Thesis: Local Community Hospitals SystemCHAPTER I

INTRODUCTION

Context of the Study

Today, computerization is a major advancement in technology that helps in many ways: it makes information storage easier and faster thus it can save a lot of time and manpower, and many tasks are done in a certain amount of time.

Great amount of time is being consumed by information retrieval and the billing process of most Local Community Hospitals without computer generated system is slow. To be able to provide the medical needs of the rapidly growing population, Local Community Hospitals must be versatile to the current trends and innovation in today's changes in technology.

One of the concerns of Local Community Hospitals nowadays is how to lessen the number paper works in having a transaction with the patient that could fasten the process of admission, discharging and billing of a patient. This greatly affects the profitability of the institution that makes the admission and billing of patients a long process.

Another concern is how to extend the accuracy in computing the patient bills, which is very essential in Local Community Hospitals. Because some patients are so smart that they can find a way that they do not have to pay their Local Community Hospitals bills. Some are having a difficulty in paying because of the slow process of computation which can take less or more than a month depends on the number of laboratory procedures or other cases.

Observing the institution; the researchers decided to propose a computerized patient monitoring and billing system that is intended to solve the concerns that they discovered. Efficient patient monitoring and billing management greatly affect areas of a Local Community Hospitals such as medical services, billing policies and price rates. With the help of this proposed computerized system the Local Community Hospitals can easily keep track and maintain each patient's information.

The computerized patient monitoring and billing system is expected to help Local Community Local Community Hospitals because of its ability to automatically compute the patient's bills, generates reports and official receipt that surely fasten their transactions with the patients. From admitting a patient to discharging, laboratory procedures and other Local Community Hospitals procedures will be updated and presented in precision.

Objectives of the Study

General Objective

The general objective of the study is to develop a computerized patient monitoring and billing system, for the medical institution Local Community Local Community Hospitals to fasten the admission and discharging process of patients, and to provide automatic computation of one's patient bills.

Specific Objectives

• To design a prototype that will provide an accurate patient information, monitor the medical services that each patient undergo, make the recording of all patient information more organized and generate automated reports of patients in the Local Community Hospitals.

• To develop a system that will lessen the numbers of paper works and provide security of patient information and medical records of each patient.

• To test and evaluate the acceptability of the system by gathering feedbacks from the target users, the Local Community Hospitals management and technical experts.

Scope and Limitations of the Study

This study is about patient monitoring and billing system for Local Community Local Community Hospitals. The scope of the study is to monitor the admission and release of each in-patient inside the Local Community Hospitals. It will track the services that each in-patient undergo, time spent by the in-patient inside the Local Community Hospitals, backing up the records. This study also includes the billing system of the Local Community Hospitals; the automated calculation of patients total payment, change and printing of receipt.

This study tries to eliminate the manual patient monitoring and billing system that is currently used by Fabella Local Community Hospitals. All information from the admission of a patient to his discharge will be recorded, even the laboratory procedures and medicines. With this information, the patient bills will be automatically computed and generated.

The study also includes Discounts and other privileges in the billing process. The study does not include the payroll of employees and the issuance of Birth Certificates.

Significance of the Study

Local Community Hospitals

The study will serve as a new instrument for the technological advancement that greatly benefits the Local Community Hospitals. This computerized system is intended to lessen the manpower which will lead to a faster and more accurate billing process which will lead to profitability of the Local Community Hospitals.

Employees

The job of the employees will become more accurate and efficient through the use of the proposed system. This leads to less error which saves time and energy on the side of the workers. Employees can also focus on other tasks assigned that will make them more productive.

Patients

The service of the Local Community Hospitals to the patient will become more convenient. Less time will be consumed during the payment process. This will also lessen time for patients to wait for computation of Local Community Hospitals bills. The study is also expected to increase the satisfaction of the patients to the services of the Local Community Hospitals.

Researchers

This study is a great achievement for the researchers because it will improve their skills in technical writing. The experiences while doing the research build up their characters and teach them values like creativity, working hard, team building and responsibility and time management. It also builds friendship and camaraderie among the co-researchers. The research also tests their skills that helped them gain sense of fulfillment and responsibility. It also gives them an overview of the IT industry and trains them to prepare to the competitive professional field.

Operations Definition of Terms

Admission refers to the formal acceptance by a Local Community Hospitals or other inpatient health care facility of a patient who is to be provided with room, board, and continuous nursing service in an area of the Local Community Hospitals or facility where patients generally reside at least overnight.

Discharging refers to the term which means that the patient leaves the Local Community Hospitals and either returns home or is transferred to another facility such as one for rehabilitation or to a nursing home. Discharge involves the medical instructions that the patient will need to fully recover.

Diagnose refers to the process of recognizing disease by signs and symptoms.

Diagnosis refers to the act of act of identifying a disease from its signs and symptoms.

