PATIENT, EMPLOYEE MONITORING AND BILLING SYSTEM; A CASE OF KIZIBACOMMUNITY HOSPITAL WAKISO DISTRICT

CHAPTER ONE INTRODUCTION 1.0 Introduction This chapter covers the background of the study statement of the problem, the purpose of the study, objectives of the study, research questions, scope of the study, significance of the study and structure of the organization. 1.1 Background The aspect of computerized system emerged as one of the basic forms of storing information in many organizations like hospitals, Banks and institutions of higher education. This tries to replace the paper based form of tasks being used in hospitals. The computerized patients, employee monitoring and billing system is one of the best system that can keep all the records in the best way possible. In todays world, change is a major driving force in the hospital industry. Development in the biological, technological are in general responsible for these changes driven by the common objective namely effective, efficient and improved processing, retrieval and storage of patient ,employee monitoring and billing records. The success of any organization depends on its ability to acquire accurate and timely information. Computerized patient, employee monitoring and billing system manage a vast amount of data and quickly find the relevant amount of information to a given question as the amount of information increases thus coming up with the best results. 1.2 Statement of the problem The patient, employee monitoring and billing system in local community hospital is manual where by records keeping is done in traditional files and
1

folders. This manual system waste a lot of time in collecting, monitoring, billing, accessing and searching through the numerous patients, employee records to retrieve certain information needed. The hospital has got a problem of data security in a way that records can easily destroyed in case of any disaster like fire out break rain and theft. There is wastage of space because they keep a lot of hand written documents thus creating a big burden to the employees to trace for the patients information within a short time. Data concerning patients and employee is inconsistent since their information put on different papers which can easily get lost in the long run. This study seeks to identify the causes of such challenges and come up with a computerized patient, employee billing and monitoring system. 1.3 Objectives 1.3.1 Main objective The purpose of the study is to develop a patient, employee monitoring and billing system to act as a central repository for patients, employee records so as to reduce data insecurity, in the hospital. 1.3.2 Specific objectives
i.

To investigate and analyze fully the current system and gather information which describes the performance of the system requirements. Design and model a system for storing, monitoring patients, employees records. To develop a system/software that will guide/enable to locate all the information about the patients and employees. To test and validate the system.

ii.

iii. iv.

1.3.3 Research questions

i.

Has the hospital ever had any computerized system for storing its employee, patients record? How is your data system structured? How long does it usually take you to retrieve information? Will they be able to test and validate the system to a certain its efficiency towards the employee, patient monitoring and billing system?

ii.
iii. iv.

1.4 Scope 1.4.1 Geographical scope The research was conducted at Kiziiba Hospital in Masulita. The hospital is a Community Based Not For Profit (CBNFP) facility located in Wakiso District, 40 km from Kampala along Kakili road opposite kiziiba primary school. It is a rural hospital, which transformed from a health center three (3) to general hospital in 1982. It was chosen as a case study because of its proximity and quick access to information due to both the cooperative staff -add patient and the patients in the hospital. -View patients info
-view user information System treatment -add patient details.

admin

Doctors/nurses

1.4.2 Subject scope The project deals with employees records like payments, applications and -manage
system users -view personal information. It also covers the patients monitoring and billing -manage patients system in the patients The designed system covers finance department, hospital. records information -Edit patients welfare department, laboratory, data bank.E M BS P records

Context Diagram of the system

-Update patients details -Enter patients treatment -Enter patient details

Pharmacist Data entrants Database 3 -patients details -user details View treatment records

1.5 Significance of the study This project will serve to monitor the operations in the hospital and hence account of every patient and employees of the hospital. Implementation of the system has the following advantages. Acts as evidence in cases of hospital interventions where they should provide proof of records that the hospital has been in existence. Records are important and must be kept well and this can be achieved with the computerization of records. This involves development of databases that are used to store information for easy access and in tern be used in data analysis report generation and hospital operations.

