Patient Record Management Information Systems (Prmiss) in Existence, but They Are Not Readily Usable Nor Are Their Designs Available for Improvement

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Patient Record

Management

Information System

Adewale O Adebayo

School of Computing and Engineering Sciences,

Babcock University, Ilishan-Remo, Ogun, Nigeria

Olugbake Kanyinsola

School of Computing and Engineering Sciences,

Babcock University, Ilishan-Remo, Ogun, Nigeria

Toluhi David School of Computing and Engineering Sciences,

Babcock University, Ilishan-Remo, Ogun, Nigeria

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Abstract The purpose and essence of any records management system is to provide the right information in the right place, in the right order, at the right time for the right person at the lowest cost. This is better achieved by a computer-based system. There are some patient record management information systems (PRMISs) in existence, but they are not readily usable nor are their designs available for improvement. The main objective of this research was, therefore, to design and develop a PRMIS that would automate patient information management and give direct benefit in certain terms, whilst avoiding any confusion that would jeopardize the quality of patient care. The research strategy was design and creation, and the software development model used was the waterfall. The design and implementation of PRMIS is presented, a veritable stepping stone.

Keywords: Patient Record, Hospital Management, Management Information System, Patient Record management, Record Management

1. Introduction Patient Management Information Systems (PMISs) are comprehensive, integrated information systems designed to manage the information of patients of a hospital and manage the service processes. Hospitals are becoming more reliant on the capability of patient management information system to assist in the diagnosis process and management, for better and improved services and practices. The main goal of PMISs is to streamline the flow of information across the hospital towards effective decision making for patient care, in an optimized and efficient manner. Recording of patient information, be it medical, personal, financial or legal, or recording of medical personnel information on paper is at risk of thievery, fire outbreaks, misplacement by employees and even petty things such as handwriting legibility. An automated PMIS will be necessary because there are a lot of difficulties in maintaining a large amount of information on paper, especially as there is usually no back-up for the information, access to information can prove difficult and time-consuming if it has to be searched for, and accuracy is needed in the recording of vital information, and chief medical personnel cannot oversee all that is written on the vast amount of paper to be used. It is, therefore, vital for a healthcare organization such as a hospital to have an automated patient management information system.

There are a number of hospital management applications, open source and non-open source, but they are usually difficult to customize or proprietary and expensive, and their designs are not readily available for appreciation and improvements. The aim of this research is, therefore, to design and create a patient record management system that would enhance information integrity, reduce transcription errors by minimizing the chances of wrong documentation, reduce duplication of information entries, optimize report turnaround time,

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reduce the chances of pilferage as related data would be readily available electronically, and maintain records of indoor and outdoor patients.

The research strategy was design and creation (Oates, 2009). The development model employed for the project was the waterfall model (Hughes & Cotterell, 2009) because the project‟s requirements were clear and understood before the commencement of design and development. Interview and direct observation data collection methods were utilized at two hospitals to gather information about patient record management. In addition, extant literatures were reviewed and existing software providing similar facilities were examined for enlightenment and possible improvement. The resultant application was evaluated within certain limits. No exceptional difficulty of being ethical researcher was encountered.

Effective management of information in any organization is vital for the optimal maintenance and growth of that organization. Management of information in healthcare organisation can in some cases be the difference between life and death. Hence, a healthcare organization such as a hospital will benefit from system such as the proposed, and its design is available for adoption and improvement.

2. The Patient Record Management System The system specification describes the functional and non-functional requirements posed on a system element (Modelli, 2010). The Use Case diagrams, Figures 1 to 4, present the Receptionist, Nurse, Doctor, and Administrator, the key hospital entities, requirements of the system. The attendant processes flowcharts are shown in Figures 5 to 8, respectively.

Receptionist Login Register Patient

View Patient Record

Search for Patient Record

Edit Patient Record

Save Patient record as pdf-document Logout

Figure 1 - Receptionist Requirements

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Nurse Search for Patient Record

Assign Patient to Ward Assign Patient to Bed

to Room

Administrator Search for Staff Record

Assign Staff to Department

Delete Staff record

Logout Login Figure 3 - Administrator Requirements

Upload patient Diagnosis Summary Doctor

Search For patient record

Logout

Figure 4 - Doctor Requirements

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Start

Validation details

NO Validation successful YES

Save patient record

Update database

NO Logout

YES

Stop

Figure 5 - Receptionist Processes Flowchart

Start

Validation details

NO Validation successful

YES

View patient record Search for patient Assign patient Assign patient record to ward/bed to bed

Update database

NO Logout

YES

Stop

Figure 6 - Nurse processes

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Start

Validation details

NO Validation successful

YES

View patient record Search for patient Upload patient record diagnosis summary

Update database

NO Logout

YES

Stop

Figure 7 - Doctor processes

Start

Validation details

NO Validation successful

YES

Create staff record Search for staff Assign staff to Delete staff /patient record department record

