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UNIVERSITY OF GHANA
DEPARTMENT OF INFORMATION STUDIES
A PROPOSED AUTOMATED MEDICAL RECORDS TRACKING 
SYSTEM FOR THE RIDGE HOSPITAL
BY
EDWIN TETTEH AYERNOR  
SEPTEMBER, 2003.
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A PROPOSED AUTOMATED MEDICAL RECORDS TRACKING 
SYSTEM FOR THE RIDGE HOSPITAL
BY
EDWIN TETTEH AYERNOR
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF 
GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT 
FOR THE AWARD OF M. A. DEGREE IN ARCHIVES 
ADMINISTRATION.
SEPTEMBER, 2003.
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DECLARATION
I hereby declare that except fo r references to o ther p eop le ’s w ork  which I 
have duly acknowledged, this project is the result o f  my own research work 
and i t h as  n either in  part n o r  wholly been presented elsewhere fo r another 
degree.
Student ........ ........................................
Date:2. .‘A*.. . ,r& .\5?.1? . . .?rr¥ .9J . Signature: . . . . .
I
Superv iso r :,^ . ■ .. € £ r  .. ^ 9^ 1.
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This research work is dedicated to Lemer Adjoa Obeng and my family.
DEDICATION
Ill
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ACKNOWLEDGEMENT
I thank the Almighty God for the time and chance he granted me to complete 
another degree programme.
My sincere gratitude and ample thanks goes to my supervisor, Doctor Emmanuel 
Adjei for his awe-inspiring patience, supervision, encouragement and all the support 
he gave throughout the research process. Thank you and God bless you.
I also acknowledge the contributions of the managing consultant of AZ Multimedia 
Company, The Health Administrator of Ridge Hospital, and the Head and Staff of 
the Records Unit, Ridge Hospital.
Finally, I thank my parents Mr and Mrs Ayemor for all their support and sacrifices 
which have contributed to the success of this project.
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ABSTRACT
The astronom ical increase in attendance rate at health  institu tions confron t medical 
records m anagers w ith  large volumes o f  records to m anage. R ecords storage 
facilities and inform ation retrieval system s are therefore faced w ith  several 
challenges in m edical records m anagement. This situation  is very  crucial i f  patients 
medical records retrieval system s are w ho lly  m anual. A t the R idge hosp ital, the 
m anual m edical records tracking system  contributes imm ensely  to m issing  patients 
medical records, delays and long queues patien ts endure before receiv ing  medical 
treatment. This paper therefore em ploys the system s analysis and design  approach, 
(also know n as system s developm ent lifecycle) to design and develop  an autom ated 
medical records track ing  system . This p roposed  system  is a case s tudy  at the R idge 
H ospital w hich  is lim ited to tracking and m anagem ent o f  on ly  inpatients records. 
B ased  on the adopted  m ethodology, p relim inary  investiga tions and analysis o f  the 
m anual system  w ere  conducted  to find the scope o f  the problem . Follow ing  the 
results o f  the system s analysis, M icrosoft A ccess database p rog ram  w as used  to 
develop a logical design to autom ate the m anual track ing  system . The design w as 
finally m odified  and developed by  using  M icrosoft V isual B asic  6 codes to operate 
as an autom ated  m edical records tracking system . The developed  system  does not 
only track records faster and more efficiently  than the m anual system  but can also 
perform  other records m anagem ent functions such  as generation  o f  reports on 
adm issions and d ischarge cases.
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LISTS OF TABLES AND FIGURES
Tables Page
2.0 Inpatient Analysis Year 2000-2002...................................................................... 12
3.0 Hardware and Software Requirements................................................................ 35
Figures
2.0 Inpatients Folder Tracking System....................................................................... 19
3.0 Example of Hierarchical Database Model........................................................... 28
3.1 Example of Network Database Model................................................................ 28
3.2 Relational Data Model of the Automated System.............................................. 30
3.3 Folder Tracking Procedure................................................................................... 36
3.4 Main Window of the System................................................................................ 37
3.5 Example of Main Windows of Transit Points (Surgical Ward)...................... 37
3.6 Display of Folder Request Information during Tracking................................38
3.7 Display of Folder Request Information Showing Transit Point...................... 38
3.8 Display of Folder Transferred from one Transit Point to Another..................39
3.9 Display of Folder Transfer Verification............................................................ 39
6.0 Folder Creation Window...................................................................................... 68
6.1 Folder Request Window........................................................................................68
6.2 Folder Tracking Window..................................................................................... 69
6.3 Folder Transfer Form............................................................................................69
6.4 For Transfer Confirmation Form..........................................................................70
6.5 Folder Transfer Verification Window................................................................. 70
6.6 Admissions and Discharge Records Window (editable)..................................71
6.7 Admissions and Discharge Records Window (Read Only).............................71
6.8 Admissions and Discharge Report Window.....................................................72
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TABLE OF CONTENTS
Page
Title Page.......................................................................................................................... I
Declaration.......................................................................................................................II
Dedication.......................................................................................................................Ill
Acknowledgement.........................................................................................................IV
Abstract............................................................................................................................V
List of Tables and Figures............................................................................................ VI
Table of Content...........................................................................................................VII
CHAPTER ONE
BACKGROUND TO THE STUDY...............................................................................1
1.0 Introduction.......................................................................................................... 1
1.1 Statement of the Problem.................................................................................... 3
1.2 Aim of the Study..................................................................................................4
1.3 Objective of the Study........................................................................................ 4
1.4 Literature Review................................................................................................ 4
1.5 Methodology........................................................................................................6
1.5.0 Preliminary Investigation.................................................................................... 7
1.5.1 Systems Analysis.................................................................................................7
1.5.2 System Design..................................................................................................... 7
1.5.3 Systems Development......................................................................................... 7
1.6 Data Collection and Analysis..............................................................................7
1.7 Description of Chapters...................................................................................... 8
1.8 References............................................................................................................ 9
CHAPTER TWO
PRELIMINARY INVESTIGATION AND SYSTEMS ANALYSIS
2.0 Introduction........................................................................................................ 10
2.1 Background Information about Ridge Hospital...............................................10
2.2 The Structure of the Hospital............................................................................ 12
2.3 The Records Unit...............................................................................................13
2.3.0 Computerisation.................................................................................................15
2.3.1 General Records Management..........................................................................15
2.3.2 Circulation of Records.......................................................................................16
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2.3.3 Inpatients Records.............................................................................................. 16
2.3.4 The Folder Movement book.............................................................................. 17
2.4 Manual Tracking of Records............................................................................ 19
2.5 Problems within the System.............................................................................21
2.6 The Need for Automation................................................................................. 23
2.6 References.......................................................................................................... 25
CHAPTER THREE
SYSTEM DESIGN AND DEVELOPMENT
3.0 Introduction........................................................................................................ 26
3.1 Database Management System.........................................................................26
3.2 Models of Database............................................................................................27
3.2.0 Hierarchical Model............................................................................................27
3.2.1 Network Model..................................................................................................28
3.2.2 Relational Model................................................................................................ 29
3.3 Structured Query Language (SQL)...................................................................31
3.4 System Requirements.........................................................................................31
3.4.0 Input Requirements............................................................................................32
3.4.0.0 Input Interface Requirements............................................................................ 32
3.4.1 Output Requirements.........................................................................................32
3.4.2 Processing Requirements.................................................................................. 33
3.5 Design Interface................................................................................................. 36
3.6 References.......................................................................................................... 40
CHAPTER FOUR
EVALUATION OF THE SYSTEM............................................................................ 41
4.0 Introduction....................................................................................................... 41
4.1 Review of the Proposed System.......................................................................41
4.2 Software and Hardware.....................................................................................43
4.3 Data Integrity.................................................................................................... 45
4.3.0 Validation Rule................................................................................................. 47
4.3.1 S ecurity System................................................................................................ 47
4.4 References......................................................................................................... 49
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CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS........................................................ 50
5.0 Conclusion............................................................................................................50
5.1 Recommendation................................................................................................. 52
Bibliography................................................................................................................... 54
Glossary..........................................................................................................................56
Appendix.........................................................................................................................58
6:0 Some Major Visual Basic Codes within the System......................................... 58
6.1 Major Windows in the Automated Tracking System........................................68
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CHAPTER ONE 
BACKGROUND TO  THE STUDY
1.0 Introduction
Health institutions experience tremendous increase in the number of medical 
records in their repository due to patients visitation and emergency cases. When 
medical officers attend to patients and clients, records of all transactions are kept for 
essential future use. In some cases, returning patients cannot receive adequate 
treatment if their case files or hospital cards are misplaced. Large volumes of 
records demand appropriate records management practices in order to ease storage 
and retrieval of records.
Although computerisation of medical records has become a modem phenomenon, 
hard copies of records still maintain their traditional values and thus, must be 
managed accordingly. Diamond (1991), stated that “retrieval speed is improved 
through the use of both non-paper based technology and appropriate records 
management system”.
Automated medical records tracking system is resourceful in providing fewer tasks 
in retrieving records and tracing the movements of records. Chopra (1990) defines 
automation as “the technology concerned with the design and development systems 
that minimise the necessity of human intervention in their operation”.
The Ridge Hospital Records Unit has a workforce of sixteen employees, and 
operates twenty-four hours daily. The active records section is currently keeping 
about a hundred and seventy thousand records and with about hundred and fifty 
new records created daily. When patients files remain inactive for five years, they 
are sent to the hospital’s archives for preservation and storage.
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Authorised users of patients files are the nurses, doctors, staff of the pharmacy unit, 
and personnel at the accounts section. Circulation of a patient’s record during 
treatment begins from the active records section. Then, it goes to the consulting 
room, followed by the pharmacy and accounts units respectively, and finally, 
returned to the Records Unit for filing, in a case of an outpatient.
Inpatients records are kept provisionally by nurses on duty in the wards where they 
are receiving treatment. The records are however, returned to the Records Unit 
following discharge of patients. Apart from regular circulation schedule, records 
can be requested for use any time necessary by any of the legitimate users for an 
official action.
