HOSPITAL MANAGEMENT SYSTEM:

CASE STUDY: JUBA TEACHING HOSPITAL

By

[PUT YOUR NAME HERE]

14/KUA/BSCIT/001SN
DEPARTMENT OF COMPUTER SCIENCE AND INFORMATION TECHNOLOGY
FACULTY OF SCIENCE AND INFORMATION TECHNOLOGY

A Project Proposal Submitted to the Faculty of Science and Information Technology

for the Study Leading to a Project
in Partial Fulfillment of the Requirements for the Award of the
Degree of Bachelor of Computer Science in Information Technology
of Kampala University.

August, 2016

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DECLARATION
―This Proposal is my original work and has not been presented for a Degree or any other
academic award in any University or institution of Learning‖.
Student: [Put Your Name Here] _______________ Date here_________________

2
APROVAL
―I confirm that the work reported in this proposal has been carried out by the candidate under
my supervision‘.
Supervisor: Mr. [I will put my Name Here] ________________ Date _______________

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List of acronyms
NMOH-------------------National Ministry of Health

UN------------------------United Nations

NGOs --------------------None Governmental Organizations

SQL----------------------Structured Query Language

RNAHF-----------------Rapid Needs Assessment of Health Facilities

HPF ---------------------Health Pooled Funds

A&E------------------- Accident and Emergency

SAM --------------------Severe Acute Malnourished

RMC---------------------Respectful Ministry Care

MYSQL-----------------My Structured Query Language

PHP----------------------Hyper text Pre Processor

WAMP------------------Windows Apache Mysql PHP

HTML-------------------Hyper Text Markup Language

HIM---------------------Healthcare Informatics

AHIMA------------------ American Health Information Management Association

HER-----------------------Electronic Health Record

AAFP--------------------- Academy of Family Physicians

DFD-----------------------Data Flow Diagram

ERM/ERD----------------Entity Relationship Model/Diagram

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List of tables
[The list will sit here]

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List of figures

e.g.:

Figure 1: System Analysis Control Flow Diagram .................................................................................... 14

Figure 2: The data flow diagram ................................................................................................................. 40
Figure 3: Description of objects as used in the ERD ................................. Error! Bookmark not defined.
Figure 4: The Entitty relationship model .................................................................................................... 42

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Contents
DECLARATION ................................................................................................................................... 2
APROVAL............................................................................................................................................. 3
List of acronyms .................................................................................................................................... 4
List of tables........................................................................................................................................... 5
List of figures ......................................................................................................................................... 6
ABSTRACT........................................................................................................................................... 9
CHAPTER ONE .................................................................................................................................. 10
1.1. INTRODUCTION ................................................................................................................... 10
1.2. Background Of The Case Sturdy ............................................................................................. 10
1.3. Statement Of The Problem....................................................................................................... 11
1.4. Main Objective......................................................................................................................... 12
1.5. Scope of the study .................................................................................................................... 12
1.6. Research Questions .................................................................................................................. 13
1.7. Project Justification / Significance ........................................................................................... 13
1.8. Conceptual design .................................................................................................................... 14
CHAPTER TWO LITERATURE REVIEW ....................................................................................... 16
2.0. Overview .................................................................................................................................. 16
2.1. Classification Of Hospitals ...................................................................................................... 16
2.8. Evaluation Of Health Care ....................................................................................................... 18
2.9. System Quality ......................................................................................................................... 19
2.10. Reliability And Validity Of Quality Measures .................................................................... 20
2.11. Cost And Benefit.................................................................................................................. 21
2.12. Service Performance ............................................................................................................ 23
2.13. Time Efficiency ................................................................................................................... 24
2.14. Usability ............................................................................................................................... 24
2.15. Legal Aspect ........................................................................................................................ 26
2.16. Legal Interoperability........................................................................................................... 27
2.18. Database ............................................................................................................................... 27
2.19. Types Of Database System .................................................................................................. 28
2.20. Increased Cost: ..................................................................................................................... 29
2.24. Hospital Management .......................................................................................................... 29
CHAPTER THREE ............................................................................................................................. 31
METHODOLDY ................................................................................................................................. 31
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3.0. Overview .................................................................................................................................. 31
3.1 System Study and Analysis ...................................................................................................... 31
3.2 Requirements Determination ................................................................................................... 32
3.3 Requirements Analysis ............................................................................................................ 33
3.4 Architecture Design ................................................................................................................. 33
3.1 Research Design....................................................................................................................... 33
3.2 Target Population (Research Population) ................................................................................ 34
3.3 Data Collection: ....................................................................................................................... 34
3.4 Data Storage: ............................................................................................................................ 35
3.5 Data Communication And Manipulation ................................................................................. 35
3.6 Data Security. ........................................................................................................................... 35
3.7 System Cost ............................................................................................................................. 36
3.8 Function Specification ............................................................................................................. 36
3.9 The Logical Flow Chart ........................................................................................................... 36
CHAPTER FOUR................................................................................................................................ 37
SOFTWARE DESIGN ........................................................................................................................ 37
4.1 STRUCTURED DESIGN ........................................................................................................ 39
ENTITY RELATIONSHIP MODEL / DIAGRAM (ERD) OF THE DESIGN .................................. 42
DIFINITION OF OBJECTS AS USED IN THE ERD ........................................................................ 43

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ABSTRACT
―The purpose and essence of any Records Management system is the right information in the
right
place in the right order, at the right time for the right person at the lowest cost.‖ Hospital
management system is a computerized system designed and programmed to deal with day to
day operations taking place. The program can look after inpatients, outpatients, records,
database treatments, status illness, billings in the pharmacy and labs. It also maintains
hospital information such as ward id, doctors in charge and department administering. The
purpose of the project is to computerize the Front Office Management of Hospital to develop
software which is user friendly, simple, fast, and cost – effective. It deals with the collection
of patient‘s information, diagnosis details, etc. Traditionally, it was done manually. The
project outlines all the process followed to come up with the software that is from analysis to
testing the system.

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 CHAPTER ONE
1.1.INTRODUCTION

This chapter extrapolates the case sturdy, discusses the problem that is draining Juba teaching
hospital in their daily health care services rendered, it discusses the scope and purpose of the
study. The researcher looks at assessing and identifying the key components of the hospital,
performance indicators of the current system and whole project attempts a benchmarking
perspective.

1.2.Background Of The Case Sturdy

Juba Teaching Hospital (JTH), the only referral hospital in the whole country of South
Sudan, its located in its capital Juba, Central Equatorial State. With an estimated population
of 9.6 million basing on annual population growth of 3% from a population census conducted
in 2008 and lack of proper functioning primary health care facilities upcountry, many South
Sudanese have nowhere to go to but this national referral hospital. The facility has only 580
beds. Military and police hospitals, if any, are non-functional country wide, forcing soldiers
and officers to share the limited facilities with civilians.

Juba Teaching Hospital is directly funded by the central government through the National
Ministry of Health (NMOH), and supported by RMF, UN agencies and other NGOs.
However, with support from UN agencies and NGOs, the hospital is still not well equipped
and lacking basic medical supplies and equipment as well as human resources to deliver
quality healthcare services to the people. Its overarching goal is to improve the quality and
sustainability of medical and surgical services provided at Juba Teaching Hospital.

