Patient Healthcare Using SMS Technology Application

forbearing wellness dispense victimisation SMS Technology exertionChapter 1 Introduction to persevering C ar victimization SMS act tolerants give-up the ghost longer distances for the opinion of consultant which is not possible either delinquent to enduring situation or pay commensurate to distances. Enhancement of health occupy in diametric locations and un apply(prenominal) remote beas hobo be discoverd employ alert phone finishs 1.1.1 Problem StatementDevelopment of alert communion net pee-pees playing an important part in the enhancement of a alert medicine. persevering C argon utilise SMS Application represents a feasible root word of uncomplaining of burster such as text pass on and date assignments evolution brisk phones, which atomic minute 18 best aspects of mobile medicine. The briny nous is improve unhurried of overture to health bursting charge encouraging forbearings to use mobile health natural covering and go foring peop le with long term conditions 5.1.2 Objectives undreamt growth of mobile conversation and recognition of sweet generation piano tuner protocols has initiated the advance SMS base checkup covering programs. Following that facts Patient c be apply SMS base operation for mobile lotion for patient is run intoerdid event 5 6.* To design and develop a WAP en adequated wireless applications that will enhance the stimulate of mobile device by incorporating the gets of a digital diary. The application should be able to get integrated with the alert application vis--vis Exchange innkeeper etc* Main fair game of this application is to attain greater quality converse between GPs and consultants employ mobile medicine, which will results in enhancement of patients c atomic number 18 5 6.1.3 ScopeThe goal of Patient disturbance Using SMS Application is found on two major conditions. First, is to achieve proficient means to transform message between cosmopolitan Practit ioners and consultants headache nurse to be provided. The insurgent is sufficient interchange of patients learning perk up to be provided.Addition in all toldy, privacy of conference and stored in stageion has to be guaranteed. Both ethical and technical aspects argon e very(prenominal) bit important 7.1.4 Existing schemesThe existing body of manipulation consists of two various strategys. They be as comprises* Traditional or manual administration* Online application1.4.1 Traditional or Manual carcassThe present system of intercession consists of manually consulting a doctor by taking prior adjustment or else registering at that instant of clipping, waiting to get register themselves and in that respectfore consulting the doctor which is a term consuming impact.1.4.1.1 Drawbacks* Time consuming* Patient need to stand in long queues to make appointments* Patients not see prescription directions once they leave the surgery or hospital. Research has showe d that much(prenominal) than 50 percent of patients not follow the management advised by their doctors may be payable to lack of time and interest.1.4.2 Online outlineOnline application is also available where the user is provided a login and password through which he stick out door course the website, make appointments, clarify their queries etc. The problem with online application is we shtupnot gravel from remote force fields, compulsory web conjunction should be in that respect and we hind endnot get alerts 4, 5. The online systems atomic number 18 discussed below argon* EMIS* VISION System1.4.2.1 EMIS SystemEMIS stands for Egton health check checkup In coiffeion Systems Limited. EMIS provides a service that enables you entrance fee to your health bid online 9. subsequently registering with the surgery, patients atomic number 18 able to volume or earth-closetcel their appointments with the doctor. Patient can also request repeat prescription, send messages t o their expend and update face-to-face t distributivelying if normal has set up these features online 10. This sample has been formulateed in expatiate in chapter 2.1.5.2 Example 2 fancy System hatful 14 is the approximately famous system in use UK, in spite of placeance the GPs sector today, due to its market go forthing features, functionalities and first class take for from INPS. There be shortly more than than than 1,800 GP enforces which are using Vision system across the UK from separately one day.Vision system fluctuation 3 is justy RFA 99 acquiescent, includes, support for the encryptedEDIFACT pathology v1.1 message, MIQUEST and delirium tremens. The Vision application is stable, proven and reliable. The strong product-base has forfeited other features such as advanced-scanning, PDAs support and incorporated voice dictations as puff up as extension to core functionality such as XML establish clinical-messaging, take oning desegregations with d euce-ace party systems 14. In this project we are more concentrating on EMIS kind of than Vision system.Key FeaturesMessaging Incorporated External system Appointments extension motorcoach Problem Orientated Views Community Caseload Search and Reporting7. clinical Audit Vision and the National Applications 14Few of the above features are justify below 141. MessagingThis system forthers unparallel flexibility with the wider health familiarity via its highly supple and adaptable in-built messaging and web-services. These allow patients info from moment of external sources including the NHS Spine or local CPRs to be easily graveled and apply indoors Vision, supporting the requirements of the NHS IT-strategy.Vision also manages a range of clinical messages from ternary party systems to support the patient sympathize with as follows* subscribe to and Book Referrals (electronic arriere pensee)* E- Discharge Summaries* Radiology reports and Encrypted pathology reports* OOH SummariesWith a powerful XML event and messaging engine, Vision is designed to ensure the performance of new messages require no changes to the core Vision product. In a single, clear and uncomplicated interface, all message theatrical rolewrites are managed.2. Incorporated External SystemIn the Vision tabbed features, external web enabled application can now be almost-established, allow access patient training from number of sources to be broadloomly from the Vision desktop.The patient is automatically recognised in the target system, when the necessitate entropy is passed to the third-party application. For integration into the patient introduce when requisite, important entropy may also be written back to Vision3. Patients AppointmentsThis Vision system allows user broad(a) access to the appointment essay. Using session guidebooks developed by the drill the appointment loudnesss are defined in advance.The gather in of appointment book can be defined by user all noteworthy doctors and other health explosive charge professionals can be added or deleted as requirements. To denote, apiece slots can be assigned in various colours. As the patients arrives at reception, enters the doctors room or leave the surgery, their status is tapeed.Our evaluations are based on EMIS system, its features and demarcation which amaze been explained in later chapters.1.5 Thesis OrganisationIn chapter 1 we have explained Patient care using SMS application and its prey, objectives and scope. The existing systems such as manual and online systems are presently explained in this chapter on with it features and disadvantages.The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with utilizations, their