information system for administering preclinical clerkship in the faculty of dentistry ums,

8/10/2019 INFORMATION SYSTEM FOR ADMINISTERING PRECLINICAL CLERKSHIP IN THE FACULTY OF DENTISTRY UMS,

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INFORMATION SYSTEM FOR ADMINISTERING

PRECLINICAL CLERKSHIP

IN THE FACULTY OF DENTISTRY UMS

A Final Project

Presented in Partial Fulfillment of the Requirements for

Graduation in Informatics in the undergraduate colleges

Of the Universitas Muhammadiyah Surakarta

by

Muhammad Dawud

L200102009

DEPARTMENT OF INFORMATICS ENGINEERING

FACULTY OF COMMUNICATIONS AND INFORMATICS

UNIVERSITAS MUHAMMADIYAH SURAKARTA

2014


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APPROVAL

A project with title

INFORMATION SYSTEM FOR ADMINISTERING

PRECLINICAL CLERKSHIP

IN THE FACULTY OF DENTISTRY UMS

Has been approved by:

Supervisor

Husni Thamrin, S.T., M.T., Ph.D. Date : _____________________

NIK 706


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RATIFICATION SHEET

This Project titled INFORMATION SYSTEM FOR ADMINISTERING

PRECLINICAL CLERKSHIP IN THE FACULTY OF DENTISTRY UMS,

submitted by Muhammad Dawud to the Department of Informatics Engineering,

Muhammadiyah University of Surakarta, has been accepted as satisfactory for the

partial fulfillment of the requirements for the degree of S.Kom and approved as to

its style and contents. The presentation has been held on ____________________.

BOARD OF EXAMINERS

This Project has been accepted as satisfactory for the partial fulfillment of the

requirements for the degree S.Kom

Date: ..

Examiner II

_____________________

Examiner I

___________________

Head ofDepartment of Informatics

Engineering

Heru Supriyono, S.T., M.Sc., Ph.D.

NIK. 970

Dean ofFaculty of Communications and

Informatics

Husni Thamrin, S.T., M.T., Ph.D.

NIK. 706

Supervisor

Husni Thamrin, S.T., M.T., Ph.D.

NIK. 706


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LIST OF CONTRIBUTION

I declares that this research does not use the work of other people that had

been proposed before to get their bachelor degree in a university and as long as I

know, there is no the work or opinion of other people that had been published,

except the written references on this paper and it is mentioned at list of references.

Following is the list of contribution that is declared by the author of the

research arrangement:

The author gets a major functional requirement and supporting documents

from a business contract between Tebar System Development and Faculty of

Dentistry Muhammadiyah University of Surakarta.

The following libraries which are used in this project are under Apache

License 2.0: commons-beanutils-1.8.0, commons-collections-3.2.1, commons-digester-2.1, commons-javaflow-20060411, log4j-api-2.1, log4j-core-2.1, also

under Eclipse Public License Version 1.0 and Eclipse Distribution License

Version 1.0: eclipselink-2.5.2, javax.persistence-2.1, also under GNU LGPL

version 3.0: JasperReports 5.6.1, so it is legal to use it either for commercial or

non-commercial purpose. We use com.lowagie version 2.1.7 for pdf reporting,

that is licensed under MPL/LGPL, not com.itextpdf version 5.x that is licensed

under AGPL, according to http://itextpdf.com/salesfaq, the cost for the old version

of iText is zero, but there is a cost to the quality of the application. If we decide to

use this deprecated version, we do not need to purchase a license. The classes

under package org.netbeans.swing.outline & mysql connector java 5.1.33 use

restrictive GNU GPL version 2, the GPL licence on the Oracle library meant that


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anyone wanting to use the library with closed source software and distribute the

resulting binary had to go to Oracle and get a commercial licence from them.

The author creates this system with a laptop, MySql 5.6 as the database

provider, Netbeans 8.0.1 as the IDE for the java programming.

Thus, the declaration or statement and list of contribution are created

actually and honestly. The author takes the responsible for content and the truth of

list above.

Ascertain,

Supervisor

Husni Thamrin, S.T., M.T., Ph.DNIK. 706

Surakarta, December 2014

Muhammad Dawud


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MOTTO

"If I can do many things, then I can produce many things"

"A lot of prayer is nothing without effort and a lot of effort is not useful without

prayer"

"All people in the world must be successful, but the difference is successes that

has been achieved, success to make trouble for itself or success to make happy for

itself"


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DEDICATION

1. Alhamdulillahirabbilalamin, the first word that the author said, because

the mercy and blessing from Allah SWT, the author may complete this

research.

2. My beloved parent, Muslih and Siti Hamidah that always give their prayer

to me mentally and material support. Thank you very much for your love

and anything that you give to me, may Allah always love you too.

3. All my family that always give their supports and advices to me.

4. All of lecturers of Department of Informatics Engineering, Faculty of

Communication and Informatics, Muhammadiyah University of Surakarta.

5. All friend of my home stay, all friends of Informatics Engineering class

2010, especially international class. Thank you for your supports.

6. All partners that cannot be mentioned one by one.


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PREFACE

Assalamualaikum. Wr. Wb.

Alhamdulillahirabbil alamin, all prise to Allah who has given us the

mercy and blessing, also shalawat and salaam to the our Prophet Muhammad

SAW and his family, so I completed the research from the beginning until this

writing report with title INFORMATION SYSTEM FOR ADMINISTERING

PRECLINICAL CLERKSHIP IN THE FACULTY OF DENTISTRY UMS.

This research and report is completed and arranged for getting a bachelor

degree of Department of Informatics Engineering, Faculty of Communication and

Informatics, Muhammadiyah University of Surakarta. This research and report

arrangement does not quit of aid several sides, therefore the author want to say

thanks to:

1. Allah SWT who has given us the mercy and blessing until author can

complete the research and report arrangement.

2. My beloved parent and family who always give me their prayer, spirit,

support and motivation while I do the research and arrange the report.

3. Mr. Husni Thamrin, S.T., M.T., Ph.D. as Dean of Faculty of

Communication and Informatics and also as my supervisor for the research

or thesis. Thank you for your time, guidance, advice and opinion to me, so

that I complete the research.