Update database

NO Logout

YES

Stop

Figure 8 - Administrator processes

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Some of the algorithms formulated include Login, Register User, Add a Record, Edit Record, and Delete Record algorithms. These pseudo codes detail the processes much like the flow charts. The Login algorithm, for example, follows:

- System startup - Enter login details - On click of login button - Connect to database - Database query for user login verification authenticity - If inauthentic - Deny access and return to login page with error message - If authentic - Allow login - Set administrator session - Re-direct administrator to home page with administrator-privilege access - If not administrator - Allow login - Set user session - Re-direct user to home page with user-privilege access

2.1 Database Design The database had to be designed in a particular manner, as one of the core elements of any management information system. The entities about which data is required include the Patient, Staff, Appointment, Prescription, Departments, Patient Diagnosis History, Patient Family Medical History, Patient Medical History, Admission, Wards and Responsible Party. A number of the required attributes are presented in Tables 1 to 9, as part of the physical database design. This process started at the analysis phase of the project, to identify the necessary entities and relations, and their attributes, leading to determination of tables required for the database and the associated field names, format and length of each table. The Entity Relationship Diagram (ERD), which is a graphical representation of the relationship between the entities, and their attributes within proposed database of the system, is shown in Figure 9.

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Table1: Patient Details Table

Table 2: Staff details table

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Table 3: Department Table

Table 4: Patient Diagnosis History Table

Table 5: Patient Family Medical History Table

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Table 6: Patient Medical History

Table 7: Admission Table

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Table 8: Wards Table

Table 9: Responsible Party Table

Figure 9: The Database ERD

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2.2 Software Implementation Implementation is the realization of an application, or execution of a plan, idea, model, design, specification, standard, algorithm or policy (Laudon & Laudon, 2010). Modules of the proposed application include Login, Main, Patient Registration, Admission, Diagnosis Report, Search, New User, Password Reset, Manage Departments, and Manage Wards Modules. The login module facilitates access to the system for the employee granting the employee respective access privilege. The login page is depicted in Figure 10.

Figure 10: Login Page The Main module is the module from which all operations are carried out. It consists of various operations, which vary depending on the access privilege granted to the user. Its access page has a database tab which is a container for various query requests made by the user such as search queries, employee list queries, and patient list queries, among others. These queries are represented on a table. Each record has a right click Menu. For instance, if a receptionist searches for a patient, upon selecting a record, an “edit patient record” is available for the record. Upon selection of this menu, the register patient page is displayed preloaded with information about the selected record. Screenshots of the access page to this module are shown in Figures 11 and 12.

Figure 11: Main Module Access Page (Without Requested Query)

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Figure 12: Main Module Access Page (With Requested Query)

The patient registration module is divided into four, represented by four tabs, which categorize information of the patient. They are Basic Details, Responsible Party, Patient Medical History and Family Medical History. The module enables saving a patient record to the database, generating a portable document format (PDF) report for a patient and updating a patient record. Screenshots of this module access pages are shown in Figures 13 to 16. This module is available to employees with Receptionist-privilege access to the system.

Figure 13: Patient Registration Module Basic Details Tab Page

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Figure 14: Patient Registration Module Responsible Party Tab Page

Figure 15: Patient Registration Module Patient Medical History Tab Page

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Figure 16: Patient Registration Module Family Medical History Tab Page

The Admission module facilitates assigning a patient to a ward and a bed in the respective ward. It is preloaded with existing information on wards and respective number of beds from the database. This module is only available for employees with Nurse-privilege access to the system. A screenshot of this module access page is shown in Figure 17.

Figure 17: Admission Module Access Page

The Diagnosis Report module facilitates uploading a diagnosis report for a patient. It is preloaded with information about the selected patient and the doctor uploading the diagnosis report. A screenshot of this module access page is shown in Figure 18. This module is only available for employees with Doctor-privilege access to the system.

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Figure 19: Diagnosis Report Module Access Page

The Search module is accessible to all users of the system. It facilitates searching for a patient record. A screenshot of this module access page is shown in Figure 20.

Figure 20: Search Module Access Page

The New User module facilitates adding new staff to the system. It is only accessible by users with Administrator-privilege access to the system. A screenshot of this module access page is shown in Figure 21.

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Figure 21: New User Module Access Page

The Password Reset module facilitates setting a new password for a user. It is accessible by all users. It retrieves the security question of the user and prompts the user for a new password if the user answers the security question correctly. A screenshot of this module access page is shown in Figure 22.

Figure 22: Password Reset Module Access page

The Manage Departments module facilitates creating and editing (the fields in the table are editable) information about departments in the hospital. It is preloaded with existing information about departments initially input by the system administrator. It is only accessible by users with Administrator-privilege access to the system. A screenshot of this module access page is shown in Figure 23.

