employees to physically look for the records in
an office. This, in turn, saves medical practices money, since employees are no longer
expected to lose time while retrieving records. Searching for and recovering medical
records is as simple as typing on a keyboard and clicking buttons on a mouse.
There are also a number of personal advantages that patients may experience
should their health care providers implement computerized medical records. For
example, digital medical records are easily accessible during emergencies. Records can
be quickly updated for patients who have serious, progressive or chronic illnesses.
People with digital records do not have to worry about unsecure storage facilities or the
loss of records through theft, accident or natural disasters. Patients may also be able to
choose who can access their files and for what purposes.
HISTORY OF COMPUTERIZED MEDICAL RECORD SYSTEM
In the 1960s, a physician named Lawrence L. Weed first described the concept of
computerized or electronic medical records. Weed described a system to automate and
reorganize patient medical records to enhance their utilization and thereby lead to
improved patient care.
Weed's work formed the basis of the PROMIS project at the University of
Vermont, a collaborative effort between physicians and information technology experts
started in 1967 to develop an automated electronic medical record system. The project's
objectives were to develop a system that would provide timely and sequential patient
data to the physician, and enable the rapid collection of data for epidemiological studies,
medical audits and business audits. The group's efforts led to the development of the
problem-oriented medical record, or POMR. Also, in the 1960s, the Mayo Clinic began
developing electronic medical record systems.
In 1970, the POMR was used in a medical ward of the Medical Center Hospital of
Vermont for the first time. At this time, touchscreen technology had been incorporated
into data entry procedures. Over the next few years, drug information elements were
added to the core program, allowing physicians to check for drug actions, dosages, side
effects, allergies and interactions. At the same time, diagnostic and treatment plans for
over 600 common medical problems were devised.
During the 1970s and 1980s, several electronic medical record systems were
developed and further refined by various academic and research institutions. The
Technicon system was hospital-based, and Harvard's COSTAR system had records for
ambulatory care. The HELP system and Duke's 'The Medical Record' are examples of
early in-patient care systems. Indiana's Regenstrief record was one of the earliest
combined in-patient and outpatient systems.
Paper-based records have been in existence for centuries and their gradual
replacement by computer-based records has been slowly underway for over twenty years
in western healthcare systems. Computerized information systems have not achieved the
same degree of penetration in healthcare as that seen in other sectors such as finance,
transport and the manufacturing and retail industries. Further, deployment has varied
greatly from country to country and from specialty to specialty and in many cases has
revolved around local systems designed for local use. National penetration of EMRs may
have reached over 90% in primary care practices in Norway, Sweden and Denmark
(2003), but has been limited to 17% of physician office practices in the USA (2001-2003)
[HHS, 2005]. Those EMR systems that have been implemented however have been used
mainly for administrative rather than clinical purposes.
Electronic medical record systems lie at the center of any computerized health
information system. Without them other modern technologies such as decision support
systems cannot be effectively integrated into routine clinical workflow. The paperless,
interoperable, multi-provider, multi-specialty, multi-discipline computerized medical
record, which has been a goal for many researchers, healthcare professionals,
administrators and politicians for the past 20+ years, is however about to become reality
in many western countries.
Over the past decade, the political impetus for change in almost all western countries has
become stronger and stronger. Incontrovertible evidence has increasingly shown that
current systems are not delivering sufficiently safe, high quality, efficient and cost
effective healthcare (see Public Reports section on Open Clinical), and that
computerization, with the EMR at the centre, is effectively the only way forward. As
Tony Abott (Australian Minister for Heath and Ageing) said in August 2005: "Better use
of IT is no panacea, but there's scarcely a problem in the health system it can't improve".
For the first time, the responses have been national and co-ordinate. Governments in
Australia, Canada, Denmark, Finland, France, New Zealand, the UK, the USA and other
countries have announced - and are implementing - plans to build integrated computer-
based national healthcare infrastructures based around the deployment of interoperable
electronic medical record systems. And many of these countries aim to have EMR
systems deployed for their populations within the next 10 years.