All file requests are recorded in a book referred to as “folder movement book”. 
Ideally tracer cards or outguides are the most suitable instruments for this function. 
Nurses as provisional custodians of files from the time a patient is admitted to 
discharge, also keep records on all the inpatients files in their possession in a form 
of a folder movement book. In a situation where a patient’s folder is needed 
immediately but not found on shelf, a search is done by going through all the folder 
movement books to locate who is using the file.
Taking into consideration the large volumes of records and the mechanism used to 
track records, it is important to consider automation as a beneficial solution to 
problems posed by the manual system. In addition, networking the automated 
system to other units of the hospital where patients records are relevant to their 
legitimate operations will ensure a centralised online monitoring system. This will 
be a desirable solution compared to searching through the folder movement book.
In hospitals where automated tracking systems are used, movements of records are 
easily monitored, and retrieval of records is efficient. Siemon and Kuratomi (1982) 
remarked that, “an automated system is not only an efficient method of tracking and
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retrieving records, but an efficient tool for management purpose as an integrated 
component of a management information system”.
1.1 Statement o f the Problem
The Ridge Hospital has a policy on records movements. Request for medical 
records must be recorded in order to monitor and manage the movements of records 
as they p lay v ital r ole i n the m edical p rocess. H owever, i n c ompliance w ith t his 
policy the following situations, which are the main problems of the study, are 
encountered:
Due to the large number of people who visit the hospital daily, this policy is limited 
to only inpatients records. Tracking or tracing records is fully manual and in certain 
cases demands critical detective work. The use of folder movement book instead of 
tracer cards or outguides consequently, makes the manual system cumbersome to 
operate. I t  is difficult to  trace a file when it is not found on shelf at the time o f  
demand.
Patients join long queue at the Records Unit waiting for their files to be retrieved 
before any medical attention is offered to them. The delays are caused by the 
inability of Records Unit staff to retrieve patients files within the shortest possible 
time.
Personnel time expended in tracking records is formidable due to insufficient 
storage facilities and the absence of tracer cards for faster tracing of files. Problems 
therefore arise when a patient’s file is needed immediately during the course of 
diagnosis but the file is not found on shelf. Such a file could be in the possession of 
any of the legitimate users but may take Records Unit staff considerably a long time 
before detecting which of the users is keeping the file. Unfortunately, although the 
Records Unit at the hospital is undergoing computerisation, it does not cover tracing 
of records. This study seeks to design an automated records tracking system which 
can conveniently replace the existing manual system at the Ridge Hospital.
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1.2 Aim of the Study
The study sought to explore, identify and analyse the difficulties inherent in the 
manual tracking system with the view to designing an automated medical records 
tracking system for the Ridge Hospital.
1.3 Objectives o f the Study
The study had the following objectives:
• To identify problems inherent in the manual system
• To justify the need for automating the records tracking system
• To design a systems flowchart to reflect an automated system
• To develop a proposed application to replace the manual system
1.4 Literature Review
Automation has become a critical resource for information storage and retrieval 
systems. Due to the ever-increasing array of volumes of information, records 
keeping and claims processing have become a complex and never ending task.
A study conducted in the United States shows that in the 1940s 57% of the United 
States labour force were factory or manufacturing plant workers, and 31% 
information related activities workers. After 40 years, 34% of the labour force were 
factory workers and 54%, information related activities workers. This change was 
due to factories and manufacturing industries using automation systems as a 
resource for their production processes (Bohl, 1990).
The study, however, suggests that automation systems have been amply used by 
large manufacturing industries to enhance efficiency and to increase productivity. 
Bohl, revealed that today, doctors, clinics, and hospitals can operate more 
efficiently with computerisation and automation especially when large volumes of 
records are involved.
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Furthermore, in the hospital settings automation plays very important role in 
administrative paper work, patients records, billing, insurance claims, accounts 
receivable, payroll, and recording of patients clinical history.
In Ghana, some academic research works have considered automation of academic 
libraries. Others have evaluated the effects of automation on libraries and records 
management systems. Agbe (1997), gave several reasons why automating the 
Balme Library of the University Of Ghana w as a credible c ourse to p ursue. H is 
reasons included, “to manage a process more rapidly and more accurately, or less 
expensively”. He further observed that automation in the Balme Library was 
indispensable, due to increase in  student population and high demand for library 
services. The project demonstrated that automation of the cataloguing system could 
reduce the time expended to retrieve a piece of information thus, lessening the 
difficulty in the manual use of catalogues. This is comparatively parallel to 
automating records tracking system in a health institution for faster retrieval of 
records.
In records management, previous literature concentrated predominantly on the 
evaluation of electronic database management, hardware and software for database 
management, networking, data storage, etc. Amehoe (2000) evaluated the impact of 
automation on students records management in the University of Ghana. He 
recommended personnel training, decentralisation of students data, networking, and 
high capacity data storage facilities as a means of enhancing the automation project.
Siemon and Kuratomi (1982) evaluated the numerous problems faced by manual 
systems, and proposed automating medical records tracking system as a significant 
means of support for operations, management and decision making function of a 
hospital.
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This study adopted Seimon and Kuratomi’s approach to developing an automated 
tracking system as a component of management information system using the 
systems analysis and design methodology.
1.5 Methodology
The systems design and analysis o r systems development lifecycle approach was 
employed for the study. This process involved, preliminary investigation, systems 
analysis, systems design, systems development, systems implementation and 
systems maintenance. The methodology is most suitable for achieving the 
objectives of the study; this is in conformity with Badu’s (2001) view on the post­
positivist approach, where an adopted methodology is what the researcher considers 
appropriate for the study and uses it effectively to achieve the objectives of the 
research.
The systems analysis and design methodology has been prescribed by authors such 
as O’Brien (1997), Williams, Sawyer and Hutchinson (1999), and Laudon and 
Laudon (2000), as efficient in appraising systems building alternatives and offers a 
step-by-step procedure for examining and developing an information system. The 
systems analysis and design methodology entailed the following steps:
1.5.0 Preliminary Investigation
This stage determined the objectives and structure of the Records Unit. Secondly, 
the nature and scope of the problem were identified. This was achieved by critical 
observation and analysis of the manual system in order to obtain deeper 
understanding of the problem.
1.5.1 Systems analysis
All the processes involved in the manual tracking system and circulation of medical 
records were analysed and illustrated using data flow and connectivity diagrams.
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The diagrams depicted areas in the manual system where major problems are 
located.
1.5.2 System Design
A preliminary design was done to lay out the requirements of all the components of 
the automation system and a detailed design to determine the software and hardware 
requirements for input, output, process, and storage systems.
1.5.3 Systems Development
Following the outcome of the previous stages, Microsoft Access was used to 
develop a database management application for the automation system. The 
database was further modified and customised with Microsoft Visual Basic 
programming language which converted the manual tracking process into an 
automated tracking system. Testing and debugging was finally conducted to assess 
and remove programming errors within the developed system.
1.6 Data Collection and Analysis
Data was gathered by observation, from interviews and available written documents 
such as annual reports, manuals and policy statements. The officials interviewed 
were: the hospital administrator, the head and two staff members of the Records 
Unit, four senior nurses, two doctors, and a person each from the pharmacy and 
accounts units.
The systems analysis modelling tools prescribed by Williams, Sawyer and 
Hutchinson (1999) were used to analyse the data collected. These analytical tools 
such as dataflow diagrams, systems flowchart, and connectivity diagrams were used 
to represent the analysed data in a pictorial format pending the outcome of the 
systems analysis.
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1.7 Description o f Chapters
Chapter one comprises introduction, statement of the problem, purpose of the 
study, objectives of the study, methodology, data analysis, and literature review.
Chapter two looks at background information about The Ridge hospital, structure 
of the Records Unit, flowchart of records circulation, problems with storage 
facilities, systems design and analysis, and the need for automation.
Chapter three looks at systems design and development of programs for 
automating the tracking system.
Chapter four covers the evaluation and review of the system 
Chapter five documents findings, conclusion and recommendations.
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1.8 References
1 Diamond, Susan Z. (1991). Records Management: Policies, Practices, 
Technology. Amacom, New York, p. 8
2. Chopra, Nielum R. (1990). Dictionary o f Library Science. Anmol, New 
Delhi, p. 39
3. Seimon, James E. and Ruby M. Kuratomi (1982). “Automated Records 
Tracking as a Component of a Management Information System”. Journal o f  
Health Information Management, September 1982, Aspen Systems 
Corporation, California, pp. 55-65
4. Bohl, Marilyn (1990). Essentials o f  Information Processing. Macmillan, 
New York, pp. 13-15, 400, 403
5. Agbe, Adolph K. (1997). Automation o f  Academic Libraries in Ghana: a 
Case Study o f  Balme Library. Unpublished Thesis for the award of Master of 
Arts degree, University of Ghana, p. 5
6. Amehoe, Christopher K. (2000). An Evaluation o f  the Impact on Automation 
on Students Records Management in the Academic Section o f  University o f  
Ghana. Unpublished Thesis for the award of Master of Arts degree, 
University of Ghana, p. 9
7. Badu, Edwin E. (2001). “The African Corporate Culture: an Obstacle to 
Effective Strategic Planning in Ghanaian University Libraries”. Library 
Management, MCB University Press Vol. 22, No. 4/5, p. 212
8. Williams, Brain K., Stacey C. Sawyer and Sara E. Hutchinson (1999). Using 
Information Technology: a Practical Introduction to Computers. (3rd ed.), 
McGraw-Hill, Boston, pp. 473-493
9. O’Brien, James. A. (1997). Introduction to Information Systems. (8th ed.), 
McGraw-Hill, Boston, pp. 380-395
10. Laudon, Kenneth C. and Jane P. Laudon (2000). Management Information 
systems: Organisation and Technology in the Networked Enterprise. (6th ed.), 
Prentice-Hall, New Jersey, pp. 347-356
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CHAPTER TWO
PRELIM INARY  INVESTIGATION  AND SYSTEMS ANALYSIS  
2.0 Introduction
This chapter looks at the background information about the Ridge Hospital 
including statistical information about medical services that are provided annually. 
