DESIGN AND IMPLEMENTATION OF AN ELECTRONIC PATIENT MANAGEMENT SYSTEM . (A CASE STUDY OF SHONAHAN HOSPITAL, NSUKKA ENUGU)

ABSTRACT

This project title is written to help hospitals especially SHONAHAN HOSPITAL, NSUKKA, Enugu in the areas they encounter problems in keeping their attendance scheme for patient and the solution given to tackle problem such as transforming the existing manual attendance scheme for patients system in which the existing problems involved at the time was laziness of the Doctors to work, misplacement of files, excessive loitering around of patient for their files and loitering of paper in the office.
This software reports on our pilot evaluation of AN ELECTRONIC PATIENT MANAGEMENT SYSTEM and their Doctors. The aim is to improve the quality of care to patient and the information about them, as indicated by an improvement in the effectiveness and efficiency of care and in an increase inpatient’s satisfaction.
This study makes clear that a thorough exploration of users needs before building the system, using qualitative research methods may be crucial because it can prevent data mismatch and maximize the chance that the eventual management system meets its most important aim: to enhance patient’s empowerment and improve the quality of care services.
In order to handle this, I decided to introduce a new an electronic patient management system for patients. The project dwells more on Computer duty schedule. This is implemented with Visual Basic programming 6.0 language and Microsoft Access for effective information keeping.

CHAPTER ONE
INTRODUCTION

1.1 BACKGROUND OF THE STUDY

An Electronic Patient Management System is any tool used to assist in the delivery of clinical care from point of care initiation to completion. Tools include computer based attendance scheme for patient, payment processing software and information

technology systems, blood group and genotype to avoid test result mismatch of data.Electronic based attendance scheme for Patients is used by hospital to create process and record their attendance scheme for patient’s information. This system is used to calculate the nurse punctuate to work. It’s an effective tool in the hands of the hospital management.

Duty is a term that conveys a sense of moral commitment to someone or something. The moral commitment is the sort that results in action, and it is not a matter of passive feelings or mere recognition. When someone recognizes a duty, that person commits himself/herself to the cause involved without considering the self-interesting courses of actions that may have been relevant previously. This is not to suggest that living a life of duty precludes one from the best sort of life, but duty does involve some sacrifice of immediate self-interest.Cicero is an early philosopher who acknowledged this possibility. He discusses duty in his work “On Duty”. He suggests that duties can come from four different sources:

1. It is a result of being human

2. It is a result of one’s personality place in life (your family, country, and job)

3. One’s own moral expectations for you can generate duties

From the root idea of obligation to serve or give something in return, involved in the conception of duty, have sprung various derivative uses of the word; thus it is

used of the services performed by a minister of a church, by a soldier, or by any employee or servant.Nurses today have a broad scope of responsibility as health care providers that require them, under some circumstance, to exercise independent professional judgment. When nurses exercise their judgment negligently, they may be held liable because courts hold them to a correspondingly higher level of accountability.Nurses have been held liable for their failure to monitor and/or promptly respond to patients by informing physicians of significant changes in patient’s condition. Under these types of circumstance, nurses have an affirmative duty to exercise their professional judgment to ensure that all adequate steps are taken to treat patients appropriately.

Usage of Information Technology (IT) remained comparatively very less in Health sectors that other sector despite having more potential. Health Institution, which is an important sector, should encourage IT usage resulting better productivity, effectiveness, efficiency and economics leading to better health care of all. This paper tells a success of implementation of ICT (Information Communication Technology) in monitoring of medicine in health institution. System work on low-end resources and E-mail (Electronic mail) based data transfer from District Head Quarter to State Head Quarter.Implementation of Med-Centre in all the district of Enugu result in checking on pilferage (the act of stealing amounts or small articles) for medicine, increase in availability of medicine at Government institution,

increase in attendance of patients/doctor in health institution, optimal utilization of medicine and data capturing at source, resulting in availability of error-free data at Head Quarter.

Electronic Patient Management System is a certified automated payment processing software. It is used by hospitals to input, process and display their patient information. This system is used to manage and maintain electronic medical records, patient information, prescriptions, lab reports etc. It is an effective tool in the hand of the hospital management. Shonahan Hospital,Nsukka, Enugu which is the case study, has patients whose fees are to be collected after treatment.

Shonahan Hospital, Nsukka, Enugu is one of the biggest and well equipped hospitals in Nigeria. It has nine (9) training schools/programmers in the hospital.From the studies carried out by the researcher, the hospital’s initial means of recording was manual from automated system to computerized system which lacked some features such as patients and nurses records.

