Laboratory information system for arada health center

ADDIS ABABA UNIVERSITY SCHOOL OF INFORMATION SCIENCE AND SCHOOL OF PUBLIC HEALTH M.SC IN HEALTH INFORMATICS PROGRAM Laboratory Information System for Arada Health Center: Using a Design Approach By: Debritu Kebede A Project Submitted To the School of Information Science and School of Public Health for Partial Fulfillment of the Requirement for the Degree of Masters of Science in Health Informatics June, 2017 Addis Ababa, Ethiopia ADDIS ABABA UNIVERSITY SCHOOL OF INFORMATION SCIENCE AND SCHOOL OF PUBLIC HEALTH M.SC IN HEALTH INFORMATICS PROGRAM Laboratory Information System for Arada Health Center: Using a Design Approach By: Debritu Kebede A Project Submitted To the School of Information Science and School of Public Health for Partial Fulfillment of the Requirement for the Degree of Masters of Science in Health Informatics Advisors Tibebe Beshah (PhD) Signature _ Date Yimer Seid (MPH) _ Date _ Signature Approved by Examining Board Getachew Hailemariam (PhD) Mengistu Yilma (MPH) ii _ Signature _ Signature _ Date _ Date DEDICATION This project work is dedicated to my beloved family, to my dad, Ato Kebede Mamo, my husband Mesfin Abebe, and my children’s Robel, Ruth & Mathania for being my support of strength and for their patience when I devoted long time in my project work iii ACKNOWLEDGEMENT First of all I owe my heart-felt gratitude to Almighty God, His mother Saint Virgin Mary, Saint George and all of His Saints for their being with me in every aspects of my life including this project work I am also indebted to my Advisors, Dr Tibebe Beshah and Ato Yimer Seid for their unreserved guidance, valuable and constructive, comments and inputs throughout this project work Their Guidance and intellectual advices were my inspirations, without their help it would have been impossible to finish the whole project and I really want to thank you I am very grateful to Meseret Ayano coordinator of the Health Informatics Program for valuable guidance, facilitation and support during this project and throughout the entire program of study and many thanks also go to Arada health center manager, staff for willingly, gave their time for the interview in the requirement collection stage I would like to pass my deepest thanks to, Addis, Atkilt, Mebratu, Tigist , Solomon, Tadesse and Turifat who helped me one way or another during preparing and finalizing this project work Finally, I would like to thank my beloved family, my husband Mesfin Abebe, my children Robel, Ruth, Mathania and Burte for their love and support in all the times of my project This accomplishment would not have been possible without them Thank you iv Table of Content DEDICATION iii ACKNOWLEDGEMENT iv LIST OF FIGURES vii LIST OF TABLES vii ACRONYMS viii ABSTRACT ix CHAPTER ONE INTRODUCTION 1.1 Background 1.2 Statement of the Problem 1.3 Objective 1.3.1 General Objective 1.3.2 Specific Objectives 1.4 Scope of the Study 1.5 Significance CHAPTER TWO LITERATURE REVIEW 2.1 Overview 2.2 Information System 2.2.1 Health Information System 2.3 Information System Development 2.3.1 Contemporary Modeling Approaches 10 2.4 Laboratory Information System 11 2.5 Related Work 13 CHAPTER THREE 17 METHODS AND MATERIALS 17 3.1 General Approach 17 3.2 Study Population 17 3.3 Data Collection Methods and Process 17 3.4.1 Data Analysis Methods 18 3.4.2 Requirement Analysis and Design 18 3.5 System Modeling and Designing 19 3.6 Analysis and Design Tools 19 v 3.7 Evaluation and Testing Methods 20 3.8 Methods of Dissemination of Results 20 3.9 Operational Definitions 21 3.10 Ethical Consideration 21 CHAPTER FOUR 22 ANALYSIS AND DESIGN OF THE SYSTEM 22 4.1 Overview 22 4.2 Description of Existing Systems 22 4.2.1 The Work Process and Forms Used 22 4.2.2 Identified Problems from Existing Laboratory System 26 4.2.3 Infrastructure in Place 26 4.3 The Proposed System 27 4.3.1 Requirement Gathering and Analysis 27 4.3.2 Functional Requirements 27 4.3.3 Non Functional Requirements 28 4.3.4 Analysis Model 29 4.3.5 Design 40 CHAPTER FIVE 45 IMPLEMENTATION AND RESULT 45 5.1 Overview 45 5.2 Major Function of the System 45 5.3 Sample Prototype Interface 46 5.4 Testing and Evaluation 50 5.5 Discussion 52 CHAPTER SIX 54 CONCLUSION AND RECOMMENDATION 54 6.1 Conclusion 54 6.2 Recommendations 56 REFERENCE 57 Annex-I Consent Form 60 Annex II- Interview guide 61 Annex III-Existing Laboratory Test Order Format and Log Book 65 Annex IV- Picture taken during system evaluation 66 Declaration 67 vi LIST OF FIGURES Figure 1: Laboratory information system processes and procedures (25) .12 Figure System Use Case Diagram 31 Figure 3: Overall Activity Diagram of LIS 37 Figure 4: Patient Registration Activity Diagram 38 Figure 5: Search Patient Activity Diagram 39 Figure 6: Laboratory Test Order Activity Diagram 39 Figure 7: Laboratory Test Result Activity Diagram 40 Figure 8: LIS Class Diagram 42 Figure 9: persistent diagram .43 Figure 10; LIS Deployment Diagram 44 Figure 11: Home Page Interface 47 Figure 12: Patient Registration Interface 48 Figure 13: Laboratory Test Order Interface .48 Figure 14: Laboratory Test Result Interface .49 Figure 15: Report