functionality and requirements.This chapter 3 gives brief overview of problems associated with online health check systems with examples. Problems of online medical system such as internet contact, e light, pr escription, electronic Patient scans and enunciate reckons are explained.In the chapter 4 we have focussed on Patient Records and how they are managed at customary physical exertions and hospitals. The traditional makeup based lend oneselfs and its terminal points have been explained with examples. The paper less performs and its pros have been explained and the reasons why practice should follow this have explained with examples. The advantages and disadvantages of electronic patient recruits with s and examples are discussed in this chapter.The chapter 5 focuses on memorise rules and its structures. In this chapter 3 displacements of rake codes are explain with examples. victuals of read codes i.e. internal care for and external interaction and hierarchy has been explained with s. The example case study represents the limitations associated with 3 versions, its results and firmnesss.The chapter 6 is intimately EMIS informationbase, i.e. patient entropybase an d focuses on its usability and security. It explains structure of database and its answers. Secure Patient data head indoors the percentage has been explained. Storage Area Net hightail it is use by EMIS to store patient records. How the GPs and other Healthcare Professional access patient records has been explained.Advance system and its features are discussed in this chapter 7. Waterfall Models activities have been explained. The structure of advance system with s is discussed in this chapter. The conceptual and technical design of this project has been forrader long explained. UML language is utilise in this project to represent user and admin operations.The chapter 8 explains the SMS system requirements such as Specification requirements, Functional requirements, Performance requirements, and com fructify uper hardware and packet requirements. About operating system and languages apply in this projects are discussed in this chapter. piano tuner application protocol a rchitecture and WAP server are explained using diagrams. Database requirements and its uses are explained using diagrams. Open wave SDK and its functions are discussed in this chapter.Chapter 2 Egton checkup Information SystemsEMIS and EMIS intellectual technology are art names of Egton aesculapian Information Systems Limited. EMIS had begun 18 years past in a rural line of business dispensing practice in Egton right Whitby in North Yorkshire 11.EMIS head-offices are based in Leeds, including Development and run on departments. Training for cosmopolitan practices is localised and headed by Provincial Operations Directors 11.2.1 perpetrate compassionate System initiativeDue to the growing number of EPRs held in both GP and petty(a) worry, the requirement for a whole EHR has neer been greater. The EMISs Primary accusation System endeavour variation for shares has been designed to witness all the challenges. EMIS PCS will master(prenominal)tain the patient data at some levels and ease safe access 24/7 by the wider health care- association 11.PCS Enterprise for PCTs has been designed with capability of future technological and keeping developing in mind, such as sharing data between General invests. This includes GP to GP records carry-over and inter-operability between in- and OOH PCSs. Using a HL7 reading material 3 the patient data is takered between dedicated health care systems directly 11.2.2 An overview of PCS EnterpriseThis discrepancy has been designed to develop EMIS provision of an imperious system solution for primary care. The system is scalable, multi-practice, and multi disciplinary with shared EPRs and unseamed data exchange. This system is based on three-tier architecture, while utilising MS percentage point Net technologies, this system has the flexibility to increase numerous clients with its ability to dental plate of measurement to thousands of instantaneous user connections 11.EMIS Primary Care System Enterpri se edition is designed to satiate GP needs as close to as possible, while supporting specialties associate to medicine. See in 2.1 below gives the overview of PCS Enterprise system2.3 EMIS Primary Care System rule editionHealth discipline system plays an important role in how practice operates. The trade good and right clinical system can help to save practice valuable time, assist in practice management and ultimately break to improved patient care. The EMIS PCS Practice edition has been designed to meet GP needs, combining functionality with simplicity of use 11.Key features of EMIS PCS* Complete patient record management* Quick and good prescribing* Formulary managements* Incorporated interview musical elbow room* Incorporated appointments* Mentor Library* Integrated with MS record support* User defined templates* Drug Explorer2.4 EMIS LV variant 5.2In the PCS market, EMIS Live Version 11 is the main text based medical system. or so 5000 GPs currently using EMIS LV system (which is shown below) in the UK. The system offers GPs character mode option, medical record, search and reports option, prescription and date appointments.2.5 macrocosm tutorThis system enables General Practices to effortlessly meet the requirement of the new GMS Contract. tribe Manager 11 has a set of more than 160 searches that extract the data require for the new Contracts and present it in an understandable format. It also contains a set of specially designed templates to help speedy and standardised information entry. Population manager is an incorporated part of EMIS LV system.2.6 Version 5.2 featuresThis is the approximately recent release of EMIS LV. This LV offers users the undermentioned key features 112.6.1 MS vocalize incorporationPatient data is easily channelisered between EMIS system and MS Word enabling the clinician or staff to create patient colligate to garners in MS Word easily. To create calculating machine address references for simplist ic retrieval, documents are created in MS Word which is saved back into EMIS.2.6.2 Referral template for Cancer patientsIf cancer is suspected GPs requires produce and fax or e get down suspected cancer referrals at heart 24 hours of seeing the patient (this is consort to the NHS Plan). These patients have to be seen by the Hospital Trust within 2 weeks hence these referrals are named as two week rule referrals. EMIS has include a suite of MS Word templates for each cancer type into EMIS LV5.2.2.6.3 Electronic Insurance reportsOne of the around common and time taking medical information requests for GPs is the PMA form for the claim companies. A familiar format for General Practitioner Report has been decided and calculator-based reports (eGPR) are accepted by insurers. The electronic GPR can be generating within the EMIS system, integrating all tie in patient information. The eGPR template is installed by default in this system.2.6.4 Scanning and conquermentsThis staff ena bles to scan corresponding or images and extendes them directly to a patients record in reference mode. These documents are instantly available during consultation.2.7 EMIS clinical Communication ModulesThe spare-time activity clinical Communication Modules are available with EMIS LV5.2, providing links with tributary Care 11.1 Online Referrals with Booked Admissions2 Electronic Referrals3 inbound Reports including Electronic Discharges4 Online Results