The Hospital is a very important part of our society and it is imperative for healthcare providers to do their jobs in an efficient and effective manner. Each day hundreds of thousands of patients enter healthcare facilities challenging the administration to run the show smoothly. The employees have to manage and integrate clinical, financial and operational information that grows with the practice.Information technology has made a significant impact on the healthcare sector. The past decade has witnessed the foray of numerous information systems and their resultant products into the hospital scenario. The number of investments in computers and types of hospital systems has increased. This is because paper medical records are cumbersome, bulky to use and difficult to manage. On the other hand digital records are much easier to handle and improve the workflow efficiency by integrating various tasks. The ultimate objective therefore, is to build a network of interdependent centers such as the clinical laboratory, radiology department, pharmacy, and so on in order to effectively meet the needs arising within the hospital. Despite the fact that these individual centers are autonomous, they are interdependent in terms of delivering services and to ensure effectiveness of providing care. All this can be achieved through hospital information systems that have formed the cornerstone of today’s modern hospital.

A patient is any person who receives medical attention, care or treatment. The person is most often ill or injured and in need of treatment by a physician or any other medical professional whereas an outpatient is a patient who is not hospitalized for 24 hours or more but who visits a hospital, clinic, or associated facility for diagnosis or treatment. Treatment provided in this fashion is called ambulatory care.

This Electronic Patient Management System is necessary to ensure the medical practitioner to maintain its operations in an organized and well-coordinated manner. These solutions save time and run the operations using the best mechanisms against liabilities. This system is especially helpful in organizing and keeping patient records up-to-date. Patient names, records of treatment and medicine given records are well maintained. Maintaining patient records is really helpful when you are allowed to refer to the patient's old history. Say for example, you want to refer your old patients for mouth cancer or jaw piece ulcers and cancers, you may be able to locate such records on the basis of their symptoms or conditions as you had entered in the database in the past. By law hospitals are required to record in the outpatient information register once at the beginning of the morning session and once during the afternoon whether the pupil is present, absent, engaged in an approved, or unable to attend due to exceptional circumstances as defined in regulation. If compulsory hospital patients are absent the register must show whether the absence is authorized or unauthorized. It must also record the nature of any approved activities.By using this Electronic Patient Management System, the department will provide the patients with convenience and security of having their payment records been stored automatically into the database for further processing. This automated method is the most advanced and least expensive way to maintain and process patient’s payment records. If a patient’s payment record is not found in the database, definitely that patient’s fees has not yet been paid.

1.2 STATEMENT OF THE PROBLEM

Prior to the problem encountered with patient’s attitude to their check up and treatment, the nurse’s laxity (laziness) over their duties, the need arose to develop a software that will be able to solve the problem. The problem caused by the use of manual method of keeping outpatient information and the use of manual method of keeping attendance scheme for patients can only be solved by computerizing the hospital attendance scheme for patients and computerizing the hospital outpatient information system. The problems that this project is set to solve in the manual method of keeping outpatient information are:

1. Improper documentation of patient payment record.

2. Difficulty in retrieving patient payment record.

1.3 OBJECTIVE OF THE STUDY

The primary purpose of this project is to enhance the reliability, security, and convenience in the administration of Shonahan Hospital, Nsukka, Enugu, and to have a database that contains complete and comprehensive details of patient departmental payment records as well as a computer based attendance scheme.

The subsidiary objectives of this project are:

1. To improve checkup and treatment load functionality: Staffing level and appropriate skill-mix per shift can be more easily determined by the shift modules. This leads to less time spent in designing and amending roasters.

2. Better care planning: Time spent on care planning is reducing, while the quality of what is recorded improved. This makes for more complete care plans and more complete assessments and evaluations.

3. To facilitate diagnosis of patients thereby reducing patients wasting time

4. To exploit the use of ICT as a platform for medical services

5. To better drugs administration

6. For better maintenance of duty rosters

1.4 SIGNIFICANCE OF THE STUDY

A patient management system works best as an early intervention; more success was reported when targeted at more entrenched cases.While some patient’s care is usually required, the nursing supervisee’s new checkup and treatment include setting up checkup and treatment schedules, assigning checkup and treatment to a nursing staff, and ensuring that each member of the nursing team is adequately trained.This means that they must ensure that nursing records are correctly maintained, that report is correctly given at each shift change that patient data are up to date and that equipment and other supplies are in stock. Among these, other areas where this project work is significant include:

1. Reducingmortality rate arising from important administration in the medical service.

2. Helping to determine how computerized of hospitals has contributed to easy medical services.

Furthermore, this work will serve as a reference work to students who are carrying research on this topic.

