Chapter I

Introduction

The Irosin District Hospital is the only public hospital in Irosin that presides in the
province of Sorsogon. It was developed by provincial Government of Sorsogon by the
virtue of the full implementation of the Local Government code 1991 with the full
responsibility of a good health service to the people.

Nowadays many problems have encountered by the management of the hospital in

terms of delivery health services. Paper based records are still by far the preferred
method of recording patient information for most hospitals and practices in the said
hospital. The majority of doctors still find their ease of data entry and low cost hard to
part with. However, as easy as they are for the doctor to record medical data at the point
of care, they require a significant amount of storage space compared to digital records.
In the said hospital, the costs of storage of files, such as papers and folders, per unit of
information differ dramatically from that of electronic storage media. When paper
records are stored in different locations, collecting them to a single location for review
by a health care provider is time consuming and complicated, whereas the process can
be simplified with electronic records. This is particularly true in the case of person-
centered records, which are impractical to maintain if not electronic (thus difficult to
centralize or federate). When paper-based records are required in multiple locations,
copying, faxing, and transporting costs are significant compared to duplication and
transfer of digital records. However most of the time manual operation is necessarily as
duplication for some reasons but not as simple, sometimes the practical option is much
better than the complicated thing that we usually did because innovation are
continuously changing the way even small companies do businesses and by the use of
this innovations that can help our operation less aesthetic but eminent more helpful and
can perform various task.

Handwritten paper medical records can be associated with poor legibility, which
can contribute to medical errors. Pre-printed forms, the standardization of abbreviations,
and standards for penmanship were encouraged to improve reliability of paper medical
records. Electronic records help with the standardization of forms, terminology and
abbreviations, and data input. Digitization of forms facilitates the collection of data just
like any other record keeping, moving patients' records from paper and physical filing
systems to computers and their super storage capabilities creates great efficiencies for
patients and their providers but efficiency isn't the only benefit. For individual patients,
access to good care becomes easier and safer when records can easily be shared by
monitoring, handling, manipulating, organizing, storing and updating of patients
information’s also by automatically monitor clinical events, by analyzing patient data
this can include admitting and discharging transferring to the other hospital and other
aspects of our patients medical history can be accounted for much more quickly.
Furthermore, computerized medical record created in an organization that delivers
care, such as a hospital and doctor's surgery. Electronic medical records tend to be a part
of a local stand-alone health information system that allows storage, retrieval and
modification of records in contrast with paper-based record also the reason why federal
and state governments, insurance companies and other large medical institutions are
heavily promoting the adoption of electronic medical records. Like medical records,
must be kept in unaltered form and authenticated by the creator under data protection
legislation, responsibility for patient records irrespective of the form they are kept in is
always on the creator and custodian of the record, usually a health care practice or
facility. The physical medical records are the property of the medical provider (or
facility) that prepares them.
 PURPOSE AND DESCRIPTION

The Software is for the automation of Medical Record System.

It maintains two levels of users:

 Administrator level – the Administrator level are the one who have the total root
Power or privileges to access for all the information or transaction within the
system.
 User level – the user level only have a limited access for the information.

Main facilities available in this project are:

 Recording personal information about the Patients that come both indoor/outdoor
patient
 Monitoring Admitting and Discharging of Patient
 Recording patient’s information about diagnostic result, remarks and other
advised tests to be done.

Secondary facilities:

 Maintaining backup of data

 Creating users account
 Generating report

The main purpose of this system is to:

Planned approach towards working - The working in the organization will be well
planned and organized. The data will be stored properly in data stores, which will help in
retrieval of information as well as its storage.

Accuracy - The level of accuracy in the proposed system will be higher. All operation
would be done correctly and it ensures that whatever information is coming from the
center is accurate.

Reliability - The reliability of the proposed system will be high due to the above stated
reasons. The reason for the increased reliability of the system is that now there would be
proper storage of information.

No Redundancy - In the proposed system utmost care would be that no information is

repeated anywhere, in storage or otherwise. This would assure economic use of storage
space and consistency in the data stored.
Immediate retrieval of information - The main objective of proposed system is to
provide for a quick and efficient retrieval of information. Any type of information would
be available whenever the user requires.

Immediate storage of information - In manual system there are many problems to store
the largest amount of information.

Easy to Operate - The system should be easy to operate and should be such that it can be
developed within a short period of time and fit in the limited budget of the user.

IMPORTANCE OF THE STUDY

The result of this study will enhance the process of manual operation of into an
automated system that would make the flow of operation faster and easier.