The structure of the Records Unit and records management practices, principles and 
policies were studied carefully.
The chapter sought to study in detail all the steps and procedures involved in the 
manual system of tracking records as part of the preliminary investigation stage of 
the systems analysis and design methodology, in order to reveal the problems that 
exist in the system. This was followed by the systems analysis stage, where a 
diagram was used to illustrate the record circulation paths and how patients records 
flow within the manual system. Finally, the chapter was concluded by considering 
the need for automating the manual system.
2.1 Background Information about Ridge Hospital
The Ridge Hospital, once known as the European Hospital is located in the centre of 
the commercial and administrative capital city Accra. The hospital was established 
around 1928. The geographical location of the hospital is within an area which was 
mainly European settlement during the colonial era in Ghana (Ridge Hospital 
Annual Report, 2002).
The Ridge Hospital operates as a regional hospital for the Greater Accra region, 
receives referral cases from poly clinics, private hospitals, quasi government 
institutions and health posts in the region and other regions. The mission of the 
hospital is “to provide universally accessible, efficient, quality and affordable 
specialist services to the people of the Greater Accra Region”. To accomplish this
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mission the hospital has adopted the five main objectives of the Ministry of Health 
and the Ghana Health Service (MOH-GHS) namely:
1. Increase access to health care
2. Improvement in quality of care
3. Improvement in efficiency
4. Foster collaboration with stakeholders
5. Equitable and efficient resource distribution (Ridge Hospital Annual 
Report, 2002).
With these objectives the hospital has put in place strategies to develop and improve 
the medical and non-medical units, sections or departments. The strategies include 
capacity development of units/departmental heads in that they can administer their 
duties more efficiently, generate effective systems of evaluating and reporting on 
hospital activities, ensure efficient and effective resource mobilisation, and motivate 
staff.
With clinical services the hospital seeks to strengthen its 24 hour emergency 
service, supply of drugs and to intensify in-service training in order to upgrade the 
capabilities and skills of staff.
Computerisation is one of the top priorities on the lists of facility development. The 
hospital is currently networking all its computer operations. The Records Unit 
which is receiving much attention from the computerisation programme is being 
networked with the pharmacy and the accounts units. This facility makes it more 
efficient for the pharmacy unit to serve drugs to only patients who have approved 
prescription from a staff physician. It is however within the scope of the hospital’s 
future plans to have a local network which covers all the various units in order to 
share information resources, and to communicate effectively. This is being 
supported by the provision of a 24 hour power supply to computers and other 
information and communication technology appliances.
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2.2 The Structure o f the Hospital
The hospital is structured under three main divisions; Clinical, Clinical Support and 
Support Services. The clinical division is made up of Internal Medicine, Paediatrics, 
Obstetrics and Gynaecology, Surgery, Dental, and Accidents and Emergency. 
Pharmacy, Laboratory, X’ Ray, Blood Bank, Physiotherapy and Public Health falls 
under the Clinical Support Division. The Support services are General 
Administration, Medical Statistics, Catering, Environmental Health, Medico-Social, 
Information Technology, Welfare, Transport, Estate, and Engineering and 
Maintenance.
Ridge Hospital has 36 Doctors including 9 specialist, 192 nurses, 197 paramedical 
staff and 48 other staff all totalling about 482. The Outpatients Department 
attendance is more than 50 thousand per annum. Between the year 2000 and 2002, 
outpatients attendance increased by 18.6 percent (Ridge Hospital First Quarter 
Report, 2003).
The Inpatients Care Unit is supported by 172 beds. The unit has a surgical ward, 
mobile ward, female ward, maternity ward, children’s ward and Very Important 
Personalities (VIP) Ward. Statistics show that from the years 2000 to 2002 there 
was an average of 7136 admissions per year. Table 2.0 shows the details of 
admission from the year 2000 to 2002 (Ridge Hospital Annual Report, 2002).
Inpatient Analysis Year 2000-2002 Table 2.0
YEAR 2000 2001 2002
Admissions 5737 10451 5220
Discharge 5222 8820 5096
Number of Beds 173 180 169
Average admission per day 16 29 14
Average length of stay 8 9 10
Source: (Ridge Hospital Annual Report, 2002)
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The given data (table 2.0) suggests the number of times medical records are 
searched for, retrieved and returned to shelf after treatment. It is therefore 
established that efficient medical services also depend on efficient medical records 
management. To every health institution medical records are as important as the 
treatment offered to patients. The increasing attendance and admission rates at the 
hospital demand e ffective and e fficient records m anagement activities in o rder to 
speed up medical services.
Apart from general outpatients services the hospital also has a dental clinic, an eye 
clinic, diabetic clinic, and an emergency recovery ward. All these sub clinics 
experience increasing attendance rate. The dental clinic for instance, recorded 20 
percent increase on attendance from 2001 to 2002, while the eye clinic treated 8,887 
cases in the year 2002. The outpatients department also carries out a cervicare 
project dubbed “Ghana Safe Demonstration Project”, where screening for cervical 
cancer is done. This project is sponsored by a non governmental organisation 
(Ridge Hospital Annual Report, 2002).
All the various medical units receive a great deal of service from the Records Unit. 
It is within the hospital’s policy framework that the personnel at the Records Unit 
who are the custodians of all medical records must be able to retrieve records before 
treatment procedure begins. This task is however becoming increasingly difficult 
due to the astronomical increase in attendance rate which paints a clear picture of 
the work load on the Records Unit staff. This situation is much severe in the early 
hours of each day particularly working days when hundreds of files must be 
retrieved for hundreds of patients seeking medical attention, before they can see a 
physician to make their complains.
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2.3 The Records Unit
The Records Unit operates a 24 hour service. There are 16 workers at the unit 
running on shift. The unit has an active section and an archive section. The archive 
section keep records which have been declared redundant - that is records which 
have been inactive for more than five years.
The active section is located within the main outpatients department block. It covers 
an area of about 28 cubic metres with 12 feet ceiling height. The section is 
partitioned into three rooms. The first room is known as the server room where all 
patients must first visit for their hospital cards retrieval process to begin. New 
identification and hospital cards are created for first time patients. All other requests 
on medical records and complains are received in the server room for necessary 
actions to be taken. This room is equipped with information and communication 
resources that run the pilot computerisation program on medical records. One of the 
other two rooms is used as an office for records staff and as a stack area purposely 
for inpatients records. The third room is however, fully used for keeping outpatients 
and a few inpatients records.
The stack room where outpatient records are kept currently holds about 1 80,000 
cards. About hundred and thirty cards are generated daily. Cards are arranged 
serially and laterally on shelf. Files are often found arranged on the bear floor or on 
desks due to insufficient shelving capacity. This situation makes the stack room 
somehow congested. Folder Movement Books, Admissions and Discharge Books, 
and Daily Ward State Books are arranged on the floor and on writing desks because 
they have no place on shelves.
Besides managing records, the Records Unit also keeps records and reports on 
admissions and discharge cases. The Admissions and Discharge note book is used 
to report daily admissions and discharge cases whiles the Daily Ward State book is 
for recording patients on admission, total admitted, number of empty beds, patients
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transferred from one ward to another and bio data of admitted and discharged 
patients.
The unit generates reports on the number of admissions and discharge cases, deaths, 
and so on, quarterly and annually. This information is very useful to the hospital 
administration to aid their strategic planning for the hospital.
The unit is also responsible for the archives section. Records within the archives are 
patients cards which have remained inactive for 5 years. The records within the 
archives are in boxes and there is a special list that is used as a finding aid for the 
records.
2.3.0 Computerisation Program
The computerisation program at the unit handles creation of new hospital 
identification numbers for patients, creates soft copy of patients bio data, and other 
information such as occupation, address, region of birth, etc. Hospital identification 
numbers are generated uniquely by the computer program. The program is basically 
an integrated database management system. It has the capabilities of generating 
reports by simple instructions and can also run basic query functions such as finding 
out daily outpatients attendance, number of new identification cards generated, and 
so on.
Such query functions are resourceful for tracking outpatients records. Though the 
program is not designed specifically to track movement of medical records, some of 
the query functions can be used to aid tracking of records. For example, the daily 
attendance report can also be used to determine the number of cards that were 
retrieved.
2.3.1 General Records Management
Most of the records management activities take place at the active section which is 
located within the outpatients department. The archives section is only used when a
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patient whose record has been inactive for more than five years revisits the hospital. 
In such situation the record is sent to the active section after use and remains active 
again.
All o utpatient i nformation i s written on a c ard. The c ard i s m easured 1 0.5cm b y 
15cm which is about the size of an A5 paper and a soft copy of bio data information 
is kept in a computer system. When the writing space for physicians is exhausted a 
new card is attached to the old one.
Inpatients cards are kept in folders. When a patient is discharged and his or h er 
folder is returned to the Records Unit, the card is taken out of the folder and kept 
among the outpatients cards, and the folder is kept among the inpatient folders. If a 
patient is detained again on his next visit his folder is then retrieved and his card is 
kept in it again until discharged.
2.3.2 Circulation of Records
The server room is the first point of contact for any medical records request. Apart 
from emergency cases every patient must first visit the server room to make a 
request for their hospital card. Patients make their request by first submitting their 
hospital identification card. A first time patient would however get the hospital 
identification card created for him or her.
In case of an emergency, as soon as patients are rushed into the emergency ward 
they are given numbers which are sent to the Records Unit for provisional 
identification cards and records to be created for them. Afterwards, when all the 
necessary bio data and other information about patients have been collected, all 
information on temporary cards is transferred into appropriate hospital records.
The requests made by outpatients are sent to the stack area for extraction of records 
which are sent to nurses at the outpatients department. These nurses then schedule
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consultation arrangement for the incoming patients to see a physician. After 
consultation all the records are sent back to the Records Unit for shelving.
