Rethinking The CPR: Is Perfect The Enemy Of The Good?

Chapter 1
The Problem and Its Scope

Introduction
Technology plays an important role in retrieving patient records in the lives of every patient, an office staff and a medical hospital because of the big boom of technology across the globe it enhanced the services of health institutions. Big, small hospitals or even clinics use the advantage of technology that gave ease to every transaction made especially on important document stored and released for patients. Every record is important just like birth certificates that every parent will retrieve from a hospital for future use of their children, a medical record or laboratory results needed by doctors for medical purposes.
For the past decades, medical hospitals all over the world are using a paper system in the retrieval of patient’s
records. Patient Record Retrieval is the process of getting the patient records back from a repository or a place where records are stored. Such as, an outpatient record is stored in the deck of folders, envelopes mostly sorted by family names, and there are hundreds or thousands in one of the corner of the office. Patients come and will retrieve records if needed anytime and does not have the assurance that a record will be able to retrieve in a short period of time.
Medical centers in the country, it maybe prestigious or not, has also encountered the same problems as other countries encountered, scattered records are everywhere and occupied the whole space of the office, adds manpower for processing transaction and waste of office supplies and most especially retrieval services are slow. Government hospitals have many patients most especially poor people from rural areas and retrieving patient records in the hospital is the common problem.
Negros Oriental Provincial Hospital is a government health agency intended for the poor and one of its services is to retrieve records of patients. One problem that clients lost their patience is because of turtle-like services of the agency in retrieving records. Factors that the hospital has a slow service in retrieving patient records and it is because records are very hard to locate that consumes couple of minutes in retrieving for a specific record being requested. In addition to the problems of Negros Oriental Provincial Records Department is that the paper system consumes the office space, waste of paper materials and additional personnel for locating records.
Thus, with all problems encountered by Negros Oriental Provincial Hospital Records Department in retrieving records, the researchers came up a solution to have a new computerized patient records retrieval system.

