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Nowadays, manually handling patient information could be very troublesome. However, most of the medical centres in Malaysia such as clinics are still falling behind in technology era. Manual system in handling patient's information and records are yet a common issue in most of the clinic in Malaysia. Using the conventional way to handling patient records would reduce the effectiveness and efficiency of a clinics operation significantly.
In a manual system clinic, patients would need to register themselves at the front desk if they are first time visiting the clinic. They would have to provide their Identification Card and fill up an information form with their personal details. In the process of registration, misinterpretation of information may occur due to illegible handwriting. The administrator may wrongly record the new patient information into a medical file or card. As the result, the clinic may not be able to accurately contact the patient.
If the patient had visited the clinic before, administrator needs to search for their personal record in the folder tray. It might take time for the administrator to lookup for the right patient's records; Sometimes it takes longer time for administrator to search for a patient's records, as it may lose due to misplacement from the administrator. As mentioned in (Prathima and Koushika, 2011), handling important patient information using paper chart is a cumbersome, time consuming process that can leads to critical medical faults such as documents being mislaid. Important medical records can be mislaying in case of fire or any form of natural disaster. Most businesses operations are unprepared for a natural disaster such as fire and flood, and miss opportunities to minimize damage and resume operations quickly, stated in (Jeffcoat, 2011).
Next, the patient will be asked to wait for their name to be call up before meet with their doctor. During the diagnosis, the doctor will write down the patient diagnosis record on their personal medical file and as well as the medical prescription. Misinterpretation of information not only happened during registration, sometimes doctor might not able to understand their handwriting on prescribed medication or remarks to patient's record profile. From the study by (Jain, A. & Rastogi P., 2009), the handwriting of healthcare professionals in general and doctor is known to be illegible and difficult to understand or decipher. From one study of 117 case notes were examined and 18 (15%) of the notes were illegible that the handwriting and meaning is unclear (Jain, A. & Rastogi P., 2009). This provides supportive evidence that the doctors' handwriting is unusually poor.
After the diagnosis, administrator will obtain the medical prescription from doctor. Then patient will acquire the prescribed medicine from administrator. Occasionally, administrator might have difficulty in reading the prescribe medication on the medical report card due to illegible doctor's handwriting. As a result, a misinterpreted prescribe medication might be issued to the patient and affects the recoverability of a patient from the illness. From the research in (Cohen, 2007), many prescription were misread due to poor handwriting; Letters and numbers can be misinterpreted even the handwriting is clear to be seen.
Since all patients' medical profile are recorded in paper. It means more storage spaces are required to keep all patient's information and data. From the research in (McCorry K.J., 2009), storage of documents is high cost associated with paper, for instances, filing cabinets can be expensive as it consumed the office space. Therefore, the storage space cost increase when the amount of patient increases if the patient records are still handled by paper-based. If clinic maintain of using paper document-approach, higher paper storage cost is unavoidable as the business growing day by day. As mentioned in (Intuit. Inc, 2008), handling large numbers of paper documents and files could reduce available cash, lost revenue and wasted administrative time. The main high costs of paper documentation fall into copying, delivery, handling, storage, and retrieval of that paper, with copying costs at 33% and distribution costs at 56%, and every dollar spent on the printing documents, the companies incur another 6 dollars in handling and distributing the paper, stated in (McCorry K.J., 2009).
Furthermore, patients who are overseas and have emergencies to view their medical records for the previous prescribed medication or medical history. Patient may misplace or did not bring their medical record while travelling overseas. If such situation occurred, patients will not able to provide their medical record to the foreign doctor during emergencies. Foreign doctor may not understand the current body condition of patient. Therefore, it isn't a convenient for patient to manage their personal medical records. As study in (D'Mello and Rozenblit, 2007), patients need to be able to easily access their patient medical data from the different geographical area so as to promote effective management of their medical information.
5.2.2 How the proposed system works?
An online medical management system (E-Care) is developed to supports the daily operation of clinic in a higher effectiveness and efficiency manner including reduce paper storage cost, increase room space, reduce information processing time, reduce damage from disaster, easily accessible to patient records and prevent interpretation of information.
By implementing the E-Care medical management system, patient information will be store over the web database. Patient information can be easily retrieved by administrator, doctor and patient themselves. Whenever patient visit the clinic, they would need to provide either their patient ID or patient Identification Number at front desk to allow administrator register them to meet their doctor. The system allows the specific patient record to be found using patient ID or patient Identification Number in short period of time. Registration process will be taken if there are new patients in the clinic. Patients are required to provide their Identification Card and contact information to allow the clinic to store the patient information into the system. After the patient registered, they will be inserted into the queue and wait for the consultation.
During the diagnosis, the doctor will be recording down the patient diagnosis information and medical prescription into the system. Saving a patient medical prescription required just a click from doctor and the system will automatically processed the request. It is much more convenience and easier for administrator and doctor to keep track on their patient records. At that point of time, the administrator will be able to view the medical prescription from the system instantly after doctor have save the prescription medical into the system. Misinterpretation of information caused by illegible handwriting can be eliminated. As the standard of font style used in the system could be understand by the system user easily.