2.3.3 Inpatients Record
When a doctor asks for the detention of an outpatient in order to continue intensive 
medication, the patient is declared an inpatient. The patient is then sent to a ward 
with his records. Ward nurses then send a request to the Records Unit for an 
inpatient records folder. If the patient has not been admitted before, a new folder is 
created for the patient’s medical records.
The inpatients folders are kept by nurses at the wards till patients are discharged. 
They are then returned to the Records Unit for shelving. It is a policy for nurses to 
return inpatients folders within one week after their discharge, however in  many 
cases folders stay at least two weeks in the wards after patients are discharged.
Whiles the folder is in the ward where the inpatient is receiving treatment it may be 
requested for by other legitimate users. All these requests first go to the Records 
Unit for tracing. To trace an inpatient record in transit the folder movement book is 
used.
2.3.4 The Folder Movement Book
The folder movement book is used instead of a tracer card. A tracer card simply 
replaces a folder when it is removed from the shelf. Therefore, when a folder is not 
on shelf the tracer card is checked to determine whether the folder has been loaned. 
The tracer card also contains details of the loan agreement in order to trace the 
movements of folders.
The folder movement book functions the same as the tracer card. The book has a 
column for the name of the borrower, purpose for borrowing, patients number, date 
of loaning, date returned, ward o r destination o f  the folder, and so on. All these 
information aid the records staff to be able to track records when needed.
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A version of the Folder Movement Book is kept by nurses at the wards to enable 
them keep records on movements of folders which are in their custody. This folder 
movement book is very useful in tracking records. It is the principal mechanism for 
locating a file not on shelf. It is only used for inpatients folders. Despite the 
usefulness of the folder movement book, it is sometimes cumbersome to use. This is 
because to  locate for example, a folder that was last used for instance, weeks or 
months ago it means that one must spend time going through many rows and pages 
in a the folder movement book or books.
To design an automated tracking system simply means automating the folder 
movement book. The folder movement book must be studied critically to be 
restructured into an automated system. This can also be considered alongside the 
other recording books, such as the daily ward state note book, and the admissions 
and discharge notebook because they are also used as finding aids to track records. 
For example, it is always possible that if by mistake a staff at the Records Unit did 
not record in their folder movement book that a folder has been requested for by a 
legitimate user, the admissions and discharge note book can be used to determine 
the date of admission or date of discharge of the patients who bears the folder in 
question.
This will further, lead to a cross check in the daily ward state book to determine the 
ward where the patient was admitted. As the investigation proceeds, nurses on duty 
during the period may also be questioned leading to possible clue about the transit 
point of the folder.
All these processes are useful to the automation process which would mean; 
integration of all the mechanism involved in using the folder movement book, 
admissions and discharge book and the daily ward state book.
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2.4 Manual Tracking of Records
Figure 2.0 is a graphical representation of how folders are tracked by the use of the 
folder movement book.
Inpatients Folder Tracking System Figure 2.0
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Step One
At step one attempt is made to search the shelf for the folder requested for by a user, 
with the assumption that the folder has been returned to the Records Unit by the last 
user. If the folder is found all requests proceedings are recorded in the folder 
movement book. The folder is then submitted to the user.
Step Two
The folder movement book is consulted to trace folders transit point. At this point it 
may be helpful to find the last time the patient was admitted. Such information may 
be gotten from the patient or other sources, such as the admissions and discharge 
note books. When folder requests information is found in the folder movement book 
it is then traced to the transit point, if not, tracking then c ontinues b y f  ollowing 
investigation proceedings at step three.
If the folder is found at the transit point request information is updated in the folder 
movement book before submitting to user else step four is followed.
Step Three
All the recording books are checked to retrieve patient’s last visit information such 
as ward o f  admission, date discharged, whether patient was transferred from one 
ward to another, and all other folder movement books are consulted. After the 
success of this exercise the folder is traced to all possible transit points (step four). 
Request proceedings are then updated in the folder movement book if the folder is 
found, else the folder search is aborted with the assumption that it is missing.
This step requires a lot of intelligence and detective work to track the folder. The 
staff believes strongly that a missing folder may be lying on a doctor’s desk in his 
office, under certain files in a ward and so on. However, a successful search 
depends on accurate information about patients last visit.
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Step Four
Step four is the real physical search for folders at all possible transitional point. This 
include ward of admission, transferred ward, accounts and pharmacy units, 
consulting rooms and sometimes offices of doctors. This step also depends on 
accurate information about patient last visit to speed up the search process.
2.5 Problems within the System
The problems within the manual records tracking system to a large extent cannot be 
entirely solved by introduction of an automated system. The folder movement book 
which is the principal aid for tracking the movement of records is very resourceful, 
and can be reliable if  all the policies on folder requests are followed. This is because 
many complicated cases during tracking of folders are due to the fact that the 
appropriate modus operandi for folder request, or transfer from one user to another 
were not followed.
In situations were requests for folders are for emergency cases staff may postpone 
the requests recording proceedings in a folder movement book. However, if the 
folder requests records are not updated later, such a folder may be on a transitional 
path which will be difficult to track in future.
The major factors involved in tracking folders are;
a) the time taken to retrieve folder
b) available tracking aids
c) effectiveness and efficiency of tracking aids
Within any tracking system these among other factors give problems to the manual 
system. The time taken to track records at the Ridge hospital in many cases depends 
on how long the records have been inactive. Tracking a folder that has been used a 
month ago takes a shorter time to find than say, a folder which was last active six
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months ago. This is due to the structure of the folder movement book which 
depends on time to go through pages and many rows and columns.
The main problem with the folder movement book is the time spent to go through in 
search for information about a folder which is not on shelf. Even the different styles 
of handwriting can slow down searching for folder request information.
The structure of how requests for folders are recorded in the folder movement book 
does not seem to be of much problem. However, though it takes about a minute to 
record a folder request it takes about five to ten minutes to search for request 
information about a folder which has remained inactive for about a month. It can 
therefore be said that efficiency in the use of folder movement book is affected by 
the time taken to search for folder requests information. This situation is worsened 
when there is no information about folder request and yet does not exist on shelf.
In such a situation the other finding aids, Daily Ward State Book and Admissions 
and Discharge Book are used. These can only provide information about a patient’s 
last visit to the hospital, the ward in which the patient received treatment and other 
relevant information which can aid tracking investigation.
Another prevalent problem with the manual system is that there is no appropriate 
mechanism to determine which folders are in transit or on shelf. It is only when an 
attempt to retrieve a folder on shelf fails does the folder movement book is 
consulted for information about the folder’s transit point. This has resulted to a 
situation where one cannot know by any means whether a folder is present on shelf 
or not till it  is requested for by a user. This is because there are no tracer cards 
which can be used to check for folders in transit and that on shelf.
In summary it was observed that the main problems within the manual systems can 
be enlisted as;
• The time taken to search for folder information is formidable
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• Because the Records Unit does not use tracer cards there is no mechanism to 
determine which folders are in transit and that on shelf.
• Records staff and nurses failure to record appropriately folder requests 
information proceedings contribute to much of the difficulties in tracking 
folders.
2.6 The Need for Automation
Automation cannot on a full hundred percent scale solve the problem within the 
manual system. An effective and efficient manual system may not need any 
automation. However the following reasons can be considered for an automated 
tracking system.
• An automated tracking system can significantly reduce the time spent to 
retrieve information about folder movements compared to the folder 
movement book and other finding aids.
• All the information needed to track records in steps one, two, three and four 
in figure 2.0 on page 19 can be displayed at ones on a computer screen or 
printed on paper by a well designed database management program.
• An automated system can also be used to generate reports about folder 
movement and can be queried to retrieve specific information about folders.
Taking into consideration figure 2.0, one would observe that considerable minutes 
are spent to just retrieve folder request information before physical search for the 
folder begins. Therefore, if automatic machines c annot b e designed to  s earch for 
folders physically, a database management program can be designed to reduce the 
time spent to search for folder request information from the folder movement book 
or the other finding aids.
Tracking records takes two segments. In the first segment, search for information 
about the needed folder is conducted. The second segment is the physical search for 
folder at a ward or other possible transit points. The time spent at the first segment
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is equal to or more than the time spent at the second segment. The need for 
automation is to speed up the search for folder request information which in actual 
sense reduces the time spent to track records.
One burden of the Records Unit is generating of reports on admissions and 
discharge cases, and preparing daily ward state report which is done daily, quarterly 
and then annually. Report generation can be part of the automated tracking system. 
This is possible because the sources of information for tracking and reports 
generation are linked with folder request information.
To automate the Records Unit at the Ridge hospital means developing a database 
system which is an integration of all records management practices at the Records 
Unit. This database must be expandable with the incorporation of the folder 
movement book, the daily ward state book, admissions and discharge note books 
and all other recording books at the unit. This is because when tracking records an 
average of three recording books are consulted as finding aids.
Finally, there is a need to create a database management system that can manage all 
recordings at the unit, by integrating the various recording note books into one 
database management system as a requirement for an automated tracking system. 
Such database management system will be very efficient and cost effective in 
information retrieval for tracking folder movement, report generation and other 
records management activities at the Records Unit.
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2.6 References
1. Ridge Hospital Annual Report, 2002
2. Ridge Hospital First Quarter Report, 2003
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CHAPTER THREE
SYSTEM  DESIGN  AND DEVELOPMENT  
3.0 Introduction
The system design stage in a development life cycle begins with a logical design 
followed by physical design specification to establish major systems requirements; 
namely, input requirement, output requirement, storage requirement, processing 
requirement, and maintenance requirement.
In this chapter, preliminary design that reflects the procedure in the manual tracking 
system was developed. This was followed by a detailed design to determine system 
requirements for the automation system.
