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Systems Analysis and Design
For Dr. Kawajas Office
Report Prepared by
Omar Kaleem
Rizwan Khalil
Minkyung Kim
Bunden Lin
Bruci Lopez
Paul Rattray
Monday, December 3, 2007
Contents
Table of Contents
1.
Project Proposal
2.
Preliminary Analysis
Current Information System Diagram
3.
Feasibility analysis
3.1 Introduction
3.2 Operational Feasibility
3.3 Technical Feasibility
3.4 Schedule Feasibility
11
3.5 Economic Feasibility
12
4.
14
Requirements analysis
4.1 Interview Schedule
14
4.2 Interview Reports
15
4.3 Functional Requirements
17
4.4 Forms
21
4.5 Nonfunctional Requirements
32
4.6 Use Cases
33
5.
38
Systems Analysis
5.1 System Summary
38
5.2 Entity Relationship Diagram
39
5.3 Dataflow Diagram Overview
43
5.4 Observation
44
5.5 Interviews
45
5.6 Questionnaires
54
5.7 Business Rules
62
6. Systems Design
65
6.1 Introduction
65
6.2 Alternate Solutions
66
6.3 Feasibility of the alternate solutions
71
6.4 Alternative Matrix Chart
71
6.5 Decide on an appropriate solution
73
6.6 Specific Hardware/Software needed
74
6.7 Additional Work to be done
77
7. Conversion Plans
78
8. Training and Maintenance Plans
81
8.1 Training Plan
81
8.2 Maintenance Plan
9. Project Assessment
82
10. Suggestion and Recommendations
84
11. Meeting Notes
86
Document Depository: http://userpages.umbc.edu/~pr3/436PROJECT/
1. Project Proposal
Subject
Dr. Kawajas Medical Clinic Project Proposal (System Analysis and Design)
Purpose
This proposals purpose is to seek permission to analyze the current system used
in Dr. Kawajas medical clinic and design a new system for it if appropriate.
Organization Information
Dr. Tahoora Kawajas medical clinic, composed of Dr. Kawaja and two clerks,
will be the focus of this project. Located in Owings Mills, this business offers a
variety of services: Pre-operation examinations, physical examinations,
cardiograms, x-rays, ect. At the present time, Dr. Kawaja offers these services to
about one thousand clients. Last year, revenue was about $100,000 and expense
was about $45,000.
Omar Kaleem, a Group #3 member, worked in this clinic as a clerk for four
years. Omar will provide us with inside details of the day-to-day operations. Also,
he can contact Dr. Kawaja with additional questions since he is in touch with her.
Problem
As the above details imply, this organization is required to store, maintain, and
retrieve a plethora of information. Unfortunately, the clinic is not taking
advantage of technology to engage these tasks. Instead, Dr. Kawaja is still using a
folder system which causes several problems, including:
Time is wasted maintaining paperwork
Not all folders can fit in the clinics file storage area, a separate storage area must
be rented for $600 per year
Inability to book keep, an accountant must be hired for $2000 per year
Disorganization, vital papers are lost on occasion
At this point, it seems that a new system, which utilizes technology, will solve
these problems.
2. Preliminary Analysis
This preliminary analysis will focus on the office of Dr. Kawaja. Doctor
Kawajas office is a small medical practice in Owings Mills in a Medical Center that
primarily services families while functioning as a smaller one-to-one type medical
center. The office also employs a Specialist that handles infectious diseases in
addition to Dr. Kawaja. The specialist is seen by appointment and works in a
separate building but is associated with this particular Medical Center. The Medical
Center is currently paper records only and has a one computer but it does not serve
the office in an Information Systems sense but rather for basic document word
processing. The machines is old, slow and runs Windows 98 around 486mghz , with
4.18 gigabyte hard drives. Because of the lack of automation for customer records,
an excess amount of paper is used for daily operations.
The process employed for a customer visit to Dr. Kawaja is also archaic. It
involves the patient coming in and being greeted by an Administrative Assistant.
New patients who come in are required to fill out a general info form, which involves
history and physical forms. The Administrative Assistant is the person who initially
greets the patient. She has a large appointment book where she has the schedule
written about 2 months in advance. In case of emergency the office makes exceptions
and tries to bring the patient in as soon as possible. New patients are then given Dr.
Kawajas Privacy Practices sheet which is based on the outline of the HIPAA (The
Health Insurance Portability and Accountability Act passed by Congress in 1996)
guidelines passed by the federal government. Then they are given a few forms that
outline what disease they have, if any, conditions, allergies, purpose for the visit,
family medical history, in addition to filling out another form with personal data,
like first name, last name, DOB etc. When the Assistant needs to retrieve data from
the pile of folders, the patients last name or first 2 letters of first name and 2 letters
of last name are used to conduct the search. The patient after this signs-in and waits
for the Medical Assistant to call them. The Medical Assistant then gets the weight,
height, blood pressure, and fills out a form with all this information and talks to the
patient so that the Doctor can know about any new info and so she can be fully
prepared to diagnose them. At this point the Doctor or the Specialist performs a
check up or the service prompted by the visit. After this is over, the patient then is
prescribed medicine or a course of action along with a general timeline for a return
check up. The patient then leaves and pays for the service at the front desk and at
this point if necessary, a follow-up visit is scheduled with Administrative Assistant
for the Doctor or Specialist.
There are some other details of the current procedures not outlined in this
description of how a patient visit occurs and is handled by the office. One of the main
ones is how HIPAA guidelines affect the recording and storage of patient records.
Title II of HIPAA, the Administrative Simplification (AS) provisions, requires the
establishment of national standards for electronic health care transactions and
national identifiers for providers, health insurance plans, and employers. The
Administrative Simplification provisions also address the security and privacy of
health data. These standards are meant to improve the efficiency and effectiveness
of the nation's health care system by encouraging the widespread use of electronic
data interchange in the US health care system. In one way this can affect flow of
information in the office in storage. Since the office does not employ any computer
systems or automated systems for file storage and instead relies on paper file records
and by law, the office is required to keep patient files at the location of the main
office for 5 years. Because of this huge storage related problems occur. Only after the
five years the office can then move the files to a separate location, but even if they do,
they still have to keep the records on file for 3 more years before they can destroy
them. This creates a large problem of overhead because the main office can only
physically support a certain number of files at a time. These files are then moved to a
warehouse location (if a patient stops coming for a long time) for long term storage.
So, not only is the overhead a problem in the main office, but the office has to pay for
an entire facility dedicated to storing older files. This is incredibly costly and
inefficient. Another way that the lack of automation creates a problem is through
time management. Filling out forms themselves can take a very long time and then
fetching them every time a customer comes in adds to the problem. Also, this is
problematic because it assumes that the files are secure and will never be misplaced.
The staff has commented on the difficulty of occasionally finding files and keeping
them all organized. This indicates that a potential disaster could occur if careful
scrutiny is not taken on filing procedures. Another time issue brought upon by the
paperwork system is that the office has designated Friday as a day of catch up.
Because the paperwork is time consuming, it cannot all be done during the operating
hours, which are Monday through Thursday. Friday gives the staff the time needed
to make sure all files are up-to-date. The only patient services provided on Friday
are emergencies. This not only creates time issues during the day to day operations
of the office but also wastes an entire day by centering it around paperwork instead
of patient services, which is the offices primary function. In addition to the time
mismanagement, the paperwork is also redundant. New forms for customers with
new issues have to be filled out from scratch when in fact an automated system
would prevent this by allowing the re-use of basic personal patient information
across all forms. Another large problem that occurs is the networking of patients
from the Medical Center and office to hospitals. Since everything that occurs is on
paper, this problem occurs because all the patients information has to be sent by
mail to the hospitals and vice versa. This communication can occur by phone or mail
but most personal information and patient records must be on official forms and
sent via email or fax which can take a few days to get to the destination.
This entire process can be streamlined by the implementation of a medium
sized database and server system with computerized terminals that would have a
front end application for the Medical Center Staff. The front-end application would
be easy to use and portable. It will allow the updating of records both externally and
internally and would allow integration of technology such as automated doctors
prescription reference pads and PDAs. The database would primarily serve to store
patient records. This would serve the purpose of eliminating several of the outlined
problems at once. Redundancy of forms would be eliminated thus creating a system
where a new form can transfer over all the basic information and history of a patient.
This also serves to eliminate the problem of non-centralization of patient
information and history, which is a crucial issue. One of the main problems with the
Medical Centers networking with hospitals is the ability to transfer information
quickly. Easily accessible patient records in a database would fix that problem as well.
The application interface would contain a form or sheet that would allow the Medical
Center staff to easily send patients records to a Hospital in a form that would
interact easily with any records the hospital has (since they would all conform to the
HIPAA guidelines). This database system would also eliminate the problem of
overhead. The computerization of patient records would free up a lot of space in the
main office as well as eliminate the need for an off-site record warehouse. Such a
warehouse creates an additional security risk of the records being stolen or misused
since it is not monitored most of the time. Time reduction would also be a major
benefit, eliminating the need for catch up days or spring cleaning days. The
interface design would make it easy to access customer records through the database
at any time and the applications program in the database solution would constantly
update and organize that data as needed.
Current System of Information at Medical Center (not automated)
Patient
(Gets an
(Patient gets a new
Appointment)
appointment)
(By Phone)
(Personally)
Doctors
Office
(Patients fills out a first

Time form)
(Patients Record is
Retrieved)
Record of
Patient
(Patient gets attended by)
Medical Assistant
(Patient gets attended by either)
DOCTOR
SPECIALIST
(UPDATE the Record)
(Updated)
Patients
Record
Patients
----------------------------------------- > Records
Warehouse
(After 5 years of inactivity)
8
3. Feasibility Analysis
3.1 Introduction
The goal of this project is to install computers that will enable the office staff
to schedule patients with a professional scheduling application and maintain files of
patients with a relational database that will suit the specific needs of the office.
Currently, Dr. Kawajas office has old scheduling and filing system that are hard to
manage. Everything is done on paper by writing. Dr. Kawaja and her staff have
strongly stated an urgent need to upgrade their current system into a more efficient
automated system. While the current system is working fine for their daily practice,
it is however, inefficient and time-consuming. For example, when in need of a
patient file, a staff member goes through alphabetized files on the wall to locate the
file. Oftentimes, a file is found in a wrong place of the wall filing system. Also, the
office is closed on Fridays so that the assistants can organize the patient files.
Because of this Dr. Kawaja loses every Friday as a day to see patients. In this
feasibility analysis study, we will consider operational, technical, schedule and
economic aspects to determine the projects feasibility, along with any types of risks
that this project may encounter.
3.2 Operational Feasibility

The end users of the developing system will be the office staff and a doctor.
The staff will schedule the patients and file the patient database with basic
information, and the doctor will update a patient record to the database each time
she sees the patient. The front desk assistant (administrative assistant), ,
responsible for scheduling appointments and organizing patient files, clearly stated
that she is confident using the proposed system and has basic computer skills. The
doctor will have her own personal computer to be used as a primary source for
producing patient notes and prescriptions. Besides these two primary users, the
office will require at least one other person who understands the system to back up
the primary users. This additional person will be selected from the current office
staff. It is unclear that who will be a backup staff member at this point, and we will
assume that the backup staff member has at least a basic knowledge of operating the
computer. However, the impact of this position is minor to the project because the
vendors are offering a full-scale training session for the current employees.
Training the office staff will be feasible because of their competency in
operating the computer. The medical field-related applications are extremely
sensitive, thus provided with an extensive training program. Upon receiving
necessary training for the customized application(s), the software will be very useful
and will offer satisfaction over the current filing system. Therefore, it can definitely
be concluded that this project is operationally feasible.
3.3 Technical Feasibility

