Designing a web based nursing care process information system for hospitals

ADDIS ABABA UNIVERSITY SCHOOL OF INFORMATION SCIENCE AND SCHOOL OF PUPLIC HEALTH M.Sc in HEALTH INFORMATICS Designing a web based nursing care process information system for Hospitals By: Zehara Abdulkadir June, 2017 Addis Ababa i ADDIS ABABA UNIVERSITY SCHOOL OF INFORMATION SCIENCE AND SCHOOL OF PUBLIC HEALTH DESIGNING A WEB BASED NURSING CARE PROCESS INFORMATION SYSTEM FOR HOSPITALS By ZEHARA ABDULKADIR Approval Advisor Name Dr Martha Yifiru (PhD) Dr Ababi Zergaw (PhD) Signature _ _ Date Examiner Name Signature Date Dr Dereje Teferi (PhD) _ Mr Wondemu Ayele _ ii DEDICATION To my beloved mother Mulu Mohammed (Talem) i Acknowledgements This study would not have been completed without the direction and guidance from Dr Martha Yifiru and Dr Ababi Zergaw for their constructive guidance, wonderful comments and encouragement throughout the entire period of this project My sincere thanks to them for the time given in providing recommendations this thesis I would like to express my honest thanks to Dr Samuel Habtie for his support, valuable comments, and encouragement throughout the entire period of my studies and this project I am also very thankful to my classmates for valuable suggestion and supply of project materials My thanks also goes to my best friends, Mehiret Birhanu, Melat Assefa and My sisters Herya Abdulkadir for their support in my study and during the data collection I extend my thanks and appreciation to health workers in Zewditu Memorial Hospital for providing me with necessary valuable information Finally, I am greatly thankful to my parents for their moral support, constant encouragement and enormous patience while preparing this thesis and especially for all the years pursuing my education ii Contents DEDICATION i Acknowledgements ii List of figure v List of table vii Acronyms viii Abstract ix Chapter one 1.1 Introduction 1.2-Statement of the problem 1.3 Objective 1.4 Scope and limitation of the project 1.5 Significance of the Study Chapter two Literature review Chapter three 17 Methodology 17 3.1 System analysis and design methodology 17 3.2 Nursing Care Process Information System Designing Phases and Tools 17 3.3 User interface evaluation 20 3.4 Dissemination of Results 21 3.5 Operational definition 21 3.6 Ethical consideration 21 Chapter Four 22 Analysis and Design of the Nursing Care Process Information System 22 4.1 System analysis 22 4.2 System analysis model 28 4.3 Designing NCP information system 50 4.4 User interface evaluation 69 Chapter five 71 5.1 Conclusion 71 5.2 Recommendation 72 Reference 73 iii ANNEX I 76 Information sheet and Consent form 76 Guide line of interview question 77 ANNEX II 78 User interface evaluation question 78 ANNEX III 79 Manual Recording Format 79 iv List of figure Figure Use case diagram for NCP information system Figure Class diagram for NCP information system Figure Sequence diagram for login use case Figure Sequence diagram for registration patient demographic information use case Figure Sequence diagram for recording patient nursing history use case Figure Sequence diagram for nursing assessment use case Figure Sequence diagram for diagnosis use case Figure Sequence diagram for care plan use case Figure Sequence diagram for implementation use case Figure 10 Sequence diagram for evaluation use case Figure 11 Sequence diagram for follow up use case Figure 12 Sequence diagram for report generating use case Figure 13 Contextual diagram for proposed system Figure 14 System architecture of NCP information system Figure15 User interface flow diagram for web based NCP information system Figure 16 Home page user interface for NCP information system Figure 17 Login user interface for NCP information system Figure 18 System administration user interface for NCP information system Figure 19 Card department main form user interface Figure 20 New patient demographic information user interface screen Figure 21 OPD main form user interface for NCP information system Figure 22 Patient history registration form user interface Figure 23 Severity index result interface Figure 24 Vital sign form user interface for NCP information system Figure 25 Medication user interface for NCP information system v Figure 26 IPD main form user interface for NCP information system Figure 27 NC plan menu user interface screen Figure 28 Nursing assessment page user inter face Figure 29 Nursing assessment page user interface Figure 30 Nursing assessment page user interface Figure 31 Nursing diagnosis user interface screen Figure 32 Care plan user interface screen Figure 33 Evaluation note user interface screen Figure 34 Follow up user interface form Figure 35 Report user interface form Figure 36 Design ER diagram for NCP information system vi List of table Table Sample for the study NCP information system Table Data element in current system Table Description of login use case Table Description of register patient demographic information use case Table Description of register patient history use case Table Description of nursing assessment use case Table Description of diagnosis use case Table Description of care plan use case Table Description of implementation use case Table 10 Description of evaluation note use case Table 11 Description of follow up use case Table 12 Check guideline use case Table 13 Description of report use case Table 14 Description of manage account use case Table 15 Description of logout use case Table 16 User interface evaluation result vii Acronyms EHR electronic health record ER entity relationship EPR electronic patient record FMOH federal ministry of health GUI graphical user interface HIS health information system