The system would hopefully be of value to the management of Irosin District Hospital
upon organizing their data and information. Using this system it would allow the Irosin
District Hospital of providing additional health services in terms of organizing
collecting, manipulating, handling, sorting, and securing the patient’s information easily
and time-reducing. in the Irosin District Hospital (IDH).
Hopefully, the benefits of this project will also serve as an inspiration for other
businesses to require having their own systems to maximize efficiency and business
performance. This system will also be beneficial for the researcher that will serve as a
guide and reference for them to develop, make and execute computer a program that will
enable them to make a new process.
 OBJECTIVES OF THE STUDY

This proposed system primarily aimed to developed and execute a computer

database program that will collect, manipulate, handle, sort, organize and secure the
patient’s information in the Irosin District Hospital (IDH) by substituting the Manual
operation into a Computerized System that will upgrade the operation of the said
Hospital.

STATEMENT OF THE PROBLEM

 Lack of immediate retrievals:-The information is very difficult to retrieve and to

find particular information like- E.g. - To find out about the patient’s history, the
user has to go through various registers. This results in inconvenience and
wastage of time.
 Lack of immediate information storage: - The information generated by various
transactions takes time and efforts to be stored at right place.
 Lack of prompt updating: - Various changes to information like patient details or
immunization details of child are difficult to make as paper work is involved.
 Preparation of accurate and prompt reports: - This becomes a difficult task as
information is difficult to collect from various registers.
 SCOPE AND DELIMITATIONS

This study will focuses on the automated procedure of transaction between the
IDH management and their patients for the enhancement of the operations of Irosin
District Hospital in terms of recording and storing patient’s medical records
systematically and orderly also by monitoring the admitting and discharging of patients
faster and easier it focuses on the difficulties encountered by Irosin District Hospital and
the possible solution that we can be proposed to solve and eliminate or even can lessen
such problems by substituting the Manual operation- Computerized System that will
upgrade the operation of the said Hospital.

This system is limited only for the Patients Information such as collecting, storing,
updating and recording patient’s medical records, monitoring Admitting and discharging
of patient and strictly not for Computing and recording their total Expenses or patient
bills and not by the entire Hospital records such as monitoring attendance of nurses,
doctors, staffs and administration.
 REVIEW OF RELATED LITERATURE/SYSTEM

This chapter will provide a literature review that was designed to identify related
research, to set the current research project within a conceptual and theoretical context.

Related Literature

Computerized medical records are the digital counterparts to patient medical

records kept in paper files and folders in health care offices. They are, in essence, an
electronic version of the same medical records. In many cases, when a health care
practitioner wants to invest in computerized medical records, paper medical records are
simply scanned and entered into a medical records system.

Instead of documenting patient information on paper and creating a need for filing
and extra space, electronic medical records are stored on a computer server. In contrast
to their traditional counterparts, computerized medical records can be accessed quickly
and efficiently, eliminating the need for employees to physically look for the records in
an office. This, in turn, saves medical practices money, since employees are no longer
expected to lose time while retrieving records. Searching for and recovering medical
records is as simple as typing on a keyboard and clicking buttons on a mouse.

For professionals, the benefits of using computerized medical records are

numerous. In addition to helping save time and money, digital records aid doctors to
better serve the patient, as patients no longer have to wait unnecessarily while an
employee searches for files. Records can be cross-filed and cross-referenced according
to any number of factors. Digital records can instantly expand an office and provide a
more secure location for storage of files which, when physical, are only guarded with
locks.

There are also a number of personal advantages that patients may experience
should their health care providers implement computerized medical records. For
example, digital medical records are easily accessible during emergencies. Records can
be quickly updated for patients who have serious, progressive or chronic illnesses.
People with digital records do not have to worry about unsecure storage facilities or the
loss of records through theft, accident or natural disasters. Patients may also be able to
choose who can access their files and for what purposes.
 HISTORY OF COMPUTERIZED MEDICAL RECORD SYSTEM

In the 1960s, a physician named Lawrence L. Weed first described the concept of
computerized or electronic medical records. Weed described a system to automate and
reorganize patient medical records to enhance their utilization and thereby lead to
improved patient care.

Weed's work formed the basis of the PROMIS project at the University of
Vermont, a collaborative effort between physicians and information technology experts
started in 1967 to develop an automated electronic medical record system. The project's
objectives were to develop a system that would provide timely and sequential patient
data to the physician, and enable the rapid collection of data for epidemiological studies,
medical audits and business audits. The group's efforts led to the development of the
problem-oriented medical record, or POMR. Also, in the 1960s, the Mayo Clinic began
developing electronic medical record systems.

In 1970, the POMR was used in a medical ward of the Medical Center Hospital of
Vermont for the first time. At this time, touchscreen technology had been incorporated
into data entry procedures. Over the next few years, drug information elements were
added to the core program, allowing physicians to check for drug actions, dosages, side
effects, allergies and interactions. At the same time, diagnostic and treatment plans for
over 600 common medical problems were devised.