The system is also useful to the hospital because it reduced the time spent searching for specific records in the data stores since it came up with an advanced mechanism of querying information from the database using a computer. The system improved the quality of services provided by the hospital to the patients in that patients are not required to carry their medical forms during their next visit to the hospital. It also provided methods of protecting records of patients for future use and research purposes. Security mechanism were also put in place where by only authorized personals are allowed to retrieve information of patients to avoid miss use of medical data from being used for malicious purposes.

CHAPTER TWO
5

LITERATURE REVIEW 2.0 Introduction A literature review is a body of information that aims to review the critical points of current knowledge on a particular phenomenal. This section presents a critical analysis of documented evidence and ideas from other works that are relevant to the project the goal of literature is to bring the reader up to data with the current information on the topic and forms a basis for another goal for example justification for other future research in the place. A good literature review is composed of the following: local flow of ideas, appropriate referencing style, proper use of terminology and effective use of previous research. 2.1 State of patients records management system According to Walde Billie Hiester, Nursing Economics (Jan/Feb 1999), in his research he computerized estates can improve the cost and the outcome of sites delivery He also noted that the most important aspect is security and confidentiality of computerized information system over manual system. A word like flexibility is stimulated to characterize an information system which helps to tackle a problem of a manual system. Conte, (1999), believes that its impossible these days to consider dissemination and utilization strategies without focusing on information technology .If you are a disability researcher or a service provider whose worker includes linking consumers with information resources, you are no doubt well acquainted with tools like bulletin boards. This advocate says that judiciously collected effective communicated information can help
6

professions provide better care and turn patients into enlighten consumers of health services. There is strength in Contes arguments in that for a number of years there has been little research in the field of health care and information technology. Snaedal, (2002), argues that the database with patients health information have been used for a long time and have not been considered to have any problems. He goes ahead to say that database have been used in various ways such as quality control. Research and health authorities have for some time used them for health information. He further says that its important for the authorities to have information on infectious diseases that may cause much distress in society. Therefore credit should be given to his argument in the way information on various diseases affecting the community is collected in central database it will be possible for the health manager to come up with timely and responsive actions. Wong and Chu (2001), article an online health care and informatics review put it in line that online health care informatics is a dedicated tool in retrieving and interpreting significant developments in health care delivery. In their journal article the Auckland RISSP strategy is the Auckland metropolitan region IT strategy that aims to improve health outcome for the people of Auckland through appropriate health information exchange. According to Conte, (1999), many hospitals and health Maintenance Organizations (HMO) are planning or implementing comprehensive computer based patients record system. Often these system are combined or linked to other technology applications intended to help health care providers be more timely and responsive to patients for example Kaiser
7

Permanente the largest HMO in the united states. Adoption by hospitals and HMO of computerized patients records and diseases management system is also helping to drive changes in use among medical practitioners. However, the adoption of hospitals of computerized patients records and diseases management system in most cases will not help to drive changes in the use among medical practitioners which entails personal and organizational initiatives. Katende (2003), states that a record management system for criminal investigation department Wandegeya police station is manual and has a lot of loop holes. It has constantly delayed activities such as updates of particular records, finding a particular record in a stack of records making statistics of most of the criminal activities, completing reports on particular criminal especially if it involves searching for criminal records and security of this information. This problem is aggravated by the fact that the whole police station does not have an existing records management system coupled with an absence of a database application to manage the data of the police station. These problems present a need of automation of this departments way of handling information in order to improve efficiency. In relation to Katendes, argument, the research agrees that Kiziiba hospital handles their record manually which is subject to delays established in producing required reports and therefore there is a need to have a database application established to improve on their efficiency Mukwano industries Uganda (clinic) under enterprise resource planning (ERP) Mukwano industries implemented a module which is used by their clinic to handle patients records. Many patients are received at the company clinic therefore need for storage of records arises.
8

2.2 Problem in the management patients records. According to Wong and Chu (1999) manual system are faced with a big challenge of natural disasters such as floods, fire, deliberate acts of malicious destruction of the records by employees which leads to total loss of data since no backup system are available for data recovery. Thomas and Begg (1998), state that manual filling system break down when we have to cross reference or process information in the files, thus when processing information, a computer becomes the most efficient means and this calls for a shift from manual to computerized system to handle data processing and management. Katende (2003) says that manual system have a lot of loop holes that can eventually minimize on the overall process of collection, storage and dissemination of information in an organisation and therefore advocates for integration of database application in routine activities of organization. Programming is creating a set of instructions to ask the computer to carry out certain jobs which normally are very much faster than human beings can do. Therefore, there are many computer languages, examples are visual basic, java, c++, c. according to (William, Joseph 2000 ), visual basic is a programming environment, which is a program specifically to facilitate the creation of new programs. It is an event driven language that responds to users actions. It is a graphical use interface (GUI) language that uses forms and different tools are placed on the form to perform different tasks.

