COMPUSOFT, An international journal of advanced computer technology, 2 (3), March-2013 (Volume-II, Issue-III)

65
HOSPITAL PATIENT DATABASE MANAGEMENT
SYSTEM
A Case Study of General Hospital NORTH-BANK Makurdi- Nigeria
1
Asabe, S. A.,
Department of Computer Science Modibbo Adama Univerity of Technology
Yola, Adamawa State- Nigeria. [email protected] ; +2348038171818.
2
Oye, N. D.
Faculty of Computer Science Department of Information Systems Universiti Teknologi Malaysia
[email protected]; +60129949511
3
Monday Goji
Department of Maths/Computer Science, MAUTECH Yola-- Nigeria
[email protected], +2348068260197
Abstract: Health care in Nigeria as in many other countries is confronted with growing demand for medical
treatment and services. The medical records must appropriately have all of the patients medical history. Physicians
must maintain flawless records, because this document serves a number of purposes. This study on hospital patient
datable management system was design to transform the manual way of searching, sorting, keeping and accessing
patient medical information (files) into electronic medical record (EMR) in order to solve the problem associate with
manual method. The existing system (manual) has been studied and hence a computer based application was
provided to replace this manual method. These computer based systems generate the patient report as the patient
register in and out of the hospital. This paper generally looks for a more accurate, reliable and efficient method of
computer to facilitate patient records keeping in General Hospitals to ensure efficient outcome that will lessen time
consuming. The study proposed that the design of hospital patient database record will be a solution to the problem
being experienced by the current manual method of keeping patient medical record.
Keywords: Data; Database; Patient; Hospital; Medical Record; Electronic Medical Record
I. INTRODUCTION
In the present era of globalization and advanced technology
efficient record keeping cannot be overemphasized.
Imagine the scenario when the manual processes and
manual modes of instruction get replaced with electronic
systems. One of such replacement can be done in the area
of patients database management system within a hospital.
Developing patient database management system software
would benefit the hospital management who can have
effortless access to the data securely and more easily.
Libraries keeps information on how many books are in the
library, how many are been loaned out and to whom they
are loaned and also the date and time this books were
loaned or given out. School also keeps students
information or records. These records of students could
include students personal data such as name, sex, date of
birth, level etc.
Hospitals are not excluded in record keeping. The records
kept include patient data, which help to maintain patients
medical records. The medical records must have correctly
all of the patient medical history. Physicians must maintain
flawless records, because this document serves a number of
purposes. It serves as a communication tool. As an
ISSN:2320-0790
COMPUSOFT, An international journal of advanced computer technology, 2 (3), March-2013 (Volume-II, Issue-III)
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important source of patient information, the medical record
facilitates the transfer of data to other physician involved in
an ongoing treatment of patient or the transfer of patient to
another physician outside the office of the attending
physician. It also facilitates the transfer of data to health
care establishment or to any other organization or
individual such as insurance company or employer. Well-
kept records usually reflect the level of care given to a
patient by the physician. Therefore medical records can be
used as an evaluation tool. The more complete the record,
the better they will serve the physician and the patient in
the event of any action. Every patients medical record
must include the following specific information. Patients
identity which includes the patients first name, last name,
sex, age, address, etc.
II. STATEMENT OF PROBLEM
In spite of the important function of medical record, it has
come under severe threat that by the manual system of
medical record keeping. This system involves taking down
patient data on pieces of papers, which are then put in to the
files and filed in cabinets.
Another problem is the missing of pieces of information.
One standard hospital study reveals that on the average,
patient records visited, there are pieces of information the
doctor could not find in the paper file.
Physicians and their office staffs have said that, they spent
more time looking for patient information, than the time
they have for the patient, as issues related to risk
management is security. The first consideration is the
physical safety of the data being stored. Threats exist
externally in the form of natural disasters. The most
important issue is the security involved in patients privacy.
Definition of Basic Terms
Data: A collection of fact on which conclusions maybe
drawn.
Hospital: An institution that provides medical, surgical or
psychiatric care and treatment for the sick or the injured.