During the 1970s and 1980s, several electronic medical record systems were
developed and further refined by various academic and research institutions. The
Technicon system was hospital-based, and Harvard's COSTAR system had records for
ambulatory care. The HELP system and Duke's 'The Medical Record' are examples of
early in-patient care systems. Indiana's Regenstrief record was one of the earliest
combined in-patient and outpatient systems.

With advancements in computer and diagnostic applications during the 1990s,

electronic medical record systems became increasingly complex and more widely used
by practices. In the 21st century, more and more practices are implementing electronic
medical records.

Electronic Medical Records provides detailed information on Electronic Medical

Records, Electronic Medical Record Software, Electronic Medical Record Systems,
Electronic Medical Record Companies and more. Electronic Medical Records is
affiliated with HIPAA Laws.
 OTHER RELATED STUDIES:

Paper-based records have been in existence for centuries and their gradual
replacement by computer-based records has been slowly underway for over twenty years
in western healthcare systems. Computerized information systems have not achieved the
same degree of penetration in healthcare as that seen in other sectors such as finance,
transport and the manufacturing and retail industries. Further, deployment has varied
greatly from country to country and from specialty to specialty and in many cases has
revolved around local systems designed for local use. National penetration of EMRs may
have reached over 90% in primary care practices in Norway, Sweden and Denmark
(2003), but has been limited to 17% of physician office practices in the USA (2001-2003)
[HHS, 2005]. Those EMR systems that have been implemented however have been used
mainly for administrative rather than clinical purposes.

Electronic medical record systems lie at the center of any computerized health
information system. Without them other modern technologies such as decision support
systems cannot be effectively integrated into routine clinical workflow. The paperless,
interoperable, multi-provider, multi-specialty, multi-discipline computerized medical
record, which has been a goal for many researchers, healthcare professionals,
administrators and politicians for the past 20+ years, is however about to become reality
in many western countries.
Over the past decade, the political impetus for change in almost all western countries has
become stronger and stronger. Incontrovertible evidence has increasingly shown that
current systems are not delivering sufficiently safe, high quality, efficient and cost
effective healthcare (see Public Reports section on Open Clinical), and that
computerization, with the EMR at the centre, is effectively the only way forward. As
Tony Abott (Australian Minister for Heath and Ageing) said in August 2005: "Better use
of IT is no panacea, but there's scarcely a problem in the health system it can't improve".
For the first time, the responses have been national and co-ordinate. Governments in
Australia, Canada, Denmark, Finland, France, New Zealand, the UK, the USA and other
countries have announced - and are implementing - plans to build integrated computer-
based national healthcare infrastructures based around the deployment of interoperable
electronic medical record systems. And many of these countries aim to have EMR
systems deployed for their populations within the next 10 years.

Terms:

Terms used in the field include electronic medical record (EMR), electronic
patient record (EPR), electronic health record (EHR), computer-based patient record
(CPR) etc. These terms can be used interchangeably or generically but some specific
differences have been identified. For example, an Electronic Patient Record has been
defined as encapsulating a record of care provided by a single site, in contrast to an
Electronic Health Record which provides a longitudinal record of a patient’s care carried
out across different institutions and sectors. But such differentiations are not consistently
observed.

C. Peter Waegemann in his Medical Record Institute EHR Status Report provides,
within a historical context, a summary of the different functions and visions implied by
the various terms used to refer to EMRs.

An EMR is a computer application that allows you to create, store, edit, retrieve
and organize your patient records electronically via a computer. It often mimics the
function of your paper medical record system; however, it can do more. The term EMR
has been previously referred to as the computerized medical record, computerized
patient record, and computer-based patient record.

A patient record system is a type of clinical information system, which is

dedicated to collecting, storing, manipulating, and making available clinical information
important to the delivery of patient care. The central focus of such systems is clinical
data and not financial or billing information. Such systems may be limited in their scope
to a single area of clinical information (e.g., dedicated to laboratory data), or they may
be comprehensive and cover virtually every facet of clinical information pertinent to
patient care (e.g., computer-based patient record systems).