Electronic Medical Record (EMR) refers to a computer-based record containing health care information. This technology, when fully developed, meets provider needs for real-time data access and evaluation in medical care. Together with clinical workstations and clinical data repository technologies, the EMR provides the mechanism for longitudinal data storage and access.

Discharge Clearance refers to the clearance that is given by the cashier to the patient after he or she paid his or her bills, this document will be presented to the ward to verify his or her discharge.

In-patient refers to apatient whose care requires a stay in a Local Community Hospitals.

List of Charges refers toan officialrecord that shows each bill of the patient that he or she will be paying to the cashier.

Medical Center Chief refers to the director of the Local Community Local Community Hospitals.

Miscarriage (also termed spontaneous abortion) refers to any pregnancy that spontaneously ends before the fetus can survive. Any vaginal bleeding, other than spotting, during early pregnancy is considered a threatened miscarriage.

Patient Clearance refers to an order given by the attending physician that declares the patient that he or she can now leave the Local Community Hospitals premises.

Patient record refers to the official list of patient treated by a Local Community Hospitals.

Physician refers to a person trained in the art of healing. In reality, contemporary physicians express their skills by combining art with science. A physician is also referred to as a doctor of medicine.

Resident on Duty refers to the doctor who diagnoses patient before admitting to the Local Community Hospitals.

Social Worker refers to the person who is in charge of verifying the statement of account of a patient. He or she is the one who decides how much the patients will give as a down payment.

Statement of Account refers to the document that shows the summary of the bills of the patient. The statement of account is verified by the social worker for benefits like discounts.

CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter discusses information about topics related and mentioned in the study. It presents and provides gathered facts and ideas from related literatures like books, journals, magazines, and electronic sources. This chapter also presents brief discussion about related studies from locally made and foreign studies.

Local Literature

The researchers consider providing the history and development of Local Community Local Community Hospitals valuable in presenting the study as basis for analysis and understanding of the profile of the Local Community Hospitals.

Local Community Local Community Hospitals

The Local Community Local Community Hospitals started as a six-bed capacity clinic called the "Maternity House" on November 9, 1920. This clinic, which was founded by then Chairman of Public Welfare Board, Dr. Jose Fabella, was originally located at Sampaloc, Manila. In 1922, the clinic added a pediatric section and a school of midwifery. In 1931, the control of the clinic was shifted to the Bureau of Health and again to the Bureau of Local Community Hospitals in 1947. It was in 1951 when the clinic was transferred to its present location in Santa Cruz, Manila. Unlike other Philippine government Local Community Hospitals, there was no legislative act that permitted the creation of the Local Community

Hospitals. Its present location was only legitimized by Administrative Order no.140, which was issued by President Manuel L. Quezon on February 19, 1941. The Administrative Order recommended that the Bilibid Local Community Hospitals will be used as a maternity Local Community Hospitals. On June 15, 1968 when the Maternity and Children's Local Community Hospitals was renamed as Local Community Local Community Hospitals in honor of the Local Community Hospitals's founder. To date, it has an authorized bed capacity of 700 (History of Fabella Local Community Hospitals hand book, 2002).

Computerization and Local Community Hospitals Management

Computers is one of the most important inventions of mankind these past decades. Its contribution in data processing and information retrieval is congruous in various fields like medicine and health services.

The idea that the use of computers in the workplace is a convenient tool for business transactions and Local Community Hospitals are included hence Haag et. al. (2006)'s book entitled "Computing Concepts" is important to study because it develops new computer systems for three primary reasons:

1. To remain efficient

2. To level the competitive playing field

3. To achieve an advantage through innovation

From an essay from the internet "Computerized Systems" (http://www.megaessays.com/viewpaper/71559.html) starting in the late twentieth century, many companies started using computerized systems. Most of these companies started using these systems to save time and reduce costs. Even though these computerized systems are rather expensive, in the long run they saved companies' money.

The companies saved money by making or purchasing a computerized system by reducing paper usage and employee overtime. Since employees did not have to spend their time doing paper work, they could do their jobs faster and more efficient (Computerized Systems, 2006).

Another article from the internet (http://www.irpsys.com/articles/tw_rura.htm) on "Rural Local Community Hospitals Utilizes an Affordable Method to Generate Accurate Medicare Reimbursements" is also significant to the study because it gives an example on Local Community Hospitals system, whereby is East Adams Rural Local Community Hospitals is a 20 bed Local Community Hospitals in a town with a population of less than 2000. The elderly constitute a very high proportion of the population of our service area which means patients tend to be quite ill and stay for a long time. The current system of Medicare reimbursements, on the other hand, bases its payments strictly on the diagnosis related group (DRG) to which the patient's stay is grouped or assigned. Most large third party payers have also adopted the DRG system in the state of Washington. As a result, reimbursements frequently do not cover the cost of patient care. Further difficulties are generated by the fact that the terminal patients are frequently transferred to larger Local Community Hospitals in Spokane. This normally means the Spokane Local Community Hospitals gets the major portion of the reimbursement because their DRG

assignment is based on the procedures performed and the larger Local Community Hospitals naturally is able to perform more procedures. Before this Local Community Hospitals had difficulties in the turnover of records, as well as manual billing system whose efficiency left much to be desired. In many cases, some charges were lost in transit because of poor paper handling and hence the Local Community Hospitals was receiving much less than the meager reimbursement it is entitled and that there was not enough time in the day to make manual system work so the need for computerized alternatives (Weiszbrod, 2004).