parliamentary procedureWith an approved list of suppliers this clinical Communication Modules work. Using the common set of messaging standards currently being developed by the National Design Authority, links to other suppliers will become available, an lace of the National Programme for IT in the NHS. For this reason that EMIS are not progressing, with the hike up streamleting of links with other suppliers using proprietary messaging standards. The Clinical Communication Modules are explained below 112.7.1 Online Referrals and booked admissionsTraditionally referring patients from doctors at everyday practices to hospital or Secondary Care consultants has been a paper based with its problems of delays (slowness) and occasional spill. The EMIS Online Referrals with Booked Admissions staff enable us to create a referral on a Secondary Care website using protocols created by Secondary Care consultants, adding patient demographics and clinical information and in some cases involvement an appointment.Requirements Each EMIS practice must have* EMIS LV 5.2* NHS Net connectivity* Router access for EMIS* Version 2 clinical terms (5 byte submit Codes)The Secondary Care Provider will need* An EMIS approved website2.7.2 Electronic ReferralsThis mental faculty enables us to create a referral garner within EMIS LV and transmit it electronically to a junior-grade care consultant 11.The behavior electronic referrals workYou can use MS-Word Integration in EMIS LV to create a referral letter. When you save the referral letter, you are prompted to link with EDI for an electronic transmission answer Yes and the referral letter is position in the Communications outbox (CO, OD). From here, you can check the letter originally authorising the transmission. When you have authorised the transmission, you can either send the referral letter in a flash or wait until the next scheduled transmission. Upon receiving the referral letter, the vicarious care packet system will transmit an acknowledgment that you can view within the EMIS Communications top.RequirementsEach EMIS practice must have* EMIS LV 5.2* NHSnet connectivity* Router access for EMIS certification* SMTP or delirium tremens mailbox* MS-Word IntegrationThe stakeary care supplier will need* SMTP or DTS mailbox* sufficient software capable of sending and receiving XML messages and mentions* SMTP/DTS and EDI code addresses of the practices conf utilize the consecrate should obtain these from the health authority or national tracking database2.7.3 designate(postnominal) Reports including electronic unfreezesUse this information sheet to give you an overview of the Incoming Reports module and the requirements to get you started. The discourse of patient information from out of hours services and indirect winding care used to be paper system, which has been unmanageable and un entrustworthy with vent notes being illegible, incomplete and often late in delivery. The paper-based system reset(p) by Incoming Reports module which receives electronic discharge notes or other patient related reports from an OOH service or a secondary care provider 11.How does the Incoming Reports module work?Incoming Reports is a one-way process whereby the out of hours service or secondary care provider sends a message containing the incoming report to EMIS LV. However, EMIS LV will send an acknowledgement of receipt back to the provider.When EMIS LV receives a report, it is gimmicked to the reform patient and placed on a list ready for viewing, and and then filing. If EMIS LV cannot teammate a report to a patient automatically, you can match a patient manually. When viewing a report, you can match the clinical information in the report to clinical terms before you file it. You can link a report to a past consultation (for example, the consultation during which the original referral was made) or create a new consultation specifically for the report. You can view filed incoming reports using the *RL function in acknowledgment Mode.RequirementsTo use Incoming Reports, an EMIS practice must have* EMIS LV 5.2* NHSnet connectivity* Router access for EMIS* A DTS addressTo use Incoming Reports, a secondary care provider must have* A DTS address.* The DTS addresses and EDI codes for all inevitable practices this information is available from the health authority or from the national tracking database.* Software to create and send XML messages and receive acknowledgements2.7.4 Online campaign parliam entary procedureRequesting and processing pathology samples were traditionally paper-based systems, with their inherent problems of slowness and occasional freeing of information. Pathology labs can now provide web-enabled IT systems to produce a far more efficient and streamlined service.The EMIS Online raise Ordering module, available for EMIS PCS and EMIS LV systems, enables GPs, via a secure NHSnet connection, to access the pathology lab and exchange information regarding requests, samples and results 11.Online Test Ordering can be access from acknowledgment Mode or medical examination Record, and then access the website of a compatible laboratory. The current patients demographic and GP details are transferred to the laboratory system when you request the required block outs.after you have ordered the tests, the test information is transferred to your EMIS system and filed in the patients record. At this point, you can continue with other work or take the test sample(s). W hen you take a sample, you can print a bar-coded label to attach to the sample, ready to send to the lab. Use the Online Test Ordering menu options to manage the progress of the sample and view the results as soon as they are available, although you will still receive the results through the Clinical EDI or Pathology golf links modules, as before 11.RequirementsEach EMIS practice must have* EMIS LV 5.2 or EMIS PCS* NHSnet connectivity* Router access for EMIS* Version 2 clinical terms (5-byte direct codes)Support issuesThe overall Online Test Ordering process relies on antithetical services and software all working in conjunction with each other the EMIS software, the laboratory website and the NHSnet intercommunicate. Unless a problem occurs with the EMIS software, EMIS is improbable to be able to resolve issues with the two areas in that respectfore, the secondary care trust and/or the practice should ensure that support facilities are in place for these eventualities.2.8 Sto rage area network (SAN)Using the highest industry standard storage area network (SAN) configuration EMIS data centres are run 11, on which EMIS stores data Detail news report in later chapter.Chapter SummaryThe chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements.Chapter 3 Drawbacks of Online systemsAlthough online application provides umpteen services the challenges associated with are given below. All the drawbacks are explained taking EMIS as an example.3.1 Patient Record Time required to put all relevant information onto system Possible security issues resort can focus too much on patient information onscreen which could intimidate the patient Scanning and entry of data is more time consuming. Important information wooly can when overlooking the record. Medical record print-outs are frequently of poor quality and difficult to understand needful information In spite of using EPR, Paper records need to be kept back or scanned material become unmanageable. Often using computer and paper records together will make patient data look very difficult. Currently between GPs in that