Currently, there are no federal or medical restrictions on electronically storing
patient records. As a result, we can safely store all the documents for the patients on
a server and create a database. There will be two separate application programs for
the new system. One will be electronic medical records (EMR) software and the
other, scheduling software.
At this time, there is a vast amount of EMR software available in the market.
We recommend that the office choose EMR software with the most basic
functionality. Because the office only needs to store basic patient information with
scanned signatures and update patient records periodically, no additional
functionality is needed for this small clinic. In the case of purchasing software, the
vendor will customize their software to meet the exact needs of the office. The
vendor will train the office staff with this customized software.
Another option to consider is web-based EMR software. Due to high start-up
costs, a lot of smaller clinics are hesitant to have their database system automated.
Actually web-based EMR software is a growing trend. The clinic will be able to
maintain their patient records on the servers database and access the database
through a web site. The office will need only a computer that has Internet access to
maintain the patient database. The web-based EMR application provider will have
10
the backup data stored on separate storage, so the office wont have to worry about
backing up the data periodically. However, there are risks for using a web-based
system. Once the office loses its Internet connection (due to hardware failure,
maintenance, or ISP problems) the only way to access the database is via telephone
(to the web application provider). This can drastically slow down the office
performance. Also, the doctor and the staff members may be concerned about
security issues. After all, it is accessible via the web, enabling chance for exploitation.
Even though the exploitation possibilities are remote, since only the authorized
office staff will have access to the database, the user must feel secure to use the webbased application.
For the scheduling system, medical scheduling software is available for
purchase. The software is built specifically for a medical clinic, therefore fitting the
needs of the office. Scheduling software vendors offer training as well. It will also be
customized to fit the office needs upon purchase. If the office chooses to purchase
the stand-alone EMR software, the scheduling software has functions to incorporate
with the existing patient database, therefore minimizing the need to search for
additional patient information for each appointment. For example, when a patient
schedules an appointment, it will be recorded to the scheduling software. The
specific time slot of the particular patient will have a link to the database, to locate
the patient file immediately. If the office chooses web-based EMR software, then the
scheduling software will be a stand-alone application, requiring additional search
into the database. However, this additional search is not very inconvenient since it
only involves typing a patients name into a system. The patients information will
be available instantly, while not enjoying the instant convenience over the purchased
EMR software.
Most of the medical software is mature and maintained in a prompt manner
because of the sensitive nature of the records. Because software failure could result
in a tremendous loss of vital patient data or an interruption of daily practice, most of
the vendors offer 24/7 technical support. If the office chooses to purchase EMR
software, in the case of functional failure (ex: computer failure) the office will have a
full backup system on site. The office will also have a PDA system for backup, which
11
can be used to schedule appointments and retrieve basic patient information. The
web-based EMR application also has a functionality to download its patient database
information to a local computer, making its information available to transfer to a
back-up PDA. While technical failure is inevitable, there will be fully functional
backup sources available, as mentioned above. Accordingly, this project can be
determined as technically feasible.
3.4 Schedule Feasibility

Our official deadline is by the end of the fall semester of 2007 (December 3rd, 2007).
At this point in time, that is roughly two months. First, we will direct the office to
the right scheduling and EMR software vendors. We approximate the shopping time
for the vendors to take about 3 weeks, for a careful consideration. Upon determining
the vendor, at least 2 weeks of time is needed to customize the software for the office.
New equipment needs to be bought, making sure the specifications of the
equipments suit the needs of the new software. Buying equipment will take less than
a week. Training will take less than a week as well. This entire process will take
approximately 7 weeks, with 1 week for adjustments. Since the office practices a
normal routine, we do not anticipate any irregularities involving the office schedule.
However, if any types of irregularities do occur, the remaining 1 week can be
accommodated accordingly. We have provided a Gantt chart to show a graphical
breakdown of our Work Breakdown Structure scheduling.
12
We determine that our project is entirely feasible in terms of the schedule.
3.5 Economic Feasibility

DEVELOPMENT COSTS:
2
Computers ($1500 / ea.)
$3,000
PDA
$400
Printer
$300
Document Scanner
$400
Backup Hardware
$500
Scheduling Software
$1,000
EMR Software
$10,000
13
PROJECTED ANNUAL OPERATING COSTS:

1
Scheduling Software Support
$200
EMR Software Support
$1,000
Routine Computer Maintenance ($200 / ea.)
$800
12
Web based EMR Software ($100 / ea.)
$1,200
Total Projected Startup Cost without EMR software:
$5,600
Total Projected Startup Cost with EMR software:
$15,600
Total Projected Startup Cost with Web based EMR application:
$5,600
Total Projected Annual Cost without EMR software:
$1,000
Total Projected Annual Cost with EMR software:
$2,000
Total Projected Annual Cost with Web based EMR application:
$2,200
The doctors initial budget for the new system was $6,000 and annual
maintenance budget is $1,000. Purchasing stand-alone EMR software is much more
expensive. With the doctors initial budget of $6,000, purchasing EMR software is
clearly out of our scope in terms of economic feasibility. With the web-based EMR
application, initial start-up cost will remain low, however the yearly maintenance
doubles the initial projection. Even with stand-alone EMR software, the yearly
maintenance costs will be approximately the same as the web-based EMR
application. If the office would like to maintain a low yearly maintenance cost, it has
to go with a scheduling software only option. Otherwise, the maintenance cost will
rise per year from $1,000 current spending to $2,000.
Other subtle tangible and intangible benefits are rather significant. The
scheduling software will provide a greater flexibility on offices operation.
Automating a schedule enables the office staff much easier to modify the schedules
14
of the patients when the need arises. Paper scheduling system is rather cumbersome
to erase and re-record schedules. Also, having it on screen, the staff will be able to
view the next days patients in one glance, thus enabling them to prepare the
databases for the patients in a more effective manner. With a paper scheduling
system, because you cannot view one days worth of scheduling only, you would have
to go through one by one on the book to find the charts. Automating a database is a
tremendous advantage over the current system. First of all, the office can now use
Fridays to see the patients, instead of closing the office for the paper works. The
office does not have to pay for additional storage to store patient charts that are
more than 3-year-old. The database will store all the necessary initial patient
document in a scanned format, so that the office do not have to carry papers that are
just there for storing purposes. Oftentimes, doctors note is one or two sentences.
Updating the database each time the doctor sees the patient will only require the
doctor to type in a couple of sentences to the computer. Before, a full sheet of paper
was used to record the session with the patient. From the cost-benefit analysis, we
think that the benefit of having the system upgraded outweighs its costs. Thus, we
conclude that this project is economically feasible.
4. Requirements Analysis
4.1 Interview Schedule
Two methods of requirement gathering were utilized: (1) Interviews with the staff (Assistants
and Doctor) (2) Questionnaires filled out by patients
Name
Anjum Randhawa
Yvonne Taylor
Position
Administrative
Assistant
Purpose of Interview
Learn about scheduling
process and payment
process
Medical
Assistant
Learn about referring

process, medication
authorization process,
Meeting
October 20,
2007
9:15 -10:00 PM
October 21,
2007
15
Dr, Tahoora Kawaja
Physician
vitals collection process,

and medication ordering
process
Confirm needs identified
by med. assistant, admin.
assistant, and patient
11:30 AM
12:00 PM
October 22,
2007
8:00 9:00 PM
4.2 Interview Reports

Interview Report #1: Anjum Randhawa
Person Interviewed: Anjum Randhawa, Administrative Assistant

Interviewer: Omar Kaleem
Purpose of Interview:
Learn more about scheduling process
Learn more about payment process
Summary of Interview
Current scheduling method is easy and should remain (Recording appointments
in book)
Each cost assessed to a patient is recorded on a charge sheet
Billing is outsourced, done via charge sheets
Some patients have been given Flex Cards from insurance company, which
works like a credit card to pay co-pay and medical bill
Open Items
Attain copies of charge sheet, reminder notice, work-leave form, prescription
record form, privacy acknowledgment notice form, record release form, and
patient registration form from clinic.
16
Detailed Notes: Will be included in System Analysis Report.
Interview Report #2: Yvonne Taylor
Person Interviewed: Yvonne Taylor, Medical Assistant

Learn about referring process
Learn more about medication authorization process
Learn more about vitals collection process
Learn more about medication ordering process
Injectable medications (GIVs) are ordered through a local sales representative.
If medication is denied by insurance company, Letter of medical necessity is
sent to appeal department.
Some insurance companies require customized referral form.
Open Items
Attain copies of referral forms, lab request forms, imaging request forms,
medication authorization form, pre-op form, physical/new patient form, and
follow-up form.
17
Interview Report #3: Dr. Tahoora Kawaja
Person Interviewed: Tahoora Kawaja, Physician

Confirm needs identified by med. assistant, admin. assistant, and patient
Went over each form used in office, thoroughly
Reviewed needs identified by Assistants
Open Items
N/A
4.3 Functional Requirements

Process Oriented Requirements
Requirement #
Priority
Description
1A
Necessary
The system must allow users to create a patient profile for a new patient.
2A
Necessary
The system must allow users to create/view/update/print a patient registration form

for a new patient
3A
Necessary
The system must force the user to input the first name, last name, and date of birth to
a patient registration form in order to store a patient profile.
4A
Necessary
The system must allow users to create/view/update/print a referral form for a patient.
5A
Necessary
The system must allow users to create/view/update/print a Quest Diagnostic lab

request form for a patient.
6A
Necessary
The system must allow users to create/view/update/print a Quest Diagnostic lab

result form for a patient.
7A
Necessary
The system must allow users to create/view/update/print a history/physical form for

a patient.
8A
Necessary
The system must allow users to create/view/update/print an Advanced Radiology

imaging request form for a patient.
9A
Necessary
The system must allow users to create/view/update/print an Advanced Radiology
18
imaging result form for a patient.

10A
Necessary
The system must allow users to create/view/update/print a pre-op form for a patient.
11A
Necessary
The system must allow users to create/view/update/print a follow-up appointment

form for a patient.
12A
Necessary
The system must allow users to create/view/update/print medication authorization

form for a patient.
13A
Necessary
The system must allow users to create/view/update/print Northwest admission order

form for a patient.
14A
Necessary
The system must allow users to create/view/update/print prescription record form

for a patient.
15A
Necessary
The system must allow Dr.Kawaja to create/view/print a work-leave form.
16A
Necessary
The system must allow users to view/print work leave form.
17A
Necessary
The system must allow user to print a reminder notice for a patient which hasnt been
seen in a year.
18A
Necessary
The system must allow Dr. Kawaja to create/view/print a certificate to return to work
form.
19A
Necessary
The system must allow user to view/print certificate to return to work form.
20A
Necessary
The system must allow user to create/view/update/print charge sheet.
21A
Necessary
The system must allow users to create/view/print privacy confirmation form.
22A
Desirable
The system must allow user and patients to input signature electronically for
documents that require it.
23A
Necessary
The system must allow user to create/view/update/print a form customized for

requesting Northwest Hospital Center tests (Imaging, labs, ect.)
24A
Necessary

Northwest Hospital Center test results (Imaging, labs, ect.)
25A
Necessary

Baltimore Imaging Center requests.
26A
Necessary

Baltimore Imaging Center results.
27A
Necessary
The system must allow user to create/view/update/print a medical information

