Managing Operation And Information - Report Example

Introduction The purpose of this report is of issues of Electronic Prescription System (EPS) developing for the National Health Service (NHS). The NHS is recognised as one of the best health services in the world by the World Health Organisation but its work need to be improved to cope with the demands of the 21st century. Recently there are two main challenges that NHS faced: NHS hospital doctors still write prescriptions by hand. As doctors always have bad handwriting it creates difficulties for patients and pharmacists to parse prescriptions/ Even if a doctor is computerized, he or she doesn’t achieve much benefit from it, because it’s not possible to send a prescription in electronic format. Therefore Electronic Prescription System (EPS) is supposed to improve NHS’s operation by improving quality of services and reducing costs. (a) Infrastructure The three-tiered Client/Server model should be used for EPS. In a three-tiered approach, the client talks to a "middleware" (application) server that then talks to a backend database server. A significant advantage of the three-tiered model is that the business processing is done on a centrally controlled machine. This provides for increased security and in some case makes it possible to change the business processing logic in the middleware without making changes to the client. Three-tiered architectures also provide better scalability and significant performance advantages for more complex applications, as MIT IS (2000) recommends. EPS includes one high-productive backend relational database server and a "middleware" server in each office, so number of "middleware" servers equals to six (the number of NHS offices). Communications between database server and "middleware" servers are provided via Internet using tunnelled TCP-IP channels. This technology provides high level of security and reliability and at the same time it allows to use widely spread Internet connections. "Middleware" server is an application server, which runs software providing business logic of EPS. Also the server maintains website of appropriate NHS’s office, so people can receive public information about prescriptions and their treatment history via Internet. Middleware server software also receives queries from client desktops from the NHS’s office, transfers them to database server and then delivers results of the queries to corresponding client desktop. There are a number of client desktops in each office connected to "middleware" server via client applications through local area network (LAN). In this way high-speed connection to the application server is achieved. Client software with appropriate user interface is launched on every client desktop. Doctors and patients can connect to the EPS through thin clients. A thin client is a computer (client) in client-server architecture networks, which has little or no application logic, so it has to depend primarily on the central server for processing activities. Therefore using standardized client software such as a Web browser can save on development costs, since one does not need to develop a custom client - but one must accept the limitations of the standard client. (b) Databases (b1) Key items of data There are following entities are used for NHS’s prescription work: patient, application, receptions, processing state, prescription, payment, document, office and doctor. EPS uses Fifth Normal Form (5NF) for its database structure. It means that all entries in it are scalar-valued; all non-key attributes are functionally dependent on the entire primary key; none of its attributes is a fact about another non-key field; it does not represent two or more independent many-to-many relationships and its information content cannot be reconstructed from several tables containing fewer attributes. (Janert, 2003, para.44-45) A normalized DB schema avoids certain anomalies when inserting, updating, or deleting data and, therefore, helps to keep consistent data in the database. The major items of information are stored in appropriate tables, and every of these tables have a primary key. The major tables of EPS database are: Patient. Information about patients: name, insurance number, ID number, address, photo and other data are stored in this table. Application. Information about applications: date, reference to patient, reference to NHS’s office, application details, reference to scanned image of application are stored in this table. Receptions. Date and time of reception, reference to receptionist (or NHS’s doctor), reference to patient, and reception results are stored in this table. Processing State. Processing information on every application is stored in this table. Having processing information separately from application information allows quickly executing queries about current state of application (new, accepted, declined, suspended etc.). Prescription. Number of prescription, reference to patient, references to NHS’s office and doctor, reference to scanned image of prescription and other related data are stored in this table. Payment. Payment details and reference to patient are stored in this table. Document. Scanned images of various documents are stored in this table. Other tables refer to it for scanned images. Office. Information about NHS’s offices: name, city, address, phone, web site URL, number of doctors and other related data are stored in this table. Doctor. Information about NHS’s doctors: name, phone, email, home address, photo and other related data are stored in this table. This way of data organization in the database separates different data entities to different tables, which refer to one another when needed, and minimizes superfluity of stored data. Primary keys, indexes, views and stored procedures are used in database to accelerate access to data. Database productivity researches showed that optimized and normalized data structure helps to reduce data change and retrieval delays on huge massive of data. (Ullman, 1993) (b2) Needs for database information There are different kinds of users of prescription information from the NHS, and Electronic Prescription System (EPS) must provide proper piece of information for every kind of EPS user. Anyway, the database must provide opportunities for retrieving, inserting, updating and deleting of data, execute SQL queries and stored procedures, give appropriate types of reports and perform other operations with data. But all the wide range of operations with data is not needed for every database user. That’s why there is notion of role as some definite set of permissions and abilities, which are available for the user obtaining the role. For example, user with role Administrator has permissions to do everything with database data and even to change database structure; and user with role Guest can only see the public data, such as addresses of NHS’s offices and doctors’ emails. Operational medical staff and doctors obtain role Staff and can perform initial operations with data: scan the application documents and put them to database, input patient’s name, address and other data to database, retrieve current application’s processing status on customer’s demand, account given out prescriptions, etc. On the contrary to staff, Managers perform composite activities using information entered to database. Managers develop various reports, build graphs and diagrams and make up daily, monthly and year summary tables to control prescription processing with staff. For example, a manager from regional office of National Health Service at the end of the day can make a report of quantity of application received from patients, controls what share of applications is processed, who of the doctors is more productive, develop an age/profession/sex of patients analytical report and do some forecast for the next day on basis of gathered data. The highest level of information usage is Top management. Top managers use data and reports made by middle managers and compile it to complex aggregate documents, such as financial plan for a year, balance sheet, tax report, calculation of resource requirements, etc. Conclusions and recommendations Electronic Prescription System (EPS) is supposed to be distributed and high-performance information system, which operates with huge data levels and allows simultaneous work of hundreds users. The three-tiered Client/Server model should be used for EPS. It worth to pay a lot of attention to the software platform and database engine, it’s better to use relational databases for the large distributed systems, such as Oracle or IBM DB2. Key items of data for the EPS database are patient, application, and receptions, processing state, prescription, payment, document, office and doctor. Doctors can perform initial operations with this data while managers create different reports, build graphs and diagrams and make up daily, monthly and year summary tables. There are a number of additional issues that should be discussed. System reliability is very important here. There are a lot of technologies developed for ascending of IT system reliability: backup servers and channels, RAID massive, caching and compression of data, etc. It is also important to choose competent software vendor or developers company for creating the software application for EPS. On selection of software provider it is necessary to gather information, on what sort of software it is specialized in, how many completed projects it has and if the customers are satisfied with the product of the company. (Brooks 1995) Also it is impossible not to admit importance of human factor during use of information system. EPS must have comfortable and easy-to-understand user interface, so as novices in NHS could quickly get to know about the system. Only simultaneous taking into consideration of all these factors allows creating really usable and productive information system, which will satisfy NHS’s requirements for the medical information system. References 1. About the NHS - How the NHS Works. (n.d.). (online). Available: http://www.nhs.uk/England/AboutTheNhs/Default.cmsx (October 21, 2005), para.1 2. Brooks, Fredrick P. 1995. The Mythical Man-Month: Essays on Software Engineering. Reading, MA: Addison-Wessley, pp. 55-63 3. Gilfillan, Ian, 2000. Database Normalization. Database Journal (online). Available: http://www.databasejournal.com/sqletc/article.php/26861_1428511_1 (October 21, 2005) 4. Janert, Philipp K., 2003. Practical database design. IBM (online). Available: http://www-106.ibm.com/developerworks/web/library/wa-dbdsgn2.html, (October 21, 2005), para.44-45 5. Martin, James 1991. Rapid Application Development. NY: Macmillan, pp.78-112. 6. Maslow, Abraham H. 1999. Toward a Psychology of Being. NY: John Wiley & Sons. 7. MIT IS. (2000). Infrastructure Requirements for Applications and Systems. MIT Informational Systems (online). Available: http://web.mit.edu/ist/integration/doc/requirements.html, (October 21, 2005), para. 6-7 8. Taylor, David A. 1990. Object-oriented technology: A Manager’s Guide. Reading, MA: Addison-Wessley, pp.24-68 9. Ullman, Jeffrey (1993). Principles of Database Systems. Rockwille, MD: Computer Science Press, pp.42-50. Presentation of written work In this report description of Electronic Prescription System (EPS) development for the National Health Service is given. The EPS is supposed to improve the functioning of the NHS by improving standards of services and reducing costs. Overall infrastructure requirements, database structure and needs for information for the doctors and their managers are discussed in the paper, and conclusions and recommendations for the system development and improvement are made. Read More