According to the book "Management Uses of the Computer" the adoption of computer processing simplifies management's tasks in direction current business activities, provided management play its role in the development of the processing system. In the application areas turned over to the computer, management policies are carried through automatically because they are embodied in the processing system. In addition, the management information system incorporated in the processing structure provides timely information in useful form (Management Uses of the Computer, 1990).

Another article from the internet (http://www.besoftware.co.uk/products-services/Local Community Hospitals-informations.html) "Local Community Hospitals Information Systems - Customized to Meet all the Management Needs of a Local Community Hospitals" Local Community Hospitals Information technology: A main component of HIS is Local Community Hospitals information technology and Local Community Hospitals management software programs. These two arms of HIS are also referred to as integrated Local Community Hospitals information processing systems (IHIPS). Local Community Hospitals information technology and Local Community Hospitals management software programs are synonymous aiming to meet all demands and needs of medical staff, surgical teams and patients. The two systems ensure that all billing, tracking, patient care, bed management, pharmacy, counseling and recruitment as well as rotation of surgical teams is on schedule. The presence of automation and software as the mainframe of a Local Community Hospitals administration means that all information has to be processed onto two or three hard disks. In case of any malfunction or crash, the data is still available in another disk. Usually, Local Community Hospitals keep two to three 'mirror' disks - one in the archives and one under the scrutiny of management personnel. Remote data backup as well as control processing and tracking automated systems ensure the smooth non-stop functioning of these systems (Local Community Hospitals Information Systems - Customized to Meet all the Management Needs of a Local Community Hospitals, 2003).

From the book "Management and the Computer in Information and Control Systems" information is the essential factor within which organizations work effectively. At the planning level, information is required to convert strategy into tactics (detailed plans and schedules and their evaluation). At the operational levels of information is required to carry out production of refining or marketing plans. Finally even the simplest loop controller in a process unit requires information from process sensors to produce their limited control action (Hodge & Hodgson, 1969).

From the book "Local Community Hospitals Accounting Systems and Controls" information about services that the patients acquired from the Local Community Hospitals greatly affects its billing process.

The information retrieval should be fast and accurate so that the accounts of the patient can be cleared immediately (Mehta & Maher, 1977).

Another article from the internet (http://www.medical.siemens.com) "Improved Care with an Integrated IT Solution" Competition in today's healthcare markets is fierce. As consumers become more informed, healthcare organizations re-examine their processes in order to improve efficiencies and to position themselves as world-class organizations. MedCentral Health System, a health organization with two Local Community Hospitals, 351 beds, and 2,600 employees in Mansfield, OH, USA, is managing this with a system-wide, information technology-(IT-) based initiative, Project Expert Care, geared to provide clinicians with reliable data, to increase patient safety, and to decrease costs by optimizing operational efficiencies.(Improved Care with an Integrated IT Solution, 2008).

According to Terry D. Lundgren and Carol A. Lundgren author of "Records Management in the Computing Age" records management, then, is planning, staffing, organizing, directing and controlling of records and those processes associated with records. Records management is organized around the life cycle of a record and ends with the permanent storage or destruction of record.

Maintaining accurate records that can be retrieved is essential to the continuation of every business. Fast retrieval of records has become so important that it is a major concern in business today. For example, through automated processes, the United States Department of State now has a capability to process and retrieve passport records more rapidly than ever before. The department uses a combination of bar coding technology, high-speed microfilming, and computer assisted retrieval to provide passport customers with the fastest possible response to requests for information (Lundgren, 1989).

Another article from the internet (http://articles.itpimp.net/business/management/modern-management-and-computerization.html) "Modern Management And Computerization" In a computer system, it is expected to have back up storage of information because data is susceptible to loss and/ or manipulation. But with a manual system, this is not necessary. A manual system cannot be able to perform self-checks in order to detect missing data and erroneous data. In a computer system, there exist certain controls over data. These include the missing fields' check and the valid character check.

The missing fields check ensures completeness of records/ transactions whereas the valid character check only allows entry of certain characters and one cannot make errors.

Computerization in the small business has very many advantages. First, the time taken in updating the financial records is reduced. Secondly, some routine jobs like invoicing of cash collections. Adding and deleting of information/transactions is speeded up. The risk of clerical errors while making calculations and transferring data between records is also reduced. Any up to- date record on the financial position is always available (amansharma881, 2008).

Clinical productivity depends on rapid access to information, seamless data flow, and reliable clinical networks. Reducing complexity results in higher efficiency. That's why our eHealth Solutions provide you with a global IT infrastructure for integrated healthcare based on both clinical and IT security expertise.