release form.
28B
Necessary
The system must allow a user to create/view/update/print a LabCorp request form.
29B
Necessary
The system must allow a user to create/view/update/print a LabCorp result form.
30A
Desirable
The system will allow patients to pay by credit, debit or flex in addition to the present
payment methods of cash or personal check.
Information-oriented Requirements
Requirement #
Priority
Description
1B
Necessary
The system must allow users to store any form that may be created in to a patient
profile by entering three pieces of information: First Name, Last Name, and Date of
Birth.
2B
Necessary
The system must request the user to input the following basic information for a
registration form: Last Name, First Name, Middle Initial, Address, City, State, Zip
Code, Referred by:, Sex, Marriage Status, Driver License Number, Social Security
Number, Date of Birth, Occupation, Home Phone Number, Work Phone Number,
and Emergency Contact Name and Number.
3B
Necessary
The system must request the user to input the following primary insurance
information for a registration form: Insurance Company Name, Insured Name,
19
Relation to Insured Name, Date of Birth of Person with Insured Name, Co-Pay
Amount, Insurance Policy Number, Insurance Group Number, and Employer of
Person with Insured Name.
4B
Necessary
The system must request the user to input the following secondary insurance
information for a registration form: Insurance Company Name, Insured Name,
Relation to Insured Name, Date of Birth of Person with Insured Name, Co-Pay
Amount, Insurance Policy Number, Insurance Group Number, and Employer of
Person with Insured Name.
5B
Necessary
The system must request the user to input the following information for a Quest
Diagnostic lab request form: ICD Diagnosis Code, type of test(s) (the same options as
in figure 1-1) being requested, fasting? (yes or no), patient first name, patient last
name, and patient date of birth.
6B
Necessary
The system must request the user to input the following information for the referral
form: patient first name, patient last name, patient date of birth, consultant name,
consultant address, consultant phone number, consultant specialty, consultant
institution/group name, consultant provider ID, reason for referral, services desired
(the same options as in figure 1-2), number of visits, period of validity, authorization
number, place of service(the same options as in figure 1-2), authorization number (if
required), and physician signature.
7B
Necessary
The system must request the user to input the following information for work-leave
form: Patient date of birth, patient first name, patient last name, first instance of
medical care, date, and period recommended to take off from work.
8B
Necessary
The system must request the user to input the following information for prescription
record form: patient first name, patient last name, patient date of birth, date, allergies,
prescription name, and relevant prescription information.
9B
Necessary
The system must request the user to input the following information for pre-op form:
patient date of birth, patient first name, patient last name, procedure name, drug
sensitivities and allergies, current medications and dosages, anesthesia issues(the
same options as in figure 1-3), pulmonary issues (the same options as in figure 1-3),
neurologic issues(the same options as in figure 1-3), obstetrics issues(the same
options as in figure 1-3); cardiovascular issues(the same options as in figure 1-3), renal
issues(the same options as in figure 1-3), hepatic issues(the same options as in figure
1-3), endocrine issues (the same options as in figure 1-3), gastrointestinal issues (the
same options as in figure 1-3), hem/one issues(the same options as in figure 1-3),
substance use (the same options as in figure 1-3), surgical history, family history,
physical examination information (the same kind of information as in figure 1-3),
impression, treatment plan, physician signature, and date.
10B
Necessary
The system must request the user to input the following information for medication
authorization form: patient first name, patient last name, patient date of birth,
diagnosis, ICD number, and date.
11B
Necessary
The system must request the user to input the following information for the follow up
appointment form: patient first name, patient last name, patient date of birth, date,
physicians signature, height, weight, blood pressure, pulse, resp. rate, body
temperature, medications, allergies, history of present illness, past medical history,
family history, social history, tobacco (packs per day), examination information (the
same areas as in figure 1-4) in regard to either normality of abnormality, detailed
explication for abnormal examination findings, results of lab (if appropriate), results
of radiology (if appropriate), result of diag. test (if appropriate), old records ordered
for a new patient (yes/no), old records reviewed (yes/no), lab independently reviewed
(yes/no), radiology independently reviewed (yes/no), diag. test interviewed (yes/no),
diagnoses, plan of action for each diagnosis, total time, counseling/coordination of
care visit (yes/no), and physician signature.
12B
Necessary
The system must request the user to input the following information for the
history/physical form: patient first name, patient last name, patient date of birth, date,
height, weight, blood pressure supine, blood pressure sitting, pulse, resp. rate, body
temperature, normality of head/neck (the same kind of information as in figure 1-5),
normality of chest (the same kind of information as in figure 1-5), normality of
abdomen (the same kind of information as in figure 1-5), normality of genitals/urine
(the same kind of information as in figure 1-5), normality of ano-rectal (the same kind
of information as in figure 1-5), dermatology normality (the same kind of information
as in figure 1-5), normality of extremities (the same kind of information as in figure 15), normality of joints (the same kind of information as in figure 1-5), normality of
tests ordered (the same kind of information as in figure 1-5), patient occupation, drug
allergies, medications, hospitalization/surgery, year of last tetanus and flu vaccine,
year of last pneumonia vaccine, year of last rectal/stool and cholesterol examination,
year of last tuberculosis examination, medical history (the same kind of information
as in figure 1-6), family history (the same kind of information as in figure 1-6), and
20
habits(the same kind of information as in figure 1-6).

13B
Necessary
The system must request the user to input information for the customized Northwest
form. This information will be the same kind of information as in figure 1-7.
14B
Necessary
The system must request the user to input information for the customized Baltimore
Imaging form. This information will be the same kind of information as in figure 1-8.
15B
Necessary
The system must request the user to input information for the customized Advanced
Radiology form. This information will be the same kind of information as in figure 1-9.
16B
Necessary
The system must request the user to input information for the customized Advanced
Radiology form. This information will be the same kind of information as in figure 1-9.
17B
Necessary
The system must request the user to input information for the Northwest Admission
Order form. This information will be the same kind of information as in figure 1-10.
18B
Necessary
The system must request the user to input information for the customized Charge
Sheet form. This information will be the same kind of information as in figure 1-11.
19B
Necessary
The system must request the user to input information for the customized medical
information release form. This information will be the same kind of information as in
figure 1-12.
21
4.4 Forms
Figure 1.1: The test options for a LabCorp lab request form
22
Figure 1.2: The possible services and the possible places of service for a referral form.
23
Section 1.3: Types of physical examination and issues listed on pre-op form.
24
Figure 1.4: Follow-up appointment form
25
Figure 1.5: Physical portion of the physical/history form
26
Figure 1.6: History portion of physical/history form
27
Figure 1.7: Northwest Hospital request form
28
Figure 1.8: Baltimore Imaging Centers request form
29
Figure 1.9: Advanced Radiology request form
30
Figure 1.10: Northwest Hospital Admission Order Form
31
Figure 1.11: Charge Sheet Form
32
Figure 1.12: Medical Information Release Form
4.5 Nonfunctional Requirements

Performance Requirements
Requirement #
Priority
Description
1C
Desirable
The system will provide the office with a working proficiency and effectiveness of
tasks, thereby allowing patients to be checked in and be seen swiftly, reducing patient
wait time.
2C
Necessary
The system will have technical support twenty-hours a day, seven days a week (In case
of a system failure of some sort)
Security Requirements
Requirement #
Priority
Description
1D
Necessary
The system will allow only Dr. Kawaja to input physical examination information on
physical/history sheet.
2D
Necessary
Except for vitals, name, age, date of birth, doctor, and date; the system will allow only
Dr. Kawaja to input information on follow-up visit sheet.
3D
Necessary
The system will allow only Dr. Kawaja to input the ICD number, the type of lab(s)
being requested on lab request forms.
4D
Necessary
The system will allow only Dr. Kawaja to input the type of imaging(s) being requested
33
on imaging request forms.

5D
Necessary
The system will allow only Dr. Kawaja to input the following information on referral
form: services desired, place of service, reason for referral, consultant name,
consultant specialty, and reason
6D
Necessary
The system will allow only Dr. Kawaja to place her signature on a document.
Operational Requirements
Requirement #
Priority
Description
1E
Necessary
The system will work on a Microsoft Windows Operating System.
Cultural and Political Requirements

Requirement #
Priority
Description
1F
Necessary
The system will operate in compliance with the Health Insurance Portability and
Accountability Act (HIPPA).
4.6 Use Cases

Use Case name: User creates patient profile
ID: 1
Importance Level: High
Short description: This use case describes how a user can create a patient profile for a new patient.
Trigger:
New patient arrives for first appointment.
Type: External
Major Inputs
Description
Source
First Name
Last Name
Date of Birth
Middle Initial
Address
City
Patient
Patient
Patient
Patient
Patient
Patient
l
l
l
l
l
l
l
l
l
Major Outputs
Description
Destination
Patient Portfolio
Patient Database
Patient Registration
Form
Patient Database
34
State
Zip Code
Referred by:
Sex
Marriage Status
Driver License #
Social Secuirty #
Occupation
Home Phone #
Work Phone #
Emerg. Contact Name
Emerg. Contact #
Primary Insurance Info.
Second. Insurance Info.
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
l
l
l
l
l
l
l
l
l
I
I
I
I
I
Major Steps:
1. Patient arrives for first appointment
2. Administrative Assistant activates a trigger on system to create new patient
profile
3. System presents patient registration form to administrative assistant
4. Administrative Assistant asks patient to verbally provide personal information
(name, address, ect.)
5. Patient provides Administrative Assistant with each detail of personal
information
6. Administrative Assistant inputs each detail of personal information in to
system
7. Administrative Assistant asks patient to verbally provide primary insurance
information (company, policy #, ect.)
8. Patient provides Administrative Assistant with each detail of primary
insurance information
9. Administrative Assistant inputs each detail of primary insurance information
in to system
10. Administrative Assistant asks patient to verbally provide secondary insurance
information (company, policy #, ect.)
35
11. Patient provides Administrative Assistant with each detail of secondary

insurance information
12. Administrative Assistant inputs each detail of secondary information in to
system
13. Administrative Assistant activates trigger to submit registration form
14. System notifies Administrative Assistant that patient profile has been created
and patient registration form is inside patient profile
Use Case name: User views a patient profile
ID: 2
Short description: This use case describes how a user can view a patients profile.
Trigger:
User wants to view a form in a patients profile.
Type: External
Major Inputs
Description
Source
First Name
Last Name
Date of Birth
Patient
Patient
Patient
l
l
l
l
l
l
Major Outputs
Description
Destination
N/A
N/A
Major Steps:
1.
2.
3.
4.
5.
User activates a trigger to search for a patient profile

System displays a GUI that will allow user to search
User inputs patient first name, patient last name, and patient date of birth
User activates trigger to use information to locate patient profile.
If a matching profile is found, corresponding forms are displayed. If a
matching profile is not found, system informs user that no such patient
exists
36
Use Case name: User views a patient profile
ID: 3
Short description: This use case describes how a user can view a patients profile.
Trigger:
User wants to view a form in a patients profile.
Type: External
Major Inputs
Description
Source
First Name
Last Name
Date of Birth
Patient
Patient
Patient
l
l
l
l
l
l
Major Outputs
Description
Destination
N/A
N/A
Major Steps:
1. User activates a trigger to search for a patient profile
2. System displays a GUI that will allow user to search
3. User inputs patient first name, patient last name, and patient date of birth
4. User activates trigger to use information to locate patient profile.
5. If a matching profile is found, corresponding forms are displayed. If a
matching profile is not found, system informs user that no such patient
exists
37
Use Case name: Patient uses credit card
ID: 4
Short description: This use case describes how a patient can pay their co-pay via a credit card.
Trigger:
The appointment ends.
Type: External
Major Inputs
Description
Source
First Name
Last Name
Credit Card Number
Patient
Patient
Patient
l
l
l
l
l
l
Major Outputs
Description
Destination
N/A
N/A
Major Steps:
1. The patient is asked to go to the Admin. Assistant to check out.
2. Admin. Assistant swipes credit card of patient.
3. Administrative Assistant finds patient profile using name and date of birth
and creates charge sheet.
4. Credit Card number is typed in to charge sheet.
38
5. Systems Analysis
5.1 System Summary
The system which we are trying to graphically illustrate is currently paperbased. It consists of people, forms, financial institutions, and billing companies.
Due to non-technical implementation of entity interactions, the relationships
between them are conceptual. This provides us with the task of identifying these
relationships. The system is archaic, inefficient, time-consuming, time-costly and
in need of updating. The services provided by the current system are basically the
everyday activities of the staff (i.e. retrieving patient files, recording payment
amounts, ordering medical supplies, etc.). This lack of automation introduces the
high probability of human error as well as an inconsistent data flow pattern. As we
analyzed the flow of data throughout the office, we concluded that a protocol does
exist regarding the polar ends of the data flow (i.e. patient provides personal info,
doctor receives patient file, etc.), but the path the data took to reach its required
destination was, at best, erratic. The system flow was not consistent. As we
observed the current system, we determined that our best method of analyzing the
different needs of the staff would be to directly interview them. We also have
determined that the effectiveness of the current system also directly influences the
patients. We asked patients to fill out a simple questionnaire. This provided us with
a measure of the indirect effects of the system. The results of their answers
statistical measurements will define certain required functionalities of the system we
will introduce with our proposed system. One last factor of the current system
which is implicitly performed is the adherence to certain business rules. We have
defined these rules both legal and organizational to provide us with certain
constraints when implementing the different functions of the proposed system.
39
5.2 Entity Relationship Diagram of Current System

