e-health Care Author: Satish Yallambatla Co-ordinator: Per Lindström

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1 e-health Care Author: Satish Yallambatla Co-ordinator: Per Lindström i

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3 Abstract The Master thesis has been written for the specific purpose of checking online status of Global life clinic (e-health Care system). The system has developed by using the.net frame work (ASP.NET and ADO.NET). It has also been analyzed different health care systems and examined how the user interacts with these systems. To achieve this purpose, we have maintained the database in the backend. To access the database we used ADO.NET and to develop the frame work we have used the ASP.NET. To understand these technologies we studied academic books and papers and related web sites. Under the category of e-health care systems, HON, PQL (Quality life for Quality tools) and IZIP were examined and explained and related with Global life clinic (e-health Care systems). Under the category of.net, ASP.NET for the frame work, ADO.NET to open the connection for the database. We have discussed the project modules to develop the e-health care systems. To develop this system we need some software and hardware requirements to run this system successfully. iii

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5 Acknowledgment This thesis work would not have been possible without the help and guidance of a lot people. It is now time to thank all of those, who have contributed to this master thesis work. It seems appropriate to start with the person, who suggested me this thesis work, my examiner and supervisor Mr. Per Lindström. He gave me an opportunity to work on this master thesis work under his esteemed guidance. He supported me with excellent suggestions and comments whenever I needed them. I am grateful to him. I would like thank the entire staff of VIVIDACS Pvt. Ltd., for the purpose supporting to complete my project successfully. Especially thank to my project leader Mr. Kishore. T I am grateful to Mr. Per Lindström, Director of Studies in Computing Science Department at Umeå University, for giving me the opportunity to conduct my master thesis at VIVIDACS Pvt. Ltd., and supporting me to complete my master studies at Umeå University. Reading a long thesis can hardly be fun. So big thanks to Suresh Yallambatla and for helping me to improve the thesis report by proof reading and correcting grammar. I thank God for my existence, encouragement and leading. I am grateful to my parents and family members for understanding my priorities during this period of time. v

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7 Table of Contents 1. Introduction to the e-health Care project Introduction Background information Project overview Business impact Project results Goal of the project Structure of the report Prestudy of system Introduction Identification of need Need for computerization Feasibility Analysis Technical feasibility Economic feasibility Operational feasibility e-health care analysis Introduction Second example : PQL Pure Quality Life Third system is IZIP Developed e-health care system (Global life clinic) Comparison of the e-health care systems with developed e-health Care system(global life clinic) Design Issue About System Introduction Software engineering paradigm applied Design methodology Database design The rapid application development model Implementation System security &integrity Implementation and Evaluation of the system Introduction Project modules Masters Maintenance Reports Payables System components Hardware specifications Software specifications Discuss about the flow charts of the project Doctors flow chart Patient flow chart Reports flow charts Doctor Schedule flow chart Category flow chart...55 vii

8 5.4.6 Diagnostic details flow chart Medical reports flow charts Discuss about the E-R diagrams of the project E-R diagram E-R diagram E-R diagram E-R diagram E-R diagram About.NET frame work ASP.NET ADO.NET Limitations Conclusion Future Work References...84 viii

9 List of Figures Figure 3.1 : Home page of HON...13 Figure 3.2 : Hon code search Toll bar...14 Figure 3.3 : PQ form...15 Figure 3.4 : Statistics...15 Figure 3.5 : Exercises...16 Figure 3.6 : PQL chat...17 Figure 3.7 : IZIP front page...18 Figure 3.8 : Client entry login form...19 Figure 3.9 : Client basic information...19 Figure 3.10: Health care professional entry login form...20 Figure 3.11: One Doctor Can Access Only One Particular institution as in one specialization...20 Figure 3.12: Health care institutions and specializations for particular doctor Figure 5.1 : Doctors flow chart Figure 5.2 : Patient flow chart Figure 5.3 : Reports flow chart...41 Figure 5.4 : Doctors schedule flow chart...42 Figure 5.5 : Category flow chart 43 Figure 5.6 : Diagnostic details flow chart..44 Figure 5.7 : Medical reports flow chart.45 Figure 5.8 : E-R diagram...46 Figure 5.9 : E-R diagram...47 Figure 5.10: E-R diagram...48 Figure 5.11: E-R diagram...49 Figure 5.12: E-R diagram...51 ix