HMIS health management information system HTML hypertext markup language ICT information and communication technology IPD inpatient department NCP nursing care process NI nursing informatics NCIS nursing care information system OO object oriented OOAD object oriented analysis and design OPD outpatient department SDLC system development lifecycle UML unified markup language UI user interface WHO world health organization WWW World Wide Web ZMH Zewditu memorial hospital viii The screen use of terminology throughout system consistency Terminology relates well to the work you are doing 10 Overall, the interface was attractive and easy to use Average result out of 10 2.5 out 6.5 out of of 10 10 Total agree value : out of 10 Table 16.User interface evaluation result The result of the user interface evaluation is shown above The value of the responses are taken based on the Likert scale that is for the user interface of the system The likert scale response is strongly agree, agree, undecided, disagree and strongly disagree Evaluator scored out of 10 strongly agree and out of 10 agree to the system was clear to access The 2nd evaluation criteria the system is clear to choose scored out of 10 agree and out of 10 strongly agree The evaluator were out of 10 strongly agree, out of 10 agree and out of 10 undecided on the criteria of the system clear on using For the criteria of the system is clear to save scored out of 10 as undecided, out of 10 as agree and out of 10 strongly agree For the 5th criteria that is the system was clear to report scored as out of 10 strongly agree, out of 10 agree and out of 10 undecided For the criteria of the system is easy to read scored as out of 10 undecided, out of 10 agree and out of 10 strongly agree The evaluator were out of 10 strongly agree, out of 10 agree and out of 10 undecided on the criteria of sequence The evaluator were scored out of strongly agree, out of 10 agree and out of 10 undecided for the criteria of the system dose have terminology consistency For the criteria of terminology relates well to the work scored as out of 10 undecided, out of 10 agree and out of10 strongly agree For the last criteria the interface was attractive and easy to use the evaluator scored out of 10 as strongly agree and out of 10 as agree Finally the average usability of the user interface design according to the evaluation results filled by the participants is out of 10 as agree 70 Chapter five Conclusion and recommendation 5.1 Conclusion Generally, this project attempted to design a web based nursing care process information system based on the finding, patient data in the hospitals are kept manually using different paper-based formats and registers And according to the responses of the interviewees and document review the paper-based record system has different problems including invisibility of records, inaccessibility and difficult to deliver comprehensive and timely health information, duplication of records, incompleteness, difficulty in retrieval and searching for patients nursing care service data is time consuming In addition to these the hospitals was having difficulty in unsecure transaction of data Information requirement of the hospitals was also identified nursing care process related information are: register patient demographic and patient nursing history, observe and register nursing assessment, diagnosis made, proposed care plan, applied implementation, evaluate of the patient progress, booking follow up date and the medications provided was required After having the essential requirements, the analysis and design of the system was done This step involved the users of the system The functional requirements were gathered and developed to address the major business requirements of the system that the users need from the system These functional requirements included registration, organization and display patient demographic, nursing history, assessment, diagnosis, care plan, implementation, and evaluation, follow up, and check guideline, manage user account and reporting Beside the functional requirements, the data requirement and non –functional requirements which are required to keep the system running like security, scalability, reliability and performance requirements were also identified Based on the analyses of the requirements, the design of the system was accomplished Object oriented system analysis and design methodology has been used in designing for web based nursing care process information system In order to translate the analysis into a design, unified modeling language (UML) was used From the different types of the UML tools, the communication modeling tools (use case and sequence diagrams) and association/relationship modeling tool (class diagram and ER diagram) were used A three tier system architecture has been proposed 71 User interface was designed to show the working model of the system The user interface consisted of the display different functionalities and sequence of different form The usability test on the designing can be achieved by evaluating the user interface User evaluation also proves that the system meets users interface factors such as screen terminology, format layout, completeness and perceived usefulness Finally the web based nursing care process information system addresses the various business process and will make a significant role to nursing care process information system in hospitals which improves the current nursing care process service 5.2 Recommendation This project design a web based nursing care process information system in order to improve the current paper based nursing care process service Based on the finding in the study the following recommendations