Since there is no real database used in current system, the following diagram only shows
conceptual relationships between each entity.
40
Definition of entities:
Physician primary caregiver

Billing Company institution responsible for calculation and collection of
payment
Patient File record of patient personal and medical information
Scheduled Appointment meeting that has been previously arranged between
patient and doctor
Visit patient instance at / arrival to office
Co-payment fixed amount paid by patient when they visit and receive a
service
Patient person who receives a medical service or good from doctors office
Insurance Information data regarding patient insurance company
41
Data Flow Level 0 Diagram of Proposed System
Description of symbols:
D#
Process
Data Flow
Entity
Data Store
42
43
5.3 Data Flow Diagram Overview:
An important concept to know when trying to follow our DFD is that while the
administrative staff is the primary user of the system, the patient initiates that
interaction on their behalf. The data flow is as follows (for clarity, entities
are underlined, data stores are italicized and process actions are in bold):
Staff member submits patient name into system for an appointment; system first
verifies patient is in system by querying the patient information data store, if
not adds them, then contacts appointment data store; system returns possible
appointment times; staff member selects appropriate date; if necessary, staff
member can request a change of appointment date from system or cancel the
appointment altogether. Once an appointment has been made, in cases of specific
procedures known beforehand (such as a flu or tetanus shot), the staff member will
submit patient name and appointment date into system to reserve the
necessary medicine. Other cases in which the system is contacted to reserve
medicine is through the patient information data store or direct approvals from
the doctor. Once system has been contacted to reserve medicine, it contacts
the doctor for approval. Once approval has been made, the system checks to make
sure the quantity needed is available from the medicine data store. If more
inventories are needed, the system requests a shipment from the medical
supplier and waits for a delivery. When the correct medicine quantity is available,
the system updates the patient information data store. Upon update, the system
creates an appointment report with information from the patient information
and appointment data stores. This report is then sent to the doctor and attached
to the appointment record in the appointment data store. Once appointment data
store has received the appointment report, the system then internally sends this
information to start the billing process. The billing process centers on the billing
data store. The information is formatted into a bill which is then presented to
the patient who determines the billing method, completes the transaction with
the system and updates the billing data store. The system then sends the bill
44
details on to create a financial report which is delivered to the doctor for recordkeeping. One final and important data flow is the update of patient data (i.e. last
name or address change, weight gain/loss, etc). The staff member would contact the
system with the new/updated information and the system update process would
modify the information contained in the patient information data store.
Information Gathering
Three methods of information gathering were utilized:
- Observation by our team members
- Interviews with the staff (Assistants and Doctor)
- Questionnaires filled out by patients
5.4 Observation
Physical Locations
Team members took several visits to Dr. Kawajas office to observe how the current
system works.
We have observed each physical component of the existing system including
computer, phones, locations of cabinet, layout of the rooms, and how they are used
(see Appendix SA-1). The layout is important for implementation. It will help with
the coordination of technological equipment and connections. By having a floor
layout of the office, we can make crucial setup decisions before delivery. This is
particularly helpful since the office is quite small and without careful planning there
is sure to be confusion during implementation.
Documents and Files
Our team members also acquired documents that are used in the office, including
copies of a charge sheet, reminder notice, work-leave form, prescription record form,
privacy acknowledgment notice form, record release form, and patient registration
forms from clinic (for examples see Appendix SA-3 14). These documents will help
45
us choose or develop the best GUI for the office application. By designing an
interface with forms and reports similar to the paper-based forms already familiar to
the staff, the time and cost necessary to train them will be significantly reduced than
if a totally restructured interface was introduced.
5.5 Interviews
Our team member had three interview sessions, which allowed us to collect detailed
information from each staff member.
Followings are detailed Interview Scripts
Interview #1
Name: Anjum Randhawa
Position: Administrative Assistant
Purpose: Learn about scheduling process and payment process
Meeting: October 20, 2007
9:15 10:00 PM
Question 1:
What do you enjoy most about working as an Administrative Assistant?
Answer:
Helping people, giving them information, and getting a Thank You from them.
Question 2:
What do you dislike most about working as an Administrative Assistant?
Answer:
People getting angry, when they want immediate attention at busy times, and
when patient unfairly blames us for a mistake made by someone else.
Question 3:
What do you enjoy most about working at Dr. Kawajas office?
Answer:
46
Its nice to be working in an all-women environment. Also, its a very positive

environment to be in. Were very supportive of one another, and try to help each
other.
Question 4:
What do you dislike most about working at Dr. Kawajas office?
Answer:
There is a lot to do!
Question 5:
How comfortable are you with MS Word? (1-10 scale, 1= very low and 10 = very
high)
Answer: 7
Question 6:
How comfortable are you with MS Excel? (1-10 scale, 1= very low and 10 = very
high)
Answer:
Somewhere between 1 and 5.
Question 7:
How comfortable are you with MS Access? (1-10 scale, 1= very low and 10 = very
high)
Answer:
1, no experience at all
Question 8:
How comfortable are you with Internet Explorer?
(1-10 scale, 1= very low and 10 = very high)
Answer:
5.
47
Questions 9:
What complaints and frustration do you generally hear from the patients?
Answer:
Prescriptions not being called out on time, records not being sent out on time,
referrals not being processed on time, and difficulty in finding a good time for an
appointment.
Question 10:
Describe co-payment process. What happens if a patient cant pay co-payment at
time of visit?
Answer:
The co-pay is included on a charge sheet. This sheet includes any charge that can
be made. These sheets are collected by our billing company each Wednesday. The
costs for the different procedures are determined by the billing company. As of
right now, patients may pay with cash and check only. Some patients have flex
cards, which are like credit cards given by the insurance companies. Unfortunately,
we cant accept these cards.
About 20-30% of the patients are unable to pay their co-payment upfront. If
patient is unable to pay, we indicate this on the charge sheet. If the patient doesnt
find a way to pay this before the charge sheets are collected on Wednesday, the
billing company will handle collection of the co-pay.
Question 11:
Describe the process of scheduling an appointment?
Answer:
First, I ask the patient for their complete name. If this is a new patient, I will have
to put them down for an appointment of at least 45 minutes. Appointments can
vary in length of time, in accordance with what needs to be done. It could be a 15
minute appointment, 30 minute appointment, 45 minute appointment, or 60
minute appointment. I always try to schedule the appointment for about 2 weeks
later, unless it is an emergency.
48
Question 12:
What is the late policy for appointments?
Answer:
We wont take them if they are more than 15 minutes late. They are also charged
theyre normal co-payment for this session.
Question 13:
Do any patient related documents require your signature? If so, which?
Answer:
I only place my initials on result documents that are given to patients. I do this to
confirm that the record is for patient use only.
Question 14:
How do you think a computerized system would help?
Answer:
Well, I dont think it would make much of an impact in regard to scheduling. I have
no complaints about using a book. Patient records on the other hand, would be
very helpful since they would save much time.
Interview #1 Result Summary

We had opportunity to interview Anjum Randhawa who is the
administrative assistant in Dr. Kawajas office. She enjoys her job; her only
complaint is that she can be pretty busy sometimes, since she is the only
administrative assistant.
We asked her to describe her level of understanding about computers. She
is experienced with MS Word and Internet Explorer. She knows how to use MS
Excel, but she doesnt have any experience with MS Access.
49
"The majority of complaints she gets are Prescriptions not being called out
on time, records not being sent out on time, referrals not being processed on
time, and difficulty in finding a good time for an appointment.
She also kindly explained how current billing system works. The co-pay is
included on a charge sheet. This sheet includes any charge that can be made.
These sheets are collected by our billing company each Wednesday. The costs
for the different procedures are determined by the billing company. As of right
now, patients may pay with cash and check only. Some patients have flex cards,
which are like credit cards given by the insurance companies. Unfortunately,
we cant accept these cards. About 20-30% of the patients are unable to pay
their co-payment upfront. If patient is unable to pay, we indicate this on the
charge sheet. If the patient doesnt find a way to pay this before the charge
sheets are collected on Wednesday, the billing company will handle collection of
the co-pay.
We also asked her how scheduling works. She said new patient usually get 45
minutes appointment, and appointments can vary from 15 minutes to 60
minutes depending on situation, but if patient is late for more than 15 minutes,
the appointment is usually cancelled. She also mentioned that she tries to book
appointment for 2 weeks later, unless it is an emergency. As far as signature
concerned, she sometime places her initials on some of the documents to
indicate these documents are for patient only. She doesnt think scheduling
needs to be computerized, but computerized patient records / files would be very
helpful in the future.
50
Interview #2
Name: Yvonne Taylor
Position: Medical Assistant
Purpose: Learn about referring process, medication authorization process, vitals
collection process, and medication ordering process
11:30 AM 12:00 PM
Question 1:
What do you enjoy most about working as a Medical Assistant?
Answer:
The satisfaction I get in helping people.
Question 2:
What do you dislike most about working as a Medical Assistant?
Answer:
It can be overwhelming. Sometimes everybody wants something at one time.
Question 3:
What do you enjoy most about working at Dr. Kawajas office?
Answer:
Again, just helping people and feeling like youre making a difference.
Question 4:
What do you dislike most about working at Dr. Kawajas office?
Answer:
Its a little out of date with the lack of technology, etc.
Question 5:
How comfortable are you with MS Word, Excel, Access, Internet Explorer, and
other applications?
Answer:
51
Im not computer literate.

Questions 6:
What complaints and frustration do you generally hear from the patients?
Answer: That their insurance refuses to pay for their medicine.
Question 7:
What are vital signs? What are some examples of vital signs?
Answer:
For a follow-up appointment there is: temperature, blood pressure, and weight.
For a pre-op, new patient or physical there is: temperature, blood pressure, weight,
and respiration.
Question 8:
Do any patient related documents require your signature? If so, which?
Answer:
Yes, there is a few: The Universal referrals, general maintenance medication
documents, and a few more.
Question 9:
How do you order the medications?
Answer:
For the samples kept in the closet, we dont have to order them. A drug rep. comes
by gives us all that. For the injectables, we have a rep. we call to place orders.
Usually, these injectables are delivered the next day by UPS.
Question 10:
Please identify and describe other tasks which we havent covered yet.
Answer:
I also fill out the insurance information on the daily referrals. We use 3 kinds of
forms for daily referrals: A Universal Form that can be used for any insurance
52
company, a specialized form for Blue Cross/Blue Shield, and a specialized form for
MDIPA. These forms are usually good for either 3 visits or 90 days.
I take care of the forms for medication authorizations, which is a form insurance
that companies send us.
I also do EKGs, for pre-ops.
I also fill out part of the forms for lab requests. Or, if we do an in-house blood draw,
I take care of that.

