A Web-Based Integrated Health Care Management System

MOHAMMED ABDULLAH ALI AL-KHAWLANI

FACULTY OF COMPUTER SCIENCE

AND INFORMATION TECHNOLOGY
UNIVERSITY MALAYA
KUALA LUMPUR

APRIL 2009
A Web-Based Integrated Health Care Management System

MOHAMMED ABDULLAH ALI AL-KHAWLANI

DISSERTATION SUBMITTED IN FULFILLMENT

OF REQUIRMENT FOR THE DEGREE OF
MASTER OF INFORMATION TECHNOLOGY

FACULTY OF COMPUTER SCIENCE

AND INFORMATION TECHNOLOGY
UNIVERSITY MALAYA
KUALA LUMPUR

APRIL 2009

ii
 GRADUATE SCHOOL
UNIVERSITY MALAYA

Permission to use

iii
Abstract

Health Care Management Systems has a set of important patient information stored in
electronic formats that provides health care staff the flexibility and accessibility to
easily interact with the patient's information, which helps to improve the quality of the
health care service. Managing the patient's information has been developed and
improved through different manners such as web-based systems, computer applications
analyzed from current problems within the system, system requirements, database
servers and user requirements.

Many problems appear as blockage for managing the health care information system.
These problems emerge in the patient's medications, consultations, and appointments,
confirming appointments, payments and doctor schedules. This research analyzes the
previous studies and the available problems of the current system in two health care
providers namely the University Hospital (UH) and Hospital of University Kebangsaan
Malaysia (HUKM). This system is a web-based integrated health care management
system, which contains the main modules such as patient module, doctor schedule
module and appointment module. This manages the patient information history
(personal information, medical information, treatment information, payment
information, and appointment information) with the easiest method and sturdy security.
In addition, this integrated web-based gives the patient the opportunity to use the system
online and confirm their own appointments by themselves, a matter that saves time and
effort of both the patient and the nurse. Moreover, by this integrated web-based, patient
will be able to check the status of their appointment and doctor availability online.

iv
 Acknowledgment

First of all, I would like to express my appreciation to Allah, the Most Merciful whom
granted me the ability and willing to start and complete this dissertation. I pray to his
greatness to inspire and to enable me to continue the work for benefits of my religion,
Islam and country.

I would also like to express my gratitude and a million thanks and appreciation to my
supervisor, Dr. Norizan Mohd Yasin, the Head of Department information science,
Faculty of computer science and information technology at the University Malaya for
her efforts and excellent guidance and advice to finish this dissertation successfully.

I would also like to express a million thank and appreciation to my family for the solid
home support. They graciously understood my tight time schedule during doing this
dissertation. And my greatest thanks to all my friends for their kind assistance and
cooperation.

Thanks for every never-endings support and kindness. May Allah bless us, Insha Allah.
Only God knows everything!
Thank you.

Mohammed Abdullah Ali Al-Khawlani

Information Science Department,
Faculty of Computer Science and Information Technology,
University Malaya

v
Table of Contents
Permission to use iii
Abstract iv
Acknowledgment v
Table of Contents vi
List of Tables viii
List of Figures viii
Appendixes x

Chapter 1
Introduction

1.1 Background 1
1.2 Research Focus 3
1.3 Problem Statement 4
1.4 Research Objectives 5
1.5 Research Significant 6
1.6 Research Scope 7
1.7 Organization of Thesis 8
1.8 Conclusion 8
1.9 Summary 9

Chapter 2
Literature Review

2.1 Introduction 10
2.2 Health Care Information system 11
2.3 Definitions of information system and health care information system 12
2.4 Health Care Management system 14
2.5 Patient Appointment system 20
2.6 Managing Patient Appointment system 21
2.7 Critical analysis for previous research 39
2.8 Conclusion 45
2.9 Summary 46

Chapter 3
Research Methodology

3.1 Introduction 47
3.2 Research Strategy 47
3.3 Data Collection 49
3.3.1 Data Collection Techniques 49
3.3.2 Data Collection Tools 50
3.4 Research Sample and Respondent 50
3.5 Plan of Data Collection 51
3.6 Framework for Data Analysis 52
3.7 System Development 53
3.8 Conclusion 55
3.9 Summary 55

vi
 Chapter 4
Data Collection, Analysis and Findings

4.1 Introduction 56
4.2 Case study 57
4.2.1 Case 1 (UH) University Hospital 57
4.2.2 Case 2 (HUKM) Hospital of University Kebangsaan Malaysia 59
4.3 Data Capture 61
4.4 Data Analysis 63
4.4.1 University Hospital (UH) 66
4.4.2 Hospital of University Kebangsaan Malaysia (HUKM) 70
4.5 Finding 74
4.6 System Testing 78
4.7 Feed back 83
4.8 Conclusion 84
4.9 Summary 85

Chapter 5
System Design

5.1 Introduction 86
5.2 System Structure 86
5.2.1 System Concept 86
5.2.2 System modules 87
5.2.3 System Environment 88
5.3 Functional Requirement 89
5.4 Non Functional Requirement 89
5.4.1 Integrity 89
5.4.2 Flexibility 90
5.4.3 Security 90
5.4.4 Maintainability 90
5.5 System Interface 91
5.5.1 User Interface 91
5.5.2 Hardware Interface 134
5.5.3 Communications Interfaces 134
5.6 System Tables 135
5.7 System Code 137
5.8 Conclusion 150
5.9 Summary 150

Chapter 6
Discussion and Conclusion
6.1 Introductions 151
6.2 Contribution to Knowledge 152
6.3 The Research Outcome 153
6.4 System strength 153
6.6 System Limitation 155
6.5 Recommendation and Future Work 155
6.7 Research Conclusion 156

References 157
vii
 List of Tables

Table 2.1 Appointment Type 32

Table 2.2 Basic Patient Flow Logic 33
Table 2.3 Critical analyses, system features and types for previous studies based
42
on the literature review
Table 2.4 Limitation and strength of the health care system based on the previous
44
study in the literature review
Table 3.1 Research Respondent 50
Table 4.1 The analysis of data collected 64
Table 4.2 UH Nurse, use system for creating patient profile and setting
80
appointment
Table 4.3 UH Patients use system to confirm the appointment 80
Table 4.4 HUKM nurse use system for creating patient profile and setting
81
appointment
Table 4.5 HUKM Patients use system to confirm the appointment 82

List of Figures

Figure 2.1 Patient accesses their own medical records 16

Figure 2.2 Integrated web page Patient Gateway portal 18
Figure 2.3 The Integrated Tbase system 19
Figure 2.4 Single point of access to the health care gateway 20
Figure 2.5 Patient appointments Flow Chart 26
Figure 2.6 Information about physicians 27
Figure 2.7 Appointment time table 27
Figure 2.8 Patient Flow diagram 29
Figure 2.9 Patient Flow diagram 31
Figure 2.10 Patient processes in the clinic 35
Figure 2.11 Patient information for registration 36
Figure 2.12 Patient appointments (electronic booking) 37
Figure 2.13 Patient appointments process 38
Figure 2.14 Conceptual framework for health care system based on the literature 43
review
Figure 2.15 Conceptual framework for the appointment system based on the 43
literature review
Figure 3.1 Framework of data analysis 52
Figure 3.2 Waterfall method 53
Figure 4.1 The current system construction use in UH and HUKM 65
Figure 4.2 Network design topology for hospital UH and HUKM 66
Figure 4.3 Patient flow steps (Chart) in UH 69
Figure 4.4 Patient flow steps (Chart) in HUKM 73
Figure 4.5 The new integrated module 75
Figure 4.6 Finding Module form the Current System Used for Managing the 76
Patient Appointment
Figure 4.7 The new module for managing the patient appointment 77
Figure 5.1 The structure chart of the new application 87
Figure 5.2 System users as group 89
Figure 5.3 Login interface 91
Figure 5.4 Today Queue 92
Figure 5.4.1 Search Patients 93

viii
 Figure 5.4.2 Create new Patients 94
Figure 6.4.3 View appointments 95
Figure 5.4.3. (a) Appointment list 96
Figure a1 Edit Appointments 96
Figure 5.4.4. (a) View Documents 96
Figure a1 Downloading document 98
Figure 5.4.4.b Upload file 98
Figure b1 Locate upload file 99
Figure 5.4.4. (c) Managing files 99
Figure c1 Editing /Deleting file 100
Figure 5.4.5 View My Tasks 101
Figure 5.4.5. (a) Editing/ Deleting Task 102
Figure 5.4.5. (b) Creating a new Task 102
Figure 5.4.6 Doctor Schedule 103
Figure 5.4.6. (a) Doctor Schedule History 104
Figure 5.4.6. (b) Editing Doctor Status 104
Figure 5.4.6. (c) Creating New Status 105
Figure 5.4.6. (d) Doctor Schedule and status history 105
Figure 5.4.7. (a) View Report (Appointment) 106
Figure 5.4.7. (b) Patients Gender Report 107
Figure 5.4.7. (c) Patients Race Report 107
Figure 5.4.7. (d) Payment Report 108
Figure 5.4.7. (e) Payment method Report 108
Figure 5.4.7. (f) Doctor Consultation Report 109
Figure 5.4.7. (g) Client Report 109
Figure 5.4.7. (h) Document Report 110
Figure 5.4.7. (i) The Patient Complaint Report 110
Figure 5.4.7. (j) The Patient Treatment Report 111
Figure 5.4.7. (k) The Diagnosis Category Report 111
Figure 5.4.7. (l) The Total Product Used Report 112
Figure 5.4.8 Patients list 113
Figure 5.4.8. (a) Patient details 113
Figure 5.4.8. (b) Full Patient Details 114
Figure 5.4.8. (c) Patient previous illness details 115
Figure 5.4.8. (d) Patient consultation history 115
Figure d1 The Patient Consolation Details 116
Figure d2 Patient Consolation Diagnosis 116
Figure d3 Patient Medication 117
Figure d4 Patient Payment page 117
Figure 5.4.9 Patient Appointment History 118
Figure 5.4.9. (a) Create/ Edit appointment 119
Figure 5.4.10 Patient allergies 119
Figure 5.4.11 Admin home page 120
Figure 5.4.11. (a) User Management 121
Figure 6.4.11. (b) Edit/ Create user 121
Figure 5.4.12 Group Management 122
Figure 6.4.12. (a) Edit/ Create group 122
Figure 5.4.13 System Management 123
Figure 5.4.13. (a) System Profile 123
Figure 5.4.13.b System Code Control 124
Figure b1 Edit/ Create System Code 124
Figure 5.4.14 Account Management 125

ix
 Figure 5.4.14. (a) Edit/ Create account management 126
Figure 5.4.15 Client management 126
Figure 5.4.15. (a) Edit/ Create Client 127
Figure 5.4.16 Vendor management 128
Figure 6.4.16. (a) Edit/ Create vendor 129
Figure 5.4.17 Product Management 130
Figure 5.4.17.(a) Create / Edit product 131
Figure 5.4.18 Patient Home Page 132
Figure 5.4.18. (a) Patient View the Appointment 133
Figure 5.4.18. (b) Patient Confirm the Appointment 133
Figure 5.4.18. (c) Patient cancels the Appointment 134

Appendixes

Appendix A primary collected data

Appendix a-1 Doctor HUKM 162
Appendix a-2 Nurse1 HUKM 166
Appendix a-3 Nurse2 HUKM 170
Appendix a-4 Patient 1 HUKM 174
Appendix a-5 Patient 2 HUKM 176
Appendix a-6 Nurse1 UH 178
Appendix a-7 Patient 1 UH 181
Appendix a-8 Patient 2 UH 183
Appendix a-9 Patient 3 UH 185
Appendix a-10 Doctor HUKM 187

Appendix B feedback
Appendix b-1 Doctor Feedback HUKM 193
Appendix b-2 Nurse 1 Feedback HUKM 195
Appendix b-3 Nurse 2 Feedback HUKM 197
Appendix b-4 Patient 1 Feedback HUKM 199
Appendix b-5 Patient 2 Feedback HUKM 200
Appendix b-6 Patient 3 Feedback HUKM 201
Appendix b-7 Patient 4 Feedback HUKM 202
Appendix b-8 Patient 5 Feedback HUKM 203
Appendix b-9 Nurse1 Feedback UH 204
Appendix b-10 Nurse 2 Feedback UH 206
Appendix b-11 Patient 1 Feedback UH 207
Appendix b-12 Patient 2 Feedback UH 208
Appendix b-13 Patient 3 Feedback UH 209
Appendix b-14 Patient 4 Feedback UH 210
Appendix b-15 Patient 5 Feedback UH 211

Appendix C system use case 213

Appendix D System Table 235
Appendix E System Chart Code 248

x
 CHAPTER 1

Introduction

1.1 Background

Information systems is collection of hardware, software, data, people and

procedures that are designed to provide the right information the user needs to do their

task more effectively, to the right person and at the right time (Davis and Yen, 1998).

Information system is important for any business because the business needs to

have accurate information and need to have the technology as a tool for solving

problems and at the same time increasing the productivity and the quality of doing

business. Businesses today use information system and use the available technologies

because they understand the importance of maintaining and updating data electronically

(Davis and Yen, 1998).

Using information system for managing information in the health care such as

patient record, patient appointment system, patients scheduling appointment, doctor

schedule and medicine prescription is not only to save time or reduce cost, but also a

way to support and improve the health care information to be more accessible and

flexible (modifying, saving, deleting, updating etc) for system users and storing data

efficiently. In addition, it improves the quality of data control (Liu and Zhu, 2007).

On the other hand, information system works to interact with the system

databases, financial module, scheduling module and the entire system modules.

Therefore, to get the best implementation, the health care system should be able to

interact with several medical health care staff (physicians, nurses, medical device users,

financial and the administrators),

1
which is the conducted way to get a good insight how health care system working and

will be more effectively and efficiently for managing the information (Song et al.,

2007).

Health care information system is looking at patients, in order to represent their

health information history and provide the flexibility and accessibility for patient

information to be more reachable by the authorized person (Rogers et al., 2006).

On the other hand, health care information system have user interface, that

provides to the system user the ability to interact with the patient; Once the patient

arrive at the medical center they must register their information and health history in the

health care center system. The system automatically will update the patient information;

then the patient will be under queue to have an appointment for medical check up by the

physician. The physician will specify whether the patient case is an emergency case or

not. If the case is an emergency, the physician will retrieve the relevant patient

information from the system database. Nevertheless, in the general case, the system will

request the examination queue for the patient. Finally, after the patient complete the

medical check the system will place the prescription order to the pharmacy unit and

update the information to the patient record (Tang et al., 2001).

The challenge here is how the information system can represent and manage the

entire information in the health care such as patient information, patient consultation

history, patient appointment, doctor's schedule, payment, products and medicines, and

document. In addition, how an integrated system can provide the accessibility to the

right and accurate information for any patient in the health care center. Moreover, how

the system can provide the accessibility for patients to allow them confirm their own

appointment by themselves.

2
1.2 Research Focus

The focus of this research is to study the following areas towards the

development of an integrated health care management system:

a. Patient information history, which include all the patient information such as

consultation history, medication history, treatments history, appointments.

b. Doctors schedule information, which include the doctor schedule status such

as (available, on leave, oversea, operation day etc)

c. Products, such as medicine information, which contains the products prices

and the supplier for the product.

d. Third party interest such as insurance companies and companies' information.

A patient can be a business client of an insurance company.

e. Managing the patient appointment and giving the opportunity to the patient to

confirm their own appointment by themselves online.

The expected outcomes for focusing on those points in this research are:

a. Providing an integrated health care system to the health care.

b. Improving the quality of health care services.

c. Keep tracking for all the patient information and patient consultation history.

d. Managing the doctor schedule.

e. Managing the patient appointment.

f. Giving the patient the opportunity to confirm their appointment by

themselves online, which help to:

ƒ Reduce the working load of nurse.

ƒ Reduce unnecessary waiting time for patients and staffs.

ƒ Encouraging continuity of medical care.

3
1.3 Problem Statement

The current health care providers are using different ways and systems for

managing information. Some health care providers are using only one system for

managing the health information but it is not comprehensive for managing all the

information, for instance the system can support only the patient information but cannot

support the patient appointment or cannot support the doctor schedule.

Therefore Mazzi et al. (2006) reported results of study about current system use

in the health care, which proved that there is a lack of software that fulfils the patient’s

need for medical information and the doctor’s need to monitor patients.

Conversely, there are a health cares are using more than one health management

system such as (patient information, doctor schedule, products and medicine suppliers,

financial etc.) for managing the health information. Those system are dedicated to only

one activity of the healthcare and this functionality is not integrated with other systems

(Mazzi et al., 2006).

Furthermore, about the patient appointment, the patient can book an appointment

through a different way such as (telephone, email, website etc); otherwise the patient

needs to go to the health center personally to make an appointment.

Traditionally, the doctors’ time is more important than patient time. So an

appointment system designed to minimize the doctor idle time only and considered that

the patient can wait for more than one hour to be attended by a physician in a health

care center, which make patients feel they are being disregarded and treated unfairly

(Dexter, 1999).

4
 On the other hand, the old appointment system designed to minimize the doctor

idle time but current designing of an appointment system is based on decisive factors

with respect to both the patient and doctor (Wijewickrama and Takakuwa, 2005).

Therefore, here is the necessity of developing an integrated health care system

that can manage the entire health care information and provide a very sturdy interacting

communication between the system component and system users.

1.4 Research Objectives

The objective of this research is to:

a) Identify and analyze the current system used for managing patient

information and health care information.

b) Design and Develop an integrated system for managing the patient

information and the health care information.

c) Develop the confirmation appointment system to allow patient to confirm

their appointment by themselves online.

d) To enhance the protection of patient health information history and provides

the flexibility and accessibility of the information to be more reachable by

authorized personnel.

e) Observe and control the huge information of health care (diseases, finance,

medication, treatment, out patients etc) to enhance the ability of evaluating

the work in the health care, which provides the necessary information for

future planning.

f) Provide very secure communication between patients and physicians. In

addition, incorporates services such as prescription renewal and

appointment.

5
1.5 Research Significance

An integrated health care management system provides an electronic document

instead of using the traditional method (paper document), which is not easy to retrieve

patient information and can not accesses remotely.

Therefore, Zeng and Cimino, (2000) mentioned that because of the huge of

patients information in the health care, it is not practical to keep going using the paper

documents for tracking and managing the patient information , but information system

in health care, systematically supports extensive manage for the of patients information

in the health care and keep tracking for all medication details

Moreover, Wilcox et al., (2005) refer that the traditional method (paper

documentation) it is limited aptitude for saving patient information, retrieving patient

information etc and cannot access it remotely. From this issue, the importance of health

care information system that can provide the flexibility and supports remote access to

patient health information.

On the other hand, regarding to Brown et al. (2008) a health care management

system provides an extensive patient record, which helps to make proper diagnoses and

prescribe proper treatments and provides track crucial medical information, insurance

data, consultation history, medications and special conditions, which means improve the

quality of health care and enhance the health care performance by allowing the

physician to diagnose diseases faster and more safely since historical information will

be collected from numerous sources to present an obvious picture of a patient’s health at

the point of care. Furthermore it provides consolidated reports for all patient records,

and historical data.

6
1.6 Research Scope

i. This research is for analyzing and developing a web based integrated system to

manage the entire information in the health care such as:-

- Patient information: personal patient information, patient consultations

history, patient treatments and diagnosis, patient medications history,

patient appointments, confirming the appointment online, patient

documents, and patient payments.

- Doctors’ schedule information.

- Products and medicine information.

- Health care client information such as insurance companies.

ii. This system can be used online through World Wide Web by the users,

however the security need to be focused.

iii. The doctor and the nurse can observe the patient health based on the

consultation history for each appointment.

iv. This system manages the patient appointment and allows the patient to use

the system online and confirm their own appointment by themselves.