Definitions:

The 2003 IOM Patient Safety Report describes an EMR as encompassing :

1. a longitudinal collection of electronic health information for and about persons

2. [immediate] electronic access to person- and population-level information by
authorized users;
3. provision of knowledge and decision-support systems [that enhance the quality,
safety, and efficiency of patient care] and
4. Support for efficient processes for health care delivery." [IOM, 2003, P4
(footnote)]

The 1997 Institute of Medicine report: The Computer-Based Patient Record: An

Essential Technology for Health Care, provides the following more extensive definition:

"A patient record system is a type of clinical information system, which is

dedicated to collecting, storing, manipulating, and making available clinical information
important to the delivery of patient care. The central focus of such systems is clinical data
and not financial or billing information. Such systems may be limited in their scope to a
single area of clinical information (e.g., dedicated to laboratory data), or they may be
comprehensive and cover virtually every facet of clinical information pertinent to patient
care (e.g., computer-based patient record systems)." [IOM, 1997]

The HIMSS EHR definitional model document [HIMSS, 2003] includes "a
working definition of an EHR, attributes, key requirements to meet attributes, and
measures or "evidence" to assess the degree to which essential requirements have been
met once EHR is implemented".

Key Capabilities of an Electronic Health Record System

Linda Kloss, executive vice president and CEO of the American Health
Information Management Association (AHIMA), defines the three essential capabilities
of an electronic health record as follows:

o To capture data at the point of care

o To integrate data from multiple internal and external sources
o To support caregiver decision making.

The US IOM report, Key Capabilities of an Electronic Health Record System

[Tang, 2003], identified a set of 8 core care delivery functions that electronic health
records systems should be capable of performing in order to promote greater safety,
quality and efficiency in health care delivery:

"The core capabilities that EHRs should possess are:

 Health information and data. Having immediate access to key information -

such as patients' diagnoses, allergies, lab test results, and medications - would
improve caregivers' ability to make sound clinical decisions in a timely manner.
 Result management. The ability for all providers participating in the care of a
patient in multiple settings to quickly access new and past test results would
increase patient safety and the effectiveness of care.
 Order management. The ability to enter and store orders for prescriptions, tests,
and other services in a computer-based system should enhance legibility, reduce
duplication, and improve the speed with which orders are executed.
 Decision support. Using reminders prompts, and alerts, computerized decision-
support systems would help improve compliance with best clinical practices,
ensure regular screenings and other preventive practices, identify possible drug
interactions, and facilitate diagnoses and treatments.
 Electronic communication and connectivity. Efficient, secure, and readily
accessible communication among providers and patients would improve the
continuity of care, increase the timeliness of diagnoses and treatments, and reduce
the frequency of adverse events.
  Patient support. Tools that give patients access to their health records, provide
interactive patient education, and help them carry out home-monitoring and self-
testing can improve control of chronic conditions, such as diabetes.
 Administrative processes. Computerized administrative tools, such as scheduling
systems, would greatly improve hospitals' and clinics' efficiency and provide more
timely service to patients.
 Reporting. Electronic data storage that employs uniform data standards will
enable health care organizations to respond more quickly to federal, state, and
private reporting requirements, including those that support patient safety and
disease surveillance."

Barriers widespread implementation of EMRs has been hampered by many perceived

barriers including:

 Technical matters (uncertain quality, functionality, ease of use, lack of integration

with other applications,
 Financial matters - particularly applicable to non-publicly funded health service
systems (initial costs for hardware and software, maintenance, upgrades,
replacement, ROI ...)
 Resources issues, training and re-training; resistance by potential users; implied
changes in working practices.
 Certification, security, ethical matters; privacy and confidentiality issues
 Doubts on clinical usefulness.
 Incompatibility between systems (user interface, system architecture and
functionality can vary significantly between suppliers' products).

Issues:

Integrated systems require consistent use of standards in e.g. medical terminologies and
high quality data to support information sharing across wide networks
Ethical, legal and technical issues linked to accuracy, security confidentiality and access
rights are set to increase as national EMR systems come online. These issues become
more pressing with the current movement to promoting consumer empowerment and
information ownership, championed by the European Commission for example, which is
leading towards patient records accessible by patients (Personal Health Records).
 Common record architectures, structures
 Clinical information standards and communications protocols
 Security and confidentiality of information
 Patient data quality; data sets, data dictionaries interoperability
Interoperability aims to support:

 Data transfer and sharing on much more than a local or enterprise-wide scale
 Knowledge transfer and integration
 Medical terminology transfer, mapping and integration
 Image transfer
 Integration with clinical and non-clinical applications

Walker et al 2005 define four levels for interoperability between health information
systems:

 Level 1: Non-electronic data (e.g. mail, telephone)

 Level 2: Machine-transportable data (e.g. faxed or scanned documents)
 Level 3: Machine-organisable data (e.g. e-mail, proprietary file formats)
 Level 4: Machine-interpretable data (e.g. structured data within standardized
messages).