During the interview with Ms. Yvonne Taylor, who is the medical assistant, we
gathered information about patient general health. Her job is to perform supportive
medical tasks before physician sees patient. She also handles several important
documents including referral forms, EKGs, and lab request forms. She mentioned
that technology in the office is little outdated, but she also told us she is not
computer literate. This suggests future training is needed for her and a simple user
interface would be helpful in the proposed system.
Interview #3
Name: Dr. Tahoora Kawaja
Position: Physician
Purpose: Confirm needs identified by med. assistant, admin. assistant, and
patients
9:00 10:00 PM
Question 1:
On these forms I collected, what do you fill out?
Answer:
53
Dr. Kawaja and I went over each form. She specified what she fills out, what the
patient fills out, and what is filled out in some of the more complex forms. Although
this took a lot of time, it was very helpful.
Question 2:
Are there any other kinds of forms you deal with?
Answer:
Social Security, Disability, MTA (for public transportation if they cant drive),
FMLA (for family-related leave), college specific forms, physical forms from high
schools, daycare center forms, and physical forms specialized for bus drivers or
truck drivers.
Question 3:
What are some of the procedures you do besides pre-ops and physicals?
Answer:
EKG, breathing treatment (for asthma), giving injections (done by Yvonne), and
PPD for tuberculosis.
Question 4:
What are some of the other kinds of documents that may go in to a patient folder?
Answer:
Lab results, x-rays, medication lists, and hospitalization notes (discharge,
summary, admission, etc.).

Interviewing Dr. Kawaja was really helpful since she had the best understanding of
the current system. She thoroughly explained each of the form types we collected
from the office. She pointed out that there are also some other documents she
handles, which are based from external sources. Some of them include: Social
Security forms, Disability forms, MTA forms, FMLA forms, college specific forms,
54
physical forms from high schools, daycare center forms, and physical forms
specialized for bus drivers or truck drivers. Besides pre-ops and physicals, she
performs EKGs, breathing treatments, giving injections (usually done by Yvonne),
and PPDs for tuberculosis. She also described that Lab results, x-rays, medication
lists, and hospitalization notes (discharge, summary, admission, etc.) may go into a
patients folder as well.
5.6 Questionnaires
We used questionnaires as one of the instruments to collect information from
patients, since interviewing each patient would be very time consuming and
inefficient. By using questionnaires, we were able to collect good, quality
information within a short period of time by asking right questions.
Here is the actual questionnaire that is created by our team member.
Patient Questionnaire
Instructions: This questionnaire will help determine the potential of an automated
scheduling and billing system. Please circle your answers in the sections which apply.
Thank you.
55
I.
General (all patients)

1.
Are you a new or existing patient of Dr. Kawaja?

New
2.
Existing
Did you schedule an appointment for your visit today?

Yes
No
56
II.
Existing Patients
1. Do you find it easy to schedule appointments with Dr. Kawaja?

Yes
No
2. Do you get the impression the staff is overworked?

Yes
No
57
3. To your knowledge has the office ever lost or misplaced your records?
Yes
No
4. How many minutes on average do you wait before you see the doctor?
0-5
6-10
11-15
16-20
20+
58
5. Would you like the option of paying by credit or flex instead of cash or credit only?
Yes
No
6. Have you ever contacted the office with an emergency?

Yes
No
59
7. If so, were you able to see the doctor within the hour?
Yes
No
8. Would you like the option of scheduling appointments via the Internet?
Yes
No
60
III. New Patients

1. Are you a walk-in or referral?
Walk-in
Referral
2. Would you like the option of paying by credit or flex instead

of cash or credit only?
Yes
No
Yes
No
No patient responses.
3. Would you like the option of scheduling appointments via
the Internet?
61
Questionnaire Result Summary

We had the opportunity to hand these questionnaires to a total of 28 Patients.
Since 93% of the responders were existing patients, we made few inferences
regarding the new patients.
Majority of patients seem satisfied with service of the office.
Maximum wait time was 20 minutes, within an acceptable time range.
Some of the patients did have emergency visits before and most were successfully
treated timely by doctor.
One interesting fact that we found was although most people own credit cards,
only a slight majority of patients prefer to be able to pay with a credit
card/flex card.
Also, the minority of patients wanted the option of scheduling

appointments over the internet.
62
5.7 Business Rules
Current Business Rules

The primary Business Rule that governs any Medical Practice is the Health
Insurance Portability and Accountability Act (HIPAA) which was enacted by US
Congress in 1996. Title II of HIPAA contains perhaps the most far reaching and
important business rule that must be adhered to by all physicians: the Privacy Rule.
The Privacy Rule establishes regulations for the use and disclosure of Protected
Health Information of a patient. Protected Health Information is any information
that documents the health status, provision of health care or payment for health care
that can be linked to a patient. This includes a patients medical record, and payment
history. An overview of the individual Privacy Rules includes:
Give patients rights to access their medical records, restrict access by others,
request changes, and to learn how they have been accessed
Restrict most disclosures of protected health information to the minimum

needed for healthcare treatment and business operations
Provide that all patients are formally notified of covered entities' privacy
practices
Enable patients to decide if they will authorize disclosure of their protected

health information (PHI) for uses other than treatment or healthcare business
operations
Establish new criminal and civil sanctions for improper use or disclosure of
PHI
Establish new requirements for access to records by researchers and others
Establish business associate agreements with business partners that safeguard

their use and disclosure of PHI.
Implement a comprehensive compliance program, including
63
Conducting an impact assessment to determine gaps between existing

information practices and policies and HIPAA requirements
Reviewing functions and activities of the organization's business

partners to determine where Business Associate Agreements are
required
Developing and implementing enterprise-wise privacy policies and

procedures to implement the Rule
Assigning a Privacy officer who will administer the organizational

privacy program and enforce compliance
Training all members of the workforce on HIPAA and organizational

privacy policies
Updating systems to ensure they provide adequate protection of patient

data
Implementation of Business Rules

A major constraint that HIPAA will cause due to the implementation of the new
system is regulation of Electronic Health Transactions. These include health claims,
health plan eligibility, enrollment, payments for care and health plan premiums
claim status, first injury reports, coordination of benefits, and related transactions.
Currently providers using non-electronic transactions are not required to adopt the
standards for use with commercial healthcare payers. Implementation of a national
standard for transactions and transmissions has the intent of simplification but will
require the new system to adhere by the HIPAA guidelines. HIPAA also requires
that a new system adopt the standard coding sets for all health transaction. This
entails any coding system that describes health problems, a root cause of a health
problem, patient symptoms, and the actions taken to correct the issue. All of these
sets have uniform guidelines that must be adhered to by the new system.
64
Current Organizational Business Rules:

Insurance of the patient must be with a Primary Care that is associated with
the Medical Center.
In the case of an HMO or a PPO, co-payment is due at the time of patient
treatment.
Current Medical Insurance must be on file and must be updated per visit.
In case patient is 15 minutes late for scheduled appointment, the patient
must pay the co-payment and will also lose their appointment time slot.
The current system only accepts cash and check.
The New Patient Process requires filling out a new patient registration form
before treatment, privacy practices form and provide medical, family, history
and habit information.
Insurance types accepted are primary care plans that have either HMO or PPO
designation. The two designations determine the amount of co-pay that is due
from the customer, and also the different options for possible elective
treatments that might be available.
Patients that are a no-show to an appointment are still obligated to pay the
co-payment.
Patients that request a lab report be mailed to them (instead of picking it up
from the office) must pay the postage costs.
Dr. Kawaja has the right to refuse a patient that has missed three consecutive
appointments.
Each assistant is allocated one half hour lunch-break for each shift.
Furthermore, the respective assistants must take their breaks at different
times.
Patients that do not provide at least twenty-four hours of notice for
appointment cancellation must pay their co-payment. The only exception to
this rule would be an emergency.
65
Assistants do not receive vacation time their first six months of employment.
After six months, they are given five days of vacation and five days for sick
leave for the remainder of the year (the next six months). After completing
their first year of employment, assistants are provided with ten days of
vacation and ten days of sick leave.
Every two to three days, Dr. Kawaja deposits checks she receives from copayments to the local K-Bank branch. If Dr. Kawaja is on vacation, one of the
assistants deposits the checks every two to three days.
Dr. Kawaja only answers calls from other doctors, nursing homes, and
hospitals. The administrative assistant takes messages for calls from patients
or pharmacies.
6. Systems Design
6.1 Introduction
We have decided to choose a packaged system for our project. Medical office
practices must comply with complex and exhaustive medical rules. Due to our
limited experience and knowledge of the medical industry we do not feel confident
enough to build a new database for the office that complies with these medical
regulations. It might be possible to build only a patient database that includes only
the address and phone numbers of the patient. However, it is practically a waste of
resources to implement a database with such minimal information. Electronic
Medical Record (EMR) software has been on the market for over 30 years, and
hundreds of software companies offer competitive prices for their mature EMR
software. Doctor Kawajas office practices Internal Medicine, and the business need
is common. In order to make the best decision for implementation, there were a few
aspects we had to take into account. The time frame was relatively short for
developing a new database. Also, the cost of building a customized system from
scratch was not within the offices budget. As for the project management, we can
66
coordinate with the vendors on behalf of the office; however our heuristic mental
models are not adequately developed to design a custom database. Therefore, we
have chosen to recommend a packaged system to the office.
As discussed in the feasibility analysis, we have recommended that the doctor
consider a web-based EMR for her medical office because of its low cost compared to
the stand-alone EMR. With the office budget of $6,000 for a start up only, standalone EMR software would be over the budget by at least $11,000. Also, with standalone EMR software, the office must have its own backup and database server, which
seemed excessive for such a small office. The office will only have 2 computers for
the practice. With web-based EMR software, there is no need to install a backup and
database server, as all the information and database backups will be on the server of
the providing vendor. The office will only need to buy 1 computer and to have the
Internet access, which the office already has.
Currently, there are over a few dozen popular web-based EMR choices on the
market. To choose the one that will fit the offices need without excessive cost, we
have narrowed the choices down to two products. In this systems design analysis
report, we will compare the two alternate solutions in terms of each products key
features, costs, as well as how each suffices the projects requirements. Feasibility of
each alternate solution will be presented as well. The weighted alternative matrix
chart will show how we have come to choose one particular product over the others.
6.2 Alternate solutions