Terms:
Terms used in the field include electronic medical record (EMR), electronic
patient record (EPR), electronic health record (EHR), computer-based patient record
(CPR) etc. These terms can be used interchangeably or generically but some specific
differences have been identified. For example, an Electronic Patient Record has been
defined as encapsulating a record of care provided by a single site, in contrast to an
Electronic Health Record which provides a longitudinal record of a patient’s care carried
out across different institutions and sectors. But such differentiations are not consistently
observed.
C. Peter Waegemann in his Medical Record Institute EHR Status Report provides,
within a historical context, a summary of the different functions and visions implied by
the various terms used to refer to EMRs.
An EMR is a computer application that allows you to create, store, edit, retrieve
and organize your patient records electronically via a computer. It often mimics the
function of your paper medical record system; however, it can do more. The term EMR
has been previously referred to as the computerized medical record, computerized
patient record, and computer-based patient record.
Definitions:
The HIMSS EHR definitional model document [HIMSS, 2003] includes "a
working definition of an EHR, attributes, key requirements to meet attributes, and
measures or "evidence" to assess the degree to which essential requirements have been
met once EHR is implemented".
Linda Kloss, executive vice president and CEO of the American Health
Information Management Association (AHIMA), defines the three essential capabilities
of an electronic health record as follows:
Issues:
Integrated systems require consistent use of standards in e.g. medical terminologies and
high quality data to support information sharing across wide networks
Ethical, legal and technical issues linked to accuracy, security confidentiality and access
rights are set to increase as national EMR systems come online. These issues become
more pressing with the current movement to promoting consumer empowerment and
information ownership, championed by the European Commission for example, which is
leading towards patient records accessible by patients (Personal Health Records).
Common record architectures, structures
Clinical information standards and communications protocols
Security and confidentiality of information
Patient data quality; data sets, data dictionaries interoperability
Interoperability aims to support:
Data transfer and sharing on much more than a local or enterprise-wide scale
Knowledge transfer and integration
Medical terminology transfer, mapping and integration
Image transfer
Integration with clinical and non-clinical applications
Walker et al 2005 define four levels for interoperability between health information
systems:
The US National Committee on Vital and Health Statistics describes three levels of
interoperability:
National Committee on Vital and Health Statistics, Uniform Data Standards for Patient
Medical Record Information: Report to the Secretary of the US Department of Health and
Human Services. US Department of Health and Human Services, July 2000.
TECHNICAL BACKGROUND
Many hospitals and clinics are still using the manual medical records for the
operation their health establishment. A manual filing system is one done by hand the
traditional way- using folders in a cabinet but still lots of problems were still
encountered in terms of the said system that they’re still practicing. Irosin District
Hospital is the only hospital here in Irosin and still using the manual system, the
patient’s medical records usually are stored in a filing cabinet in a records room in or
very near the hospital or clinic. However, the said hospital may treat thousands of
patients over the course of a year. Each patient file has to be handled physically in a
manual system, and this often results in misfiling and enormous wastes of time as files
are located. In this new proposed computerized system, the user simply can pull up
records according to any number of criteria in a database search (e.g., name, condition,
insurance company, etc.). The files can be located in a matter of seconds and will not
become misfiled. The existing systems that store hard copies of patient records require
enormous amounts of space in order to hold all the records. This can be costly to a
medical facility, because the space has to be paid for both in construction and upkeep. In
this computerized records, it will be stored on systems that take up less space than a
single filing cabinet, so the medical facility can use the space from the manual files for
other, more important things, such as a diagnostics laboratory. Many people, including
doctors, have handwriting that is hard to read. In the medical field, writing out charts and
prescriptions thus may mean that other staff members cannot read vital medical
instructions or information. Computerized records eliminate the problems that result
from record illegibility (e.g., incorrect medication given) because the "handwriting" is
clear and identical regardless of which staff member provides the data. Records often
need to be transferred, either from different departments within the medical facility or to
another facility altogether. When records are computerized, staff can easily retrieve
medical information and requests which saves time and physical strain on the staff
members.