Patient: One who receives medical treatment attention
care.
Medical records: Its any data, which is collected and use
to diagnose or treat a patients health problem.
Database: A collection of data arranged for ease and
speedy search and retrieve.
III. LITERATURE REVIEW
Health care in Nigeria as in many other countries is
confronted with growing demand for medical treatment and
services, [1] due to factors such as a graying population and
higher standard for the quality of life. Miller [2], say that
health care has been an issue of growing importance for
national government. Many national and regional health
care plans have been developed in the past decades, in
order to control the cost, quality and the availability of
health care for all citizens.
Brown [3], opined that the application of electronic clinical
information system (ECIS) has generated useful insight
into the quality of data accuracy and health care provision
in primary care settings. This is partly one of the adapted
style and approach to data entry influenced by the design
presented by the recent structure. They further emphasize,
that there is a great need for improved education and
protocols for consisting data entry in the (ECIS) and also
subsequent follow up of patient clarification on the policy
for duration and frequency treatment.
Laubbel [4], define medical, health record, or medical
documentation of a patients medical history and care as
medical record used both as the physical folder of
patients and for the body of information which comprises
the total of each patients health history. Medical records
are intensely personal document and there are many ethical
and legal issues surrounding them such as the degree of
third-party access and appropriate storage and disposal.
The key advantage of shifting to computer-based patient
record is the opportunity to strengthen the link between the
hospital records and management information system so
that resources uses and quality of care can be analyzed
using Hospital database which increase physician
efficiency and reduce costs, as well as promote
standardization of care.
IV. OVERVIEW OF PAPER-BASED PATIENT MEDICAL
RECORD
Most of the patient and administrative information that
flow throughout the health care system is still recorded on
paper. According to an earlier report by cnnmoney.com,
only about 8% of the nation 5,000 Hospital and 17% its
800,000 physician currently use the kind of common
computerized record keeping system. Philadelphia
(May 1, 2009) medicine part B spending on Imaging rose
from $6.80 billion in 2000 to $ 14.11 billion in 2006 (web
page, Wikipedia Advantage of electronic medical
records).
In general, medical records may be on physical media such
as film (X-rays), paper (note) photographs, often of
different sizes and shapes, physical storage of documents in
problematic as not all document types fit in the same size
folder or storage spaces. In the current global medical
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environments, patient are shopping for their procedures
many international patients travel from one country to the
other for special treatment or to participate in clinical trial
co-ordination these appointment via paper-based record is a
time consuming procedure. Physical records usually
requires significant amount of space to store to them, when
physical records are no longer maintained, the large amount
of storage space are no longer required paper film and other
expensive physical media usage can be reduce by
electronic record storage. Paper records are stored in
different location, furthermore, collecting and transporting
them to a single location for review by a health care
provider is time consuming. Also when paper records are
required in multiple location, copying, faxing and
transporting cost are significant.
In 2004, an estimate was made that 1 in 7 hospitalizations
occurred when medical records were not available.
Additionally, 1 in 5 lab-tests were repeated because results
were not available at the point of care. All these were as a
result of paper-based medical records.
Hand written paper medical records can be associated with
poor legibility, which can contribute to medical errors.
Paper-based patient record hinder flow according to [5]
once information has been recorded within a set of bulky
paper records, it may not be readily accessible later, effort
to compile more complete paper records are likely to make
this problem worse. Paper records can only be use in one
place at a time.
The data are only as secure as the paper itself and the entire
records are individual page within a record can easily be
misplace, damage lost or stolen.
This research work focus on how this method can be
improved through the automation of patient database
system which convert the paper based patient medical
record to computer-based paper-based.
V. REVIEW OF COMPUTER-BASED PATIENT RECORD
Laing [6], suggested that if all information in paper-based
records were digitized and embedded within information
system, that will provide rapid context sensitive access to
the data and link to other information in the institution. The
health care delivery could fully documented information
using a variety of convectional and handheld computers
equipment with keyboard, pen-based. Structured data entry
or handwriting recognition illegible or consistent entries
could be caught and corrected as they are entered in
medical order, their results and all others internal
transactions could be tracked automatically.