According to the website http://en.wikipidia.org/wik/, windows operating system is the most widely used and most versant with users than any other operating system and therefore the most appropriate operating system to use for this system to work is windows XP 2.3 INFORMATION TECHNOLOGY AND INFORMATION and

SYSTEM http://www.ichnet.org/Glossary.html, http:/www.ostinato.starcord.educ/hipaa-feedback/definitions.htm/ retrieved on 23 June 2009, define information systems as all matters concerned with the furtherance of computer science, and the technology coupled with designs, development, intal1ation and implementation of the info-system and applications. Further define it as interconnected sets of information resources under the same directed management control to share a common functionality. This system normally includes hardware, software (applications), data, and people. These systems are used to manage and maintain data in different organizations including Info-com, thus the type and nature of data organizations tend to store determines the nature of information system to be installed for use to surpass the effects of using the traditional file system. James OBrien, (2006), and Hansen, (1999). Define data, being raw facts or observations, typically about physical phenomenon or business transactions. On the other hand, data is simply described as isolated facts. They further go a head to observe that Information refers to processed data that is now ready to be meaningfully used by other processes. It also implies summarized and analyzed data into meaningful format for reporting purposes, also observes
10

that a system is an entity constituted by different sub-systems that integrate into a common function - like a human body system has a nervous sub system, respiratory sub system, skeletal sub system etc. in this case therefore, Information system refers to information technology that is used by people to accomplish a specified organizational or individual objective. Technology may be used in the gathering, processing, storing, and/or dissemination of information, and the users are trained in the use of that technology, as well as in the procedures to be followed in doing so. The specific technologies that collectively comprise information technology are computer technology and data communications technology. Computers provide most of the storage and processing capabilities, while data communications-specifically networks- provide the means for dissemination and remote access of information (Bocij et. al, 2005). The basis of an information system is the sharing and processing of information and ideas, electronic, or graphical method of communicating information, information systems enhances resources management through controlled access, enforcing compliance of usage policies, redundancy mechanisms, business continuity policies and plans in place and their routine Audit to ascertain compliancy and current status. Loudon and Loudon, (1999), define information systems as an organizational and management solution, based on information technology towards a challenge posed by the environment. Further argues that management information systems are an integral part of the organization. Key elements in that must be catered for are its people, structure, operating procedures, politics and culture. From a business perspective, information
11

system is part of an organization and can be defined as an information technology oriented solution to the organizational and management challenges. Gordon and Gordon, (2000). Business Information Systems, says interaction of the organizations information technology unit and other units, determines the organizations success Information systems generally, further defined it to refers to an interconnected set of information resources under the same direct management control that shares common functionality and often includes hardware, software, information, data, applications, communications, communication and people. Most information systems are built to address and compliment organizational goals and objectives. In many of these business areas, where products and services are offered in todays competitive markets, pre-sales and after sales service and related information is very crucial for the business success. This forms a very sensitive element of service delivery - also called customer relationship management