Besides that, E-Care Medical Management System may improve patient satisfaction as patients are able to retrieve their personal medical information at home or office through a machine that connected to the Internet. Not only that, if the patient travel abroad and he/she needs to view their medical record, he/she are also able to access to their record with any machine connected to the Internet. Therefore, the system has overcome the limitation of geographical area. Patient information and records will be much secure since it has been protected and only authorized personnel can access to view it. Features of E-Care Medical Management System are as follow.
Quick and easy to register new patient into the system. Patient required providing their Identification Card and contact information to allow the clinic to store the patient information into the system.
Medical information includes patient past medical visit history, previous prescribed medication and patient personal information can be retrieve from the system. Patients are allowed to retrieve their personal medical information at home or office through a machine that connected to the Internet without geographical boundaries. Patient can also download and print their medical information if necessary.
Providing real time status of patient in the queue to patient, doctor and administrator. By looking at the system, patient, doctor and administrator will be able to know the patient status in the clinic such as waiting, consultation, and completed. Doctor and administrator are also able to check how many patients are in the queue.
Providing a consultation interface including patient information and allow doctor to records the consultation notes, diagnosis information and medical prescription into the system.
Allow patient to share their attitudes, thoughts, and behaviours towards the clinics. The feedback will be taken into consideration to improve the clinics operations. If patient have doubts on any medical related issue they can always send the feedback to inquire regarding their doubts.
Table Features of E-Care Medical Management System
5.2.3 How others similar system works?
184.108.40.206 Clinic Plus
TRM NETT SYSTEMS (M) SDN BHD was founded in year 1997. Development of healthcare solutions is their business primary focus. They specialize in assisting clinics operation to be fully computerized. They provide their client effective & proven methodsÂ to effective in manage their clinics, increase productivity and dramatically reduce overheads and improve the bottom line. With Clinic Plus, clinics can drastically reduce their administration hassle and dedicate their time in providing quality healthcare services (TRM NETT SYSTEMS, n.d.). TRM NETT SYSTEMS (M) SDN BHD hosted their company Website on http://www.clinicplus.com.my .
One of the products developed by TRM NETT SYSTEMS is Clinic Plus with current version 8.0, a complete clinic management system. It covers the complete workflow of entire clinic's operation and its major functions. This user friendly yet comprehensive software solution will reduce tremendous amount of work load for the clinics.
The features provided by Clinic Plus including Patient Registration, Patient Queue, Patient Medical Records & Prescription, Pharmacy & Prescription, Cashier, Panel Invoice Generation & Printing, Invoices status, Payment Entry, Statement of Accounts & Panel Outstanding, Drugs Master List, Drug Inventory, Lookup & Master Information, Document Designer, Reports, Security, User Administration & Database Management, and Additional Functions.
Detail features of Clinic Plus are as follow. Information below is gathered from TRM NETT SYSTEMS Company Website.
It is quick and hassle free patient registration. It is flexible to search for existing patients using MyKad.
Flexible patient search & adding into waiting queue which supports multiple consultation rooms & doctors. Clear indication patient status in the queue (Waiting, dispensary, cashier, completed).
Patient Medical Records & Prescription
A full view of previous visit history of the patient including previous diagnosis, investigation, treatments and medications, previous medical leave information and charges.
Pharmacy & Prescription
Having option to print medication labels and provides real time drug inventory updates.
A comprehensive data entry interface of cash collection which accepts cash, cheque, credit card, debit card as payment mode.
Panel Invoice Generation & Printing
Automated generation of panel invoices and option to generate invoices by employees & dependants separately or combined.
Instant and comprehensive invoice status and complete history invoice amounts and amendments made.
Fast and easy data entry of payment received from panels and provide on demand printing of payment receipts.
Statement of Accounts & Panel Outstanding
Complete history all invoices generated for panels and payment received and allowing print of statement of accounts and outstanding list.
Drugs Master List
Consist of complete drug information and flexible classification of drugs by drug type (general drug, vaccine, poisonous, psychotropic, others) and drug grouping. It also allows tracking of drug expiry dates and stock balances at store and pharmacy.
Entry of received drugs from supplier and provides accurate stock taking and adjustment including stock movement records. Auto alerts & reports for drug which fall into reorder level.
Lookup & Master Information
An interface provides Panel / Corporate Client Information including comprehensive contact details (general, billing, administration & medical management). It provides list of doctors, diagnosis, treatments, symptoms, allergies, drugs and suppliers.
Transaction and management reports including listings, accounts and financial reports, patient visit and related transactions, drug and inventory related reports
Security, User Administration & Database Management
Unlimited number of users can be registered on the system. A flexible and user definable access levels for each function & reports. Active backup or restore features.
SMS integration for patient reminders, and supports barcode scanning, label printers, barcode printers.
Table 5 Features of Clinic Plus
Source: TRM NETT SYSTEMS. (n.d.)