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Figure 23: Manage Departments Module Access Page The Manage Wards module facilitates creating and editing information about wards in the hospital. It is preloaded with existing information about wards. It is only accessible by users with Nurse-privilege access to the system. A screenshot of this module access page is shown in Figure 24.

Figure 24: Manage Wards Module Access Page Most of the modules were rather similar and therefore required a rather easy reusable testing process. However, the user accounts module accessible to the system administrator was one of the unique components that needed to be carefully tested in the information management system (this involved testing each users‟ access right) to ensure that user privileges did not conflict.

2.3 System Testing And Evaluation Testing is critical for a newly developed system as a prerequisite for rolling out, which is conducted to ensure accuracy and reliability. Component or unit testing is a method by which individual units of source code, sets of one or more computer program modules together with associated control data, usage procedures and

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operation procedures are tested to determine if they are fit for use (Huizinga & Kolawa, 2007). In the development of the information management system, each component was tested independently before finally integrating all of them into one system. These tests were used to verify that every input of data was assigned to fields in the appropriate tables. Integration testing is the testing of the interaction among the system‟s components sequentially and continuously. This usually entails the interaction between the user interface and the database. The interaction between the database and interfaces was among the integration tests done. The seamless interaction between the User login interface and the database is illustrated in Figure 25. When another user tries to enter and the user is not authorized or the user enters incorrect login details, the system displays an error message “username or password incorrect.”

Figure 25: Successful Login

A system normally consists of all components that makeup the total functioning system. It is necessary to ensure the entire system runs smoothly and meets desired expectations. Here, technical, and functional testing were performed. The technical testing involved the process of testing the systems compatibility with the hardware, operating system, data integrity in the database, and user authorization access rights. Functional testing was also carried out to establish how the system would function in its intended working environment. Release testing involves testing a version of the system that can be released to users. This test is concerned with showing whether or not the system is working. It is usually black box testing which is based on an analysis of the expected functionality of the application without reference to its internal workings. Our application was tested by the end users to ensure that it met the requirements sufficiently well.

Evaluation is a systematic determination of a subject‟s merit, worth and significance, using criteria governed by a set of standards. It can assist an organization, program, project or any other initiative to assess any aim, realizable concept/proposal or any alternative to help in decision-making (International Center for Alcohol Policies, 2014). The primary goal of evaluation, in addition to gaining insight into prior or existing initiatives, is to enable reflection and assist in the identification of future change (The Evaluation Trust, 2007). The DeLone and McLean Information Systems Success Model (DMSM) for measuring Information Systems (IS)

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has a basic model consisting of six categories of Information System success, which are systems quality, information quality, use, user satisfaction, individual impact and organizational impact (Palmius, 2007). Concerning systems quality, the proposed system proves effective as it does what it was required to do with efficiency and speed. Concerning information quality, aside from the limitation of human error in user input into the system, the system retains quality information through the removal of redundancies and privacy protection through user authentication before access to the system. Concerning the use of the system, the proposed system proved easy to use as all fields are well labeled. Concerning user satisfaction, through the release testing, it was discerned that the system was satisfying to the users. Concerning individual and organizational impacts, these aspects could not be properly evaluated due to time constraints to observe and get information from the users over a long period to know if the system impacted the individuals‟ job performances and organizational improvement through quality information and ease of information retrieval.

3. Related Works The term hospital derives from the Latin word „hospitalis‟, which relates to guests and their treatment. The word reflects the early use of these institutions not merely as places of healing but as havens for the poor or for weary travellers. Hospitals first appeared in Greece as Aesculapius, named after the Greek god of medicine, Aesculapius (Risse, 1990). For many centuries they developed in association with religious institutions, such as the Hindu hospitals opened in Sri Lanka in the 5th century B.C. and the monastery-based European hospitals of the middle Ages (5th century to 15th century). The Hôtel Dieu in Paris, a monastic hospital founded in ad 660, is still in operation today (Science Museum, 2014). A record is stored information produced or received in the initiation, conduct or completion of an institutional or individual activity and that comprises content, context and structure sufficient to provide evidence of the activity regardless of the form or medium (Acheng, 2008). Records Management is the professional practice or discipline of controlling and governing what are considered to be the most important records of an organization throughout the records life-cycle, which includes from the time such records are conceived through to their eventual disposal. This work includes identifying, classifying, prioritizing, storing, securing, archiving, preserving, retrieving, tracking and destroying of records (ARMA International, 2001).