The US National Committee on Vital and Health Statistics describes three levels of
interoperability:

 Basic interoperability—allowing a message from one computer to be received by

another, but not requiring the receiving computer to be able to interpret the data.
 Functional interoperability—an intermediate level defining the format of
messages. This ensures messages between computers can be interpreted at the
level of data fields, so that data can pass from a structured field in one system to a
comparably structured field in another. Neither system, however, has
understanding of the meaning of the data within the field(s).
 Semantic interoperability—provides common interpretability, that is, information
within the data fields can be used intelligently.

National Committee on Vital and Health Statistics, Uniform Data Standards for Patient
Medical Record Information: Report to the Secretary of the US Department of Health and
Human Services. US Department of Health and Human Services, July 2000.
 TECHNICAL BACKGROUND

One of the broader scopes of information technology includes systems

development and data management. Many businesses are functioning through this
particular scope of information technology. Information technology allowed managing
business’ computer and data assets.

Many hospitals and clinics are still using the manual medical records for the
operation their health establishment. A manual filing system is one done by hand the
traditional way- using folders in a cabinet but still lots of problems were still
encountered in terms of the said system that they’re still practicing. Irosin District
Hospital is the only hospital here in Irosin and still using the manual system, the
patient’s medical records usually are stored in a filing cabinet in a records room in or
very near the hospital or clinic. However, the said hospital may treat thousands of
patients over the course of a year. Each patient file has to be handled physically in a
manual system, and this often results in misfiling and enormous wastes of time as files
are located. In this new proposed computerized system, the user simply can pull up
records according to any number of criteria in a database search (e.g., name, condition,
insurance company, etc.). The files can be located in a matter of seconds and will not
become misfiled. The existing systems that store hard copies of patient records require
enormous amounts of space in order to hold all the records. This can be costly to a
medical facility, because the space has to be paid for both in construction and upkeep. In
this computerized records, it will be stored on systems that take up less space than a
single filing cabinet, so the medical facility can use the space from the manual files for
other, more important things, such as a diagnostics laboratory. Many people, including
doctors, have handwriting that is hard to read. In the medical field, writing out charts and
prescriptions thus may mean that other staff members cannot read vital medical
instructions or information. Computerized records eliminate the problems that result
from record illegibility (e.g., incorrect medication given) because the "handwriting" is
clear and identical regardless of which staff member provides the data. Records often
need to be transferred, either from different departments within the medical facility or to
another facility altogether. When records are computerized, staff can easily retrieve
medical information and requests which saves time and physical strain on the staff
members.
Table 1 - Comparing Paper-based Medical Record System

Event Paper Record System EMR System

May take minutes to hours
depending on whether the chart You can search and retrieve
Medical Record Retrieval has been properly filed, is on documents in seconds right
someone's desk, or has been from your computer.
removed from the office.
Easily managed from your
May take from a few minutes to computer; once accessed,
Medical Record Filing several hours. Off-site filing is documents are re-filed
especially time-consuming. instantly with the click of a
mouse button.
Requires making multiple copies Everyone accesses the same
using a copy machine. Only one digital document, eliminating
Medical Record Sharing
clinician can work on a record at the need for physical
the same time. dup0licates.
Print, fax or e-mail
Mail 2-5 days, overnight mail, fax
documents. E-mail can be
(poor copy). Faxed copies can be
Sending Medical Records password-protected so that
seen by anybody that walks by
only the intended recipient can
the fax machine.
view the document.
Inherently vulnerable to physical
Duplicate electronic backups
Disaster Protection insults (e.g. fire and water
may be maintained off-site.
damage).
About 10,000 records can be
One incurs the cost of filing stored in one CD-R or 70,000
Storage Space cabinets and the cost for the space records in a DVD-R disc.
that they require Each of the discs cost less
than $1.
It is virtually impossible to
About 7.5% of all documents are
Lost Patient Documents lose a document filed with
missing, and 3% are misfiled.
EHR system.
Illegibility is eliminated
Medical records may contain
Legibility of Records (except scanned paper
illegible handwriting.
records).
 SYSTEM ANALYSIS AND DESIGN

This Chapter presents the System Analysis and Design of both the existing and the
proposed system this provide the process of collecting factual data, understand the
processes involved, identifying problems and recommending feasible suggestions for
improving the system functioning. The goal of system analysis is to determine where the
problem is in an attempt to fix the system. It attempts to give birth to a new efficient
system that satisfies the current needs of the user and has scope for future growth within
the organizational constraints. The result of this process is a logical system design based
on the user requirements and the detailed analysis of the existing system, the new system
must be designed. The logical system design arrived at as a result of systems analysis is
converted into physical system design.

SDLC GUIDE

 Project planning, feasibility study: Establishes a high-level view of the intended

project and determines its goals.