We focus on Integrated Care Solutions that improve processes along the healthcare continuum and clinical pathways, e.g. by featuring an electronic health record. Our Identity Solutions, in turn, enable secure access and efficient administration. This adds up to effective cooperation for healthcare providers and a better quality of patient care at reduced costs - giving relevant answers to the demands of integrated healthcare (Modern Management And Computerization, 2007).

Moving from paper to the electronic record has significant advantages:

1. It allows for simultaneous, remote access to patient data by all authorized providers.

2. It facilitates faster and better communication among providers.

3. It reduces errors which results in better health care and lower cost.

4. Electronic systems facilitate safer data and improve patient data confidentiality.

5. It allows for flexible data layout and therefore integrates easier with other information resources.

6. It allows for incorporation of various related electronic data, and records are may be continuously processed and updated.

7. It makes the searching and finding of data considerably easier

(Kauka, 2005).

Local Community Hospitals Billing

From an article from the internet (http://www.csc.com/health_services) "New England Local Community Hospitals Sees Benefits from Improved Billing Process" Modern Local Community Hospitals are using information technology, advanced medical procedures and the latest surgical equipment to transform healthcare. But with these advances, invoicing patients for operating room procedures has become much more complex. CSC worked with a 300-bed community Local Community Hospitals in New England to improve its billing process, which has resulted in more accurate invoices and increased revenue.

An efficient revenue cycle - which includes scheduling, billing and managing supplies - is essential to the operational success of any Local Community Hospitals. The Local Community Hospitals's leadership worked closely with CSC to diagnose where the operating room revenue cycle was deficient and what needed to be changed. This review concluded that the Local Community Hospitals should make improvements in a number of areas, including charge coding, materials management and supply contracts. CSC's team, bolstered by its experience in healthcare systems management, successfully transformed the Local Community Hospitals's billing process as part of a multifaceted program that has led to significant operational improvements at the Local Community Hospitals (New England Local Community Hospitals Sees Benefits from Improved Billing Process, 2007).

According to an article on the internet "Finding billing errors will be no easy task" The most common medical billing errors:

* Repeat billing: ensure you haven't been charged twice for the same procedure, supplies or medications.

* Length of stay: Double check the dates of your admission and discharge. Were you charged for the day you checked out? Most Local Community Hospitals will charge for the day you arrived, but not for day you left.

* Correct charge for type of room: If you were in a shared room, confirm you're not being charged for a private one.

* Time in OR: Sometimes Local Community Hospitals charge based on an "average" time needed to perform an operation. Contrast the charge you received against your anesthesiologist's records.

* Up coding: Happens when a doctor changes an order for medication and/or service from an expensive version to one that costs less, like generic medications. And yet you're billed at the higher rate. And sometimes you're billed for both. Keep on top of this one; it's the most widespread of all the common billing errors.

* Keystroke mistake: Happens to the best of us, an innocent slip up on the keyboard that can result in significant overcharges or in some cases an undercharge.

* Canceled service: Occasionally a medication, procedure or service that was prearranged and then canceled later will still show up on your final invoice (Local Community Hospitals Billing Errors and Fraud, 2007).

Another article from the internet (http://www.capstonemedicalbilling.com/articles/2005/managing-type-a-claims.html) "Medical Billing and Managing Type A" An advantage of using an outside medical billing firm to take care of claim responsibilities is the reduction in errors. These companies have special computer software programs that automatically check claims before they are sent off to a payer. In addition to their error-checking software, they have highly skilled individuals who have been trained extensively in Type A claims processing. Medical billing companies can alleviate some of the stress associated with hiring reliable billing staff to handle your Part A claims. (Capstone Physician Services, 2008).

Another article on the internet "Brazilian Patient Monitoring Market - Moving Towards Next Level of Competition" crucial movements brought the Brazilian Patient Monitoring to a next level of competition, challenging the approach and strategies of companies," explains Daniela Putti, Industry Analyst at Frost & Sullivan. "To be able to sustain or raise their positions, competitors will need to anticipate market needs and reinforce their competitive advantages offering complete solutions to public and private Local Community Hospitals. The greatest impacts are expected to be felt by end-users, the most benefited ones from these movements, bringing new and remarkable market dynamics (Brazilian Patient Monitoring Market - Moving Towards Next Level of Competition, 2008).

Computerized Patient Record, Electronic Medical Record & Electronic Health Record.

According to the article of Michael R. Kauka, people started talking about something called the electronic health record in the 60s. But computers were practically nonexistent. Then, in 1991, a report by the Institute of Medicine introduced a more precise concept of the computer-based patient record and its importance to future medicine. It was the first report to pioneer the idea of a computer-based, longitudinal, life-long, integrated patient record including entries from all healthcare providers. The benefits of an electronic patient record became immediately obvious (Kauka, 2005).