1.2.1. Juba Teaching Hospital Performs the following activities

 Structural refurbishments
 Continued monitoring and mentorship of healthcare professionals trained on the
usage of Health Villages tablets.
 Co-facilitated (with ADRA, THESO, CEI, SSUHA, and AFOD) the rapid health
needs assessment of health facilities in Maridi, Mundri, and Juba counties as a
baseline for Health Pooled Fund (HPF2) proposal development (refer to
assessment report).

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  Procured and provided adequate cleaning materials for the Pediatric department to
keep the wards clean.
 Continued to support RMF cleaners attached to the Pediatric department to
supplement the few cleaners maintained by the Ministry of Health (MOH).
 Procured and provided protective gear like gumboots for the Pediatric department
cleaners.
 Prepared and submitted proposal for improving the Maternity department of Juba
Teaching Hospital.
 Prepared and submitted WASH proposal to a private donor aimed at solving the
water problems at Juba Teaching Hospital.
 Facilitated and coordinated meetings with the Ministry of Health (MOH), UN
agencies, and other partners on how to improve services at Juba Teaching
Hospital.
 Facilitated RMF Founder and CEO Dr. Martina Fuchs‘ visit to South Sudan.
 Continued support for high speed WIFI internet service at the RMF office and
Maternity ward in particular.
 Procured and delivered 2 laptop computers for RMF‘s Juba coordination office.
 Procured and delivered a photocopier and a multipurpose printer for smooth
running of RMF‘s main Juba office.

1.3. Statement Of The Problem

 Lack of immediate retrieval: -The information is very difficult to retrieve and to find
particular information e.g. to find out about the patients‘ history, the user has to go
through various registers. This results in inconvenience and waste of time
 Lack of immediate information storage: - The information generated by various
transactions takes time and efforts to store them.
 Error prone manual calculation: - Manual calculations are error prone and takes a lot
of time, this may result in incorrect information. For example, calculation of patient‘s
bill based on various treatments.
 Preparation of accurate and prompt reports: -this becomes a difficult task as business
intelligence is difficult, this is due to lack of information collation (ability to put
information together and analyze them).

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1.4.Main Objective

The main aim of this project is to design an automated system for controlling the flow of
patient‘s data in the Juba teaching hospital so as to solve most of the information
management problems encountered in the hospital during the use of manual ways and excel
sheets in the old system of medical administration. In the manual system, almost all the
patient folders in the records have to be accessed by the staff. The integrity and security of
the data highly compromised. The risks are those events that threaten the data; threaten to
destroy or corrupt it to prevent its use, threaten to access it illicitly or to steal it. The
objectives of the project include:

1.4.1. Specific Objectives

 To study and analyze the strengths and weaknesses of the current system being used
at the hospital.
 To design a model that will facilitate easy, fast and secure data management and
accessibility at the hospital
 To test and validate the model

1.5. Scope of the study

1.5.1. Content Scope

The hospital management system will be capable of supporting any number of staff of the
hospital in selected departments such as; Pharmacy, doctors, Nurses, Laboratory and front
office. Each department is a module and each module of the package runs independently
without affecting other modules. This means that all departments of the hospital work
independently, yet all modules will be integrated to share common data and be able to

1.5.2. Time Scope

Depending on the scope of the content, the project will consume approximately three months
from start (documentation), through design, implementation and testing.

1.5.3. Geographical Scope

The research under taken is only considering Juba, the capital of South Sudan and
particularly Juba teaching hospital.

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1.6.Research Questions
1) Do you find the use of books and spreadsheets effective and convenient in your daily
operations:
2) How best would you like it to be?
3) How much time averagely does it take a medical worker to search for the medical
history of a patient from books?
4) Explain why you prefer to change from your manual systems to automated system in
facilitating effective management of various hospital departments.
5) What are the very vital items you would like to see in a new hospital management
system in case your administration was to purchase one?

1.7.Project Justification / Significance

Why the need for hospital management system is summarized as follows:-

 Planned approach towards work: - The activities in the hospital will be well
planned and organized. The data will be stored properly in data stores, which will
help in retrieval of information and in enforcing security.
 Accuracy: - The level of accuracy in the proposed automated system will be
higher. All operations will be done correctly and accurately. In practice, errors are not
completely eliminated, they are reduced.
 Reliability:- The reliability of the proposed system will be high as information will
be stored properly and securely
 No redundancy: - In the proposed system, extreme care will be taken to ensure
that no information is repeated anywhere in storage. This will assure economic use of
storage space and consistency in the data stored.
 Immediate retrieval of information: - The main objective of the proposed system is to
provide for a quick and efficient retrieval of information. Any type of information
will be available whenever users require information
 Immediate storage of information:- In manual systems, lots of problems are
encountered in trying to store amounts of information
 Easy to Operate: - The system shall be easy to operate, yet remaining vital in this
hospital‘s activities.

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1.8. Conceptual design

will focus on describing the proposed system in terms of a set of integrated ideas and
concepts about what the system should do, behave, and look like, The Physical design will
lead researcher to the physical realization of logical design. Tables, forms and reports will be
created and relationships will also be defined.

Figure 1: System Analysis Control Flow Diagram

Process input

Necessity analysis

System
Function
Analysis
Analysis
and control
balance

Production

Process output
System analysis as shown in fig 3.1 encompasses those tasks that go into determining the
needs or conditions to be met for a new or altered product, taking account of the possibly
conflicting requirements of the synthesis verification Process, input Process, output
stakeholders, such as beneficiaries or users. Requirements analysis is critical to the success of
a development project. Requirements must be documented, actionable, measurable, testable,
related to identified business needs or opportunities, and defined to a level of detail sufficient
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for system design. Requirements can be architectural, structural, behavioral, functional, and
non-functional. An analysis and full description of the existing system should lead to a full
specification of the users‘ requirement. This requirement specification can be examined and
approved before the system design is embarked upon. In recent times, greater emphasis has
been placed upon this stage because of former experience of designers who failed to meet
requirements. The earlier in a system life cycle that a mistake is discovered, the less costly it
is to correct. Hence, the need for requirement specification is very clear.

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 CHAPTER TWO
LITERATURE REVIEW
2.0. Overview

A Hospital Management System is a computerized medical information system that collects

stores and displays patient information. It deals with Drugs, Patients, Accounts and other
relevant information for a hospital business. They are a means to create legible and organized
patient data and to access clinical information about individual patients. Hospital
management systems are intended to complement existing (often paper / excel based
systems) of medical records management which are already familiar to practitioners. Patient
records have been stored in paper / excel form for decades and, over this period of time; they
have consumed increasing space and notably delayed access to efficient medical processes.

2.1. Classification Of Hospitals

Hospitals are distinguished by their ownership, scope of services, and whether they are
teaching hospitals with academic affiliations. Hospitals may be operated as proprietary (on
profit terms) business, owned either by corporations or individuals such as the physicians
themselves or they may be voluntarily owned by nonprofit corporations, religious
organizations or operated by city authorities. Such hospitals are usually governed by a board
of trustees, selected from among community business and civic leaders, who serve without
pay to oversee hospital operations.

2.2. Teaching Hospitals

Teaching hospitals are those community and tertiary hospitals affiliated with medical
schools, nursing schools, or allied-health professions training programs. Teaching hospitals
are the primary sites for training new physicians where interns and residents work under the
supervision of experienced physicians. Non teaching hospitals also may maintain affiliations
with medical schools and some also serve as sites for nursing and allied-health professions
students as well as physicians-in-training.