1.5 SCOPE OF THE STUDY

The scope of this study is centered on designing anElectronic Patient management system for patients. In fact it involves all parts of medical field in terms of record keepings for patient’s records and all other aspect of field. However, this project has been limited to GOPD (General Out–Patient Department) which includes the following areas:

1. Recording of patient health record

2. Acceptance of patient/personal symptom and compliant

3. Provisional prescription and treatment.

1.6 DEFINITION OF TERMS

Computer: This is an electronic device that can accept data information of inputs, process the data and it have the ability to store the data and also retrieves it for future use.

Data: These are groups of non-random symbols such as words, figures, values which represent event and things that have taken place.

Database: This is the collection of related files.

Doctors: These are those that give medical aid to patients.

Duty: This is a term that conveys a sense of moral commitment to someone or something.

Hardware: This can be defined as the physical component of the computer system. Such as monitor, keyboard, printer, mouse. Etc.

Hospital: This is a health facility where people who are ill or injured are given medical treatments and care.

File: These are collection of related records.

Information: this is a data that has been processed into a form which is meaningful to the recipient and which is of perceived value in either current or prospective decisions or action by the recipient.

Management: This is the process of getting activities completed efficiently with and through other people.

Nursing: This is a profession focused on assisting individuals, families and communities in attaining, maintenance, and recovering optimal health and functioning. Modern definition of nursing defines it as a science and an act that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life.

Records: These are collection of related fields.

Software: This is an application or program that can be run on computer.

Storage: This is a processing of storage data and information using storage media.

A COMPUTERISED -BASED RESULT MANAGEMENT INFORMATION SYSTEM

 CHAPTER ONE

1.0            INTRODUCTION

1.1     BACKGROUND OF THE STUDY

Caritas University, Amorji Nike, Enugu, is a private University approved by the Federal Government of Nigeria on December 16 2004. It was officially opened on January 21, 2005 by the Federal Ministry for Education, Prof. Fabian Osuji. The formal opening was on January 31, 2005. The pioneer students of 250 matriculated on May 28, 2005 in beautiful ceremony that attracted dignitaries both church and state. It is the second Catholic University in Nigeria founded by Rev. Fr. Prof. Emmanuel Paul Mathew Edeh Cssp, OFR. Although he founded the school, the proprietor of the University is the Congregation of Sisters the Saviour, a religious Congregation of Nuns founded by him.

The vision of Caritas University is to rescue some of our wandering and teaming youths from further slide into academic and moral decay, and development and transformation of our society through sound and adulterated education. Its mission is to discover, sanctify and apply the knowledge of science, environmental and engineering for human well-being and sound development of man for better society.

Caritas University’s goal is to give efficacy to the University’s motto and to its philosophy of education. We embrace not only sound education for professional skills and competency in various fields; but also maintain strict discipline. We train the mind, body, soul and spirit in the exercise of obedience and self control. The students must not only be intellectually and professionally prepared for different tasks and roles in the world, they must also be morally equipped to face the world itself with all its tensions, conflicts, challenges and contradictions. We achieve this with the help of God Almighty who is with us always.

The philosophy is to promote sound education for professional skills and competencies in various fields with strict discipline. By discipline the University meant the training of the mind, body and soul and spirit to obedience and self control. Also to prepare the students to be intellectually and professionally sound for different tasks and roles in the word with its tensions, conflicts, challenges and contradictions.

The University operates faculty system. Presently, the University operates six faculties: Education and Arts, Engineering, Environmental Sciences, Management, Social Sciences and Natural Sciences.

1.2     DEFINITION

A Computer-Based Result Management Information System (CBRMIS) is a set of software programs that  is designed to control the institution’s (practically using CARITAS UNIVERSITY), storage, management, and retrieval of data (RESULT) in a database. CBRMISs are categorized according to their data structures or types. The CBRMIS accepts requests for data from an application program and instructs the operating system to transfer the appropriate data. The queries and responses must be submitted and received according to a format that conforms to one or more applicable protocols. When a CBRMIS is used, information systems can be changed much more easily as the organization's information requirements change. Use of manual imputation of result is discarded and new categories of data can be added to the database so easily without disruption to the existing system.