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11 1. Introduction to the e-health Care project 1.1 Introduction This Master Thesis describes the requirement and functional document for e-health Care. It symbolizes all the needs and the requirements for the client [Global Life Clinic] to achieve a quality that is desired for the application and it contains information for the development team to design the application and the database for the working of e-health Care. 1.2 Background information Global Life Clinic is a leading Health care group in the country, which provides exclusive service towards life support systems and services of international quality at an affordable price providing its services to the society from since 15 years to the country. A NRI Doctor, Dr. Narayan, who was a leading cardiologist of his time in U.K, found it. It focuses mainly on providing quality and inexpensive services with international standards, which are not available widely across the country. After detailed research and analysis of existing competitors and also identifying benchmarks and best practices from some of the major player in the same sector (i.e. Health cure industry) currently in the market, this requirement and functional specification document was put together to enable developer of the application to develop it with the maximum ease. 1.3 Project overview An overall idea of what are the impacts, the system is going to have in the business activity and the expected results from the system towards managing the daily activity with the system Business impact By making all the internal activity of a hospital towards automation is going to improve the 1

12 productivity of each & every department by making the internal process faster with respect to retrieval & storage of information in organized manner, which enables the hospital to provide services to the patient in a faster way Project results Reduction in the time spent by the staff to gather the information & to store it in an organized manner. Also reduction in the time for generating reports related to various activities like diagnosis report, death certificates, birth certificates, fitness certificates etc. 1.4 Goal of the project In this project we need to develop a system with all requirements of Dr. Narayana's clinic with fully functional GUI application. Here I developed a system I s, how user can be interact with a system. I designed the system of Dr. Narayana's clinic all requirements about patients it means patients registration details and identification number and which date he came into the hospital, which deceases he has, his medical reports and his payment details and patient receipts. The user can check the Doctor's schedule and the information like his past records how many patients he has treated till now. All these information maintained in the database. This system developed with fully function GUI application using with ASP.NET programming and ADO.NET. 1.5 Structure of the report The second chapter Pre-study of the system, includes the system study to develop the e-health care system. 2

13 The third chapter e-health care analysis explains an examinee the different e-health Care systems and compare those techniques with Global clinic life clinic. The fourth chapter Design Issues of the system, this deals with the design methodologies of the system. The Fifth chapter Implementation and Evaluation of the system explains the project modules of the e-health care system. The sixth chapter Limitations explains the limitations of the system. The seventh chapter Conclusions summarizes the conclusion of the thesis work. The eighth chapter Future Work explains the future work of the system. 3

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15 2. Pre-study of system 2.1 Introduction Before developing a system we have to study the system for what are the requirements we need and we have to identify those requirements. This is the starting point for system design. In this chapter we describe what we need for developing a system. 2.2 Identification of need Before developing this system, the various activities are performed and reports are prepared manually. The main disadvantages of the Manual System are: More manpower requirement. Greater chances of human errors. Lacking uniformity and conformity in data Bonded for frequent changes for Rules and Regulations. Less flexibility and more time consuming. Reduced value addition due to paper work. Lack of accuracy due to duplication of work at divisional level. Decentralization of data which increases the time for retrieval Less transparency as the information is maintained individually At present, all the application packages in any company maintain individual registers for their local references. There is mismatch between the data. Codification present in all the existing packages. This leads to a state of confusion with the different packages acting like isolated islands. The integration of these packages can be made possible only through the design of a centralized database. Through computerization, sophisticated technology can be used for making the information more flexible, accurate, and secure and user friendly. Time and manpower can be more effectively utilized. 5