However, the patient cannot change the appointment time or date, they have

to see the nurse to do that and the patients are not allowed to booking the

appointment by themselves.

v. Before the patient can use the system, the patient must register through the

nurse to create the user account.

7
1.7 Organization of Thesis

This research contains seven chapters to cover the entire academic research

requirement. Chapter one covers introduction and background about information system

and how the Information system supports health care and highlights the system

limitation and system significant, in addition to research objective and problem

statement.

Chapter two highlights the literature review which is related to what the earlier

researches have done in the aspects of health care information system. Chapter three

highlights the research methodology. This chapter covers the research methods that the

researcher uses to collect data to determine the user requirements needed to develop the

system. Chapter four highlights the case study and data collection. Chapter five covers

the data analysis, finding, developing, implementation and testing. Chapter six covers

all the concepts about the system designing and finally chapter seven highlights the

research results and conclusion.

1.8 Conclusion

This chapter has introduced that the information system use in the health care to

manage the health care information such as patient information, medical information,

appointments etc. and presents the research focus, which is studying many areas (patient

information history, medication history, doctors schedule information, products,

insurance companies, managing patient appointment) toward developing an integrated

health care management system, because the current health cares are using non

integrated system for managing their information. So, this research aims to develop an

integrated health care management system.

8
1.9 Summary

Introduction chapter is the initial chapter that represents the research headline

and research objectives. This chapter starts by presenting health care information system

backgrounds, definitions and importance of information system in the health care. Next

the research focuses on the research area study and the expected outcomes from this

research. Moreover, the scope of this research is about managing the patient information

in the health care center.

On the other hand, the problem statement of this research is to analyze how the

current health care centers use the information system for managing patient information

and patient appointments. The objective is to develop an integrated health care

management system. Hence, the significance of this research comes from the

importance of using health care electronic record to provide a complete patient health

records to make proper diagnoses, prescription, and treatments. It is also to track down

all patient information. The next chapter is the literature review of previous studies.

9
 CHAPTER 2

Literature Review

2.1 Introduction

Information system is an enabler for operation process in an organization.

It plays a major role for interactive process service in the organization system by

updating, saving, deleting, retrieving, storing, and sharing data. In addition an operating

and robust information system provides the right information to the right person at the

right time with the lowest cost (Mehdi et al., 2004).

Therefore, in the business world today, most organizations would prefer to use

information system to manage their database, which include among others, the name of

business employee and work schedule. As data and information are increasing and

becoming more complex with time, computerize data are unavoidable not only to

improve the performance of practical works but also safeguard the database from bad

intentions such as hacking and doodling.

Information system uses a client-server environment to provide flexibility for

interactive adding, deleting, updating, etc of data among the clients. In addition to

managing data, it also distributes data based on client-server environment, thus

increasing its efficiency (Mehdi et al., 2004).

The challenge here is how an information system manages the health care

database to save time and reduce cost and improve the quality of services. A health care

system generates a large amount of patient data, archived and can be manipulated by a

computer based information system. For instance, a computer-based medical record

improves the accessibility of patient information and provides useful data for several

studies in patient health information.

10
 This chapter highlights earlier researches on health care management system,

which contains several aspects of managing the health care and the health care

information systems. The chapter starts with the introduction on information system and

how it supports patient's health care. Then, it highlights the health care management

model and managing the appointments in the health care information system, touching

on previous studies on managing the appointment system in the health care center.

Finally, the advantages and disadvantages of the current system used in health care

center are discussed.

2.2 Health Care Information system

Using information system for managing patient information such as electronic

patient record, patient appointment system, and patients scheduling appointment system

not only saves time but also reduces cost. It is a means to support and improve patient

information availability to be more accessible and flexible (modifying, saving, deleting,

updating. etc) for users (health care center staff); and to store patient data efficiency.

Moreover it improves the quality of data control (Liu and Zhu, 2007).

On the other hand, information system works as guidelines, using system

prototype, patient monitoring and documentation tools to integrate the health care

information database, financial system, scheduling and the entire user requirements -

patient, nurse, doctor, etc. Therefore to get better performance and implementation, the

system developers should interact with several medical health care staff physicians,

nurses, medical device users, finance personnel and the administrators, to have an in-

depth knowledge of how the health care center works (Song et al., 2007).

Furthermore, any process or sub-process in the health care system of an existing

information system provides a service to the patient. This service is produced

within a particular process according to defined requirements, rules, and constraints.

11
Consequently, a health care system needs to manage patient services, while it is

working with users to improve the system performance and the quality of health care

(Snyder et al., 2005).

Nevertheless, a health care information system is still not utilized in many health

care centers because of the lack of economic incentive and cost-benefit justification, let

alone developing the ability to share information with different systems and the ability

to change from the traditional environment based paper documentation to the new

digital environment (Liu and Zhu, 2007).

2.3 Definitions of information system and health care information system

An information system is an arrangement of information technologies used for

capturing, storing, and distributing data to meet an organization needs. These include

computer hardware, operating system and application software as well as

telecommunication and networking technologies. Profit making business enterprises,

non-profit making charity bodies, social organizations and government agencies all rely

on information systems to be effective (Wikipedia.org, 2008).

Hence, health care information system is a computer application for patient

health center to represent patient information in a user friendly interface to allow users

to review and interact (adding, saving, modifying, deleting, etc) with patient health

information, such as diagnosis, medicine orders and other services. Moreover,

application health information system works as data repository for patient health

information such as patient registration, systems administrator and financial

management (Giffin et al., 2006).

In addition, a health care information system has a set of important patient

information stored in electronic format that provides health staff, the flexibility and

accessibility to patient's information, stored in the system server.

12
 On the other hand, an Electronic Patient Record (EPR) is defined as the process

to convert the traditional documentation medical paper based records into electronic

computer based information system medical records. These include all patient medical

records such as written text, codes, images, audios, and video notes and any other

information related to the patient (Liu and Zhu, 2007).

In the same manner Laserfiche (2007) developed application software to

improve the health care services in the health care called EMR/HER. Initially EMR

/HER are working to reduce using paper inside the health care through generating an

electronic health record or electronic medical record for each patient and improving the

electronic document management (EDM). Moreover, this system can work as two

categories.

1- Stand alone: typically focus for developing comprehensive functions that can be

used in a side-by-side manner or integrated with other applications. This category

helpful for health care that required a document management and caring about the

digital record.

2- Add-on modules to primary applications: Realizing the need and importance

functions, that makes it easily to linking to a specific record which help the health

care that care about integrating a module with the primary application.

The advantages of this application are the ability to be integrated with other

application based on the user requirements such as the following:-

i. Side-by-side: Most people are familiar to working with multiple applications like

Outlook, word and excel. Electronic document management system provides very

easy way to switch to for retrieval the electronic records.

ii. Data Look-Up: EDM provides solution to populate template automatically, and the

source of the populated data for instance a data stored in another application such as

a practice management or an EMR system.

13
iii. Data Push to Other Applications: which mean the data that is manually or

automatically captured in template fields can be exported to other applications.

iv. Image-Enablement: The most common integration of stand-alone EDM with third-

party applications involves searching the document repository from within the other

application by activating an option in EMD to activate the function.

2.4 Health Care Management system

It is very important to keep extensive information of patients, but it is not easy to

retrieve them from traditional patient records (papers) because the amount of available

data about patients is huge. So, initially the importance of information system in health

care has originated from this issue, which means systematically replacing the papers

documentation in health care to electronic media record (Zeng and Cimino, 2000).

Moreover, a health care information system protects patient health information

history and provides the flexibility and accessibility of the information to be more

reachable by authorized personnel (Rogers et al., 2006).

Therefore, paper documentation is not practical as it has limited aptitude (saving

patient information, retrieving patient information, etc) to support patient health care

and cannot be accessed remotely. Health care information system addresses these

limitations by providing the flexibility (saving, updating, modifying, deleting, etc) to

patient information. In addition, it supports remote access to patient health information

(Wilcox et al., 2005).

According to Brown et al. (2008) the benefit for using the health care

information system is to provide a complete patient health records to make proper

diagnoses and prescribe proper treatments and provides track crucial medical

information, insurance data, consultation history, medications, and special conditions.

14
In addition, using the information system to improve the quality of health care to

improve the health care performance in several ways such as allowing the physician to

diagnose diseases faster and more safely since historical information will be collected

from numerous sources to present an obvious picture of a patient’s health at the point of

care.

According to Ibrahim (2002) using the Health Management Information System

(HMIS) it is an effective way for planning, developing, co-ordination and evaluation the

work in the health care because it is linked the Health Information system to the

management, which provides the necessary information for future planning. Moreover,

the health care integrated system it’s not only for managing patient information but it

also is used for managing the entire health care information, which is the best way to

observe and control the huge information of health care (diseases, finance, medication,

treatment, out patients, etc).

According to Stolyar et al. (2006) the health information system supports patient

health care and gives patients the opportunity to access their own medical health

information. Patients can access health information, modify and control information in

their records. In addition, the system also allows patients to keep their medical health

record even if they change the doctor.

Ciminoa et al. (2000) developed a health care information system with a

common gateway interface that presents a set of applications to patients, organized into:

i. Data Entry which contains entering information into the patient record.

ii. Data Review which contains reading and retrieving information stored system

database.

iii. Education which contains information resources on various topics.

iv. Advice which contains application of patient data to be online guidelines.

15
 The system developed by Ciminoa et al. (2000) gives patients the opportunity to

access their own medical records and to observe the results for a patient view (Figure

2.1). In addition, the health care data are presented in the same manner that is used to

present to the health care staff.

Figure 2.1 Patient accesses their own medical records

(adapted from Ciminoa et al., 2000)

Chua (2005) developed a Tele Primary Care implemented as distributed

application has a repository of medical records for patients. The health care maintains

the patient’s Electronic Medical Record (EMR), which are local to each clinic in the

health care and contains patient’s medical history, surgeries, immunizations, risk

factors, and health and activity status, providing a historical database. In addition, this

system maintains the central repository by having the member clinics update the

repository. Other advantages for this system in the following:

i. Capability to capture online EMR for all patients at primary care area.

ii. Consolidated reports for all patient records, and historical data.

16
 iii. Ease of patient registration.

iv. Provide an easy way for making appointments.

v. Enabled 24-hour remote medical treatment.

vi. Increased network reliability.

vii. Ensured scalability for expansion to 2,000 clinics.

Mazzi et al. (2006) refer to result of study about current system use in the health

care, which reveal most healthcare technology is dedicated to the resolution of a

patient’s complaint of the healthcare and there is a lack of software that fulfils the

patient’s need for medical information and the doctor’s desire to monitor patients.

Furthermore the study also reveals that current software applications are dedicated to

only one activity of the healthcare and that this functionality is not integrated with other

systems.

Based on that study Mazzi et al. (2006), a health care information system called

agent software was developed. This system illustrated the relationship between doctor

and patient during a treatment process, using a prototype agent system, which consist of

three stages:

i. An initial Personal Meeting stage.

ii. An Examination stage.

iii. Integration through Dialogue stage.

The most important is the third stage, which involves the integration of medical

information into the continuing dialogue between doctor and patient. In addition, this

system able to provide the following services to the patients.

9 The patient-doctor relationship is extended

9 Proactive healthcare with emphasis on prevention

9 Patients have access to high quality medical information

9 Patients are monitored at home or on the road.

17
 9 Patients often do not know if their symptoms are serious enough to see a doctor.

Agents can help to identify those patients who really need medical attention

from those that only need information

9 Better treatment completion

Wald et al. (2004) developed a web page Patient Gateway portal called

Longitudinal Medical Record (LMR). This system is an electronic medical record

system used by physicians and other clinical staff in the outpatient setting to automating

the documentation of medical care, including patient problems, procedures,

medications, allergies, health maintenance topics, and encounter notes. In addition LMR

is used to write prescriptions and to communicate with other providers.

The main concept for LMR system (see Figure 2.2) is web-based health care

management system portal to provide very secure communication between patients and

physicians, in addition incorporates services such as prescription renewal and

appointment.

Figure 2.2 Integrated Web Page Patient Gateway Portal

(adapted from Wald et al. 2004).

18
 Lindemann-v et al. (2002) developed a TBase2 health care system. This system

is designed to store relevant data for each patient and allow access to that data by all

persons who are authorized to do so in the health care. In addition, there exists an

intranet within the health care that allows connecting almost every computer to the

health care system (TBase2) (Figure 2.3). TBase2 is designed to comprise the whole

medical information about a patient, e.g. medical free-text, numerical data, standard

definitions and medical images. Moreover, it is presented at web-based electronic

patient record of transplantation patients running in the daily routine of large health care

distributed over a wide area.

Figure 2.3 The Integrated Tbase system

(adapted from Lindemann-v et al., 2002)

Lim et al. (2006) developed a portal web-based healthcare system that integrates

components such as patient management, patient accounting, appointment, house call

and communications into one complete package solution. These components are

developed using portal technology. A healthcare web portal serves as the integrated

getaway in a healthcare centre website and provides to the users a single point of access

(Figure 2.4) for the healthcare services delivery. This portal technology supports single

point of access and also different accessing levels to prevent patients’ records being

accessed by un-authorized personnel while maintaining one simple gateway for all

levels users.

19
 Figure 2.4 Single point of access to the health care gateway
(adapted from Lim et al., 2006)

A health care information system has an interface that facilitates the user to

interact with the system. So, once the patients arrive at the clinic, they must register

their personal information and health history in the health care center. The system

automatically updates the patient information. Then, the patient will be under queue to

make an appointment for medical check-up by a physician. Next, the physician will

specify whether the patient case is an emergency case or not. If it is an emergency case,

the physician will retrieve the relevant patient information from the system database.

Nevertheless, in general, the system can also request the examination queue for the

patient. Finally, after the patient has completed the medical check, the system will place

the medicine order to the pharmacy unit and update the information of the patient record

(Tang et al., 2001).

2.5 Patient Appointment system

A patient appointment system or appointment schedule for health care center

started long time ago. Management of patient appointments has earlier works and has

developed simplified queuing models and fairly static scheduling conditions. Another

attempt was made to calculate the waiting time between patient and doctor using the

mathematical queuing models to minimize waiting time (Harper and Gamlin, 2003).

20
 However; traditionally the appointment system has considered that the doctor

time is more important than patient time. So an appointment system was designed to

minimize the doctor idle time but current designing of an appointment system is based

on decisive factors with respect to both the patient and doctor (Wijewickrama and

Takakuwa, 2005).

The patient appointment system has complex structures because it represents the

patient appointment time in the healthcare center and controls the patient waiting time

based on the type and the period of patient appointment (Harper and Gamlin, 2003).

Moreover, a patient appointment system is meant for:

i) Managing doctor time.

ii) Reducing patient waiting time

iii) Reducing doctor idle time.

iv) Reducing nurse idle time.

v) Improving the quality of service in the health care.

2.6 Managing Patient Appointment system

According to Dexter (1999), managing patient appointment system is a

computer application used to manage and reduce the patient waiting time in the health

care center. Some health care centers do not use any appointment system. So it has a

longer average patient waiting time than the health care center that adopts the patient

appointment system.

While patients can wait for more than one hour to be attended to by a physician

in a health care center, they also can feel that they are being disregarded and treated

unfairly. So when patients are given the time of appointment in a health care centre,

they can evaluate the quality of service in the centre (Dexter, 1999).

21
 Hence, developing a patient appointment process for health care center

necessitates the use of a sophisticated queuing model that captures much of the real

system’s features (saving time, reducing idle time, etc). Therefore the appointment

schedule represents the real situation in the health care center faced by patient

appointment schedulers. On the other hand, the standard practice for scheduling and

processing patient appointments are based on the nature of treatments of the patients

and that better approaches more sensitive to patient needs are desirable (Rohleder and

Klassen, 2002).

According to Hall (2006) the success of a patient appointment system depends

on how the patient appointment can be managed. Therefore there are several approaches

to improve the management of patient appointment. They are:

a) Enforcing the continuity of patient care.

b) Increasing the effectiveness of each appointment.

c) Reducing the demand for face-to-face patient physician interaction.

The continuity of a patient health care can be improved by reducing the

unnecessary appointments, once the patient is attended by a physician, who did not treat

patient in the previous visits. The probability for extra appointment is increased. In

addition, once the patient requests an appointment, the schedule is checked for any

appointments and/or some predictable appointments in the future. Thus, a single

appointment can be used to attend to multiple patient needs. An effective manner for an

appointment request is through phone call and/or email. Through this means, the patient

need not worry about getting an appointment and need not go to the health centre

personally to make an appointment, thus saving precious time. Moreover, using the

email or phone for direct interaction between the health care centre and the patient

enables also checking test results, appointment reminders and other services

(Hall, 2006).
22
 In the same manner, in some appointment systems, the patient appointment is

scheduled directly by the primary care provider in the health care centre at the

beginning of each month. All appointments of new patients are also scheduled in the

health care centre. The patient could mail a letter containing explanation of the purpose

of the appointment to a health care center and requests for information on the

procedures of health care, primary care providers and the attendance time. Generally the

schedule is set between two or four weeks. After the patient has visited the health care

center and is already charged a fee for treatment, patient can then make another

appointment. In addition, approximately 10 patients are scheduled for each clinical

session. The patient registration is done by the nurse, who has to give information to the

patient about procedures in the health care center and collects patient information,

which are then entered into the patient’s medical record (Jain and Chou, 2000).

One application developed to manage patient appointment scheduling has used

exponential enter arrival times. This model assumes that the exponential enter arrival

times could not be directly validated by date, and it is limited due to the nature of the

appointment scheduling. Since appointments are scheduled in the future, the exact

model of call arrivals will only have limited impact on measures related to the time

between the call and the appointment time. For this reason, the challenge for making

appointment system is designing a suitable system based on the health care procedure

environment. Hence, the appointment provider in the health care center can schedule a

patient into an appropriate time slot on a given day (Rohleder and Klassen, 2002).

Klassen and Rohleder (2004) have developed another method for managing

patient appointment using multiple schedule appointment in multiple period

environments. Patients can call for any appointment time but if the period time is full,

they should replace the appointment to another time.

23
Moreover, various combinations for multi appointment and double booking are

measured and recommended for different operational use depending on the heath care

environment, because the varying appointment request has little effect on appointment

system performance especially maintaining acceptable performance, except when the

system has the overloaded option.

Many studies about patient appointment have found that there are rules or

policies for scheduling appointment system such as no scheduling for more than 20 or

30 clients and the best schedule is to place two patients in the first appointment and

spread the rest consistently over a period based on average service times. On the other

hand, a patient can call for an appointment without knowledge of the type of

appointment and appointment queue number and patient is not aware whether the

appointment is variable or not. Sometimes the exact duration for each patient can be

known but at other times this is unknown (Klassen and Rohleder, 2004).

Giachetti et al. (2005) have observed the process for patient flow, from the time

they arrive at the health care center until they are discharged and designed a patient

appointment flowchart as shown in (Figure 2.5), giving more explanations about the

patient appointment process.

a. Patients are checked in the scheduled appointment by a Patient Care

Assistant (PCA). Patients, who arrive after 15:30 are not allowed to check-

in. They have to leave the clinic without being treated.

b. After the patients have checked in, they are given identification numbers.

c. Then they have to wait in the waiting area. Meanwhile, the PCA prepares the

charts for the checked-in and places them on a table.

24
d. A nurse retrieves the charts to call in the patient for preliminary assessment.

If a patient is a follow-up (not first visit) then patient does not require a

preliminary assessment.

e. Once the preliminary assessment is performed, the patient returns to the

waiting area, and the nurse places the charts on the disposition table for the

doctors.

f. After the doctor has treated the patient, patient gives the (patient’s chart) to

the PCA.

g. The PCA enters the patient information into the computer and gives the

patient the next appointment date as needed.