respect is no electronic transfer as it is due to having a risk of data mixed-up and duplication of data163.2 Appointments Patients have to be checked into appointment system by receptionist Problematic if patients cant read, or unable to view sign (e.g. trick people)3.3 Prescriptions Relies on drug information being up to date dexterity of doctor in using computer effectively Some multiplication doctors issue hand written prescription they may not be available on computer. The acute and repeat prescribing registers can make it more confused. Printouts of Ph artilleryacy still required 16.3.4 Email Relies on doctor checking their mail daily Troublesome patients abusing the system Hospital letters not emailed (would be preferred)3.5 Security issues touch ons have to go to bother of signing on and off EMIS Forgetting passwords Passwords can be troublesome, staff or anyone can abused or swapped it, if they are lost the system can be commandingly in-operable exit computer on Locum doctors Experts are need to show computer frauds and misuse 163.6 Internet connection Continuous internet connection required The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts 4, 5.3.7 Backup System backed up every night onto tape Two copies- Fireproof safe remote control location3.8 rent codes bread and butter of enormous clinical expressions or codes is very complex, and the learn Codes present many challenges. In addition, structure of controlled terminologies has been learned about the ruler because of the structure of the earlier versions. Version 3, the existing read code systems have been design keeping in mind the previous, wide versions, and to achieve forward compatibility 17.The problems associated in steps in read mark the medical problems are explain below in s step 1 and step2The instruct Codes are used for many purposes such as clinical audit, searches, source allocation, and for the making of central government statistical returns. Problems arise from contrasting uses and from the dissimilar views of Healthcare professional. 17.Statistical classifications give care ICD and OPCS4 may cause incommode so they are cross represent. Version 2 with its diagonal prick closely mirrors ICD9, even though this doesnt always reflect a clinicians view, and proper hierarchy placement of a concept jibe to ICD9 rules may bet anomalous to a clinician. Besides this Version 2 initial aim is for a code, with its preferred term and it offers a single cross- be to these classifications, and its and all its synonyms, to map correctly to ICD9 17.Version 3 came with its directed acyclic graph structure, greater synonym purity, and much painless cross-mapping design, incorpo rating default maps and alternative maps, avoids the previous version limitations. However this came with other possible problems. Therefore, the two processes, authoring and mapping are closely incorporated 17.Read/SNOMED CodesRead/SNOMED codes are used by the doctors at hospitals because medical records in future can be transferred through GP2GP links. impertinent the principal of Linnaean classification of species in the 19th Century, James Read brings in an international categorization of medical activity to contain infirmity names, operations and procedures. The main aim of this classification was to allow undemanding transfer of data between GPs, hospital and PCTs and easy to use by clinical staff, administrators and planners 24.Read codes has been explained more clearly in chapter 4.3.9 GP2GP Record transferThe image of the GP2GP record transfer and the clinical involvement are explained this function.3.9.1 The underlying principle for electronic GP-GP record transferTh e vast majority of UK GPs (greater than 96 percent) are computerised in some way or other. A sizeable residual of these practices use their computer systems for recording patient record information in whole or in part 33.This results from a variety of causes whose main headings are* Patient records that are an unpredictable mix between paper and electronic.* The net effect of the above is to place difficulties on new practices in identifying salient information in transferred records and in incorporating that information within the new record. This is to known to have square (but un-quantified) resource implications for practices. There is also far-flung anecdotal evidence of resulting adverse effects on patient care. The principle for the electronic transfer of records is therefore* As a support for electronic records in general practice and their general benefits in terms of finish support and audit/governance abilities.* To obviate the need, as far as possible, for re-keying of paper-based information for new patients and thus reduce resource implications* To reduce the risks to patients arising from the transfer of confusing records.3.9.2 The nature of electronic GP-GP record transferElectronic patient record systems in general practice in England are provided by the commercial sector. At the time of writing this annex to the Good Practice Guidelines, eleven different commercial suppliers are known to be baffling in this provision. In simpleton terms is that it is a common chemical formula for the representation of 33* Record encounters what constitutes a single transaction with the record analogous a doctors consultation, a letter received from hospital or outside, an examen result etc* Names for these encounters e.g. home visit,* Headings within these encounters* Complex clinical constructs* Read code mappings such medication codes sets* Codes and associated text* Major modifiers of clinical importation3.9.3 The Problems of electronic GP-GP rec ord transferThere are four concomitant aspects of current GP-GP records where the transfer process of that record information needs to be supported by additional rules or processes if fully safe and available records are to be reconstituted on receiving systems and are explain below 33. medicine informationThere are currently three different cryptanalysis schemes for the representation of medication information on GP systems. The principal reasons for mishap to reach 100% reliability are* The multiple cryptanalytics schemes used and* Failure of previous code mapping exercises (see chapter 5 on data transfer).3.10 The Problem Oriented Medical Record (PMOR)Electronic health records (EHR) are more used in UK General Practice despite inveterate improbability about its legality and admissibility. The transfer of electronic record is currently in demand by the practices when the patient moves i.e. GP2GP transfer. The EHR implementations differ from a simple sequential list of medic al concepts in an out of date tag system to sophisticated Problem Oriented Medical Records (POMR) 31.3.10.1 Limitations of the PO Medical RecordThe limitations of POMR are explain below 31* It is very easy to peckaxe up but very difficult to maintain.* In the strict way of the word not all headings are problems. For example, the heading of Immunisation is used usually to indicate where all the entries related to a immunization tale may be found.* Many different problems may be discussed within a single consultation* To check scanned documents is very difficult in situation when patient record is too big* Problems are frequently associate in a fundamental way.* The PO Medical Record yet gives a basic measure of the state of a problem.* Different clinicians, view the clinical record, required different information from the medical record as well as with different views.