16 On line information can be made easily available at random to any user at the same time maintaining high level of security. Every thing is done manually in current system. A few of the components are being processed automatically using computers but as such no specialized application exists to take care of the complete process. 2.3 Need for computerization Since as we know that the human are prone to errors, the transactions produced by them may give erroneous results, which results in wastage of time in trying to locate the error. The generation of reports is a very lengthy procedure where data has to be collected from a number of fields. With the advent of computers, all these operations are made easy. The operations, such as data entry, processing of data and generation of reports are done in very less time. Since all these work are done faster, a lot of work can be done every day with out pilling up of work for the next day as can be seen in the most of the organizations where the processing is done manually. Scrutinizing and maintaining large volumes of records manually is a time consuming process and there is always a chance of committing mistakes. Required information is not reached when needed by the manger for decision-making. In manual process, there is not security and unauthorized persons can utilize data. 2.4 Feasibility Analysis This state of study is very important to decide whether the project is worth doing or not. The process following in making this determination is called a Feasibility study. The analyst will prepare the final 6

17 project requirements and specifications once the project is decided as feasible. Feasibility study is to understand the entire system and design the process. There are three types of feasibility studies conducted as technical, economical and operational Technical feasibility Here we analyze the exact technical requirements needed for the project which will satisfy the user requirements. The technical needs of the system may very considerably but might include. 1. Estimation of output in the required time schedule. 2. Response -time under certain conditions. 3. Ability to process a certain volume of transaction at a particular speed. 4. Distribution of data to a district location. Technical feasibility of a system deals with the functionally, performance and constraints that affected the system. For this project the technical requirements are given below. The hardware required is 200 MHz or higher clock frequency processor. 512 MB or higher RAM and sufficient disk Storage. The software is MS SQL server 2000, ASP.NET Economic feasibility To test the effectiveness of the proposed system Economic analysis is used. Here the estimation of the cost is made basing on the design and implement of the system, if cost exceeds a then alternative changes in proposed system has to be done Operational feasibility Proposed project is benefited only if this can be turned into information systems that will meet the requirements. If there are any change request be made in the system. Here the points to be considered 7

18 What changes will be brought with the system? What organizational structures are disturbed? What anew skills will be required and does the existing staff have these skills and if not can they be trained in due course of time. The software that is developed should be in such an away that the staff must easily understand the operations and be able to do the transaction property. User-friendly screens are to be designed to allow the staff to get familiar with the developed software. 8

19 3. e-health care analysis 3.1 Introduction "e-health care is an over achieving term used today to describe the application of information and communications technologies in the health sector. It encompasses a whole range of purposes from purely administrative through to health care delivery"[5]. In this chapter we are going to discuss about different e-health care systems. In these systems how can the user interacting with those systems and how the user can get the available information from health care systems. [1] E-health care systems mainly divided into three types based on the services provided for the customer [2]. 1 e-health information tools and services for citizens: - providing information through health portals electronically. 2 e-health administrative support tools and services for citizens In order to provide health service to customers rather than providing information electronically like administration, e- Prescription, e-results. 3 e-health home care and telemedicine tools and services for citizens For providing the information about services like remote ECG s, remote emergency management. In this thesis we have examined the websites implemented by hospitals. The infrastructure of the website, protection of the customer private data, information is crucial to success of the web sites. On other hand, globalization, integrity and availability are three key issues for the development of a website. Now we are going to discuss the structures of the three websites of three different e-health care systems. 9

20 3.2 First system Health on the Net Foundation This is basically for providing information about health and ethical issues. The main advantage of this site is HON code search tool bar as shown in Figure.3.1 HON code is one of the most popular non profitable portal to providing information about the medical in Internet. HON code is also providing accredited facility for calculating the trustworthy of the sites. For being a member in Hon code accredit ion you have to apply through their website. The procedure to apply they clearly described on their website. To reach their globalization procedure they provided their site in different languages. [6] Fig 3.1 Home Page 10

21 Figure 3.2 HON code Search Toll bar. HON code search tool bar is used to search different trustworthy sites related to different health problems as shown in Figure 3.2. You can add this tool bar to your favorite web browser. According to cyber Europe report 3000 websites are using this tool bar. For searching they are using Google custom search technique. 3.3 Second example: PQL Pure Quality Life This is a good web site. Daily I use to follow their suggestions which are designed by considering my feelings on different issues. You can see the questionnaire named as Pqform in Figure 3.3. All the questions are related to psychological feelings of a person like concentration, satisfaction of work etc...hardly it takes may be 1 or 2 mints to fill the form every time. It will store your history until a certain period on your user name which is given when you register. After filling this form you have to click on the save button which is available at the end of the form.if you have look at statistics page it will show the results of measurements as shown in Figure 3.4. Here you can compare the results over time and also have a look at action plan based on your measurement report. [3] 11

