the description of a new medical software tool for hospitals ...

THE DESCRIPTION OF A NEW MEDICAL SOFTWARE TOOL FOR HOSPITALSMANAGEMENT AND FINANCEAnca IonLiana StanescuDumitru Dan BurdescuUniversity of Craiova, Faculty of Automation, Computers and Electronicsanca.ion@software.ucv.ro, stanescu@nt.comp-craiova.ro, burdescu@topedge.comAbstract: In this paper we present an efficient and flexible software system as an alternative for theDRG-National application, used by the Romanian Government to finance the hospitals. Thisalternative software system is in fact an on-line application based on JSP technology and a MySQLdatabase in order to replace the old application realized in MS Access 2000. This application willhelp the DRG National Bureau to analyze, at any time, real-time data, and even send it to theinternational organizations. The users can easily get accustom to this new application, because itkeeps the structure and many menus from the old application.Keywords: medical applications, management systems1. INTRODUCTIONThe software system used for the managementand finance of the Romanian hospitals permits toclassify the patients based on the diagnosis, theprocedures and other information (the complexity ofeach case) and to link this type of patients that eachhospital treats to the expenses needed (DRG, 2005).The necessary data for the patient classificationon the basis of the diagnosis and the procedures inthese system categories are: age, sex, hospitalizationperiod, principal diagnosis, secondary diagnosis,procedures, health condition when leaving hospital,the birth weight (in the new-born child case).Through the system of the diagnosis group thecharacteristics of each patient who left the hospitalare analyzed, and in accordance with these, thepatients are classified in a different category. Thisway, this system makes an ,,image” to the hospitalresults, trying to standardize the results of thisactivity.The diagnosis groups have two essentialcharacteristics:1) The clinical homogeneity, meaning that in acertain DRG the cases (the patients) aresimilar from the clinical point of view, butnot identical2) The costs homogeneity, meaning that eachDRG has cases that need similar usage ofresources.To be able to classify each patient that left thehospital in a diagnosis group there have to be runfour phases:1. the disponibility of the clinical data for thepatients that left the hospital2. the codification of the necessary data for thediagnosis and the procedures in order tohave a standardized language for thesevariables and to be able to use them easily3. gathering these data in an electronic manner4. the automatic classification of each patientin a diagnosis groupNowadays, to gather the information for thepatients it is used the v4.0 application that isdelivered through the district agencies (DRG, 2005).This application must be installed on every computerused for gathering data about the patients. Theelectronically registration for a patient, one for thewhole period the patient stays in hospital, is inconcordance with the new clinical observation form

introduced by the Romanian Health and FamilyMinistry. Once collected, the data are added to adatabase, which has to be sent monthly to the DRGdepartment from the National Health Institute forResearch and Development, Bucharest. This is aRuntime application implemented in MicrosoftAccess 2000 that collects information about thepatients at the department level, encrypt them andafter that send them to the DRG National Bureauusing the e-mail. The data centralization from alldepartments on a single computer is also possible,where the application also has to be installed, andsend them in this centralized manner to the DRGNational Bureau.The application has minimal requirements at thehardware level and at the level of the Internetconnection.2. THE PRESENTATION OF THE NEWALTERNATIVE FOR THE DRG SOFTWARESYSTEM2.1 Brief comparison of the two applicationsBecause of the difficulties presented by the DRG-National application, we propose a new softwaresystem.The desavantages of MS Access 2000 are: it is anadministration system for desktop databases andadministrates with efficiency a slightly reducednumber of recordings: around 20000-30000 records,generally used in activity management in smallcompanies. That is why, instead of using MS Access2000 it is proposed a much stronger system ofdatabase administration, named MySQL (Welling ,2003).The proposed on-line application offers moreadvantages:- With this solution, the encrypt phase of dataand the transmission through the e-mail areeliminated, because it can bring a lot ofproblems; the data received by e-mail at theDRG National Bureau must be saved in acertain format, eventually a database, inorder to be consulted either withvisualization, or with the elaboration ofsome reports, statistics or graphics; whenadding in the same database informationresulted from different sources there mightbe a lot of data inconsistencies.- The data that DRG National Bureau sees arealways up to date; it is not necessary to waitfor the end of a certain period of time toreceive those data.- The application and the database servermust be installed on a single computer(server); it will be accessible for any user inthe range of his rights from his owncomputer, using a browser; in this manner itis not needed to install the application oneach client’s computer; of course, theserver’s performances must be very high.The application described below is a client/serverapplication implemented using Java technologies(Goodwill,2000) and represents the ideal solution toimplement a competitive database with minimumcosts (software costs are zero). It is based on aMySQL database server.2.2 The database descriptionAs we said above, the database used forimplementation is a MySQL database server. Thedatabase structure is the following:1. Table tblStatus allows encoding of thepatient status by means of two fieldsstatus_id (primary key) and status name.2. For encoding the diagnoses there are threetables tblClass, tblSubclass andtblDiagnoses connected by a 1:mrelationship because in one class there areseveral subclasses, and in one subclassthere are several diagnoses.3. For encoding the XR investigations and thefunctional explorations there is table tblXr,respectively tblInvestFunct4. There is also a table which allows theencoding of the surgical procedures,tblSurgical5. The table tblInt allows encoding of thedifferent types of hospital registrationSome other tables in the database are:6. In the table tblHospital there are data aboutthe hospital from the DRG network:hospital_id (primary key), hospital name,county, city, number of beds.7. In the table tblDepart there are data aboutthe departments from each hospital:department_id ( primary key), departmentname, hospital_id (foreign key) used toimplement the relationship 1:m between thetables tblHospital and tblDepart.8. In every department works a number ofdoctors about whom there are data in thetable tblDoctor: doctor_id (primary key),name, specialty, department_id (foreignkey) used to implement the relationship1:m between the tables tblDepart andtblDoctor.9. For a certain department and a certaindoctor are registered the patients who havea new sheet at every hospital record. Fortheir data a new table tblPatient wascreated having the following structure:sheet_id (primary key), personal_id, firstname, last name, sex, birth weight in thenew-born child case, data of registration,data of release from the hospital, doctor_id(foreign key) in order to know the doctorwho attended the patient, the code of thefirst principal diagnosis, the code of the

