The Department of Health and Ageing established the Electronic Health Record (EHR) (Bartlett et al., 2008). Every kind of E-health application is supported by the EHR which shares connections between health care providers, public and private hospitals, the pharmacy, and medical and non-medical specialist providers (Bartlett et al., 2008). However little development has taken place regarding systems that handle skin cancer diagnoses specifically. Doctors require a system to follow the flow of a normal skin cancer examination to not miss diagnoses while the system should reduce the time and cost of repeat examinations and diagnoses, thus increasing the efficiency of health services. The development of a web-based system allows a patient’s medical history of skin cancer to be recorded and lesion procedures to be followed through to reduce medical errors and avoid significant misdiagnoses. Ideally the system should have efficient interfaces that reduce the need for doctors to type, e.g., a chosen list for data entry should be present negating the need for typing.
The system should have different authorisations for varying roles such as doctors, nurses, and receptionists. The system should also 1) provide a clinical model to highlight the spot or lesion on a patient’s body; 2) generate pathology forms and reports from patients’ databases; 3) generate bills – depending on the part of the body and size of lesion – along with the number of spots or lesions; and 4) upload pathology reports or images, and then record them in the patient’s record.
EHRs may be further subdivided into Personal Health Records (PHR) and Electronic Medical Records (EMR). A PHR is a system partly controlled by individuals to manage their own medical records. The PHR can assist physicians make informed decisions whilst improving the sharing of health records (Tang et al. 2006). If individuals keep their records up to date but make mistakes by entering inaccurate data, there will be consequences in their treatment methodology (Liu et 2011). An Electronic Medical Record (EMR) interacts with Hospital Information Systems (HIS), Radiological Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) to collect patient data in one place. When clinicians diagnose patients, they typically require x-rays – consequently patient results will be stored in the EMR which in turn will document and provide evidence for clinicians to choose appropriate treatment (Ebadollahi et al.
2006). Data in EMRs can be categorized as text, image, video, and other media formats such as signals of electro-encephalograms.
The increase the effectiveness of EHRs, familiar interfaces reduce typing to decrease the possibility of errors. Regarding security issues, Yee and Trockman (2006) note EHRs data can be encrypted while being exchanged through a system and suggest approaches to managing access for multiple users via different keys that implement varying access restrictions.
One solution is a patient-held electronic health-record wallet-card. When patients approach health-care providers, they can give them the card and have it updated with further information. If a patient wishes to see their information online,they should have a username and password to access their account; the card could be used in emergency situations as well.
A surgery requires a Skin Cancer Information System (SCIS) which should generate reports, bills and forms and connect with other records such as a PHR, therefore the SCIS will include shard EHR specifications, clinical information, clinical terminologies, user authentication, standards implementation, and longitudinal health records. The system should include: patent information: including general details such as full name, address and contact details; patient history including health information such as previous health details, allergies and medication used; management i.e. observing the flow of health information including employees printing reports; reception or adding patients’ details and organizing waiting lists; clinical models of the human body illustrating the position of lesions on patients; staff information such as contact details; and finally the ability to generate reports, forms and bills.
The following forms a general background of the Skin Cancer Information System design process. We are concerned with one cycle of a skin cancer patient flow for this assignment (see Modelling the Process Flow below), but you may wish to model aspects the system design as given under ‘Design’ here.
The SCIS is web-based, hence the system is hosted by a webserver (Jazayeri, 2007; Linthicum, 2004).
The main interface illustrates a patient’s clinical details, as well as headers providing navigation to cross inside the clinical portal. There should be waiting lists, the ability to edit patient’s details and insert the patient’s general medical information. Another interface provides interfaces such as a log-in page. Finally, headers in the first and second interface provide the details on who is accessing the system.
Receptionists access the system through a login page; they can then navigate between the waiting-list page and the insert and edit patient-details pages. The SCIS could be implemented in four major stages – implementing the database,developing the management of SCIS, building the patient and user forms, and coding the clinical portal.
The client provided permission to access their server, create a subdomain and install the database that was designed in MySQL (jQuery Project, 2012). The system was tested with certain transactions, for example the insertion of staff details.
The management and reception components were designed using Muse web designer software. An example of the login page is provided. Database connection code takes place using PHP between the client and the server.
Patient and user forms
Designing and coding other pages continued in the third stage. Examples of work in this space include inserting and storing new staff and patient details.
The clinical portal
Verification and Validation
HTML5 forms were implemented for input fields where the user inserts information. For example, email and date input fields used an email datatype and a date-type for the date of birth or other date input. To reduce data entry errors,drop-down-lists, radio buttons and checkboxes were used.
User log-in is via username and password encrypted by applying MD5 (a Message-Digest function in PHP), will be sent to webserver which encrypts the password before comparing it with the database. Receptionists cannot access clinical portals. Physicians can access receptionist portals. Images are stored in the database instead of being saved as files in the server. The final interface for the SCIS can be seen in figure 1 below: