DESIGN AND IMPLEMENTATION OF PATIENT MANAGEMENT SYSTEM

ACHI PHILIP TERSUUR

19/52273/DE

ABSTRACT

This study investigated online hospital management system as a tool to revolutionize medical
profession. With many writers decrying how patients queue up for hours in order to receive
medical treatment, and some end-up being attended to as „spillover‟, the analyst
investigated the manual system in detail with a view to finding out the need to automate the
system. Subsequently, a computer-aided program was designed to bring about improvement
in the care of individual patients, taking the advantage of computer speed, storage and
retrieved facilities. The software designed will take care of patient’s registration, billing,
treatment and payments. The programming language employed in this work was Microsoft
C#.
1.1 INTRODUCTION

The goal of any system development is to develop and implement the system cost
effectively; user-friendly and most suited to the user’s analysis is the heart of the process.
Analysis is the study of the various operations performed by the system and their relationship
within and outside of the system. During analysis, data collected on the files, decision points
and transactions handled by the present system. Krishna medical center, luck now (K. M. C.)
is a prestigious hospital situated in the heart of Hazrat Genj with a very large patient
capacity. This number is increasing at a rapid pace with each passing day. The management
of the hospital is concerned with the increasing effort in keeping records of the patient and
recording their activities. Health is generally said to be wealth. It takes healthy people to
generate the wealth the nation requires for the general well-being of its people. There is
therefore the need for adequate Medicare especially in the area of diagnosis and treatment of
diseases. Since there is a good relationship between the job output and health of the workers,
a good Medicare is vital.

1.2 STATEMENT OF THE PROBLEM

It has been observed that to receive medical treatment in most of our hospitals, the patients
queue up for several hours from one unit of the hospital to another starting from obtaining a
new hospital folder, or retrieving an old one before consulting a doctor, to the laboratory unit
for lab test then to the pharmacy to get the prescribed drugs and so on. With the manual
processes involved in handling the patient most of them waste the whole day in the hospital.
Very often, patients leave their homes very early in the morning in order to be among the
first group to see the doctor.
Otherwise, they may end up wasting the whole day without due attention.

This situation is discouraging to most patients and sometimes forces them to turn to non-
professionals or even resort to self-medication for quick recovery.

Moreover, the volume of work for the hospital personnel is much. Patients outnumber the
doctors, nurses and other medical personnel that too much are required from them. In this
regard, to examine all his patients for the day the doctor hurries over his work without
adequate attention and expertise to his clients.
Still, at the end of the day he is exhausted.
In addition to this, the diagnosis and prescription depend on the doctor’s memory and drug of
choice. Their brains are often loaded with different diseases, signs and symptoms,
complications and various drugs for their treatment and so on. Some of which are very
similar. To remember and process this huge information in his clinical work is very tasking.
For this reason, accurate diagnosis and prescription may not always be obtained.

The keeping and retrieval of accurate records on patients are poorly carried out in most of
our hospitals. Files may be misplaced; the record in them may be wrongly filled. Hence, it
is not easy to obtain accurate and timely information or data.

This is also the case with obtaining other medical information and data especially when new
folders and numbers are obtained each year.

Finally, the keeping of folder for each patient manually takes a lot of time and money and
some of the information are redundant. All these have net effect of loss of lives and
inefficiency on the part of management.
1.3 OBJECTIVES OF THE STUDY
This study is centered on the following objectives.
1. To examine the current procedures employed in our hospitals with regards to
patients’ admission, diagnosis and treatment.
2. To examine the associated problem(s) or flaws in the current system

3. To improve on the already existing system by designing an efficient practical patient

billing software, this is aimed at an accurate, faster and reliable patient’s information system.
1.4 SCOPE OF THE STUDY
This research work is limited to patient’s admission information system including treatments,
bills and payments. The software developed will be carried out using Microsoft C# to
manage the database.
1.5 LIMITATIONS
This project covers all aspect of medical system with regards to patient’s information. Due to
time and financial constraint, the software developed excluded laboratory units.

1.6 SIGNIFICANCE OF THE STUDY

Several possible advantages to practical patient billing software System over paper records
have been proposed which includes:
Reduction of cost
A vast amount of funds are allocated towards the health care industry. The computerized
system is implemented, it will reduce the personnel cost.

Improve quality of care

The implementation of electronic health records (EHR) can help lessen patient sufferance
due to medical errors and the inability of analysts to assess quality.

Promote evidence-based medicine

Computerized medical record provides access to unprecedented amounts of clinical data for
research that can accelerate the level of knowledge of effective medical practices.