Interface 50 LIST OF TABLES Table 1: Techniques, Tools and Method 20 Table 2: SWOT Analysis of Arada Health Center .25 Table 3: Identified Actors and Their Description 30 Table 4: Description of Login Use Case 32 Table 5: Description of Search Patient use case 33 Table 6: Description of Register Patient Use case 33 Table 7: Description of Laboratory Test order Use Case 34 Table 8: Description of Laboratory Test Result 35 Table 9: Description of Generate Report Use Case 35 Table 10: Description of Maintain User Account Use Case .36 Table 11: Description of Classes identified 41 Table 12 : System Evaluation for Laboratory Information System 51 vii ACRONYMS AIDS Acquired Immune Deficiency Syndrome CDC Centers for Disease Control CHI Canada Health Info Way CMS Central Medical Stores CSS Cascading Style Sheet HER Electronic Health Record EMR Electronic Medical Record FMOH Federal Ministry of Health GFATM Global Fund to Fight AIDS Tuberculosis and Malaria HIT Health Information Technology HIV Human Immune Deficiency Virus HLISAG Hospital Laboratory Information System Advisory Group HMIS Health Management Information System ICT Information Communication Technology I/p Insertion Parameter in the database LIS Laboratory Information System NHL National Health Laboratory OO Object Oriented PEPFAR President Emergency Plan for AIDS Relief PHP Hypertext Processer SQL Structured Query Language SWOT Strength, Weakness, Opportunity and Threat TAT Turnaround Time USAID United States Agency for International Development UML Unified Modeling Language viii ABSTRACT Background: The laboratory information system is a data processing and dissemination system used in the laboratory to deliver accurate and understandable results within a reasonable timescale as requested by physicians The problem of manual system used in Arada health center makes it difficult to provide efficient and quality health service data and the lack of integration of data, organized test result, different reporting formats and long turnaround time brings about delay of treatment and poor data quality Objective: The objective of this project is to design and develop laboratory information system for Arada health center Method: This used a combination of qualitative purposive method and object-oriented system analysis and design methodology with the incremental approach which includes requirement collection, analysis and design phases The design emphasized the structure and behavior of systems, which interacts different objects or class within the system Requirement was collected using the following tools (interview and relevant document review techniques) Analysis and design of the proposed system was performed using the Use Case Diagram, Activity Diagrams, Class Diagrams, Deployment Diagram and Persistent Model Result: Considering the importance of the Laboratory Information System for the health center the researcher has identified the problem of ordering a number of laboratory test papers for the single patient, the long time for data retrieval, transcription error and illegible hand writing that has been encountered while using paper based documentation After identification of the problem, laboratory information system has been developed and tasted so as to solve the identified problems Conclusion: The developed system solves the problem of data integration and can capture a number of laboratory test order forms with a single interface used by the physician and the laboratory technician in the exchange of information for ordering laboratory tests and receiving the results back to the physician This makes the laboratory data to be easily manageable and accessible by health professionals and decision makers Usability test has been done and discussion was made with users in order to determine functionality, effectiveness and acceptability of the project and almost all of the respondents accepted the prototype Regarding the functionality, the system produces reliable data and hence avoids the problem that used to occur by the manual system ix x The laboratory information system has been commonly used in the hospitals with higher work load; however this laboratory information system is different in that it is tailored to be used to the level of health center The evaluation is based on the fact that data requirements were collected and analyzed successfully before the development of the system The design and development of laboratory information system was further accomplished with patient registration, laboratory test order register and return back laboratory test result to physician and generate report functionalities in the system 53 CHAPTER SIX CONCLUSION AND RECOMMENDATION 6.1 Conclusion Considering the importance of the laboratory information system for the health center the researcher in this project has identified the problem of ordering a number of laboratory test order papers for single patient, the long time for data retrieval, transcription error and illegible hand writing that has been encountered while using paper based documentation Consequently the researcher has designed an integrated laboratory information system that can capture a number of laboratory test orders with a single interface used by the physicians and the laboratory technicians in the exchange of information for ordering of laboratory tests and receiving the results back to the physicians and generate report The method used in this project was a qualitative study combined with a design oriented iterative (incremental) approach following an object-oriented system development The techniques used for analysis and design in this project were use case diagram, activity diagram, class diagram, deployment diagram and persistent model Microsoft Visio 2007 was also used to design the system The functional requirements of the system were gathered from the health professionals, data clerk and higher officials in the health center who have direct contact to laboratory department Also, system modeling was done using unified modeling language (UML) Requirement analysis has been done using document review and interview with the staff that has directly contact with the laboratory department and come up with the identification of the following use cases The system was developed using Joomla Testing and evaluation was done to describe to what extent the system is usable by using Likert Scale The result of the test shows that almost all of the respondents were happy with the system 54 The developed system solves the problem of data integration and can capture a number of laboratory test order forms with a single interface used by the physician and the laboratory technician in the exchange of information for ordering laboratory tests and receiving the results back to the physician This makes the laboratory data to be easily manageable and accessible by health professionals and decision makers Usability test has been done and discussion was made with users in order to determine functionality, effectiveness and acceptability of the project and almost all of the respondents accepted the prototype Regarding the functionality, the system produces reliable data and hence avoids the problem that used to occur by the manual system 55 6.2 Recommendations After completing the project the researcher provided the following recommendations for practice and future work Recommendations for practice  The health centers should be able to provide the hardware that is required to deploy the system and the necessary infrastructural support during the implementation of the system like electric power in the health center  The Regional Health Bureau, the Arada Sub city health office, the Arada health center management committee and other concerned government & non-government organizations need to give attention to this valuable project and support for its deployment Recommendations for future work  56 The system should be upgrade to the full-fledged patient management system REFERENCE Delhi N Guidelines for good clinical laboratory practices (GCLP) Indian Counc Med Res New Delhi 2008; Strategic N Sample country Laboratory Services National Strategic Plan 2008;1–42 Systems M What is a LIMS - a laboratory toy , or a critical IT component ? 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29 Harrison JP, Mcdowell GM, Harrison JP The role of laboratory information systems in healthcare quality improvement 2008; 30 Services M of H and S National Public Health Laboratory 2012;(October) 31 Mbah H, Ojo E, Ameh J, Musuluma H, Negedu-Momoh OR, Jegede F, et al Piloting 58 laboratory quality system management in six health facilities in Nigeria PLoS One 2014;9(12):1–14 32 Blaya A, Shin SS, Yagui M, Contreras C, Cegielski P, Yale G Reducing Communication Delays and Improving Quality of Care with a Tuberculosis Laboratory Information System in Resource Poor Environments : A Cluster Randomized Controlled Trial 2014;9(4) 33 Sarah Andersson MM Logistics System Design for Botswana 2009;(March) 34 Waruhari P, Ng’ang’a J Implementation of a web-based laboratory information system (lis) in a hiv care and treatment program: kenyatta national hospital comprehensive care centre (knh ccc) case 2009;(Knh Ccc):1079–87 35 Shiferaw W Data exchange interoperability framework For laboratory information system (LIS) and electronic health record (EHR) of two hospitals in addis ababa 2013; 36 Alemu G Designing an Electronic Medical Record System for Amanuel Hospital 2014; 37 Ribeiro VV, Travassos GH Testing Non-Functional Requirements- Lacking of Tehnologies or Researching Opportunities.pdf 2016;15 38 Priestly M Practical Object-Oriented Design with UML 2000 39 Jacobson I Use-case 2.0 A Guid to succeding with use case 2011;(December) 40 Ambler SW The Elements of UMLTM2.0 Style 2005 41 Bhattacharjee AK, Shyamasundar RK Activity Diagrams: A Formal Framework to Model Business Processes and Code Generation J Object Technol 2009;8(1):189–220 42 Paper W, Chemistry C The Need to Harmonize Clinical Laboratory Test Results 2015;(July) 43 Jackson D Web Usability Testing Guidance 2015;1:2–5 44 Block AJ Introduction To Usability 1994;105(3):649a–649 59 Annex-I Consent Form Good Morning / Afternoon Introduction My Name is Debritu Kebede, I am a postgraduate student at Addis Ababa University School of Information Science and School of Public Health in Health Informatics Program Currently I am collecting data to carry out the project as a partial fulfilment of the requirements for M.Sc in Health Informatics programm with the title “Laboratory information system for Arada Health Center: Using a Design Approach” The aim of this preliminary survey is to identify functional and non-functional requirements for the system This project will improve the turnaround time (TAT) for laboratory service , quality of data and reduce transcription error as well as benefiting the laboratory technician, the government and the community at large The interview will take 15-20 minutes and I would like to assure you that the information that you provide will completely be kept confidential and will be used only for the project purpose Your honest responses will be used as an essential input for the defining of requirements which is important for designing and developing the Laboratory Information System As a participant of this survey, please note that you may seek clarification on any of the questions and you may withdraw from the survey at any time you wish to so Thank you for your kind cooperation and taking the time to complete this survey Are you willing /voluntary to participate in this survey? Circle your response Yes No Name of data Collector _ Signature Date 60 Annex II- Interview guide A Recipients: Users of LIS program (Health professionals) What are the main challenges in your laboratory? How did you communicate laboratory results to the physician? _ How many tests did you perform per day Can you please explain it in terms of workload? Did you face misdiagnosis complain due to transcription error? _ _ Please describe your general opinion on the existing laboratory documentation Do you have a unique patient identification number in your laboratory? If you have please describe _ _ How you record & keep the patient data confidential? How you prevent loss of patient data due to theft or other incidents? 61 How you evaluate turnaround time (TAT) of laboratory result? 10 How you retrieve laboratory data for revisiting patients? 11 How you solve transcription error of laboratory result? _ 12 How did you generate laboratory reports periodically? _ _ 13 Is there any specific task in laboratory system that you feel is difficult & can be supported through LIS? B Interview Guide for Higher Officials How many laboratory professionals you have? _ _ Did you get laboratory report timely? Did you use the laboratory reports for reagent procurement plan? _ Did you face misdiagnosis complain due to transcription error? _ _ 62 What are the challenges you have got when you use the manual system? _ Does the health center have a plan to develop laboratory information system? _ How is the connectivity at the health center? _ _ System Evaluation Question The Likert Scale represents system evaluation questionnaires according to functional requirements of the system given their response being to strongly agree,4 to agree,3 to neutral,2 to disagree and to strongly disagree in terms of the functional requirements being met or not No Question of evaluation The system provides adequate registration format I thought the system is easy to use The system saves entered data properly The instructions were easy to follow There is no unnecessary format available in the interface Overall interaction to the system is good 10 Strongly Disagree (1) Disagree (2) The system provides secured and reliable information The interfaces are visible and clear There is uniformity in the system interface The user interface is easy to follow Average result Total agree value 63 Neutral (3) Agree (4) Strongly Agree (5) Laboratory Test Order View Interface Laboratory Test Result View Interface 64 Annex III-Existing Laboratory Test Order Format and Log Book Chemistry laboratory test order form Sample Collection Log Book 65 Annex IV- Picture taken during system evaluation Arada health center physicians while testing the developed system Arada health center laboratory technician While testing the developed system 66 Arada health center laboratory technician while doing manual result record Declaration I, the undersigned, declare that this project work is my own original work and effort and that it has not been presented for a degree in any other university, where other sources of information have been used, they have been duly acknowledged Name Debritu Kebede Signature Date This project has been submitted for examination with my approval as university advisor Signature Date Tibebe Beshah (PhD) _ _ Yimer Seid (MPH) 67 ...ADDIS ABABA UNIVERSITY SCHOOL OF INFORMATION SCIENCE AND SCHOOL OF PUBLIC HEALTH M.SC IN HEALTH INFORMATICS PROGRAM Laboratory Information System for Arada Health Center: Using a Design Approach... Hospital Laboratory Information System Advisory Group HMIS Health Management Information System ICT Information Communication Technology I/p Insertion Parameter in the database LIS Laboratory Information. .. disseminate and use health information differs amongst the health institutions (5) Therefore, this project is designed and developed a Laboratory Information System for Arada Health Center to integrate