Most teaching hospitals, which provide clinical training for medical students and other health
care professionals, are affiliated with a medical school and may have server hundred bends.
Many of the physicians on staff at the hospital also hold teaching positions at the university
affiliated with the hospital, in addition to teaching physicians-in-training at the bedsides of

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the patients. Patients in teaching hospitals understand that they may be examined by medial
students and residents in addition to their primary ―attending‖ physicians.

One advantage of obtaining care at a university-affiliated teaching hospital is the opportunity

to receive treatment from highly qualified physicians with access to the most advanced
technology and equipment. A disadvantage is the inconvenience and invasion of privacy that
may result from multiple examinations performed by residents and students. When compared
with smaller community hospitals, some teaching hospitals have reputations for being very
impersonal; however, patients with complex, unusual, or difficult diagnoses usually benefit
from the presence of acknowledged medical experts and more comprehensive resources
available at these facilities. A teaching hospital combines assistances to patients with
teaching to medical students and nurses and often is linked to a medical school, nursing
school of university.

2.3. Community Hospitals

Most community hospitals offer emergency services as well as a range of inpatient and
outpatient surgical series and other treatment series. Community hospitals, where most
people receive care, are typically small, with fifty to five hundred beds. These hospitals
normally provide quality care for routine medical and surgical problems. Some community
hospitals are nonprofit corporations, supported by local funding. These include hospitals
supported by religious, cooperative, or osteopathic organizations. In the 1990s, increasing
numbers of not-for-profit community hospitals have converted their ownership status,
becoming proprietary hospitals that are owned and operated on a profit basis by corporations.
These hospitals have joined investor-owned corporations because they need additional
financial resources to maintain their existence in an increasingly competitive industry.
Investor-owned corporations acquire nonprofit hospitals to build market share, expand their
provider networks, and penetrated new health care markets.

2.4. Public Hospitals

Public hospitals are owned and operated by federal, state or city governments. Many have a
continuing tradition of caring for the poor. They are usually located in the inner cities and are
often in precocious financial situations because many of their patients are unable to pay for
services. The city authorities match the states‘ contribution to provide a certain minimal level

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of available coverage, and the authorities may offer additional services at their own
expensive.

2.5. General Hospital

This is the best type of hospital; it is set up to deal with many kinds of diseases and injuries,
and normally has an emergency department to deal with immediate and urgent threats to
health.

2.6. District Hospital

This is the major health care facility in its region, with large numbers of beds for intensive
care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, and
bioassay laboratories.

2.7. Specialized Hospital

This is a special type of hospital meant for a particular case like trauma centers, rehabilitation
hospitals, children‘s hospitals, seniors‘ (geriatric) hospitals, and hospitals for dealing with
specific medical needs such as psychiatric problems, certain disease categories such as
cardiac, intensive care unit, neurology, cancer center, and obstetrics and gynecology,
oncology, or orthopedic problems.

2.8. Evaluation Of Health Care

A literature review by Delone and McLean 1992 in the field of management information
systems aimed at identifying determinants for system success. They presented a framework
with six dimensions of success -:1) system quality, (2) information quality, (3) usage, (4)
user satisfaction, (5) individual impact, and (6) organizational impact. The purpose of their
review was to analyze evaluation studies of inpatient patient care information systems
requiring data entry and data retrieval by health care professionals, published between 1991
and May 2001, to determine the attributes that were used to assess the success of these
systems and to categorize these attributes according to the Delone and McLean framework.
They also examined how the attributes were measured and what methodologies were used in
the evaluation studies. Their review did not cover outpatient.

Further still, way back in 1995, van der Loo conducted a literature review to classify
evaluation studies of information systems in health care (van der loo et al 1995). The primary
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objective was to get an insight into the variety of evaluation methods applied. In all, 76
studies published between 1974 and 1995 were included in the review. Many different
performance measures or success factors were applied in the studies reviewed. The review‘s
main conclusion was that the evaluation methods and effect measures depended on the
characteristics of the information system under evaluation. However, the range of identified
evaluation methods and effect variables was broad for every type of system. Among the
effect variables were costs, changes in time spent by patients and health care personnel,
changes in care process, database usage, and performance of users of the system, patient
outcomes, job satisfaction, and the number of medical tests ordered. Several authors have
suggested approaches to evaluating information technology in health care (Anderson et al
1997). These approaches concerned assessment of technical, sociological, and organizational
impacts.

2.9. System Quality

Delone and McLean 1992, proposed to subdivide success measures of management

information systems into six distinct categories that define the five dimensions to measuring
success of system deployment as follows: (1) system quality, (2) information quality, (3)
usage, (4) user satisfaction, (5) individual impact, and (6) organizational impact. Within each
category several attributes could contribute to success. The information processing system
itself is assessed with system quality attributes (e.g., usability, accessibility, ease of use).
Information quality attributes (e.g., accuracy, completeness, legibility), concern the input and
output of the system. Usage refers to system usage, information usage, or both. Examples of
attributes of usage are number of entries and total data entry time. User satisfaction can
concern the system itself or its information, although they are hard to disentangle. Delone
and McLean included user satisfaction in addition to usage, because in cases of obligatory
use, user satisfaction is an alternative measure of system value. Individual impact is a
measure for the effects of the system or the information on users‘ behavior, and attributes can
be information recall or frequency of data retrieval or data entry. Organizational impact, the
last category, refers to the effects of the system on organizational performance. Thus, success
measures vary from technical aspects of the system itself to effects of large-scale usage.
DeLone and McLean 1992 concluded that success was a multidimensional construct that
should be measured as such. In addition, they argued that the focus of an evaluation
depended on factors such as the objective of the study and the organizational context.

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Furthermore, they proposed an information system success model in which the
interdependency—causal as well as temporal —of the six success factors was expressed. In
their view, success was a dynamic process rather than a static state; a process in which the six
different dimensions relate temporally and causally. System quality and information quality
individually and jointly affect usage and user satisfaction. They influence each other and
have a joint influence on user behavior. A study was conducted in 2004 by Healthcare
Informatics in collaboration with American Health Information Management Association
(AHIMA) to measure the level of readiness of health information management (HIM)
professionals and the extent of (Electronic Health Record) EHR implementation in their
organization. The findings showed the industry is continuing to see more movement toward
EHR. For example, when organizations were asked to describe their progress toward an
EHR, 17 percent of respondents indicated they were extensively implemented; 26 percent
indicated they were partially implemented; 27 percent said they were selecting, planning, or
minimally implemented, and 21 percent indicated they were considering implementation and
gathering information about it (Minal Thakkar and Diane .Davic August 14 2006). In a study
conducted during the summer of 2004 by the American Academy of Family Physicians
(AAFP), nearly 40 percent of respondents, who were members of AAFP, indicated they
either had completely converted to EHRs or were in the process of doing so. Twenty-four
percent had purchased the EHR system within the first half of the year. Findings showed that
cost remained a major barrier for physicians in small and medium practices in the move to
EHR systems. Previous research on risks of EHR systems identified privacy and security as
major concerns. Other risks identified were financial risk (billing errors in software),
software systems becoming obsolete, software vendors going out of business, computer
crashes, data capture anomalies, programming errors, automated process issues, and
populating invalid information in the decision support systems module of EHR systems.
Some of the main benefits of EHR systems that have been identified include reducing
medical errors, improving quality of care, conserving physician time, sharing patient
information among healthcare practitioners, and workflow efficiency.