A medical error is a preventable adverse result that may occur during a medical process irrespective of whether it is evident or harmful to the victim of the error (usually the patient being attended to). Medical errors occur when a staff member of a health care institution uses an unsuitable method of care or performs a wrong method of care. These errors are often described as human errors in healthcare (Zhang, Patel & Johnson, 2008). Errors may include misdiagnosis, administration of the wrong drug to the wrong patient or in the wrong way which in some cases may be due to misrepresentation of information, prescription of multiple

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drugs that may interact negatively, surgery on an incorrect site, failure to remove all surgical instruments, failure to take the correct blood type into account, or incorrect record-keeping (Wikipedia, 2013). Poor communication (whether in one's own language or, as may be the case for medical tourists, another language), improper documentation, illegible handwriting, inadequate nurse-to-patient ratios, and similarly named medications are also known to contribute to the problem. Patient actions may also contribute significantly to medical errors (Palmieri, DeLucia, Ott, Peterson & Green, 2008). Most Hospitals today still maintain the traditional writing materials (pen and paper) and methodologies for keeping records. This methodology may include usage of printed forms that include all the necessary fields for the respective medical process or medical department, the evolution of the digital world and presence of modern-day devices which operate at high speeds suggest that these traditional methodologies can be improved and be more efficient. Digital advancements of this methodology can reduce costs, enhance patient safety and increase the pace of the traditional methodology, thereby making it more efficient.

Bayanno Hospital Management System is one of the many products created by the developers at codecanyon.net. It is a complete multi-language supported management software for hospital, clinic and medical institutes. It supports desktop, laptop, Smartphone and tablet devices. It integrates and facilitates seven types of user area of a hospital, namely Administrator, Patient, Doctor, Nurse, Pharmacist, Laboratorist, and Accountant. The software also includes a security feature which is claimed to be insusceptible to threats such as SQL-injection, XSS attacks and CSRF (Codecanyon.net, 2014). Improvements made by the proposed system regarding Bayanno Hospital Management System include reduced possibility of data redundancy, and cost effectiveness.

Calorisplanitia Hospital Management System has the following features: Registration, Patient Check In / Check Out, Out-Patient, Patient Record Maintenance, and Billing. Registration: users are able to register, add, update and delete the records from the system with username and password protected proper privileges, according to organizational hierarchy; Patient Check In / Check Out: (IPD): new patient gets admitted with unique records, including the room reservation, case papers, check out, billing, and other details, generated for each patient. Out-Patient (OPD): the system generates a unique record, including case papers, billing, and other details, for each out-patient patient. Patient Record Maintenance: the system maintains a detailed record of each patient. Billing: the entire detailed bill for each patient is automatically created (Calorisplanitia.com, 2014).

Sanjeevani Hospital Information Management System is an integrated health management system, which addresses the critical requirements of hospitals. It is a powerful, flexible and easy to use application designed

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and developed to convey real conceivable benefits to hospitals and clinics which reduce the paper overload. It streamlines the flow of information across the hospital that helps effective decision making for patient care, hospital administration/management and streamline financial accounting in an optimized and efficient manner. It could also be customized to the requirements of a hospital. It is a platform independent, browser- based application developed on .Net technology using 3.5 frameworks with MS-SQL as the database. It has a user friendly Graphical User Interface (GUI). Its features include Hospital Administration, Out- and In-patient Management, Emergency Patient Management, and Laboratory Tests, among others (Centre for Development and Advancement of Computing, 2014).The proposed system adopts this systems‟ ideology of emergency patient management.

Most existing healthcare management systems are too generalized. This may result in omission/abstraction of necessary information which can result in horrendous consequences. Fortunately, through specialization, said consequences can be avoided and this is why a patient management information system is needed. It can be considered a sub-system of a healthcare management system that specializes in managing patient information effectively.

OrangeHRM offers a flexible and easy to use Human Resource Information System (HRIS) solution for small and medium sized companies free of charge. By providing modules for personnel information management, employee self-service, leave, time and attendance, benefits and recruitment companies are able to manage the crucial organization asset - people. The combination of these modules into one application assures the perfect platform for re-engineering and aligning HR processes along with organizational goals (OrangeHRM, 2013). Fedena is multi-purpose school management software which is used by thousands of educational institutions worldwide for all administration, management and learning related activities. Fedena school management information system is used to manage students, teachers, employees, courses and all the system and process related to running learning institutes efficiently (Fedena, 2013).

4. Conclusion Computers are finding their way into every business, industry and research activity today. The use of computers is diverse, such as in entertainment, education, problem solving, research, personal management, among others. In hospitals, the process of maintaining the record of patients and employees working in the hospital, calculating bills, and so on, requires processing and record keeping in different departments. Keeping in view a strong need for managing the various important information fast and efficiently, Patient Information Management System (PIMS) has been designed and developed. Proper analysis and assessment of the developed system indicates an efficient, usable and reliable records-management system, which

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adequately meets the minimum expectations that were set for it initially. The application scope, though, could be widened to accommodate entire hospital records management. The system can also be further enhanced so that the patients themselves can be able to access their information in a secure manner for the purpose of greater doctor-patient transparency.

5. References

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