Table 1 - Comparing Paper-based Medical Record System
This Chapter presents the System Analysis and Design of both the existing and the
proposed system this provide the process of collecting factual data, understand the
processes involved, identifying problems and recommending feasible suggestions for
improving the system functioning. The goal of system analysis is to determine where the
problem is in an attempt to fix the system. It attempts to give birth to a new efficient
system that satisfies the current needs of the user and has scope for future growth within
the organizational constraints. The result of this process is a logical system design based
on the user requirements and the detailed analysis of the existing system, the new system
must be designed. The logical system design arrived at as a result of systems analysis is
converted into physical system design.
SDLC GUIDE
Integration and testing: Brings all the pieces together into a special testing
environment, then checks for errors, bugs and interoperability.
Maintenance: What happens during the rest of the software's life: changes,
correction, additions, and moves to a different computing platform and more. This,
the least glamorous and perhaps most important step of all, goes on seemingly
forever.
In the following example (see picture below) these stage of the Systems Development
Life Cycle are divided in ten steps from definition to creation and modification of IT
work products:
System Planning
Irosin District Hospital undergoes manual recording of patient’s information from day-to-
day basis, the hospital stores them on one place and until now certain unwanted pile up
on files still remain intact because of its manual recording that leaves the files vulnerable
on data loss and other unwanted uncertainties. The proposed system that the researchers
plan is to develop a system with easy data manipulation, access on records and safe and
secure patient’s information in comparison to the manual.
System Analysis
The researchers focused the compatibility and specification of the project’s requirements
solely for Irosin District hospital. The manual Recording system of Irosin District
Hospital has minimum security as well as a poor organization system of files. As the
researchers observed on the said hospital, file cabinets aren’t only the place to put on files
but also in storage rooms and other offices that supposedly can be used for other purposes
but most unlikely wasted space for the multiple patients’ record over the past decade. The
Researcher’s plan is to enhance the existing record system in a more easy and convenient
way possible as to keeping the file sorted placed in a more secure location and would not
be a burden in space location.
System Design
The researchers designed a system that would be making it easier for the researchers and
the users to be able to incorporate the hospital and patient records within the
computerized system. The researchers looked for available software, researched possible
improvement upon the previous manual system at the same time easy to use as to make
the system possible. The design covers the fields of saving and updating record
information of the patients in a more organize way as to just filing it on one place and
storing it in a very long time. This system will help not only the administration but also
the patient so that the process will be easy rather than waiting in line or getting another
card in the hospital. The system also records the previous medical visits the patients have
and compile it in one safe location unlike the previous operation where different forms
are stored in different location that makes it harder to locate, the system is built to never
again repeat that over view of difficulties and just enhances the potential of the hospital’s
services In terms of medical care.
The researchers developed a system that will be able to achieve all the objectives of the
study and replace the manual system by the proposed system. Upon developing, the
researchers went through with the originally drafted system and continue making changes
needed while developing in order to maximize the flexibility of the system. These
changes in improving previous manual operating went through series of consideration as
how will the system suffice the needs of the hospital in meeting their desire improvement
in helping their facility to a more advance, more organize and secure way of recording
patient and hospital records.