2.10. Reliability And Validity Of Quality Measures

Previous reviews of research on electronic health record (EHR) data quality have not focused
on the needs of quality measurement. The authors Chan, Kitty S. et al, in 2010 reviewed
empirical studies of EHR data quality, published from January 2004, with an emphasis on

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data attributes relevant to quality measurement. Many of the 35 studies reviewed examined
multiple aspects of data quality. Sixty-six percent evaluated data accuracy, 57% data
completeness, and 23% data comparability.

2.11. Cost And Benefit

The major barrier to adoption of an EHR system, as identified by some studies, was
misalignment of cost and benefits or financial reimbursement (Bates, David 2005). Brailer
said that reimbursing physicians for using EHR systems and reducing their risk of investing
in them should accelerate the adoption of EHR systems in physicians‘ offices. Other barriers
that have been identified are technical issues, system interoperability, concerns about privacy
and confidentiality, lack of health information data standards, lack of a well-trained clinician
informatics workforce to lead the process, the number of vendors in the marketplace, and the
transience of vendors (Brailer david J et al 2003) . These studies and other previous research
conducted in the area of EHR systems determined the risks, benefits, and barriers as well as
analyzed the relationship between the adoption of EHR systems and the size of the hospital
or physician office. Moreno 2003 stated, ―The evidence from our literature review suggests
that large physician groups and hospitals are at the forefront of using EHRs; however, the
extent to which small physician practices—those made up of eight or fewer physicians
representing nearly 80 percent of all physicians in the US—have adopted EHRs nationally
remains unclear. The American Hospital Association (AHA) conducted a survey of all
community hospitals in 2005 to measure the extent of information technology (IT) used
among hospitals and better understand the barriers to further adoption. CEOs from 900
community hospitals (19.2 percent) participated in the study. The study found that 92 percent
of the respondents were actively considering, testing, or using IT for clinical purposes. The
remaining 8 percent that were not considering IT were primarily small, rural, non teaching,
and no system hospitals. The study reported that more than 50 percent of the respondents
fully implemented the EHR functions results review—lab, order entry—lab, order entry—
radiology, access to patient demographics, and results review—radiology report. This study
also reported that 50 percent of the rural hospitals specified they were just ―getting started‖
on IT system implementation, whereas 48 percent of the urban hospitals indicated
―moderate‖ or ―high‖ levels of implementation of IT systems. Cost was the number one
barrier to the adoption of EHR systems; 59 percent of the hospitals found that initial cost was
a significant barrier; 58 percent found acceptance by clinical staff as somewhat of a barrier.
Among the smaller hospitals with bed size less than 300, more than 50 percent saw cost as a
21
significant barrier. Historically, test results has been among the earliest components of the
information system to be automated and it is possible that not-for-profit hospitals, which
constitute the more traditional form of hospital organization, may have more experience
developing this component of their information systems. Though there has been significant
attention placed on the promise of computerized order entry systems to reduce medical
errors, starting with the IOM reports in the 1990s, fewer hospitals have successfully installed
such systems. We found that hospitals with older age of plant (i.e., building) scored 8 points
28 lower on the order entry sub-domain. One might suspect that newer hospital facilities
would be more easily equipped with computerized order entry systems than hospitals with
older physical facilities, as these results suggest. The latter may not necessarily correlate with
the building age, though it could be captured in the age of plant variable and may explain the
findings we observe. Historically, urban safety net hospitals in the United States are least
able to meet the challenges associated with acquiring new medical technology. These
hospitals balance multiple claims on their resources, perhaps reducing the capability to invest
in the information technologies that support healthcare. Our analysis suggests, however, that
urban safety net hospitals in Texas do not significantly trail their peers. Due to their size and
scale, these hospitals may achieve IT parity because they can afford the fixed costs necessary
for the IT infra-structure and have decided to pursue this course. In addition, all of the safety
net hospitals in this sample are major teaching hospitals. Thus, it is difficult to differentiate
between the effects of teaching status and safety net status. According to recent estimates,
adoption of clinical information technologies remains low but follows certain patterns. Our
findings are consistent with these trends. Historically, the computerized display of lab results
has been among the first aspects to be automated. In the last decade, digitization of
radiological images has also increased. Both of these components fall under the test results
sub-domain, which in our study showed the greatest degree of adoption. Though some
hospitals may be experimenting with computerized order entry and decision support, these
efforts have not yet translated into systems that physicians widely use, as indicated by the
low scores in these areas. Electronic decision support is perhaps the most challenging
component to implement since it requires all other components first. The nationwide health
information network (NHIN) has been proposed to securely link community and state health
information exchange (HIE) entities to create a national, interoperable network for sharing
healthcare data in the USA. Dixon BE et al, J Am Med Inform Assoc paper describes a
framework for evaluating the costs, effort, and value of nationwide data exchange as the

22
NHIN moves toward a production state. The paper further presents the results of an initial
assessment of the framework by those engaged in HIE activities.

2.12. Service Performance

VIASANT, a leader in web-based service support systems for the healthcare industry,
announced that Northwestern Memorial Hospital has deployed its Sent act service
application to document and manage service requests for four of the organization‘s service
departments including: Facilities Management, Environmental Services, Biomedical
Engineering and Food & Nutrition. Utilizing Sent act, Northwestern Memorial has improved
staff productivity, streamlined support operations and increased service performance. Sent
act has enabled Northwestern Memorial to manage services delivery with a detailed, real-
time view into work activities. Escalation and alert procedures have been automated to meet
service level objectives, reducing response and resolution times. Hospital employees can now
submit requests and check on work status on-line. Also, by accessing a single system,
hospital staff more easily locates the appropriate resource for service requests and resolution.
Overall call volume into the support centers has been reduced by 32% with the use of Sent
act‘s self-support channels. ―Northwestern Memorial is very effective at using technology to
enhance or enable their business practices,‖ says Shirley Escobar of VIASANT.
Northwestern Memorial has also successfully integrated Sent act with other hospital support
applications. By integrating Sent act with the billing platform for the accounting group in one
department, and automating time-consuming functions, administrative tasks have been
reduced by nearly 10 percent. Northwestern Memorial also integrated Sent act with their
Biomedical Engineering preventative maintenance system, extending its features to capture
online corrective maintenance requests from the hospital staff. This enabled the department
to centralize and document all work orders for better tracking management. Recently the
hospital launched a centralized call center to support multiple service department requests.
More than 16,000 requests come through the system in a month and the Sent act personnel in
the call center can enter and monitor work requests across different service teams. ―The Sent
act system allows us to analyze trends and continually refine our methods of servicing the
hospital and supporting our patients and staff,‖ says Brian Stepien, director, Support
Services. ―The data we collect enables our staff to benchmark and improve service delivery
across the organization.‖