4. Mr. Aris Rakhmadi as my supervisor for the thesis project. Thank you for

your time, guidance, advice, and opinion to me.


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5. Mr. Heru Supriyono, S.T., M.Eng.Sc., Ph.D. as Head of Department of

Informatics Engineering.

6. All friends of Department of Informatics Engineering class 2010

especially international program for your motivation and support.

Finally, the author realizes that this research or thesis and its report is not

perfect. Therefore, the author hope to the reader gives the good critics and

suggestions. The author hopes this report useful for himself and can increase the

knowledge of reader.

Wassalamualaikum. Wr. Wb.

Surakarta, July 2014

Author


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Table of Contents

APPROVAL ................................................. ................................................................. ................. IIRATIFICATION SHEET............................................................................................. ............... III

LIST OF CONTRIBUTION ....................................................................................................... IV

MOTTO ........................................................................................................................................ VI

DEDICATION ......................................................... ................................................................. ... VII

PREFACE ..................................................... ................................................................. ............ VIII

TABLE OF CONTENTS .............................................................. ................................................. X

TABLE OF TABLES ......................................................... ....................................................... XIII

TABLE OF FIGURES ................................................................. ..............................................XIVABSTRACT ............................................................. ................................................................. ... XV

CHAPTER I INTRODUCTION ............................................................ ........................................ 1

A. BACKGROUND OF RESEARCH................................................................................................ 1B. PROBLEM STATEMENT................................................................................................ .......... 3C. PROBLEM LIMITATION........................................................................................ .................. 3D. PURPOSE OF RESEARCH................................................................ ........................................ 4E. BENEFIT OF RESEARCH....................................................................................... .................. 4F. WRITING SYSTEMATICAL.............................................................. ........................................ 4

CHAPTER II LITERATURE REVIEW ................................... ................................................... 6A. STUDY OF RESEARCH.......................................................... .................................................. 6B. FUNDAMENTAL THEORY................................................................ ....................................... 9

1. Electronic Health Records ....................................................... ........................................ 9What is the Difference? ..................................................................................................................... 10EHR Systems .................................................................................................................................... 11Possible Advantages.......................................................................................................................... 12Improved Efficiency.......................................................................................................................... 12In the Operatory ................................................................................................................................ 13Post-Visit........................................................................................................................................... 13

2. Expression Language (Java Specification Request 245) ............................................... 13EL in a nutshell ................................................................................................................................. 14

3. BeansBinding (Java Specification Request 295) ........................................................... 144. Java Persistence Architecture (a java-based Object Relational Map) .......................... 15

Object-Relational Impedance Mismatch ........................................................................................... 15The Java Persistence API .................................................................................................................. 16

5. Jaspersoft Studio ............................................................ ................................................ 16Report Life Cycle .............................................................................................................................. 17

6. Business Process Modeling Notation.................................................. ........................... 17AN ACTIVITY ................................................................................................................................. 20AN EVENT ....................................................................................................................................... 20A GATEWAY................................................................................................................................... 21A SEQUENCE FLOW ...................................................................................................................... 21A MESSAGE FLOW ........................................................................................................................ 22

A DATA OBJECT ............................................................................................................................ 22


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AN ASSOCIATION ......................................................................................................................... 22

CHAPTER III RESEARCH METHOD .................................... ................................................. 23

1. TIME AND LOCATION.................................................................................................. ........ 232. TOOLS AND MATERIALS..................................................... ................................................ 23

1. Hardware ............................................................ ........................................................... 232. Software .................................................................................................................... ..... 23

a) Windows 7 ............................................................................................................................... 23b) Netbeans 8.0.1 Integrated Development Environment .............................. ...................... ........ 23c) Xampp 1.8.5 ............................................................................................................................ 23

3. PLOT OF RESEARCH...................................................................... ...................................... 24Explanation about this flowchart: ............................................................... ........................... 25

Requirement analysis ........................................................................................................................ 25Database designing and creation ....................................................................................................... 25

Research report arrangement ............................................................................................................. 254. DESIGN SYSTEM WITH USE CASE AND CLASS DIAGRAM.................................................... 26Use Case Diagram ................................ ................................................................. ................ 26

Explanation of Use Cases .................................................................................................................. 27Design of Class and Table ................................................................ ...................................... 42

Class Diagram ................................................................................................................................... 42Table Instance Chart ......................................................................................................................... 43

5. DESIGN EVALUATION................................................................... ...................................... 51

CHAPTER IV RESULT AND ANALYSIS ................................................................................ 52

A. RESULT OF RESEARCH........................................................................................ ................ 521. Result of Program Display ............................................................................ ................ 52

i. Form of Login ......................................................................................................................... 52ii. Patient Table ............................................................................................................................ 53iii. Diagnoses Table ...................................................................................................................... 54iv. Display of revenue sharing ...................................................................................................... 55v. Report of the most common dignoses ...................................................................................... 55vi. Form of students paper discussion ......................................................................................... 56

B. ANALYSIS OF RESEARCH................................................... ................................................. 561. As-Is Business Process Diagram ................................................................................... 572. To-Be Process Diagram ................................................................................................ 593. Functionality Testing ................................................................ ..................................... 60

i. Medical Billing Report, Students & Dentist ............................................................................ 611. Diagnoses form ................................................................................................................... 61

2. MySQL data ....................................................................................................................... 623. Print preview of Medical Billing ........................................................................................ 624. Print preview of dentist report ............................................................................................ 635. Print preview of studentss achievement ............................................................................ 64

ii. Rental Billing .......................................................................................................................... 651. Rental form ......................................................................................................................... 65On the last December 14th, Diag Agnintia have rent two items of instruments, Bein Bangkok andarticulator, each are two items. So, in MySQL the Dian Agnintias account should have the twoitems listed. .................................................................................................................................. 652. MySQL data ....................................................................................................................... 653. Print preview of rental billing ............................................................................................. 66

4. CRITICAL REVIEW.................................................................................... ........................... 66

CHAPTER V CLOSURE ............................................................. ................................................ 67


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A. CONCLUSION........................................................... ........................................................... 67B. SUGGESTION....................................................................................................... ................ 67

BIBLIOGRAPHY ......................................................................................................... ................ 68

APPENDIX .................................................................................................................... ................ 71