2.4 BENEFITS OF INFORMATION TECHNOLOGY OLeary, J. (2000), Microsoft access 2000, states that data in a database appears once unlike in the file system where information or data files are repeated. This means that when data has repeating values, creates a lot of redundancies and thus affecting the storage resources as they take a lot of space, thus OLeary analogy tries to help reduce redundancy of data in an database. He researcher also tries to highlight the worthiness of speed,
12

consistency, accuracy and correctness, reliability, and security of data as one of the major concerns in organizations for which information systems should be developed, to help them take appropriate decisions, during planning, organizing control and coordinating different activities. 2.5 Management information systems Shelly, et. al. (2002), Defines management information system as a computer based system that generates the timely and accurate information for managing an organization. The researcher further observes that obtaining processed information from a system requires more than just the hardware (equipment) and software. Other elements which constitute information systems include; data, users and documented procedures and other information systems personnel. For information systems to provide accurate, timely and useful information each element in the system must be present and all of them must work together. The software must have been carefully developed and tested, and the data entered for processing must be accurate. The equipment must be capable of reliably handling the expected workload. 2.6 Analysis and design techniques Jeffrey, L. Whilter, Lonnie, D.Kevin C. Dihman, (2000). Say that system analysis of business problem is the basis for the construction or building of the system which is stipulated by the business requirement specification identified. The writer further observes that what is done in the process of investigation, the analyst must interact with the stake holders including the system owners to specifically identify and validate the business problem needs, to ensure that the technical solutions satisfy the business needs and the integrates the solutions to suit the design. They operationalized the word
13

problem to describe many situations like real problem either suspected or anticipated and requires corrective actions; Opportunities to improve a situation in spite of the absence of a complaint; a directive to change a situation even if there is no one that has complained. Michael Wood, (1979). Systems analysis, suggests that systems analysts are people who communicate with management and users at those levels, document their experiences, facilitate system development, not originating it but become supportive of the organizations in question and understand their goals and objectives, use good tools to help solve the problem]s. such details and descriptions of the systems analysis help most researchers build their systems using and / or following the outlined methods that guide system development. James Wertherbe and Nicholas P. Vita Lou, (1994). Systems analysis and design best practices, talks about mechanisms of setting up the project scope, objectives, and strategies during systems analysis design and development for any identified project and states that the impetus for most projects is some combination of problems opportunities and directives as demanded by the situation in organizations. The researchers defined a problem as an undesired situation that prevents an organization from fully achieving its goals and objectives. A project would be initialized to achieve a more responsive and timely satisfaction or order fulfillments. Wilbertz Galitz, W.O. (1993). User interface designs, says before designing interfaces using known tools, it is useful to understand those elements that frequently cause people have difficulty with the computer, such as excessive
14

use of computer jargons and acronyms, non obvious or less intuitive designs, inconsistent problem solving approaches and designs. The researcher nominates that problems are as a results of confusion, panic, frustrations, boredom, misuse, abandonment and many other consequences, thus Galitz provides the following commandments as to, understand the users and their tasks as the information increasingly extends to implement business to customer or business to business functionalities especially when using network environment and the Internet; involve users in the interface designs to help know what they like or dislike; test the database on the actual users and lastly practice iterative designs, the researcher further suggested that a good goal is that the 95% of the typical users can perform tasks or routines without any difficulty or help. Hughes, (2000). referred to design as the process of turning an abstract solution into a practical specification suitable for implementation thereafter. On the basis of the requirements identified during the systems requirements analysis process, a computerized system was developed. Whitten et al, (2001). Postulated that primary design goal of any system is achieved by ensuring that the resulting system improves the business performance, information quality and accessibility, control and security, resulting into better efficiency of people, processes and services to customers, further recommended that a structured analysis which is a process centered technique for modeling business requirements for a system, be used. Here dataflow diagrams are used to illustrate existing and proposed business
15

process requirements, associated inputs, outputs and files. Based on the considerations, the researcher ensured that the system is designed basing on the methodologies to provide timely, accurate and reliable information regarding. Denlarco, (1978, 1979). Dataflow diagrams as the tools for modeling

suggests that they should be the first tools used by the systems analyst to model system components. Therefore this exposition helps researchers to structure their systems such that these diagrams reflect the exact models of how they will look like and also showing how the different processes work for every anticipated input and the expected format of output. 2.7 INFORMATION TECHNOLOGY Information technology covers all the machinery and software that, until recently, was seen as belonging to individual disciplines. It is the coming together of data processing, communication technologies telecom technologies, office automation and production automation, so that IT describes any kit concerned with the capture, storage, transmission or presentation of information. The convergence of this technology has brought the separate disciplines into one management arena and paved the way for an integrated view that permits an organizational focus on the purpose of the whole rather than upon the technical difference of the parts.