Realistically, these benefits may only be realized if the systems are interoperable and wide
spread (for example, national or regional level) so that various systems can easily share
information.

Record keeping and mobility

EHR systems have the advantages of being able to connect to many electronic medical
record systems. In the current global medical environment, patients are shopping for their
procedures.

1.7 DEFINITION OF TERMS

Electronic Health Record– An electronic health record (EHR) (also electronic patient
record (EPR) or computerized patient record) is an evolving concept defined as a systematic
collection of electronic health information about individual patients or populations

INFORMATION – Information is data, or raw facts, shaped into useful form for human
use.

SYSTEM – A system is a combination or arrangement of parts to form an integrated whole,

working together to achieve specific tasks. A system includes an orderly arrangement
according to some common principles or rules.

Subsystem – A complex system is difficult to comprehend when considered as a whole.

Therefore, the system is decomposed or factored into subsystems. Subsystems constitute the
entire system. They are complete systems on their own but exit in another system called the
complex system. Subsystems can be further decomposed into smaller subsystems until the
smallest subsystems are of manageable size. The subsystems resulting from this process
generally form hierarchical structures. In the hierarchy, a subsystem is one of a supra-system
(the system above it).

Expert system: is software that uses a knowledge base of human expertise for problem
solving, or clarify uncertainties where normally one or more human experts would need to be
consulted.

Hospital information system (HIS): variously also called clinical information system (CIS)
is a comprehensive, integrated information system designed to manage the administrative,
financial and clinical aspects of a hospital. This encompasses paper-based information
processing as well as data processing machines.

MIS- Management Information System is the system that stores and retrieves information
and data, process them, and present them to the management as information to be used in
making decision. It can also be defined as an integrated machine system that provides
information to support the planning and control functions of managers in all organizations.
By these definitions, MIS must serve the basic functions of management, which include
planning, organizing, staffing, directing and controlling. Information systems that only
support operations and do not have managerial decision-making significance is not part of
MIS.

MCS- Management Control system is a form of Information System used by the

management of an organization to analyze each application of information system in terms of
input, storage, processing and output. The MCS has functional subsystems such as the
hardware system, the operating system, the communication system and the database system.
Management control systems are human artifacts.
This means that MCS exits only because human beings design and build them.

2. LITERATURE REVIEW
According to Terry (2005), electronic health record (HER) is an evolving concept defined as
a systematic collection of electronic health information about individual patients or
populations. It is a record in digital format that is capable of being shared across different
health care settings, by being embedded in network connected enterprise-wide information
systems. Such records may include a whole range of data in comprehensive or summary
form, including demographics, medical history, medication and allergies, immunization
status, laboratory test results, radiology images, vital signs, personal stats like age and
weight, and billing information. Its purpose can be understood as a complete record of
patient encounters that allows the automation and streamlining of the workflow in health care
settings and increases safety through evidence-based decision support, quality management,
and outcomes reporting, Swinglehurst D (2009).The terms EHR, EPR and EMR (electronic
medical record) are often used interchangeably, although a difference between them can be
defined. The EMR can be defined as the legal patient record created in hospitals and
ambulatory environments that is the data source for the HER, Habib, (2010). It is important
to note that an EHR is generated and maintained within an institution, such as a hospital,
integrated delivery network, clinic, or physician office, to give patients, physicians and other
health care providers, employers, and payers or insurers access to a patient's medical records
across facilities.

A personal health record is, in modern parlance, generally defined as an EHR that the
individual patient controls. Within a meta-narrative systematic review of research in the
field, Prof. Trish Greenhalgh and colleagues defined a number of different philosophical
approaches to the HER, Berg (1997). The health information systems literature has seen the
EHR as a container holding information about the patient, and a tool for aggregating clinical
data for secondary uses (billing, audit etc.). However, other research traditions seen the EHR
as a contextualized artefact within a socio-technical system. For example, actornetwork
theory would see the EHR as an actant in a, while research in computer supported
cooperative work (CSCW) sees the EHR as a tool supporting particular work. Prof. Barry
Robson and OK Baek also reviewed these aspects and see the EHR as pivotal in human
history, Baek, OK. (2009). In the United States, Great Britain, and Germany, the concept of a
national centralized server model of healthcare data has been poorly received. Issues of
privacy and security in such a model have been of concern. Privacy concerns in healthcare
apply to both paper and electronic records. According to the Los Angeles Times, roughly 150
people (from doctors and nurses to technicians and billing clerks) have access to at least part
of a patient's records during a hospitalization, and 600,000 payers, providers and other
entities that handle providers' billing data have some access also Health & Medicine (2006-
06-26). Recent revelations of "secure" data breaches at centralized data repositories, in
banking and other financial institutions, in the retail industry, and from government
databases, have caused concern about storing electronic medical records in a central location,
CNN.com (May 23, 2006). Records that are exchanged over the Internet are subject to the
same security concerns as any other type of data transaction over the Internet. The Health
Insurance Portability and Accountability Act (HIPAA) was passed in the US in 1996 to
establish rules for access, authentications, storage and auditing, and transmittal of electronic
medical records. This standard made restrictions for electronic records more stringent than
those for paper records. However, there are concerns as to the adequacy of these standards,
Wafa (2010).