1. LABORATORY ASSISTANT WAS OPERATING THE PANUMSYSTEM.................................... 712. ONE OF THE GROUPS OF STUDENTS WERE IN LAB ASSITANTS ROOM................................... 713. TEBAR SYSTEM DEVELOPMENT AGREEMENT..................................................................... 724. LETTER OF ACCEPTANCE FROM FACULTY OF DENTISTRY................................................... 73


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Table of Tables

TABLE 1VALIDATE USER..................................................................................... ........................... 27TABLE 2MANAGE MASTER DATA.............................................................................................. ..... 28TABLE 3ADD &EDIT CONSUMABLE.................................................................... ........................... 29TABLE 4INCREASE CONSUMABLE STOCK............................................................. ........................... 30TABLE 5USE &CANCEL CONSUMABLE DATA.......................................... ...................................... 31TABLE 6RECORD &CANCEL TREATMENT DATA............................................................ ................ 32TABLE 7PRINT A DIAGNOSES........................................................... ................................................ 33TABLE 8ADD,EDIT,DELETE DIAGNOSES DATA.................................................. ........................... 34TABLE 9PRINT COMMON DIAGNOSES....................................................... ...................................... 35TABLE 10PRINT DENTIST REPORT............................................................. ...................................... 36TABLE 11DISPLAY DAILY RENTAL REPORT.......................................................... ........................... 37

TABLE 12DISPLAY GENERAL REVENUE REPORT...................................................................... ........ 38TABLE 13ADD STUDENT'S PAPER DISCUSSION................................................................................. 39TABLE 14PRINT STUDENT'S ACHIEVEMENT..................................................................... ................ 40TABLE 15RENT INSTRUMENTS........................................................................................ ................ 40TABLE 16PRINT RENTAL BILLING................................................................................................... 41TABLE 17STRUCTURE OF TABLE MMANUSIA............................................................................ ..... 44TABLE 18STRUCTURE OF TABLE EJENISKELAMIN.......................................................................... 44TABLE 19STRUCTURE OF TABLE EGOLONGANDARAH................................................... ................ 44TABLE 20STRUCTURE OF TABLE MMAHASISWA................................................. ........................... 45TABLE 21STRUCTURE OF TABLE MLABORAN................................................................................. 45TABLE 22STRUCTURE OF TABLE MDOSEN............................................... ...................................... 45

TABLE 23STRUCTURE OF TABLE MPASIEN................................................................................ ..... 45TABLE 24STRUCTURE OF TABLE MALAT................................................................................... ..... 46TABLE 25STRUCTURE OF TABLE MBAHAN.......................................................... ........................... 46TABLE 26STRUCTURE OF TABLE MJURNAL.......................................................... ........................... 46TABLE 27STRUCTURE OF TABLE MKELOMPOK............................................................................... 47TABLE 28STRUCTURE OF TABLE MPERAWATAN............................................................................. 47TABLE 29STRUCTURE OF TABLE EJENJANGPENDIDIKAN................................................ ................ 47TABLE 30STRUCTURE OF TABLE EKATEGORI........................................... ...................................... 47TABLE 31STRUCTURE OF TABLE EPERAWATANBIAYA................................................... ................ 47TABLE 32STRUCTURE OF TABLE EPERAWATANWAJIB........................................ ........................... 48TABLE 33STRUCTURE OF TABLE ETEMA......................................................................................... 48TABLE 34STRUCTURE OF TABLE TRDETILPEMINJAMAN................................................................. 48TABLE 35STRUCTURE OF TABLE TRDIAGNOSA............................................................................... 49TABLE 36STRUCTURE OF TABLE TRDIAGNOSABAHAN................................................................... 49TABLE 37STRUCTURE OF TABLE TRDAIGNOSAPERAWATAN........................................................... 49TABLE 38STRUCTURE OF TABLE TRKELOMPOKMAHASISWA......................................................... 50TABLE 39STRUCTURE OF TABLE TRMAHASISWAJURNAL............................................... ................ 50TABLE 40STRUCTURE OF TABLE TRMAHASISWAJURNAL............................................... ................ 51


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Table of FiguresFIGURE 1RESEARCH FLOWCHART................................................................................................... 24

FIGURE 2USE CASE DIAGRAM............................................. ........................................................... 26FIGURE 3CLASS DIAGRAM.............................................................................................. ................ 43FIGURE 4LOGIN FORM.................................................................... ................................................. 52FIGURE 5PATIENT TABLE................................................................................................................. 53FIGURE 6DIAGNOSES TABLE................................................................................................... ........ 54FIGURE 7DISPLAY OF REVENUE SHARING............................................................. ........................... 55FIGURE 8REPORT OF THE MOST COMMON DIGNOSES....................................................................... 55FIGURE 9FORM OF STUDENTSPAPER DISCUSSION.......................................................... ................ 56FIGURE 10AS-IS BUSINESS PROCESS DIAGRAM...................................................................... ........ 57FIGURE 11TO-BE BUSINESS PROCESS DIAGRAM............................................................. ................ 59FIGURE 12DIAGNOSES INPUT.......................................................................................... ................ 61

FIGURE 13DIAGNOSES'RECORD IN DATABASE................................................................ ................ 62FIGURE 14PRINT PREVIEW OF MEDICAL BILLING............................................................................ 62FIGURE 15PRINT PREVIEW OF DENTIST................................................................ ........................... 63FIGURE 16PRINT PREVIEW OF STUDENTSS ACHIEVEMENT.............................................................. 64FIGURE 17STUDENT'S RENTED INSTRUMENTS RECORDS............................................................ ..... 65FIGURE 18PRINT PREVIEW OF RENTAL BILLING............................................................................... 66FIGURE 19LAB ASSITANT OPERATING PANUM .............................................................. ................ 71FIGURE 20SEVERAL STUDENTS WERE IN LAB ASSITANT 'S ROOM..................................... ................ 71
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ABSTRACT

Preclinical Clerkship is a form of clinical skills training program that its

purpose is to prepare an undergraduate dental student facing clinical clerkship.

Every new graduate student must take this training takes place in Faculty of

Dentistry of Muhammadiyah University. Every participant must complete all of

the requirements that are listed in the book in order to pass the program. However,

in this second period of preclinical clerkship there are several business process

change and the number of students is not as few as previous students, so the

number of patients. These has extend the responsibilties the lab assitant poses. He

has to generate a report for every dentist, a report for every student, a report about

most common diagnoses and few others.