Microsoft Access database version 2002 was used at the logical design stage to 
create a database meant to function as the folder movement book, the daily ward 
state book and the admissions and discharge book. Diagrams such as connectivity 
tools and systems flowchart are given to reflect the functional requirements of the 
input, output, and processing. Finally, the detailed design was customised and 
refined with visual basic programming language.
3.1 Database Management System
Laudon and Laudon (2002) defined a database management system as “the software 
that permits organisations to centralise data, manage them efficiently, and provide 
access to the stored data by application programs”. A database management system 
has the capacity to allow managing and sharing of information very much easier, 
and make information retrieval faster and efficient.
Data redundancy can be reduced efficiently by database management software. For 
example, fields are not repeated in different files within the same database. In the
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case of the Records Unit at the Ridge Hospital, files would be considered as the 
folder movement book and the other recording books. To speed up records 
management activities requires a database management program as a component of 
information management.
The Records Unit at the Ridge Hospital is no exception from institutions that need a 
database management program to improve their records and database management 
activities. The number of tasks associated with records management at the Records 
Unit, can be integrated into a unique database management program to reduce 
repeated task. The use of the folder movement book, daily ward state report book 
and other recording books is associated with repeated tasks. A typical example is a 
“patient date of admission”. This field is a given column in all the recording books. 
A database program will be efficient by reducing all the repeated operations to just 
a single task by linking field records to many tables within the database.
3.2 Models o f Database
Every database management system has a structure or a logical principle for 
organising and representing data. Laudon and Laudon (2000), William, Sawyer and 
Hutchinson (1999) categorised the structure of database as models, namely, 
Hierarchical, Network, and Relational data models.
3.2.0 Hierarchical Model
In this structure, data is represented from the root, which is a top level segment to a 
lower level segment. The hierarchical model resembles parent -  child relationship. 
Parents can have many children but, a child, just one parent. Figure 3.0 on page 28 
illustrates how a folder will be traced if hierarchical model of arrangement was used 
for the automated system.
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Example of Hierarchical Database Model figure 3.0
^Folder Numbc^
c PatientsInformation )  c Adm issionInfonnation ) CFolder R equest Infonnation0
Patient
ID X Wt/d ^  f  Date | | Dale | f  Date j  f  Dale | f  UserJ  V Admitted J  i  Discharged J  V Taken J  Returned ) \  Name J
3.2.1 Network Model
Laudon and Laudon (1999) described the network model as “variation of 
hierarchical data model”. A database can be converted from network into 
hierarchical and vice versa. Unlike the hierarchical model which is a one-to-many 
arrangement the network functions as many-to-many arrangement.
The network model follows the method used to track records which has no request 
information about a folder in the folder movement book but has patients last visit 
information in the daily ward state report. In searching for such a folder all possible 
transitional points are checked. Figure 3.1 represents how tracking could be 
conducted if the system is based on the network database model.
Example of Network Database Model Figure 3.1
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It shows the relationship that may exists between transit points and finding aids. For 
example, information about a patient’s ward of admission can be traced to all the 
three finding aids, and the date a folder was transferred from shelf to a user, or from 
one user to another, can be traced at all the transit points. These examples depict the 
many-to-many relationship of the network data model.
The network data model permits retrieval of specific information in a database from 
different sections within the database system but follows a sequential order of 
arrangement. Accessing records from a database system which follows the 
hierarchical data model is rigid. The rigidity is due to the fact that a restricted path 
must be followed, starting from the root (upper segment), to the branches (lower 
segment). This depicts the parent-to-child relationship.
3.2.2 Relational Model
The relational data model is a very flexible system. Modem database management 
software such as Microsoft Access has relational database model capabilities. This 
model is the integration of the other two models. Tables from different database can 
be connected into one database. It does not restrict itself to paths as hierarchical and 
network models do. Certain relational database management programs have been 
developed into what is known as Object Oriented Database which can allow 
graphical images, videos, sound and other multimedia functions to be used within 
its interface.
In order to make the automated tracking system efficient, the logical principle for 
data representation, arrangement and tracking is based on the relational database 
model. The flexibility of the relational model permits search for information 
through columns and rows which contain related records. This feature which is 
incorporated within the automated system makes it undemanding for report 
generation since specific records can be retrieved from different tables and columns 
within the same database system.
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It is this flexibility that Laudon and Laudon (2000), described as “power to combine 
information from different sources, simplicity of design and maintenance, and the 
ability to add new data and records without disturbing existing programs and 
applications”. Figure 3.2 illustrates how all the transit points are linked to the 
central database where all folder records are kept. This is to ensure uniformity of 
folder information and prevent duplicate records.
Relational Database Model of the Automated System Figure 3.2
(Illustration of a relational database model using the case of Ridge Hospital as an 
example)
This structure allows automatic update of folder request records within the system. 
With such a system installed, tracking of records will not be the only function of the
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automated system, but a speedy generation of reports which also form part of 
records management activities at the Records Unit.
Microsoft Access w ith i ts st ructured q uery I anguage (SQL) w hich h as r elational 
data model features was used to develop the first phase of the database for the 
automation. With the structured query language support, updating records, adding 
records and deleting records can be performed by simple task, and it does not 
require a user much knowledge and skills to be able to manage the database.
3.3 Structured Query Language (SQL)
SQL is used to specify how a system should combine and select data from a table or 
tables within a database. Burrow and Langford (2000) defined structured query 
language as “the standard for manipulating database management system”. With 
SQL incorporated into the automation program, report generation and retrieval of 
specific information such as folder request for tracking of records can be done more 
efficiently.
Another relevance of SQL incorporation into a database management system is that 
it reduces redundancy in the retrieval of specific information, and can also be used 
to retrieve data from several database files from many programs that have 
compatibility with each other.
3.4 System Requirements
The system design stage requires that all the various requirements for a new system: 
input requirements, output requirements, storage requirements and maintenance 
requirements must be determined after a logical design. William, Sawyer and 
Hutchinson (2000), recommended that functional capabilities of the system should 
be described at this section.
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3.4.0 Input Requirements
Input requirements for the system considered compatibility with computer systems 
used at the hospital. The ongoing computerisation program at the Records Unit is 
built on Windows NT technology, and complies with SQL server. To save cost in 
acquiring a new server technology, the automation system and the network server, 
are within compliance with the Microsoft Windows NT and SQL server technology.
3.4.0.0 Input Interface Requirements
The user interface considered the following;
• Users of the program
• Data entry method
The user interface uses terminologies that Records Unit staff and other legitimate 
users of medical records are familiar with to facilitate acquaintance with the system. 
It is likely that if captions of menu items, labels, command buttons, message boxes, 
etc. are written in a vocabulary that is different from their usual terminologies they 
may see the system as alien which will lead to a situation where it will not fulfil the 
purpose for which it was designed.
Workers at the Records Unit have at least skills in mouse usage which presupposes 
that graphical and menu driven interface was suitable. List box, check box and 
option buttons which are features of graphical driven interface facilitate speedy 
retrieval of records.
The type of data to be entered, are mainly names of patients, dates, patients 
identification numbers, etc. Other data such as wards, folder user names, etc. have 
been input in a list box for selection during data entry. For an automated tracking 
system, the user interface should be such that users do not spend much time to 
retrieve needed information. The user interface should be such that information is 
retrieved by just some few mouse clicks or menu item selections.
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3.4.1 Output Requirements
The user interface design stage considered soft copy output. This is because hard 
copies may not be needed all the time. If a folder request information is needed a 
user may prefer to just view it on a computer screen. Output requirement depends 
on the use of the information retrieved from the system. Output such as report will 
demand a hard copy. A printer is therefore required to be part of the system.
Soft copy display should be possible for printing if a hard copy is required. This 
required that the system should have features to transfer retrieved information into 
other applications, for example, a word processor to aid s uitable p rinting 1 ayout. 
William, Sawyer and Hutchinson (2002), recommended that irrespective of the 
output (soft or hard) a database should be designed with a format such that 
headings, columns, rows, menu etc., are clearly distinct in appearance.
3.4.2 Processing Requirements
Software and hardware for running an automation program basically determines the 
efficiency of a system in relation to retrieval and processing speed. Running a 
database with modem database management system requires high speed processing 
capacity, such as Pentium 4, large hard disk size including the use of Redundant 
Array of Independent Disk (RAID), and servers for efficient operations.
The Microsoft Corporation recommends the following specification as the 
minimum hardware requirements for the installation of Windows XP professional:
• 233 megahertz (MHz) Pentium or higher microprocessor (or equivalent)
• 128 megabytes (MB) recommended (64 MB of RAM minimum)
• 4 gigabytes (GB) of RAM maximum)
• 1.5 GB of free space on your hard disk
• VGA monitor
• Keyboard
• Mouse or compatible pointing device
• CD-ROM or DVD (http://www.microsoft.eom/hcl/~>.
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Though the Microsoft Office XP version of Access Database System and Visual 
Basic 6 codes were used for the development of the automation system, it is also 
possible to run the program on previous versions of the mentioned platforms. It 
could be made possible by straightforward conversion from current version to other 
previous versions. The decision to convert to older platforms will mean that 
management of the hospital is not yet ready to upgrade from the present Microsoft 
windows 98 and 2000 edition operation system software, and Microsoft office 2000 
which is commonly used at the hospital.
Software requirements, however, can be fully optimised in Microsoft windows and 
office X P p rofessional environment w hich support a lot of database management 
system. The software requirements lead to determining the hardware required for 
processing and storage.
Microsoft Office has complex software utilities that can aid a preferred report 
layout and other analytical tools such as graphs, chart, etc. The hardware 
requirements examined the processes involved with the tracking system, the storage 
requirement, and the total volume of operations within the system.
Aside memory size, storage capacity and central processing units speed, 
communication and networking facilities are also required for the system. Modems, 
network cards, port hub, and Ethernet cables which are basic accessories for a local 
network must not only be compatible with the software platform on which the 
operation system is built, but also require a capacity that can match up with features 
of the software designated for the system. Table 3.0 on page 35 shows the standard 
hardware and software requirements for the system.