Though, [6], have made a significant contribution toward
the development of a computerize medical records for
medical institutions, however this project intends to look at
how medical record of a hospital would be share only
within the hospital by the staff and not across the
institution.
Health information could be stored as individual indexed
items of information that could be abstracted into reports
and compare among patients. Record could be accessed and
easily duplicated when necessary. Information anywhere
within the record could be access by minimal delay. Data
could be located from any one delivery medium and digital
device that access them could be designed with a wide
variety of capability and capacity [7]. A page from a paper-
base patient record could be stored electronically in many
different ways. The information could be scanned and store
as an image (much like a fax) that is the picture of a paper
form but is not searchable or editable document imaging
system are widely available that use computer and optical
disk to store such image and make them available to
clinicians on workstation with graphic terminals. These
system reduces the amount of physical storage space
require for patient record and they allow the record to be
shared by clinicians and administrative officers without
physically transporting the records.
Handwritten medical record can be associated with poor
legibility which can contribute to medical error, pre-printed
firms, the standardization of abbreviation and standard for
penmanship were encouraged to improve reliability of
paper medical records. Electronic record help with the
standardization of forms terminology and abbreviation and
data input. Digitization of form facilitates the collection of
data for epidemiology and clinical studies. Duplication of
lab tests, diagnostic imaging, and other services can be
prevented by good record-keeping of any type. However,
because database records can be available at many
locations at once, integration of services and awareness of
duplication can be reduced. Database management system
enable health organization to access old records instantly,
thereby allowing the health work to send to another health
organization in the event of an emergency.
VI. THE NEED FOR COMPUTERIZED PATIENT MEDICAL
RECORD
Tumba [8], developed a database for drugs that improved
the effectiveness and efficiency to eliminate drugs wastage
through over stocking or expiring of drugs following a
stock of inventory of Hyelada pharmaceutical. They intend
to develop not only a database for drug but a computerized
medical record that would encompass other related records
of patients within the health care institution.
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According to [9] cited by [8], to enhance the work of
medical practitioners in hospital/clinics it is widely
recognized that information system is essential for
managers, because most organization need information
system for help companies extend their reach too far away
location often new product and services reshape job and
work flow and perhaps profoundly change the way they
conduct business. Laboratory information system (LIS) is
one of the integrated parts of information system which
involve many different applications. Use of a LIS is a
critical piece of a clinical information technology spectrum
of system which contributed significantly to the overall
care given to patients.
Fielde [10], stated that transformation of medical practices
is emerging not only as a result of the availability of these
technology but as a deliberate attempt to address the image
challenges facing the health care delivery. According to
[11], an Electronic Health Record (EHR) refers to an
individual patients medical record in digital format.
Electronic health record system co-ordinate the storage and
retrieval of individual record with aid of computer.
VII. COMPUTER MANAGEMENT STYLE
By alignment of impact information technology (IT) [12],
say that a hospital that moves from a level to another shows
the changes in management information technology (MIT)
in hospital management. Alignments start from the existing
business organization and its needs, generating the
supporting IT services. Impacts start from IT opportunities
and generate changes to the overall business plan and the
hospital processes. In that way, the software can be used to
follow the developments in hospital overtime; obviously
the program can be used to compare several operation of
the hospital at a given moment.
VIII. RECORD AND METHOD/PROCEDURE
Patients record and procedure vary greatly according to
patient data received and the extension of automation in
processing data.
These are some fundamental step which is common to
patient record in all clinics and hospitals. According to
[13], some of these steps taken at each treatment of patient
and assessment in clinical procedure include:
Assessment: To get the information and the
assessment of patients symptom and signs.
Data entry: recording of data into a patients
record (which may be a complex electronic
data written records results etc)
Data retrieval: extracting data for
interpretation.
Information interpretation: governance of
interpretation of individual patient data
utilization of existing knowledge and
guidelines. Therefore, when these fields are
put together they produce a medical record.