In order to empowering the laboratory assistant generating the sheer

number of the reports required to be generated, this research has developed an

information system that could make the generation of report more quickly. This

research uses some methods such as directly interview with stakeholders, read the

literature, get requirement analysis, make a UML Use Case & Class Diagram, and

Business Process Model and Notation (BPMN)that help researcher to create the

preclinical information system application program.

The results of this research is desktop application that help laboratory

assitant to record the data of instrument, consumable, treatment, paper discussion,

and people involved in the activity and also generate the required report quickly.

Keyword: preclinical clerkship, information system, BPMN, UML.


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When a registered patient that was invited by each of groups come to the

clinic, a representative of the group ask the laboratory assistant to find the

patients map, then the student will find available teaching dentist to treat the

patient. When the doctor treat the patient, every students of the group observe

him, ask a certain thing that they do not already know, answer some questions

from the teaching dentist, record instruments and consumable that are ordered by

the doctor into the patients medical record, take that record to the laboratory

assistant and bring back the required instruments and consumable, then the

student also record what kind of treatment the doctor has been given to the

patients medical record.

At the end of the shift, the laboratory assistant receives the map from

every group then he writes a medical billing for the patient based on the patients

medical record. Then at the end of period, the laboratory assistant also makes a

general report for dentist about their revenue which was equal for every /dentist

then creates a summary report to head of laboratory about pass or fail of student.

Even though all of these tasks only performed once in one semester, the

burden the laboratory assistant has at one time is still quite large. There is a need

to reduce the workload that is caused by this repetitive task. One way to solve thisis by developing an electronic medical record that could make the retrieval of

patients electronic medical record and generating the required reports faster.

According to Miss drg. Ana, this system is also expected to solve duplicated map

in the case of patient forgets his medical record number also it could generate

report for each dentist about their own revenue based on what they have done.


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B. Problem Statement

Based on the reason of background of study above, the author states some

problems, such as:

1. How to solve duplicated patients medical record map?

2. How to efficiently generate medical report?

C. Problem Limitation

Considering from limited ability of the author, this study has some

problem limitation to achieve the goals. Problem limitation is as follows:

1. The identified objects are patients, dental instruments and consumable,

dental student, and teaching dentist at faculty of dentistry UMS.

2. The author does not create a web-based application to display the records

of medical related data, but using the desktop-based application.

3. In this paper, the author only develop an EMR-like system, not an EHR,

An EMR contains the medical and treatment history of the patients in one

organization. While EHRs are designed to reach out beyond the health

organization that originally collects and compiles the information (Garets

& Davis, 2005).

4. This system only designed to meet the requirements specified by faculty of

dentistry UMS, since Health Ministry of Indonesia in its act they published

that is Permenkes no. 269/MENKES/PER/III/2008 about Rekam Medis,

Pasal 2 ayat 2 just stated penyelenggaraan rekam medis dengan

menggunakan teknologi informasi diatur lebih lanjut dalam peraturan


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tersendiri, however this act does not give further details about electronic

medical record. As this system is developed for use in Indonesia, the

requirements specified by Health Information Technology for Economic

and Clinical Health (HITECH) Act of United State of America do not

apply.

D. Purpose of Research

The purpose of this research is to create information system to manage

preclinical clerkship activities from registration to reporting in the Faculty of

Dentistry, Muhammadiyah University of Surakarta.

E. Benefit of Research

The expected benefits of these researches are preclinical clerkship

administration is easier, faster retrieval of patients medical record, faster

generation of report.

F. Writing Systematical

Writing Systematical is created to facilitate essay arrangement processing.

Writing Systematical to be used is:

CHAPTER I INTRODUCTION

This chapter contains the background of research, problem statement,

problem limitation, purpose of research, benefit of research.

CHAPTER II LITERATURE


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This chapter contains some study of researches and fundamental theories

that are used for complete this essay.

CHAPTER III METHOD OF RESEARCH

This chapter contains about the object being studied and some activity to

study for object.

CHAPTER IV RESULT AND ANALYSIS

This chapter contains about the design of system, result of testing program

and its analysis.

CHAPTER V CLOSURE

This chapter contains conclusion and suggestion of all activity of research.


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CHAPTER II

LITERATURE REVIEW

A. Study of Research

(Ludwick & Doucette, 2009) had been identified the state of knowledge

about health information systems adoption in primary care. Their goal was to

understand factors and influencers affecting implementation outcomes from

previous health information systems implementations experiences. Articles show

that systemsquality of graphic user interface design, feature functionality, project

management, procurement and users previous experience affect implementation

outcomes.

(Mans, et al., 2013) proposed a process-oriented methodology for

evaluating impact of Information Technology (IT) on a business process. In their

method, process mining and discrete event simulation are key ingredients. Based

on automatically stored data, process mining allows for obtaining detailed

knowledge on a business process, e.g., it can be discovered how a business

process is actually executed. Using discrete event simulation, a model can be

build which accurately mimics the discovered process and which can

subsequently be used for exploring and evaluating various redesign of the same

process. Their method is evaluated by means of a detailed case study. For two

complex dental processes, it turns out that the introduction of new digital

technologies is largely beneficial for patients and dental lab owners, whereas for

dentists there is hardly any benefit.


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(Jansen-Vullers & Reijers, 2005) redesign an intake procedure in a mental

health-care setting. Business Process Redesign is being applied to processes

within hospitals as they attempt to achieve improvement in time, cost, quality, and

flexibility, just like any other business.

(Rebuge & Ferreira, 2012) introduced a methodology for the application

of process mining techniques that leads to the identification of regular behavior,

process variants, and exceptional medical cases. The approach is demonstrated in

a case study conducted at a hospital emergency service. For this purpose, they

implemented the methodology in a tool that integrates the main stages of process

analysis.

(Nawrocki, et al., 2006) described two experiments that aimed at

comparison of diagram-based (BPMN) and text-based (Use Cases) notation.

Moreover, they describe some extensions to use cases that they have found

interesting when working on description of business processes based on use cases.