 Systems analysis, requirements definition: Refines project goals into defined

functions and operation of the intended application. Analyzes end-user
information needs.

 Systems design: Describes desired features and operations in detail, including

screen layouts, business rules, process diagrams, pseudo code and other
documentation.

 Implementation: The real code is written here.

 Integration and testing: Brings all the pieces together into a special testing
environment, then checks for errors, bugs and interoperability.

 Acceptance, installation, deployment: The final stage of initial development,

where the software is put into production and runs actual business.

 Maintenance: What happens during the rest of the software's life: changes,
correction, additions, and moves to a different computing platform and more. This,
the least glamorous and perhaps most important step of all, goes on seemingly
forever.
In the following example (see picture below) these stage of the Systems Development
Life Cycle are divided in ten steps from definition to creation and modification of IT
work products:

SYSTEM DEVELOPMENT LIFE CYCLE

System Planning

Irosin District Hospital undergoes manual recording of patient’s information from day-to-
day basis, the hospital stores them on one place and until now certain unwanted pile up
on files still remain intact because of its manual recording that leaves the files vulnerable
on data loss and other unwanted uncertainties. The proposed system that the researchers
plan is to develop a system with easy data manipulation, access on records and safe and
secure patient’s information in comparison to the manual.

System Analysis

The researchers focused the compatibility and specification of the project’s requirements
solely for Irosin District hospital. The manual Recording system of Irosin District
Hospital has minimum security as well as a poor organization system of files. As the
researchers observed on the said hospital, file cabinets aren’t only the place to put on files
but also in storage rooms and other offices that supposedly can be used for other purposes
but most unlikely wasted space for the multiple patients’ record over the past decade. The
Researcher’s plan is to enhance the existing record system in a more easy and convenient
way possible as to keeping the file sorted placed in a more secure location and would not
be a burden in space location.
System Design

The researchers designed a system that would be making it easier for the researchers and
the users to be able to incorporate the hospital and patient records within the
computerized system. The researchers looked for available software, researched possible
improvement upon the previous manual system at the same time easy to use as to make
the system possible. The design covers the fields of saving and updating record
information of the patients in a more organize way as to just filing it on one place and
storing it in a very long time. This system will help not only the administration but also
the patient so that the process will be easy rather than waiting in line or getting another
card in the hospital. The system also records the previous medical visits the patients have
and compile it in one safe location unlike the previous operation where different forms
are stored in different location that makes it harder to locate, the system is built to never
again repeat that over view of difficulties and just enhances the potential of the hospital’s
services In terms of medical care.

System Development and testing

The researchers developed a system that will be able to achieve all the objectives of the
study and replace the manual system by the proposed system. Upon developing, the
researchers went through with the originally drafted system and continue making changes
needed while developing in order to maximize the flexibility of the system. These
changes in improving previous manual operating went through series of consideration as
how will the system suffice the needs of the hospital in meeting their desire improvement
in helping their facility to a more advance, more organize and secure way of recording
patient and hospital records.

System Implementation

The researchers underwent coding, programming, as well as trial-and-error approach to

determine the errors of the proposed system as well as to solve and debug these errors.
When done, the researchers put the system into practice.

The plan in implementation is to install two (2) computers in the Information area where
all the records are kept and organize and also where the patient are being registered first,
(2) sets of computer in the Head Nurse’s Area for monitoring and recording all in and out
patients records such as date and time admitted and consulted, the diagnostic result and
treatment and other patient information that only the attending physician and nurses can
be updated, one in the Medical Record Service office (MRS) for the monitoring of
generation reports and printing out forms for the medical records such as e.g. releasing all
patient’s information. We will also be installing one to two (1-2) sets of computers in the
administration office for the monitoring of daily procedures in the hospital. The admin
will be the only one that can access and manipulate the whole program. The other entire
computer will have their own username but by they are only consider as guest and can
only get access to some features in the program unlike the admin. We tend to network
the program in the hospital and also plan to see what the program may enhance after the
trial usage in the hospital.

System Maintenance

The researchers continuously update the system and look for current trends and
visualizations to improve the system and its usability. When problem occurs, the
researchers continue to solve the problem and when bigger scope arose, the researchers
are doing their best to broaden the scope of the system for the business as well.
Requirements and Specification

 Programming Language and Other software use:

 The Frontend and the Backend:

Front-end and back-end selection

An important issue for the development of a project is the selection of suitable front-
end and back-end. When we decided to develop the project we went through an
extensive
study to determine the most suitable platform that suits the needs of the organization as
well as helps in development of the project.