25
 Figure 2.5 Patient appointments Flow Chart.
(adapted from Giachetti et al., 2005)

Through observation of this process, the patient’s appointment is not a strictly

first-in first-out (FIFO) process. Once the patient is checked in, the appointment process

is done upon ordering of the patient charts. If the charts get shuffled out of order then

the FIFO processing is upset. Moreover, a physician will skip over a patient if the

patient is a follow-up of another physician. This is done for clinical reasons called

continuity of care (Giachetti et al., 2005).

26
 Another system developed by Mustafa, (2004) allows a registered patient,

having user name and password, to access and explore the list of physicians

alphabetically and select a physician, whose email contact and profile are also provided.

A patient can also view the physician working calendar to find out his/her working and

non working day to make an appointment. When the patient selects ‘View Calendar

(Figure 2.6), the patient can then choose any valid day in any month to make an

appointment (Figure 2.7). After that, the patient will receive an e-mail from the system

to confirm the appointment time or to inform the patient that the selected time is already

taken by another patient or blocked by the physician.

Figure 2.6 Information about physicians

(adapted from Mustafa, 2004)

Figure 2.7 Appointment time table

(adapted from Mustafa, 2004)
27
 In general, the patient appointment system provides all the choices and the

capabilities to the patients, such as selecting a physician, selecting the time of

appointment, and allows them to access the health care system day or night and

schedule their own appointments using the Internet without spending time holding for a

nurse or having lengthy phone calls (Mustafa, 2004).

A study by Wijewickrama and Takakuwa, (2005), mention that the health care

operating time (due time) is from 8:30 am to 5:30 pm during the week days. Throughout

this period, four types of patients arrive to have a consultation appointment in the health

care center-appointed patients, same day appointment patients (walk-ins), patients who

come for a medical test and new patients.

Therefore, for the patient flow in the appointment system as depicted in

(Figure 2.8), new patients will have to go to the reception for registration (filling-out the

application) and other patients may have to go to the reception to check whether they

have to submit some requirements such as insurance care. Patients, who have

appointments are given priority over those who walk-in for consultation. Consequently,

these latter patients have to wait a long time in the waiting room to meet a doctor even if

the consultation time only last few minutes (Wijewickrama and Takakuwa, 2005).

28
 Figure 2.8 Patient Flow diagram
(adapted from Wijewickrama and Takakuwa, 2005)

Harper and Gamlin, (2003) studied the methods of managing patient

appointments in health care centers to reduce outpatient waiting times by improving the

appointment schedule. They made several schedules to do this process. The aim of the

initial step was to find out the balanced number of patients arriving every 5 minutes, for

instance, between 14:00 and 15:40 and all the extra patients would be scheduled

between 15:45 and 16:00. The patients are arranged in booking blocks, which have

different sizes according to the type of patients as follows:

a. Follow-up – 3 every 20 minutes.

b. Extra – 2 every 30 minutes.

29
c. New – 1 every 15 minutes.

d. Urgent – 2 every 30 minutes.

e. Ward discharge – 1 every 30 minutes.

This block appointment contains also buffer periods (15 minutes) for patients

without booking. Hence, for the system flexibility, the appointment time between 15:35

and 15:45 is kept free. This process of managing patient appointment is based on an

algorithm, which spreads among the appointments based on clinical sessions, for

instance, using the time between 14:00 and 16:55 for patients, who are in the schedule

but not in the block appointment. The algorithm below has considered this process

(Harper and Gamlin, 2003):

a. Choose the patient type, except diary patients, with the largest average consultation

time.

b. From the patient type, schedule individual patients in every available appointment

slot, determined by total number of patients divided by the total number of

appointment slots, in the clinic sessions.

c. If no patient type remains to be allocated, go to step (vii).

d. Else, if there exists patient types not previously located, choose (i).

e. For the clinic under consideration, calculate the total number of patients booked for

each time duration and identify the largest consecutive cluster of time duration, that

contains the minimum total number of patients booked.

f. Scheduling a patient in the middle of the group. If the group contains a numbers of

times, scheduled the patient in the earlier of two middle.

g. If there are still patients of this type, which need to be allocated then, go to step (iv),

Otherwise go to step (iii).

h. Stop.

30
 Porta-Sales et al. (2005) have developed another system. The main concept of

the system is contacting, screening and scheduling appointment with the health care

center initially by an expert nurse and the patient initiating contacting with the health

care center using the telephone. Moreover, the health care center can be accessible from

different places. So there should be PC resources and PC consultations to be accessed

from different sources, from other hospitals, from general practitioners, or even from

the patients themselves (see Figure 2.9).

Figure 2.9 Patient Flow diagram

(adapted from Porta-Sales et al., 2005)

31
 Porta-Sales et al. (2005) studied 534 patients for a period exceeding one year.

After the first visit, 195 patients did not return for the second scheduled appointment

and 203 patients had progressed on to the third scheduled visit. The main reason given

for the scheduled visits was admission into the health care; the median time-lapse

between the first and second visit was 21 days, between the second and third was 27.5

days and between the first and third was 48 days. Comparing patients, who did not

attend the three consecutive visits with those who did, indicated that the former had (at

the first visit) a lower performance status.

According to Guo et al. (2004), the patient appointment is a process performed

by customer service representatives in call centers and the schedules are assigned to

incoming requests for appointments but the main problem in determining the

appointment is the randomness of patient demand. For outpatient scheduling

appointment system, there are four components detailed below:

a) External request for appointments

Once a patient calls to request an appointment, the request is taken by the system

appointment model. Patient calls are organized into types of appointments (Table 2.1).

Calls are usually different day to day, and the requests for appointments sometime are

for specific time periods (e.g. weeks or months) in the future. In addition, the type of an

appointment depends on the patient request, whether if it is a specific type or not.

Table 2.1 Appointment Type

(adapted from Guo et al., 2004)

32
 b) Patient Flow Logic

Patient Flow Logic is a sequence of appointments (Table 2.2). The historical

data is used to determine the appointment. Often the patients prefer to see the same

doctor for each visit to the clinic and new patients would like to get early appointment

times. Follow-up appointments are sometimes scheduled well in advance of the actual

date.

Table 2.2 Basic Patient Flow Logic

(adapted from Guo et al., 2004)

1.Arrival of new patient call

2.Patient characteristics are drawn from distributions (appointment type,
insurance.)
3.Appointment is scheduled
4.Delay until appointment day
5.Does patient show up for appointment? If not, go to 6, otherwise go to 7
6.Does patient call for rescheduling? If not, exit, otherwise go to 3.
7.Does patient need a follow-up appointment in the same appointment
category? If so, than go to 8, if not then go to 9.
8.Delay until patient calls for follow-up appointment, than go to 3.
9.Does patient need a "regular" follow-up appointment? If not then exit
system.
10. Delay until patient calls for follow-up appointment, and then go to 3.

c) Supply

In practice, schedules providers are determined by templates, which are

essentially daily specifications of the number of appointments for different types of

appointments. This accommodates different productivities of the providers as well as

different specializations, which will result in different proportions of appointment types

attributed to various scheduling requirements, such as vacation time, research time, and

other commitments.

33
 d) Scheduling Rules

Computerizing the schedule moves the scheduling operation to the call center,

through a specific model, assigned to a patient appointment request. The main principle,

currently used by the schedulers, is the level of urgency of the appointment. It

determines the scheduling flexibility whether or not an appointment may be over

reserved and whether the appointment is specific to a particular provider, any available

doctor should provide the necessary care.

Su and Shih, (2003) have studied in a private hospital, which has several clinics.

For each clinic, the average patient load is 20 per consultation section (morning or

afternoon) and the health care system adopts both a patient appointment model and

patient registration model. The system allows patients to have self-selected specific

physicians for consultation and registration.

The management appointment system studied by Su and Shih, (2003) is based

on the first 20 reserved for scheduled patients, after that, only seven are offered for

scheduling. Odd numbers after 20 are left for walk-ins. The arrival time of the first

patient is assumed to be the same as the clinic starting time. The scheduled patients are

assigned based on 3- main intervals and are also informed about their appointed arrival

times (see Figure 2.10).

34
 Figure 2.10 Patient processes in the clinic
(adapted from Su and Shih, 2003)

If the scheduled patient does not appear on time, the next available patient

receives consultation immediately. The management operating philosophy of services

here is based on ‘‘first in, first seen’’ to limit patient waiting time. Therefore, a patient

can walk-in to see a physician, when patient shows up at the appointed time (Su and

Shih, 2003).

35
 Ellingsen and Obstfelder, (2006) studied on Individual Action Implementing

Electronic Booking System. The system refers to the patient's appointment, when

patient arrives at the hospital for examination and/or treatment. Traditionally, the patient

must have an appointment. Determining the appointment depends on the hospital

resources and the patient current condition. When the decision of an appointment time is

made, the patient is informed by mail with the hope that it suits the patient. The

implementing system here is to solve this problem through establishing a flow of

patients through the health care system by giving the opportunity to a patient to choose

a suitable date and appointment time for them.

A web-based booking application to help the patients to get an appointment can

be developed. Once the nurse decides that the patient needs an appointment, the nurse

logs in the web-based booking application using both username and password and then

specifies the appointment time. Ellingsen and Obstfelder, (2006) have developed a new

concept to facilitate two or more systems in the health care center such as electronic

patient record and electronic booking application. They incorporated the electronic

patient record and electronic patient record in the same system when a patient needs to

enter their particulars, where there is special page for this purpose (see Figure 2.11) and

when the patient want an appointment they have to log in the specific page in the

appointment process (Figure 2.12).

Figure 2.11 Patient information for registration

(adapted from Ellingsen and Obstfelder, 2006)
36
 Figure 2.12 Patient appointments (electronic booking)
(adapted from Ellingsen and Obstfelder, 2006)

Aiello (2005) worked on the patient appointment system in an army primary

care clinic. It is an Open Access Appointment System. There are three classes of

appointment systems in the army primary care, with each having different types of

appointments:

i) The traditional access system: patient has to call the clinic for an appointment and

depending on the patient medical need, patient given an appointment type and time.

ii) Predictable request for appointment: Patient, who calls earlier, will benefit from

confirmed appointment, whereas the patient, who calls later, will be placed in an

unconfirmed future date.

iii) Nontraditional appointment approach: the patient is asked `Do you want an

appointment today? and who is your preferred physician? Then, the patient will

define and control the appointment process.

In managing patient appointments in the army primary care, normally, there are

nine types of appointments. Once a patient calls for an appointment, patient will be

placed into one of the nine appointment types. Many clinics in the army are establishing

this service to handle the inability of patients to receive the same day care. The open

access method is a solution for patients, who is unable to see the nurse for the second

appointment and this reduces the current backlog of clinic appointments until every

patient is able to accept the same day appointment.

37
 Kopach et al., (2007) has developed a system, where the appointment can be

made many months in advance. Once the patient wants to have an appointment to see

the physician, they just have to call the health care informing the preferred date and

time. If the appointment slot is available within a day or two of the preferred date, the

patient appointment is then scheduled. If not the patient has to call back later;

(Figure 2.13) shows this concept, which balances between the request of appointment

and the clinic capacity. This has improved patient access to physicians and reduced

uncertainty in the health care operations by eliminating no-shows, resulting from long

appointment times. In addition, in static appointment, all decisions about appointment

times are made prior to the start of a session, but in the dynamic case, the appointment

times are adjusted as patients arrive.

Figure 2.13 Patient appointments process

(adapted from Kopach et al., 2007)

38
 There are three parameters in the appointment system - the “block,” which is the

number of patients arriving at the beginning of an appointment period; the “initial

block,” which is the number of patients arriving for the initial appointment; and the

“interval,” which is the length of the appointment (Kopach et al., 2007).

2.7 Critical analysis for previous research

Based on the literature review (see Table 2.3), all the previous studies are

targeting to do some or all of the following:

‐ Improving the quality of health service.

‐ Managing patient information in the health care.

‐ Managing the patient appointment.

‐ Reducing the patient waiting time.

‐ Providing the easy way for patient health.

‐ Keep tracking for patient information.

On the other hand, those studies come out with one or both of the following points:

a) Analysis: some of the previous studies were targeted to analysis the current

system use in the health and find out the points that can help to improve the

performance of health care system and improve the quality of health care.

An analyses aim was focusing on the steps of patient treatment and

consultation. In addition, managing the patient appointments and focusing on

reducing the patient and doctor idle time. Therefore the results of those

analyses were Patient treatment and consultation flow chart and Patient

appointment flow chart (see Table 2.3).

(Giachetti et al., 2005), (Wijewickrama and Takakuwa, 2005), (Porta-Sales et

al., 2005), (Guo et al., 2004), (Su and Shih, 2003) and (Kopach et al., 2007).

39
b) Developing health care system: some of the studies were targeted to come

out with a health care information system, such those systems were

developed based on the user requirements and or based on the system needs.

The main point here is the health care has much information that needs to be

managed such as patient information, medication history, appointment,

doctor schedule, health care document and payment and so on. Therefore the

researchers followed a different method for developing those systems (see

Table 2.3).

i. Application: Computer application developed as a client and

server in entrant network. This type of application can manage

the health care information and it helps to automate the health

care information. Such an application was developed by

Laserfiche (2007) and Rohleder and Klassen (2002).

ii. Web-based: It’s a health care website is linked to an

interactive database. This system can be accessed as a normal

website because it's been developed to be work based on the

web browser. Such a Web-based was developed by   (Wald et

al. (2004), Lindemann-v (2002) and Lim et al. (2006).

iii. Website: It is a health care website and the patient can review

and register online through it. Such a Website was developed

by Ciminoa et al. (2000).

iv. Email: Used for sending messages from the health care staff

to the patient to inform them about new appointments or any

announcements and the patient can send to the staff regarding

40
 any inquiries. Such these service used in a system developed

by Mustafa (2004).

v. Telephones: The traditional way for connecting between the

patient and the health care staff. The patients use it for

booking appointments or confirming appointments or any

other inquiries. Such this system an integrated with computer

application. This system has been developed by Porta-Sales et

al. (2005).

vi. Blocks: This means dividing the patients to groups. This way

it’s a result for analysis study has been done by Harper and

Gamlin (2003).

vii. Multiple methods: Some of the researchers use multiple

methods for developing health care system to get the benefit

of each method. Such as Application and Web-site by Chua

(2005), Mazzi et al. (2006) and Aiello (2005).

41
Table 2.3 Critical analyses, system features and types for previous studies based on the
literature review

42
 Based on the previous study, and analysis done in section 2.7 the conceptual

framework based on the literature review in an integrated developed system show on

(Figure 2.14). In addition the conceptual frame works for the appointment system (see

Figure 2.15).

Figure 2.14 Conceptual framework for health care system based on the literature
review

Figure 2.15 Conceptual framework for the appointment system based on the
literature review

43
Table 2.4 Limitation and strength of the health care system based on the previous study
in the literature review
Strength of health care system
- Improving the quality of service in
the health care (Laserfiche, 2007),
- Using the system online and
allowing the patient to view their
profile online (Lindemann-v et al.,
2002).
- Integrated health care system (Lim
et al., 2006).
- Patient can choose the physician
and the appointment date online
(Mustafa, 2004).
- Using the call by phone to interact
between the patient and the nurse.
- Using the online manner to support
the health care application.
- Dividing the problem of managing
the appointment into small blocks,
which help to find a good solution
(Harper and Gamlin, 2003).
Limitation of health care system
- Most of the systems are not
integrated system (Mazzi et al.,
2006).
- Some of the systems developed to
manage part of the health care
information (Mazzi et al., 2006).
- All the applications hold around
the appointment problems and did
not give enough mention about
conforming the appointment
(Mazzi et al., 2006).
- Confirmation the appointment
usually using the call by phone
(Porta-Sales et al., 2005).
- Using the email for booking and
confirming the appointment, which
is some time not suitable for some
patients (Hall, 2006).
44
2.8 Conclusion

Information system is a technology used to deliver the right information to the

right person at the right time in any fields of business. Essentially, the system is an

arrangement of information technologies used for capturing, storing, and distributing

data to meet an organization's needs. This includes computer hardware, operating

system and application software as well as telecommunication and networking

technologies.

In the health care information system, the importance of an information system

has originated from the need of keeping tracking of patient information efficiently. The

Health Care information System is the preservation of individual patient information to

represent their health information history and provide the flexibility and accessibility for

patient information to be more reachable by authorized personnel. On the other hand,

managing patient appointment is a computer application used to manage and reduce the

patient’s waiting time in the health care center. This means a patient appointment

system uses a sophisticated queuing model, that captures much of the real system’s

features.

Traditionally, determination of patient appointment is dependent on the hospital

resources and the patient current conditions. So, when the decision of appointment time

is made, the patient is informed by mail, phone, or other means with the hope that the

appointment time satisfies the patient. Therefore, developing a software or application

for solving the health care problems has to consider several aspects of the problems.

Based on the literature review, and the critical analysis done in section 2.6 there

are some points of relevance to be considered:

i. The proposed health care information system should cover every single aspect of

administrating and managing health care.

45
 ii. In using the information system, for managing the health care information to

improve the quality of health service.

iii. In using the information system, the patient is given the opportunity to use the

system and access his/her information.

iv. In using the information system, the patient can access the appointment

possibilities and chose the suitable time.

2.9 Summary

The literature review dedicated to review what the previous researchers have

done to improve the quality of health care. In this research, the objectives focuses into

analyzing the previous studies and the current systems use in the health care, then

design and develop an integrated health care system for managing the patient

information and tracking the patient information history. In addition, provide very

secure and sturdy communication between patients and physicians.

Hence, a general information about health care information system has been

presented to give briefing about definitions and significant of health care information.

Then the next part present the health care management system, patient appointment

system, managing patient appointment system, which reviewed the previous studies that

explained several methods for managing the health care information and the patient

appointments. Finally, it is the critical analysis part for the previous studies, which

present the features of each study and the result is conceptual framework and

comparison between the limitation and the strength of each study. The next chapter is

the research methodology, which describe the method that use to implement this

research.

46
 CHAPTER 3

Research Methodology

3.1 Introduction

Research methodology is a guideline for application development. It provides an

overview of the methodology flow and the research methods to be used to achieve the

aims of the research. The purpose of using research methodology is to solve the

research problem or problems and achieve the aims of research (Dawson, 2002).

This research aims to develop an integrated health care computer application to

manage the entire patient information such as medical history, consultation history,

treatments history and patient appointment etc. Therefore, the objectives focuses into

analyzing the previous studies and the current systems use in the health care, then

design and develop an integrated health care system for managing the patient

information and tracking the patient information history. In addition, provide very

secure and sturdy communication between patients and physicians.

This chapter highlights several points started by chapter introduction, the

research strategies, data collection and highlights of the research respondents, the plan

of data collection and emphasizes on the data analysis framework, and finally focuses

on the way of system development.

3.2 Research Strategy

The concept of this research strategy comes from analyzing the literature review

that proved the current health care information system is not completely comprehensive

and each researcher focused only in part of the health care information system and there

is a lack of the integrated health care systems that can fulfil the patient’s need for

medical information.

47
 So, this research aims to provide a proper academic solution through following

the research methodology structure. Therefore, this chapter starts by research strategy,

which is describing the way of implementing the research study.

Hence, the adopted research strategy is presenting the finding from analyzing the

previous studies in chapter two and supports the result by adopting case study from the

real live, which is typically observing the characteristics of the research respondents,

how they are doing their work, because the adopted strategy is proving the credibility

results of analyzing the previous studies.

Therefore, the research respondents should be staff member in a hospital who

uses a health care management system and patients in hospital for medication purpose,

because the staff member they are daily use the current health care system and they are

familiar with the system environment. So these people absolutely know about the

limitation and /or problem in the current health care system. Conversely the patients

may have suggestions which could helps to enhance the quality of health care especially

with the aim of all the health cares are targeting to deliver a very good health services to

the patients.

However, the reason of using such strategy is for achieving the problem

statement of this research needs to study and analyze the finding from the literature

review and the current health care system, which is requiring the implementation of

empirical research. So using a case study is approaching facilitates for this research and

drive to probe deeply into a health care responses through interviewing the respondents

in both hospitals (UH and HUKM). The interview was by asking the respondents

several open questions, those questions are arranged in sequence started by the current

system use in the hospital and then the respondent’s suggestions about the new system,

then the respondent’s answers written as notes under each question asked.