MedexOne is a solution driven technology services provider. The company mainly provides IT solution and services to the healthcare sector. They are specialized in the development of fully integrated clinic management system for small to medium sized medical practices as well as hospitals. MedexOne develops product solutions to ensure staff and patients remain their top priority as they take their health information systems to a new level of integration and performance (MedexOne, 2011). MedexOne hosted their company Website on http://www.medex-1.com .
One of the products developed by MedexOne is MedexClinic, a fully integrated clinic management system incorporating the tablet PC function and covers the complete workflow of entire clinic's operation and its major functions. The system is customizable to suit individual requirements and preferences. It allow user to easy understand the functionality provided by the system itself. The system only requires basic hardware components to be functional.
The features provided by MedexClinic including Registration, Queue Management, Appointment and Scheduling, Patient Records, Consultation, Dispensary / Inventory Control / Supplier Management, Medical Billing / Patient Management, Image Management / Interface with other hardware and software, Lab Analysis, Label, Medical Certificate / Referral Letter, Reports Management, Security Management, Multi workstations, and other enhancement. Detail features of MedexOne are as follow. Information below is gathered from MedexOne Company Website.
Quick and easy way to register existing or new patient by using MyKad reader. Provide registration for family members, spouses and dependents. Enable segregation of individual from panel patients.
Providing real time status of patient in the queue. By looking at the screen, one will be able to know the patient status in the clinic such as waiting, consultation, dispensary payment or billing process. Also provides automatic alarm to alert patient to enter the consultation room and simultaneously notify the doctor. Doctor is also able to check online how many patients are in the queue.
Appointment and Scheduling
Scheduling module is designed for maximum flexibility in scheduling patient. Appointment schedule can be planned as long as twelve months ahead. Able to schedule appointment date and auto alert patient .Sorting of appointments of patients to doctors. Enable viewing of all appointments from anywhere in the system.
Medical information includes patient past medical visit history, allergy charting history, medical leave and etc. Non-medical records like patient related family address, patient contact number, if clinics with more than one doctor, who is his doctor, family members who are patients of the clinic and etc. Built in calendar for easy scheduling of appointments.
Consultation screen is very comprehensive. All the information is displayed in a single screen. This eliminates the need to look into multiple screens for patient data. Ability to transfer or incorporate images or diagrams into the treatment screen, enabling easy reference and diagnosis. Incorporates Tablet PC function (handwritten technology) thus enabling doctors to adhere to their traditional way of prescribing their consultation notes. Doctors are able to computerize their clinics without changing their way of working.
Dispensary / Inventory Control / Supplier Manage
Auto calculation of the total selling price of the dispensed drugs. Drug alert when patient has drug allergy history for particular drug. Enables doctors to keep an optimum level of inventory in the clinic. Monitoring of inventory and stock movement and built in mechanism to alert stock reorder level and also tracking of drug expiry dates. Integrate lists of popular drugs .Provide detail of purchase invoices and complete supplier outstanding reports and account statements.
Medical Billing / Payment Management
Provide billing for individual and panel companies. Allow for different modes of payment such as cash, credit card or on credit term. Provide comprehensive invoices and payments records for panel companies. Able to generate aging reports of panel companies for financial analysis.
Image Management / Interface with other hardware or Software
Incorporates functions to scan documents and attached directly to patient records that facilitate diagnoses. System also provides function to store digital photographs of patient and chart progress. Quite often, doctors especially specialists will purchase medical equipment such as imaging or X ray machines to stay competitive in the business. Our system is developed with this in mind and enables major medical equipment to interface with it. In this way, all the data and images can be extracted from a single source.
Patient's various Lab data and findings are maintained in the system. System also supports Internal and external Lab analysis details. Internal analysis details will be keyed by the own people.
Other than printed as a medical label sticker on the drug bottles that are given to patients. Labels are also provided for pharmacy, inventory, folder and address. Can use to print for clients, patients and suppliers.
Medical Certificate / Referral Letter
Medical certificates can be customized according to the requirement of the panel companies. Tracking system on the number of medical certificates issued for the month by a clinic and this can be sorted to individual and panel companies. Medical certificate reasons can also be stored in the system. System can generate auto referral letters that can be email to other doctors.
Provide statistical reports for analysis of the patients. Daily sales collection, breakdown into patients and companies. This can be broken down into different mode of the payments ie cash, credit card or on credit. Aging account analysis of panel companies for better collection and credit control. Listing of patients / panel companies. Master inventory list/ stock movement and adjustments and many other reports.
User flexibility. Staff will have different security access to different level of functions and reports. Multi-level security arrangement System back up and restoring data functionality.
System is designed to support single and multiple working stations in a clinic.
Provide Emailing and SMS integration for patient reminders Audit trail for records amendments and deletion. Software can be customized according to client requirements. Data migration from existing system is allowed System not only can interface with medical equipment, it also allows integration with accounting software and any other backend systems.
Table 6 Features of MedexOne
Source: MedexOne (2011).