23
2.13. Time Efficiency

Abu Dagga A et al, 6th October 2010 Telemedicine and e-Health, searched five databases
(PubMed, CINAHL, PsycINFO, EMBASE, and ProQuest) from 1995 to September 2009 to
collect evidence on the impact of blood pressure (BP) telemonitoring on BP control and other
outcomes in telemonitoring studies targeting patients with hypertension as a primary
diagnosis. Fifteen articles met their review criteria. They found that BP telemonitoring
resulted in reduction of BP in all but two studies; systolic BP declined by 3.9 to 13.0 mm Hg
and diastolic BP declined by 2.0 to 8.0 mm Hg across these studies. These magnitudes of
effect are comparable to those observed in efficacy trials of some antihypertensive drugs.
Poissant et al, J Am Med Inform Assoc, 25th September 2010 made a systematic review to
examine the impact of electronic health records (EHRs) on documentation time of physicians
and nurses and to identify factors that may explain efficiency differences across studies. In
total, 23 papers tallied their criteria; five were randomized controlled trials, six were posttest
control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected
data using a time and motion methodology in comparison to work sampling (33%) and self
report/survey methods (8%). A weighted average approach was used to combine results from
the studies. 31 Verhoeven F et al, 2nd June 2010 Journal of Diabetes Science and
Technology, 1994 to 2009, carried out a research to determine the effects of teleconsultation
regarding clinical, behavioral, and care coordination outcomes of diabetes care compared to
usual care. Two types of teleconsultation were distinguished: (1) asynchronous
teleconsultation for monitoring and delivering feedback via email and cell phone, automated
messaging systems, or other equipment without faceto-face contact; and (2) synchronous
teleconsultation that involves real-time, face-to-face contact (image and voice) via
videoconferencing equipment (television, digital camera, webcam, videophone, etc.) to
connect caregivers and one or more patients simultaneously, e.g., for the purpose of
education.

2.14. Usability

The Clinical Information Technology Assessment Tool (CITAT) examines information

technology capabilities in the hospital within the context of the socio technical environment
of the organization (Wears RL and Berg M 2005). In exploring which hospital characteristics
are most associated with highly automated and usable clinical information systems as
measured by the CITAT, we found that hospitals with larger information technology staff,
24
budgets, and capital expenses had statistically significantly higher scores on automation, test
results, and order entry scores. Spending on these factors alone appears to be more relevant
than other structural factors, such as bed size, ownership status, and total margin, and
persisted after adjustment for these factors. In a separate sensitivity analysis, however, after
we normalized each of these factors for hospital size the association diminished or
disappeared. Although bed size, by itself, was not related to higher automation scores, these
results suggest that larger hospitals may enjoy an economy of scale with respect to the high
fixed costs associated with large IT projects. Achieving this level of cost-effectiveness with
respect to IT spending may be more challenging for smaller hospitals. Likewise, teaching
hospitals, perhaps because of their history of innovation and experimentation, appear to
embrace information technologies sooner than other 32 types of hospitals. These hospitals
scored higher on the CIT score and on multiple automation and usability sub-domains. As
with other innovations in medicine, it is possible that academic physicians advocate for
newer information technologies, increasing the speed of its adoption in these organizations.
The CITAT assesses a system's automation and usability. Automation represents the degree
to which clinical information processes in the hospital are fully computerized and is divided
into four distinct sub-domains: test results, notes & records, order entry, and a set of other
sub processes largely consisting of decision support. To score highly on a given automation
sub-domain, the CITAT requires three factors of routine information practices: 1) The
practice must be available as a fully computerized process; 2) The physician must know how
to activate the computerized process; 3) He or she must routinely choose the computerized
process over other alternatives, such as writing an order or making a telephone call. Usability
represents the degree to which information management is effective and well supported from
a physician standpoint, regardless of whether a system is automated or manual. An overall
measure, called the CIT score, represents an average of the automation and usability scores
(the survey items can be obtained from the corresponding author). Usability items in the
CITAT do not presuppose the use of technology. The usability domain is constructed to
measure the ease, effectiveness, and support of the information system regardless of the
technologies in place (Amarasingham et al 2006). As an example of the types of questions in
this domain, one of the survey items asks whether physicians are able to obtain adequate
computer support in less than 2 minutes. As might be expected, we found that usability
scores were generally higher than automation scores. It is feasible that thoughtfully planned
paper-based systems could produce usability scores higher than, or equal to, systems which

25
employ poorly designed electronic processes. However, consistent with two previous studies,
we found that a higher automation score correlated with higher usability scores, suggesting
that digitization may be necessary to produce usable information systems. Alternatively,
these results may indicate that physicians' expectations are changing; electronic processes
may be perceived to be more usable than non-electronic processes, independent of overall
merits, and therefore are rated more highly. Usability of the information system, an often
elusive goal for hospital systems, was not specifically associated with any of the hospital
characteristics we measured, with the exception of teaching status. In that case, hospitals with
a teaching affiliation had higher user support scores than non-teaching hospitals. Our results
suggest that usability may be more dependent on factors we did not measure as part of our set
of hospital characteristics; these may include the quality and direction of leadership at the
institution, the focus on quality improvement, and the concentration on human factors
engineering in designing the information system. . The analysis explores a number of
hospital characteristics, raising issues of multiple testing and increasing the probability of
some false-positive relationships. As with all cross-sectional studies, positive associations
will need to be confirmed in repeated studies. A Bonferroni correction for the number of tests
performed would have eliminated many of the significant relationships we report. However,
the Bonferroni method of correction for multiple testing is itself controversial, and argued by
some to be too severe a method for correction. The purpose of this study was to find potential
relationships to explore further, given that the explanatory power of a cross-sectional study
may be weak despite the construction of a well-validated instrument. Appropriate assessment
of information technology requires multiple methods. Survey-based methods are one
important method, but other methods such as electronic queries, time-motion studies, and
qualitative analyses are needed to arrive at a complete portrait of an information system.
Furthermore this study attaches importance to higher scores on the CITAT, as a measure of
the strength of the socio-technical environment at the hospital. However, we do not yet know
whether, and to what degree, CITAT scores correlate with important clinical and financial
outcomes. These relationships will need to be assessed in the future.

2.15. Legal Aspect

Legal liability in all aspects of healthcare was an increasing problem in the 1990s and 2000s.
The surge in the per capita number of attorneys and changes in the tort system caused an
increase in the cost of every aspect of healthcare, and healthcare technology was no

26
exception. Failure or damages caused during installation or utilization of a hospital
management system has been feared as a threat in lawsuits. Some smaller companies may be
forced to abandon markets based on the regional liability climate. Larger EHR providers (or
government-sponsored providers of EHRs) are better able to withstand legal assaults. In
some communities, hospitals attempt to standardize EHR systems by providing discounted
versions of the hospital's software to local healthcare providers. A challenge to this practice
has been raised as being a violation of Stark rules that prohibit hospitals from preferentially
assisting community healthcare providers. In 2006, however, exceptions to the Stark rule
were enacted to allow hospitals to furnish software and training to community providers,
mostly removing this legal obstacle.

2.16. Legal Interoperability

In cross-border use cases of EHR implementations, the additional issue of legal

interoperability arises. Different countries may have diverging legal requirements for the
content or usage of electronic health records, which can require radical changes of the
technical makeup of the EHR implementation in question. (Especially when fundamental
legal incompatibilities are involved) Exploring 35 these issues is therefore often necessary
when implementing cross-border EHR solutions.

2.17. Importance

The literature review has helped me to see what people have done in the past, their finding
and result, and it will help me improve on my work and also to do a project that is standard
with new innovation.