Electronic Record: Benefits

Moving from paper to the electronic record has significant advantages:

1. It allows for simultaneous, remote access to patient data by all authorized providers.

2. It facilitates faster and better communication among providers.

3. It reduces errors which results in better health care and lower cost.

4. Electronic systems facilitate safer data and improve patient data confidentiality.

5. It allows for flexible data layout and therefore integrates easier with other information resources.

6. It allows for incorporation of various related electronic data, and records are may be continuously processed and updated.

7. It makes the searching and finding of data considerably easier.

The First Attempt: Computerized Patient Record (CPR)

The first attempt at electronic records was the computerized patient record, or computer based record, CPR. The basic idea behind CPR is a computer-based medical record system that includes all information (clinical and administrative) for one patient and covers all practitioners ever involved in a person's health care. The CPR established the foundation for the vision of all systems that were to follow: the CPR as a basis for and an integral part of decision support (Kauka, 2005).

The concept and vision failed, mainly due to:

• No electronic data standards - not yet, and not for the foreseeable future;

• Disparate information systems - notice the term "allows" in the list above. As of today, it is highly unlikely that the health information system of a provider in LA is communicating with that of a provider's HIS in Atlanta;

• Privacy concerns - who decides who has access to what?

• A national data bank is currently politically unacceptable as keeping track of each patient requires an unique patient identifier, or ID.

So, we're left with a CPR system today that basically consists of some records on some computers (Kauka, 2005).

Moving On: Electronic Medical Record (EMR)

This is presently the catch-all phrase for medical records existing on millions of hard drives. It is also the most misunderstood term. Software companies adopted it as an all encompassing term for medical records created and stored in an electronic format. An electronic medical record system (sometimes referred to as EPR - electronic patient record) is an organized collection of all records about an individual patient stored in the computer systems and databases of all the providers who have provided care to that patient within one enterprise. The EMR is not stored on any one individual computer, but is assembled dynamically, in real time, from various systems when needed (Moving On: Electronic Medical Record (EMR), 2005).

According to John Mello "It's one of the fastest-growing segments of IT..."."There are two major applications: PACS and electronic patient records." PACSs (picture archiving and communications systems) store cardiology and radiology tests, magnetic resonance imaging (MRI) results, and other large files.

Still, Mello says healthcare is a late adopter of technology, claiming that only about 5 percent of healthcare firms have sophisticated electronic storage systems. He says that most large Local Community Hospitals already have them, while smaller and midsized facilities plan to implement them soon. (Byte & Switch, 2002)

From his article in the internet, Michael Young expound that, EMRs improve physician and overall Local Community Hospitals efficiency, reduce costs, and promote standardization of care. It is also suspected that they reduce medical errors and ultimately increase the quality of care. Researchers from Harvard have just released a study that may be the first real proof that electronic medical records have an advantage over traditional paper systems.

EMRs improve physician and overall Local Community Hospitals efficiency, reduce costs, and promote standardization of care. It is also suspected that they reduce medical errors and ultimately increase the quality of care. Researchers from Harvard have just released a study that may be the first real proof that electronic medical records have an advantage over traditional paper systems.

The VA Local Community Hospitals in Buffalo is prime example of the successful transition to a practice management system. Companies like e-MDs are hard at work supporting this movement with revolutionary medical management software. Congressmen Peter Stark is leading the way with his Health-e Information Technology Act of 2008 introduced in the House this past September (Young, 2008).

Gen Wright's article about EMR's entitled, "EMR Software Helps Physicians Be More Productive", without the help of EMR Software technology, keep any kind of records can be a nightmare. Over time,

the mountain of records just keep building and building, until the entire system becomes unmanageable.

Without the help of technology, keep any kind of records can be a nightmare. Over time, the mountain of records just keep building and building, until the entire system becomes unmanageable. Records get lost or buried, and they become impossible to find. This happens to many businesses that require record keeping like medical practices or financial companies (EMR Software Helps Physicians Be More Productive, 2008).

According to the article from the internet, "The Night Float Local Community Hospitals System", in which one resident works the night shift so that others can sleep, was created so that patients could receive care from rested, focused doctors. But there are rarely mechanisms in place to ensure the night workers have all the patient information they need when they take over, meaning doctors can make potentially fatal errors, reports physician Sandeep Jauhar in Slate.

Information is often forgotten when one resident discusses a patient when handing off a case. To avoid accidents, Local Community Hospitals need to implement standardized electronic information hand-off systems-covering specific details-to provide night-shift doctors with the background they need to make informed decisions, Jauhar argue. "In medicine, as in aviation, most errors occur at transitions," he writes. "Without better hand-off systems, work limits may weaken medicine more than exhausted residents ever did" (Jauhar, 2008).

According to the article, "Soarian Integrated Care" With Soarian® Integrated Care* (Soarian IC), we provide you with a web-based eHealth solution for the communication of patient-related data, forms and documents among connected partners using a secure connection. Soarian IC optimizes the flow of information and integrates communications media into existing treatment workflows and systems - across all sectors, for both regional healthcare networks and national healthcare programs (Soarian Integrated Care, 2008).