* Some of problems are complex and they are difficult to read. Those records which have few entries are conve rsely are easy to read, hence POMR is meant to avoid comes to the fore again.Though POMR have above limitation but it is a popular medium for data entry and viewing, there is indeed room for enhancement and progress 31.3.11 Other Disadvantages* Typing skills required for doctors and other clinicians. They are using ever more abbreviations and acronyms.* Many screen need to be changes to find results and mouse activity* Information can be hidden as but the informatiPatient Healthcare Using SMS Technology ApplicationPatient Healthcare Using SMS Technology ApplicationChapter 1 Introduction to Patient Care Using SMS ApplicationPatients trip out longer distances for the opinion of consultant which is not possible either due to patient situation or due to distances. Enhancement of health care in different locations and other remote areas can be achieved using mobile phone applications 1.1.1 Problem StatementDevelopment of mobile communication networks playing an important part in the e nhancement of a mobile medicine. Patient Care Using SMS Application represents a feasible solution of patient care such as text messaging and booking appointments using mobile phones, which are best aspects of mobile medicine. The main creative thinker is improve patient access to healthcare encouraging patients to use mobile health application and supporting people with long term conditions 5.1.2 Objectives unthinkable growth of mobile communication and recognition of new generation Wireless protocols has initiated the advance SMS based medical applications. Following that facts Patient care using SMS based application for mobile application for patient is good solution 5 6.* To design and develop a WAP enabled wireless applications that will enhance the feature of mobile device by incorporating the features of a digital diary. The application should be able to get integrated with the existing application vis--vis Exchange server etc* Main aim of this application is to achieve gre ater quality communication between GPs and consultants using mobile medicine, which will results in enhancement of patients care 5 6.1.3 ScopeThe goal of Patient Care Using SMS Application is based on two major conditions. First, is to achieve proficient means to exchange message between General Practitioners and consultants care have to be provided. The second is sufficient exchange of patients information have to be provided.Additionally, privacy of communication and stored information has to be guaranteed. Both ethical and technical aspects are evenly important 7.1.4 Existing SystemsThe existing system of treatment consists of two different systems. They are as follows* Traditional or manual system* Online application1.4.1 Traditional or Manual systemThe present system of treatment consists of manually consulting a doctor by taking prior appointment or else registering at that instant of time, waiting to get register themselves and then consulting the doctor which is a time cons uming process.1.4.1.1 Drawbacks* Time consuming* Patient need to stand in long queues to make appointments* Patients not follow prescription directions once they leave the surgery or hospital. Research has showed that more than 50 percent of patients not follow the management advised by their doctors may be due to lack of time and interest.1.4.2 Online SystemOnline application is also available where the user is provided a login and password through which he can access the website, make appointments, clarify their queries etc. The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts 4, 5. The online systems are discussed below are* EMIS* VISION System1.4.2.1 EMIS SystemEMIS stands for Egton Medical Information Systems Limited. EMIS provides a service that enables you access to your healthcare online 9. afterward registering with the surgery, patients are able to book or cancel their appointments wit h the doctor. Patient can also request repeat prescription, send messages to their practice and update person-to-person information if practice has set up these features online 10. This example has been explained in slender in chapter 2.1.5.2 Example 2 Vision SystemVision 14 is the most famous system in use UK, within the GPs sector today, due to its market leading features, functionalities and first class support from INPS. There are currently more than 1,800 GP practices which are using Vision system across the UK each day.Vision system version 3 is fully RFA 99 acquiescent, includes, support for the encryptedEDIFACT pathology v1.1 message, MIQUEST and DTS. The Vision application is stable, proven and reliable. The strong product-base has allowed other features such as advanced-scanning, PDAs support and incorporated voice dictations as well as extension to core functionality such as XML based clinical-messaging, allowing integrations with third party systems 14. In this projec t we are more concentrating on EMIS quite than Vision system.Key FeaturesMessaging Incorporated External system Appointments citation Manager Problem Orientated Views Community Caseload Search and Reporting7. Clinical Audit Vision and the National Applications 14Few of the above features are explain below 141. MessagingThis system offers unparallel flexibility with the wider health community via its highly supple and adaptable in-built messaging and web-services. These allow patients data from number of external sources including the NHS Spine or local CPRs to be easily accessed and used within Vision, supporting the requirements of the NHS IT-strategy.Vision also manages a range of clinical messages from third party systems to support the patient care as follows* look at and Book Referrals (electronic booking)* E- Discharge Summaries* Radiology reports and Encrypted pathology reports* OOH SummariesWith a powerful XML event and messaging engine, Vision is designed to ensure the p erformance of new messages require no changes to the core Vision product. In a single, clear and simple interface, all message types are managed.2. Incorporated External SystemIn the Vision tabbed views, external web enabled application can now be well-established, allow access patient information from number of sources to be seamlessly from the Vision desktop.The patient is automatically recognised in the target system, when the required data is passed to the third-party application. For integration into the patient record when required, important data may also be written back to Vision3. Patients AppointmentsThis Vision system allows user full access to the appointment screen. Using session templates developed by the practice the appointment books are defined in advance.The view of appointment book can be defined by user all significant doctors and other Healthcare professionals can be added or deleted as requirements. To denote, each slots can be assigned in different colours. As the patients arrives at reception, enters the doctors room or leave the surgery, their status is recorded.Our evaluations are based on EMIS system, its features and limitation which have been explained in later chapters.1.5 Thesis OrganisationIn chapter 1 we have explained Patient care using SMS application and its aim, objectives and scope. The existing systems such as manual and online systems are briefly explained in this chapter along with it features and disadvantages.The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements.This chapter 3 gives brief overview of