chapter 3: discussion of findings
TRANSCRIPT
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Emergency. Emergency cases are automatically taken
direct to an ER bed which would be seen by a nurse and/or
resident physician. Orders are carried and patients data
are taken.
Auxiliary Services. Auxiliary services consist of
laboratory, pharmacy, x-ray and dental. This would be done
once the Resident-On-Duty requested for any test to the
laboratory, X-Ray scans, prescribed medicines or for dental
consultation
Billing Section. Once the doctor permitted the patient
to be discharged and all of the patients charts were
filled, all of the charts would be checked by the Billing
Section to countercheck and compute the bills of the
patient.
Cash Section. The Cash Section counter check the bills
of the patient, check computation of bills and collect
payment and issues official receipt and gives final
clearance for discharge to the patient if the patient was
admitted.
In-Patient Service. Nursing care services provided for
the admitted patients. Nurses checks the vital signs, give
medications, carry out orders of the doctor, records
progress and charts of the patient.
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Figure 3
Patient Management Flowchart
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Problems in the Bacnotan District Hospital Information
System
Based on interviews conducted among the staffs and
nurses, supplemented with personal observation done by the
researchers the following are the identified problems along
the areas on data management and security.
The identified problems along the area on data
management are redundancy of data and limited storage.
Redundancy of data. Nurses are required to fill out
forms every time a patient visits especially if the patient
visited the hospital for the first time. Some of the forms
require the same data specifically the personal information
of the patient specially if the patient visited and has
records in the hospital. Another instance is when a patient
visits the hospital and the nurses and staffs could not
locate the record of the patient due to misplaced form, a
new form would then be required to fill out by the nurses
in order to replace the missing record. This process
results to data redundancy.
Limited storage. With the numerous number of records
stored in shelves the problem on limited storage arises.
Once a new patient visits the hospital for consultation or
admission additional records are being kept on shelves.
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Security of the Records. Records are kept in shelves
and it is easy to access because it is not stored in a
room. The shelves are just behind the desk of the OPD and
once a staff or nurse gained access to the records they can
disarrange the records and can cause problems in retrieving
the information of the information of the patient.
Features of the Proposed System
Based on the existing processes and problems
identified, the following proposed features are drawn to
give solutions to the problems encountered by the Bacnotan
District Hospital.
Login Page. This feature allow user to login to the
system. Only users with registered account are only allowed
to log in into the system and this would prevent other
people looking to the records of the patient.
Figure 4
Login Page Module
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Admin User Privilege. On the Admin User Privilege, the
Admin can Add User Accounts, Edit or Reset the Password of
the Users, Update the privilege of a user and delete
accounts. This would limit the users using the system
because only few users can use the system because only the
user with an admin privilege can add users that can access
the system, change the account privilege, reset password
and delete the account.
Figure 5
Account Registration Module
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Figure 6
Account Management Module
Management of Patient Record. This feature allows the
nurses and staff to manage the patient records. This
feature is used during data buildup of the system
especially to a new patient.
The management of patient information and records
comprises of registration of new patients and updating
patient information and record. The patient record would
determine if the patient would be confined or not based on
the findings of the physician that was inputted into the
system.
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Figure 7
Patient Registration Module
Figure 7 above shows the new patient registration
module.
Figure 8
Patient List View Module
Figure 8 above shows the list of patients registered
in the system.
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Figure 9
Patient Search Module
Patient Search. This feature allows searching for
patients that were registered in the database. This would
fasten in searching patient records especially if the user
has already an existing record in the hospital.
Figure 9 above shows the patient search module.
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View Patient Information and Record. Patients
individual information is shown in this page. Previous
records are shown also in this page and there is Add Record
module included if the patient returned to the hospital.
Figure 10
Patient Information Module
Figure 10 above shows the patients personal
information.
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Figure 11
Patient Record List Module
Figure 11 above shows the records of the patient from
the previous records to the current records.
Figure 12
Patient Add Record Module
Figure 12 above shows the Add Record form. This is
used if the patient returned to the hospital.
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Figure 14
Patient Admitted List Module
Patient Admission Management. This feature allows the
nurses and staff to manage the patient records who were
admitted in the hospital. This feature is used to keep
track of the patients by looking into their charts.
The management of patients that were admitted in the
hospital comprises of viewing the charts of the patient,
updating the charts, transferring the patient to another
ward or room and discharging the patient.
Figure 14 above shows the list of patients admitted in
the hospital
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the patient, the bed number and the ward where the patient
would be admitted.
Figure 17
Patient Admission Information and Record Module
Figure 17 above shows the complete patients
information and record taken.
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Figure 18
Therapeutic Form Module
Figure 18 above shows the therapeutic form where all
the therapeutics given to the patient is listed. On this
form, the form automatically shows a new form once the day
changes to make inputting data much easier.
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Figure 20
History and Physical Form Module
Figure 20 above shows the History and Physical
Examination form. The nurse or doctor would input the
information they got from examining the patient. This is
one of the basis for checking the medical history of the
patient.