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Hardware and Software Requirements Table 3.0
HARDWARE/SOFTWARE MINIMUM CAPACITY/SPEED/VERSION
Storage 10 Mega byte (Mb) for each computer
Memory (RAM) 64 per computer
Disk Operating System Windows 98: Windows XP preferred
Microsoft Office Office 97: Office XP preferred
Network card Ethernet type
Network cables Ethernet standard cabling
Port hub 24 channel
Processor Pentium 400 Megahertz per PC
Keyboard 102 keyboard
Mouse Ps2/serial Mouse
Monitor 15/17 inches
Source: Roger Jennings (1999). Special Edition Using Microsoft® Access 2000 
http://www.microsoft.com/hcU
The automation system requires that all the transit points for folders should be 
networked with information and communication facilities installed equitably at all 
transit points. This would enable a standard speed for the automation. The Records 
Unit must, however, be equipped with a server machine with a large storage device 
and high speed processing capacity. The server will serve as a backbone for 
efficient electronic storage purposes.
A minimum of 40 mega byte hard disk, Pentium 4 processor, and 256 random 
access memory size could be given as server properties. The transit points suggest a 
minimum of 24 channel port hub with all the computers having network and 
Ethernet adaptors and cables. All the computers at the transit points must run the 
same operation system and office suite program such as Microsoft office.
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3.5 The Design Interface 
Folder Tracking Procedure Figure 3.3
This diagram is an automated version of the manual dataflow diagram (figure 2.0 on 
page 19) which reflects how folders are tracked with the manual system. Base on 
figure 3.3, tracking a folder can be done from any transit point. If it appears that a 
folder is transferred from one user to another, the system can be commanded to 
display details about the transfer. This is done to find out whether the supposed 
current user has confirmed that a folder has been transferred to him.
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Based on figure 3.3 on page 36, figures on pages 38 and 39 show an example of 
how the system tracks folders. Figures 3.4 and 3.5 are main windows of the system 
and transit points.
Main Window of the System Figure 3.4
Example of Main Windows of Transit Points (Surgical Ward) Figure 3.5
INPA1r iE N TS  RECORDS  TR ACK IN G  SYSTEM
....
MAIN MENU
ADMISSIONS AND DISCHARGE
SURGICAL WARD
[TRANSFER FOLDER!
CONFIRM FOLDER TRANSFER
EXIT FOLDER TRACKING 
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Display of folder request information during tracking: The folder status states that it 
is on shelf. Figure 3.6
FOLDER MOVEMENT RECORDS
_____________________ | ENTER PATIENT ID | mmm -i
PATIENT ID | | 010101 
PATIENT NAME I 
NAME OF USER i 
DATE QE REQUEST! 
DATE RETURNED I
p u r po s e !
(ASANTE MICHAEL 
jMARY ADOTEY 
|l6-0ct-03 
|l2-Feb-99 '
Iadmission  Z J
i R E S j I S  pUM BEft OF FOLDERS: | 12
Update Record | Create New Folder I Folder Request | Exit To  Main Menu |
Display of folder request information showing transit point. 
I FOLDER MOVEMENT RECORDS
Figure 3.7
j ENTER PATIENT ID | 048538 _J
PATIENT ID 048638
PATIENT NAME) 
NAME OF USER j 
DATE OF REQUEST]
ImICHAEL AYIVOR
(EMMANUEL SACKEY 
jl6-0ct-03
DATE RETURNED | 
PURPOSE
REG: | 2*
Update Record | Create New Folder j Folder Request j Exit To Main Menu j
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The system shows that the folder being tracked has been transferred from the 
surgical to maternity ward. The transfer details can be verified by clicking 
“VERIFY FROM MATERNITY WARD/UNIT” command button.
I FOLDER MOVEMENT RECORDS
| ENTER PATIENT ID | ~3
PATIENT ID | 202020
PATIENT NAME| (AKOTO ASARE BAAH
NAME OF USER | [AMAABAMKO
DATE OF REQUESTl |l2-Sep-02
DATE RETURNED | I
PURPOSEl (ADMISSION VFRTFV FRflM MATFRNTTV
WARD/UNIT |
TRft <SrER 1
REG: { 25 )!IUMBER OF FOLDERS: | 32
Update Record | Create New Folder | Folder Request | Exit To Main Menu |
PATTEMTIDW202020
DATE OF TRANSFER|.V|20-Scp-03
TRANSFER FROMI3ISURGICAL
TRANSFERED BY I lEMMANUEL SACKE'r
The system displays transfer details after clicking “VERIFY FROM MATERNITY 
WARD/UNIT” command button. The transferred details have been confirmed by 
the user from the maternity ward. This, however, proves that indeed the folder’s 
current transit point is the maternity ward. Figure 3.9
I F O L D E R  T R A N S F E R  C O N F I R M A T I O N
MATERNITY 
VAN KEY ISAAC
ord l< | <
| ENTER P A TEN T  ID f M l U l  j J
- y  PATIENT ID
DATCOfTRWS  ^
TRANSFERED FROM
202020 n
2 0 -S e p - 0 3  a B  
S U R G I C A L _ _ j l
I m m a n u e l s a c k e y  
Ma t e r n i t y  "_|]B  
y a n k e y  ISAAC
TRANSFERED BY
TRANSFE
RECEIVED BY
C O N F R M E D
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1- Laudon, Kenneth C. and Jane P. Laudon (2000). Management Information 
systems: Organisation and Technology in the Networked Enterprise. (6th ed.), 
Prentice-Hall, New Jersey, pp. 231-255, 453-457
4 .6  R eferences
2. Williams, Brain K., Stacey C. Sawyer and Sara E. Hutchinson (1999). Using 
Information Technology: a Practical Introduction to Computers. (3rd ed.), 
McGraw-Hill, Boston, pp. 315-320, 473-493
3. Burrow, William E. and Joseph D. Langford (2000). Programming Business 
Application with Microsoft Visual Basic 6.0. Irwin McGraw-Hill, Boston, pp. 
386-388
4. Microsoft Corporation (2003). Systems Requirements for Microsoft Office XP, 
http://www.microsoft.com/hcl/
5. Roger, Jennings (2003). Special Edition Using Microsoft Access 2000. 
http://www.safari.oreillv.com/0789716062/dle4761. O'Reilly & Associates, Inc., 
Sebastopol, CA
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CHATPER FOUR
EVALUATION OF THE SYSTEM
4.0 Introduction
This chapter reviews the proposed automated tracking system, taking into account 
the cost of developing, running and maintaining the system. The hardware and 
software requirements and the efficiency level of the system were reviewed. Further 
evaluation was conducted to forecast future challenges that may possibly confront 
the system.
The user interface, characteristics of the program and general functions of the 
system were carefully examined in order to ascertain the strength and weakness of 
the system. Other database related issues such as data integrity, security, 
networking, backup and maintenance were also evaluated.
4.1 Review o f the Proposed Design
The program was basically designed in Microsoft Access from the Office XP 
Professional version based on the relational database model which permits several 
flexibility properties for retrieval of data. Bradley and millspaugh (1998) stated that 
“user interface should to clear and consistent”. In line with this the program was 
highly designed with a graphical user interface (GUI) model. This makes it possible 
to retrieve or track data by few mouse clicks.
Basic functions such as deleting, adding records, updating records, and others 
including tracking records, printing, view report, etc. were customised into 
command buttons to reduce the burden of selecting from menus or typing 
commands. A significant property o f  the user interface is that all functions to  be 
performed by a user are delegated to command buttons.
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The introduction screen or the main window of the system displays command 
buttons of the main functions that the system performs (figure 3.4 on page 37). Such 
functions include tracking, retrieving, viewing and report generation.
Each window has a link to the main window and links to other windows. This 
makes is easier to move directly to other windows within the systems without going 
to the main window. For example, the “search for folder” window has a link to 
“folder request” window. This is because it is mostly imperative to records staff that 
searching for a folder means a request for it has been made.
The linking of window to window attribute of the tracking system follows similar 
proceedings within the manual system. The navigation therefore follows the 
flowchart (figure 2.0 on page 19), which reflects the searching procedure in the 
manual system. Another feature of the program that makes data entry easier is the 
pull down lists or combo boxes for selection of items. Fields such as USER, 
PURPOSE, TRANSIT POINT, etc. have items listed in a combo for a user of the 
program to just click a pull down button to select name of user, transit point, and so 
on, order than typing which may be slower. This function also reduces typing 
errors and ensures consistency in the fields which have such property.
Another advantage of the combo box is that it prevents the user from entering data 
which is not acceptable. For example, all ward names and transit point are given 
within the TRANSIT POINT field. Therefore, no user can enter any other data for 
transit points apart from what is given in the combo box.
This does not however mean that for instance, if a new user is introduced to the 
system his name cannot be added. The combo boxes are expandable. New items can 
be added o r removed from a combo box. This function is limited to  the systems 
administrator who can use a special window within the system to add or delete 
items to and from combo or list boxes.
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4.2 Software and Hardware
In selecting a software and hardware for the system the author seriously considered 
not only the application he has adequate proficiency to develop an automation 
system for tracking records, but, most importantly a software environment which is 
most common to the users at the hospital.
Early interactions and observation period of the this study revealed that all 
computers at the hospital are basically running Microsoft windows and Microsoft 
Office using, Microsoft word for all word processing tasks such as reports, letters, 
memos, etc. They use Microsoft Excel for accounting and spreadsheet functions, 
including graphs, charts and statistical functions. Microsoft PowerPoint is the only 
software known to the hospital for presentations and demonstration on computers. 
This software is resourceful at seminars and training sections for the hospital.
Based on the fact that users are already familiar with the Microsoft environment and 
have gained knowledge in the basics of the Microsoft Windows operating system 
and its graphical characteristics, the author recognised the significance in designing 
a system in this environment.