22 Figure 3.3 PQ form Figure 3.4 Statistics 12

23 Figure 3.5 Exercises In Exercises, they divided exercises into three formats based on the requirements and style of learning. This exercise is designed based on the clinical and biological aspects of the group performance. Journal, here you can keep your own journal and you can use like a calendar. You can record health related things like blood pleasure, weight etc. 13

24 Figure 3.6 PQL chat As shown in figure 3.6, in PQL chat is available to chat with the people through out the world either in public or private and also discussion forum to discuss medical related things. 3.4 Third system is IZIP The main function of this site is providing interface between health service providers and patients electronically. The site is mainly divided into two zones. One is for health care professionals and another one is for patients and public. To become a member you have to register to this site either as a client or health professional. Here I am giving sequence of screen shots if you enter as a client or patient [4] 14

25 First Case: - In main page two options is available as shown in Figure.3.7 one is for health care professional and another one is for patients and public. If you want to enter like a client you have to click on the second option "entry into the zone for patients or public". If you click one that it will ask client identification number and client access password as shown in Figure3.8. If the authentication password and id is correct then it will show particular user personal data like name, address, patient-id, -id, e-prescription, e-results as shown in Figure3.9. Second Case: - For health care professionals they need id number, access password and personal password to enter into their personal page as shown in Figure3.10.Each doctor can work in one or more institutions and in several specializations as shown in Figure3.12 and as shown in Figure3.11. The doctor should select one institution and one specialization to enter into that particular page. Doctor can access records from only one institution and in one specialization at a time. After that if he wants to see particular client information he has to enter client id and client password etc. Figure 3.7 IZIP front pages 15

26 Figure 3.8 Client entry login Form Figure 3.9 Client Basic Information 16

27 Figure 3.10 Health Care Professional Entry Login Form Figure 3.11 One Doctor Can Access Only One Particular institution as in one specialization 17

28 Figure 3.12 Health care institutions and specializations for particular doctor. 18

29 3.5 Developed e-health care system (Global life clinic) The Home page of the Portal has the Login screen to enter the credentials as user name and password for security purpose. There are 3 types of users Administrator, Doctor, patient. The page was designed in such a way that only one person can login once for the same id, i.e. unique session ID is maintained. Technical: The User interface for all the pages was done using the Macro media tool, Explanation: Login screen The UI of this contains two server control textboxes to enter the user id and password, the front end validation was done using the script language to enter the data but null values are not accepted to enter. There are 3 options for the user to select as Administrator or patient or Doctor, the controls used are Radio buttons server controls, user can choose only one selection at a time, by default one options as administrator will be checked.one command button was used to do the transaction once the validation is validated from the database. If the user credentials are correct then it will redirect to the administrator home page. Code implementation The database connection string was declared in the web. Config file, which will be implemented for entire project solution. The Add key value was declared in the appsettings of the config file. Radio button list was used for selection adding three list item values. In the page_load event the value entered in the user name textbox is stored in the session. In the submit_click event the entire logic of storing the values was written. Here the selection item was equated to corresponding list item values (administrator, patient, doctor). Using the sql-command pass the corresponding query and the connection object. Declaring a variable int_cnt equal to 1, if the condition is true it will redirect to the corresponding pages. 19