Networking and Database

According to dictionary "The New Lexicon Webster's Dictionary of the English Language" network is basically a system in which terminals and computers are linked together according to such factors as the distance between them, the amount of message traffic expected between them, and the existence of appropriate communications facilities needed to connect them (Cayne, 2000).

From article on the internet "Content, Cost Savings And Convergence Drive Network Storage" Over the past decade, organizations of all stripes have experienced phenomenal growth in the data volumes they must manage in order to compete and win in a challenging and dynamic marketplace. Traditionally, organizations employed corporate messaging and business applications in order to foster employee productivity and manage critical corporate information. These had relatively modest information requirements (Jaegel, 2007).

According to the book "Understanding Local Area Networks" 3rd ed. Distributed processing, taken to its conclusion, came to mean linking microcomputers together so they could share information and peripherals. This was the idea behind the first local area networks. The broadest definition of LAN is: a communication network used by a single organization over a limited distance which permits users to share information and resources (Schatt, 1992).

According to article from the internet "Local Area Network (LAN) Basic Components" The local area network (LAN) is home to sheer bandwidth and countless client server applications. Different companies have radically different networks; some have a single PC and others have hundreds of locations and thousands of computers. This page is intended to explain the basic principles and components frequently found on the LAN. The internal network is usually built with the highest bandwidth available. It is then connected to a tiny internet connection which is almost always a bottle neck for internet traffic. Most businesses of any size have at least one server to provide extra computing features to the business. The internet is explicitly distrusted and generally the network has protection from the internet built in. The LAN is something that businesses have complete control over. Network devices are much simpler than servers and PCs. It is common (and best practice) to duplicate significant portions of the Network to allow for failure without having a noticeable impact on the network. A LAN is the local cabling and set of network devices at an individual location building or campus but the internal network can easily include many LANs connected to form a WAN (Joe, 2007).

According to David Avison and Christine Cuthberson, author of "A Management Approach to Database Applications" with database systems, it is possible to hold facts relating to parts of the organization in this context could be the whole business or, more likely, a part of it, such as division or a department (Avison & Cuthberson, 2002).

According to an article from the internet "Benefits of Databases" The gathering, processing and use of information relating to the operations of a business are vital to its success. Even something as simple as a customer mailing list needs to be managed appropriately if it is to be kept up to date and accurate. Therefore, any tools or applications that can make the tasks involved easier and more efficient need to be given serious consideration.

The database is one of the cornerstones of information technology, and its ability to organize, process and manage information in a structured and controlled manner is key to many aspects of modern business efficiency (Benefits of databases, 2005).

From the book "An Introduction to Database Systems" The advantages of a database system over traditional, paper-based methods of record keeping are perhaps easier to see in these cases.

Here are some of them:

* Compactness: There is no need for possibly voluminous paper files

* Speed: The machine can retrieve and update data far faster than any human can.

* Less drudgery: Much of the sheer tedium of maintaining files by hand is eliminated. Mechanical tasks are always better done by machines.

* Currency: Accurate, up-to-date information is available on demand at any time.

* Protection: The data can be better protected by unintentional loss and a unlawful access

A database is used to help people keep track of things. Many people do keep track of things using lists, and sometimes such lists are valuable. In other cases however, simple lists lead to data inconsistencies and other problems (Kroenke & Auer, 2008).

According to Spencer Collaghan, "Small businesses and their entrepreneurial spirit have always been a source of creativity and innovative thinking. However, while their ideas can push the envelope of possibilities, the execution has often been restricted by limited resources or access to the latest communications tool." Thanks to innovative solutions specially designed for small and medium sized businesses (SMBs), simple yet sophisticated technologies like VoIP, unified communications and enhanced mobility are within reach of these business innovators.

In the current era of hyper connectivity, where anything that can be connected to the network, will be connected, SMBs can now keep pace with the big guys through advanced technologies that increase productivity and ensure reliable mobility wherever employees may roam.

Features like secure mobility and unified messaging - with one click access to voice, email and conferencing - allow employees to stay productive and in contact across all types of communications either in the office or on the go. Even the smallest of companies can have the benefits of an integrated contact center with BCM 50's automated "attendant" phone answering features that ensure clients and partners can be directed to the right person, right away, wherever they are (Callaghan, 2008).

From the article "Tech O' Clock", there is a new technology discovered called, Cloud Computing, this refers to emerging computing technology that relies on central servers of the delivery and maintenance of applications, That is, the hardware and software that businessman and consumers use on a daily basis would be centralized and accessed over the internet. This technology allows for much more efficient computing by centralizing storage, memory, processing and bandwidth (Business Tech Trends for 2009, 2009).

New Technological Trends:

From the article of Oracle last June 2007 entitled "Xml Marks the Spot", database enhances its capabilities in providing features to the users, a guide was launched so that the users will easily understand the databases. This guide approaches database performance tuning from a more business centric perspective than the traditional bottoms-up approach. It seems to help DBA's quickly get answers to some of the most commonly asked performance related questions, using a new structured guided methodology.