48
3.3 Data Collection

Once the research strategy has been adopted, the next step, method of Data

collection is required, which is containing description of the research sample

(respondents) and the sample technique, and then the data collection technique

(interview and observation).

In this research data collection is from two public hospitals (UH and HUKM),

because those hospitals are big, public and daily hundreds of patients come to the

hospital for medication. So definitely the management of hospital they are facing

problems for managing the patient information and managing the patient appointment.

In addition, they are using non integrated health care system for managing the patient

information. Furthermore, these hospitals are academic hospital, which have a good

environment to conduct such academic research.

3.3.1 Data Collection Techniques

Data collection is a technique, that allows researcher to systematically collect

information about the study population (people objects, phenomena etc) and the setting

in which they occur (Biggam, 2008).

Likewise, collection data in this research goes through the interview because the

individual interview is straightforward to get the information from the respondents

(doctor, nurse and patient) and this research needs to meet the respondents individually

and ask them closely about the problems they are facing from using the current system.

Moreover, observing them, how they are doing their work to probe deeply and to

analyze intensely the process of managing the patient information.

49
3.3.2 Data Collection Tools

Many data collection tools can be used for collecting data; they are either

interview or observation based. Therefore, the tools used for each technique differ.

Below is description of some the data collection tools used in this research:

i. Interview schedule: which means scheduling the respondents in check

list, first is doctor then nurse then patient and arranging the list of

interview questions in sequence and the answer of each question is

written under each question (see Appendix A).

ii. Observation: which is observing the participants, how they are doing

their works and writing down the process as it is appears in (UH and

HUKM) case studies.

3.4 Research Sample and Respondent

In this research, the respondents are group of people (doctor, nurse and patient)

from public hospitals (UH and HUKM) (Table 3.1) and respondents sample chose

randomly because that data needed for this research is looked in the standpoint of each

sample about the current system use in the hospital.

Table 3.1 Research Respondent

HUKM UH Total
Doctor
2 - 2
Nurse 1 Nurse (Dr assistance)
1 Nurse
1 Nurse (senior) 3
Patient 2 3 5

50
3.5 Plan of Data Collection

Disposing plan for collecting data is a very important step before starting

collecting data. It helps for getting the correct data. The researcher has to have very

clear plan for data collection and decides on the type of study needed. The data

collection techniques and sampling methods are needed because the following reasons:

1) To ensure that all needed information are going to be collected.

2) To avoid collecting unnecessary data, the data collection plan includes the

following:

i. Type and number of data collection tools are needed.

ii. Categories and number of data collecting personnel (doctors, nurses, patients

etc).

iii. Duration and content of data collection.

iv. Schedule for data collection (Selection of personnel, preparation of tools,

starting date, closing date and time for each study phrase etc.)

Hence, the adopted strategy, increased the reliability of collected data and

enhance credibility of the research, where the data for the study were collected from

different public hospitals in Malaysia (University hospital -UH and Hospital University

Kebangsaan Malaysia - HUKM) after getting the respective approvals from the

management of UH and HUKM for conducting the interviews and the observations. The

interviews and observations were timed during the appointed times at different dates. In

UH, the interview was conducted with a senior nurse for about one hour. In addition,

three patients in UH chosen randomly were also interviewed. In HUKM, the interview

was also done with one nurse alone and another nurse with doctor assistance. In

addition, one doctor and two patients who were chosen randomly were also interviewed.

51
 Observations were carried out both in HUKM and UH for one hour each. The

observations were focused on the staff nurses, when they were on duty registering new

patients, and managing the appointments between the patients and the doctors. In

addition, attention was also focused on patients themselves - how they follow the steps

to get the appointment with the doctor and how they confirm the appointment and meet

the doctor.

3.6 Framework for Data Analysis

After disclosing the proposition of collecting data, next is explaining the method

of analyzing the collected data by breaking down the collected data from interview into

easily identified groups as it is appear in (appendix a) UH and HUKM group, and then

identifying subset in each group (Doctors, Nurses and Patients) and then organizing the

questions of each subset into two parts. The first part is about the current health care use

and the second part is suggestions about the new system. (Figure 3.1) illustrates the

adopted analysis approach.

Figure 3.1 Framework of data analysis

52
3.7 System Development

System development is the methodology of developing a system based on

measures and rules. In addition, developing a system is implemented as a set of steps or

phases. The reason for organizing the methodology of development is to ensure that

nothing is ignored in the process of solving a problem such as developing an

information system (Davis and Yen, 1998).

In this research, developing an integrated health care management system using

waterfall method, which works cascading from step to step like series waterfalls and the

good feature of this method is that there are feedbacks between the steps (See Figure

3.1).

Figure 3.2 Waterfall method

(adapted from Davis and Yen, 1998)

i. Problem definition: This step initially identifies the problem and why the health

care needs a system.

ii. Analyzes the problem: This step determines exactly what must be done to solve

the problem and identifying all the points that’s my have influence on the

system.

53
iii. System Design: which means determining how the problem will be solved and

implementing how the system will look. On the other hand means identifying

and designing the system database and the system interface.

iv. System Development: This stage moves from the logical to the physical

processes, converted to manual procedures or a computer program which means

using the programming language that will be used for developing the system. In

this research the following programming languages will be used for developing

the system,

a. Apex Oracle,
b. Oracle PL/SQL,
c. SQL,
d. HTML and
e. Java Script.

v. Testing: After the system has been developed it should be ready for testing.

Testing stage is testing all the system function and checks the system validation.

This stage is very important because it’s providing feedback to the developer.

vi. System implementation: This stage is continuation of the system development

based on the feedback.

vii. Maintenance: It is the final stage, where the system functioning is kept at an

acceptable level.

54
3.8 Conclusion

The research strategy of this research adopts analyzing the previous studies and

supports the results by a case study from the real live and collecting data through

interview and observation. The reason of using such this strategy is because of this

research considered on the analysis results of literature review, which needs to be

supported by data from the real live such a case study and then comparing and

analyzing the finding. Moreover, this chapter covers the methodology of developing a

system, which is the waterfall method, because this method works cascading from step

to step like series waterfalls and the good feature of this method is that there are

feedbacks between the steps.

3.9 Summary

The first part of this chapter is the research strategy that describes the way of

implementing the research study, and then covering collecting data method which

contains data collection technique and data collection tools, then presenting overview

about the research sample and participants, then the plan of data collection. Once the

data is collected, the next part is presenting the framework of data analysis and finally is

the methodology of system development. The next chapter is presenting the case study

and the collected data.

55
 CHAPTER 4

Data Collection, Analysis and Findings

4.1 Introduction

Data collection is the very next step after identifying the research methodology

and the research strategy. Determining the methodology of collecting data depends on

the type of data that the researcher wants. Therefore data collection can be a multiple

technique, such as observation and interview. The researchers may prefer to use more

than one technique for collecting data, which help them to get the range of perspectives

(Biggam, 2008).

As mentioned in Chapter 3, there are two ways used for collecting data, namely

interview and observation. Both methods are suitable for collecting data to get accurate

and correct information about health care management system. Data should be collected

specifically to provide reliable and valid base information to address the objective of

this research.

On the other hand, analyzing data investigates and evaluates words and

observations, which means using the interpretation to improve the understanding of the

data collected. However, there is nothing call the best way for analyzing data because

the analysis must come through steps and the results of the analysis depends on that

steps (Powell and Renner, 2003):

i. The questions that needs to be answered.

ii. Who will use that answers.

iii. The resources of that answers.

56
4.2 Case study

Case study is a result of observation in this research and it is a method that

enables one to learn and analyze a real situation and to develop a solution by applying

theoretical concepts and experience. Moreover, through a case study, a researcher faces

new problems might never experience before. So, because Health Care Management

System is very complicates to understand by interview only, it is very important to

include a case study to include every single point, the researcher might think not

important.

4.2.1 Study 1 (UH) University Hospital

This case study is a result of observing the patient medication process in (UH)

University Hospital, and the systems used in the UH for managing the patient’s

information and the process of patient appointment confirmation.

Generally, regarding to the data collected through the interview (appendix a-6),

UH is using several systems used for managing the patient’s information and other

systems are used for managing different information related to UH. The systems, which

used for managing the patient information, are four major systems (patient information

system, pharmacy system, laboratory system, payment system) these systems are

connected together through database server unit. The nurses are working with the

patient information system to manage the patient information such as patient personal

information, diagnosis reports, suggested treatments and appointments etc. If the patient

has medicine or the doctor prescribed a medicine to the patient the information about

prescribing the medicine it’s in other system (pharmacy system). This system is for

managing the medicine information (product information, prescribing information).

Likewise, if the patient has a laboratory test, all the information related to the laboratory

test is managed by the laboratory system.

57
In addition; if the patient needs to pay for medication, treatment or anything else the

payment information is managed by another system calls payment system this system to

manage all the payment information in the hospital.

Through observing the process of work in UH the patient cannot see the doctor

unless the patient has an appointment. So once the patient has completed the registration

process and obtained the green card (patient card), patient has to check with the

appointment staff for the appointment booking.

The appointment staffs, who are not necessarily a nurse, will check the doctor

availability on another system called (doctor schedule) and give the patient the clinic

number. Then, the patient has to go to the clinic, where will get the queue number to

meet the doctor.

i. Doctor checks the basic diagnosis repot that comes from the nurse or from

the external consultation clinic.

ii. If the patient needs a medicine, the doctor will write down the medicine

prescription in the patient report.

iii. Then the nurse takes the report and key in the medication information in the

pharmacy system (some doctors are keying in the medicine prescription in

the system by themselves).

iv. The patient has to go by himself to the pharmacy and collect his medicine.

v. About the payment there are special staffs, the patient has to go to them and

pay the payment and this staff has special system for them to manage the

payments.

58
 On the other hand, the process of managing the patient appointment, once the

patient has received the treatment, the doctor will write in the green card (patient card)

for the next appointment date, if the doctor needs to make another medical check up on

the patient in the future. Then, to get an appointment, the patient has to show up at the

appointment staff to book the next appointment. The patient is then given an

appointment on a specific date. In the next time, when the patient comes to the hospital,

patient has to see the appointment staff to confirm the appointment.

4.2.2 Study 2 (HUKM) Hospital of University Kebangsaan Malaysia

This case study is a result of observing the patient medication process in the

Hospital of University Kebangsaan Malaysia (HUKM), and the systems used in HUKM

for managing the patient’s information and the process of patient appointment

confirmation.

Generally, HUKM is using the same method as in UH for managing the hospital

information, they have a several systems for managing the patient’s information and

other systems are used for managing HUKM information (appendix a-1, a-2 and a-3).

The systems that used for managing the patient information are three major systems

(patient information system, pharmacy system, and payment system), these systems are

connected together through database server unit. The nurses are working with the

patient information system to manage the patient information such as patient personal

information, Patient diagnosis, patient treatments and patient appointments, etc. If the

patient has medicine or the doctor prescribed medicine to the patient the information

about prescribing the medicine it is in another system (pharmacy system), this system is

for managing the medicine information (product information, prescribing information).

59
 In addition, if the patient needs to pay for medication treatment or anything else,

the payment information is managed by another system calls payment system, this

system to manage all the payment information in the hospital.

Through observing the process of work in HUKM the patient cannot see the

doctor unless he books an appointment. So, once the patient has finished the basic

treatment in the emergency hall or from any external clinic, the consultation report send

direct to the doctor’s room, where there is a nurse or staff, whose main job is to manage

appointments between the patient and the doctor. If the patient is paying his/her first

visit, the appointment staff or the nurse will make the appointment based on the doctor’s

availability (checking the doctor availability in different system called (doctor

schedule). From next visit, the patient has to use the system to make appointment;

otherwise he/she would not be allowed to see the doctor. This patient has to show the

nurse the patient card; the nurse will then check the appointment date and confirms the

appointment. Finally the nurse tells the patient to take a queue number and waits to meet

the doctor, then the next steps in the doctor consultation room.

i. Doctor checks the basic diagnosis report that comes from the nurse or from

the external consultation clinic.

ii. The doctor will write down the medicine prescription in the patient report.

iii. Then the nurse takes the report and key in the medicine information in the

pharmacy system (some doctors are keying in the medicine prescription in

the system by themselves).

iv. The patient has to go by himself to the pharmacy and collect his medicine.

v. About the payment, there are special staffs, the patient has to go to them and

pay the payment and this staff has special system for them to manage the

payments.

60
 Once the patient has been treated, and if the doctor needs to make another check

up in the future, the doctor will write on the green card (patient card) the next

appointment date. Then, to get the appointment, the patient will show up at the

appointment staff to book the next appointment. So, now the patient has a specific

appointment date. In the next time, when the patient visits the hospital, patient has to see

the appointment staff to confirm the appointment.

4.3 Data Capture

Based on both of the case studies in UH and HUKM, and the interview, both of

the hospitals have the same structure for managing the patient information. In UH and

HUKM the nurse has to look in more than one system for managing the patient

information (personal information, medicine information and appointment information).

Although the appointment processes are clear for both hospitals, there have been

cases where some patients with appointments did not come to the hospitals and other

patients without appointments came to the hospital. To manage unscheduled

appointments of such type, the nurse and the doctor should know how many patients

with appointment and how many of them are coming. This is because in the normal

process, the doctor has many things to do in the hospital (operations, conferences,

critical care, etc) and needs to manage his time based on the confirmed number of

appointed patients.

Actually, the nurse has a daily list of patients, who have appointments with the

doctor, but nurse doesn't know how many of them would turn up to see the doctor.

Based on this, the nurse manages the doctor time - how long time the doctor has to be in

the clinic and how many patients the doctor has to see.

61
 Consequently, in this research the data captured through the observation in both

of the hospitals (Case study) and the data captured also through the interview (see

appendix a-1 to a-10) summarized in the following:-

i. Both of the hospitals have more than one system for managing the patient

information.

ii. The nurse has to work for more than one system to manage the patient

information.

iii. For prescribing the patient medicine, the doctor or the nurse has to use another

system called pharmacy system. 

iv. For managing patient information, the nurse enters the patient information into

the system, called Electronic Patient Record. If the staff needs information they

have to see the nurse or access the system themselves using their own user name

and password. 

v. For managing the appointment time, after the patient is registered, the nurse

gives the patient an appointment card. Then, the patient has to wait in the queue

to meet the doctor. After the treatment and if the patient needs another

appointment for instance after one week or two week, patient has to see the

nurse again for booking. In the next visit, there is no need for the patient to

register again and patient has only to go to the nurse to confirm the appointment.

The nurse will then give him the appointment card. 

vi. The coordination between the patient and the doctor is done through the nurse

by specifying the appointment time and schedule. 

vii. The nurse determines the patient appointment based on the doctor’s schedule

through another system. If the patient needs another appointment, the nurse has

to check the doctor schedule and the patient’s need for the appointment. After

the nurse finds the suitable date. 

62
viii. The patient is expected to arrive about 10 minutes before the appointment time

because the patient needs to register and confirm the appointment.

ix. For appointment confirmation, the patient has to arrive earlier to the hospital, if

the patient wants to see the doctor early, because the rule in the hospital is first

come first reserve. If the patient does not have an appointment or has not

confirmed the appointment, the patient will not get to meet the doctor.

x. Checking the doctor availability by the nurse through different system called

(doctor schedule).

xi. For medicine prescribing, it is through different system.

xii. The consultation payment and the treatment fees it is in separate system for

managing the payment only.

xiii. Managing the Products (medicines) it is through different system for the

pharmacy. 

xiv. For appointment confirmation procedure, the patient has to inform the nurse that

wants to meet the doctor and has an appointment. The nurse will then check the

appointment in the system and confirms the appointment for patient. If there

arises, any additional information, the patient has to see the nurse again. On the

other hand, the doctors usually never use the system.

4.4 Data Analysis

In this research, the general analytical strategy is presenting analysis the current

system construction in (UH and HUKM) based on the data collected through the

interview and observation. After that, presenting analysis of the patient registration

process and the appointment process in (UH and HUKM), and then representing the

results in flow chart diagram to find out the difference between them. The reason for

using this strategy for analyzing the collected data is because of the purpose of collected

data is supporting the finding from the literature review.

63
 Therefore, the open questions that have been answered from the interviewee and

the data collected from the observation organized in themes (Table 4.1):

i. The system construction.

ii. Current system use.

iii. Patient registration process.

iv. Patient appointment process.

v. Appointment confirmation process.

Those themes help to analyze the respondent's answers (appendix a and observation i.e.

case study). In table 4.1, if the number is 1 means that the answers and the observation

data from the respondents in both hospitals are same and if the number is 2 mean that

the answers and the observation data from the respondents in both hospitals are not

same.

Table 4.1 The analysis of data collected

UH HUKM
Data Source
Nurse Patient Nurse Doctor Patient
System Interview and
1 1 1
construction observation
Current
1 1 1 Interview
system use
Patient
Interview and
registration 2 2 2 2 2
observation
process
Patient
Interview and
appointment 1 1 1 1 1
observation
process
Appointment
Interview and
confirmation 1 1 1 1 1
observation
process

Based on the (Table 4.1) those hospitals are using more than one system for

managing patient information, such as patient registration, patient consultation, patient

medication, and the medication payment, and setting the appointment and confirm the

appointment. All those systems are separated systems (appendix a) and connected

through server database (Figure 4.1).

64
 Figure 4.1 The current system construction use in UH and HUKM

In addition, some of those systems are used to manage information related to the

hospital (see Figure 4.2) such as (pharmacy hospital for managing the products and

doctors schedule for managing doctor status, etc). Hence, the user needs to use more

than one system to find or to manage different information such as (medicines

prescription, it should be through the pharmacy system and the doctor status for patient

appointment, it should be through doctor schedule system, etc). The following is the

steps that the user has to follow to manage the patient medical information:-

i. Doctor checks the basic diagnosis repot that comes from the nurse or

external consultation clinic.

ii. The doctor writes down the medicine prescription in the patient report.

iii. Then the nurse takes the report and key in the medicine information in the

pharmacy system (some doctors are keying in the medicine prescription in

the system by themselves).

iv. The patient has to go to the pharmacy and collect the medicine by himself.

v. About the payment there is a special staff they are using payment system to

manage the patient payment.

65
 Figure 4.2 Network design topology for hospital UH and HUKM

On the other hand, the analysis of patient appointment and appointment

confirmation process in both of the hospital (UH and HUKM) are the following:

4.4.1 University Hospital (UH)

Based on the data, that have been collected about patient appointment process,

(interview and observation) from UH (senior nurse (appendix a-6) and three patients

(appendix a-7, a-8, a-9 Patient 1, 2, 3)), the patient has to follow specific procedure and

steps based on the patient categorize such as; new patient, existing patient has an

appointment and existing patient does not have appointment. For each category there is

a different procedure and steps the patient has to follow to get the treatment, (see Figure

4.3 and appendix a).

These steps can be organized into two steps, firstly the registration step and

secondly is the appointment step. Therefore, referring to the senior nurse and the

patients (appendix a-7, a-8, a-9 Patient 1, 2, and 3) in UH, these steps presented in

(Figure 4.3) and summarized as the following:

66
1) First time, patient without appointment

i. Patient arrives.

ii. Get queue number, to see the nurse for basic medical check up.

- If the patient came from external medical consultation, the nurse

follows the consultation report and send patient to the clinic or

doctor that’s mentioned in the report.

- If not, the nurse will specify the clinic or the doctor based on the

basic medical check up and patient case.

iii. Then, patient should see the registration counter,

iv. Then, patient goes to the clinic,

v. Get queue number.

vi. Patient meets the doctor,

vii. Doctor treats the patient.

viii. Doctor prescribes the medicine.

ix. If the doctor wants to see the patient again for medication purpose,

doctor will write down behind the patient card the next appointment date.

x. The patient, who has next appointment, should see the nurse for

reservation purpose.

xi. Nurse books the next appointment date for patient.