Review of Related Literature, Studies and Systems
Review of Related Literature
Patients record a collection of documents that provides an account of each episode in which a patient visited or sought treatment and received care or a referral for care from a health care facility. The record is confidential and is usually held by the facility, and the information in it is released only to the patient or with the patient 's written permission. A problem-oriented medical record also contains a master problem list. The patient record is often a collection of papers held in a folder, but it may be computerized.
Retrieval of medical record has been a significant means of communication between the Provider, Payer and Legal community. For decades it has been an extremely manual driven, paper driven process and time consuming process. With the advent of technology, issue of regulatory guidelines of PHI security and confidentiality such as Privacy Rules or HIPAA, Medical Record Retrieval and Release of Information is an industry which has undergone and is going through a lot of transformation. Earlier being done by the organizations themselves, this service is now being outsourced to specialists with the end goal to reduce retrieval time by process automation, reduce paper usage, and abide by the stringent HIPAA and Privacy rules.
Retrieving medical records isn 't overly difficult, but it is a process with specific requirements. For example, medical records aren 't always stored at a physician 's office. First, the medical provider needs to be contacted and asked about where the medical records request forms should be sent. Once the correct mailing address has been obtained, the record request forms as well as a HIPAA authorization form and a check for copy charges needs to be sent. In a perfect world, the provider would receive the request and fill it right away. However, it 's not unusual for a request to sit in a pile on some clerk 's desk making follow-up calls an absolute necessity. Lehnart et al. defines a patient record management system as a system that stores demographic, and medical information from ancillary services such as registration, lab, radiology, pathology, pharmacy, consultation and transcription.They state that a record management system is not simply automated updates of paper based charts, but rather a dynamic system used to help health care workers make better informed dragonesses. According to Gaillour et al. a record management system is only effective at achieving the goals of increasing quality of care and lowering costs if the organization re‐designs it’s current workflow and practices. Hence a very user‐ friendly system needs to be created to mitigate the risk of user dissatisfaction towards the new system. Fromberg et al. claim the clinical benefits to such a system includes easier, more rapid access to patient data charts; Improved clinical decision making and disease management; More educated patients about their own ailments; An increase in time to spend consulting with patients; An increased perception of patient care and theoretically a better working environment. All these benefits overall translate to better patient care. More benefits include a more efficient workflow, as duplicate tasks would not be performed as the need to re gather information would be eliminated as all data pertaining to the patient is readily available at all times. Time taken to execute administration functions, such as capturing patient demographics, drop dramatically. According to Dassenko and Slowinski, an average of up to 15 minutes was saved per patient on the patients first visit and further 20 minutes on each subsequent visit as a result of implementing a computer based patient record. Fischer and Bloude (1999) states findings that the retrieval of paper records was time consuming and finding the required information amongst many documents for certain patients could be a lengthy process. Wellen et al (1998) emphasized the advantage of EPR because it enables information be Time is saved by EPR in not requiring the whole patient file to be used to find to available quickly about specific requirements perhaps just one piece information. Coiera (2003) EPR added that information instantaneously drugs though many documents. with EPR instead of requiring a search such as allergies to particular could be obtained information strategy states that in the EPR system the patient records should be secure, accurate, and legible. They can be easily accessed by authorized staff and in addition to use for individual patients can be incorporated in research. Data can also be available for the improvement of quality. Bush (2002)recommended introducing and using an appropriate EPR system since it helps to reduce costs and ongoing expenses in providing multiple users access to faster. Distance is information, data protection and backups. An EPR backup system is more economical than the manual system since it saves space, time to locate and access information and maintenance costs. Abdellhak et al (1996) and Young (2000) state that physical control of a file are not always available, EPR data can be accessed at any provides adequate security. However, sometimes as many as 30% of which is not possible with paper records. Englebardt and Nelson (2002) and Reynolds (2003) agree that an increasing number of paper records approved workstation are authorized difficult more Robert(2002) one the information for the right reason. Especially Friedman (2005) considered security for confidentiality must be ensured this is and relevant with EPR systems even if it makes authorized access access patient record especially in emergency cases. Kirshna and authorized person. Where as a paper based system is available to only one person at a time to point out that an EPR system can be used simultaneously by more than Amatayku (2004) drew attention to access policy which needs not only a ban sharing passwords but also a reminder of the possible legal consequences. Schmitz (1979 p.74) described an early EPR system at a time when "there is as yet no such thing as a fully electronic medical record". The benefits were then seen to