IX. THE OLD SYSTEM
The procedure involved in the current system is that, when
a patient visit the hospital for medication, the patient will
first of all buy the identification card which contains name,
and other relevant information needed, and card
identification number. The patient will then waits for the
card to be processed together with a file jacket that holds
the card that has column for diagnosis made by physician,
drugs prescribed, and date at the waiting room for the
arrival of the card.
When the file arrived, the patient joints the queue to see a
doctor. In this current system, file cabinets are used for
keeping individual patient card enclosed in a file. This
system is so tedious in tracing a record files slow in
processing of records, space occupied by the file time
waiting while waiting for the patient file to be retrieve by
the receptionist.
X. THE NEWSYSTEM
This new system is design for medical
practitioner/physician to keep track of all patients medical
record/information such as diagnosis, drug prescribed,
admission and discharged, etc the new system will take
care of the long processes and tedium work involved in
tracing and retrieving a patients record in the old system in
a nut shell this will improve the efficiency of the
management in a daily work as it can provide required
records on time.
System Specification
For maximum and effective execution of the task by the
system, there are the hardware and software requirement.
Hardware requirement
System unit
Monitor (VDU)
Uninterrupted power supply (UPS)
RAM (64)
CD Rom
Hard disk capacity of 40GB
Printer
Software Requirement
Window XP operating system
Microsoft access
Microsoft visual basic
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Programming Language
The programming language to be use in designing the
program is Microsoft visual basic MS, access 6.0
Visual basic programming: is a programming language
environment that are specially designed for creation of
other programs, which is an object oriented programming
(OOP) and event driven,(user dont control and determine
the sequence of execution, but user will just press keys and
click on various button and boxes in the window). In visual
basic, we work with object (things), properties (which tell
something about the object), and method (action associated
with object). Therefore a visual basic program is made up
of many subprograms, each has own program codes, and
can be executed independently and at the same time each
can linked together in one way or the other. The
programming language are window basic program contain
tools to make programming for windows easy, code is
compiled, therefore the compiled code runs quick, keeping
simple organized and protected, arranging component or
control on a form using drag and drop techniques. Visual
basic is user friendly.
XI. SYSTEMDESIGN
According to [14], system design is the process of art of
defining the architecture, component, modules, interface,
and for system to satisfy specified requirement.
Architecture desire creates a blue-print for the design with
necessary specification for the hardware, software; people
and data resources. In many cases multiple architectures are
evaluated before one selected. The research question such
as what is currently being done, how is it being done. How
well is the task being perform.
The analysts gather details about the business (medical
record) process and try to improve on them.
In order to enter information into an electronic medical
record, special software is required. In designing the
program with Microsoft visual basic the design will include
the following.
i. Use case diagram
ii. Database design and
iii. Normalization
Database Design
Database: is a collection of structure and related record
(information) stored somewhere or some location for easy
retrieval and exploration. Database is designed in order to
assist in eliminating unnecessary data and to minimize
duplication of data.( see Appendix)
Database Normalization
Normalization is the organization of data to conform to a
standard called Normal form and for efficient
manipulation, storage and update of data. (See Appendix)
Database Implementation
The database of this application was implemented in
Microsoft office Access. MS-Access is database
application with which one can create database files using
the relational model. With this model you can create tables,
store and manipulate data within the tables as required.
Relationship can also be established to create
communication among them.
XII. CONCLUSION
This study embarked on the patient medical information
which substitutes the current (manual system) of sorting,
handling, searching, amending and keeping of patient
medical records. This portrays the importance and
indispensable nature of the computer and its application in
the hospital. The database aimed at reducing paper work
in the reception area to reduce the time wasted by patients
in the course of waiting for their files to be retrieved. This
also reduced the spaced occupied by the files and provide
adequate security for patient s medical record. Based on the
finding of this study, the design of hospital patient database
record will be a solution to the problem being experienced
by the current manual method of keeping patient medical
records. The study has critically indentified the importance
associate with using electronic in keeping patient medical
record to eliminate missing files and enhance speedy
retrieval of patients record. The management of General
Hospital North Bank (Makurdi) has agreed that the manual
method of keeping patient records should be change to
computerized patient medical records which will help them
to eliminate inefficiency, and unreliability associated with
the manual method. Through the exhausted study and
analysis made in this research, it was recommend that
General hospital Makurdi and other medical centre that had
been providing health care service should have an
automated system for effective operations.
