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ii. Patient Information Flow
Figure 3.3 Patient information flow
In the patient information flow, the patient goes to the medical records to obtain card and goes to see the doctor. The doctor sends the patient to the lab. The patient goes to the pharmacy if the ailment is not chronic, get the drugs and gets discharged. If the patiet’s ailment is chronic, the patient is placed on admission and the vital signs monitored and recorded. When the vital sign becomes abnormal, the nurse instructs the health attendant who calls the doctor to proffer medical advice and solution.
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should be admitted or treated as an out patient. If the patient is an out patient, the doctor prescribes the drugs, sends the patient to the pharmacy to collect drugs after payment and go home. If the patient is on admission, the doctor again determines if the patient is suffering from a chronic disease. If the patient is not suffering from a chronic disease, the patient remains on admission where treatment is administered until the patient is fit to go home. But if the patient’s ailment is chronic, the vital signs of the patient is simulated using the software that runs in the simulated phone to generate the blood pressure and the pulse rate which is sent tothe server and new set of readings are generated every twenty five seconds and sent to the server.
In the server there is a queuing model which accepts these readings, analyse them before sending them to the database. Also for security reasons, as the patient’s data travel from the mobile phone to the server, they are encrypted using the encryption key and can only be decrypted in the server using the decryption key by an authorised staff. This is to safeguard the patient’s health records from unauthorised acess and use.
The doctor from time to time can check his computer and view the patient’s record and provide suggestions and solution. The doctor can also view each patient’s vital sign reading graph to see the progression of the readings.
When a patient’s vital sign becomes abnormal, the nurse can send a message to the doctor. The doctor can also see it in his computer and since these readings get to the server every twenty five minutes, the doctor will always have a long range of readings to look at at every point in time and this will aid the doctor in taking accurate and timely decisions.
3.7.2 Merits of the New System
The merits of the new system are outlined below:
i. The sensors collect the readings for the vital signs of patients and forward it through the Internet to the server, which then report any unsafe situation to the medical network for medical interpretation and intervention. This saves the nurses a lot of trouble, so they will have more time for other clinical activities in the hospital.
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ii. Monitoring the patients manually cause a lot of disturbance to the patients as they may be sleeping at the time or they may be very weak and may need to be allowed to rest. So in this situation where the signs are monitored without the patient knowing it, it gives the patients enough time to relax and recuperate.
iii. Any unsafe situation is reported to the medical team in charge immediately so that they can swing into action. This solves the problem of not getting the doctors in their offices when they are needed as the message will be relayed right into their phones.
iv. The readings are more accurate and reliable than the ones gotten from manual monitoring of patients.
v. The sensors periodically transmit their status and events, therefore significantly reducing power consumption and extending battery life.
vi. High performance and fault tolerant wireless devices can now be employed to eliminate medical errors, to reduce workload and increase the efficiency of hospital staff, and to improve the comfort of patients.
vii. There is better performance in the new system.
viii. Records from individual monitoring sessions can be integrated into research databases that would provide support for data mining and knowledge discovery relevant to specific conditions and patient categories.
ix. Death rate is drastically reduced to the barest minimum since the patients are attended to at the appropriate time.
x. Continuous monitoring of the patients tell a much deeper story about what is going on with the patient, revealing early signs of trouble that can trigger life-saving intervention.
xi. There is reduced loss of life in the new system since there is a real time monitoring of the patients’ vital signs.
xii. The new system will provide automated working with less human interaction.
xiii. It enables villagers and chronically ill patients to have their vital signs monitored since they can be anywhere other than the hospital and their vital signs will still be checked.
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xiv. More hospital beds will be made available since the patient’s do not need to be in the hospitals before their vital signs can be monitored. The hospital beds can thus be reserved for emergency situations.
xv. It enables the doctors to take more timely and accurate decisions since they always have a long range of vital signs readings of each patient at every point in time.
3.7.3 Demerits of the New System The demerits of this new system are as follows:
i. The major problem this new system will face is the network problem. Since the data stored in the mobile devices are sent over the web to the medical network, there may not be network in all the places this technology will be used and that will pose a problem for the new system.
ii. The sensors use batteries and they will tend to be discharging quickly since the sensors will be on the patients all the time.
iii. The patients may not understand this system and therefore they may tend to feel that they have been completely abandoned.
iv. The nurses may feel very uncomfortable with this system as they may tend to think that the major part of their work have been taken away from them thereby making them redundant.
v. Sometimes there may be interference between the Bluetooth devices and the medical equipment).
3.7.4 Justification for the New System
This system will be of immense help to health care in Nigeria generally despite the disadvantages. This is because:
i. The problem of network can always be solved by using the Bluetooth as a means of communication between the mobile devices where the data is stored and the medical network since the Bluetooth technology can work anywhere.