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Figure 21
Doctors Orders Form Module
Figure 21 above shows the list of orders from the
Attending Physician of the patient. There are options if
the order was carried, administered, request made, endorsed
or discontinued.
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Figure 22
Progress Notes Form Module
Figure 22 above shows the progress notes form. Nurses
input the progress of the patient.
Figure 23
Nurses Notes Form Module
Figure 23 above shows the nurses notes form. Nurses
input their notes about the patient.
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Figure 24
IVF Consumption Form
Figure 24 above shows the IVF consumed by the patient.
The nurse would input the shift and time the IVF
consumption started the name of the IVF and the date and
time the patient consumed the IVF.
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Figure 25
List of Patients for Discharge
Billing Management Module. This feature allows the
Billing Section to manage the patient billing statements
who were admitted and ready to be discharge from the
hospital. This feature is used to keep track of the
patients billing statement.
The management of patients that were admitted in the
hospital comprises of automatic calculation of the expenses
of the patient depending on the case of the patient,
discounts and benefits of the patient.
Figure 25 above shows the list of patient that was
already cleared and ready to be discharge.
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Figure 26
List of Previous Patients Discharged
Figure 26 above shows the list of patients that were
already discharged. This is used to keep track of the
previous billing statements of the patients.
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Figure 27
Billing Statement Form Module
Figure 27 below shows the form for creating the billing
statement of the patient. The form automatically computes
the bill of the patient
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Figure 28
List of Available Doctor Module
Doctor Management Module. This feature allows the
nurses and staffs to manage the doctors information. This
feature is used to keep track if theyre On-Duty, On-Call
or On-Leave.
The management of doctors in the hospital comprises of
doctor information with their contact numbers, duty,
specialization and position in the hospital
Figure 28 above shows the list of available doctors
that were On-Duty or On-Call.
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Figure 29
List of all Doctors Module
Figure 29 above shows the list of all of the doctors
working in the hospital.
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Figure 30
Add Doctor Module
Figure 30 above show the add doctor form where the
only user with Admin privilege can add a doctor to the
system.
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Figure 31
Doctors Information Module
Figure 31 above shows the doctors information
with its specialty, contact number, address and duty
status.
Figure 32
Doctors Current Patient List Module
Figure 32 above shows the list of current patients
handled by the doctor.
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Figure 33
Doctors Previous Patient List Module
Figure 33 above shows the previous patients handled by
the doctor.
Figure 34
User Information Module
Account Management Module. This feature allows the
user to manage his account. The user can view the users
information, login history, change the users password.
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Figure 34 (see page 65) shows the users information.
Figure 35
Account Settings Module
Figure 35 above shows the Account Settings module
where the user can view his login history and change his
password.
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Figure 36
Add Therapeutics Module
Figure 36 above shows the Add Therapeutics Form where
the user can add therapeutics by inputting the name of the
therapeutic, type and price the price.
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Figure 37
Add PhilHealth Pricing List Module
Figure 37 above shows the Add PhilHealth Pricing List
where the user can add a PhilHealth price list. The user
would input the membership type and the amount for each
benefit a patient can get.
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Figure 38
PhilHealth Price List Module
Figure 38 above shows the PhilHealth Price List. The
system shows the list of PhilHealth benefits a patient can
get according to the type of membership.
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Figure 39
Data Deletion and Update Security Module
Data Deletion and Update Security Feature. The records
of the hospital are sensitive because once a data was
deleted it can compromise the findings and diagnosis on the
cause of illness of a patient. It can also create conflicts
once a patient consults and the patients records are
nowhere to be found even though the patient previously
visited the hospital. Once the user tried to edit or delete
a patient record, the system would prompt the users
username and password to confirm if the user has the right
to delete or update patients records.
Figure 39 above shows the data deletion and update
security module.