XIII. REFERENCE
[1] Fellegi, A and mooney, S. (1998). Population and
higher individual standard for the quality of life.
[2] Miller, R. J. (1994). Modernizing Health care
through Electronic Medical Record information
system http://www.clinictools.org
[3] Brown, P.J. (2000). Evaluation of the quality of
information retrieval of clinics finding from a
COMPUSOFT, An international journal of advanced computer technology, 2 (3), March-2013 (Volume-II, Issue-III)
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computerized patient database using a semantic
technological.
[4] Laubbel, A. (1998) Define medical health care, or
medical documentation of A patient history and care.
[5] Schneider, K., & Wagner, I. (1993). Constructing
the Dossier Representatif. Computer-Based
Information Sharing in French Hospitals. In:
Computer Supported Cooperation Work, NO 1.
Kluwer Academic Publishers.
[6] Laing K. (2002). The benefits and challenges of the
computerized electronic Medical record (Web page
retrieved February 20, 2007 from the world wide
web. http;//en wikipedia.org/wiki/medical
prescription.
http://en.wikipedia.org/wiki/laboratory
[7] Hunt, Dereck, L. Hayners, R.B. Hanna S.C, Smith
and kristia (1999).Effects of computer based clinic.
Decision system on physician.
http//www.va.gov./133h.
[8] Tumba, I.A (2006) information system development
to enhance the work of medical practitioners in
hospital/clinics.
[9] Landon, K.C. and London, J.P (2002), Management
Information System, Prectice- Hall, New Jersey.
[10] Fielde (1994). Health management Online. Web
page retrieved February 20, 2007 from http:// en.
Wikipedia. Org/wiki/medical-information.
[11] Abdullah, M.H Gainers, S.A and Lagier (2003)
International journal of systematic Educationary
medical oxford press, London.
[12] Henderson, J., & Venkraman, N. (1996). Aligning
Business and IT Strategies, Compting in the
Information Age, Luftman, New York, Oxford
University Press.
[13] Van der Vleuten C., Swanson D. (1990) Assessment
of clinical skills with standardized patients: state of
the art. Teach Learn Med, 2:58-76.
[14] Ulrich L. and Eppingger (2000). Data base system:
concepts languages and architectures. McGraw
publishing company New York.
Authors
[1] Asabe, S. A., receives her Masters degree in Computer
Science at Ahmadu Tafawa Balewa University (ATBU)
Bauchi, Bauchi State- Nigeria in 2003. Currently she is
a lecturer in the Department of Computer Science at
Modibbo Adama Univerity of Technology Yola,
Adamawa State- Nigeria. [email protected] ;
+2348038171818.
[2] Oye, N. D. receives his M.Tech OR (Operations
Research) degree from the Federal University of
Technology Yola-Nigeria in 2002. He is a lecturer in
the department of Mathematics and Computer Science
in the same University (for the past 15yrs). At the
moment he is a PhD student in the department of
Information Systems in the Faculty of computer
Science and Infor-mation systems at the Univeristi
Teknologi Malaysia, Skudai, Johor, Malaysia.
+60129949511; [email protected]
.[3] Monday, G. receives his Bachelors Degree in
Maths/Economics from MAUTECH, Yola Adamawa
State Nigeria. [email protected]
+2348068260197.
COMPUSOFT, An international journal of advanced computer technology, 2 (3), March-2013 (Volume-II, Issue-III)
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APPENDIX
Fig. 1: NORMASLISATION FORM ONE (1NF)
Fig 2: SECOND NORMALISATION FORM TWO (2NF)
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Fig 3: THIRD NORMALISATION FORM THREE (3NF)