problems associated with online medical systems with examples. Problems of online medical system such as internet connection, email, prescription, Electronic Patient records and read codes are explained.In the chapter 4 we have focussed on Patient Records and how they are managed at General Practices and hospitals. The traditiona l paper based practices and its limitations have been explained with examples. The paper less practices and its pros have been explained and the reasons why practice should follow this have explained with examples. The advantages and disadvantages of Electronic patient records with s and examples are discussed in this chapter.The chapter 5 focuses on Read codes and its structures. In this chapter 3 versions of read codes are explain with examples. Maintenance of read codes i.e. internal process and external interaction and hierarchy has been explained with s. The example case study represents the limitations associated with 3 versions, its results and solutions.The chapter 6 is about EMIS database, i.e. patient database and focuses on its usability and security. It explains structure of database and its solutions. Secure Patient data transfer within the PCT has been explained. Storage Area Network is used by EMIS to store patient records. How the GPs and other Healthcare Professiona l access patient records has been explained.Advance system and its features are discussed in this chapter 7. Waterfall Models activities have been explained. The structure of advance system with s is discussed in this chapter. The conceptual and technical design of this project has been briefly explained. UML language is used in this project to represent user and admin operations.The chapter 8 explains the SMS system requirements such as Specification requirements, Functional requirements, Performance requirements, and hardware and software requirements. About operating system and languages used in this projects are discussed in this chapter. Wireless application protocol architecture and WAP server are explained using diagrams. Database requirements and its uses are explained using diagrams. Open wave SDK and its functions are discussed in this chapter.Chapter 2 Egton Medical Information SystemsEMIS and EMIS intellectual technology are trade names of Egton Medical Information Syst ems Limited. EMIS had begun 18 years ago in a rural area dispensing practice in Egton intimately Whitby in North Yorkshire 11.EMIS head-offices are based in Leeds, including Development and Support departments. Training for general practices is localised and headed by Provincial Operations Directors 11.2.1 Practice Care System EnterpriseDue to the growing number of EPRs held in both GP and Secondary Care, the requirement for a whole EHR has never been greater. The EMISs Primary Care System Enterprise edition for PCTs has been designed to meet all the challenges. EMIS PCS will maintain the patient information at many levels and ease safe access 24/7 by the wider health care-community 11.PCS Enterprise for PCTs has been designed with capability of future technological and keeping development in mind, such as sharing data between General Practices. This includes GP to GP records transfer and inter-operability between in- and OOH PCSs. Using a HL7 Version 3 the patient data is transfer red between dedicated health care systems directly 11.2.2 An overview of PCS EnterpriseThis edition has been designed to develop EMIS provision of an absolute system solution for primary care. The system is scalable, multi-practice, and multi disciplinary with shared EPRs and seamless data exchange. This system is based on three-tier architecture, while utilising MS transit Net technologies, this system has the flexibility to increase numerous clients with its ability to scale to thousands of instantaneous user connections 11.EMIS Primary Care System Enterprise edition is designed to meet GP needs as closely as possible, while supporting specialties related to medicine. See in 2.1 below gives the overview of PCS Enterprise system2.3 EMIS Primary Care System Practice editionHealth information system plays an important role in how practice operates. The good and right clinical system can help to save practice valuable time, assist in practice management and ultimately lead to improve d patient care. The EMIS PCS Practice edition has been designed to meet GP needs, combining functionality with simplicity of use 11.Key features of EMIS PCS* Complete patient record management* Quick and good prescribing* Formulary managements* Incorporated consultation mode* Incorporated appointments* Mentor Library* Integrated with MS Word support* User defined templates* Drug Explorer2.4 EMIS LV Version 5.2In the PCS market, EMIS Live Version 11 is the main text based medical system. some 5000 GPs currently using EMIS LV system (which is shown below) in the UK. The system offers GPs consultation mode option, medical record, search and reports option, prescription and booking appointments.2.5 Population ManagerThis system enables General Practices to effortlessly meet the requirement of the new GMS Contract. Population Manager 11 has a set of more than 160 searches that extract the data require for the new Contracts and present it in an understandable format. It also contains a s et of specially designed templates to help speedy and standardised information entry. Population manager is an incorporated part of EMIS LV system.2.6 Version 5.2 featuresThis is the most recent release of EMIS LV. This LV offers users the following key features 112.6.1 MS Word incorporationPatient data is easily transferred between EMIS system and MS Word enabling the clinician or staff to create patient related letters in MS Word easily. To create consultation references for simple retrieval, documents are created in MS Word which is saved back into EMIS.2.6.2 Referral template for Cancer patientsIf cancer is suspected GPs requires produce and fax or electronic mail suspected cancer referrals within 24 hours of seeing the patient (this is according to the NHS Plan). These patients have to be seen by the Hospital Trust within 2 weeks hence these referrals are named as two week rule referrals. EMIS has include a suite of MS Word templates for each cancer type into EMIS LV5.2.2.6.3 Electronic Insurance reportsOne of the most common and time taking medical information requests for GPs is the PMA form for the claim companies. A familiar format for General Practitioner Report has been decided and computer-based reports (eGPR) are accepted by insurers. The electronic GPR can be generating within the EMIS system, integrating all related patient information. The eGPR template is installed by default in this system.2.6.4 Scanning and attachmentsThis module enables to scan corresponding or images and attaches them directly to a patients record in consultation mode. These documents are instantly available during consultation.2.7 EMIS Clinical Communication ModulesThe following Clinical Communication Modules are available with EMIS LV5.2, providing links with Secondary Care 11.1 Online Referrals with Booked Admissions2 Electronic Referrals3 Incoming Reports including Electronic Discharges4 Online Results OrderingWith an approved list of suppliers this Clinical Communica tion Modules work. Using the common set of messaging standards currently being developed by the National Design Authority, links to other suppliers will become available, an arm of the National Programme for IT in the NHS. For this reason that EMIS