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Figure 40
Use Case Diagram of the Proposed System
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Figure 41
Entity Relationship Diagram
Patient Doctor
Records
Admitted Charts
Bills
examines
has Fill-up
has
can be
has
1..* 1..*
1..*
1..*
1..*
1..*
1..* 1..*
1..1
1..*
1..1
1..* 1..*
1..*
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Database Scheme
tbladmissionaid, pid, rid, bednumber, roomno,
service, status, dateadmitted
PK: aidFK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
tblbed
bid, bednumber, roomno, roomtype,
pid, rid, aid, status,
priceperday, dateadmitted
PK: bidFK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
tblclinicalface
cfid, pid, aid, rid, category,
nameofnextkin, relationshipkin,
addresskin, dateadmitted,
timeadmitted, datedischarged,
timedischarged, noofdays,
servicedept, ward, servicedept2,
did, admittingdiagnosis, wb, imp,
unmp, exp, ref, trans, hama, abs,
others, admittingphysician,
admittingclerk, disposition,
finaldiagnosis, complications,
surgicaldone, pathologicalreport,
residentincharge,
medicalspecialist,
seniorresidenthead,
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persondischarged, dateaddedform
PK: cfid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
-did referencing to table tbldoctors
tbldoctors
did, firstname, middlename,
lastname, title, specialization,
position, address, contact, duty,professionalfee, dateleave,
dateregistered
PK: did
tbldoctorsattendeddaid, pid, rid, did, task,
datetimeadded
PK: daid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-did referencing to table tbldoctors
tbldoctorsorderoid, pid, rid, aid, doctorsorder,
ordercarried, datetimeordered
PK: oid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
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tblhistoryphysical
hid, rid, pid, aid, complaint,
presentillness, fcancer, ftb,
fhypertension, fmental, fblooddys,
heartdisease, fdiabetes,
fallergies, familyplanning,
genapp, skin, headbent, necklymph,
chestbreast, hrate, bp, rrate,
stomach, liver, gallbladder,
spleen, kidneyblad, genitalia,
spine, neurological, admitimpre,
doctor, dateadded
PK: hid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
-did referencing to table tbldoctors
tblivfconsumption
cid, pid, rid, aid, datestarted,
shift, timestarted, ivfbt,
dateconsumed, timeconsumed
PK: cid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
tbllogins lid, uid, browser, os, loginPK: lid
FK:-uid referencing to table tblusers
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tblnursenotesnid, pid, rid, aid, datetimeadded,
nursenotes
PK: nid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
tblpastillness
iid, pid, rid, hid, aid, measles,
tb, malaria, arthritis, syphilis,
drugs, mumps, asthma, rheumatic,
typhoid, diarrhea, alcoholism,
mental, diabetes, cancer,
hypertension, blooddys, allergies,
others, previousop, children,
dateadded
PK: iid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
-hid referencing to table tblhistoryphysical
tblpatientbills
pbid, pid, rid, aid, membership,
billingnumber, nurseonduty,
finaldiagnosis, drugsandmedicines,
supplies, laboratory, xray,
ultrasound, ecg, oxygen,accomsubs, professionalfee,
orfeedrfee, admissionfee,
wardservice, nebfee, ambulancefee,
phdrugsandmedicines, phsupplies,
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phlaboratory, phxray,
phultrasound, phecg, phoxygen,
phaccomsubs, phprofessionalfee,
phorfeedrfee, exdrugsandmedicines,
exsupplies, exlaboratory, exxray,
exultrasound, execg, exoxygen,
exaccomsubs, exprofessionalfees,
exorfeedrfee, exadmissionfee,
exwardservice, exnebfee,
exambulancefee, total, extotal,
status, datetimerecorded
PK: pbid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
tblpatientrecords
rid, pid, dateofvisit, age,
timein, timeout, bp, cr, rr, temp,
weight, complaint, remarks,
foradmission, admit,
dateregistered
PK: rid
FK:-pid referencing to table tblpatients
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tblpatients pid, firstname, middlename,
lastname, membership, sex, cs,
dateofbirth, opdnum, address,
placeofbirth, occupation,
contactno, religion, nationality,
dateregistered
PK: pid
tblphilhealthpricing
phid, membershiptype,
drugsandmedicines, supplies,
laboratory, xray, ultrasound,
ecg, oxygen, accomsubs,
professionalfee, orfeedrfee
PK: phid
tblprogressnotespgid, pid, rid, aid, datetime,
progressnotes
PK: pgid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
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tbltheraconsumedtcid, pid, rid, aid, tid, shift,
given, givendate
PK: tcid
FK:-pid referencing to table tblpatients
-rid referencing to table tblpatientrecords
-aid referencing to table tbladmission
-tid referencing to table tbltherapeutic
tbltheranamestnid, therapeutic, type, price,
datetimeadded
PK: tnid
tbltherapeutictid, pid, rid, aid, theraname,
type
PK: tid
FK:-pid referencing tblpatients
-rid referencing tblpatientrecords
-aid referencing tbladmission
tblusers
uid, firstname, lastname,
username, password, priviledge,
department, dateregistered,
lastlogin
PK: uid
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Figure 42
Virtual Table of Contents of Bacnotan District Hospital
Information System
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As a summary, the existing processes in the hospital
patient management flow of BDH are focused on three areas
namely: storage, access, and security. Along on the area on
storage, the existing processes identified are filling out
of patient record and storing patient records on shelves.
Along the area on security, the processes are authorization
of user access, labeling of envelopes for records and
organizing of records.
The problems identified are redundancy of data,
limited storage for records, inefficiency in retrieval of
patient record, loss or misplaced charts and records, slow
pace of searching of records, unorganized filing shelves
and updating the patient records and charts.
The features drawn to give solutions to the problems
encountered include management of patient information,
management of patient records and charts, search engine
mechanism, automatic retrieval of patient records and
charts, automatic computation of bills and management of
user level.
The proposed system shall be a web-based user
interface which would run on an Intranet network
connection.