16

Foulks, Lynch, (2002). States that Information Systems is refers to that part of the organization related to Information Technology (IT), Management Information Systems (MIS), Decision Support Systems (DSS), the IT supporting hardware that provides the infrastructure to run the information systems and so on. MIS is a generic term used to describe information systems, although it can refer to provision of management Information, normally at the tactical level of management. Unfortunately, information systems is a misused phrase and is often used to refer to specific elements of the data manipulation process, especially that of database administration rather than to the managerial and organizational concerns that the term information systems (IS) can be taken to represent, (Foulks Lynch, 2002).

17

CHAPTER THREE METHODOLOGY 3.0 Introduction This is a detailed description of selected methodology thats to say, step-bystep methods used by the researcher to achieves the objectives of the proposed system. This included the tools, instruments, approaches, techniques and methods that were employed in the data collection, analysis, design and implementation of the proposed system. 3.1Research design The research employed qualitative research methods, through this research design detailed and specific information was obtained from key respondents like employees and patients. The study was designed in such a way to identify and collect data about patient, employee monitoring and billing system in the hospital. 3.2 Proposed system Patient, employee monitoring and billing system is reliable and efficient in that it provides reliable ground for effective decision making and management. The records database system that was implemented in the Hospital maintains records. It is a computerized records system that allows easy access for authorized users to the data. It also provides convenient methods of inputting, storing and retrieving the information contained in the database.

18

3.3 Organizational units The following are the units that will be covered based on how the organization is organized; i) Top level management people who establish objectives and handle big problems that may cripple the hospital. ii) Middle level management people who provide ideas for improving present system and are in departments within the hospital. Handle staffing activities.
iii)

Operational staff these are day to- day people who handle different activities within the hospital. They include the employees, subordinate staff and other external workers.

3.4 Study population These are total elements of interest and they include; Employees these are the people who work in the hospital for example Nurses, Doctors, Data entrants, hospital Cleaners Lab attendants. Employers these are people who employ. Like hospital director, Hospital manager. Records these are the key data that are needed beforehand and after. For example employee and patients records that contain all their details. Staff and the management these are the administrators that offer supervision, control and managerial services in the company.
19

Patients these are people who come to the hospital to seek for medical treatment. 3.5 Sample size Sample is the representative part of the study population which was selected for study. This was used to draw conclusion about the entire population. Random sampling is a technique we used to carry out the investigations. About 100 patients and 20 employees from the different sectors of the hospital were used as our sample. Information that was collected from them was how they measured the growth rate of the hospital and their future expectations about the hospital. 3.6 Data Collection Data was gathered from the samples. The major techniques were interviews with limited questionnaires and document reviews. The choice of the method depended on the information needed and the time available for the various respondents. From the doctors, interviews were used exclusively, from the nurses, both interviews and document analysis were used, and the rest of the respondents questionnaires were used exclusively. Interviews were conducted on one by one, yet for those that used questionnaires were given two weeks to complete the documents. After that period of time, the researchers collected the documents that were later taken for analysis. 3.6.1 Structured interview

20

The employees were interviewed one by one. This allowed probing to clarify on the un-understood questions. The process involved the following steps: (a) The interviewer made an appointment with the interviewee. (b) The interviewer drafted questions before hand. (c ) The interviewer established the objectives of the interview. (d) The Interviewer conducted the interview one person at a time. (e) The interviewer analyzed and evaluated the interview. 3.6.2 Observation The researcher conducted the observation mainly in the Billing and monitoring system which deals directly with the records. The researcher observed the whole process of data recording. They also observed the time taken to access and retrieve information, observed different attendants while they handled records. 3.6.3 Record review Patients and employee registration forms were studied to obtain data kept about each patient and employee in the hospital. The information kept includes names, nationality, age, sex, diagnosis, status. Receipts of treatment bills were also studied and the show information like unit cost and total cost of treatment, patients name and number. 3.6.4 Questionnaires A number of questions were designed on a piece of paper and given to different employees and patients in the hospital plus other people in around the hospital. These questions were answered privately and returned