Those extensions, among others, allow describing actor metamorphosis and

specifying steps that must be performed before the main scenario is executed. The

ideas described in the paper have been incorporated into UC Workbench a tool

supporting editing and animation of use-case-based models.(Mei, et al., 2013) observed that case management suits well to address the

problem of flexibility and ad hoc variations in execution of clinical tasks when

implementing care pathways (CPs) and they proposes a CMMN-based CP model,

where CMMN (Case Management Model and Notation) is becoming an industry

standard. Via an experimental experience on modeling CHF (congestive heart


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failure) ambulatory CP, they illustrate that the usage of case management paves

the way to popularize CPs, particularly for its quick deployment and execution in

industrial products.

(Kamil, 2014) determined the best BPM (Business Process Management)

tool for designing digital lab order process flows. The chosen tool was used to

design an improved flow of digital lab order process for Humber River Hospitals

lab order process in a highly advanced way. He selected 15 open source

workflow tools, and filtered them based on certain criteria, which include the

availability of: analysis done by the tool, tool features, support, a graphical editor,

an execution engine, and simulation. He chose four tools (YAWL, Together,

Bonitasoft, and NOVA) that satisfied these criteria.

(MacKinnon, 2014) seeks to understand the impact of EMR system on

healthcare delivery in healthcare organizations, by developed a model that

suggests that two dynamic capabilities: process management and change

management, will positively impact usage of EMR systems, and that EMR

use is the key driver of operational performance at the subunit level. They

tested their theory with a sequential mixed method approach. Their unit of

analysis was hospital emergency clinicians. Their quantitative data collectionmethod was through the use of an online survey of mainly nurse and nurse

managers. Survey data was analyzed using structural equation modeling. Their

qualitative data collection method was through the use of qualitative

interviews with emergency department stakeholders. The interviews were

conducted to obtain additional insight into the issues surrounding implementation


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and use of EMR systems and to help explain our quantitative results. They found

that process management and pre-implementation change management positively

affects EMR use, and that EMR use positively affects clinician related

performance. Post-implementation change management was found to have a

negative effect on EMR use. Finally, they found that process management had a

direct positive effect on patient-related performance and EMR use had an

indirect positive effect on patient-related performance, mediated by clinician-

related performance.

B. Fundamental Theory

1. Electronic Health Records

Since the 1980s, many terms have been used to denote the concept of an

electronic patient record, or to information systems designed to create, manage,

and store information associated with an electronic patient record (Ada.org, n.d.).

These have included terms like Computerized Patient Record, Computer Medical

Record, Electronic Medical Record, Automated Patient Record, and possibly a

dozen more, all of which appear to mean more or less the same thing, some

people use the terms electronic medical record and electronic health record

(or EMRand EHR) interchangeably, and evoke much debate. The EMR term

came along first, and indeed, early EMRs were medical. They were for use by

clinicians mostly for diagnosis and treatment. In contrast, health relates to The

condition of being sound in body, mind, or spirit; especiallyfreedom from

physical disease or painthe general condition of the body. The word health


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covers a lot more territory than the word medical. And EHRs goa lot further

than EMRs.

What is the Dif ference?

Electronic medical records (EMRs) are a digital version of the paper charts

in the clinicians office(Garrett & Seidman, 2011). An EMR contains the medical

and treatment history of the patients in one practice. EMRs have advantages over

paper records. For example, EMRs allow clinicians to:

1. Track data over time

2. Easily identify which patients are due for preventive screenings or

checkups

3. Check how their patients are doing on certain parameterssuch as blood

pressure readings or vaccinations

4.

Monitor and improve overall quality of care within the practice

However, the information in EMRs does not travel easily out of the

practice. In fact, the patients record might even have to be printed out and

delivered by mail to specialists and other members of the care team. In that

regard, EMRs are not much better than a paper record.

Electronic health records (EHRs) do all those thingsand more. EHRsfocus on the total health of the patientgoing beyond standard clinical data

collected in the providers office and inclusive of a broader view on a patients

care. EHRs are designed to reach out beyond the health organization that

originally collects and compiles the information. They are built to share

information with other health care providers, such as laboratories and specialists,


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so they contain information from all the clinicians involved in the patients care.

The National Alliance for Health Information Technology stated that EHR data

can be created, managed, and consulted by authorized clinicians and staff across

more than one healthcare organization.

The information moves with the patientto the specialist, the hospital, the

nursing home, the next state or even across the country. In comparing the

differences between record types, HIMSS Analytics stated that, The EHR

represents the ability to easily share medical information among stakeholders and

to have a patients information follow him or her through the various modalities

of care engaged by that individual. EHRs are designed to be accessed by all

people involved in the patients careincluding the patients themselves. Indeed,

that is an explicit expectation in the Stage 1 definition of meaningful use of

EHRs.

Moreover, that makes all the difference. Because when information is

shared in a secure way, it becomes more powerful. Health care is a team effort,

and shared information supports that effort. After all, much of the value derived

from the health care delivery system results from the effective communication of

information from one party to another and, ultimately, the ability of multipleparties to engage in interactive communication of information.

EHR Systems

As a result of the Centers for Medicare & Medicaid Services (CMS)

Medicare and Medicaid EHR Incentive Programs (the EHR Meaningful Use

Incentives Program), the term "Electronic Health Record" is often used to


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designate a particular information system that utilize various technologies,

standards, and interfaces that work together to create, manage, store, and share

information associated with an electronic health record. The terms "EHR System,"

"EMR System," and "EDR system" may be used in this manner as well. Ideally,

an EHR or EDR System for the dental care setting would capture, store, present,

import, and/or export relevant extracts of patients' longitudinal electronic health

records. Perhaps the most important feature of such systems is the ability to

communicate health information with authorized supplier quickly across more

than one health care organization or even across multiple health care settings.

Possible Advantages

EHR systems provide the potential to ameliorate care quality and patient

safety by amend both the quantity and quality of information available to

suppliers for decision-making. An EHR system's ability to seize detailed clinical

information in a highly structured manner can enable analysis for quality

assessment, identification of areas for improvement and the design of decision

support tools like allergy alerts, medication alerts, and other prompts.