We have narrowed our choices down to final 2 products: Elysium EMR LITE and
Aquifer EMR. These 2 products are rated well among the blogs, journals, websites,
and magazines that relate to health care and EMR technology. 1 We were able to
gather necessary information via each websites and by talking to each vendors sales
personnel. We also noted other doctors reviews on health review websites. 2 We will
1
www.emrconsultant.com, www.healthcaretechnologyreview.com, www.emredge.com, www.emrforum.com
Refer to footnote #1
67
present the common features of both solutions and then present the key features
that differentiate the products.
Common Features 3
Because we were looking into an EMR package that will enable us to maintain a
database on the vendors database server, both Elysium EMR Lite and Aquifer EMR
are web-based. Both software products are developed so that it meets the current
HIPAA rules and regulations. Both products run on a secure server thus enabling
the clinicians to safely log their patients medical history and records. Management
functionalities that are being offered by both companies are clinical and
appointment management. Customization is also offered as well as training. 24/7
technical support is offered with these two packages.
It is worth noting that both products meet all the requirements that were mentioned
in the requirements analysis, except #30A. 4 Under Process Oriented Requirements,
the forms that were mentioned in #5A, 8A, 10A, 13A, 23A, 25A, 28B, and 29B can be
custom designed and included in the software to automatic document preparation,
printing and storing. 5 Nonfunctional requirements and information-oriented
requirements are either easily accommodated with a custom-designed template or
already included with the software.
Elysium EMR Lite
Elysium EMR Lite is a client/server based software that provides integration
between physician access and records access for small and mid-sized medical
practices. It can be fitted to the needs of a variety of health care services and
modified to fit the form and function of the needs of any client. Several features
included in the EMR Lite package make it a good option for an upgrade. Below are
some of the features, listed in detail:
The side-by-side feature comparison chart is offered on Alternative Matrix Chart on page 13.
Payment by credit card is not fulfilled, which was a desirable element but not critical.
Requirements Analysis (pg.3-4)
68
Clinical Messaging
Clinical Messaging is one such feature that puts the physician closer to the
data they need. This feature includes a personalized inbox, which each staff
member can utilize. This function enables the physician to write prescriptions,
request lab tests, and queue data to print. Also, the physician and other staff
members can use secure correspondence to work with each other and their
health care partners. Any results or patient data acquired in an appointment
can automatically be routed to the physicians inbox. Furthermore, anyone
can send reports to consulting physicians. The consulting physicians can also
view updated personal information received from a patient.
Workflow Management
With this feature, the physician has the ability to create orders, sign
documents and delegate tasks to assistants. The user will be able to create
customized forms for clinical encounters, authorizations, and referrals.
Prescription Managment
The concern addressed by this feature is the workflow associated with the
creation of prescriptions, refills, and renewals. It allows the physician to
deliver prescriptions quickly and accurately to the pharmacy and to the
patient.
Electronic Ordering
Any staff member will be able to create and use ordering forms to send lab
and radiology orders to the appropriate supplier. For each supplier, Elysium
stores a collection of tests, order forms and automatic printing of Advanced
Beneficiary Notices. This allows the physician or staff member to customize
their orders for their own practice and makes it flexible to the needs of
different patients.
69
Aquifier EMR
Aquifer EMR is also a client/server based software that provides integration between
physician access and records access for small and mid-sized medical practices. It can
be fitted to the needs of a variety of health care services and modified to fit the form
and function of the needs of any client. Since its we based, the user is able to utilize
a secure internet connection to access all of its features. Security is enforced with the
128 Bit SLL encryption which meets HIPPA compliance. Here are some of the
detailed features of this application:
Patient Management
The interface package allows for many different options on managing patient
health care. There are many different facets of the program that come together
to form a patient profile. These profiles can be financial in nature,
demographic comparisons or health profiles. The physician can then use
these features to find a patient by either demographics or clinical health
factors. This also allows cross referencing of family members so that a history
of disease can be factored into prognosis. The GUI also allows for multiple
instances of a patient chart to be opened in the same session allowing for a
flexibility of use. The charts that the package supplies are convertible to many
different formats for ease of use. Different formats offered included MIME,
word documents, Microsoft Compatible documents, and various Audio and
Video formats.
Clinical Documentation
The Aquifer EMR package comes with an extensive documentation feature
that is in accordance with most medical documentation standards.
The
documentation allows for a range of different entries including Chief

Compliance (coded as CC) which allows the physician to check on compliance.
History of Present Illness (HPI) allows documentation of the trends of a
70
current chronic illness. Past Family and Social history (PFSH) allows for the
physician to create an entry for trends to predict the future possibility of an
illness. Lastly, a feature for Patient Instruction and Prognosis is featured for
future reference during follow ups. The entries that a physician codes in are
narratives and the system allows for customizable templates that quickly
provides consistent and organized reports. The templates also come with
default exams for the patient that include height, weight, physical vital signs,
allergies, blood type and chronic illnesses for ease of use. Once used these
templates produce a clinical summary and condition list that is automatically
generated for each patient. These reports can then be used to produce
comprehensive progress notes (for chronic conditions) and generate follow up
appointment instructions and referrals.
Appointment Scheduling/Management
Aquifer comes with a customizable appointment book feature that gives each
physician the maximum flexibility to sort patients. Each physician can input
personal schedule of availability and their standard appointment length. Once
this is done appointments are scheduled, rescheduled or modified by any user
with qualifying rights on the system (even patients). Physicians can view their
appointment book for any day and upload any patient info (including charts)
to the online appointment books. Appointments are flexible in that they do
not have to refer to a particular physician but can also be a certain group of
physicians as well. Office personnel can use the appointment book to manage
all physician appointments in the office and manage the flow of incoming and
outgoing patients to the doctor.
Secure patient-access portal
A unique feature of Aquifer is that patients can access information directly
online and remotely. They can look up appointments, personal information,
71
health information and any physical results from an appointment. This online
information is directly linked to public online resources so they can educate
themselves as to their own symptoms and issues. They can also privately
message a physician directly and ask them a question or concern about a
current appointment or health issue.
6.3 Feasibility of the alternate solutions

The Alternative Matrix Chart is drawn both from the feasibility analysis and our
research. Each criterion is carefully measured to reflect its degree of effect to this
project. One thing to note is that we are no longer considering a PDA option that
was mentioned a possibility in our feasibility analysis. For a PDA to fully function as
a backup source, it must carry all the necessary critical information, such as
scheduling information and patient profiles. Even though the PDA technology has
evolved greatly in recent years, it still lacks the CPU and memory capability to fully
accommodate the medical office as a backup source. Also, it is not critically
necessary to have a backup source because there can be other ways of getting
information in case of technical failure. If the high speed internet is down, a dial-up
modem can be used as a backup. Even though its slow, it gets the job done in an
effective manner.
Also to note on the pricing, on the feasibility analysis report, our projected
start up cost for the EMR program and related hardware was $5,600, and the total
annual expense cost was $2,200. 6 As noted below on the Alternative Matrix Chart,
both products meet the budget that was stated in the initial feasibility analysis report.
Thus, our decision will be based more on the other feasibility issues than the
economic issues.
6.4 Alternative Matrix Chart

The Alternative Matrix Chart compares the two products. Comparing with building
a system is not necessary because, as explained earlier in this analysis, the build
6
Feasibility Analysis
72
option is clearly out of scope for the terms of this project. Technical issues,
especially being HIPAA Compliance and providing E-Prescriptions is nearly
impossible because of its complexity and lack of medical knowledge. Also, if we
build a system, it will not be a web-based system, rather it will be a stand-alone
system. It will not meet the project deadline, and having built from the scratch, it
fails to demonstrate its maturity in the market.
Brief description on each criterion:
-
Web Based: a system is accessible via web from the Internet browser, and the
database will be on the vendors server.
HIPAA Compliance: a system meets the current HIPAA rules and regulations
Patient Access: a system is accessible by patient for his information only
Secure Servers: a system is running on secure servers to enhance the security

measure of protection of the patient profiles
Electronic Signature: a system has the ability to accept patients and doctors
signature and electronically store them
Clinical management: a system provides a functionality to support a doctorpatient session, as well as records of medical examination
E-Prescriptions: a system sends a prescription note to the subscribed pharmacy

of patients choice for automated prescription service
Appointment Management: a system is offering a scheduling service that links

directly to the patients profile from the scheduling book
Dates between customization and deployment:
Demonstrated product in market: a system has been on the market for

consistent number of years and been discussed on medical journals or related
articles for its proved value
Customizable interface: a system can be accommodated for modification to suit

the offices special needs
Training offered: a system offers a staff training session prior to the deployment
73
ALT1: Elysium EMR LITE

ALT2: Aquifer EMR
* RI = Relative Importance (Weight); S = Score (1-5); WS = Weighted Score
Evaluation Criteria
Technical Issues:
Web Based
HIPAA Compliance
Patient Access
Secure Servers
Electronic Signature
Clinical Management
E-Prescriptions
Appointment Management
Dates between
Customization and
Deployment
RI
ALT1
WS
ALT2
WS
5
5
5
5
5
5
5
5
5
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
3-5 Days for
full
customization
5
5
1
5
5
5
3
5
5
25
25
5
25
25
25
15
25
25
Yes
Yes
Yes
Yes
No
Yes
No
Yes
0 Days, other
customization
offered on the
go
5
5
2
5
1
5
1
5
4
25
25
10
25
5
25
5
25
20
10
10
$0
$1,140
5
4
50
40
$0
$1400
5
3
50
30
Program used 5
by other
medical offices
25
25
Customizable Interface
15
Yes, fully
customizable
75
Training offered
TOTAL
10 Yes
100
25
410
Program used 5
by other
medical
offices
Yes, but not
2
for patient
database
Yes
5
Economic Issues:
Initial Fee
Yearly Cost
Organizational Issues:
Demonstrated product in
market
30
25
325
6.5 Decide on an appropriate solution

Upon exhaustive comparison between the two EMR products, we are
recommending that Dr. Kawajas medical office choose Elysium EMR Lite. As
shown on the Alternative Matrix Chart, one critical technical feature made a
difference in our decision: the electronic signature capability. Being able to legally
store a doctors and patients signature to a database is very significant. If the
signature cannot be recorded electronically, when the need arises, the doctor or the
74
patient must sign a printed copy, which makes the system only semi-automated and
vulnerable to errors. Another feature to mention is the customizable feature option.
While Elysium EMR Lite offers full customization down to its patient database fields,
the Aquifer EMR patient database cannot be modified. While we liked the idea of a
zero deployment date that Aquifer EMR offered, we decided that a patient database
that can get customized to our own specific needs outweighs the zero deployment
date. With a fully customized database, there are no unnecessary information forms
to fill, thus maintaining one, concise database. Also with Aquifer EMR, if a
necessary field is missing from a patient record form, for instance, it will be recorded
under Note section, where it will not always be obvious. We are confident that
Elysium EMR Lite will satisfy the needs of Dr. Kawajas office.
6.6 Specific hardware/software needed