2.18. Database

A Database Management System (DBMS) is a system in which related data is stored in an

efficient and compact manner. It is a set of computer programs that control the creation,
maintenance, and the use of the database of an organization and its end users. It allows
organizations to place control of organization wide database development in the hands of
database administrators (DBAs) and other specialists. A Database Management System is a
system software package that helps the use of integrated collection of data records and files
known as databases. It allows different user application programs to easily access the same
databases.

27
THE NEED FOR A DATABASE SYSTEM

Most organizations in this information age are faced with the problem of managing
information effectively. Information can only be an asset if it is accurate and available when
needed. Accuracy and availability are achieved if an organization purposefully organizes and
manages its data. A database is the standard technique for structuring and managing data in
most organizations today. This is because data is very useful for variety of purposes in
organization. A database system is very important so as to avoid duplication of data, which
introduces the problem of inconsistency in data.

2.19. Types Of Database System

2.19.1. INTEGRATED DATABASE SYSTEM:

This is the kind of system whereby the database contains data for many users, not just one,
which in turn connotes that any one user (batch or on-line) will be concerned with just a
small portion of it. In addition, different user‘s portions may overlap in various ways (i.e. the
data may be shared by several users). An integrated system is based on the concept that there
should be integration of data and processing. For an information processing system, this
consists of all data that can be accessed by the system. In a computer-based Management
Information System (MIS) the term database is usually reserved for data that can be readily
accessed by the computer. Any application that uses a data item accesses the same data item,
which is stored, and made available to all applications. Also, a single updating of a data
updates it for all users. The use of an integrated database system provides the following
advantages: (i). Reduces cost of data collection and maintenance through sharing of data. (ii).
Ensures enforcement of standard. (iii). Reduces data inconsistency. (iv). Reduces data
redundancy. (v). Assures maintenance of data integrity. (vi). Simplifies handling of data
security since the Database Administrator (DBA) usually applies security restrictions to
protect data and privacy.

2.19.2. Non-Integrated Database System

This is the type of system in which data files support individual application in various units
that are also developed independently. This type of database poses a number of problems that
affect the efficient utilization of data available in an organization. These problems include;
increased cost, data inconsistency, data redundancy, and lack of data integrity.

28
2.20. Increased Cost:

There is duplication in the effort to create independent files. As a result, additional cost is
incurred in unifying such independent applications in order to derive maximum benefit from
the various data files.

2.21. Stored Data Inconsistency

There is frequent need to change some data in a file of one application system. Redundancy
and duplicated data in other applications are often not up-dated simultaneously. This usually
results in inconsistency of data.

2.22. Redundancy Of Data

Each independently developed application system duplicates some data that may be present
in some other applications developed in other units of the organization. Identification codes,
personal data etc are examples of such redundancy. This necessarily results in greater
expenses to collect prepare and store the duplicated data.

2.23. Lack Of Data Integrity

The problem facing integrity is that of ensuring that the data in the database is accurate. The
creation of files necessarily needs personnel of different experiences and skills. When the
control of data stored by various personnel lack integrity, the end result is that the public
perceives the computer as unreliable. Inconsistency between two entries representing the
same ―fact‖ is an example of lack of data integrity (which of course can occur if redundancy
exists in the stored data).

2.24. Hospital Management

Health Care services delivery especially in developing nations such as Nigeria are
continually hampered by very weak information infrastructure to support data collection,
collation, analysis and interpretation. This has led to a myriad of problems such as poor and
inadequate information for clinical care of patients, education, research, and planning,
budgeting and report generation amongst others. The burdens of poor information
infrastructure are missing and misfiled patients‘ records which are gradually becoming a

29
norm while data reporting are either absent or delayed to the point of un-usefulness.
Hospitals are still groaning with the burden of manual health records, absence of good health
library and long patient waiting time for documentation. They are still struggling to benefit
from the gains of information and communication technology, hence the need for Hospital
Management System. Having considered the above and other problems besetting information
management in our hospitals, this project aims at developing software for hospital
management using oracle database system (see section 6.3). The goal is to satisfactorily
integrate all efforts to ensure successful design and implementation of the hospital
management system, which must result to precision, cost cutting and efficient management.
The product (Hospital Management System) must be very accurate and suit all environments
including large, medium or small-scale hospitals. By implementing the hospital management
system, hospitals will enjoy the following benefits: 1. Hospital management system will
provide not only an opportunity to the hospital to enhance their patient care but also can
increase the profitability of the organization. 2. The hospital will require smaller staff to cater
for more patients in the same time or even less. 3. Hospital Management System would
enable the hospital to serve the rapidly growing number of health care consumers in a cost-
effective manner. 4. This software system will allow for development of additional modules
including automation of more services as the resources and job tasks of the hospital grow in
time. 5. Upgrading of the software does not and will not require taking down of the existing
running application modules. 6. Hospital administrators would be able to significantly
improve the operational control and thus streamline operations. 7. Hospital Management
System would enable the hospital to improve the response time to the demands of patients
care because it automates the process of collecting, collating and retrieving patient
information. 8. The hospital management system software interface would also save a lot of
time for doctors. 9. Accounting sometimes becomes awfully pathetic and complex. This
product will eliminate such complexity since the retrieval of information through its
management information system will come virtually to their fingertips. These advantages
will justify the decisions of hospitals to invest or purchase this cost saving and life saving
management system. But practical limitations exist for example (1) Proper adoption strategy
(2) ability to absorb the cost of training and finally following the appropriate change
management life cycle.

30
 CHAPTER THREE
METHODOLDY
3.0. Overview

The methodology describes the procedures, tools, techniques that were employed to achieve
the specific objectives of the hospital management system for Juba Teaching Hospital. The
researcher employed requirement determination, requirement analysis, system design,
implementation, testing and validation.

3.1 System Study and Analysis

This will be carried out on the existing system. It will help to show the weaknesses of the
existing system. The researcher shall use various methods to collect information about the
current system as shown below.
3.1.1 Interviews
These will be carried out on Juba Teaching Hospital staff, the current users of the existing
system. This will be about how patient information is mined, monitored and evaluated. A set
of interview guide (a sample has been provided in chapter one of this compilation) will be
designed by the researcher and these questions will guide the researcher during the interview.

This method has the following advantages;

The researcher will be exposed to firsthand information from the current administrators of
the current system;

I. This will help the researcher to get the feel of the current system.
II. The researcher will be able to ask follow up questions and this will help him to gain
more insight into the current system

Disadvantages of this method

I. This method will be time consuming and tiresome since it will involve interviewing a
big number of Juba Teaching Hospital staff.
II. Some of the interviewees may not show up for the interview.
III. Some interviewees may be biased to some questions and such characters tend to give
biased answers that may not the researcher to obtain the research objective
IV. Others may be too reserved and refuse to provide relevant and timely information.

31
Because of the disadvantages of the above tool, the researcher shall use another method in
order to better understand the current system. The tool is discussed below.

3.1.2 Questionnaire
The researcher shall also use a questionnaire guide to gather information from patients who
will come in for treatment. The researcher will employ a combination of both open ended and
closed questionnaire as demonstrated in chapter one of this compilation. The respondents may
be asked to tick their choices from a given number of choices. Also the respondents will be
asked to describe the current system in their own words. The questionnaire will be distributed
and later picked when answered.