be "timeliness, accuracy, completeness and availability" resulting from"having physicians interact directly with an electronic management information system" (Schmitz 1979, p.75). He seems to have been one of the pioneers in anticipating the potential of EPR, and the benefits from professional input. Kovner (1990), who considered the use of electronic records for patient history and current treatments. The availability of computer systems from 1990 onwards further helped to prove the arguments raised by the two authors above. This availability changed medical record keeping to electronic methods, which were beneficial in many ways. methods of recording have reduced the size of records despite the fact that they contain very much more information. By using computers, doctors can easily access information from more than one source. The organization of records for ease of access is essential for efficiency and the importance of the service is recognized by supervisors in charge. Good organization and management requires good leadership to ensure efficiency and co-operation and a constant improvement performance. In addition to the above observations, Meijden et al (2000) measured the attitudes towards electronic patient record among physicians and nurses. The researchers noted that the experienced physicians and nurses were move positive, whereas the inexperienced ones found EPR to be more time consuming for data entry and retrieval, and they were concerned about their familiarity with computers and the need for training. This study implies that one has to be experienced in making the optimum use of EPR systems. Furthermore, an EPR system proves to have more effect on improving quality of patient care. Bickford (1995)noted the in as a restriction potential that EPR systems have for improving patient health costs, adding satisfaction for providers, researchers and administrators. Dick and Steen (1991) argued that patient records should include more information than just treatment details for as proposed by earlier researchers such as Kovner (1990), example, guiding problem solving, decision analysis, reminders, and risk assessment ,an do the relevant details(Dick & Steen1991,p.37). The system could prompt staff about additional considerations not available in paper records. The system would be accessible at all times. Similarly, a report by the Institute of Medicine (IOM 1997) helped to argue further that an electronic patient record is to be as the one that is specifically designed to support users through of complete and accurate data, practitioner reminders and alerts, clinical understood availability decision support systems, links to bodies of medical knowledge and other aids. Novak(2005) considered EPRs as time saving which can be life saving, transfers to cost other physicians history, effective whilst maintaining confidentiality and, making easy and immediate. However A personal EPR can contain a total medical complicated. EPR systems have to a greater extent improved patients records and facilitated the selection of the most appropriate treatment. Amongst these advantages, Burton et al with the patient 's input can be created when records are retrieved much Lane & Hayward (1999) investigated the value of electronic patient records make adequate and legible records has been reduced to take only a few minutes per patient, when physicians ' time is tightly scheduled. However, Soper (2000) observed that more time to see a patient, together commented that the time taken to. Furthermore, the above author noted that accessibility of record sat a made possible. Electronic records are more legible and can resolve the problem of misplaced documents and the opportunity to show parents the records of their children if required. For GPs and found them to be considerable, but there were doubts about the system on a larger. Furthermore, (Atkinson 1997; British Medical Association 2002). The training of users on EPR scale in hospital use. Mansoor (2002) Training the users in manipulating EPR systems has proved to be easier them to familiarize themselves with other aspects of computer supports the observation in that physicians use systems motivates applications. Computers for administrative purposes as well as EPR systems, and are keen to acquire computer skills and knowledge to enhance their clinical practice. They learn how to access computer based information and to how to make the best use of such resources. Svenningsen (2003) found the advantages of EPR included no loss of records, ease of access for all medical staff, some reduction in professionals. The same was the case for Smith, (2003) who considered good medication errors, better documentation, and more co-ordination between leadership and supportive staff were essential for a planning, strong successful EPR system. Benefits include accurate medication lists, legible notes and physician. Having experienced EPR he would never revert to paper records. Seems to summarize the general point of view of those who have experienced prescriptions. This the change from manual to electronic systems. Amatayakul (2005) emphasized the value of EPRs providing reminders to alert hospital staff to particular problems which may arise, and improve decision making, in addition to reducing errors. At the same time much information is still being handwritten in many hospitals and the electronic records do not necessarily include information which would assist decision making. Also it was helpful to have systems which work similarly in different places e.g. surgeries, clinics and hospitals. The benefits of EPR as outlined by Ginneken (2002, p. 115) included Flexibility in content and use, integration and adaptability to change. Once consensus is reached on terminology, architecture, and legislation, the EPR will become as established as the Hippocratic Oath record has been for centuries". It seems from the literature that benefits have been obvious in all the countries that have adopted the system, and even those who originally had difficulties in making the changes now express no regrets, because they have experienced the great advantage of electronic systems.