2) Second time, patient with appointment.

i. Patient arrives.

ii. Get queue number to see the nurse.

iii. Show the nurse the patient card,

iv. Nurse look in the system to check the patient appointment,

v. Then, confirm the patient appointment based on the doctor

availability.

67
 vi. Patient get queue number to meet the doctor.

vii. Then, patient meets the doctor and got the treatment.

viii. Doctor prescribes the medicine.

ix. If the doctor wants to see the patient again for medication purpose,

the doctor will write down again behind the patient card, the next

appointment date.

x. The patient, who has next appointment, should see the nurse for

reservation purpose.

xi. Nurse books the next appointment for patient.

68
Figure 4.3 Patient flow steps (Chart) in UH

69
4.4.2 Hospital of University Kebangsaan Malaysia (HUKM)

In HUKM the patient procedures to meet the doctor and getting the treatment is

more complicated than UH, but the steps are very similar. Based on the data, that have

been collected through (interview and observation) about patient appointment process

from HUKM ((nurse (appendix a-2, a-3) and patients (appendix a-4, a-5)) the patient in

HUKM has to follow specific procedure and steps.

Initially, before starting to explain the steps, the patient in HUKM can be

categorize into three categories same as UH, which is new patient, existing patient has

an appointment and existing patient does not have appointment, and each categories of

patient has to follow different procedure, (Figure 4.4) representing that in flow chart.

1) First time, patient without appointment:- which means, its the first time to

come to HUKM and below what the patient should follow:-

a) Patient arrives to the emergency hall.

i. See the registration staff,

ii. Then, the registration staff sends patient to the nurse for basic medical

check up,

iii. Then, the patient sends to the emergency hall to wait for the doctor.

iv. Patient gets the treatment.

- If the patient needs especial doctor, the emergency doctor should

send the patient back to the nurse with the patient case report and

the patient medication needed

- Then the nurse can send the patient with the report to the special

doctor.

70
 b) Patient arrives at the clinic or doctor directly. But here the patient should

have a patient report from external clinic.

i. Patient arrived to the hospital with the report form external

clinic.

ii. Patient asks the nurse for registration purpose.

iii. Nurse registers the patient and getting all the information

needed from the report.

iv. Patient got the queue number and wait for doctor.

v. Doctor treats the patient.

- If the doctor needs to see the patient again the doctor

writes the next appointment in the patient card.

- The patient, who has next appointment, should see the

nurse for reservation purpose.

- Nurse books the next appointment date for patient.

2) Second time, patient with appointment: Patient might arrive to the hospital

and it's not the first time, it might the second time or above. In this case,

this patient categorized into two types:

a) Second time and patient has appointment.

This patient have seen the doctor in the previous visit and got the

appointment. So the patient comes to meet the doctor for that’s

appointment.

i. Patient arrived (not to the emergency hall).

ii. Patient sees the nurse and presents the patient card.

iii. Nurse gets the patient card from the patient and checks the

appointment in the system.

iv. Nurse checks the doctor availability.

71
 v. Then, confirms the appointment,

vi. Patient gets the queue number and sees the doctor.

vii. Doctor treats the patient.

- If the doctor needs to see the patient again, doctor will write down

the next appointment in the patient card.

- If the patient has next appointment, patient should see the nurse for

reservation purpose.

b) Second time and patient does not have appointment.

Some patient comes to the hospital and don’t have appointment, in this

case the patient should go to the emergency hall and follow the steps,

except the registration step because this patient information already in

the system.

72
Figure 4.4 Patient flow steps (Chart) in HUKM

73
4.5 Findings

After the analyzing process for the current system in (UH and HUKM) is

completed, and based on the analysis part in the literature review in this research,

several points are appeared to reflect the necessity of developing such this system.

Based on the analysis results for both systems the findings are:

i. The nurse has to work through different system to manage the patient

information.

ii. If the nurse looks for different information about patient, the nurse has to

look at different system.

iii. It is time consuming procedure for the nurse.

iv. It is more time consuming for the doctor.

v. It is not easy for the new user to be a familiar with the system.

vi. The new user, need long time training to understand the system.

vii. It is not easy for the admin to do the maintenance.

viii. It is not easy to add a new module to the system to support another service in

the hospital.

ix. If the network is down or network failure everything will stop and the user

needs to work manually.

Based on the analysis part and the finding, below is the new module (Figure 4.5) for

developing an integrated system to manage the health care information:-

i. Easy to use.

ii. No need for the user to look in different system to find patient information.

iii. The system has friendly interface, so the user can easily find the wanted

information.

iv. The user can be familiar very fast with the system.

74
 v. The health care management can use the system for managing all the health

care information.

vi. The way of developing the system, allowing the admin to extend unlimited

modules needs, based on the user requirements or the healthcare service

requirements.

vii. If the network is failure, the users still can work as long as if they have

internet connection.

Figure 4.5 The new integrated module

According to UH and HUKM case study and data collected (Appendix a-1 to

a-10) through the interview and observation, the patient has to go through steps to get

the treatment (registration step and the appointment step), those steps in different

hospital for getting the treatment are same and the different is the manner for following

the steps. Therefore, based on the analysis part, the finding of the current system

presented in the following module (Figure 4.6)

75
Figure 4.6 Finding Module from the Current System Used for Managing the Patient
Appointment

The current module aspects summarized in the following:

i. Nurse has to hold all the patient information.

ii. Usually, there is long patients queue; they are queuing to confirm their

appointment.

iii. For reducing the nurse working load the management determined special

staff for managing the appointments and one of their staff for confirming the

appointment.

iv. Usually, the doctor doesn’t know, how many patients have confirmed their

appointments.

v. The patient waits long time in queue.

vi. If there is no special staff for the appointment, the nurse has to do this work,

which carry over work load for her.

vii. The patient and the nurse need to spend at least ten minutes in confirming

the appointment.

viii. For each appointment show on, the patient has to present the patient card to

the nurse to confirm the appointment.

ix. The management cannot keep tracking for the confirmed appointment.

x. Only the nurse or the special staff has the authority to confirm the patient

appointment.
76
 Based on the analysis part and the finding, below is the new module, below

(Figure 4.7) is the new module for reducing the nurse working load and giving the

patient the opportunity to use the system to confirm appointment.

Figure 4.7 The new module for managing the patient appointment

Moreover; the aspects of the new model are summarized in the following:

i. It is not necessary for the nurse to hold all the patient information.

ii. There is not queue any more for patient to confirm the appointment.

iii. It is not necessary from the management to determined special staff for

confirming the appointment.

iv. The doctor can know how many patients are confirmed their appointment,

which will help him to manage his time.

v. There is no hustle for the patient any more.

vi. If there is no special staff for the appointment, the patient can confirm the

appointment by him self.

vii. The patient and the nurse need very shot time for confirming the appointment

and booking the patient appointment.

viii. It is not necessary to confirm the patient for the nurse about their

appointments.

77
 ix. The management can keep tracking for the confirmed appointment and give

powerful reports for all the system movement.

x. The patient has the opportunity to use the system and do some thing by them

self.

xi. The conformation process reduced.

4.6 System Testing

The developed system has been tested in two types of testing carried out; to

make sure the system is working successfully according to the specifications to achieve

the research objectives. First test it has been done by developer (researcher) and the

second test it is done by the system users.

The first testing is very important before the system released, which is testing

the system interface, buttons, menus, functions, charts, reports and system validation.

So, based on the first testing all these are working properly and testing two proved that.

The second testing is very important to get the user feed back. So, the system

should be tested in the real live environment, to check the extent of the system efficient.

Therefore, the integrated health care management system is ready to use by the system

user (Admin, Doctor, Nurse and Patient).

The second testing was in two public hospitals, (UH and HUKM), after getting

the approval from the hospital management, system testing was by two nurses from UH

staff and five patients in the hospital. In addition, another two nurses form HUKM staff

and five patients in the hospital. During the system testing there was system user

instruction to guide patient on how to use the system:

78
 i. Enter the patient number (Medical registration number).

ii. Enter the password (NRIC number or the password number).

iii. Click on button (all) to view all the appointments that you have.

iv. Click on button (new) to view all the new appointments that you have.

v. Click on button (cancel) to view all the canceled appointments that you have.

vi. Click on button (close) to view all the closed appointment that you have.

vii. Click on button (postponed) to view all the postponed appointments that you
have.
viii. Click on button (confirm) to view all the confirmed appointments that you
have.
ix. Press on button (reset) to reset the page.

x. To confirm today appointment press on view today appointment button.

- Press on button (view) for the appointment that you want to confirm.

- Press on button (confirm) to confirm your appointment.

- If your process is successes this message will appear" Congratulation

your appointment has been confirmed".

- If your process is not successes this message will appear "appointment

ID number …… has been canceled or closed. If you wish to set a new

appointment, please contact the nurse".

79
 1) University Hospital (UH)

The testing method was by timer; to count how long time the user needs to use

the health care management system successfully. Table 4.2 presents how long time the

nurse in UH needs to create patient profile and setting the appointment for new patient

and existing patient.

Table 4.2 UH Nurse, use system for creating patient profile and setting appointment
Start use Finished duration Create Pat Second Purpose for
system use system First time time using system
come
Nurse 1 11:10:00 11:13:50 9 Create Pat
First time am am 00:03:50 and set app
use system
Nurse 1 11:15:00 11:15:50 9 Set app for
First time am am 00:00:50 existing Pat
use system
Nurse 2 12:00:00 12:03:00 9 Create Pat
second time pm pm 00:03:00 and set app
use system
Nurse 2 12:30:00 12:30:30 9 Set app for
second time pm pm 000:0:30 existing Pat
use system

Once the nurse has finished creating the patient profile and setting the

appointment, the patient in UH allowed using the system to confirm their own

appointment by themselves (Table 4.3).

Table 4.3 UH Patients use system to confirm the appointment

Arrival Starting use Finished use duration First Second Purpose for Created by
Time sys sys time time using system
User User
sys
11:12:00 11:14:00 am 11:14:50 am 50 sec 9 Confirm app
Patient
am 11:17:00 am 11:17:30 am 30 sec 9 Confirm app Nurse 1
1
11:15:00 11:20:00 am 11:21:00 am 1 minute 9 Confirm app
Patient
am 11:30:00 am 11:30:50 am 50 sec 9 Confirm app Nurse 1
2
11:55:00 12:05:00 pm 12:06:00 pm 1 minute 9 Confirm app
Patient
pm 12:32:00 pm 12:32:45 pm 45 sec 9 Confirm app Nurse 2
3
12:35:00 12:40:00 pm 12:40:55 pm 55 sec 9 Confirm app
Patient
pm 12:45:00 pm 12:45:40 pm 40 sec 9 Confirm app Nurse 2
4
12:40:00 12:50:00 pm 12:50:50 pm 50 sec 9 Confirm app
Patient
pm 12:52:00 pm 12:52:45 pm 45 sec 9 Confirm app Nurse 2
5

80
 For doing the process of creating patient profile and setting the appointment in

UH (Table 4.2), if it is the first time for the nurse to use the system, the nurse needs

00:03:50, but once the nurse got familiar to use the system, the nurse needs 00:03:00. In

addition, for setting the appointment only, the nurse needs 00:00:50, if it is first time,

but once the nurse got familiar, the nurse needs 00:00:30. Moreover, for doing the

process of confirming the appointment (Table 4.3), if it is the first time for patient to use

the system, the patient needs between 00:01:00 to 00:00:50 second, but once the patient

got familiar to use the system, the patient needs between 00:00:50 to 00:00:30 second.

2) Hospital of University Kebangsaan Malaysia (HUKM)

Table 4.4 presents the duration of the nurse in HUKM needs to create patient

profile and setting the appointment for new patient and existing patient.

Table 4.4 HUKM nurse, use system for creating patient profile and setting appointment

Starting use Finished duration Create Pat Second Purpose for

system use system First time time using system
come
Nurse 1 9 Create Pat and
First time 03:10:00 pm 03:13:30 pm 00:03:30 set app
use system
Nurse 1 9 Set app for
First time 03:20:00 pm 03:21:00 pm 1 minute existing Pat
use system
Nurse 2 9 Create Pat and
second time 03:45:00 pm 03:48:00 pm 00:03:00 set app
use system
Nurse 2 9 Set app for
second time 04:04:00 pm 04:04:30 pm 00:00:30 existing Pat
use system

Once the nurse has finished creating the patient profile and setting the

appointment, the patient in HUKM allowed using the system to confirm their own

appointment by themselves (Table 4.5).

81
 Table 4.5 HUKM Patients use system to confirm the appointment

First
Arrival Starting use Finished use time Second Purpose for Created
Duration
Time system system Use time using sys by
system
Patient 03:8:00 03:15:00 pm 03:15:50 pm 50 sec 9 Confirm app
pm Nurse 1
1 03:16:00 pm 03:16:40 pm 40 sec 9 Confirm app
Patient 03:20:00 03:25:00 pm 03:25:53 pm 53 sec 9 Confirm app
2 pm Nurse 1
03:27:00 pm 03:27:34 pm 34 sec 9 Confirm app
Patient 03:44:00 03:49:00 pm 03:49:49 pm 49 sec 9 Confirm app
3 pm Nurse 2
03:52:00 pm 03:52:30 pm 30 sec 9 Confirm app
Patient 04:02:00 04:05:00 pm 04:05:56 pm 56 sec 9 Confirm app
4 pm Nurse 2
04:06:00 pm 04:06:37 pm 37 sec 9 Confirm app
Patient 04:11:00 04:13:00 pm 04:14:00 pm 1 min 9 Confirm app
5 pm Nurse 2
04:15:00 pm 04:15:45 pm 45 sec 9 Confirm app

For doing the process of creating patient profile and setting the appointment in

HUKM (Table 4.4), if is it the first time the nurse use the system, the nurse needs

00:03:30, but once the nurse got familiar to use the system, the nurse needs 00:03:00. In

addition, for setting the appointment only, if is it first time the nurse needs 00:01:00, but

once the nurse got familiar, the nurse needs 00:00:30. Moreover, for doing the process

of confirming the appointment (Table 4.5), if is it the first time the patient use the

system, the patient needs between 00:00:49 to 00:01:00 second, but once the patient got

familiar to use the system, the patient needs between 00:00:30 to 00:00:45 second.

Based on the tables of system testing, the results have proves and reflected the

efficiency of the developed system by clarifying, how much this system can save nurse

and patient time. On other word, where the nurse needs minutes to create patient profile

and setting the appointment, the patient needs seconds to confirm their appointment. In

addition, the result from the tables are reflecting how much this system is easy to use

because the system is presenting all the needed information in a friendly interface,

which helps the user for doing their tasks in short time.

82
4.7 Feed back

During the system second testing, the users (doctor, nurses, and patients) add

some perspectives that can make the system more efficient. Referring to the appendix

(B-1 to B-15) the following is summary of the feedback outcome from the user in UH

and HUKM during the system testing.

a) Nurses in UH and HUKM

According to appendix (B-2, B-3, B-9, and B-10) below is the feedback summary:

i. The System should support all the patient information (personal information,

medical information, appointment information).

ii. Within the appointment, include the patient consultation, which means the

doctor and nurse can observe the patient medication based on the appointment.

iii. The nurse and doctor can have report about the patients with different criteria.

iv. Within the nurse part, its better if the system can support the nurse schedule task

based on the priority, because it helps for managing patients based on their

cases.

v. In the patient interface, no need to give the patient more details because it may

confuse them, especially most of the patient here are not knowledgeable about

using computer.

vi. The patient part should include many details about patient information.

vii. The medication part should be includes in the system.

viii. Saving the process of the patient consultation between the doctor and the patient

and the nurse.

83
 b) Doctor in HUKM

According to (appendix b-1) below is the feedback summary:

This system is for managing the patient appointment and allowing patients to confirm

their appointment by themselves, but the system should be able to support more

functions related to the patient health, such as:-

i. The system should include all the process that can help to support managing the

patient information and patient appointment.

ii. Managing the patient medication thought the patient appointment.

iii. Managing the patient consultation through the patient appointment.

iv. The system should be flexible for adding or removing any of the system

functions.

v. The nurse and the doctor can manage all the patient information such as personal

information, medical information and/or appointment information through this

system and no need for them to look into another system to retrieve any

information related to the patient.

C) Patient

According to the feedback appendix (see appendix B-4, 5, 6, 7, 8, 11, 12, 13, 14, and

15) the patients are suggesting to use system online

4.8 Conclusion

This chapter has presented the collected data analysis and the findings. In this

research, two methods have been used for collecting data – interview (see appendix a-1

to a- 10) and observation (2 case studies). Through the interview the data collected

proved, both of hospitals are using same structure for managing the patient information.

Furthermore observing (2 case studies) the work process in both hospitals provides a

comprehensive and deeply details about the systems use their.

84
 Analyzing the collected data it is the next important step, the analysis process

consists of several steps starting from organizing the collected data and finished by

finding and results. In this research collected data was about the current health care

system used in UH and HUKM. Moreover, the current system use for managing the

patient appointment and appointment confirmation in both of the hospitals.

Therefore, based on the collected data, the users have to use different systems to

find or to manage different information, which means user interface is difficult to use

because the users need to look at different user interface to get different information. In

addition the system used based on the local network (intranet), which is risk if the

network is down. So developing an integrated health care management system come to

provide easy user interface and trustable network because it’s developed based on the

internet explorer. In addition the patients have the opportunity to use the system online

and confirm their appointment by themselves.

4.9 Summary

This chapter adopted to present the collected data form both hospitals (UH and

HUKM) by interview (see appendix a-1 to a-10) that presented in the appendix as

groups and subnets, and then the observation (see case studies) in both hospitals (UH

and HUKM) that presents a deeply details about system used, and then is data capture,

which presents the captured data from the interview and the observation (case study).

Moreover, this chapter presents the analysis and the finding, which used as guide

line to produce the new system framework and system modules. After that testing the

system with sample user in both hospital to get a real feed back, which help to improve

the developed system. The next chapter is discussing the system design and system

interface.

85
 CHAPTER 5

System Design

5.1 Introduction

Based on the data analysis and data finding in chapter four, this chapter

discusses the system design. The first part of this chapter is to determine system

structure, which contains the system concept and the system modules. The second part

of this chapter is the functional requirement for the system (system Use Case). The third

part of this chapter is to determine the nonfunctional requirements that represent the

system abilities and flexibilities, and fourth part of this chapter is the system interfaces

and finally is the system tables and code.

5.2 System Structure

5.2.1 System Concept

An integrated health care management system is a computer application to

manage the health care information allowing the user to access their information based

on the user privileges. Moreover, this application can be used online and it typically

offers a wide range of information content, applications and services, integrated into a

single-theme interface that is easy to navigate and reflects interests of different users

and allows them to access information from multiples sources based on their privileges

(figure 5.1).

In addition; the application provides the following:

a. Offers an easy and flexible infrastructure that organizations do not need to

develop.

b. Allow users to visually arrange components into a customized screen display.

c. Make it possible for non-technical users to choose information to be displayed.

d. The application presents a unified interface to back office business systems.

86
 Figure 5.1 The system structure chart

5.2.2 System modules

i. Patient module
This module is for managing all the patient information such as (personal
information, consultation information, medication information and payment
information.
ii. Doctor module
This module manages the doctors’ schedule and keeps track of the doctors’
status as well as availability.
iii. Appointment module
This module is for managing the patient’s appointments with the doctors.
iv. Product module
This module for managing the products (medicine) in the health care and
keep tracking for all the information related to the product such as ( expire
date, suppliers name, availability in the health care pharmacy, etc).
v. Client module
This module is for managing all the information related to health care
clients.
vi. Document module
This module manages all the information related to health care documents
and all the documents related to the patients.
vii. Task module
All the user tasks inside the health care is managed by this module.
87
 viii. Account module
This module for managing all the accounts information in the health care
ix. User module
This module for managing all the information related to the system users and
their privileges.