Advantages of this method will be;

i. It will result into result into a wide range of views from different users about the
system in use and this helps the researcher to fully understand the current manual
system.
ii. This method provides clear mind facts about the current system and this helps the
researcher in understanding fully the weaknesses of the system in use.
However this method has its disadvantages, though not so strong to resent its usage and these
may include;

i. Some handwriting may be unreadable

ii. Some views may deviate from the question

In this section above the researcher achieved his first objective

3.2 Requirements Determination

The requirements determination shall involve the collection of information about how the
system should operate. The requirements determination activity will be the most difficult part
of the solution / system analysis because it will involve gathering and documenting the true
and real requirements for the system being developed, which is really hectic. In here the
researcher will be primarily thinking and trying to answer the question, "What must the

32
system do?" this information will be used to identify the user‘ requirements and the system
specifications.

3.3 Requirements Analysis

The primary goal of this phase will be to create a detailed Functional Specification defining
the full set of system capabilities to be implemented, along with accompanying data and
process models illustrating the information to be managed and the processes to be supported
by the new system.
It will involve examination of the collected data. Models such as Data Flow Diagrams (DFD)
and Entity Relationship Diagrams (ERDs) will be used to model individual processes and
data respectively. Under this phase, requirements will be classified as functional and
nonfunctional requirements. The determination and analysis of requirements will help the
researcher to achieve his second objective.

3.4 Architecture Design

This will describe the application of system theory to product development by defining the
architecture, components, modules, interfaces and data for a system to satisfy specified
requirements. The goal of the design phase is not just to produce a design for the system;
instead it also to find the best possible design within the limitations imposed by the
requirements and the physical as well as the social development in which the system will be
required to operate. The system design process will be divided into logical, conceptual and
physical design.

In Logical design; the logical model processing will consider indicating all the vital steps that
the system development will go through. Here, the researcher will employ case tools like
flow Charts and Entity Relationship diagrams.

3.1 Research Design

The design is the structure of any scientific work that gives direction and systematizes
the research whereby the researcher‘s choice affects the results and the conclusion of the
findings since most scientists are interested in getting reliable observations that help in
understanding the phenomenon depending on the aims of the study and the nature of the
phenomenon as stated by Creswell.
33
Shuttleworth (2008) compounds that there are two main approaches to a research design
which are quantitative research method which is the standard experimental method of most
scientific disciplines and qualitative research method which is used extensively by scientists
and researchers studying human behavior and habits.

This section therefore presents a description of the procedures, tools, instruments,

approaches, processes, data collection techniques and data structures that will be employed in
the research study to determine the relevancy of a hospital management system for South
Sudan‘s Juba Teaching Hospital.

3.2 Target Population (Research Population)

The study was conducted at Monaco Institute of Business and Computer Science
purposely, it is an institute already established in the territorial boundaries of Kampala
Capital City Authority, and it had enough sample space that the researcher could use to
generated dependable analytical results

3.3 Data Collection:

In hospital management system, the type of data that the researcher requires to collect
include: (1). Patient‘ Bio-data (2). Patient‘s Registration Data (3). Patient‘s Admission
Information (4). Patient‘s next of kin data. In the manual system used by most hospitals in
South Sudan, the patients‘ folders are packed into shelves in the patient record department.
These folders are grouped into shelves according to year of admission. A patient in need of
any of these folders will make a request at the records department where the staff in charge
of this folder will now choose from the shelves which one belongs to the patient. In the
shelves, the names are repeated because two or three persons may bear the same name. As a
result the patient folder number is preferably used to look for the folder. It takes a lot of time
to look for these folders and it may be impossible to retrieve a folder if the patient forgets his
or her card where the folder number is written. Inspecting the existing manual system very
closely reveals a lot of loopholes like data duplication, data redundancy, data manipulation
and data inconsistency which make the system inefficient and hence calls for urgent
improvement to the existing manual system. The improvement envisaged is the proposed
electronic records management system or data base management system.

34
 3.4 Data Storage:
Hospitals using the manual record system require large space for storing records in shelves
or alternatively dumping them on the ground if the shelves overflow.

3.5 Data Communication And Manipulation

If the original forms of data were suitable for all purposes, less processing would be
necessary. Seldom, can the real objective of a transaction or situation be attained without
converting data into a more useful forms-manipulation. This conversion is accompanied by
one or more of the following procedures – sorting, comparing, analysis and calculation.
Difficulties arise when it actually comes to manipulation of data before communication.
Processing data manually consumes a lot of time; for instance, sorting of folders into years of
admission. This takes a lot of time. Hence the access time or process time of the present
system is extremely high and results in patients spending more time in hospitals than is
necessary. Now, with the availability of high speed modern electronic information processing
machines, this need for improved speed of transaction processing could easily be
accomplished.

3.6 Data Security.

In the manual system, almost all the patient folders in the records have to be accessed by a
staff for every folder request. The patients‘ record in a manual system is not secure and
confidential information may be accessed by unauthorized persons. The manual systems
are subjects to risks and threats: for example events that may destroy or corrupt records,
prevent them from use, or steal them. The risk may be physical loss or damage to storage
devices holding the data including natural disaster, accident fire, and dust. Theoretically, a
folder last the length of a patient‘s life. This means that in say twenty years the number of
folders accumulated by a hospital may be so large that it may be impossible to manage
them securely manually. Containment strategies, for example, to archive folders may be
adopted on the assumption that such folders may be inactive. Such actions though
pragmatic may be unwise and show clearly why electronic means for managing hospital
records may now be mandatory.

35
 3.7 System Cost
The cost of the system determines whether it should be feasible. If the cost of the system
designed is too costly for the people to afford then it is practically a failure. In order to make
the system economical the cost per unit of storage data must be low enough hence the need
for cost analysis in the design of automated management system in very important.
3.8 Function Specification
A function specification explains what has to be done by identifying the necessary tasks,
action or activities that must be accomplished in the design. Hospital management is a
system, which is conceived, designed and developed to increase clinical outcomes,
operational efficiency, improve financial outcome, and manage all hospital records on
computers. Hospital Management System (AHMS) addresses all major functional areas of a
hospital. It keeps track of a patient record from registration to discharge. This software helps
to maintain the data of each individual patient with a unique identification for a life time. The
development environment ensures that AHMS has the portable and connectivity features to
run on virtually all-standard hardware platforms, with stringent data security and easy
recovery in case of system failure. The software provides the benefits of streamlining
operations, enhancing administration and control, improving response to patient care, cost
control and profitability. AHMS provides effective information across the continuum of
patient care for inpatient, outpatient, accounting, pharmacy, and laboratory.
Now let us turn our attention to the system flow chat
3.9 The Logical Flow Chart

Figure 2:The Logical flow Chart

Getting ready to
be started

Login

No
Is user
Authentic
36
NBs:

No one has any rights to use the pictures I used for someone’s project. Creatively come up with
yours.

In the interest of time, each group or individual is supposed to document at least four chapters
instead of six. What does this mean?

1. Writers are supposed to speed up the writing process and use chapter four to display screen
shots of a working system as shown below

CHAPTER FOUR
SOFTWARE DESIGN
4.0 Detail Overview Software Design Schematics

A software design is a model of a real world system that has many participating entities and
relationships. This design is used in different ways. It acts as a basis for detailed
implementation; it serves as a communication medium between the designers of subsystems;
it provides information to system maintainers about original intentions of the system
designer.