The advantages are that it will stimulate users affinity to adapt the system within a 
short period. On the other hand, it may not be the best information and 
communication technology platform for development of an automated system. The 
author for this reason admits that all the weaknesses, limitations, and challenges of 
the Microsoft systems as well as its essential advantageous properties will be 
characterised by the automation system.
Another benefit of choosing the software can be discerned taking into account the 
cost involved in acquisition of new software. The author measured major issues that 
are inseparable from new software and systems acquisition. They include training of 
users, supportive hardware, expertise, and the fiscal implications of the whole 
system. Already, management of the hospital are facing financial challenges in
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information and communication technology resource acquisition for basic needs. It 
will therefore be and extra burden to acquire new technologies though it may be 
relevant and resourceful.
The author sees the need for an automated system to improve efficiency in tracking 
records. The records unit and users of the records also expressed the need for an 
automated system irrespective of the financial challenges. It is reasonable and a 
challenge to an information technology professional, systems analyst, or records 
administrator to design a system by the exploitation of available resources, both 
hardware and software impeccably at the least cost. With this knowledge, the 
author, resolved to design the automation system with Microsoft Access database 
management system and visual basic 6 codes which can be installed on the already 
available Microsoft applications in the hospital.
There are other platforms which can be used to develop an automation system more 
efficiently. An example of such system is oracle database system. However, it 
means that a lynus server or lynus machines must be used to run the program.
The program demands training users to:
•  Understand the navigation and linking of windows within the system
• New terminologies in the system
• Error messages
• How to perform tracking operations and report generation
This training does not involve any strenuous learning and can be conducted within 
hours. In future old users can also train new users to understand the system. A user 
is not required to have any knowledge in Microsoft Access or any data base 
management system. Nevertheless, a fair knowledge in windows graphical 
environment will be a plus.
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The systems administrator will have to undergo comprehensive training to 
understand the framework of the system. A fair knowledge in Microsoft Access 
would be a plus. Apart from that any person who has certain amount of knowledge 
in Microsoft windows and office environment can be trained as systems 
administrator. The function of the administrator would include:
• Adding new users
• Adding, deleting and updating records items in list or combo boxes
• Changing passwords
• Deleting or adding records
• General maintenance of the system
4.3 Data Integrity
One of the most crucial challenges of every electronic database management system 
is about whether and electronic data in  reality represents what i t  stands for. The 
integrity of a database system can be measured by:
• The impossibility of data alteration by unauthorised users
• Validation rules that govern data entry
It is very important that any information retrieved from the system represents 
precisely what i t  stands for. Name o f  patients, patient i dentification number, and 
information about a folder’s transit point must not be different from what is 
retrieved from the system. It is not impossible for a database to recall wrong 
information about an item within its records. Another possible misinformation 
could be that two patients may bear the same identification number in the database, 
or the system may indicate that a patient’s ward of admission is for instance, the 
mobile ward, but in reality it is the surgical ward. If these and many other possible 
examples are common in a database management system, then data integrity of the 
system is at stake.
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Data integrity is affected by many issues including:
• Wrong coding
• Entering wrong data by users
• Common syntax error
• Bugs
• Insufficient error checks
To ensure data integrity, peculiar measures must be taken during the design stage of 
system. A program must be tested thoroughly in search for errors and bugs. Mitchell 
and Atkinson (2003) observed that “the more code you write, the more bugs you will 
create, and the larger your application, the more bug-ridden it will be”. They recommended 
that the time spent in programming should be equal to; if not more than, the time spent to 
ensure that a program is free of bugs and errors in order to achieve high data integrity.
Certain measures have been put in place to ensure that information within the automated 
system represents what it stands for. To obtain this, error checks have been encoded into 
the system to ensure the following:
• Patients identification numbers are not duplicated
• Correct dates are entered
• A transferred folder can be verified from the user who received the folder
• A user cannot edit a transferred form from another user
• A user does not mistakenly confirm that he has received a folder
• The central database cannot be edited by any user apart the systems 
administrator.
• Unauthorised users cannot have access to the system
All these ste p s  have b een put in  place to  reduce errors and to  achieve high data 
integrity. To ensure this, two main checking systems were employed into the 
program. These are Validation Rule and Security systems.
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4.3.0 Validation Rule
The validation rule is a mechanism to ensure that only appropriate data is entered. 
Jennings (2003) stated that validation rules govern the format by which data is 
entered and prevents invalid data entry. For example, the system has a validation 
rule that prevents a user from entering say, the date a folder was returned not earlier 
than the date the folder was taken. It also regulates date format to “day”, “Month”, 
and “year” sequence.
Validation rule goes with what is known as validation text. The validation text is a 
warning message that appears on a screen when the validation rule is violated. For 
example the system may display a message box that reads “Invalid date format, 
enter correct date”. Data can never be accepted by the system if it does not comply 
with validation rule. There is another validation rule within the system that prevents 
more that one person to bear the same patients identification number.
4.3.1 Security System
The system ensures that unauthorised users do not have access to the system. This is 
ensured by the use of passwords, and assigning read only property to files that 
should not be edited by any user except the system administrator. Apart from 
passwords the system has been designed in a manner that makes it impossible for a 
user to have access to co-users transfer form. A transfer form is filled when a user 
receives a folder transferred to him from any transit point. To certify that indeed a 
user has received a folder from another user, a transfer form from the receiver’s 
transit point is checked to seek for confirmation from him through the system.
The important issue about transfer form is that it serves as prove of folder transfer 
transaction, for both the unit that transferred the folder and the unit that received it. 
This is put in place to avoid a situation where a user claims he has transferred a 
folder, but the supposed recipient does not accept responsibility to that effect.
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Another security system is the user access permission facility. All users have 
permission to view only patients’ folders information and current state of folders. 
The permission is also extended to viewing admissions and discharge records. Any 
user can therefore have a read only access to all patients folder records. Access is 
however denied to users to perform the following functions:
• Delete records
• Modify another users transfer form
• Change system settings
• Modify system design
• Add records
In conclusion the system can be said to function exactly as the manual system but 
with high speed and several flexibility which makes it more efficient. Within the 
manual system, report generation is a separate exercise. The fragmented finding 
aids such as folder movement book, daily ward state book, admissions and 
discharge book are integrated into a central database system which makes the 
automation system quiet dynamic and multi-purpose.
One important feature is that the system is easily expandable and can go through 
redesign and modification without troubling the database. However, the author 
admits that the system will face all the challenges that confront the Microsoft 
application systems including errors that are not yet debugged.
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4 .4  R eferences
1. Bradley, Julia C. and Anita C. Millspaugh (1998). Programming in Visual 
Basic 5. Irwin McGraw-Hill, Boston, p. 55
2. Mitchell, Scott and James Atkinson (2003). Sams Teach Yourself Active Server 
Pages 3.0 in 21 Days, http://www.safari.oreillv.com/0672318636/chl41evlsecl. 
O'Reilly & Associates, Inc., Sebastopol, CA
3. Roger, Jennings (2003). Special Edition Using M icrosoft Access 2000. 
http://www.safari.oreillv.com/0789716062/ch051evlsec5. O'Reilly &
Associates, Inc., Sebastopol, CA
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CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
5.0 Conclusion
The methodology employed in designing this automated tracking system has led to 
several discoveries within the manual tracking system and records management 
practices as a whole at the Ridge Hospital. The most remarkable finding is the use 
of the folder movement book which is the prime mechanism for tracking folders in 
place of tracer cards. In fact, it is based on this folder movement book that the 
logical framework was derived to develop the automated tracking system.
An automated tracking system is one of the swift mechanisms to enhance electronic 
database management systems. The designed automated tracking system basically 
aims at finding solutions to part of the problems that confront the manual system, 
especially the use of folder movement book to track records. However, the system 
exceeds the primary function of tracking folders, but can be used to generate daily 
ward state, and admissions and discharge reports. The system can also be queried to 
generate daily, monthly, quarterly or annual reports.
The systems analysis and design methodology was employed to develop the 
automated tracking system. Following the procedure of the methodology, 
preliminary investigation commenced by finding some information about the Ridge 
Hospital and specifically the records unit. The structure of the hospital and the 
Records Units were carefully studied. This led to finding some useful statistics 
about operations of the hospital and the effects of the increasing patients attendance 
rate on records management.
The manual tracking system was analysed based on the systems analysis theory. 
The folder movement book was however discovered as the prime mechanism for 
tracking folders. Detailed analysis of the folder movement book was conducted to
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reveal problems that exist within the manual system. A dataflow diagram was 
drawn to reflect how tracking of folders is done manually.
From the systems analysis, problems within the manual tracking system were 
identified. It was observed that the automated tracking system may face similar 
problems that challenge the manual system if folder request policies are not 
followed. The need for automating the manual tracking system was, however, 
justified after the systems analysis stage.
The systems design and development stage of the methodology followed the results 
of the systems analysis to design and develop an automated system. A logical 
design was done in Microsoft Access. The logical design paid attention to different 
data models or structures and considered the relational model as suitable for the 
system due to its flexible characteristics. During the logical design, other records 
management functions apart from tracking folders were also incorporated into the 
system. These functions are, management of patients admissions and discharge 
records and creation of daily ward state report.
All the systems requirements: input requirements, output requirements, processing 
and storage requirements were determined. The system requirements analysed 
prospective users of the system and information and communication technology 
infrastructure at the Ridge Hospital. These aided the design of a suitable user 
interface. The system was therefore designed to be compatible with software and 
hardware already used at the hospital.
To complete a detailed design, steps were taken to make the system efficient. This 
included validation rules, security systems, debugging and testing of the system to 
ensure data integrity. The design was finally modified and customised with 
Microsoft Visual Basic codes into an automated system.
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Though the automated system does not necessarily combats all the problems within 
the m an u a l tracking system, its advantages outweigh that of the manual system 
especially in the case of the Records Unit at the Ridge hospital. If the need for speed 
is imperative to a tracking system, then, there is no doubt that the proposed 
automated tracking system should be operational as a component of electronic 
medical records management system.