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The Bluetooth connection covers a distance of 10 meters which is good since the patient has the devices on with his mobile phone having the Bluetooth connection within the same area.
ii. Ideally, sensors periodically transmit their status and events, thereby significantly reducing power consumption and extending battery life.
iii. When the patients are sensitized on the benefits of this new system, they will readily appreciate it and also prefer it knowing fully well that even though nobody is monitoring their vital signs, the devices in their bodies are doing that.
iv. Since the monitoring is continuous, it goes a long way to help the doctors to do their assessment of the patients and to provide the best medical treatment. This is because the blood pressure for instance fluctuates at different times of the day and so the doctors can do analysis of the readings obtained within a period of time to determine the average blood pressure of the patient.
v. Also when the nurses are assured that the new system will not make them redundant as they will use their time to perform other clinical activities efficiently, they will appreciate it.
vi. This system is very important and will be beneficial to Nigerian Hospitals because already, there are a lot of issues in the manual monitoring as discussed above resulting to high mortality rate in Nigeria. This system therefore will go a long way to reduce the mortality rate in Nigerian Hospitals.
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3.7.5 DATAFLOW DIAGRAM OF THE PROPOSED SYSTEM
Figure 3.4: Dataflow diagram of the proposed system IPDA (Intelligent Personal Digital Assistant Patient
Admission
Discharge Monitoring
devices/sensors
Lab
Doctor Retrieve Patient
card
Pharmacy
Central Database Treat/Prescription
Encrypt patient’s data
Lab Result Patient with a
chronic disease goes to the hospital
The patient sees the doctor
Check whether the disease is chronic
Prescribes drugs for the patient
The doctor views the patient’s lab result and determines whether the ailment is serious
Doctor confirms the patient is ok Analyses the vital
signs to determine the stability of the patient
Simulates the blood pressure and the pulse rate of the patient
Doctor determines whether the vital sign is abnormal
Stores the result of the patients’ vital signs readings in the central database Queuing System
Scrambles the patient medical records to make it unreadable using the secret key
Decrypt patients’
data Descrambles patients’ medical record to make it readable using the secret key
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A sick patient goes to the medical records, retrieves the card and proceeds to see the doctor. The doctor examines the patient and sends the patient to the lab. From the lab result, the doctor decides whether to put the patient on admission or to treat the patient as an outpatient depending on the nature of the patient’s ailment.
If the patient’s ailment is chronic, the monitoring of the vital signs will commence and readings are sent to the server. When the vital sign reading becomes abnormal, the doctor is notified immediately and the doctor provides solution on the next line of action.
3.7.6 Information Flow in the Proposed System
Figure 3.5: Information flow in the proposed system
In the proposed system, the information (readings) from the sensors, the blood pressure and the pulse rate sensors in this case are simulated in the Intelligent Personal Digital Assistant (IPDA) using data structures such as name, age, smoking habits, alcohol intakes etc. This IPDA which can be a laptop, a PDA or a Smartphone sends the simulated readings through the Internet to the server. The information enters the server. The queuing model queues the data according to how they are sent. The server also contains the database. The block diagram of the information flow in the proposed system is shown in Figure 3.6
Server Blood
Pressure Sensor
Pulse Rate Sensor
Collects information from sensors, analyses the data and create warnings
IPDA
Laptop PDA Smart Phone
Internet
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Figure 3.6: Block diagram of the information flow in the proposed system
3.7.7 High Level Models of the Proposed System
Figure 3.7. High level model of the proposed system (MHIMS) Blood Pressure
sensor (simulated)
Pulse rate sensor (simulated)
IPDA Internet
Server Queuing Model
Database
MHIMS
Flash
Screen(Introductory Screen)
Set –up Module
Simulation Module Log-In
Module
New Open
Save
Close
Exit
Patient Details Smoking Habit
Alcohol Habit
Server Name
Access Key
Systolic Diastolic Pulse
Mean Arterial Pressure
Age Blood
Pressure
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Figure 3.8: High Level Model of the Proposed System (IHIMS)
The two High Level Models are used to demonstrate the two malor ations in this project. One being the Mobile Health Information Management System (MHIMS) and the other being the Integrated Hospital Information Management System (IHIMS).
IHIMS
Diagnosis and vital sign emergency report database Create Patient
DataBase House
Keeping
Reports
Admission Reports Patient list in all wards Appen
Purge d
Discharge Reports Recall Reports Edit
Exit
Reports of salvaged cares due to remote monitoring
Browse
Patient Bills Exit
Patient Diagnosis Reports Accounting Reports (Daily, weekly and monthly) Report of deaths Emergency reports Diagnosis
Vital Signs Emergency Reports
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CHAPTER 4