There was a reported reluctance to change which needs to be overcome by a good training programme, and some people under-estimate their capabilities to cope with different systems ( Loomis & Ries 2002). As Huston (2004) noted, to such a change would require an agreed standard procedure and provision for the transition period. Faber(2003)draws attention to the fact that several authors new and implement argue that the implementation of EPR can fail if the assumed nature of the medical work being considered does not match the real aspects of that work. Related Studies and System According to the study of abdullah, f. Epr system in hamad medical corporation Qatar that it greatly resolved the dissatisfaction with the existing manual patient Record system expressed both doctors and nurses referred to many defects of the Present manual system which caused irritation and potential exposure to reducing Patient safety. Such obstacles can affect the improvement of patient care and delay Important treatment. From the findings the major problem of the traditional paper Based record system appears to be misfiling of records causing difficulties in obtaining Information quickly in emergencies. Thus the newly EPR system benefited the Hamad medical in terms of the accuracy,legibility, confidentiality and time saving in the patient records.

Another study from Droma, Fahad et al. in automation of the patient record management sytem in St Francis Hospital Nsambya that Patient record management systems in hospital today necessitate a competent administration when handling patients, generating reports from cashier, patient details which serves as a key factor for the flow of business transactions in St Francis Hospital Nsambya. Unfortunately the current Record management system leads to misplacement of drug details, payment details, and late release of reports and insecurity to records. This research project is aimed at computerizing all the records about patients, staff and drug suppliers. In order to achieve this goal, a thorough System Study and investigation was carried out and data was collected and analyzed about the current system using document and data flow diagrams. The concept of report production has been computerized hence, no more delay in report generation to the hospital manager. Errors made on hand held calculators are dealt out completely The method used to develop the system include iterative waterfall model approach, dataflow, logical and entity relationship diagram were used to design the system and finally the language used were MySql, php, HTML, CSS and JavaScript. Atkinson (1997), whilst seeing the benefits of EPR systems, also that they could change clinical practice, and that there could be problems of controlling access to them. His research also reported anxieties that were expressed regarding the possibility of computer failure. The argument shows that the electronic record system has a "back up" scheme for computer failure patient which automatically prevents information from being lost. In addition, even if the benefits of EPR are recognized,found that the time taken to learn procedures was an obstacle to their use.
A software engineering consultant, Sam Simple was hired to design a Computerized Patient Record system for a hospital. Each patient’s record in the database consists of a patient’s name, address, age, phone number, next of kin, name of parents, phone number, birth date and place, social security number, occupation, marital status, religion, military service, treatment history, family background, lifestyle information such as drug history and sexual preferences, diagnostic and testing information, and insurance information. At the initial meeting held to discuss the project requirements, a hospital representative indicated to Simple that the hospital had conducted research on CPR systems prior to hiring him. Based on the report produced from the hospital’s research, it considered that user authentication to verify users’ ID and password at login was sufficient for their system, as far as the system security was concerned. However, Simple learned from a study that 85 percent of the passwords on a typical computer system were guessable.
According to Dr. Marie Sy, CHITS, an electronic medical record (EMR) specifically designed for the community health centers in the Philippines, was developed through a collaborative and participative process involving health workers and the Information and Communication Technology (ICT) community, using the primary health care approach and guided by the open source philosophy. “The development of CHITS that the paper record retrieval time was decreased from 2.41 minutes to less than 5 seconds,” has resulted in increased efficiency of health workers, allowing them to spend more time for patient care, improved data quality; streamlined records management; and data-guided decision-making, both operationally and strategically,” Dr. Sy added.
The development of EPR in most countries has been rapid in recent years with some differences to meet local requirements. Beaumont (1999) noted the advantage of electronic records in the UK, including simultaneous access from multiple locations, legibility, ease of exchange of data, and confidentiality. He compares the advantages with those of paper records which are: easily transported; easy to read; require no training and are never "out of order". According to Beaumont 's personal experience, electronic records are an improvement on medical handwriting which is often illegible. In addition, he noted a need for training in the details of categories which the manual records should contain, just as computers may be "down", so misfiled patient records can be equally frustrating.
Frolick, (n. d. ) noted that electronic patient records in USA are of great benefit to patients, because they are not subject to loss, illegibility or inaccuracy, and assist in guiding patients ' daily treatment. In addition, the records would be readily available for research and accessible directly on the users ' screen. Furthermore, Madison(1997) reported Dr. Paul King 's opinion that the ability to create, and retrieve charts quickly was of importance and time saving. The choice of the best EPR in USA for a particular department as important and there should be a wide range of availability of a system for selection. By the immediate accessibility of the right technical information lives could be saved, and this is the most important consideration of all. In addition to aspects such as time saving and quality of care, Kowalsky (2002)observed that, to make the system comprehensive and cost effective was a large task and integrating existing systems was difficult.
Much as the EPR systems are suggested to provide the best solutions to improve patient record keeping, several authors have observed a number of challenges to them. For example, Fields & Duncker (2003) mentioned that although EPR systems are planned to be universal in UK by 2008, there were doubts about this. The complexity of the task and the need to complete it rapidly caused concern after previous NHS computerisation problems. There was anxiety and the need to convince staff of the benefits of the system. Bishop (2003) referred to availability, as being able to use the information or the source desired i. e., hardware, software or networks.
The same issues were discussed by Singh et al. (2004) who noted that primary care in USA is complex and includes safety problems, with no two providers being alike. EPR imposed on any health system can have unpredictable effects, reducing or increasing safety. To some extent EPR could distract a GP from properly recording observations, but, if used correctly, would greatly assist in providing immediate and accurate information. In practice it is essential that all staff are familiar with EPR systems, if these are to be used effectively, and all aware of hazards and how to avoid them.
Similarly, Pizziferri et al (2005) considered one factor which inhibits the use of EPR in USA was the concern that it may take more time than paper records. A study of 20 physicians ' use of time at primary health centres was recorded, before and after the introduction of EPR, and a decrease in time was noted. This was also the case with dictating notes, reading, and writing; however searching for data was much faster than before. The researchers concluded that EPR took less time than manual records but that there was a need to identify EPR users who had difficulty with the system.
Mikkelsen & Aasly (2005) of the neurology department at St Olave 's Hospital,
Norway analysed electronic patient records and how the system affected performance, e. g. the ability to access information. Records for a neurological department were of variable accuracy because of lack of precise definitions, and were a potential threat to the safety of the system. Strict procedures are required to ensure accuracy and sufficient relevant information.
The SteiermärkischeKrankenanstaltenGes.m.b.H. (KAGes), the governing body of the Styrian hospitals. Out of a new MIS, termed OpenMedocs, has been conducted. This system shall simplify the management, the access to and the exchange of health-related patient information. It is a centrally managed system at the headquarter of KAGes in Graz. The core of OpenMedocs is an electronic patient record (EPR) system. All documents concerning patients are stored in this system. Thus, it is possible to receive documents from a patient which have been generated in different hospitals ’at the push of a button’. Since almost all medical information of the hospitals concerning patients is managed in the ERP system, it is possible to avoid various disadvantages of ’traditional documentation’, like multiple medical attendance or local constraints of usage of retrieval possibilities, and user-oriented presentation of data should help, among other things, to speed up and to improve the quality of the medical decision-making process of physicians. Since the roll-out of OpenMedocs, the amount of these patient-related documents increased continuously. Thus, the efficient storage and the timely retrieval of documents in the EPR system have gained considerable importance.
The Problem
Statement of the Problem
This present study tries to analyze, design, develop, test and implement a Record Retrieval System for Negros Oriental Provincial Hospital.