In the European Union (EU), several Directives of the European Parliament and of the
Council protect the processing and free movement of personal data, including for purposes of
health care, European Parliament and Council (24 October 1995).

Personal Information Protection and Electronic Documents Act (PIPEDA) was given Royal
Assent in Canada on April 13, 2000 to establish rules on the use, disclosure and collection of
personal information. The personal information includes both non-digital and electronic
form. In 2002, PIPEDA extended to the health sector in Stage 2 of the law's implementation.
There are four provinces where this law does not apply because its privacy law was
considered similar to PIPEDA: Alberta, British Columbia, Ontario and Quebec. One major
issue that has risen on the privacy of the U.S. network for electronic health records is the
strategy to secure the privacy of patients. Former US president Bush called for the creation
of networks, but federal investigators report that there is no clear strategy to protect the
privacy of patients as the promotions of the electronic medical records expands throughout
the United States. In 2007, the Government Accountability Office reports that there is a
“jumble of studies and vague policy statements but no overall strategy to ensure that privacy
protections would be built into computer networks linking insurers, doctors, hospitals and
other health care providers.”Robert, (2007)

The privacy threat posed by the interoperability of a national network is a key concern. One
of the most vocal critics of EMRs, New York University Professor Jacob M. Appel, has
claimed that the number of people who will need to have access to such a truly interoperable
national system, which he estimates to be 12 million, will inevitably lead to breaches of
privacy on a massive scale. Appel has written that while "hospitals keep careful tabs on who
accesses the charts of VIP patients," they are powerless to act against "a meddlesome
pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiancé in Florida,
to check if the fellow has a cocaine habit."Appel (2008). This is a significant barrier for the
adoption of an EHR. Accountability among all the parties that are involved in the processing
of electronic transactions including the patient, physician office staff, and insurance
companies, is the key to successful advancement of the EHR in the
U.S. Supporters of EHRs have argued that there needs to be a fundamental shift in

“attitudes, awareness, habits, and capabilities in the areas of privacy and security” of
individual’s health records if adoption of an EHR is to occur, Nulan C (2001).

According to the Wall Street Journal, the DHHS takes no action on complaints under
HIPAA, and medical records are disclosed under court orders in legal actions such as claims
arising from automobile accidents. HIPAA has special restrictions on psychotherapy records,
but psychotherapy records can also be disclosed without the client's knowledge or
permission, according to the Journal. For example, Patricia Galvin, a lawyer in San
Francisco, saw a psychologist at Stanford Hospital & Clinics after her fiancé committed
suicide. Her therapist had assured her that her records would be confidential. But after she
applied for disability benefits, Stanford gave the insurer her therapy notes, and the insurer
denied her benefits based on what Galvin claims was a misinterpretation of the notes.
Stanford had merged her notes with her general medical record, and the general medical
record wasn't covered by HIPAA restrictions. Within the private sector, many companies are
moving forward in the development, establishment and implementation of medical record
banks and health information exchange. By law, companies are required to follow all HIPAA
standards and adopt the same information-handling practices that have been in effect for the
federal government for years. This includes two ideas, standardized formatting of data
electronically exchanged and federalization of security and privacy practices among the
private sector, Nulan C (2001). Private companies have promised to have “stringent privacy
policies and procedures.” If protection and security are not part of the systems developed,
people will not trust the technology nor will they participate in it, Robert (2007). So, the
private sectors know the importance of privacy and the security of the systems and continue
to advance well ahead of the federal government with electronic health records.