Improved Eff iciency

Prior to a patient visit, a dental practice's staff could use an EHR tomanage scheduling of operatories, people, and resources. They could also perform

practice management tasks such as patient enrollment and inquiring about

insurance status. In addition, the EHR might be able to import and disclose

relevant information obtained from another dentist, dental specialist, primary care


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physician or other health care supplier, such as health history, health problems,

and medication lists.

I n the Operatory

During a patient's visit, a dentist with an EHR can enter relevant clinical

documentation, electronically prescribe medication, and capture relevant charges

for billing purposes. Information needed for generating a dental claim would then

flow to the practice billing system.

Post-Visit

After the patient leaves, staff could use an EHR to manage billing, coding

for procedures, and claim submittal. The EHR could also facilitate post-visit

communications with consulting providers, payers, labs, and pharmacies using

interoperability standards. In some cases, patients may be able to access and view

their health information (such as lab results) through a secure patient portal set up

as an adjunct to the dentist's EHR

2. Expression Language (Java Specification Request 245)

The EL was originally inspired by both ECMAScript and the XPath

expression languages (Delisle, et al., 2005). During its inception, the experts

involved were very reluctant to design yet another expression language and triedto use each of these languages, but they fell short in different areas.

The JSP Standard Tag Library (JSTL) version 1.0 (based on JSP 1.2) was

therefore first to introduce an Expression Language (EL) to make it easy for page

authors to access and manipulate application data without having to master the

complexity associated with programming languages such as Java and JavaScript.


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EL in a nutshell

The syntax is quite simple. Model objects are accessed by name. A

generalized [ ]operator can be used to access maps, lists, arrays of objects and

properties of a JavaBeans object; the operator can be nested arbitrarily. The

operator can be used as a convenient shorthand for property access when the

property name follows the conventions of Java identifiers, but the [ ] operator

allows for more generalized access.

Relational comparisons are allowed using the standard Java relational

operators. Comparisons may be made against other values, or against Boolean (for

equality comparisons only), string, integer, or floating point literals. Arithmetic

operators can be used to compute integer and floating point values. Logical

operators are available.

The EL features a flexible architecture where the resolution of model

objects (and their associated properties), functions, and variables are all performed

through a pluggable API, making the EL easily adaptable to various

environments.

3. BeansBinding (Java Specification Request 295)

Developers who program applications that composed of Java Beancomponents frequently find themselves writing template code that maintain

couple of properties in accord (Violet, 2006). PropertyChangeListeners are used

to observe modification in the source and target properties and to cast and validate

data as it moves between the source and target. For example, a Swing GUI


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developer might write a half of page of code to keep the "text" property of a

JTextField in sync with the "name" property of the selected Customer in a JTable.

This specification defines a set of interfaces that simplifies connecting a

pair of Java Beans properties to keep them in accord. The association will be

configurable: type casting and validation operations may be performed before

modifying a property.

For example, to connect a String property to a Date property, a String/Date

converter would be used. Similarly, an application that desired to stiffen the legal

values for the date property would use a validation.

This API is intended to make connecting Java Bean properties simple. The

Swing APIs personify a tremendous collection of Java Beans and properties.

4. Java Persistence Architecture (a java-based Object Relational Map)

Object-Relati onal Impedance M ismatch

The term object-relational impedance mismatch refers to technical,

conceptual, and cultural issues that come up when we try to unite object and

relational artifacts (Keith & Schincariol, 2013).

An object-relational application unites artifacts based on object and

relational concepts. An object-relational application is one in which a programwritten using an object-oriented language uses a relational database for storage

and retrieval. A programmer must handle one or more problems of an object-

relational impedance mismatch during the production of an object-relational

application.


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The received wisdom is that these object-relational impedance mismatch

problems are both well understood and resolved by current method based on SQL.

For each such object-relational impedance mismatch problem however there is a

choice of solution. Each such solution is referred as an Object-Relational Mapping

(ORM).

The Java Persistence API

The Java Persistence API is a lightweight, POJO-based framework for

Java persistence. Although object-relational mapping is a major component of the

API, it also offers solutions to the architectural challenges of integrating

persistence into scalable enterprise applications.

5. Jaspersoft Studio

Jaspersoft Studio is the new Eclipse-based report designer for

JasperReports and JasperReports Server (Community, n.d.). It is a full rewrite of

iReport Designer, procurable as Eclipse plug-in, and as a standalone application.

Jaspersoft Studio let you to make elegant layouts comprising charts, images, sub

reports, crosstabs and much more. We can retrieve our data by means of CSV,

JDBC, XML, TableModels, JavaBeans, EclipseLink, and customized sources, and

then release your reports as PDF, DOCX, XML, XLS, RTF, CSV, XHTML, text,HTML, or OpenOffice.

Jaspersoft Studio's primary goal is to cater the features in the well-known

Jaspersoft Report Editor, procurable as a port of iReport Designer. This is only the

beginning - having its foundations on the Eclipse platform, Jaspersoft Studio will


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be a more consummate method permit users to expand its capabilities and

functionality.

Report L ife Cycle

When we design a report using either iReport Designer or Jaspersoft

Studio, we are making a JRXML file, which is an XML document that comprising

the definition of the report layout. The layout is visual, so we can neglect the

subjacent composition of the JRXML file. Before running a report, the JRXML

must be compiled in a binary object called a Jasper file. Jasper files are what we

need to put with our application in order to run the reports.

The report execution is performed by passing a Jasper file and a data

source to JasperReports. There are many data source types. We can fill a Jasper

file from a collection of JavaBeans, an SQL query, a .csv file, an XML file, and

others. If we do not have an appropriate data source, JasperReports permits us to

write our own custom-made data source. With a Jasper file and a data source,

JasperReports is able to produce the final document in the format we want.

iReport Designer and Jaspersoft Studio also permit us to set up data

sources and use them to test our reports. In many instance, data-driven wizards

can assist us design our reports much faster. iReport Designer includes theJasperReports engine itself to let us display our report output, test, and rectify our

reports.

6. Business Process Modeling Notation

Formal process flow diagrams are often called process maps, activity

diagrams, or workflow diagrams. Historically, process analysts have used a wide


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Business people model to simplify, highlight, clarify, and communicate.