A major upgrade to oracle comprehensive, stand-alone search engine that enables customers to make critical business information available to authorized users while enforcing corporate security policies (Kestelyn, 2007).

From the article of Ramon R. Tuazon, the President of AIJC, entitled "Cut of School Youths produce digital content on health", Health protocols in treating tuberculosis, prevention of dengue epidemic and parasitism are among the topics of the CD-ROM produced by 14 out-of-school youth from a Philippine village, as an output of the training held from 5 to 30 March 2007.

The training enabled the participants to produce information tools on priority health concerns of their community and, in the same time, to learn the basics of computing (Tuazon, 2007).

From the article "Microsoft's Smart Move for MSME'S", Microsoft Philippines(MP) recently announced the availability of the smart move program, an all-in-one Microsoft Dynamics Software, Hardware and services bundle designed for emerging small enterprises that are looking for an efficiently and cost-effective business management system. At more than 50% lower than the original cost of implementation, small businesses can avail of the bundle that includes a three user license pack for Microsoft dynamics NAV/GP, a server running windows small business server premium, and a rapid deployment service pack which can be implemented within 15 to 17 days (Microsoft's Smart Move for MSME'S, 2007).

Nowadays, the computerization of voting system is merely talked about in the televisions and newspapers, from the article of Enterprise Magazine, Botong Pinoy, which is locally made computerized voting system developed by Mega Data Corporation, a pioneer in the local IT industry, is one of the products put in place in the Election Technology Conference that showcased computerized systems available for use in the coming 2010 elections.

In this homegrown Philippine Election System, voters simply point through their finger or use a light, wired pen in order to choose from displayed candidates and their corresponding desired position on a computer screen. After voting, the computer automatically prints out filled-out ballot, showing the chosen candidates together with each voter's computer-generated fingerprint that is used an audit trail in the election count.

Botong Pinoy has already been used in key voting events such as the gubernatorial elections of the Philippine Stocks Exchange, and voting of winners for the Miss Earth pageant, to name a few. Election results are released in minutes after voting (Pinoy Computerized Voting System, 2008).

Review of Related Studies

According to the study, "Patient Monitoring and Billing System for Children's Medical Center", there are many advantages of having a computer-based patient record

Some of these advantages are:

• Easy access

• remote access

• more legible and better organized

• the same information can be displayed in multiple formats

• Reports are easier to produce and be provided

Computer patient's records, checks patients in and out, generates day sheets and deposit slips and handles insurance billings. All the information that drives your practice is organized and placed at your fingertips, where it is easily accessed by the stroke of a key. According to the authors of the said study, "its tangible value is just as great by making your office run faster and smoothly." The system enhances the collections process by monitoring accounts and automatically identifying those which are delinquent. The main problem is, in the movement of every patient inside the Local Community Hospitals and how their bills can be monitored (Ong, Orido & Santibañes, 2005).

According to the study entitled "Automated Centralized Billing System for Morong Doctor's Local Community Hospitals", automated billing systems can decrease the waiting period of patients between 7 and 21 days. It also registers patients automatically when they are admitted in the Local Community Hospitals. Electronic record improves patient care by insuring that the correct information, such as the proper medication is retrievable. "No matter what happens with the stock market; economy, people are going to be sick..." (Automated Centralized Billing System for Morong Doctor's Local Community Hospitals, 2003).

From the study, "Jose P. Reyes Medical Center Billing System", Local Community Hospitals is indispensable institution brought into existence in response into an environmental need. In India, the Escorts Heart Institute and Research Centre is one of the corporate Local Community Hospitals to fall in line with enthusiasm. It is one of the Local Community Hospitals which is using a computerized system in generating the bills of there patients. The complete automation exercise is aimed at supplementing its efficiency, in providing to the users what data do they need to have or to process.

In a Local Community Hospitals billing system, "the financial information of a patient must be properly identified to him / her..." (Del Moro, Manio & Pranada, March 2005).

According from the study, "InformationTechnology and System Integration in Long-Term Care",health care reform has created a new approach to health care delivery that calls for what one observer called "the establishment of integrated provider networks linking multiple service delivery points, a holistic, patient-driven system with an emphasis on prevention and health maintenance, fixed financing, and an enlarged consumer role." The health care system is also placing increased importance on the outcomes of patient care services and has expressed a strong commitment to measuring and evaluating these economic, clinical, and humanistic outcomes.

Providers are turning to computerized databases and communication technologies to integrate data and evaluate outcomes. Outcome databases in particular are becoming increasingly important in conducting outcome assessments for patients receiving long-term care services.

These outcome assessments include both quality improvement components and monitoring programs designed to reduce variations in the process of care. Health care providers, including long-term care providers, are adopting continuous quality improvement (CQI) initiatives as a way to achieve optimal outcomes through continual process improvement.