3.0 RESEARCH METHODOLOGY

During the research work, data collection was carried out in many places. In gathering and
collecting necessary data and information needed for system analysis, two major fact-finding
techniques were used in this work and they are:
Primary Source
Primary source refers to the sources of collecting original data in which the researcher made
use of empirical approach such as personal interview and questionnaires.
Secondary Source
The need for the secondary sources of data for this kind of project cannot be over
emphasized. The secondary data were obtained by the researcher from magazines, Journal,
Newspapers, Library source
3.2 Methods of Data Collection
This was done between the researcher and the doctors in the hospital used for the studies, and
the lab attendance was interviewed. Reliable facts were got based on the questions posed to
the staff by the researcher.
3.2.2 Study of Manuals
Manuals and report based used by lab attendance were studied and a lot of information
concerning the system in question was obtained.
3.2.3 Evaluation of Forms
Some forms that are necessary and available were assed. These include admission card, lab
form, test result, bill card Etc. These forms help in the design of the new system.
3.3 The existing system
System analysis is a structure process of collecting and analyzing facts in respect of existing
operations procedures and system in order to obtain a full appreciation of the situation
prevailing so that an effective computerized system may be designed and implemented when
proved feasible. According to E.C and chapman
R.J. “system analysis is defined as the method of determining how best to use computer with
other resources to perform tasks which meet the information needs of an establishment.
Before moving into the major system design building blocks of this new system we need to
analyze the existing system and identify their weaknesses.
The existing system of medical system and drug prescription in Christ the King Hospital
Enugu involves manual activities. It has been observed that to receive medical treatment in
most of our hospitals the Patients queue according for several hours in the sequence of first
come first serve (FCFS) though, a new patient usually registers into the hospital by filling
patients form which signifies that the person is an official patient of that hospital. Also, this
gives the person access to own a hospital folder. Which is used to store the basic
information about the diagnosis and drug prescribed to the patient.
In other hand, if it is an old patient, the staff retrieved his hospital folder using the patient’s
form which the doctor have a look at first, before examining the patient and carry out the
appropriate therapy which is either he referred the patient to laboratory unit for lab test (if the
need be) or to the pharmacy unit to obtain the prescribed drugs (if the matter is not too
complex). But, any treatment offered to the patient by the doctor must be recorded on the
patient’s folder to avoid inappropriate therapy. Though, it sounds so easy but it has some
stumbling blocks.
3.4 INPUT ANALYSIS
The input to the new system is derived from the patient’s card. When a patient visits the
hospital, he/she fills the patients form from where a card is issued to the patient. This forms
the input to the new system designed. The information required for entry into the system
includes:
1. Patients Name
2. Sex
3. Address
4. Age
5. Disease Symptoms
6. Date visited

3.5 PROCESS ANALYSIS

Based on the information collected from the patient, an analysis is carried out. The
symptoms are processed to obtain the accurate diagnosis of the sickness. Also, the diagnosis
will help in the processing of the system to obtain the best emergency health care system to
be administered to the patient.
3.6 OUTPUT ANALYSIS
The output is derived from the processing carried out on the input data. The output is
presented in form of reports on a patient’s diagnosis and possible treatment to the ailment.
The reports are displayed on the screen and can also be printed out as a hard copy.
3.7 WEAKNESS OF THE EXISTING SYSTEM
The weaknesses of the existing system are highlighted below.
Lack of Accuracy: This situation crates problem in the sense that proper and adequate
medical attention is far-fetched. Due to doctors usually hurries over their duties in order to
attend to all the patient present in the hospital and along the line they may became exhausted,
and the cases of traits and errors may be practiced.
In addition, the diagnosis, and prescription depends on the doctors memory so their brain are
often loaded with different diseases, symptoms and various drugs for treatment, hence, to
remember and process the hug information is his clinical work is very tasking. For this
reason accurate diagnosis and prescription may not always be obtained.
Lack of speed of operations and effectiveness: It has been observed that to receive medical
treatment in most of our hospitals, The patients queue up for several hours from one units of
the hospital to another, Normally, the medical records system is based on the traditional file
keeping system. Although, many patients are attended to with the method of information
recording or retrieving an old file but above all, t wastes time. And at times many patients
are as spillover. Moreover, the problem of redundancy may occur due to human brain is too
complex and may not perform and may not perform effectively especially when new folders
and card save obtain each year.
3.8 JUSTIFICATION FOR THE NEW SYSTEM
The new system among other things will have the following characteristics which will
improvement the current system in use
1. The new system designed will help the management to use computer system to find
patients information with regards to billing, treatments, etc.
2. Accuracy is maintained, as the computer information will yield an accurate result.