Thus, any notation that makes things too complex is counterproductive. At the

same time, we want to enable different individuals within the same organization

to read common process diagrams; thus, we need to agree on a minimum set of

conventions. We believe that the core set of BPMN notational elements provides

the best of currently available. On the other hand, when we find we want to

express something that is not easily expressed in BPMN, we feel free to extend

BPMN informally to be sure we make our point as clearly as possible.


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The core BPMN symbols are as follows:

AN ACTIVITY

A generic term for work a company performs. Activities take time.

Activities can be composed of activities. Complex activities include value chains,

processes and sub processes. Specific activities include tasks.

AN EVENT

An event is something that happens during the course of a business

process. An event is a point in time. Events include triggers that start processes,


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messages that arrive that disrupt processes and the final production of products,

services or data that result in the end or termination of a process or sub process. In

extended notation, symbols can be placed within the circle to specify things about

the nature of the event.

A GATEWAY

A gateway is used to show the divergence or convergence of a sequence

flow. This might indicate forking or merging activities, or it might indicate a

decision that determines which of two or more subsequent flows is to be followed.

In extended notation, symbols are placed within the diamond to specify things

about the gateway. They might indicate, for example that all preceding activities

need to be done before the next activity occurs.

A SEQUENCE FLOW

An arrow is used to show the order that activities will be performed in a

process. A sequence arrow does not imply that a physical output, information, or

people move from one activity to the next, though they may. It simply suggests

that a subsequent activity is performed next in the normal course of accomplishing

the process. Labels can be associated with the flow arrows to indicate when

decision paths are being followed or when things or information is flowing alongthe arrow. If useful, you can write the name of what is flowing via a particular

arrow above or below the arrow. If there is more than one flow from a given

activity, you can use a slash to indicate which flow is the main or default flow

path.


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A MESSAGE FLOW

A dotted arrow is used to show flows between activities in separate pools.

(This is misnamed, since the flow can be a message or a thing like a product or a

service.)

A DATA OBJECT

Data objects are artifacts that do not have a direct effect on the sequence

flow or the message flow of processes. They provide information that activities

require to produce what they produce.

AN ASSOCIATION

An association is used to associate text or other annotations to activities or

arrows on a diagram.


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3. Plot of Research

This research was performed in repetitive manner in order to create

application program achieve the expected contract. The process of research started

from requirement analysis, implementation, confirmation, reimplementation until

the expected contract satisfied then research reporting arrangement.

No

Start

Do some revisionand consultation

Yes

Program testing andupload data to database

Create a user interface tomanage preclinicalclerckship relatedinformation

Write and finish the

report of research

No Fix it and inputall data todatabase

Yes

End

Create Design of Database

RequirementAnalysis

Is it proper withthe analysis?

Is it all runswell anduploaded?

Figure 1 Research Flowchart


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Explanation about this flowchart:

Requi rement analysis

First step is requirement analysis about the system that will be built. This

activity will provide information to create the database, user interface for the

preclinical clerkship. If the analysis is proper to system requirement, it will

continue to next step.

Some information related to this research is required, such as the

diagnoses, preclinical clerkships instruments, students, doctors to be identified

and the user that use the application program.

There is an additional feature of this program, such as patients medical

history. This feature recordspatients visit history. After the requirement analysis

has been done, at least three tasks for this research are gained, such as create the

master form, detail form, and print layout using Jaspersoft Studio.

Database design ing and creation

Database creation is used for provide data storage. This database at least

will contain information such as humans, patients visit, instruments, and

consumable.

Research report arr angement

Arrange this research report to be reported to the supervisor and presented

to the examiners to be tested.


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4. Design System with Use Case and Class Diagram

Use Case Diagram

A use case diagram is a diagram that shows a set of use cases and actors

and their relationships (Booch, et al., 2005). A use case specifies the behavior of a

system or a part of a system and is a description of a set of sequences of actions,

including variants, which a system performs to yield an observable result of value

to an actor.

Use case is just applied to capture the intended behavior of the system

being developed, without having to specify how that behavior is implemented.

Use cases provide a way for developers to come to a common understanding with

the system's end users and domain experts. In addition, use cases serve to help

validate the architecture and to verify the system as it evolves during

development.

Figure 2 Use Case Diagram


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Explanation of Use Cases

This PANUM system has sixteen use case and two actor, dentist and lab

assistant. The difference between dentist and lab assistant is just right in printing

dentists report, only dentist that is allowed to print the report. Currently, there is

no requirement for administering the user roles.

Use Case Description

Table 1 Validate User

USE CASE # PANUM-01USE CASE Name Validate UserACTOR HumanGoal To Enter into the systemOverview and scope To authenticate & to authorize the system user using

their username & password, and their rolesassociated with the username

Level PrimaryPreconditions Human has created an account for use with the

PANUM administration system.Post conditions The Human was presented with list of patients to be

treated laterTrigger A human double clicks the PANUM Shortcut iconIncluded Use Cases NoneExtending Use Cases NoneMAIN SUCCESSFUL

SCENARIO

Actor Action System Action

1. Human doubleclick PANUMicon

2. System displaylogin form

3. Human fills

username &password

4. System check

whether theentered username& passwordcorrect &whether thespecifiedusername isdentist or labassistant, if it is adentist thenenable print

dentists report


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use case5. Human views the

list of patientsOTHER SUCCESSFUL

SCENARIOS

Step Branching Action

3a. Human enterincorrect usernameand/or password

Human re-enter theusername and password

UNSUCCESSFUL

SCENARIOS

Conditions Actions

2a. System cannotdisplay form login

The human contacts thesystem developers

customer servicedepartment

4a. System cannot findthe specified usernamedue to they do notregistered yet

The human contactslaboratory assistant forregistration

Priority in scheduling FirstFrequency Often (every launch) when the human launch the

applicationOther non-functional

requirements

None

Super ordinates NoneDeveloper Muhammad Dawud

Creation date and lastmodified date

October 14, 2014

Other Comments

Table 2 Manage Master Data

USE CASE # PANUM-02USE CASE Name Manage Master DataACTOR HumanGoal To record a data to master data

Overview and scope The human will use this use case to record dentist,lab assistant, patient, student, group of student,assinging student to the group, instrument,consumable and journal

Level PrimaryPreconditions Human has logged in to systemPost conditions The Human was presented with blank form or

prefilled form in the case of update data. When hefinish, the view of table will show updated data.