5.2.3 System Environment

This application developed using Oracle Application Express (Apex), which

provides everything necessary to develop and implement any application to share

information. The following is the scales and the tools that have been used in apex to

develop this web-based:

i. HTML for building the web-based forms.

ii. SQL for the inquiry purpose from the database.

iii. PL/SQL is the programming code.

iv. Java script, for system structure and validation.

v. CSS for the interface design to make the system interface more attractive.

vi. FUSION Chart for reports analysis chart.

The benefit for using Apex to develop the web based is:

i. Provides a complete and integrated application platform.

ii. Enable a fast, scalable Web Site with pre-assembled set of scripting, runtime,

and monitoring tools.

iii. Simplify information sharing, internally and externally, with Instant web

based and Enterprise web based.

iv. Provide easy access to data stored in databases. A perfect complement to

Oracle Database 10g Standard Edition One.

v. Platform flexibility to pick the best, most cost-effective hardware. Choose

Linux, Windows, or both.

88
5.3 Functional Requirement

The functional requirement (Use Case) is detailed out to provide the explanation

for the system function and details about system requirement specification. System Use

Case (Appendix C) is a describing the interaction between the user and the system

functions. In this system there is a user call administrator created by the developer

during system installation in the computer and has full privilege to create the system

user in groups (Figure 5.2).

Figure 5.2 System users as group

5.4 Non functional Requirement

It is defining the emergent of system properties such as integrity, flexibility,

security, maintainability etc. that is not directly related to the specific functions

provided by the system.

5.4.1 Integrity

It is to prevent any mistake or errors may happen from the users or operators

while using the system. For instance, the integrity in this system is verifies and checks

the patient appointment. After the nurses make sure about the doctor availability, the

nurse entered the patient appointment in the system and then the patient can use the

system correctly and confirm the appointment on date. This integrity process to prevent

any errors may happen during entering the patient appointment.

89
5.4.2 Flexibility

Developing this system is based on the problem statement and the user

requirement. Consequently after two, three years or less or more, the system user will

have a new requirements such as extra database, external users or extra functions such

as (patient, set the appointment by themselves, laboratory module and online

consultations, etc). So the system should be flexible enough to upgrade, modify any part

of the system also flexible to change the users interface and can extend DB capacity. So

it’s flexible for any requirements regarding to the user requirements.

5.4.3 Security

Security it is to prevent any unauthorized user to access the system. The system

users have username and password provided by authorize person (admin) to let the users

accessing the system. So if the user doesn’t have username and password, cannot access

the system. This process to avoid any problem might happen from illegal users. In

addition, even if the user has username and password, they have limited authorization,

which means each user have special privilege based on their job level (doctor, nurse and

admin etc).

5.4.4 Maintainability

Maintainability it is one of the must important points in any system or part of the

system that have the ability for modifying and/or correction to improve the system

performance. System can support the maintainability by supporting the re-engineering

or redeveloper to change the format of the existing system without changing the system

function.

90
5.5 System Interface

System interface is the tool that allows the system users to interact with the

system. These interfaces such as the following:

5.5.1 User Interface

This Interface describes the progress of the system to understand how the system

works. Basically there are four different users in the system listed below:

i. Patient: can use the interface for confirming the appointment

ii. Nurse: user in the health care can use the system based on the privileges

provided by the system admin.

iii. Doctor: user in the health care can use the system based on the privileges

provided by the system admin.

iv. Administrator: the system admin has full privilege to manage the system.

Some of the system functions such as (medication history, consultation, consultation

history, allergies, task manager, documentation, payment) were added based on the user

requirement that collected during the system testing (feedback).

1- Login interface:

This is the first page in the system and the user can use this page to login into the

system (Figure 5.3).

Figure 5.3 Login interface

Notes: For patient only (Username=Patient ID & Password = I/C or passport number).
91
2- Today Queue (Today’s consultation queue) (Home Page).

Users: Admin/nurse/doctor

• This page (Figure 5.4) appears by clicking on (today’s queue) in the system

navigator. It’s the home page for the system user except the patient. Here the

user can view the patients queue list, which have been sent to the doctor for

consultation purpose and they are ready for treatment. Here for more efficient

work the patient name held with the doctor name and the consultation status.

• Through this page the doctor will be able to go through patient consultation

history and by clicking on view the details for particular consultation will

appear.

This is the list of patients list that has been sent by the
nurse to the doctors for medical consultation purpose
and these patients are ready to meet the doctor.

Figure 5.4 Today Queue

92
3- Search Patient

Users: Admin/nurse/doctor

Search patient (Figure 5.4.1) it helps user to search about patient using different criteria.

• This page appear by clicking on (Search Patient) in the system navigator in the

home page. Here the user can search for any patient in the system by the

followings:

9 Patient Name

9 IC No / Passport

9 Telephone

9 Fax No

Figure 5.4.1 Search Patients

93
4- Create new Patient

Users: Admin/nurse/doctor

• This page (Figure 5.4.2) appear by clicking on (Create new patient) in the

system navigator in the home page or from the search page by clicking on button

new patient.

Figure 5.4.2 Create new Patients

94
5- View appointment
Users: Admin/nurse/doctor

• This page (Figure 5.4.3) appears by clicking on (View appointment) in the

system navigator in the home page.

• From this page (Appointment calendar) the user can view all the patients’

appointments for each doctor for a specific date.

• By clicking on view list the list of patients who have appointment with selected

doctor will appear (Figure 5.4.3. (a)).

By clicking on view list, the list of patient

appointment will appear (Figure 5.4.3. (a)).

Figure 5.4.3 View appointments

95
 Figure 5.4.3 (a) Appointment list

From this page the user can view the list of appointment that they have in particular day,

and by clicking on edit button the next page (Figure a1) will appear to allow user to edit

the appointment.

The user presses

on apply Changes
button to save

The user presses on

delete Button to
delete appointment

Figure a1 Edit Appointments

96
7- View Documents

Users: Admin/nurse/doctor

• This page (Figure 5.4.4) appears by clicking on (View Documents) in the system

navigator in the home page.

• From this page, the user can manage all the documents (download, upload),

based on the document categorize.

• This function helps the user to keep tracking and archiving all the documentation

they have.

• By clicking on download button the page (Figure 5.4.4. (a)) will appears.

• By clicking on upload button the page (Figure 5.4.4. (b)) will appear.

• By clicking on the manage file button the page (Figure 5.4.4. (c)) will appear.

Figure 5.4.4. (a) View Documents

97
Figure a1 Downloading document

Upload button to upload

file to the Database

Browse button to locate the

file like the next page
(Figure 5.4.4.b1)

Figure 5.4.4.b Upload file

98
 Figure b1 Locate upload file

Manage file button is for managing the files editing/deleting; (Figure 5.4.4. (c)).

By clicking on edit button the

next page (Figure c1) will
appear for editing or deleting
the file.

Figure 5.4.4. (c) Managing files

99
 Apply changes button to
save the changes after
editing

Delete button to
delete file

Figure c1 Editing /Deleting file

100
8- My Tasks

Users: Admin/nurse/doctor

• This page (Figure 5.4.5) appears by clicking on (View My Tasks) in the system

navigator on the home page. Here the user can view the list of the tasks that has

to do it based on the priority.

• The importance of this function came from the user work environment. So they

needs to schedule their tasks based on the task priority.

• By clicking on add new task or edit button the next form (Figure 5.4.5 (a)) will

appear to create a new task or to edit task.

To search about task using different criteria

To create new task press add new task button

the next (Figure 5.4.5. (b)) will appear

To edit or delete the task press edit button

the next (Figure 5.4.5. (a)) will appear

Figure 5.4.5 View My Tasks

101
 This button to save the
changes

This button to delete the

task

Figure 5.4.5 (a) Editing/ Deleting task

Figure 5.4.5 (b) Creating a new task

102
9- Doctor Schedule

Users: Admin/nurse/doctor

This page (Figure 5.4.6) for managing the doctor status and through this page the

user will be able to:

- View the history of doctor status by clicking on view button the page (Figure 5.4.6)
will appear.

Select doctor name and press

on go (Figure 5.4.6. (a)) will
appear to view the selected
doctor status or press on Add
new schedule to add new
schedule status for any doctor
(Figure 5.4.6. (c)).

Figure 5.4.6 Doctor Schedule

103
 The schedule details for
To edit the doctor Selected doctor
status press on edit
(Figure 5.4.6. (b))

Figure 5.4.6 (a) Doctor Schedule History

Figure 5.4.6 (b) Editing Doctor Status

104
 Figure 5.4.6 (c) Creating New Status

Doctor status:
- Completed: the status is
completed.
- Postponed: the status
postponed to next time.
- Cancelled: the status
cancelled.
- Attending patient: doctor
attending in the clinic to
treat the patients
- Meeting: doctor in
meeting.
- On-leave: doctor not
available

Figure 5.4.6 (d) Doctor Schedule and status history

105
10 – Reports
Users: Admin/nurse/doctor

• This page (Figure 5.4.7) appears by clicking on (View Report) in the system

navigator in the home page.

• From this page the user can view different reports and can export reports based

on specific criteria such as appointments, patient’s race, gander etc.

• The user can search for specific report by using the search criteria.

• And by clicking on the list of report option, the next pages will appear.

To view a report about the appointment and use

the search criteria to search for appointment

Figure 5.4.7. (a) View Report (Appointment)

106
By clicking on break
down of patient by gender
the report about patient
gander will appear

Figure 5.4.7. (b) Patients Gender Report

By clicking on break
down of patient by Race
the report about patient
Race will appear

Figure 5.4.7. (c) Patients Race Report

107
By clicking on break
down the payment the
report about payment
(monthly and daily)

Figure 5.4.7. (d) Payment Report

By clicking on break
down the payment
method the report about
payment method will
appear

Figure 5.4.7. (e) Payment method Report

108
 By clicking on summary
of doctor consultation
the report about doctor
consultation per month
will appear

Figure 5.4.7. (f) Doctor Consultation Report

By clicking on
breakdown of client type
a report about client type
will appear

Figure 5.4.7. (g) Client Report

109
By clicking on breakdown
of document a report about
the document uploaded will
appear

Figure 5.4.7. (h) Document Report

By clicking the patient

complaints a report about
the patient complaints will
appear.

Figure 5.4.7. (i) The Patient Complaint Report

110
 By clicking the patient
treatment a report about the
patient’s treatment will
appear.

Figure 5.4.7. (j) The Patient Treatment Report

By clicking diagnosis
category a report about
the diagnosis category
will appear.

Figure 5.4.7. (k) The Diagnosis Category Report

111
By clicking the total
product use a report about
the total product use will
appear.

Figure 5.4.7. (l) The Total Product Used Report

112
11- The patient consultation

The patient consultation managed in steps. The following is the details.

- (Figure 5.4.8) is contained the patient list and by clicking on view button the next

page (Figure 5.4.8. (a)) will appear.

By clicking on view button the next page will

appear and the user can view the patient
details

Figure 5.4.8 Patients list

Starting from this page the user can view or edit

all the information related to particular patient.

Figure 5.4.8. (a) Patient details

By clicking on view/ details in the patient options list, full patient details will appear
(Figure 5.4.8. (b)).

113
 Figure 5.4.8. (b) Full Patient Details

By clicking on previous illness in the patient options list, the previous illness for

that’s particular patient will appear (Figure 5.4.8. (c)).

114
 Figure 5.4.8. (c) Patient previous illness details

By clicking on consolation history in the patient option list, a list of history consultation

will appear (Figure 5.4.8. (d)).

By clicking on view button, the details for the selected

consultation will appear in the next page (Figure d1)

Figure 5.4.8. (d) Patient consultation history

115
In this page the user can
view or edit all the
consultation information
related to the patient for
particular consultation.

Figure d1 The Patient Consolation Details.

This page is for patient

diagnosis details.

Figure d2 Patient Consolation Diagnosis

By clicking on medication button in the consultation option list, the medication page
(Figure d3) will appear.

116
By clicking on prescribe
new medication add
medication page will
appear and the user can
add the medication or
patient or edit. Once the
user finished prescribing
the medicine, user need to
press on submit button
than the prescribed
medicine will be appear as
roe in the upper page.

Figure d3 Patient Medication

By clicking on the payment button in the consultation option list, the payment page
(Figure d4) will appear.

This page is for user to

key in the consultation
and the medication
payment for patient.

Figure d4 Patient Payment page

117
12- Patient appointment history

This page (Figure 5.4.9) for managing the patient appointment

- By clicking on appointment history button in the patient option all the appointments

history for the particular patient will appear (Figure 5.4.9).

- By clicking on new appointment the page for creating new appointment will appear,

(Figure 5.4.9.(a)), and the same form will appear if you press on edit button for

editing selected appointment will appear.

Press on edit button to Press on new appointment button

edit the selected to create new appointment
appointment.

This is the main page for the appointment

for particular patient.

Figure 5.4.9 Patient Appointment History

118
 Figure 5.4.9. (a) Create/ Edit appointment

13- Patient allergies

Patient allergies are the last button in the patient option list. By pressing on this button

the allergies page (Figure 5.4.10) will appear.

Figure 5.4.10 Patient allergies

119
14 – Administration

User: Admin

This is the home page (Figure 5.4.11) for the system administration, from this page

the admin can manage all the information related to the system and the system user.

The landing page for the system administration

Figure 5.4.11 Admin home page

15 – User management

User: Admin

From the admin home page the admin has the admin task list, by clicking on user

management the next page (Figure 5.4.11. (a)) will appear and the admin can

manage the entire system user from this page.

120
In this field the admin can search
for any user

By clicking on add new user button,

new form will appear (Figure
5.4.11. (a)) to the admin to create a
profile for the new user.

By pressing on admin button the admin will be

able to edit the user profile (Figure 5.4.11. (b))

Figure 5.4.11. (a) User Management

Figure 5.4.11. (b) Edit/ Create user

121
16 – Group management

User: Admin

By clicking on Group management the next page (Figure 5.4.12) will appear and

the admin can manage the entire system group from this page.

By clicking on edit button the

admin can edit the group
information (Figure 5.4.12. (a))

By clicking on Create button

the admin can create a new
group (Figure 5.4.12. (a)).

Figure 5.4.12 Group Management

Figure 5.4.12. (a) Edit/ Create group

122
17 – System Management

User: Admin

By clicking on system management the next page (Figure 5.4.13) will appear and the

admin can manage all the information related to the system.

By clicking on profile button

the admin will be able to view
the system information
(Figure 5.4.13. (a))
By clicking on code
control button the admin
will be able to edit the
system code information
(Figure 5.4.13. (b))

By clicking on edit button the admin

will be able to view the system
information (Figure 5.4.13. (b))

Figure 5.4.13 System Management

Figure 5.4.13. (a) System Profile

123
By clicking edit button the
admin can edit the
selected code (Figure b1)

Figure 5.4.13.b System Code Control

Figure b1 Edit/ Create System Code

124
18 – Account management

User: Admin

From this page (Figure 5.4.14) the admin can manage all the accounts system. In the

administrator home page by clicking on account management on the page navigator, the

list of accounts will appear, for managing the accounts. By clicking on edit button to

edit the account and by clicking on add new account button for adding a new account.

Add new account to

button to add a new
account profile
Edit button to edit the (Figure 5.4.14. (a))
account information
(Figure 5.4.14. (a))
]

Figure 5.4.14 Account Management

Figure 5.4.14. (a) Edit/ Create account management

125
19 – Client management

User: Admin

From this page the admin can manage the health care clients (Figure 5.4.15)

In the administrator home page by clicking on Client management on the page

navigator, the list of client will appear for managing the clients. By clicking on edit

button to edit the client account and by clicking on add new account button for adding a

new account client.

To add new client (Figure 5.4.15.(a))

To edit the client profile

(Figure 5.4.15.(a))

Figure 5.4.15 Client management

126
Figure 5.4.15. (a) Edit/ Create Client

127
20 – Vendor management

User: Admin
From this page the admin can manage the vendors (supplier) profile (Figure

5.4.16). In the admin home by clicking on the Vendor management on the page

navigator, the list of vendors will appear, for managing the vendors (suppliers). By

clicking on edit can editing the vendor file and by clicking on add new can create new

vendor (supplier) profile. This will help the management to keep tracking about the

supplier who dealing with them.

To create a
new vendor
profile
(Figure
5.4.16.(a))

To edit the vendor profile

(Figure 5.4.16. (a))

Figure 5.4.16 Vendor management

128
Figure 5.4.16. (a) Edit/ Create vendor

129
21 – Product management

User: Admin

From this page the admin can manage the products profile (Figure 5.4.17). In

the admin home by clicking on the Product management, the list of the entire medicine

product will appear. This is will help the management to manage the medicines. By

clicking on edit button for editing the Product file and by clicking on add new for

creating a new Product file.

To add a new product

profile (Figure 5.4.17. (a))

To edit the product

profile
(Figure 5.4.17. a))

Figure 5.4.17 Product Management

130
Figure 5.4.17.(a) Create / Edit product

131
15- Confirmation Appointment
User: Patient

After login to the system using username and password

(Username = MRN & Password = NRIC or passport No) the Appointment

Confirmation page appears to the patient.

• Thorough this page, the patient can confirm or cancel or postponed the

appointment. In addition can view the doctor availability.

• By clicking on the view today appointment button the patient can view the

current day appointment.

View today appointment

to view today appointment
only

Doctor status

Figure 5.4.18 Patient Home Page

132
By clicking on view the next page (Figure 5.4.18. (a)) will appear.

This buttons use

to confirm or
cancel or
postponed the
appointment.

Figure 5.4.18. (a) Patient View the Appointment

Figure 5.4.18. (b) Patient Confirm the Appointment

133
 Figure 5.4.18. (c) Patient cancels the Appointment

5.5.2 Hardware Interface

The hardware interface is the hardware devices that use to communicate with each other

such as the wires, plugs, computers and sockets, etc.

5.5.3 Communications Interfaces

The communication interfaces is the tools that help the user to interact with the system

user interface and establishing the communications.

i. The web browser

The web browser is a software application installed by default with any windows

(XP, Vista, etc) and Linux. This application enable user to interact with any information

(text, mage, music, etc) located on the web page in the World Wide Web or in the local

area network. Health care management system recommended working on internet

explorer because this system developed using apex oracle, which support windows

internet explorer more than the other browsers and it support to work over mozilla fire

fox or any kind of web browser. To configure Microsoft Internet Explorer to connect to

the Oracle Database XE Database Home Page:

134
 1. From the Start menu, select Control Panel, then Internet Options.

2. In the Internet Options dialog box, click the Security tab.

3. Under Security, select Local Intranet and then select Sites.

4. In the Local Intranet dialog box, select Advanced.

5. Under Add this Web site to the zone, enter the following site:127.0.0.1

6. Click OK.

To configure Firefox to connect to the Oracle Database XE Database Home Page:

1. Under the Tools menu, select Options.

2. From the General tab, select Connection Settings.

3. If you are using a proxy server, add the following setting to the No Proxy For

setting:127.0.0.1

ii. The protocol

The web browser initially uses HTTP (hypertext transfer protocol) protocol. The http

supports the web browser to interact with the web server.

iii. Connection ports

This is the most ports used for oracle application server and oracle database:

- 7777 it is Oracle HTTP Server port and listener port for Oracle Application Server.

- 8080 its Oracle XMLDB HTTP port Oracle Database.

5.6 System Tables

System is designed in 17 tables (see appendix D).

1) Appointment Table: it is contains all the appointments information.

2) Clinic Profile Table: it is contains information about the health care profile.

3) CMS Account Table.

4) CMS Tasks Table: it is contains all the system users’ tasks information.

135
5) Consultation Table: it is contains all the information related to the patient

consultations.

6) Patient Diagnosis Table: it is contains all the information related to the patient

diagnosis.