should be taken To developer:    The nursing care process information system should be enhanced by adding decision support system The project work should be developed to be functional system The NCP information system should be integrated with electronic health record 72 Reference Ministry of health Over view of the Sector.2013; Available From: Http://Www.Moh.Gov.Et/English/Information/Pages/Overview%20of%20the%20Sector.Aspx World Health Organization The Need for Strong Health Information Systems 2012 Edwards M., Routine Health Information Systems 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of human-system interaction Usability Definitions and concepts Part 11 2011 75 ANNEX I Information sheet and Consent form Thank you for taking the time to complete this project My name is Zehara Abdulkadir, I am a student at Addis Ababa University in Health Informatics, graduate studies The title of my project is “designing a web based nursing care process information system.” This project will support the recording and accessibility of nursing care process information service due to lack of information Nurses, to benefit from the results of this project.Your cooperation in this project is much appreciated Your responses will be used as an essential input for the defining of requirements which is important for designing a web based application for nursing care process information system As a participant of this project, please note the following: You may seek clarification on any of the questions Your responses will be kept absolutely confidential The results collected will be used for the purposes of the project only I the undersigned have been informed that this interview is part of the study that explore nursing care process information requirement analysis I have been told that the study will help to designing a web based nursing care process information system , which enables nurses to access patient nursing care information easily Once again, thank you for your kind cooperation Yours sincerely, Therefore, I am consented to participate in the study by signing this form The Study participant’s Signature _ Date _ Investigator Name 76 Guide line of interview question used for design a web based nursing care process information system to identifying requirement of the system and to analyze the system Data processing What kind of service you give for your patient? What kind of information you need to record from patient? What data are included in each type of information? How long will it take for one patient during service delivery and information taking? How is the information you took are recorded and stored? How you retrieve patient information in the current system? Do you have guide line to help your nursing care process? What are the problems on the existing form? What are the current problems on the data processing? 10 What types of error happen most in nursing care recorded process and how? Report and sharing 11 How is the collected data used in the nursing care decision making? 12 In what way the information you took is shared with others? 13 How you prepare report currently? 14 How frequently you prepare the report in the current system? 15 To whom is the report submitted? Information Management 16 What does the information communication infrastructure look like in the organization? 17 How is a problem on patient information recording and transferring process handled? 18 Do you have any mechanism to trace the problem and how? 77 ANNEX II User interface evaluation question User satisfaction questioner Rate your agreement with the following statements Place an X in the appropriate column The system was clear to access the different options menus Strongly disagree dis agree undecided agree strongly agree The system was clear to choose from the different options Strongly disagree dis agree undecided agree strongly agree The system was clear on using the different functionalities of the system in the given privilege Strongly disagree dis agree undecided agree strongly agree The system was clear to save the different data onto the database Strongly disagree dis agree undecided agree strongly agree The system was clear to report the different data on the database Strongly disagree dis agree undecided agree strongly agree Characteristics on the device screen easy to read Strongly disagree dis agree undecided agree strongly agree Sequence of screens clear Strongly disagree dis agree undecided agree strongly agree The screen use of terminology throughout system consistency Strongly disagree dis agree undecided agree strongly agree Terminology relates well to the work you are doing Strongly disagree dis agree undecided agree strongly agree 10 Overall, the interface was attractive and easy to use Strongly disagree dis agree undecided 78 agree strongly agree ANNEX III Manual Recording Format Figure Registration form 79 Figure Card ordering Figure Severity index guideline 80 Figure Medication sheet Figure Vital sign sheet 81 Figure Kardex form Figure Nursing care manual form 82 Figure Report form Figure Report result 83 Figure 10 Follow up form 84 ... information database that has store, retrieve, and analyze health related information and also contain administrative data into it Apart from this, the database also has tables to collect information. ..ADDIS ABABA UNIVERSITY SCHOOL OF INFORMATION SCIENCE AND SCHOOL OF PUBLIC HEALTH DESIGNING A WEB BASED NURSING CARE PROCESS INFORMATION SYSTEM FOR HOSPITALS By ZEHARA ABDULKADIR Approval Advisor... health sector [6] Integrating the nursing care process into web based information system is fundamental and essential part of general health information system To deliver nursing care information