Hardware
The Elysium EMR Lite Hardware Specifications are rather simple to
implement. The customers do not need to deploy the hardware since it is web based
access. The company that produces this software will employ a cluster that contains
a dedicated system for storage and access. This company will need two Dell Servers
that would both be Quad Core two gigabyte processors with up to sixteen gigabytes
of RAM. These Servers would interface with a four to five terrabyte filer for storage.
Generally, they use Metapp filers for this purpose because there are also network
area devices and can be employed on a network with ease.
The medical center will have to deploy at least two terminals that can run
Windows XP and have up to fifty gigs of storage space with at least one gigabyte
processors. The terminals will also need connection to the internet via an internet
service provider. In the area the medical center is located Comcast High Speed
Internet can serve this purpose.
The center will also need a document scanner for inputting documents and
prescriptions. They will also need a large printer that can handle the output of files
and prescriptions and paperwork. For this purpose a Xerox 4595 Copier/Printer will
serve the office well. The printer and copier comes with Email, Print capability (both
75
color and black and white), Print Controller Copying and high resolutions. The
printer runs at speed at up to the ninety-five ppm, and the maximum print
resolution is 2400 x 2400 dpi and the maximum copy resolution is 600 x 600 dpi.
Operating System
Microsoft Windows (2000, XP, Vista)
Special Software
Microsoft Office (2000, XP, 2003, 2007)
Database Design
Each table below represents an entity of interest for the database to be developed. In
each table are the names, types, and field sizes corresponding to the respective
attributes of the entity.
PATIENT
Name
*P_ID
P_firstname
p_middle
P_lastname
P_sex
P_dob
P_address
p_city
p_state
p_zip
p_driverLicenseNum
p_socialSecurityNum
P_homephone
P_workphone
P_emergencyContact
P_emergencyContactPhone
P_emergencyContactRelationship
P_firstvisit
P_lastvisit
Type
NUM
VARCHAR
VARCHAR
VARCHAR
CHAR
DATE
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
DATE
DATE
Field Size
9
25
20
20
1
30
15
2
5
13
9
10
10
50
10
20
76
PATIENT FILE
Name
*pf_id (p_key)
*p_id (f_key)
pf_date
pf_Preop
pf_referralForm
pf_hospitalrequestForm
pf_imagingcenterrequestForm
pf_advancedRadiologyRequestForm
pf_hospitalAdmissionOrderForm
pf_chargesheetForm
pf_medicalInfoReleaseForm
pf_Privacy
PracticesAcknowledgementForm
pf_labcorpDagnosticsRequestForm
pf_questDagnosticsRequestForm
pf_patientRegistrationForm
pf_meetingReminderForm
pf_prescriptionRecordForm
pf_medicationAuthorizationForm
pf_workLeaveForm
DOCTOR
Name
*d_id (p_key)
d_speciality
d_firstname
d_lastname
d_address
d_address
d_city
d_state
d_zip
d_homephone
d_cellphone
d_pager
d_fax
d_signature
Type
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
VARCHAR
BFILE
Type
VARCHAR
VARCHAR
DATE
BFILE
BFILE
BFILE
BFILE
BFILE
BFILE
BFILE
BFILE
BFILE
Field Size
9
9
BFILE
BFILE
BFILE
BFILE
BFILE
BFILE
BFILE
Field Size
9
25
25
20
100
30
15
2
5
10
10
10
10
77
BILLING_ACCOUNT
Name
*ba_id (p_key)
*p_id (f_key)
ba_amountDue
ba_dueDate
ba_unpaidBalance
Type
VARCHAR
VARCHAR
NUMBER
DATE
BOOLEAN
Field Size
9
9
10
INSURANCE
Name
*ins_id (p_key)
*p_id (f_key)
ins_primaryCompany
ins_primaryAcountNum
ins_PrimaryPhone
Ins_secondaryCompany
ins_secondaryAccountNum
ins_secondaryPhone
Type
VARCHAR
VARCHAR
VARCHAR
NUMBER
NUMBER
NUMBER
VARCHAR
NUMBER
Field Size
9
9
20
15
10
15
20
10
6.7 Additional Work to Be Done

Since our team did a lot of research to find a suitable EMR, the product
selected doesnt require additional work to be done. We used the requirements as a
guide to find an EMR that: is supported on a 24/7 basis, works on a Microsoft
Windows Platform, grants users the ability to input their signature and is compliant
with HIPPA. As stated above, the Elysium EMR has all of these qualities.
Moreover, since customization is offered by Elysium, this EMR covers many
of the remaining requirements. For example, Elysium programmers can recreate any
form mentioned in the process-oriented requirements along with the corresponding
inputs described in the information oriented requirements. Additionally, the
programmers can apply many of the security requirements by implementing some
sort of access control within the application (User IDs, passwords, ect).
Unfortunately, the EMR cant be customized to Allow patients to pay by
credit, debit or flex in addition to the present payment methods of cash or personal
check. However, this requirement is only a desirable at this time since the staff
placed nearly all the importance on changing the medical record maintenance
78
process instead of changing the payment process. Perhaps after the new medical
record system is installed and proves to be an effective/efficient system, the office
can seek a solution for a new payment process.
7. Conversion Plans
Below is a discussion of how the three subjects of interest for a system conversion
(Conversion Style, Conversion Locations, and Conversion Modules) will be
addressed in the system implementation for Dr. Kawajas office.
Conversion Style
Options:
(1) Direct Conversion Complete and immediate switch over form the old
system to the new system.
(2) Parallel Conversion Operating both the new system and old system
concurrently for a specified amount of time.
Analysis:
Clearly, the files Dr. Kawaja currently stores in her office cant be neglected.
The vital documents in these files have to be integrated in to the system
somehow. The least complex route to take is for the documents to be scanned
and thereby converted in to PDF files. Although this will be a time consuming
task, Dr. Kawajas son has volunteered to scan each form in each file over his
winter break from college.
Also, the EMR can be customized by the programmers to have a
partition placed in each patient profile. One side of the partition can contain
the new forms created by using the EMR, and the other side can contain the
old forms as PDF files.
As long as the plan above is successfully executed, before the system is
implemented, the old files will not be a concern for the staff. As a result, direct
conversion is definitely feasible. But is it the most effective/efficient choice?
79
Considering the importance of these records, there will be a significant risk in

undergoing a direct conversion.
And when one contemplates about the possibility of losing vital medical
documents (in the case of a major system failure or even Dr. Kawajas son
forgetting to scan some documents) it seems that the consequences could be
quite tragic. Honestly, when dealing with the medical/healthcare field the risk
goes far beyond loss of cash and capital. With hazards such as severe allergic
reactions and misdiagnosis, even a minor mistake can be a risk to somebodys
life! Therefore, risks should be avoided as much as possible.
Initially, running the systems in parallel may not seem attractive to the
staff. They will be required to create/update forms using the EMR, print them
out and place these forms in the patient files used in the current system.
Unfortunately, the staff will have to spend the same amount of time (which
translates to the same amount of costs) searching for and maintaining
paperwork as they did before. As is evident from the interviews with the staff,
this is the main annoyance caused by the current system. Nevertheless, the
staff should understand this decision when reminded of the danger that will
be imposed on patients with a direct conversion.
Looking at time as a factor, we need to provide programmers with an
opportunity to discover bugs and other errors as the system is operated in
daily functions. With this in mind, it appears that eight weeks (or about thirtytwo working days) should be a sufficient amount of time.
With a parallel conversion the staff can reap the benefits of using an
EMR based system and rely on the old file system as backup in the case of the
slightest error. In the period in which the parallel conversion takes place, the
office staff can decide what they will do with the old file system.
Decision:
Parallel Conversion (two months)
Conversion Locations
80
Options:
(1) Pilot Conversion- One or more locations of an organization tryout the
system before other locations. If successful at this location or at these
locations, it will be implemented at the other locations.
(2) Phased Conversion- System is implemented at the various locations in a
sequence (One after the other).
(3) Simultaneous Conversion- System implemented in each location at the
same time.
Analysis:
There is only one location, so by default the conversion will be simultaneous.
.
Decision:
Simultaneous Conversion
Conversion Modules
Options:
(1) Modular Conversion- Separate modules of the system are converted
sequentially (one after the other).
(2) Whole System Conversion- The respective modules are simultaneously
implemented.
Analysis:
Overall, the system is rather simple. The few modules within the system are
rather unified since all of them are centered on the forms used in the office. At
this point, it seems that many modules will be dependent on other modules.
So it seems that a modular conversion will be a waste of time and money for
this application.
Decision:
Whole System Conversion
81
8. Training and Maintenance Plans

8.1 Training Plans
Elysium EMR Lite offers an initial training program. It is offered free at
regional training center. It will take total of 4 hours to complete the training. At the
training, the users will be trained on specific details on every aspects of the software.
The training will not likely be very intense or hard, as this program is a web-based
one which has a fairly intuitive menu design.
8.2 Maintenance Plans

The computer installed at the doctors office will need a periodical check up.
We have selected to choose a local company called Computer Geeks, LLC. The
company serves in the DC/MD/VA area and an experienced small business
computer service provider. The company will charge $192.00 for the quarterly check
up. The cost is already included in the budget. We do not expect a frequent outage
on the internet connection. However, if the case does occur, the Comcast will be the
maintenance provider for its ISP problem. Elysium will offer 24/7 technical service
as well.
The project team was well organized throughout the analysis and design
phases. There were times of both success and hardship but we managed to strongly
conclude this project with the analysis report and design report. Because most
members work part-time jobs, efficient time management was difficult. Additionally,
reaching agreements was somewhat difficult because we had a rather large group.
Definitely, the opinions of team members often vary, causing conflict within the
group. Another challenge was meeting with the Doctors Office staff and attaining
information from the different medical companies.
We had meetings once a week that lasted about an hour or more depending on
the number of issues to be addressed. At certain points, it was almost impossible to
gather everyone for these meetings. Even when everyone was not present, the
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meetings were very involved and many of the major project decisions were made
here. Meeting notes became really important to summarize our meeting decision
and task breakdown. It allowed those who could not attend the meeting to view all
the points covered, thereby keeping everybody on the same page.
In order to make meetings more effective/efficient, it was decided that each
meeting should be assigned a facilitator. After the first few meetings, it was clear
that time was being wasted figuring out the topics to be discussed and how to
distribute the work evenly amongst team members. This is when we decided to
assign the responsibility to one group member (for each week) to create a meeting
schedule with the main points to discuss. Even though the length of meetings
remained the same, meetings became more detailed, organized and a broader set of
issues were covered.
Another type of communication used was phone calls. Sometimes an
immediate answer from a group member was needed, making a phone call necessary.
However, this method of communication is not always successful because its not
certain that the group member would immediately answer the call. Although this
method had some advantages, the primary form of contact was sending e-mails and
phone calls were reserved for time of absolute necessity.
Moreover, an important subject when reflecting on what worked and what
didnt work was delegating responsibilities amongst group members. For the first
couple of deliverables the strategy was to assign one person to do everything for each
deliverable. This seemed like a good way to evenly split up the work. Unfortunately,
the group failed to realize that all of the deliverables required a tremendous amount
of effort, and having only one person working on it was not nearly enough to produce
documents of high quality. After one of the deliverables did not meet the guidelines,
the group decided to divide the work even further. This resulted in each team
member working on some part of the deliverable and one member would check the
grammar, spelling, and format.
Another effect of this change was that group members in general were able to
effectively communicate ideas to one another. This definitely helped in that it kept
the entire team involved and able to express their thoughts without hesitation. ]
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Meeting with the medical office staff provided valuable information and was
necessary to carry out this project. In part, we were lucky because the office staff
was very receptive and willing to cooperate with us throughout the project. They
showed interest in the project and were also enthusiastic about using the new system.
Since most of them already had experience in working with computers, the
transition from the paper based system to the new automated system will not be
extremely hard. Once again, having the whole team visit the office at the same time
was not possible because of the busy schedules. This problem was addressed by
communication through e-mail.
One surprising difficulty was finding screen shots for the interface from the
selected software. We tried reaching the EMR Company for about a week to obtain a
few screen shots of the interface. It was quite difficult to get in touch with them.
Despite this problem, we went ahead and used some screen shots from a similar
product to show how the interface would look in the deliverable.
10. Suggestion and recommendations

This project definitely taught us a lot about working as a team. We also had the
opportunity to work in real life applications such as working in a doctors office.
Covering the development life cycle in this small scale environment proved to be
rather challenging. If we had to scale this project to a much greater degree, one with
a larger budget and more resources, its easy to see how involved and time
consuming it would be. Although our group communicated well and we were
organized the lack of a clear leader made it hard to operate. In addition, coming to
realize our mistakes in the beginning was essential in achieving a good performance.
Our group did not have a leader per se, but different team members stepped
up to make sure the deliverables would be submitted on time and met the necessary
requirements. Even though we are all responsible for our own work, leadership
helped the group to produce a high quality product. One can clearly see by looking at
84
our deliverables. It might be useful in future projects to assign a willing member as

the project leader to help organize the work.
On top of this, class participation became an important factor. We realized that we
needed to be more involved in the class environment in order to better comprehend
the material and this was also reflected in our project performance.
Another important group issue that was addressed and had an impact on our
work was participation within the group. After one of the deliverables was not
accepted for lack of requirements, we came together as a group and determined what
we needed to be done in order to get back on track. All of the team members were
not participating enough in the discussions and not providing enough feedback for
the work performed. This became a major issue. Once team participation among
other factors was improved, our deliverables started to become more robust and our
performance improved as well.
Another lesson that we learned from this project was that it is very important
to maintain good relations with our clients. Keeping them informed about project
details and improvement makes them feel part of the project and they become more
willing to deal with difficult circumstances and to help overcome them. We also
realized that when interviewing workers about the system it is important to have
them feel comfortable and make sure they know their job is not in jeopardy in order
to obtain useful information. Otherwise they could be scared and valuable
information could be hard to retrieve.
85
11. Meeting Notes