30 Administration Registration A hyperlink is used to sign up for the administrator registration; here we give user name, password, Confirm password, Address, DOB, and Sex. We have used the server controls textboxes to enter the data and a submit button for doing the registration. Code implementation For the two textboxes password and confirm password we have used compare validator control to compare the two values. In the btnregister_click event the sql command class is used to accept the name of the stored procedure and the connection object. The execute on query will execute the object. In the logout link button in the page session abandon method is used to logoff the session and redirect to the login.aspx. Administration Home Page Here the features given to the administrator to access the links are to create a new admin, Schedule Patients, Invite Doctor, Validate Patients Category, Generate Bills, Fitness Certificate, and Logout. The role of an administrator is to maintain the masters information. Here he can create a new administrator, which will be redirected to same administrator registration page. He even has the responsibility to schedule the patient s list. When a user selects the patient option from the main menu and clicks on the sign in hyperlink button it redirects to the patients registration form. Code Implementation All link buttons were used as a hyperlink to rewrite to other pages. Respond. Redirect ( page name.aspx ); Patient registration In this form patient will get registered himself by entering his data like patient name, conform password, fathers name, age address and problem. Here the problem will be selected from the dropdown. These values will be added by the administrator from the masters data base table. All these values are entered in the corresponding text boxes and dropdowns. All the front-end validations are taken care not to allow null values. The password and conform password values are encrypted and 20

31 stored in the database. For each entry after recording the database is stored in a patient id, which is an identity value. On clicking of the register button the corresponding values will be stored in the database and redirects to main menu page. For storing the values we have used the stored procedure. Code implementation: Here also compared validator was used to compare two values in the password and confirm password textboxes. To enter the address in the textbox multiline property was set to true. In the btnregister_click event the sql command class is used to accept the name of the stored procedure and the connection object. The executen on query will execute the object. The patient id is generated with the combination of two values numeric and alphabets. Declaring n=0 and concatenating with the PID as a string. This is done in the page_load event. Doctor registration form When the user checks on the doctor s radio option and clicks on the sign in hyperlink from the main menu it redirects to the doctor s registration form. Doctor will give his personal details to the corresponding controls to enter the information in the particular form. The data stored as doctor s name, password, conform password, address (used a list box to enter multiple entries), age, specifications (these values are populated from the master s database of different types of specializations), qualification, percentage and other entries are made in the text boxes. On click event of the registration button present in the page the information will be stored in the database. There will be an auto generated identity column to store the doctor id in the table. We have taken care of the frontend validations to avoid null value entries in the table. E.g. only numerical values are entered for the AGE, if any string data is entered then same alert message will display. Code implementation Here we have the compared validation of the user. The compared two values are the password and confirm password textboxes. To enter the address in the textbox multiline property was set to true. In 21

32 the btnregister_click event the sql command class is used to accept the name of the stored procedure and the connection object. The execute non-query will execute the object. The doctor id is generated with the combination of two values numeric and alphabets. Declaring n=0 and concatenating with the PID as a string. This is done in the page_load event. Patient's schedule: The administrator to add the schedule for the patients will access this page. We have used a data grid control to display the information about the patient and the corresponding doctor s visit. The columns displayed are patient id, name, problem, date to visit, doctor to visit and schedule (hyperlink). When the user clicks on the schedule hyperlink it will redirect to assign doctor page. Here the schedule is made for the corresponding patient id. The data entered here are date to visit an editable text box control and a calendar icon. When the user clicks on the calendar icon a calendar control will populate to select the date. The date format will be stored as MM/DD/YYYY and doctor id will be chosen from the dropdown lists, which were populated from the master s data list. The change event of the doctor id selection value the corresponding doctor s name will be displayed in the text box. On click event of the schedule button the data will be stored in the database and redirects to the schedule patient page. Here also we have used the stored procedure to store the values in the database. At least one doctor id needs to be selected to save the data. Code implementation In the page_load event the data is displayed in the data grid with the bound column data field. Here we are using the dataset to capture the data from the corresponding table with an alias name for the dataset binding the data grid to this dataset Doctor s information The administrator has the authorization to view all the doctors information details. Here he can change the status of the doctor or delete the entry also. We display all this information in a data grid control 22