3. There will not be much congestion in hospitals, as the medical system developed will
assist patients to be treated and the information stored.
4. The speed of operation of the medical system is high when compared to manual
method.
4.1 OUTPUT SPECIFICATION AND DESIGN
The output form is designed to generate printable reports from the database. The output is
placed on a database grid and contains information on patient’s records. The output produced
can be printed on a hard copy or viewed on the screen. The output generated includes:
1. Patients File
2. Bill Record
3. Treatment Record.
4.2 INPUT SPECIFICATION AND DESIGN
The input to the new system is the patient’s admission form, which is entered through the
keyboard. The input form design takes the format bellow.
4.3 FILE DESIGN
In any good database design, effort should be made to remove completely or at worst reduce
redundancy. The database design in the software is achieved using Microsoft access
database. Below is the structure of the file designed in the database.

PATIENTS TABLE

FIELD FIELD TYPE FIELD SIZE

Card No Text 15

Patients Name Text 20

Address Text 30

Age Integer 2

Sex Text 8

Ward Text 20

Bill Single 4

Date admitted Date/time 8

Treatment Text 100

System Flowchart

Input Data -
patient File

Input From
the
Result To Screen
Keyboard

2 Control
Unit

Disk Output
Storage (Report)

4.5 Procedure Chart

Main Menu

Patients Query Report Help Exit

Admission
Patients
Record List of Admitted
Patients
Bill

Patients Bill
Payment Information

Treatment
4.6 Program Flowchart

Start

Main Menu
1. Patients
2. Query
3. Report
4. Exit

Yes
Option 1 ? Call patients form

No

Yes
Option 2 ? Call query program

No

Yes
Option 3 ? Call Report Module

No

No
Option 4 ?

Yes

Stop

4.7 Choice of Programming Language

The new system is implemented using Microsoft C#. This is because the programming
language has the advantage of easy development. Flexibility and it has the ability of
providing the developer/programmer with possible hints and it produces a graphical user
interface.

4.8 HARDWARE AND OPERATING SYSTEM REQUIREMENT

Computer system is made up of units that are put together to the work as one to achieve a
common goal. There are two parts of the computer system, namely.
 The Hardware
 The Software
Hardware Requirement
The program for this project is written in Visual Basic Programming Language. 6.0. it is
designed to run on an IBM personal computer. The following minimum hardware
specification is needed
Intel Pentium 1. MMX technology
14” VGA or SVGA Monitor
16 MB RAM
3.5 Floppy Drive
24 x CD ROM Drive
2.1 GB Hard Drive
Keyboard
Printer

Software Requirement
The following minimum software specification is needed:
Microsoft windows 98 or later versions
Microsoft Access 97
Microsoft C#.

5.1 SUMMARY
Without the use of computerized system for medical system, I wonder what will be the stand
of our economy today. Since, the implementation of this system does better than harm in our
country especially health sector. Hence not only does it provide good health with the help of
the following factors, accuracy, flexibility, and speedy treatment. But also, it will be a big
relief for medical doctors and nurses when attending to patients.

This project is well designed with reliability and efficiency as our mainstay, have come just
in time to correct those weaknesses and anomalies, which exist in the existing manual
method. The achievements made up this design can be summarized

a. Result of high processing speed of the computerize system

b. Patient’s records can now be retrieved easily.
c. Billing system in the hospital will be more effective.
d. Similarly, there is also an easy access to clinical reports for research purpose and
decision making.
5.2 Problems Encountered and Recommendations

During the processing of the project, I was faced with a lot of physical problems. These
problems include:

I was seriously faced with the problem of data collection, which helps in building the
manuscript. Because information they said is the tool of business so without solid data
collection or material one finds it difficult to present a meaningful report. So, inability to get
materials on time really set my project back. Actually, it took me more than five months to
gather enough information needed for this project.

Also, for collection of data from my case study a lot of money is spent on transportation.
Hence for one to be effective in this project, money must be involved.

Finally, the major limitations of this study were time, financial constraints and poor response
by some medical doctors fearing that computers may take over the practice of medicine
which in advance, they may lose their jobs. For this reason, the researcher is recommending
compulsory information technology training for all the medical practitioners to enable them
cope with the current trend in information technology.

5.3 Conclusion
Based on the findings, the following conclusions were reached. The implementation of a
patient billing software for a hospital will be a big relief for medical doctors and nurses when
operational. The system can be a tremendous help to hospital management. It will also serve
as a tool for quick operational decision making of the patient, thus enabling them to reach the
solutions of their problem more quickly and more accurately than human being. Thus the
overall effect of the use of computer in medical system is that patients acquire competence,
accuracy, and effectiveness within the shortest time in their operations and can break into
new ground with certainty.

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