System Implementation
The plan in implementation is to install two (2) computers in the Information area where
all the records are kept and organize and also where the patient are being registered first,
(2) sets of computer in the Head Nurse’s Area for monitoring and recording all in and out
patients records such as date and time admitted and consulted, the diagnostic result and
treatment and other patient information that only the attending physician and nurses can
be updated, one in the Medical Record Service office (MRS) for the monitoring of
generation reports and printing out forms for the medical records such as e.g. releasing all
patient’s information. We will also be installing one to two (1-2) sets of computers in the
administration office for the monitoring of daily procedures in the hospital. The admin
will be the only one that can access and manipulate the whole program. The other entire
computer will have their own username but by they are only consider as guest and can
only get access to some features in the program unlike the admin. We tend to network
the program in the hospital and also plan to see what the program may enhance after the
trial usage in the hospital.
System Maintenance
The researchers continuously update the system and look for current trends and
visualizations to improve the system and its usability. When problem occurs, the
researchers continue to solve the problem and when bigger scope arose, the researchers
are doing their best to broaden the scope of the system for the business as well.
Requirements and Specification
An important issue for the development of a project is the selection of suitable front-
end and back-end. When we decided to develop the project we went through an
extensive
study to determine the most suitable platform that suits the needs of the organization as
well as helps in development of the project.
Visual Basic (VB) is Visual Basic 6.0 supports object-oriented language elements
and has support for objects distributed in libraries. These programming language serve
as the front end or in automated the electronic form of the system that responsible for
collecting input in various forms from the user and processing it to conform to a
specification the back end can use.
the third-generation event-driven programming language and integrated development
environment (IDE) from Microsoft for its COM programming model. Visual Basic 6.0
supports object-oriented language elements and has support for objects distributed in
libraries.
Microsoft Access, is a pseudo-relational database management system from
Microsoft that combines the relational Microsoft Jet Database Engine with a graphical
user interface and software-development tools. Access stores data in its own format
based on the Access Jet Database Engine. It can also import or link directly to data
stored in other applications and databases. These database serve as the backend of the
system that automatically handle and stored data that inputted on the forms.
OTHER SOFTWARE USE:
The Irosin District Hospital is still practices the paper-based method in terms of
recording patients information. They file all the record according to the proper
arrangement to its chart all the process record after the patient being discharge all of
their record will give at the information Department then the Information clerk will store
it at the filling cabinet and when they sort for these records they will look from where
filling cabinet they stored that records.
The patient went first at the Information for registration then the information
released the ID card then filled up the necessary information by the patient then that is
their identity whether they are old or new patient every time they went at the hospital
they must have to present first their Identification card and if that card were being left or
misplace they will provide another card you will pay for it.
After that if the patient is for out patient the information released the form and
were being supplied and filled up by the patient also if they are In-patient though
different station are responsible for releasing the admission and discharge form still the
patient or their relative are responsible of supplying the necessary inputted information
with regards to patients personal information and then the physician and nurse attendant
are responsible for the other related information that were being inputted such us the
date and time that the patient being admitted or the consultation date if they are out
patient then the diagnostic result both for In or out patients the remarks, the
recommendation and prescription and other information that only for the responsibility
of the management.
INPUT FORMS:
There are different forms and information that are necessary to be supplied and
filled up both by the patient and the attending physician and nurse and these information
includes.
1. Patients Full name such us Given Name, Middle Name or Initial and Family Name
3. Birthplace, Birth date, Age, Gender, Civil status, Nationality, Occupation and Other
personal information.
1. The Date and Time of admission and discharge of patients the type and number of
room also the bed being occupied if they are being admitted for confine
2. The diagnostic result and remarks, medical treatment or prescription,
recommendation and others.
The patient status of the IDH is in manual procedure. As describe earlier in the
narrative description of the process flow, the present system of IDH starts when the
patient is confined or resided and checked up inside the medical establishment. Records
of the patient is manually inputted through different forms, stored in a filing cabinet,
retrieved manually and stored out y by alphabetical list.
With this present status, it will take much time for an informant chief nurse and the
attending physician to sort and seek the different information, and accurately make a
report whom and where to find the specific patient if he/she is still confined in the said
establishment. Since they are also concerned with security and easily retrieval of records
in just a minute, the manual system could not offer the fast accession for these records.