September 19, 2007
Attendees: Omar Kaleem, Bruci Lopez, Rizwan Khalil, Paul Rattray
Issues:
Preliminary Analysis (Rizwan and Bruci???)
- What has been done so far?
- Should Bruci and Rizwan go to the clinic? When?
- When will it be complete by?
Assigning Tasks
- Preliminary Analysis
- Feasibility Analysis
- Requirements Analysis
- System Analysis Report
- System Design Report
Decisions/Observations:
- Hasnt been started yet
- Everyone will go Friday @ 11 AM
- Rizwan and Bruci will have a draft by Monday at latest
Assigning Tasks
- Preliminary Analysis
Bruci and Rizwan
- Feasibility Analysis
Allison
- Requirements Analysis
Omar
- System Analysis Report
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Paul and Bunden

- System Design Report
Rizwan, Paul, and Bruci
September 26, 2007

Attendees: Omar Kaleem, Bruci Lopez, Minkyung Kim, Paul Rattray
Issues:
Preliminary Analysis edit
- Grammatical errors on the draft
- Who will edit?
Next step, Feasibility Analysis
- More research needed
- When to visit the office?
- Who will visit?
- Paul will edit and turn it in -> but Rizwan edited it and turned it in
- Kim and Paul will visit the office next week on their own time
October 3, 2007
Attendees: Omar Kaleem, Minkyung Kim, Paul Rattray, Rizwan Khalil
Issues:
Feasibility Analysis due
Kim is responsible for writing
Visited the doctors office for an interview
87
Theories and methods

What direction should we take
Methods of implementing the system
Specific details on the software design
None
October 10, 2007

Attendees: Omar Kaleem, Minkyung Kim, Paul Rattray, Bruci Lopez, Bunden Lin
Issues:
Submitting in tonight
Participation from everyone
Everyone should to be more active
Respond to email
Meeting attendance is crucial
None
October 29, 2007

Attendees: Omar Kaleem, Bruci Lopez, Rizwan Khalil, Bunden Lin, Minkyung Kim
Issues:
Template to be used for final report
- Any ideas????
88
- Good Job, Allison!
- Mr. Dinmores Suggestion (economic feasibility would be improved by
combining the costs and benefits to show an overall return on
investment to support your position that the project is economically
feasible)
Requirements Analysis
- Feedback
- Needs to be improved regardless of deliverable pass/fail by 1-3
group members
Requirements should be more organized
More non-functional requirements
More use cases
- Make sure to ask when we will receive feedback for this
deliverable.
Systems Analysis Report
- Is there a current system?
What is meant by current system
If no current system, thorough analysis of each task is necessary
- Individual Assignments
What are they?
Whos doing what?
- Business Rules?
What is meant by this
Will there be any for our project?
- Needs to include survey/interview scripts
- Allison will select a template; she has a few in mind
89
- Allison will make the correction that Mr. Dinmore suggested in
his feedback
Requirements Analysis
- Feedback
Abundant, lots of detail
Rizwan needs it present
- Needs to be improved regardless of deliverable pass/fail by 1-3
group members
We will organize this once we get feedback
- Make sure to ask when we will receive feedback for this
deliverable.
Will ask about this today
Systems Analysis Report
- Is there a current system?
Dont understand what is meant by current system
Needs to be asked about in class today
- Individual Assignments
If Current System does exist:
- Bruci: Data Flow Diagram
- Bunden: Entity Relationship Diagram
- Rizwan: Business Rules/Constraints
- Omar and Paul: Interview / Questionnaire Scripts
- Allison: TDB
- Business Rules?
Legal Constraints or guidelines that are followed
HIPPA, general office-specific policies
Ask Norico or Dinmore for more clarification on what is a business
rule
- Needs to include questionnaire/interview scripts
Interview scripts will be sent out by Wednesday
90
Questionnaires to be handed by Wednesday
November 5, 2007
Attendees: Omar Kaleem, Bunden Lin, Bruci Lopez, Paul Rattray
Issues:
Went over last weeks notes
Begin the system design and then based on that we can add additional
non-functional requirements
Use cases and organization of requirements needed more for
documentation than for content

ROI to be included in Feasibility Analysis?
Ask Dr. Norcio the level of the DFD diagram

Decided that everything should be completed and sent out for editing/review
by Tuesday (11/6)
Paul
-
Summary of current system
Short definition of entities in EER diagram
Bunden
-
Add attributes to patient and medical record entities in the ER diagram
Add the billing company attribute
Information gained from interviews
Allison
Send out initial office observation notes (?)
Rizwan
- Business rules to be sent out
Bruci
- DFD to be sent out
91
November 12th, 2007 1:00 PM

Attendees: Omar Kaleem, Bruci Lopez, Rizwan Khalil, Minkyung Kim, Paul Rattray
Issues:
-
Should be similar to real world templates (show example from GE

Healthcare)
everything should be standardized! (having the same format, etc.)
Document Revision History
Create an electronic repository of all the documents

-
incase the documents need to be updated/revised
use somebodys user page
Systems Analysis
-
Business Rules
HIPPA rules look good
Organizational Business rules need to be improved
o Staff should add on to this
- Inconsistent font size/style

-Data Model
Missing
o Under Patient: Notice of Privacy Practices
Acknowledgement (also needs to be included in
requirements), work-leave form, medication authorization
form, prescription record form, meeting reminder form,
patient registration form, labcorp and quest diagnostics
request form (not just lab request form)
92
o Under Physician (Address, City, State, Zip Code, Phone

Number, Fax Number)
-Other feedback
System Design
-Due the day before Thanksgiving
Anybody traveling this day or the day before, ect? If so, when?
-Order that needs to be followed with each part
(1) Determine alt. solutions, discuss feasibility of alternative solutions,
and decide on appropriate solutions
(2) Discuss hardware/software needed
(3) Design normalized databases
(4) Discuss plans to complete what needs to be done?
-Individual assignments for each part
o Allison and Omar/Paul/Bruci/Rizwan
o Should be done before weekend
o Omar/Paul/Bruci/Rizwan
o Should be done by end of weekend
o Bunden?
(4) Discuss plans to complete what needs to be done
o Omar/Paul/Bruci/Rizwan
-Determine alternate solutions (buy vs. build?)
Not sure what buy vs. build means.
-Designing normalized database
Just a logical schema, or is actual DDL(SQL) statements needed?
Seems like this can be done at any point (doesnt need to follow
order)
- Discuss plans to complete what needs to be done
93
Implementation outline?
Allison will take a look at GE Healthcare documentation and make our
template similar to GE Healthcare template
Omar will create an electronic repository
Omar will ask physician/assistants to write down extra organizational
business rules
Bunden absent in meeting. Omar will go over data model issues with him in a
one-on-one basis.
Nobody travelling the day before Thanksgiving
Individual assignments for each part
o Allison and Rizwan
o Will be done before weekend
o Allison and Rizwan
o Bunden
(4) Discuss plans to complete what needs to be done
o Omar and Bruci
-Paul will edit
-Buy = ordering from a vendor, build = technical dirty work done by us
-Database Design = Logical Schema
Will be done by Bunden as soon as Software Vendor is chosen
94
November 26th, 2007

Attendance: Paul Rattray, Omar Kaleem, Rizwan Kahlil, Bruci Lopez
General Issues:
Who is putting everything together?
Need consistency, font either Arial or Times New Roman
Omar and Allison will work together on this.
Are we adding the meeting notes to the Appendix?
We will ask Mr.Dinmore in Wednesdays class.
Adding group picture to Repository
We could take a picture on Monday before class since we need everybody to be
present.
Business Rules
Omar will ask physicians to write down additional organizational business rules.
Send e-mail to remind him.
Title will be: Systems Analysis and Design for Dr. Kawajas Office
Paul will send the interface pictures by tonight
Requirement Analysis. Do we need to add more use cases?
Omar might add more non-functional requirements. Ask Mr.Dinmore how many
use cases is a good number for the project.
System Analysis.
Seems fine after Pauls changes
95
Final Project
1. Screen Design:
Ask Mr. Dinmore what this is
2. Output report Design. What is this?
Ask Mr. Dinmore .
3. Conversion Plans.
Agreed on a Waterfall model, Ask Mr. Dinmore what else he wants to be added
here
4. Tranining Plans
Ask Allison if the software vendor provides training
5. Maintenance Plans
Vendor can provide maintenance as well.
What did or didnt work
Bruci will do this part
7. Suggestion and Recommendation
Bruci will do this part
For Mondays Presentation
We agreed that Paul and Rizwan will present. Everybody will send them the main
bullets in what they worked on so that they can put together the Power Point.
Next meeting could be Friday at 10am or Saturday.
It is recommended that everybody shows up for Mondays presentation.
96

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Systems Analysis and Design

For Dr. Kawajas Office

Current Information System Diagram

3.2 Operational Feasibility

3.3 Technical Feasibility

3.4 Schedule Feasibility

3.5 Economic Feasibility

4.1 Interview Schedule

4.2 Interview Reports

4.3 Functional Requirements

4.5 Nonfunctional Requirements

4.6 Use Cases

5.1 System Summary

5.2 Entity Relationship Diagram

5.3 Dataflow Diagram Overview

5.7 Business Rules

6.2 Alternate Solutions

6.3 Feasibility of the alternate solutions

6.4 Alternative Matrix Chart

6.5 Decide on an appropriate solution

6.6 Specific Hardware/Software needed

6.7 Additional Work to be done

8. Training and Maintenance Plans

8.1 Training Plan

8.2 Maintenance Plan

10. Suggestion and Recommendations

11. Meeting Notes

Document Depository: http://userpages.umbc.edu/~pr3/436PROJECT/

Current System of Information at Medical Center (not automated)

(Patient gets a new

(Patients fills out a first

(Patient gets attended by either)

(UPDATE the Record)

3.2 Operational Feasibility

3.3 Technical Feasibility

3.4 Schedule Feasibility

We determine that our project is entirely feasible in terms of the schedule.

3.5 Economic Feasibility

Computers ($1500 / ea.)

PROJECTED ANNUAL OPERATING COSTS:

Scheduling Software Support

EMR Software Support

Routine Computer Maintenance ($200 / ea.)

Web based EMR Software ($100 / ea.)

Total Projected Startup Cost without EMR software:

Total Projected Startup Cost with EMR software:

Total Projected Startup Cost with Web based EMR application:

Total Projected Annual Cost without EMR software:

Total Projected Annual Cost with EMR software:

Total Projected Annual Cost with Web based EMR application:

Learn about referring

Dr, Tahoora Kawaja

vitals collection process,

4.2 Interview Reports

Person Interviewed: Anjum Randhawa, Administrative Assistant

Detailed Notes: Will be included in System Analysis Report.

Interview Report #2: Yvonne Taylor

Person Interviewed: Yvonne Taylor, Medical Assistant

Interview Report #3: Dr. Tahoora Kawaja

Person Interviewed: Tahoora Kawaja, Physician

4.3 Functional Requirements

The system must allow users to create/view/update/print a patient registration form

The system must allow users to create/view/update/print a Quest Diagnostic lab

The system must allow users to create/view/update/print a Quest Diagnostic lab