Quality assurance and improvement programs are becoming mandatory in many instances, as employers, third-party payers, and managed care organizations step up requirements that health care providers monitor and improve the quality of care (Information Technology and System Integration in Long-Term Care, 1997).

In a study conducted, it is stated that, Medical records are the keystone to the healthcare profession; however these records are not utilized to their fullest potential. Often records are inaccurate, misplaced, and / or duplicated unnecessarily. In a world which recognizes the improvement of data digitization and networking as a constructive force which often increases efficiency while lowering costs; it is our view that medical records networking could only benefit the quality of healthcare offered in the United States.

An information system which is primarily linked between a physician's office and his Local Community Hospitals would be able to capture and store data from either location giving access to diagnostics from satellite locations. Added functionality could include ability to gather data in real time from a remote monitor or an inbound Emergency transport vehicle (Computer Information Systems Program College of Business Florida Gulf Coast University, 2002).

According from the study Peer-Based Recovery Strategy for Reliable Multicast Transport Protocol (RMTP), it is a study conducted for Multicasting; Multicasting is the transmission of data to a subset of hosts. It is a bandwidth conserving technology that reduces traffic by simultaneously transporting a single stream of packets to multiple hosts. Video conferencing, software upgrade distribution, whiteboards and distributed interactive simulations are some examples of applications that can take advantage of multicasting technology. Multicasting is still gaining interest and attention because of increasing demand for such group collaboration applications and for new paths for media distribution on the Internet. The more familiar cases of Unicasting and Broadcasting may be considered to be special cases of Multicasting1. Multicasting implements new services that are not possible in unicast transmission because unicast requires larger bandwidth than multicasting.

Reducing network traffic and resource utilization are the main benefits of multicasting. Under his adviser David Cheriton, Dee ring worked on a distributed operating system called Vsystem. The operating system allows a computer to send a message to a group of other computers on the local Ethernet segment using a MAC Layer 2 multicast addressing (Lu, 2003).

From a study conducted from the Mapua Institute of Technology entitled, "User Interface Generation for Smartphones", the development of applications for mobile and other non desktop devices using established and traditional methods often require tremendous development effort in order to fit in with the limitations of the mobile devices. A major challenge therefore is to find a way to generate interfaces, which usually take the bulk of a mobile application and essentially important to mobile devices like

smart phones, and reduce the application size thus allowing the device to allot the freed space for other processes. With this study, the proponent has designed a new approach for the new generation of technology (Abanacay, 2008).

From a thesis dissertation from Ateneo De Manila University entitled, "An Enhanced Lecture Viewer for eLearning", Most distance education systems today provide students with a limited experience of the lecture they are viewing. In this

paper, we describe the features of the Enhanced Viewer Experience System (EVES), a distance education tool that enhances students' learning experience by supporting the creation and playback of multiple synchronized time-indexed information streams, such as slide sequences, topic indices, transcripts, snapshots, and notes, together with the video of the lecture. These time-indexed streams move along with the lecture video as it plays. Furthermore, they are all synchronized with each other, such that clicking on any time indexed item causes the video and all the other streams to jump to the corresponding time in the lecture. By providing access to such multiple time-indexed streams, we hope to enhance the experience of eLearning students and thus improve their learning and information retention (Mate, Velasquez & Sarmenta, 2005).

From the study, "BayanihanComputing.NET", Bayanihan Computing.NETis a generic framework for volunteer computing, that allows you to quickly and easily tap the power of networked computers to perform complex calculations much faster than a single computer, or even a supercomputer, can. Bayanihan Computing.NET is the first system in the world to allow programmers to write their own volunteer computing applications with the convenience, flexibility, and power of Microsoft's .NET technologies and tools. It is also the first system in the world to use XML web services to offer "computation web services" that allow programmers to easily tap the power of volunteer computing networks through simple method calls in their .NET programs. BayanihanComputing.NET brings something that no one has offered before: supercomputing power that you can access anytime, anywhere, and on any device (Chua, Echevarria, Mendoza, Santos & Tan, 2001).

A thesis for networking is launched from Ateneo de Manila University, Developing a UTC-Synchronized University Network Time Service A network clock synchronization protocol is required which can read a server clock, transmit the reading to one or more clients and to adjust each client clock as required. Protocols that do this include the Network Time Protocol (NTP) and the Digital Time Synchronization Protocol (DTSS). These protocols provide accuracies typically within a millisecond on LANs and up to a few tens of milliseconds on WANs, relative to Coordinated Universal Time (UTC) via a GPS receiver. Typical NTP configurations utilize multiple redundant servers and diverse network paths in order to achieve high accuracy and reliability. The Network Time Protocol (NTP) is a protocol used to synchronize the time of a computer client or server or some other network devices and appliances to another server or reference time source, such as a radio or satellite receiver or modem. It provides accuracies typically within a millisecond on LANs and up to a few tens of milliseconds on WANs relative to Coordinated Universal Time (UTC). (Yu & Doroja, 2002).

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