DATA FLOW DIAGRAM OF EXISTING SYSTEM:
Summary Flow
Patient
New Old
OPD *in-Patient
*Outpatient
Findings
Admitting
Disposition
Ward Work
The computerized means of the present system of the IDH can make an
enhancement not only in the record security and in the physical facility, rather as a
means to deliver a good, yet faster service to the community and general welfare as its
vision and mission. Though this system it will enable not only the convenience of record
manipulation and handling but as well as to promote the security of the files and records
in accessing this different information, as well as the easy access in retrieval of patient’s
diagnostic information in the past years and also the convenient way of how the
administration can monitor hospital information and procedures during the day as in
conclusion to the system the login time of the users handled by perspective offices will
be monitored by the networking of the system.
The system can manipulate record handling in a time bounded, efficient and
effective enhancement for them or sort retrieval and make an inventory report and
summary about the patients record and also monitoring of patient’s information
regarding their diagnostic record will be highly prioritize, the administration can easily
also monitor the hospital’s generation report which includes room availability, report \s
of charts, birth and death monitoring and awareness of causes of ailments, diseases and
the causes of deaths in the certain area recorded by the hospital
With the use of the same system, the database or the application will automatically make
a query report, save and update, and make a thorough summary regarding the patient’s
records. The database will store this information, in flexible and updateable tables and
will save different information for a long term service. And thus, with the proposed
system, there will be a comfortable means to sort, handle, secure and retrieve personal
information so that the said medical establishment may reach and achieve to deliver a
good, yet faster service to the general welfare.
NARRATIVE DESCRIPTION OF THE FLOW:
In terms of admission and discharge, the user will just select the patient ID and
then automatically the system will fill some necessary information regarding his
personal record and the respective admission or discharge date and time, and what room
he/she is confined and what diagnoses the physician given to her/him. admission also
monitors the diagnostic record of the patients as also encoding the findings of the said
patient for easy access later on when the patient wants to see his/her results.
If the patients are not yet registered, the system will automatically bring the user
for the registration of the new patient. Then, fields that are asked by the system should
be filled up. And in regards of updating the patient’s information, the room numbers and
the beds for such room the registration of physicians and nurses, creating user accounts
and viewing login history for security tracing, and some other maintenance were some of
few that his system offered. Also indicated in these registrations for is the family
background so that in case of any emergency the hospital will know who they will get in
touch with regarding the patient’s status.
The system will also automatically check the system time, monitor patient’s
current status ands make a thorough report of the hospital’s generation report which is
very helpful considering that the hospital gives out information to other government
offices such as the census regarding patient’s birth and death monitoring of the certain
area recorded in the said hospital. The output or report will automatically summarizes
and print out the fields and forms supplied by the patient during the admission,
treatments and diagnoses given by the physician, and the desired result the management
wants to be printed out using different query reports. Also the easy monitoring of the
administration regarding the hospital’s transactions and procedure in and out of the day.
THE PROPOSED OUTPUT FORMS
The proposed system will produce and print out some necessary record forms and
reports inputted from the personal information of the patient. It will make enhanced,
productive, convenient, efficient, effective and edited forms to be printed out by the
management.
This system will automatically produce the desired forms and reports. Among
these forms are:
Economic justification is generally the “Bottom Line” consideration for most systems.
Economic justification includes a broad range of concerns that includes cost benefit
analysis. In this we weight the cost and the benefits associated with the candidate
system and if it suits the basic purpose of the organization i.e. profit making, the project
is making to the analysis and design phase.
The financial and the economic questions during the preliminary investigation are
Verified to estimate the following:
DEVELOPMENT COST
SYSTEM REQUIREMENTS:
Operating System
Capacity
6. Memory must be higher for this will hold of archives which will need a high memory
capacity (HARD DISK, RAM& VGA)
Other Devices:
7. Printer
8. Switch
9. rj 45