7) Vendor Table: it is contains all the information related to products suppliers’

information.

8) CMS Client Table: it is contains all the information related to health care client’s

information.

9) CODE Type Table: it is contains all the information related to the system codes.

10) Library CODE Table: it is contains all the information about the documents.

11) Patient Table: it is contains all the information patients.

12) Patient Medication Table: it is contains all the information about patient’s

medications.

13) CODE Table.

14) Patient Allergies Table: it is contains all the information related to the patient

allergies.

15) Product Table: it is contains all the information about the products.

16) Doctor Schedule Table: it is contains all the information related to the doctor’s

schedule.

17) Doctor schedule history: for managing the doctor status history.

136
5.7 System Code

The system code in this system is PL/SQL and it is contains four parts (Table 5.1):-
1- System Sequence Code
2- System Triggers Code
3- Functions Code
4- Packages (Chart Code)
Code Name Code Description

1- System Sequence Code

CMS_SEQ CREATE SEQUENCE cms_seq This is the CMS sequences

INCREMENT BY 1 Started by 1, incremented
START WITH 6141 with 6141 and the max
MINVALUE 1
value is
MAXVALUE 999999999999999999999999999
NOCYCLE 999999999999999999999
NOORDER
CACHE 20
/

code_ctrl CREATE SEQUENCE code_ctrl_seq

_seq INCREMENT BY 1 This is the Code Control
START WITH 2420 Sequence. Started with
MINVALUE 1
2420, incremented by 1 and
MAXVALUE
999999999999999999999999999 the max value is
NOCYCLE 999999999999999999999
NOORDER
CACHE 20
/

LIBRARY_D CREATE SEQUENCE library_docs_seq

OCS_SEQ INCREMENT BY 1
This is the Library code
START WITH 161
MINVALUE 1 sequences
MAXVALUE Started by 161, incremented
999999999999999999999999999 by 1 and the max value is
NOCYCLE 999999999999999999999
NOORDER
CACHE 20
/

MAL_MEDI CREATE SEQUENCE

CINE_LIST_ mal_medicine_list_seq
INCREMENT BY 1 This is the Medicine Code
SEQ sequences
START WITH 5521
MINVALUE 1 Started by 5521,
MAXVALUE incremented by 1 and the
999999999999999999999999999 max value is
NOCYCLE 999999999999999999999
NOORDER
CACHE 20
/

CREATE SEQUENCE pat_seq

PAT_SEQ
INCREMENT BY 1
137
 START WITH 1141 This is the Patients
MINVALUE 1 Sequences
MAXVALUE Started by 1141,
999999999999999999999999999
incremented by 1 and the
NOCYCLE
NOORDER max value is
CACHE 2 999999999999999999999

Code Name Code Description

2- System Triggers Code

APPOINTME CREATE OR REPLACE TRIGGER This is the appointment
NT_BI appointment_bi trigger, started before
BEFORE inserting or updating data.
INSERT OR UPDATE
ON appointment
REFERENCING NEW AS NEW OLD AS OLD So it's referring to the row
FOR EACH ROW new as new and the old as
declare old.
v_patient_name varchar2(300);
begin Begin select full Patient
select pat_full_name into Name from patient table,
v_patient_name where The patient ID = new
from patient
appointment Patient ID.
where pat_id =
:new.apt_pat_prn;

if inserting and :new.apt_id is

null then If the inserting value is null
select cms_seq.nextval into back to the system sequence
:new.apt_id from dual; and select the next value.
end if;
if inserting then
:new.apt_status := 'New';
:new.search :=
:new.apt_pat_prn ||' | '||
v_patient_name;
:new.patient_name :=
v_patient_name;
end if;

if updating then
if trunc(:new.apt_date) <
trunc(sysdate) then
:new.apt_status := If the data is updating trunc
'Closed'; the current appointment and
end if; set the new status date.

if :new.apt_duration is not
null then In the app duration is nut
:new.APT_END_DATETIME null set the appointment end
:= to_date(:new.apt_DATE +
date time and the
(:new.apt_Duration/1440), 'DD-MON-
YYYY HH24:MI'); appointment duration.
end if;

:new.search :=
:new.apt_pat_prn ||' | '||
v_patient_name;
:new.patient_name :=

138
 v_patient_name;

end if;

end;
/

BD_LIBRAR CREATE OR REPLACE TRIGGER This is library trigger

Y_DOCS bd_library_docs starting before deleting
BEFORE
DELETE And it's referring to the row
ON library_docs
REFERENCING NEW AS NEW OLD AS OLD
new as new and the old as
FOR EACH ROW old.
BEGIN

insert into library_docs_history

(id, Begin Than for inserting the
filename,date_deleted,deleted_by,ol data into library doc ( the
d_owner,created_date,created_by,PRO data required)
JECT_CODE,file_id)
The values.
values
(library_docs_seq.nextval,:old.file
name,sysdate,v('APP_USER'),:old.upl
oad_user,sysdate,v('APP_USER'),:old
.file_upload_id,:old.id);

END;
/

CREATE OR REPLACE TRIGGER

BI_CONSUL This is a consultation trigger
bi_consultation
TATION starting before inserting data
BEFORE
INSERT OR UPDATE
ON consultation And it's referring to the row
REFERENCING NEW AS NEW OLD AS OLD new as new and the old as
FOR EACH ROW old.
begin

if inserting and :new.id is

null then
select "CMS_SEQ".nextval Begin If the inserted ID in
into :NEW."ID" from dual; null than back to the system
end if; sequence and take the new
ID from the Dual file.
if inserting then
:new.created_by :=
v('USER');
:new.created_date := If inserting than appear the
sysdate;
user name and the date of
end if;
end; creating the data (system
/ date).

139
BI_MAL_ME CREATE OR REPLACE TRIGGER
DICINE_LIS "bi_MAL_MEDICINE_LIST"
T BEFORE
This is a MEDICINE_LIST
INSERT
ON mal_medicine_list trigger starting before
REFERENCING NEW AS NEW OLD AS OLD inserting data to the
FOR EACH ROW medicine list
begin
if :new."ID" is null then And it's referring to the row
Select new as new and the old as
"MAL_MEDICINE_LIST_SEQ".nextval old.
into :new."ID" from dual;
end if;
end;
Begin If the selected
/ medicine ID is null than
back to the system sequence
and select a new ID.

BIU_CMS_T CREATE OR REPLACE TRIGGER

ASKS biu_cms_tasks
BEFORE
INSERT OR UPDATE This is the Task trigger
ON cms_tasks
REFERENCING NEW AS NEW OLD AS OLD
starting before inserting or
FOR EACH ROW updating data.
begin
if :NEW."ID" is null then
Select "CMS_SEQ".nextval into And it's referring to the row
:NEW."ID" from dual; new as new and the old as
end if; old.
if inserting then
Begin If the selected item
:new.created_date := sysdate;
:new.created_by := ID is null back to the system
v('USER'); sequence and select a new
:new.task_status := 'New'; ID from the table.
end if;
If the data entered is
if updating then inserting appear the user
if name and the system date
:new.task_actual_complete is not and the new task call it
null then
"new".
:new.task_status :=
'Closed';
end if;
If the data entered is
--:new.task_duration := updating.
to_date(:new.apt_DATE + (if the task complete is not
(:new.apt_Duration/1440), 'DD-MON- null, the task status is
YYYY HH24:MI'); ''Closed").
end if;

end;
/

140
CLINIC_PR CREATE OR REPLACE TRIGGER
OFILE_BIU clinic_profile_biu
BEFORE
INSERT OR UPDATE
ON clinic_profile
REFERENCING NEW AS NEW OLD AS OLD
FOR EACH ROW This is the Clinic Profile
begin trigger starting before
if inserting and :new.id is inserting or updating data.
null then
select cms_seq.nextval into And it's referring to the row
:new.id from dual; new as new and the old as
end if;
if inserting then
old.
:new.clinic_address :=
:new.CLINIC_ADD_1 ||' |
'||:new.CLINIC_ADD_2 ||' | '|| Begin If inserting data and
:new.CLINIC_CITY ||' | the ID is null than back to
'||:new.CLINIC_STATE ||' | the system sequence and
'||:new.CLINIC_POSTCODE ||' | select the next value.
'||:new.CLINIC_TEL_1 ||' |
'||:new.CLINIC_FAX_1;
And the inserting the
end if;
if updating then address(" " )
:new.clinic_address :=
:new.CLINIC_ADD_1 ||' |
'||:new.CLINIC_ADD_2 ||' | '||
:new.CLINIC_CITY ||' |
'||:new.CLINIC_STATE ||' |
'||:new.CLINIC_POSTCODE ||' |
'||:new.CLINIC_TEL_1 ||' | If the inserting is updating
'||:new.CLINIC_FAX_1;
end if;
than the address(" ")
end;
/

CREATE OR REPLACE TRIGGER This is the account trigger

CMS_ACCO cms_account_bi
UNT_BI starting before inserting
BEFORE data.
INSERT
ON cms_account
REFERENCING NEW AS NEW OLD AS OLD And it's referring to the row
FOR EACH ROW new as new and the old as
begin old.
if inserting and :new.id is
null then
select cms_seq.nextval into Begin If inserting the new
:new.id from dual; ID is null than back to the
end if;
system sequence and select
end;
/ the next value

141
 This is the Client trigger
CMS_CLIEN CREATE OR REPLACE TRIGGER starting before Update data.
TS_BU cms_clients_bu
BEFORE
INSERT OR UPDATE
ON cms_clients And it's referring to the row
REFERENCING NEW AS NEW OLD AS OLD new as new and the old as
FOR EACH ROW old.
begin
if inserting and :new.id is Begin if the inserted ID is
null then null, back to the sequence
select cms_seq.nextval into and select the next value.
:new.id from dual;
end if;
if inserting then
If inserted, than the user
:new.created_by := name is null, appear
nvl(v('USER'),'Mohammed'); 'mohammed' and appear the
:new.created_date := created date "system date"
sysdate;
:new.search :=
:new.CLIENT_CODE ||' |
'||:new.CLIENT_NAME ||' | '||
:new.CLIENT_STATE ||' |
'||:new.CLIENT_TEL_1 ||' |
'||:new.CLIENT_CONTACT_NAME ||' |
'||:new.CLIENT_CONTACT_DID ||' |
'||:new.CLIENT_CONTACT_MOBILE;
end if;
if updating then If update appear the updated
:new.updated_by := username and the date of
v('USER'); updating "system date"
:new.updated_date :=
sysdate;
:new.search :=
:new.CLIENT_CODE ||' |
'||:new.CLIENT_NAME ||' | '||
:new.CLIENT_STATE ||' |
'||:new.CLIENT_TEL_1 ||' |
'||:new.CLIENT_CONTACT_NAME ||' |
'||:new.CLIENT_CONTACT_DID ||' |
'||:new.CLIENT_CONTACT_MOBILE;
end if;
end;
/

CODE_TYPE CREATE OR REPLACE TRIGGER This is the Code Types

S_BD code_types_bd trigger starting before
BEFORE deleting data.
DELETE
ON code_types
And it's referring to the row
REFERENCING NEW AS NEW OLD AS OLD
FOR EACH ROW new as new and the old as
BEGIN old.
delete from codes
where cod_cot_id = :old.cot_id;
END; Begin Delete the Code
/ where the cod_cot_id =
:old.cot_id;

142
PATIENT_A CREATE OR REPLACE TRIGGER
LLERGIES_ patient_allergies_bi
BI BEFORE
INSERT
ON patient_allergies This is the Patients Allergies
REFERENCING NEW AS NEW OLD AS OLD trigger starting before
FOR EACH ROW Inserting data.
begin
if inserting and :new.id is And it's referring to the row
null then new as new and the old as
select cms_seq.nextval into old.
:new.id from dual;
end if;
end; Begin if the inserted ID is
/ null back to the system
sequence and select new
PATIENT_BI CREATE OR REPLACE TRIGGER value.
U patient_biu
BEFORE
INSERT OR UPDATE
ON patient
REFERENCING NEW AS NEW OLD AS OLD
This is the Patients trigger
FOR EACH ROW
declare starting before Inserting or
Update data.
v_prn number;
d_cuur_date date := sysdate; And it's referring to the row
v_sec_group_id number; new as new and the old as
v_group_id number; old.
v_user_id number;
p_password varchar2(100);
v_prn_prefix varchar2(100);
Declaring the new values
begin ( v_prn, d_cuur_date,
v_sec_group_id
if inserting and :new.pat_id is ,v_group_id
null then ,v_user_id
,p_password
select pat_seq.nextval into v_prn ,v_prn_prefix)
from dual;
Begin
:new.pat_id := v_prn;
:new.pat_prn := 'MRN00'||v_prn;
end if;
If the inserted patient ID is
null Back to the patient
if inserting then sequence and select new
:new.created_by := value.
nvl(v('USER'),'ADMIN');
:new.created_date := d_cuur_date; The patient ID =The Patient
Registration Number 'PRN'
:new.pat_full_name := = The Medical Registration
:new.pat_first_name ||' '|| Number followed by '00'
:new.pat_middle_name ||' '||
:new.pat_last_name;
"MRN00"
:new.pat_ic_no :=
:new.pat_ic_no_1||'- If inserting name, appear the
'||:new.pat_ic_no_2||'- username if not appear the
'||:new.pat_ic_no_3; 'admin' and the created date.

:new.pat_address :=
:new.pat_address_1||'
'||:new.pat_address_2||'
143
'||:new.pat_address_3 ||'
'||:new.pat_city ||'
'||get_code_name('STATE',:new.pat_s
tate) ||' '||:new.pat_postcode;

:new.PAT_AGE := age_now
(:new.PAT_DOB_DD, :new.PAT_DOB_MM ,
:new.PAT_DOB_YYYY);

:new.pat_search:= :new.pat_prn ||'

| '||:new.pat_full_name ||' '||
:new.pat_ic_no ||'
'||:new.pat_old_ic_no ||'
'||:new.pat_passport_no ||'
'||:new.pat_tel_1 ||' |
'||:new.pat_tel_2 ||' | '||
:new.pat_address;

v_sec_group_id :=
apex_util.find_security_group_id(p_
workspace=>'DEV');

v_group_id :=
APEX_UTIL.GET_GROUP_ID(p_group_name
=> 'PATIENTS');

if :new.pat_ic_no is not null then

p_password := :new.pat_ic_no;
elsif :new.pat_passport_no is not
null then
p_password := :new.pat_passport_no;
end if;

APEX_UTIL.CREATE_USER (
p_user_name => :new.PAT_ID,
p_first_name => :new.PAT_FIRST_NAME If the Patient ID is not null
||' '||:new.PAT_MIDDLE_NAME, than the Password= IC
p_last_name => :new.PAT_LAST_NAME, number
p_description => null,
p_email_address => null,
p_web_password => p_password,
p_web_password_format => null,
p_group_ids => v_group_id,
p_attribute_01 => 'CMS',
p_attribute_02=> null,
p_attribute_03 => null,
p_attribute_04 =>
:new.PAT_HAND_PHONE,
p_attribute_05 => null,
p_attribute_06 => null,
p_attribute_07 => null,
p_attribute_08 => null,
p_attribute_09 => v_group_id,
p_attribute_10 => null);

:new.user_name :=:new.pat_prn;

update wwv_flow_fnd_user
set person_type = 'CMS',

CHANGE_PASSWORD_ON_FIRST_USE = null
where user_name = :new.pat_prn;

144
 end if;
In update, in the system user
if updating then set the type is 'CMS' and
:new.modified_by := v('USER');
change the password in the
:new.modified_date := d_cuur_date;
first use where the username
:new.pat_full_name := = PRN
:new.pat_first_name ||' '||
:new.pat_middle_name ||' '||
:new.pat_last_name;
:new.pat_ic_no := If updating the modified by
:new.pat_ic_no_1||'- (username) and the current
'||:new.pat_ic_no_2||'- updating date.
'||:new.pat_ic_no_3;
:new.pat_address :=
:new.pat_address_1||'
'||:new.pat_address_2||'
'||:new.pat_address_3 ||'
'||:new.pat_city ||'
'||get_code_name('STATE',:new.pat_s
tate) ||' '||:new.pat_postcode;

:new.PAT_AGE := age_now
(:new.PAT_DOB_DD, :new.PAT_DOB_MM ,
:new.PAT_DOB_YYYY);

:new.pat_search := :new.pat_prn
||' | '||:new.pat_full_name ||' |
'|| :new.pat_ic_no ||' |
'||:new.pat_old_ic_no ||' |
'||:new.pat_passport_no ||' |
'||:new.pat_tel_1 ||' |
'||:new.pat_tel_2 ||' | '||
:new.pat_address;

end if;

end;
/

This is the Patients

CREATE OR REPLACE TRIGGER
PATIENT_DI patient_diagnosis_bi Diagnosis Trigger starting
AGNOSIS_B BEFORE before Inserting or Update
I INSERT OR UPDATE data.
ON patient_diagnosis
REFERENCING NEW AS NEW OLD AS OLD And it's referring to the row
FOR EACH ROW new as new and the old as
begin old.
if inserting and :new.id is null
then
select cms_seq.nextval into :new.id
Begin
from dual; If the inserted ID is null,
end if; back to the system sequence
end; and select new value
/

145
PATIENT_M CREATE OR REPLACE TRIGGER
EDICATION patient_medications_bi This is the Patients
S_BI BEFORE
Medication trigger starting
INSERT
ON patient_medications before Inserting data.
REFERENCING NEW AS NEW OLD AS OLD
FOR EACH ROW And it's referring to the row
begin new as new and the old as
if inserting and :new.id is null old.
then
select cms_seq.nextval into :new.id Begin
from dual; If the inserted ID is null,
end if;
back to the system sequence
if inserting then and select new value
:new.created_by := v('USER');
:new.created_date := sysdate; Than appear the user name
end if; and the created date.

end;
/
This is the Products Trigger
PRODUCTS_ CREATE OR REPLACE TRIGGER
products_bi starting before Inserting
BI data.
BEFORE
INSERT
ON products And it's referring to the row
REFERENCING NEW AS NEW OLD AS OLD new as new and the old as
FOR EACH ROW old.
begin
if inserting and :new.id is null Begin
then
select cms_seq.nextval into :new.id
If the inserted ID is null,
from dual; back to the system sequence
end if; and select new value
end;
/

TRG_ALL_T This is the Library Doc

CREATE OR REPLACE TRIGGER Trigger starting before
EXT_LIBRA trg_all_text_library_docs
RY_DOCS BEFORE
Inserting or Update data.
INSERT OR UPDATE
ON library_docs And it's referring to the row
REFERENCING NEW AS NEW OLD AS OLD new as new and the old as
FOR EACH ROW old.
BEGIN
:NEW.ALL_TEXT := Begin
UPPER(:NEW.FILENAME ||'|'|| Insert the file information
:NEW.STATUS ||'|'||
:NEW.UPLOAD_DATE||'|'||
:NEW.UPLOAD_USER ||'|'||
:NEW.DESCRIPTION ||'|'||
:NEW.MIME_TYPE ||'|'||
:NEW.FILE_TYPE ||'|'||
:NEW.KEYWORD);
END;
/