21

individually which also helped to visualized and managed the whole skeletal representation of the system. 3. 7 Validity and Reliability of Data The Researcher analyzed the requirements gathered from the users to find out what they really needed or wanted of the new system. This was to identify the functional requirements, non-functional requirements, if the requirements are realistic and interface requirements. Experts in this sector were also used to validate the accuracy of the collected information. This was achieved through consultative meetings. 3.8 Data Analysis The Researcher analyzed the requirements gathered from the users using a computerized software system. In this case SPSS was used to analyze data and generated the required graphs and charts that were used to attach meaning for decision making 3.9 Design techniques/tools and modeling The new system includes a database driven website with a search tool/engine for faster information retrieval. This section describes the system design that includes the context diagram, Level one DFD, system architecture and database design. The following are the advantages we enjoyed when using entity relationship diagrams. i) ii) They are effective communication tools compared to other designing tools because they are visually presented. Exceptional, conceptual simplicity.
22

iii)

Integrated in the relationship database model

System admin registers one to many data entrants. Cardinality is 1:

Admin 1..1

Registers 1. .*

Pharmacist

3.8.5 Development tools Operating system Operating system that will be used to develop ran on a windows platform. According to (Ida, Ann, 2001), this ensures job scheduling, resource allocation, communication, recovery from failure and accounting information on who uses the machine. The programming language that were used are PHP and MYSQL. It was used to create the user interfaces for input, output and other manipulation forms. 3.9 Requirement specification document After data analysis, requirements were documented into requirements specification. It gave a description of what the proposed system would be. It consists of functional and non functional, user and interface requirements.

23

The document was to serve as input in designed specification of the proposed system. 3.9.1 System design documentation The requirement specification were studied to prepare the system design. This helped in specifying the hard ware and software requirements and defined the overall system architecture. 3.9.2 System development This is the process of constructing information system of software. It also denotes a frame work that is used to structure plan and control the process of developing an information system. The development of PEMBS software passed through a series of identifiable stages during its life time. System development involves various activities like coding, system testing and debugging. 3.9.4 Implementation The pages were designed using XHTML| HTML| HTM this language was used for designing plain web pages also use of CSS helped to improve the dynamic content of the system and several scripting languages were also employed these included Java script for validating forms, PHP which was the main scripting language. With the help of open software like PHP whereby PHP is defined as scripting language originally designed for making dynamic pages and MYSQL which is a language used for querying databases hence its structured languages that supports the use of standard SQL syntax when Querying the database. MYSQL supports applications acts as the database component of Xampp, and Wamp plat forms for
24

example Linux, Windows. The system interfaces were developed using tools such as macromedia dreamweaver8 were used for managing and editing the interfaces. Dream weaver is good for graphical interfaces which makes design much more easier. Hyper text markup language is generally used for building web pages, cascading style sheets(CSS) was used for ensuring uniformity of all pages and java script (JS) was used for form validation, intellective image display and at one point redirection. Page burner was edited using macro media fire works8 and images used programs like Corel draw and adobe photo shop. Code: After implementation the code was obtained for the system which was tested in the following stages to ensure that its working properly and efficiently. 3.9.5 Testing Unit testing is defined as the process of executing an evolving software product in order to see if the results are incompliance with the user expectations and technical specifications. Each individual component of the system was tested to verify its functionality. We did this by examining each unit for example the under writers page which was checked to ensure that it functions as required and it adds patient and other details and also ensure that this data is sent to the database. The success of each individual unit gave us the go ahead to carry out integration testing. All identified errors were dealt with. 3.9.6 System testing After different modules had been put together we carried out integration testing to make a complete system. This was aimed at ensuring that the modules are compatible and they can be integrated to form a complete
25

working system. For example we tested to ensure that when a user is logged in, he\she is linked to the appropriate page and also could access the database. 3.9.7 Validation This ensures that the data inserted into the application satisfies predefined formats or complies with stated length and character requirements and other defined input criteria. To validate, sample data was feed into the system to find out if the system was able to respond according to the data entered, that is if it is correct or incorrect data. Questionnaires were provided to the experts to find out the validity of the system.

26