33 with columns as change status (edit button), delete (delete button) identification, name, address, age, specialization, qualification, percentage and status. On clicking the edit button all the entries in the data grid will become text boxes for the corresponding row and update and cancel button will get enabled. We can change any entries in the corresponding text boxes by clicking on the update button. Then records will be displayed in the data grid for single page and paging facility was given to move to next pages. Code implementation In the page_load event the data is displayed in the data grid with the bound column data field. Here we are using the dataset to capture the data from the corresponding table with an alias name for the dataset binding the data grid to this dataset. In the data grid we are using the edit command column to do the transactions like update, delete and cancel. Patient category The administrator will view the patient details and assign them to corresponding categories. Here he selects the patient id from the dropdown values and the respective data will be displayed as patient name, age and problem. Category values will be populated in the dropdown. Depending upon the patient details he will select the corresponding category and the amount of concession% (text box) need to be given to him. On clicking the validated button information will be stored in the database. Bill generation On clicking the bill generation hyperlink from the administrator homepage by the admin it will redirect to this page. Here the admin will generate the bills for the respective patients depending upon the ids. Here the patient id will be selected from the dropdown and respective patient s details will be displayed and the bill date, total bill, net bill will be generated. On click event of the generate button bill details will be stored in the database. Here the bill number will be auto generated using the identity column. All the calculations will be done in the back end using the stored procedures. 23

34 Fitness certificate Admin is the person to give the fitness certificate to the patients. Here we have the patient id in the dropdown list on selection of any patient id and clicking on the GO button we generate a fitness report. We have used crystal-report-viewer as a control to display the data. Diagnosis page Here the doctor will give the prescriptions to the patients. The doctor will suggest depending upon the patient id and his problem, medicines and dosages will be given. On clicking the submit button data will be stored in the database. All the entries in this page are made by the text box control and the patient id will be selected from the dropdown list. Doctor s schedule To verify the schedule of the doctor to the patient and to give the details are checked from this page. To view this information data grid was used. The columns specified here are patient id, patient name, fathers name, age, address, and problem; visit date, doctor visited and status (link button). Paging was used to move from one page to another in the data grid. Assigned doctor This page is redirected from the scheduled patient page where doctors will be assigned to their patients ids. Here we have an image control to populate the calendar control to select the date. A non-editable text box is used to store the corresponding date. From the list of doctors ids one will be selected and doctor s name will be populated in the text box. On clicking the schedule button the data will be stored in the database depending upon the patient id. Only one patient can be mapped to doctor id. Stored procedure is been used to store the information in the database. Room allocation Administrator will allot the rooms to the corresponding patients depending upon the severity and 24

35 doctor s advice. In this the entire patient id will be populated to the dropdown and enter the date of joining by the calendar control we have provided and also the date of leaving. Room number will be selected from the dropdown list and on clicking on submit button data will be stored on corresponding table from the database. Room master Here the administrator will fill the room details as room id, room description, rent per day. On clicking on submit button data will be stored on corresponding table from the database. Operation schedule Here patient id will be mapped to the operation id. The values are operation id (selected from dropdown list), doctor s id and the patient id, operation date and time. All the date controls are in the standard format. On clicking the validated button information will be stored in the database. 3.6 Comparison of the e-health care systems with developed e-health Care system (Global life clinic) Nowadays most of the people are busy with their work. So they are using e-health care systems to get the medicine as well as getting information from the well know hospitals. We have examined and analysed the health care systems; how can the user interact with the system. We have discussed the e-health care in the 2.5. The first e-health care system (Health on the Net Foundation) is working in searching the hospitals and gives the list to the users. On the base of that, user can navigate and interact with the e-health care system. This system cannot search for the hospitals, but this can give the Doctor s information as well as Doctor s available timings in the hospital. The second is system (PQL) is good, because this system gives all the instructions to the user, depending on the user s provided information. The developed 25

36 system mayn't provide the instructions to the user, but it can tell the medicine name depends on the user decease. The third system (IZIP) is almost all same to my system. In this, the technology of providing Doctor s (As shown in Figure 12) information is organised in structured way. The technology in developed system is different. This can show the doctor's schedule like when the user checks on the doctor s radio option and clicks on the sign in hyperlink from the main menu it redirects to the doctor s registration form. Doctor will give his personal details to the corresponding controls to enter the information in the particular form. The developed e-health care system can provide the Fitness certificate and room availability information also to the user. This could be an advantage of the system. 26