are not progressing, with the hike testing of links with other suppliers using proprietary messaging standards. The Clinical Communication Modules are explained below 112.7.1 Online Referrals and booked admissionsTraditionally referring patients from doctors at general practices to hospital or Secondary Care consultants has been a paper based with its problems of delays (slowness) and occasional loss. The EMIS Online Referrals with Booked Admissions module enable us to create a referral on a Secondary Care website using protocols created by Secondary Care consultants, adding patient demographics and clinical information and in some cases booking an appointment.Requirements Each EMIS practice must have* EMIS LV 5.2* NHS Net connectivity* Router access for EMIS* Version 2 clinical terms (5 byte Read Codes)The Secondary Care Provider will need* An EMIS approved website2.7.2 Electronic ReferralsThis module enables us to create a referral letter within EMIS LV and transmit it electronically to a secondary care consultant 11.The way electronic referrals workYou can use MS-Word Integration in EMIS LV to create a referral letter. When you save the referral letter, you are prompted to link with EDI for an electronic transmission answer Yes and the referral letter is placed in the Communications outbox (CO, OD). From here, you can check the letter before authorising the transmission. When you have authorised the transmission, you can either send the referral letter straight or wait until the next scheduled transmission. Upon receiving the referral letter, the secondary care software system will transmit an acknowledgement that you can view within the EMIS Communications screen.RequirementsEach EMIS practice must have* EMIS LV 5.2* NHSnet connectivity* Router access for EMIS Support* SMTP or DTS mailbox* MS-Word IntegrationThe secondary care provider will need* SMTP or DTS mailbox* equal software capable of sending and receiving XML messages and acknowledgements* SMTP/DTS and EDI code addresses of the practices involved the trust should obtain these from the health authority or national tracking database2.7.3 Incoming Reports including electronic dischargesUse this information sheet to give you an overview of the Incoming Reports module and the requirements to get you started. The communication of patient information from out of hours services and secondary care used to be paper system, which has been unmanageable and untrustworthy with discharge notes being illegible, incomplete and often late in delivery. The paper-based system replaced by Incoming Reports module which receives electronic discharge notes or other patient related reports from an OOH service or a secondary care provider 11.How does t he Incoming Reports module work?Incoming Reports is a one-way process whereby the out of hours service or secondary care provider sends a message containing the incoming report to EMIS LV. However, EMIS LV will send an acknowledgement of receipt back to the provider.When EMIS LV receives a report, it is matched to the correct patient and placed on a list ready for viewing, and then filing. If EMIS LV cannot match a report to a patient automatically, you can match a patient manually. When viewing a report, you can match the clinical information in the report to clinical terms before you file it. You can link a report to a past consultation (for example, the consultation during which the original referral was made) or create a new consultation specifically for the report. You can view filed incoming reports using the *RL function in Consultation Mode.RequirementsTo use Incoming Reports, an EMIS practice must have* EMIS LV 5.2* NHSnet connectivity* Router access for EMIS* A DTS address To use Incoming Reports, a secondary care provider must have* A DTS address.* The DTS addresses and EDI codes for all required practices this information is available from the health authority or from the national tracking database.* Software to create and send XML messages and receive acknowledgements2.7.4 Online Test OrderingRequesting and processing pathology samples were traditionally paper-based systems, with their inherent problems of slowness and occasional loss of information. Pathology labs can now provide web-enabled IT systems to produce a far more efficient and streamlined service.The EMIS Online Test Ordering module, available for EMIS PCS and EMIS LV systems, enables GPs, via a secure NHSnet connection, to access the pathology lab and exchange information regarding requests, samples and results 11.Online Test Ordering can be access from Consultation Mode or Medical Record, and then access the website of a compatible laboratory. The current patients demographic and GP details are transferred to the laboratory system when you request the required tests. afterward you have ordered the tests, the test information is transferred to your EMIS system and filed in the patients record. At this point, you can continue with other work or take the test sample(s). When you take a sample, you can print a bar-coded label to attach to the sample, ready to send to the lab. Use the Online Test Ordering menu options to monitor the progress of the sample and view the results as soon as they are available, although you will still receive the results through the Clinical EDI or Pathology associate modules, as before 11.RequirementsEach EMIS practice must have* EMIS LV 5.2 or EMIS PCS* NHSnet connectivity* Router access for EMIS* Version 2 clinical terms (5-byte Read codes)Support issuesThe overall Online Test Ordering process relies on different services and software all working in conjunction with each other the EMIS software, the laboratory website and the NHSnet network. Unless a problem occurs with the EMIS software, EMIS is improbable to be able to resolve issues with the two areas therefore, the secondary care trust and/or the practice should ensure that support facilities are in place for these eventualities.2.8 Storage area network (SAN)Using the highest industry standard storage area network (SAN) configuration EMIS data centres are run 11, on which EMIS stores data Detail description in later chapter.Chapter SummaryThe chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements.Chapter 3 Drawbacks of Online systemsAlthough online application provides many services the challenges associated with are given below. All the drawbacks are explained taking EMIS as an example.3.1 Patient Record Time required to put all relevant information onto system Possible security issues Doctor can focus too much on patient information onscreen which could intimidate t he patient Scanning and entry of data is more time consuming. Important information lost can when overlooking the record. Medical record print-outs are frequently of poor quality and difficult to understand essential information In spite of using EPR, Paper records need to be kept back or scanned material become unmanageable. Often using computer and paper records together will make patient data look very difficult. Currently between GPs there is no electronic transfer as it is due to having a risk of data lost and duplication of data163.2 Appointments Patients have to be checked into appointment system by receptionist Problematic if patients cant read, or unable to view sign (e.g. slur people)3.3 Prescriptions Relies on drug information being up to date cleverness of doctor in using computer effectively Some measure doctors issue hand written prescription they may not be available on computer. The acute