second principal diagnosis, the code of thesecondary diagnosis, the code of thehospitalization type, the code of the patientstatus.The database also contains a series of tables asthe result of the implementation of some m:mrelationships between the above tables.10. The table tblPatient_XR stores for everyobservation sheet identified by sheet_id thecodes of the effectuated XR investigations11. The table tblPatient_FuncExpl stores forevery observation sheet identified bysheet_id the codes of the effectuatedfunctional explorations12. The table tblPatient_Surgical stores forevery observation sheet identified bysheet_id the codes of the surgicalprocedures made during the hospitalizationtimeFig. 1. The user authentication windowDepending on the security level , the user will haveaccess to different application modules2.3 Thelevels of security and user rightsFor the application security some levels ofsecurity are created.The higher level is the zero degree, which is thedatabase administrator and he has all the rights.For identification a username and a password areused. One of its roles is to introduce in thetblHospital table a record for each hospital added inthe DRG system.For each hospital a new administrator is created,who has all the rights over his hospital information.This is the first level.The administrator from first level has thepossibility to view all the user data(diagnosis andinvestigation tables). Also the hospital administratorfrom first level can add a departement record in thetable tblDepart and one or more users for eachdepartment.Aloso he modify the department records. The is thesecond level. A user from the second level will haveaccess only to the information from the itsdepartment.Fig. 2. One of application modules depending on thelogged userWhen the user from zero level have to add a hospitaladministrator, the following window will be openedas in the bellow figure:2.4 Graphical User InterfaceAt the start of the application the user has tointroduce the username and the password for havingaccess to the application menu.The interface functions are presented in this paper.The main application window is presented in thefollowing figure:Fig. 3. The form by which an adminstrator of zerodegree adds a hospital administratorThe roles of the hospital administator are: creation ofa new department in the hospital which headministrates , the creation of a department user, thecreation of the doctors lists of the department.

Fig. 4. A form which permits to a hospitaladministator to add a department user and thedoctors’ listThe user from the second level (the department user)has no access to the operations of the user anddepartment creation. The department user has anoption for creating the patient sheet(PatientSheet), inwhich he can introduce information of the patientsfrom his department.Fig. 7. The form which permits the diverse reportscreation at the department, hospital or globallevelThe Report option permits the edit of diverse reports,either at the level of department or hospital or atglobal level. The access to these reports isdetermined by level of security, so that a user fromthe second level has access only to his departmentreports.Fig. 5. The form which allows the department user toadd patientsThe department user can introduce specific data ofthe patient: from general data to diagnosis andprocedures.Also the application allows the visualization of thedata, depending to the logged user. So the user canvisualize the patients, the diagnosis, the surgicalprocedures and the functional explorations.Fig. 7. The Report windowThe Search option permits the searching of thediagnosis, surgical procedures or functionalexplorations in the database. The searching form isthe same for all the users.Fig. 8. The searching windowFig. 6. The visualisation of the data from thedepartment or hospital level

CONCLUSIONSThe application described below is a client/serverapplication and represents the ideal solution toimplement a competitive database with minimumcosts (software costs are zero). It is based on aMySQL database server.This application is an alternative to the DRG –National application, which have a lot ofdesavantages.This paper has presented not only the drawbacksand the inconvenients of the used application, butalso a new solution.The new solution is not expensive and offers aseries of advantages:- The MySQL database has performancessuperior to those offered by MS Access- The data viewed by the DRG NationalBureau are every moment the up-to dateones, without having to wait for the end ofthe month- The application and the database areinstalled on a single computer, from whereis accessed by everyone who has the rights- The administration and the security of thedatabase have been realized by means ofsome security levels and of some views onthe database defined for each type of userIn the end, it has to be mentioned that theapplication is in the developing stage.REFERENCESGoodwill J. (2000). Pure JSP, Java Server Pages: ACode-Intensive Premium Reference, SmasDRG Romanian Oficial Page(2005)http://www.d rg.roWelling L, Thomson L. MySQL Tutorial, MySQLPress, 2003