This study attempts to answer the following questions. 1. What is the current retrieval system used by Negros Oriental Provincial Hospital Records Department in retrieving records? 2. What are the problems encountered by retrieval section employees in the retrieval of patient’s records in NOPH Records Department? 3. What are the requirements needed for the development of the Computerized Retrieval System for Negros Oriental Records Department Retrieval Section? 4. How secure and manageable is the Computerized Retrieval System for NOPH Records Section? 5. How beneficial is the Computerized Retrieval System for Negros Oriental Provincial Hospital Records Department Retrieval Section.

Hypothesis H0: There is an existing problem with the current retrieval system of Negros Oriental Provincial Hospital Records Department. H1: Negros Oriental Hospital Records Department is in need of a new system that will help them improve their service.

Technical Background
Design Concept

Input

Data Captured
Process
Working with records
Output
Showing results by print outs

Storage of the patient records

Figure 1
It shows the input, process and output of the patient record retrieval system that in input in order to retrieved such records they need a personal information and the records they want to be retrieved in a system. In Process it is where the records has been process in order they could release the record and in output it is where the records have been already retrieved and ready to release to the authorized person.

Design Method

Figure 2 Agile Approach The methodology that use in developing the system is agile the researcher use agile since it promotes adaptive planning, evolutionary development and delivery; time boxed iterative approach and encourages rapid and flexible response to change. A conceptual framework promotes foreseen interactions throughout the development cycle. There are five phases in this methodology the requirements, design, implementation, test and deployment. In requirements phase in which the requirements for the software are gathered and analyzed. This is equivalent to researching and brainstorming what the product requires. Examples can include general features, architecture discussions, workflow discussions and general product discovery. Design phase this is which will have all the requirements defined for the product. Implementation phase during the development, needed to test the code as well as get feedback from the customer on progress. Feedback from the customer can include mockups, front-end designs, and usability. Testing phase bugs and defects are always a constant in the software development process. It is important that there are good quality assurance standards to eliminate general issues. Deployment the software application is finally deployed and live. Once this occurs, a support plan needs to be in place for maintenance and general support on potential future issues.

Significance of the Study
Negros Oriental Provincial Hospital Record Department.The study will serve as a new instrument for the technological advancement that greatly benefits for Negros Oriental Provincial Hospital. This computerized system is intended to lessen the manpower which will lead to a faster and more accurate record retrieval process which will lead to profitability of the Negros Oriental Provincial Hospital.
Employees. The job of the employees will become more accurate and efficient through the use of the proposed system. This leads to less error which saves time and energy on the side of the workers. Employees can also focus on other tasks assigned that will make them more productive.
Patients. The service of Negros Oriental Provincial Hospital to the patient will become more convenient. Less time will be consumed during the retrieval process. This will also lessen time for patients to wait for their records to be release. The study is also expected to increase the satisfaction of the patients to the services of the Negros Oriental Provincial Hospital.
Researchers This study is a great achievement for the researchers because it will improve their skills in technical writing. The experiences while doing the research build up their characters and teach them values like creativity, working hard, team building and responsibility and time management. It also builds friendship and camaraderie among the co-researchers. It also gives them an overview of the IT industry and trains them to prepare to the competitive professional field.

Questionnaire
Directions: Please put a checkmark on the selected choice.
Name (Optional):____________________________________
Age:______
Gender:____________ Department:______________________ I. The current system that NOPH are using in retrieving records: 1. What is the present system used by Negros Oriental Provincial Hospital Records Department Retrieval Section?
__ Manual Retrieval
__ ComputerizedRetrieval
If manual, what are the tools or things used in retrieving records or how a single record is retrieved according to its arrangement? _By folders _By logbooks
_By envelopes
_By family names
_By cabinets
_By disease/injury
Others (Specify):______________________

If computerized, what are the applications used?
_ Microsoft Excel
_Microsoft Word
_Microsoft Access
_Others(Specify):_____________________________
II. The problems encountered by employees in retrieving records: 2. What are the problems encountered by Negros Oriental Provincial Hospital Records Department in retrieving records?
_Unarranged Documents
_Difficulty in finding records
_Lost Documents
_ Mountainous Stocked Files
_Crowded area
Others(Specify):______________________________
III. Particular documents that Negros Oriental Hospital retrieve. 3. What are the common documents that hospital clients retrieved mostly?
_Birth certificates
_Death certificates
_Laboratory results
Others(Specify):___________________________________

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Spat, Stephen,. March 2007 Institute of Information Systems and Computer Media (IICM) Graz University of Technology 8010 Graz, Austria http://www.iicm.tugraz.at/iicm_thesis/sspat.pdf