 Database Design (Ms Access)

 Form Design (VB 6.0) and Adobe Photoshop (CS3)
 Coding (VB 6.0)
 Testing (VB 6.0)
 Reporting Tool (MS Excel)

 Visual Basic (VB) is Visual Basic 6.0 supports object-oriented language elements
and has support for objects distributed in libraries. These programming language serve
as the front end or in automated the electronic form of the system that responsible for
collecting input in various forms from the user and processing it to conform to a
specification the back end can use.
the third-generation event-driven programming language and integrated development
environment (IDE) from Microsoft for its COM programming model. Visual Basic 6.0
supports object-oriented language elements and has support for objects distributed in
libraries. 
 Microsoft Access, is a pseudo-relational database management system from
Microsoft that combines the relational Microsoft Jet Database Engine with a graphical
user interface and software-development tools. Access stores data in its own format
based on the Access Jet Database Engine. It can also import or link directly to data
stored in other applications and databases. These database serve as the backend of the
system that automatically handle and stored data that inputted on the forms.
 OTHER SOFTWARE USE:

 Adobe Photoshop (CS3), or simply Photoshop, is a graphics editing program

developed and published by Adobe Systems. It is the current market leader for
commercial bitmap and image manipulation software, and is the flagship product of
Adobe Systems. This software use to develop a good and compatible design for the
interface of the system.

 Microsoft Excel 2007 is one of the versions of Microsoft Office's worksheet

(spreadsheet) program. Worksheets contain numerical information presented in tabular
row and column format with text that labels the data. This program use to print the
report regeneration or the whole summary of the patients Records. This application is
use as our report tool for printing the output of the medical report or the whole summary
of the patients Records.
EXISTING SYSTEM OVERVIEW

The Irosin District Hospital is still practices the paper-based method in terms of
recording patients information. They file all the record according to the proper
arrangement to its chart all the process record after the patient being discharge all of
their record will give at the information Department then the Information clerk will store
it at the filling cabinet and when they sort for these records they will look from where
filling cabinet they stored that records.

NARRATIVE DESCRIPTION OF THE PROCESS FLOW

The patient went first at the Information for registration then the information
released the ID card then filled up the necessary information by the patient then that is
their identity whether they are old or new patient every time they went at the hospital
they must have to present first their Identification card and if that card were being left or
misplace they will provide another card you will pay for it.

After that if the patient is for out patient the information released the form and
were being supplied and filled up by the patient also if they are In-patient though
different station are responsible for releasing the admission and discharge form still the
patient or their relative are responsible of supplying the necessary inputted information
with regards to patients personal information and then the physician and nurse attendant
are responsible for the other related information that were being inputted such us the
date and time that the patient being admitted or the consultation date if they are out
patient then the diagnostic result both for In or out patients the remarks, the
recommendation and prescription and other information that only for the responsibility
of the management.
INPUT FORMS:

There are different forms and information that are necessary to be supplied and
filled up both by the patient and the attending physician and nurse and these information
includes.

For the patient:

The personal Information

1. Patients Full name such us Given Name, Middle Name or Initial and Family Name

2. The address and Contact number if they have.

3. Birthplace, Birth date, Age, Gender, Civil status, Nationality, Occupation and Other
personal information.

For the physician and nurse:

1. The Date and Time of admission and discharge of patients the type and number of
room also the bed being occupied if they are being admitted for confine
2. The diagnostic result and remarks, medical treatment or prescription,
recommendation and others.

DATA PROCESSING PROCEDURE:

The patient status of the IDH is in manual procedure. As describe earlier in the
narrative description of the process flow, the present system of IDH starts when the
patient is confined or resided and checked up inside the medical establishment. Records
of the patient is manually inputted through different forms, stored in a filing cabinet,
retrieved manually and stored out y by alphabetical list.
With this present status, it will take much time for an informant chief nurse and the
attending physician to sort and seek the different information, and accurately make a
report whom and where to find the specific patient if he/she is still confined in the said
establishment. Since they are also concerned with security and easily retrieval of records
in just a minute, the manual system could not offer the fast accession for these records.
DATA FLOW DIAGRAM OF EXISTING SYSTEM:

Summary Flow

Patient

New Old

OPD *in-Patient
*Outpatient

Findings

Admitting

Disposition
Ward Work

Other Home Referral

PROPOSED SYSTEM:

The computerized means of the present system of the IDH can make an
enhancement not only in the record security and in the physical facility, rather as a
means to deliver a good, yet faster service to the community and general welfare as its
vision and mission. Though this system it will enable not only the convenience of record
manipulation and handling but as well as to promote the security of the files and records
in accessing this different information, as well as the easy access in retrieval of patient’s
diagnostic information in the past years and also the convenient way of how the
administration can monitor hospital information and procedures during the day as in
conclusion to the system the login time of the users handled by perspective offices will
be monitored by the networking of the system.

The system can manipulate record handling in a time bounded, efficient and
effective enhancement for them or sort retrieval and make an inventory report and
summary about the patients record and also monitoring of patient’s information
regarding their diagnostic record will be highly prioritize, the administration can easily
also monitor the hospital’s generation report which includes room availability, report \s
of charts, birth and death monitoring and awareness of causes of ailments, diseases and
the causes of deaths in the certain area recorded by the hospital
With the use of the same system, the database or the application will automatically make
a query report, save and update, and make a thorough summary regarding the patient’s
records. The database will store this information, in flexible and updateable tables and
will save different information for a long term service. And thus, with the proposed
system, there will be a comfortable means to sort, handle, secure and retrieve personal
information so that the said medical establishment may reach and achieve to deliver a
good, yet faster service to the general welfare.
NARRATIVE DESCRIPTION OF THE FLOW:

The proposed system is just an enhancement, or simply in a computerized

approach of the manual system. Unlike the manual system, the records will be kept and
processed in an electronic means, save and create new records during and after the
admission of the patient. The records and information will be inputted, saved and
updated through the use of a computer database application, together with the use of
some programming language, to make an effective and efficient approach that will
handle, retrieve and make a query report of summary about the admitted patient.
The records and forms were being supplied and filled up by the administration for
verification whether the patient is already registered. If the patient is already registered,
the user will automatically go to the admission form.

In terms of admission and discharge, the user will just select the patient ID and
then automatically the system will fill some necessary information regarding his
personal record and the respective admission or discharge date and time, and what room
he/she is confined and what diagnoses the physician given to her/him. admission also
monitors the diagnostic record of the patients as also encoding the findings of the said
patient for easy access later on when the patient wants to see his/her results.

If the patients are not yet registered, the system will automatically bring the user
for the registration of the new patient. Then, fields that are asked by the system should
be filled up. And in regards of updating the patient’s information, the room numbers and
the beds for such room the registration of physicians and nurses, creating user accounts
and viewing login history for security tracing, and some other maintenance were some of
few that his system offered. Also indicated in these registrations for is the family
background so that in case of any emergency the hospital will know who they will get in
touch with regarding the patient’s status.

The system will also automatically check the system time, monitor patient’s
current status ands make a thorough report of the hospital’s generation report which is
very helpful considering that the hospital gives out information to other government
offices such as the census regarding patient’s birth and death monitoring of the certain
area recorded in the said hospital. The output or report will automatically summarizes
and print out the fields and forms supplied by the patient during the admission,
treatments and diagnoses given by the physician, and the desired result the management
wants to be printed out using different query reports. Also the easy monitoring of the
administration regarding the hospital’s transactions and procedure in and out of the day.
THE PROPOSED OUTPUT FORMS

The proposed system will produce and print out some necessary record forms and
reports inputted from the personal information of the patient. It will make enhanced,
productive, convenient, efficient, effective and edited forms to be printed out by the
management.

This system will automatically produce the desired forms and reports. Among
these forms are:

1. Personal Information record

2. The List of all patients both In and Out Patient records
3. The disposition records whether the patient is discharge or being referred
4. Nurses and Physicians note and other print summary of reports about patient’s
medical record.
5. Prints out hospital generation records such as statistic charts and the monitoring
of patient’s information throughout the day.
 Economical feasibility

Economic justification is generally the “Bottom Line” consideration for most systems.
Economic justification includes a broad range of concerns that includes cost benefit
analysis. In this we weight the cost and the benefits associated with the candidate
system and if it suits the basic purpose of the organization i.e. profit making, the project
is making to the analysis and design phase.
The financial and the economic questions during the preliminary investigation are
Verified to estimate the following:

DEVELOPMENT COST

Desktop Computer Cost - Php. 14,700.00

License copy of OS Cost - Php. 2,500.00

LICENSE COPY OF AUTOMATION

System Software Cost - Php. 10,000.00

Training Cost - Php. 2000.00

Total cost –Php.29, 200.00

ANNUAL OPERATING COST

Maintenance Cost –Php.1500.00/month

Technical Inspection Cost –Php.900.00/ every (6) months

Total Cost –Php.19,800.00/year

SYSTEM REQUIREMENTS:

Operating System

1 window XP/ME/ Vista/2000

Office Requirements

2Microsoft Office XP/ME/2007/2003/2000

3 MS Access Computer Database

4 Microsoft Visual Studios 6.0

Capacity

6. Memory must be higher for this will hold of archives which will need a high memory
capacity (HARD DISK, RAM& VGA)

Other Devices:

7. Printer

8. Switch

9. rj 45