Praeeediyls of The Fust Joint EMEEMES CMlferMCs Serving Humanity, Advancing Technology Oa 1516, '99, Amb, a,USA

A WEB-based Patient Record and Appointment Management System

Stathis Marinas", Panayiotis Nikolopoulos', Sotiris Pavlopoulos"
I

BiomedicalEngineering Laboratory, Department of Electrical and Computer Engineering,

National Technical University of Athens, Greece.
2

EMPHASIS Systems, SA., Athens Greece.

*e-mail:smarin@biomed.ntua.gr
Absfract
A Computer Based Patient Record and Appoinlment
Management System has been designed and installed in
a NES Trust Eospitnl. System design followed a
business process reenglneering effort thnt took place in
the hospital. The system is based on Intranet
technology, providing user-friendly, secure graphical
interface nnd office automation facilities. System
Development has undergone three cycles of refinement
before going Uve. Although system evaluation in
ongoing, initial results indicate user satisfaction, saving
in time and effort, as well as process automation.
Keywords: Hospital Infomarion System, CFR,WEB.

Infroduetion
Medical instilntionsand Hospitalsnow more than ever, feel
the need for a well shuctured Computer-based Patient
Record and Appin-t
Management System
(CPRAMS). Healthcare organizations are experiencing an
information explosion in the form of knowledge and data,
Fnrthermore there is a greater demand for data to support
activities other than direct patient care such as
administrative, statistical, economic and legal. It is
commonly accepted that a CPR should cover the following
elements: Personal data (demographic and administrative),
medical history list, data security and integrity, authorised
access only, remote multi-access, medical examinations
and tests, links to medical databases, etc.
Within the frameworkof the THESIS project (EP23428), a
pilot applicationhas been developed to serve the 5 clinical
departments of a NHS-hust Hospital in the U.K.: Inpatient,
Outpatient, x-ray, Minor Injuries, and Physiotherapy
department. The system covers patient's appointments,bed
management, letter and report generatio- and maintenance
of Electronic Patient Record

Methods
Through a Business Process Reengineering approach, the
concept of an Episode tend to the patient journey
(referral, admission, appointments, follow-ups, and
discharge) has been established AU key processes within
the Hospital have been evaluated, mapped and redesigned.
Episode uses classes such as GP, F'ractice, Patient, Primary
Contact, Appointment. By the time patient calls or patient's

0-7803-5674-8/99/$10.00Q 1999 IEEE

episode begins and this episode is

GP sends a referral,
open until the patient is discharged
The system presented here is based on Intranet technology
and client-server architecture. It provides a user-friendly,
secure graphical interface and adds exciting features as
Internet access, access to complete electronic patient
records (inclndmg medical images), remote access (off
Intranet), antomatic letter postage via email, automatic fax
operations and more. It is a combined hardware and
software system that enhances the sharing of setvices
across wide regions.
The web based part of the application is an Active X
Document. Users are connected to the Web Server through
a standard Internet connection and following document
download and registration, control and communication
with the datahase server aVougb ODBC is established and
data are accessed directly Iiom the database Server.
ACTIVES X GUI elements ensure a very friendly User
Interface. On the server si& there is a Microsoft SQL
Server 7.0 acting as the database server and Microsoft IIS
4.0 acting as a Web server (supporting the Web piut of the
application),both running on NT 4.0 SP4.
On both Web and Intranet based applications, OLE
technology has been extensively used. Thus, the
application is able to communicate with MS-Word and
MS-Excel. This is a really exciting feature because users
are familiar with Office's applications. Furthermore, users
can transfer data, save documents (in a standard format as
the .doc), interchange documents through Web,
automaticdy fax donunents and more.

Results-Discussion
The system has undergone three cycles or refmement until
the go-live was decided. Concurrently user training took
place to ensure adequate acquaintance. The NHS patient
information database has been uploaded, to reduce patient
information registration. Time performance reports are
simple to create since at each stop (arrival, book-in, triage,
and treatment) the time is recorded on the database.
Furthermore, Consultants have the option of working from
their offices; they create clinics, and hook appointmats
without the need of traditional paper-based procedure they
had to follow before system implementation. System
performance is currently assessed. Initial results indicate
mer satisfaction, saving in time and effort, as well as
process automation.

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