146
VENDOR_BI CREATE OR REPLACE TRIGGER This is The Vendor Trigger
U vendor_biu starting Before Inserting or
BEFORE
Updating data.
INSERT OR UPDATE
ON vendor
REFERENCING NEW AS NEW OLD AS OLD And it's referring to the row
FOR EACH ROW new as new and the old as
begin old.
if inserting and :new.id is null
then Begin
select cms_seq.nextval into :new.id If inserting the data and the
from dual;
ID is null, back to the
end if;
if inserting then system sequence and select
:new.created_by := new value.
nvl(v('USER'),'Mohammed');
If inserted than appear the
:new.created_date := sysdate; username and if the
:new.search := :new.VEND_CODE ||' | username is null appear"
'||:new.VEND_NAME ||' | '|| Mohammed"
:new.VEND_STATE ||' |
'||:new.VEND_TEL_1 ||' |
'||:new.VEND_CONTACT_NAME ||' |
'||:new.VEND_CONTACT_MOBILE;
end if;

if updating then
:new.updated_by := v('USER');
:new.updated_date := sysdate;
:new.search := :new.VEND_CODE ||' If updating appear the user
| '||:new.VEND_NAME ||' | '|| name and the created date.
:new.VEND_STATE ||' |
'||:new.VEND_TEL_1 ||' |
'||:new.VEND_CONTACT_NAME ||' |
'||:new.VEND_CONTACT_MOBILE;
end if;
end;
/

create or replace TRIGGER

BIU_DOCTO biu_doc_schedule
T_SCHEDUL BEFORE
E INSERT OR UPDATE
ON doctor_schedule This is The Doctor Schedule
REFERENCING OLD AS OLD NEW AS NEW Trigger starting Before
FOR EACH ROW Inserting and updating data.

declare
v_patient_id varchar2(300 ;( And it's referring to the row
begin new as new and the old as
if inserting and :new.sched_id
old.
is null
then
select cms_seq.nextval into
:new.sched_id from dual ;
end if; Begin If the inserted ID is
if inserting then null than back to the system
:new.status := 'NEW;' sequence and take the new
:new.created_date := sysdate; ID from the Dual file.
:new.created_by
:= nvl(v('USER'),'USER ;('
If inserting than appear the
new status value as new, the
147
 if :new.duration is not null created date is the system
then date, and the created by is
:new.STATUS_END_DATE := the user.
(:new.STATUS_START_DATE +
:new.duration ;(
end if;
if :new.status is not null The new duration value is
then not null so the status end
insert into date = status start date+ new
doctor_schedule_hist (hist_id, duration.
sched_id,
patient_id, New status not null so insert
created_by, into the
created_date,
prior_status,
doctor_schedule_hist the
status, following:
doctor, (sched_id,
sched_date( patient_id,
values (cms_seq.nextval, created_by,
: new.sched_id, created_date,
: new.patient_id, prior_status,
nvl(v('USER'),'USER ,(' sysdate, status,
: new.prior_status, doctor,
: new.status, sched_date(
: new.doctor_name, )
: new.status_start_date ;( The following values
: new.prior_status := ((cms_seq.nextval,
:new.status; :
:new.status := null; new.sched_id,
end if; :
new.patient_id,
end if; nvl(v('USER'),'USER
,(' sysdate,
:
new.prior_status,
: new.status,
:
new.doctor_name ,
:new.status_start_dat
e ;(
if updating then :
new.prior_status :=
if :new.status is not null :new.status;
then :new.status :=
insert into null;
doctor_schedule_hist (hist_id, )
sched_id,
patient_id,
created_by, In the updating case
created_date,
prior_status, If the value of status is not
status, null insert into the
doctor, doctor_schedule_hist
sched_date( (hist_id ,
values sched_id,
(cms_seq.nextval, patient_id,
: new.sched_id, created_by,
: new.patient_id, created_date ,
nvl(v('USER'),'USER ,(' sysdate, prior_status,
: new.prior_status, status,
: new.status, doctor,
: new.doctor_name, sched_date)
: new.status_start_date ;(

148
 if :new.status = 'POSTPONED' The following values.
then
:new.status_start_date := ((cms_seq.nextval,
:new.postponed_date; : new.sched_id,
end if; : new.patient_id,
:new.prior_status := :new.status; nvl(v('USER'),'USER
:new.status := null; ,(' sysdate,
:new.postponed_date := null; :new.prior_status,
:new.status,
end if; :new.doctor_name,
:new.status_start_da
if :new.duration is not null te ;(
then
)
:new.STATUS_END_DATE :=
(:new.STATUS_START_DATE +
And if the new status is
POSTPONED
:new.duration ;(
The new status start date =
end if; new postponed date
And new priority status =
new status,
end if;

end;

Code Name Code Description

3- Functions Code

AGE_NOW CREATE OR REPLACE This is the age function

FUNCTION age_now(dd in varchar2,
mm in varchar2 , yyyy in varchar2)
return varchar2 as

dob date;
age pls_integer; The age is Integer
age_now number;

begin Begin
The dob =
dob:=to_date(valid_dob(dd,mm,yyyy),
(DD,MM,YYYY)
'DDMMRRRR');
age_now := (trunc(months_between( The age is
sysdate,dob)/12 )); trunc(months_between(
sysdate,dob)/12 )
return age_now;

end;
/
Code Name Code Description

4- Packages (Chart Code) Refer to the appendix (E)

5.8 Conclusion
149
 System designing started by looking at the analysis result, which determines the

system boundaries based on the system need and the user requirement. In this research,

the result of analysis was developing an integrated health care management system to

manage the entire health care information. The first stage for system design was

determining the system modules and UseCase than designing the system tables and

system interface and finally writing the system codes.

The way of developing this integrated web based was using apex oracle, which

provide the flexibility to use more than one tool such as (HTML, SQL, PL/SQL,

JavaScript, CSS and FUSION) for developing the system. Therefore the main module

designed and developed in this system is patient module, doctor module, appointment

module, product module, client module, document module, task module, account

module and user module.

5.9 Summary

System design is presenting system structure, details about system modules and

system interface. Therefore, system structure covers the system concept, which covers

the research objectives through designing the system modules. Those modules

developed using (Oracle Apex) environment that provides necessary development tools.

This first stage of developing this system started by specifying the function

requirements (use case) and non-function requirements (integrity, flexibility, etc), then

developing the system interfaces, system tables and system codes. The next chapter is

presenting the research discussion and conclusion.

150
 CHAPTER 6

Discussion and Conclusion

6.1 Introduction

Health care information system is a computer application to represent patient

information in a friendly user interface and allowing users to review and interact with

patient health information, such as diagnosis, medicine orders, managing patient

appointment and other services. Moreover, application health information system works

as data repository for patient health information such as patient registration, systems

administrator and financial management.

Hence using an information system to support health care management system

follows the following steps:

1. Developing an integrated computer application system to manage the patient

information and the health care information based on database unit.

2. Developing a website and allowing the health care user and the patients to access the

system online.

3. Developing a portal and allowing the users to access the system database.

4. Developing different applications to manage all the health care information and

integrated in the database unit.

So, information system supports the health care in different way based on the

users need such as developing electronic patient record to manage the patient

information electronically, managing the patient appointment through using the

flexibility of information system.

151
 On the other hand, using the information system allows the patient information

to be accessible and the patient can access his/her own information online, register

online and in some systems can book their appointment online. This research outcome

with developing an integrated computer application for managing the health care

information and giving the patient the opportunity to confirm their own appointments

by themselves. This study began by extensive literature review (chapter 2) and finding

out what the previous researchers have done to improve the quality of services in the

health care (see table 2.3).

Chapter 3 highlighted the research methodology that have been used to get the

aims of this research, which were by interviewing different research participants to get

the real user requirement to develop a system. Chapter 4 was for using the available

technology and tools to collect the data and summarizing the user processes and jobs

(Case study). The second part is analyzing each available data about the current system

and come out with the finding, which is the system needed (modules). In addition after

the system developed, the testing process is begun by the user in the real work to get the

real feedback needed and improve the system based on the getting feedback. Chapter 5

is highlighted the system design and how the system built such as system interface and

system code.

6.2 Contribution to Knowledge

A Web based integrated health care management system is a computer

application with an interactive web database to manage and analysis the entire health

care information such as the following:

a) Patient Information, which contains: personal information, consultations history

medications history, treatments and diagnosis history, appointments, confirm the

patient’s appointment online by themselves, documents and payments.

152
b) Health Care Information, which contains: insurance companies, health care clients,

health care documents, managing the products, managing the products suppliers,

different types of reports.

c) Health Care Staff, which contains: doctor schedule, staff documents, tracking the

system user.

6.3 The Research Outcome

Based on the research findings from analyzing the previous studies and the

current health care system use, the results proved that the current health care

information system is not appropriate and comprehensive enough in managing the

health care information. So, the outcome of this research have accomplished the

objectives, which is studying previous studies and analyzing the current health care

information systems and developing an integrated health care management system. The

developed system able to manage the health care information through an interactive data

base with friendly interface and able to generate very smart reports and represent it in a

helpful chart.

6.4 System Strength

The developed system is a web based integrated health care management system

has able to overcome the problem of not having an integrated system in most of current

hospital (see chapter 1). The features of those systems has been identified as in (table

2.3) in chapter 2. Those systems did not care to integrate all the health care information

and they focuses to automate the health care information and generating an electronic

patient record.

153
 The developed system in this research approach has very strengths points. In

general, the system developed as a flexible integrated web based to keep track all

patient information, payment and appointments. In addition, tracking the doctor

schedules. This provides a full view of previous visit history of the patients and the

previous diagnosis, investigation, treatments and medications. Moreover, supports the

user to put their tasks in priority such as Urgent, High, Medium and Low. Moreover, the

developed system can run on the normal web browser, which provides very high

flexibility and very user friendly.

On the other hand, the system generates very smart reports and analyzes the

health care information providing the result in attractive charts, which helps the

management in monitoring the health care closely; such as:

1) Provided a very smart report about the patient’s appointments, which show up

all the appointment information in details and provides a percentage of

patient's gender and races, which provides a very wide show; whose is the

most come to the health care.

2) Provides a Payment report and analyzing the payments in specific date and

provides monthly report about payment amount. In addition, the end of day

Payment Report shows details of all payments made during the period time

and date. Moreover, reports the payments method and represent the result in

analysis diagram.

3) Provides a doctor consultation report, which presents the number of patient

that has been treated by each doctor every month round the year.

4) Provide a list of all the health care clients and a report analysis for the

company name and their patients such as insurance companies, banks, etc.

5) Document report presents the entire uploaded documents about patient and

health care.

154
 6) Provides a list about the patient complain and treatments, which helps to

observe the patients complain treatments.

7) Provides a very smart report about the most medicine used that has been

prescribed by doctors.

6.5 System Limitation

However the system can do, still have some limitation such as the following:

i. This system do not have a function for lab work, which means can not support

the laboratory chart such as blood test and other laboratory test because it is

more complicated and needs very advanced work.

ii. This system cannot support image processing such as x-ray and other images,

because including image processing; it needs very advanced program and at

least separate research.

iii. This system has not been fully tested in the hospital because the system is very

big and needs very long time to be full tested. In addition, the hospital

management will not accept to test the system for long time for patient

information security reason.

6.6 Recommendation for Future Work

There are many aspects that need to be considered in order to improve the

integrated health care system and the quality of service especially the patient

appointment and the appointment confirmation, which work to save both patient and

nurse time. It’s recommended in the future study the following:

i. Enhancing the integrating health care management system to be able to manage all

the information in the health care.

- Laboratory information.

- Image processing and patients images.

155
 ii. Giving the patient more flexibility to using the health care system such as:

- The patient can book the appointment by themselves online.

- The patient can change the appointment time and date by them self online.

6.7 Research Conclusion

The new integrated web based system developed to help the health care for

managing the patient information and enhancing the quality of service and saving time

and cost and maintaining data store system in the health care. The problem for using the

current system based on the literature review is the difficulty for accessing and updating

data and the maintenance process because they are using more than one system for

managing the health care information. In addition those systems are not able to allow

the patient to use the system online to confirm their appointment.

Therefore the developed system in this research is an integrated health care

management system, which is a web based computer application based on an interactive

database to manage the health care information through a friendly interface and able to

use on the web browser.

The benefit of this system is keep tracking for all the health care information in

one system and it's very easy to use and easy for maintenance. In addition it's accessible

online with sturdy security. Moreover the patient will be able to use the system online

and confirm their own appointment by themselves using their own username and

password. On the other hand the system enables data analysis and generates powerful

and helpful reports supported by a colorful diagram for all the health care information,

which help the health care management to observe all the health care process closely.

156
References

AIELLO, K. (2005) Open Access Appointing in Army Primary Care Clinics. Military
Medicine, 170, 370-374.
BROWN, G., CHRISTOPH, G., DOLAN, K. & HENRY, W. (2008) The Time for
Electronic Health Records is now. Leading the IT Community to Improve
Government.
BIGGAM, J. (2008) Succeeding with Your Master’s Dissertation, England, Open
University Press.
CHUA (2005) Teleprimary Care Software building the future of healthcare. IN
BRINFO (Ed.) brilliance information sdn bhd(374044-H).
CIMINOA, J., PATELA, V. & KUSHNIRUKB, A. (2000) What Do Patients Do with
Access to Their Medical Records? Patient Access to Clinical Information: the
PatCIS Project.
DAVIS, W. & YEN, D. (1998) The Information System Consultant's Handbook:
Systems Analysis and Design. IN DAVIS, W. S. & YEN, D. C. (Eds.) Systems
Analysis and Design. Miami, Miami University.
DAWSON, C. (2002) Practical Research Methods, United Kingdom, HowToBooks
Ltd.
DEXTER, F. (1999) Design of Appointment Systems for Preanesthesia Evaluation
Clinics to Minimize Patient Waiting Times: A Review of Computer Simulation
and Patient Survey Studies. ANESTHESIA CLINIC APPOINTMENTS, 925-
931.
ELLINGSEN, G. & OBSTFELDER, A. (2006) Collective expectations—Individual
action implementing electronic booking systems in Norwegian health care.
international journal of medical informatics, 76, 104-112.
GIACHETTI, R. E., CENTENO, E. A., CENTENO, M. A. & SUNDARAM, R. (2005)
Assessing The Viability Of An Open Access Policy in an outpatient clinic:A
Discrete-event and continuous simulation modiling Approach. IN
UNIVERSITY, F. I. (Ed.) Miami, ACM.
GIFFIN, R. B., ERICKSON, S. M., MCHUGH, M., WHEATLEY, B., DHARSHI, A.
S., MADHANI, S. J. & TRENUM, C. (2006) Hospital-Based Emergency Care:
At the Breaking Point. IN ACADEMIES, I. O. M. O. T. N. (Ed.) Committee on
the Future of Emergency Care in the United States Health System. Nap.
GUO, M., WAGNER, M. & WEST, C. (2004) Out Patient Clinic Scheduling-A
Simulation Approach. IN RESOURCES, D. O. H. (Ed.) Simulation Conference.
USA, IEEE.
HALL, R. W. (2006) Patient Flow: Reducing Delay in Healthcare Delivery, Newyork,
Springer US.
HARPER, P. R. & GAMLIN, H. M. (2003) Reduced outpatient waiting times with
improved appointment scheduling: a simulation modelling approach. OR
Spectrum, 25, 207-222.
IBRAHIM, L. (2002) Health Management Information System. Medical Care
(Implementation of ICD-10), Malaysian Experience, 1, 9.
JAIN, S. & CHOU (2000) Use of an orientation clinic to reduce failed new patient
appointments in primary care. Journal of General Internal Medicine, 15, 878-
880.
KLASSEN, K. J. & ROHLEDER, T. R. (2004) Outpatient appointment scheduling with
urgent clients in a dynamic, multi-period environment. International Journal of
Service Industry Management 15, 167-186.

157
KOPACH, R., DELAURENTIS, P.-C., LAWLEY, M., MUTHURAMAN, K., OZSEN,
L., RARDIN, R., WAN, H., INTREVADO, P., QU, X. & WILLIS, D. (2007)
Effects of clinical characteristics on successful open access scheduling Health
Care Management Science, 10, 111-124.
LASERFICHE (2007) Simplifying the Business of Healthcare. Healthcare Focus, 12.
LIM, C. C., YU, M. H. & JIN, J. J. (2006) Web-based Multimedia GP Medical System.
Research and Practice in Information Technology. Pan-Sydney, Australian
Computer Society.
LINDEMANN-V, TRZEBIATOWSKI & SCHRÖTER, K. (2002) TBase2 – How to
deal with Electronic Patient Records in an Intra-/ Internet. Berlin, University of
Berlin.
LIU, L. & ZHU, D. (2007) Electronic Medical Records: A Vision for Medical Data and
Service Grids. Service Systems and Service Management. Changdu China IEEE.
MAZZI, C., GANGULY, P. & KIDD, M. (2006) Healthcare Applications based on
Software Agents. Human-computer Interaction.
MEHDI, S., JORGE, P. & MICHEL, L. (2004) Information system architectures: where
we are? IN UNIVERSITY, C. (Ed.) Information and Communication
Technologies. Geneva Switzerland, IEEE.
MUSTAFA, Y. (2004) E-Health Centre: a web-based tool to empower patients to
become proactive customers. Health Information and Libraries Journal, 21,
129-133.
PORTA-SALES, J., CODORNIU, N., GÓMEZ-BATISTE, X., ALBURQUERQUE, E.,
SERRANO-BERMÚDEZ, G., SÁNCHEZ-POSADAS, D., PÉREZ-MARTIN,
X., GONZÁLEZ-BARBOTEO, J. & TUCA-RODRÍGUEZ, A. (2005) Patient
Appointment Process, Symptom Control and Prediction of Follow-up
Compliance in a Palliative Care Outpatient Clinic. Pain and Symptom
Management, 30, 145-153.
ROGERS, J., PULESTON, C. & RECTOR, A. (2006) The CLEF Chronicle: Patient
Histories derived from Electronic Health Records. IN UK, U. O. M. (Ed.) Data
Engineering Workshops. Atlanta GA USA IEEE.
POWELL, E. T. & RENNER, M. (2003) Analyzing Qualitative Data, Madison, UW-
Extension.
ROHLEDER, T. R. & KLASSEN, K. J. (2002) Rolling Horizon Appointment
Scheduling: A Simulation Study. Health Care Management Science, 5, 201-209.
SONG, X., HWONG, B., MATOS, G. & RUDORFER, A. (2007) Understanding and
Classifying Requirements for Computer-Aided Healthcare Workflows. IN INC,
S. C. R. (Ed. Computer Software and Applications. Beijing China, IEEE.
SNYDER, K. D., PAULSON, P. & MCGRATH, P. (2005) Improving processes in a
small health-care network A value-mapping case study. Business Process
Management, 11, 87-99.
STOLYAR, A., LOBER, W. B., DROZD, D. R. & SIBLEY, J. (2006) A Patient-
centered Health Record in a Demonstration Regional Health Information
Network. IN UNIVERSITY, H. I. W. (Ed.) Distributed Diagnosis and Home
Healthcare. Arlington VA, IEEE.
SU, S. & SHIH, C.-L. (2003) Managing a mixed-registration-type appointment system
in outpatient clinics. International Journal of Medical Informatics, 70, 31-40.
TANG, S. T., HUANG, Y.-F., HSIAO, M.-L., LEE, T.-C. & YOUNG, S.-T. (2001) An
Orthopedics Clinic Assistant System. IN ENG, I. O. B. (Ed.) Engineering in
Medicine and Biology Society. Taipei Taiwan, IEEE.
WALD, J., MIDDLETON, B. & BLOOM, A. (2004) A Patient-Controlled Journal for
an Electronic Medical Record: Issues and Challenges. Electronic Medical
Record, 5.

158
WIJEWICKRAMA, A. & TAKAKUWA, S. (2005) Simulation analysis of appointment
scheduling in an outpatient department of internal medicine. IN UNIVERSITY,
N. (Ed.) Winter Simulation Japan, IEEE.
WIKIPEDIA.ORG (2008) Information System (Information Systems). encyclopedia.
WILCOX, A., S.JONES, S., A.DORR, D., CANNON, W., BURNS, L., RADICAN, K.,
CHRISTENSEN, K., BRUNKER, C., LARSEN, A., P.NARUS, S.,
N.THORNTON, S. & D.CLAYTON, P. (2005) Use and Impact of a Computer-
Generated Patient Summary Worksheet for Primary Care. 824-828.
ZENG, Q. & CIMINO, J. J. (2000) Providing Multiple Views to Meet Physician
Information Needs. IN UNIVERSITY, C. (Ed.) System Sciences. Hawaii IEEE.

159