Trigger A human click add button or in the case ofupdate/delete he has to highlight one of humans first

Included Use Cases None


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Extending Use Cases NoneMAIN SUCCESSFUL

SCENARIO


1.

Human click AddButton

2.

System displayblank form

3. Human fills thepresented fieldsthen click save orclose the form

4. System save thedata then closethe form or justclose, if itsuccess then thedisplayed tabularwill containnew/modifieddata

OTHER SUCCESSFUL

SCENARIOS


None NoneUNSUCCESSFUL

SCENARIOS

Conditions Actions

None NonePriority in scheduling FirstFrequency Rare when the human register new data to the

systemOther non-functional

requirements

None

Super ordinates None

Developer Muhammad DawudCreation date and last

modified date

October 14, 2014

Other Comments

Table 3 Add & Edit Consumable

USE CASE # PANUM-03USE CASE Name Add & Edit ConsumableACTOR Human

Goal To record or edit consumable master dataOverview and scope The human will use this use case to record newmaster data or modify existing one. This data willdetermine the available consumbale item indiagnoses use case

Level PrimaryPreconditions Human has logged in to systemPost conditions The Human was presented with blank form or

prefilled form in the case of update data. When hefinish, the view of table will show updated data.

Trigger A human click add button or in the case of

update/delete he has to highlight one of humans first


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Included Use Cases NoneExtending Use Cases None

MAIN SUCCESSFULSCENARIO

Actor Action System Action1. Human click Add

Button2. System display

blank form3. Human fills the

presented fieldsthen click save orclose the form


OTHER SUCCESSFUL

SCENARIOS



SCENARIOS

Conditions Actions

None NonePriority in scheduling FirstFrequency Rare when the human register new data to the

systemOther non-functional

requirements

None

Super ordinates NoneDeveloper Muhammad DawudCreation date and last

modified date

October 14, 2014

Other Comments

Table 4 Increase Consumable Stock

USE CASE # PANUM-04USE CASE Name Increase Consumable Stock

ACTOR HumanGoal To increase the number of consumable dataOverview and scope The human will use this use case to increase the

number of available consumable data from existinglist of consumable. When the number of stock iszero, then the Human will not be able to consume aconsumable item in diagnoses use case

Level PrimaryPreconditions Human has logged in to systemPost conditions The Human was presented with blank form. When

he finish, the view of table will show updated data.

Trigger A human click increase button


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Actor Action System Action1. Human click Add

Button2. System display

blank spinnerfield

3. Human increasethe number ofavailable item


OTHER SUCCESSFUL

SCENARIOS



SCENARIOS

Conditions Actions

None NonePriority in scheduling FirstFrequency Rare when the item is out of stockOther non-functional

requirements

None


modified date

October 14, 2014

Other Comments

Table 5 Use & Cancel Consumable Data

USE CASE # PANUM-05USE CASE Name Use & Cancel Consumable Data

ACTOR HumanGoal To append involved consumable to the selecteddiagnose

Overview and scope This use case is used to determine the involvedconsumable

Level PrimaryPreconditions Human has selected one of the diagnoses first, then

click the add consumable buttonPost conditions The Human was presented with a combo box that

consist of available consumable, and a field todetermine the number of consumable

Trigger A human click add button or in the case of delete


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button he has to select one of previously addedconsumable

Included Use Cases NoneExtending Use Cases NoneMAIN SUCCESSFUL

SCENARIO


1. Human click AddButton

2. System displayblank form



OTHER SUCCESSFUL

SCENARIOS


3a. Human cancel theform

None

UNSUCCESSFUL

SCENARIOS

Conditions Actions

None NonePriority in scheduling FirstFrequency Often when a human want to add involved

consumable to the diagnosesOther non-functional

requirements

None


modified date

October 14, 2014

Other Comments

Table 6 Record & Cancel Treatment Data

USE CASE # PANUM-06USE CASE Name Record & Cancel Treatment DataACTOR HumanGoal To append list of treatment to the selected diagnoseOverview and scope This use case is used to determine the involved

treatmentLevel PrimaryPreconditions Human has selected one of the diagnoses first, then

click the add consumable buttonPost conditions The Human was presented with a combobox that

consist of available consumable, and a field to


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determine the number of consumableTrigger A human click add button or in the case of delete

button he has to select one of previously addedconsumable

Included Use Cases NoneExtending Use Cases NoneMAIN SUCCESSFUL

SCENARIO


1. Human click AddButton

2. System displayblank form



OTHER SUCCESSFUL

SCENARIOS


3a. Human cancel theform

None

UNSUCCESSFUL

SCENARIOS

Conditions Actions

None None

Priority in scheduling FirstFrequency Often when a human want to add involved

treatments to the diagnosesOther non-functional

requirements

None


modified date

October 14, 2014

Other Comments

Table 7 Print a diagnoses

USE CASE # PANUM-07USE CASE Name Print a diagnosesACTOR HumanGoal To print a patients medical billingOverview and scope

Level PrimaryPreconditions Human has selected one of the diagnoses firstPost conditions The Human will see print preview of medical billingTrigger A human click print medical billing button


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Actor Action System Action1. Human highlight

one of diagnoses,then click printmedical billing

button

2. System displayprint preview

3. Human decidewhether he wantto save, print orclose print

preview

4. When the humanclick save button,the system will

prompt foraddress of thedirectory, or

prompt for printselection or closeit

OTHER SUCCESSFUL

SCENARIOS



SCENARIOS

Conditions Actions

None NonePriority in scheduling FirstFrequency Often when a human want to print a patients

medical billingOther non-functionalrequirements

None


modified date

October 14, 2014

Other Comments

Table 8 Add, Edit, Delete Diagnoses Data

USE CASE # PANUM-08USE CASE Name Add, Edit, Delete Diagnoses DataACTOR HumanGoal To append new diagnoses to the selected patientOverview and scope This use case is used to determine the involved

group, dentist, and prevailing periodLevel PrimaryPreconditions Human has selected one of the patients first, then

click the diagnose buttonPost conditions The Human was presented with a table of previous

patients visit, previous treatments, and previous

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information system for administering preclinical clerkship in the faculty of dentistry ums,

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