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38 4. Design Issue about System 4.1 Introduction After detailed analysis system must be designed. System Design is the crucial point for developing a system. We design the system hardware and software requirements for developing a system. Here we design the system like more structured. 4.2 Software engineering paradigm applied There are various ways of designing the architecture; here in our project design of software involves conceiving planning out and specifying the externally observable characteristics of the software product. We have data design, architectural design and user interface design in the design process Design methodology The two basic modern design strategies employed in software design are 1. Top Down Design 2. Bottom Up Design 1. Top Down Design will give us the exact flow of control structure. Here we study the overall requirements and aspects of the tasks at hand and break them into a number of independent modules. The second step is to break one of these modules further into independent sub-modules. The process is repeated once to obtain modules in our project we strongly followed this approach because here we can analyze the requirements very carefully and design the structure. Since the task we need to do is straight forward and nothing much complexity is there in the requirements hence we take up this approach. 28

39 2.In bottom-up design one first identifies and investigates parts of design that are most difficult and necessary designed decision are made the remainder of the design is tailored to fit around the design already chosen for crucial part. We are not taking up this approach Database design To design a database design for the project various systems we use, DBMS and RDBMS and ORDBMS are some of the system Databases are normally implemented by using package called a Data Base Management System (DBMS). Here in our project we have followed the ORDBMS concept and implemented in designing the database design one of the most useful methods of analyzing the data required by the system for the data dictionary has developed from research into relational databases, particularly the work of E.F.Codd. we have normalized the design. Normalization There are 3 Normal Forms to design the database structure, and we have followed the 3NF design in our project. In the 1NF we have removed the repeating items and showed them as separate records but including in them the key fields of the original record. In 2NF we have further structured the tables to check that the record, which one is in first normal form, and that all the items in each record are entirely dependent on the key of the record. If a data item is not dependent on the key of the record, but on the other data item, then it is removed with its key to form another record. This is done until each record contains data items, which are entirely dependent on the key of their record. In the 3NF and the final stage of the analysis, we have examined each record, which one is in second normal form to see whether any items (tables and their respective columns) are mutually dependent. If 29

40 there are any items then they are removed to a separate record leaving one of the items behind in the original record and using that as the key in the newly created record. This is where our project design successfully completes the database design The rapid application development model Rapid Application Development (RAD) is a linear sequential software development process Model that emphasizes an extremely short development cycle. The RAD model is a high speed adaptation to the linear sequential model in which rapid development is achieved by using a component-based construction approach; we have followed this RAD approach in sub modules to implement because here we can understand the requirements very easily. By this we can create a fully functional system There are various stages in applying this RAD model as. a) Business modeling Here the flow of the information and business logic functional is captured to solve the frequently asked queries alike what will take up the business process? What information is generated? Where does the information go? Who process it? In our project the model is well designed to decide the work flow of the application like who will access and what. b) Data modeling In the work flow process of the information there are relationships between the data objects, which need a support for the business. And these are called as attributes, we have shown this structured Entity Relationship and implemented between the tables in our project. c) Application generation We have reused existing program components technically in implementing the coding. We have not used any automated tools to facilitate construction of the software. 30

41 4.2.4 Implementation Implementation is the stage where the theoretical design is turned into a working system. Giving confidence for the client or user that new system will work accurately. 1. Maintenance and Enhancement After the product is ready and given for the client to use it in the production server unexpected results will occur, and also to maintain the environment is very important. In this maintenance phase focus we mainly concentrated on the smooth running of the application and modifying any change request given by the client. This is categorized into 4 types. Correction Adaptation Enhancement Prevention a) Correction As our product is in the operation and if any minor changes or mistakes found then it can be taken in this phase to correct the task. We are taking only about 20 percent of all maintenance work is spent fixing mistakes. The remaining 80 percent are spent adapting existing systems to changes in their external environment, making enhancements requested by users. b) Adaptation Over time, the original environment (E.g., CPU, operating system, business rules, external product characteristics) for which the software was developed is likely to change. Adaptive maintenance results in modification to the software to accommodate change to its external environment this was planned in the initial stage when we have followed the TOP DOWN approach that even if any environment is change then also the product is compatible to that but within the guidelines of the requirements. 31