The Database design is the process of creating structure from user requirement and also
producing a detailed logical data model. It is a complex and demanding process that requires
both creativity and experience.

In this compilation, a function – oriented design was chosen. This is because of its
widespread popularity and they are concerned with record processing where the processing
of one record is not dependent on any previous processing. A function-oriented design relies
on decomposing the system into a set of interacting functions with a centralized system state
shared by these functions. This logical data model contains all the needed logical and
physical design choices and physical storage parameters needed to generate a design in a data
definition language which can be used to create a database. A fully attributed data model
contains detailed attributes for each entity.

Database design has some parallels to more classic code or software design processes. It goes
through two stages namely: the logical design and physical design. The logical model is
concerned with transforming the database specification and normalized database schemas
respectively. The physical design process is concerned with how the database system will be
37
implemented. It specifies the physical configuration of the database on the storage media. It
includes the detailed specification of data element, data types, indexing options and other
parameter residing in the database management system. It is the detailed design of a system
that includes modules, database‘s hardware and software specification of the system.

38
 4.1 STRUCTURED DESIGN

Structured design is a design process by which a program is partitioned into independent modules, each with
a unique task (i.e. functional decomposition) in order to make the program easier to implement and
maintain. This design procedure places emphasis on steady progression from overview to detail, providing
guidelines for achieving the successive partitioning.

A structured design is obtained by transforming a data flow diagram into a structured chart. Each process on
the data flow diagram will be transformed into one module. It may no longer be a single module when the
process is completed. The transition from data- flow to structure chart involves the construction of a first cut
structured design for the system. In this process, a ‗MONITOR‘ module must be identified and this module
will be the central transform.

4.1.1 The Logical system design

A patient reports to the medical center (Juba Training Hospital). At the front office (reception), the patient is
asked whether that is his first visit or has ever been treated at the hospital. If it is the first visit of that
particular patient then the reception department registers the patient in the books, which this time it‘s going
to be a system so that is possible to follow up the medical/treatment history of the patient each time he/she
reports for any other medical need.

The patient just continues to the accounts to pay the consultation fee in case the visit made is not his/her first
visit. This will imply that the medical history of that continuing patient already exists.

After the consultation fee is paid then the patient continues to the doctor for diagnosis and if the doctor
realizes that your treatment requires lab samples, he/she makes a lab request for you and the cycle continues
until the doctor ascertains that your problem and prescribes your medicine. The patient continues to the
pharmacy to pick medicine. The pharmacy prepares the medicine and bills the patient, which he/she (the
patient) clears from the accounts. The pharmacy does not issue out medicine to a patient who has not
cleared the medical bills of the stated medicine. The system stops following up the patient when the
pharmacy issues medicine to them.

39
 4.1.1.1 Hospital Operations Flow System

Figure 3: The data flow diagram

Patient

Front Office Front Office

Records
Deposit consultation
Visit Register
fee
No Is Yes
ne
Patients Records

Accounts

Financial Records
Patient issued with a
receipt

Medical Records Doctor

Prescription Laboratory
No Nee Yes
ds
Lab Records

Pharmacy

Pharmacy Records

Patient issued with a

Bill

Issues
Medicine
No Has Yes to Patient
paid

The End

40
 The data flow diagram discussed in this chapter encompasses all the functions proposed for the new system.
Each unit in the system with its files contains basic services in the diagram. From the data flow diagram it
seems that the centre of attraction is the data store; but the data store cannot be used as a central transform
since it is not a process. At the same time, there seems to be no other central process that controls the other
processes.

The first – cut design is the starting point for the structured design.
Figure 4: First cut Design

Juba Teaching Hospital Management System

RECEPTION (first level DOCTORS LABORATORY ACCOUNTS PHARMACY

patient management) ROOM

SYSTEM
ADMINISTRION

Process Transformations have been identified and discussed in the data flow diagram above.

4.2. SYSTEM PROCESSING TRANSFORMATION

This type of transformation is responsible for central processing functions. They are not
concerned with any input or output function such as reading or writing data, data validation
or filtering or output formatting.

4.3. INPUT TRANSFORMATION: These are concerned with reading data, checking
data, removing duplicates and so no.

4.4. OUTPUT TRANSFORMATION: These are transformation which prepare and

format output or write it to the users screen or other device.

41
 ENTITY RELATIONSHIP MODEL / DIAGRAM (ERD) OF THE DESIGN

Entity relationship model is the conceptual representation of data; it is a database modeling

method that is used for producing semantic data model of a system. Diagrams created by this
process are called entity relationship diagrams. The entity relationship of the design shows
how two or more entities are related to one another.

Each entity must have a minimal set of uniquely identifying attributes which is called the entity‘s primary
key

4.1.1.2 The Entity Relationship Model

Figure 5: The Entitty relationship model

ContactInfo Name Contact info Name

Info
Gende Qualificatio
Gender
ID
Code

Patient attend
DateAdmite Staff
Experience
Age Age
Date Salary Address
Discharged Address
Doctor
Billed
to

Treatement

MedicineName
TestNam

Price
Descriptio
ID
ID n
Pharmacy
Lab
TestDate
Pric
Treatment Dosage
Descriptio

42
To identify a particular record in a unique manner there must be a key.

There are three types of key

PRIMARY KEY (pk): The primary key is like a field name which can be used to uniquely
identify a given record in a database table.

FOREIGN KEY (fk): Is a key in a table ‗‘schema‘‘ that is a primary key in another table
schema of a database.

UNIQUE KEY (uk): Is a key in a table schema which is not a primary key but can uniquely
identify a record in table schema

DIFINITION OF OBJECTS AS USED IN THE ERD

Figure 6: Description of objects as used in the ERD

This is a double rectangle that is used to represent a week entity (dependent)

This is a double eclipse that is used to represent a multi valued attribute.

Derived/computable attribute. Eg: age can be computed (derived)

Double line. Represents total participation. For an entity to exist, all / at least one member of
the stronger entity to which it connects must exist for it to exist. E.g: treatment cannot exist
without a patient to clear its bill.

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An independent/strong entity

These are all entity/process connectors

Double doted eclipse: multi valued derived attribute

Unique attribute
Id

Many to 1 (m:1) cardinality and relationship

4.7. Program Design

This section of the compilation represents the actual software modules and user interactive
data management interfaces that the designer has derived to portray the full functionality of
the system as described in the Data flow diagram demonstrated in this chapter above.

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 Figure 1: The Login Page

Figure 2: Demonstration of an alert message that appears if someone tried logging into the
system without providing a user name and password

Figure 3 demonstrate an alert message if someone tries to provide a user name or password that
does not match with the ones in the database
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Figure 4: Demonstrating Provision of a correct user name and correct password

Figure 5: The Main System Interface / Layout (the default show up page on a successful
login)

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Figure 6: demonstrates that the system is modular (Module based). Every Module has got sub
modules that make it an independent system.

Figure 7: demonstrates a form that has been clicked on (User groups‘ registration page). Users
are shall belong to registered groups and shall only access information endowed to that group

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Figure 8: Registered user groups are being returned back in a tabular report format

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Fig 9: Represents user registration page. Every user can log for as long they have been registered
and group attached to them by the SUPER ADMIN dictates what that user shall be able to
access and manage.

2. Each group or individual must prepare a power point presentation, in brief style.

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