A database management system provides the ability for many different users to share data and process resources. But as there can be many different users, there are many different database needs. The question now is: How can a single, unified database meet the differing requirement of so many users?

As this study entails using a different form of database management in connection with organizational result computation and assessment. This brings about the use of computer-based result management information system (CBRMIS).

Before the database management approach, the institution relied on the manual method of data processing and storage. Each file was specialized to be used with a specific application. Needless to say, file processing was bulky, costly and nonflexible when it came to supplying needed data accurately and promptly.

This study therefore, examines clearly the effect of the computer-based result management information system (CBRMIS) towards the development of CARITAS UNIVERSITY.

1.3     OBJECTIVES OF THE STUDY

Since this study is specifically to use the physical view  to make efficient use of storage and processing resources, therefore, the objective of this study includes the following;

1.     To help in facilitating generation of ad hoc query.

2.     To ensure reliability and transparency in the creation and computation of results

3.     To present a platform for assessment of the performance of the students and workers in other to help develop enabling policy for academic quality and standard.

4.     To prevent unauthorized access or mutilation of the results of the students thereby maintaining data integrity.

5.     To help the users of the result database software (RDS) to manage the overall database environment by providing facilities for backup and recovery, security management, query optimization, concurrency control, and change management.

1.4     SIGNIFICANCE OF THE STUDY

The significance of this study is to examine closely the advantage of this result application to the benefit of Caritas University and the entire community.

1.     It will serve as a reference material to those who use this project material.

2.     It is a contribution to knowledge

3.     It will provide information to other researchers/developers on how best and beneficial the use of a management information system can be in providing accurate information for an organization’s decision making.

4.     It will ensure high level quality service development of the management which will ensure that students are not subjected to undue suffering in collection of their transcript or clearance prior to the deployment for youth service.

1.5     SCOPE OF THE STUDY

The scope of this study is an integrated study on the use of a Computer-based Result Management Information System (CBRMIS) a case of Caritas University.

1.6     LIMITATIONS OF THE STUDY

Realizing the financial and time constraints usually associated with students in project of this nature, there is no research carried out that does not experience some difficulties. This work is no exception; the following factors posed serious limitations to the research work.

Financial constraints: a study like this nature is expected to be carried out on a broader base but because of lack of funds required, some function and programs could not be applied.

Time constraint: in the course of the study, time posed a serious problem in carrying out the test. The duration given for the conduct of this study was short.

Non-availability of materials: during the course of this research, there were non-availability of some critical documents and materials which were classified as confidential.

Non-availability of Exit: because of the nature of the school as a private university, Permission to go out was not always granted and this posed a serious problem towards the actualization of this goal.

1.7     DEFINITION OF TERMS/VARIABLES

Management: Management is a human action, including design, to facilitate the production of useful outcomes from a system.           

Processing: To deal with somebody or something according to an established Procedure.

System: a set of computer components i.e. in assembly of Computer hardware, Software and peripherals functioning together.

Automation: the replacement of human workers by technology; a system in which a workplace or processes has been converted to one that replaced or ministries human labour with electronic or mechanical equipment.

Information: Data that has been worked upon and processed.

Database: a systematically arranged collection of data, designed so that it can be automatically retrieved or manipulated easily by authorized users.

Database servers: Database servers are computers that hold the actual   databases and run only the DBMS and related software.

Data structure: Data structures (fields, records, files and objects) optimized to deal with very large amounts of data stored on a      permanent data storage device (which implies relatively slow access compared to volatile main memory).

Data security: Data security prevents unauthorized users from viewing or updating the database by the use of passwords.

Data consistency: Data consistency ensures a consistent view of data to   every user.

Password: this is a secret code that a user must type into a computer to enable He/she access it or its applications. This is made up of numbers, letters, characters or contribution of any of the above categories.

PHP: Hypertext Preprocessor (the name is a recursive acronym) This is a Programming language known as a server-side scripting   language. It was used in the developing of this software.

Query language: A database query language and report writer allows users to interactively interrogate the database, analyze its data and update it according to the user’s privileges on data. It also controls the security of the database.

Software: a software is a collection of written programs which directs the computer on what to do.

Querying: Querying is the process of requesting attribute information from various perspectives and combinations of factors.

Modules: this is an independent/self- contained program.

SQL: Structured Query Language, it is a code used to query or insert records in a Database.