and repeat prescribing registers can make it more confused. Printouts of Pha rmacy still required 16.3.4 Email Relies on doctor checking their mail daily Troublesome patients abusing the system Hospital letters not emailed (would be preferred)3.5 Security issues Doctors have to go to bother of signing on and off EMIS Forgetting passwords Passwords can be troublesome, staff or anyone can abused or swapped it, if they are lost the system can be absolutely in-operable go forth computer on Locum doctors Experts are need to show computer frauds and misuse 163.6 Internet connection Continuous internet connection required The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts 4, 5.3.7 Backup System backed up every night onto tape Two copies- Fireproof safe distant location3.8 Read codesMaintenance of enormous clinical expressions or codes is very complex, and the Read Codes present many challenges. In addition, structure of controlled terminologies has been learned about the pr inciple because of the structure of the earlier versions. Version 3, the existing read code systems have been design keeping in mind the previous, simple versions, and to achieve forward compatibility 17.The problems associated in steps in read coding the medical problems are explain below in s step 1 and step2The Read Codes are used for many purposes such as clinical audit, searches, source allocation, and for the making of central government statistical returns. Problems arise from different uses and from the different views of Healthcare professional. 17.Statistical classifications like ICD and OPCS4 may cause anesthetize so they are cross map. Version 2 with its diagonal section closely mirrors ICD9, even though this doesnt always reflect a clinicians view, and correct hierarchy placement of a concept according to ICD9 rules may appear anomalous to a clinician. Besides this Version 2 initial aim is for a code, with its preferred term and it offers a single cross-map to these cl assifications, and its and all its synonyms, to map correctly to ICD9 17.Version 3 came with its directed acyclic graph structure, greater synonym purity, and much easy cross-mapping design, incorporating default maps and alternative maps, avoids the previous version limitations. However this came with other possible problems. Therefore, the two processes, authoring and mapping are closely incorporated 17.Read/SNOMED CodesRead/SNOMED codes are used by the doctors at hospitals because medical records in future can be transferred through GP2GP links. opposed the principal of Linnaean classification of species in the 19th Century, James Read brings in an international categorization of medical activity to contain illness names, operations and procedures. The main aim of this classification was to allow easy transfer of data between GPs, hospital and PCTs and easy to use by clinical staff, administrators and planners 24.Read codes has been explained more clearly in chapter 4.3.9 GP2GP Record transferThe fancy of the GP2GP record transfer and the clinical involvement are explained this section.3.9.1 The underlying principle for electronic GP-GP record transferThe vast majority of UK GPs (greater than 96 percent) are computerised in some way or other. A sizeable comparison of these practices use their computer systems for recording patient record information in whole or in part 33.This results from a variety of causes whose main headings are* Patient records that are an unpredictable mix between paper and electronic.* The net effect of the above is to place difficulties on new practices in identifying salient information in transferred records and in incorporating that information within the new record. This is to known to have significant (but un-quantified) resource implications for practices. There is also widespread anecdotal evidence of resulting adverse effects on patient care. The precept for the electronic transfer of records is therefore* As a support for electronic records in general practice and their general benefits in terms of purpose support and audit/governance abilities.* To obviate the need, as far as possible, for re-keying of paper-based information for new patients and thus reduce resource implications* To reduce the risks to patients arising from the transfer of confusing records.3.9.2 The nature of electronic GP-GP record transferElectronic patient record systems in general practice in England are provided by the commercial sector. At the time of writing this annex to the Good Practice Guidelines, eleven different commercial suppliers are known to be involved in this provision. In simple terms is that it is a common normal for the representation of 33* Record encounters what constitutes a single transaction with the record like a doctors consultation, a letter received from hospital or outside, an inquiry result etc* Names for these encounters e.g. home visit,* Headings within these encounters* Complex clinical c onstructs* Read code mappings such medication codes sets* Codes and associated text* Major modifiers of clinical nub3.9.3 The Problems of electronic GP-GP record transferThere are four particular aspects of current GP-GP records where the transfer process of that record information needs to be supported by additional rules or processes if fully safe and useable records are to be reconstituted on receiving systems and are explain below 33. medical specialty informationThere are currently three different coding schemes for the representation of medication information on GP systems. The principal reasons for trial to reach 100% reliability are* The multiple coding schemes used and* Failure of previous code mapping exercises (see chapter 5 on data transfer).3.10 The Problem Oriented Medical Record (PMOR)Electronic health records (EHR) are more used in UK General Practice despite chronic improbability about its legality and admissibility. The transfer of electronic record is currently in demand by the practices when the patient moves i.e. GP2GP transfer. The EHR implementations differ from a simple sequential list of medical concepts in an out of date coding system to sophisticated Problem Oriented Medical Records (POMR) 31.3.10.1 Limitations of the PO Medical RecordThe limitations of POMR are explain below 31* It is very easy to pick up but very difficult to maintain.* In the strict way of the word not all headings are problems. For example, the heading of Immunisation is used usually to indicate where all the entries related to a immunization memoir may be found.* Many different problems may be discussed within a single consultation* To check scanned documents is very difficult especially when patient record is too big* Problems are frequently think in a fundamental way.* The PO Medical Record only gives a basic measure of the state of a problem.* Different clinicians, view the clinical record, required different information from the medical record as well a s with different views.* Some of problems are complex and they are difficult to read. Those records which have few entries are conversely are easy to read, hence POMR is meant to avoid comes to the fore again.Though POMR have above limitation but it is a popular medium for data entry and viewing, there is indeed room for enhancement and progress 31.3.11 Other Disadvantages* Typing skills required for doctors and other clinicians. They are using ever more abbreviations and acronyms.* Many screen need to be changes to find results and mouse activity* Information can be hidden as only the informati