42 c) Enhancement As software is used, the customer/user will recognize additional functions that will provide benefit. Perceptive maintenance extends the software beyond its original function requirements. For this kind of situations also planning was done so that it does not affect the cost or maintenance cost of the project and software. d) Prevention Computer software deteriorates due to change, and because of this, preventive maintenance, often called software re- engineering, and must be conducted to enable the software to serve the needs of its end users. In essence, preventive maintenance makes changes to computer programs so that they can be more easily corrected, adapted, and enhanced. Software configuration management (SCM) is an umbrella activity that is applied throughout the software process. SCM activities are developed to Identity change Control chug. Ensure that change is being properly implemented. 4.3 System security & integrity HDB Technology (20) HDB: The abbreviation for HDB is Hippocratic Data Base It enables us to perform the following activities: 1 Provides the useful information of every patient 2 It helps in decision making with the help of computer. 3 Its also provides sequential entry of data which enables to perform tests. 4It also have a facility to share the data securely. 32

43 Policy based management system: PITAC stresses that secure, private, inter operable, electronic health care information exchange is critical to its vision of the 21 st century health care IT infrastructure. Along with sharing the electronic records of patients with the help of this technology, it also increases the chance of accessing the information illegally. Therefore PITAC emphasizes on that security related Policies. Which is responsible for security? AE is Data Base Interface layer which is responsible for security. AE: Active Enforcement Engines It provides negotiate policies between the enterprise and Data Base according to patient preferences. It governs the disclosure of the secured information. AE provides three phases 1 policy creation 2 Preferential negotiations 3 Data retrieval 33

44 Policy creator GUI User Preference GUI Preference parser Enterprise Applications User Data Collectio Policy Translator Policy Preference Data collection Services Data Base Interface Wrapper HDB Active Enforcement Engine Installed policy Preferences Data Base User Data User Data 34

45 The detailed explanation is given bellow of each and every stage Policy creation: It has disclosure policy through which the following information can be known What information can be accessed? What purpose the information can be accessed? To who it may be disclose? How it can be done? First policy specifications are expressed in privacy specification language and installed in AE engine for manipulation. Preferential negotiation: Every patient have there own preferences regarding security these preferences are translated to preferential language and communicated with the health care organization with the help of web browser. HDB compare these preferences with the privacy policy. If there are any conflicts then the patients would be given number of choices through which he can select regarding accessing and disclosure of the information. Application Data retrieval: HDB resolves all the quires of data source by programme and retrieves the data which meets the organizational disclosure policy and patient preferences. The key strengths for HDB are 1.It provides facility for handling of data, codifying the policies and preferential information. 2 It improves the query processing speed depend upon patient options and upon application. Data Encryption: In order to provide more security to the data, Data Encryption can be provided which acts as secondary layer for Data Base. Explanation 35

46 NetHMO is a national organization which is having larger number of patients and it is collaborated with laboratories and And drug research companies. Bob is a patient considering the health care. He is concerned about his personal information. Policy preferences: Policy preferences The management had reviewed the policy to meet the act like Health insurance portability. Alex tells the policy in the selected privacy language's.then he installed the policy through HDB GUI control. Privacy preferences Bob browsed the privacy page then he decided that not to reveal personal information to his employer for insurance coverage' He doesn't want to share his information to the third parties for marketing purposes. NetHMO privacy policy conflicts the Bob Referential policy. As Alex want to share the information of the patients regarding medical insurance coverage that bob don't want. The patient has two options shown. Secure information Exchange Sharing the information is a critical aspect. Ability to link patient data by the authorized user is necessary whenever patients want privacy. In order exchange information securely we need to have SII Medical Research Scenario. 36

47 Medical Research Scenario According to this scenario NetHMO, Gene Bank and IPC have installed to provide security with the help of example he explained the security of patient personal information. Wayne wants to know how many numbers of patients have Innostain reaction have a particular DNA sequence's the problem is patient don t want to reveal the information s Wayne sent a query to the NETHMO SII service through IPC client. NetHMO SII encrypts the data with the key and sends the data to Gene Bank. Gene Bank encrypts the patient data and DNA table with own key and sends back both the data. SII combine both the encrypted data and sends the number of matching results to IPC SII client application. Using this information Wayne is able to able to complete the task. 37

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