In conclusion, the author seeks to develop the system to cover both outpatients and 
inpatients records. If this automated tracking system is put to effective use the 
future challenges of the system will reveal strategies to improve the system in order 
to gain high efficiency level and enough flexibility. This will therefore enable the 
system to be expandable to finally cover all medical records management activities 
at the Ridge Hospital.
5.1 Recommendations
The most important issue of medical records management to the author is not the 
fact that there is a tracking system that is very efficient or inefficient; but, simply 
the concern about human lives which are at stake. If legitimate folder users do not 
understand, or are ignorant of the importance of patients folders to health delivery 
systems, no matter how intelligent a tracking system is designed, it will not be 
successful.
To make this proposed automated tracking system work efficiently the author has 
the following recommendations to make:
1. Considering the importance of folders to health administration, all legitimate 
users of folders must be well informed about the significance of patients 
medical records. If the users have such valuable knowledge it will definitely 
affect their approach to handling of folders, and therefore, comply with all 
the regulations that go with the use of the automated tracking system. This 
knowledge can be acquired through organised seminars and workshops.
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2. Considering the platform on which the automated system was designed, it is 
important that whoever takes the duty as systems administrator should have 
sufficient knowledge of the Microsoft windows and Office environment. He 
should also be familiar with database management systems and have fair 
understanding of Microsoft Access database system.
3. All prospective users of the automated system should also be trained to 
understand how the system works and how to handle error messages. Users 
must also make sure that they fill transfer forms whenever they transfer or 
receive folders. By doing so the automated tracking system will always 
reflect the exact transit points of folders.
4. It is also recommended that there should be available support systems to 
ensure constant operation of the system. Such support systems include, 
power supply backup systems and storage backup facilities.
5. All the computers at each transit point must run the same disk operating 
system and the same version of Microsoft Office applications to avoid any 
irregularities in the network.
6. In order to  ensure compliance with all the hardware facilities, the hospital 
should engage the services of an information and communication technology 
expert to acquire network and communication facilities.
7. Finally, the author recommends that the system should be implemented 
alongside the manual system till users gain enough understanding of the 
automated system before full implementation of the system commences.
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BIBLIOGRAPHY
Agbe, A. K. (1997). Automation o f  Academ ic L ibraries in Ghana: a Case Study oj 
Balme Library. Unpublished thesis for the award of Master of Arts degree, 
University of Ghana, p. 5
Amehoe, C. K. (2000). An Evaluation o f  the Impact on Automation on Students 
Records Management in the Academic Section o f  University o f  Ghana. Unpublished 
thesis for the award of Master of Arts degree, University of Ghana, p. 9
Badu, E. E. (2001). “The African Corporate Culture: an Obstacle to Effective 
Strategic Planning in Ghanaian University Libraries”. Library Management, MCB 
University Press, Vol. 22, No. 4/5 p. 212
Bohl, M. (1990). Essentials O f  Information Processing. Macmillan, New York, pp. 
13-15, 400, 403
Bradley, J. C. and Millspaugh, A. C. (1998). Programming in Visual Basic 5. Irwin 
McGraw-Hill, Boston, p. 55
Burrow, W. E. and Langford, J. D. (2000). Programming Business Application with 
Microsoft Visual Basic 6.0. Irwin McGraw-Hill, Boston, pp. 386-388
Chopra, N. R. (1990). Dictionary o f  Library Science. New Delhi, p. 39
Diamond, S. Z. (1991). Records Management: Policies, Practices, Technology. 
Amacom, New York, p. 8
Laudon, K. C. and Laudon, J. P. (2000). Management Information Systems: 
Organisation and  Technology in the Networked Enterprise. Prentice-Hall, (6th ed.), 
New Jersey, pp. 231-255, 347-356, 453-457
Microsoft Corporation (2003). Systems Requirements fo r  M icrosoft Office XP. 
http://www.microsoft.com/hcl/
Mitchell, S. and Atkinson, J (2003). Sams Teach Yourself Active Server Pages 3.0 
in 21 Days, http://www.safari.oreillv.com/0672318636/chl41evlsecl. O'Reilly & 
Associates, Inc., Sebastopol, CA
O’Brien James. A. (1997). Introduction To Information Systems. McGraw-Hill, 
Boston, (8th ed.), pp. 380-395
Ridge Hospital Annual Report, 2002
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Ridge Hospital First Quarter Report, 2003
Roger, J. (1999). Special Edition Using M icrosoft Access 2000.
http://www.safari.oreillv.com/0789716062/dle4761.
http ://www. safari, oreillv. com/0789716062/ch05 lev 1 sec5.
O'Reilly & Associates, Inc., Sebastopol, CA
Seimon, J. E. and Kuratomi, R. M. (1982). “Automated Records Tracking as a 
Component of a Management Information System”. Journal o f  Health Information  
Management, September 1982, Aspen Systems Corporation, California, pp. 55-65
William, Sawyer and Hutchinson (1999). Using Information Technology: a Practical 
Introduction to Computers. McGraw-Hill, (3rd ed.), Boston, pp. 315-320, 473-493
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GLOSSARY
Access permission
Check Box 
Code 
Column 
Combo Box
Command 
Command Button
Debugging
Fields
File
List Box
Main window
Modus operandi 
Network
Option Button 
Pull down button
A set of attributes that specify what kind of access a user 
has to data or objects in a database.
A check box permits a user to select or deselect options
A statement in a programming language
A vertical section of a grid in a table of a database
Holds a list of items that a user can select from. A user 
cannot add new items to a combo box (see list box)
An instruction to perform a specific task in a program
A button clicked to activate a procedure in a program
Checking through a program to eliminate errors (bugs)
A unit for collecting information in a database
A unit that uniquely identifies data, program or a 
document in a system
Holds a list of items that a user can select from. A user 
can add new items to a list box (see combo box)
The first user interface in a program. If a program is 
instructed to run the main window is the first to appear
Proper procedure for performing an operation or task
A group of computers and other devices, such as 
printers, connected by a communication link, enabling 
all the devices to interact and share resources with each 
other
Permits a user to select only one item from several 
options
This button is clicked to display a menu
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Query
Read only
Row
Server
Table
Window
A structured statement that specifies the information you 
want to find in a database
An attribute that allows a user to view data only
A horizontal section of a grid in a table of a database
A computer that provides shared resources to network 
users.
A two dimensional array that contains data about a 
specific topic within a database system. Data within 
tables are organised in rows and columns
A portion on a computer screen where programs and 
processes run. Microsoft programs run in windows.
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APPENDIX
6.0 Some Major Visual Basic Codes within the System
These codes determine the status of a folder by scanning through all the transit 
points_________  _______________________________________
Private Sub Combo27_AfterUpdate()
1 Find the record that matches the control.
Dim rs As Object
Set rs = Me.Recordset.Clone
rs.FindFirst "[ID] = " & Str(Nz(Me![Combo27], 0))
If Not rs.EOF Then Me.Bookmark = rs.Bookmark
If DATERETURNED <= Date Then
TRANSIT_POINT. Visible = False 
FOLDER STATUS = "FOLDER ON SHELF" 
FOLDER_STATUS. Visible = True 
Verify_Confirmation.Visible = False
Else: TRANSIT_POINT.Visible = True 
FOLDER_STATUS. Visible = False
End If
I f DATE OF TRANSFER > (#1/1/1900#) Then 
DoCmd.Beep
TRANSFER_FROM Visible = True 
TRANSFEREDTO.Visible = True 
TRANSIT_POINT. Visible = False
With Verify_Confirmation
.Caption = "VERIFY FROM " & TRANSFERED TO.Value & " WARD/UMT" 
Visible = True
End With
Else
TRANSFER_FROM.Visible = False 
TRANSFERED_TO.Visible = False
End If
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End Sub
These codes make the system verify folder transferred from one transit point 
to another
Private Sub Verify_Confirmation_Click()
On Error GoTo Err Verify Confirmation Click
Dim stDocName As String 
Dim stLinkCriteria As String
'Connect to surgical ward 
If TRANSFERED TO = "SURGICAL" Then
DoCmd.Beep
DoCmd.Close
stDocName = "TRANSFER SURGICAL WARD" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_V erify_Confirmation_Click:
Exit Sub
Err_V erify_Confirmation_Click:
MsgBox Err.Description
Resume Exit_Verify_Confirmation_Click
End If
'Connect to VIP ward
If TRAN SFEREDTO = "VIP" Then
DoCmd.Beep
DoCmd.Close
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stDocName = "TRANSFER VIP WARD" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
End If
‘Connect to MATERNITY ward 
If TRANSFEREDTO = "MATERNITY" Then 
DoCmd.Beep 
DoCmd.Close
stDocName = "TRANSFER MATERNITY WARD" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
End If
'Connect to PHARMACY unit 
If TRANSFERED TO = "PHARMACY" Then 
DoCmd.Beep 
DoCmd.Close
stDocName = "TRANSFER PHARMACY UNIT" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
End If
'Connect to ACCOUNTS unit 
If TRAN SFEREDTO = "ACCOUNTS" Then 
DoCmd.Beep 
DoCmd.Close
stDocName = "TRANSFER ACCOUNTS UNIT" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
End If
'Connect to CHILDRENS ward__________________
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If TRANSFEREDTO = "CHILDRENS” Then 
DoCmd.Beep 
DoCmd.Close
stDocName = "TRANSFER CHILDRENS WARD" 
DoCmd.OpenForm stDocName,,,  stLinkCriteria
End If
'Connect to MOBILE ward 
If TRANSFERED TO = "MOBILE" Then 
DoCmd.Beep 
DoCmd.Close
stDocName = "TRANSFER MOBILE WARD" 
DoCmd.OpenForm stDocName,,,  stLinkCriteria
End If
'Connect to FEMALE ward 
If TRANSFERED TO = "FEMALE" Then 
DoCmd.Beep 
DoCmd.Close
stDocName = "TRANSFER FEMALE WARD" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
End If
End Sub
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Codes to confirm folder transfer
Option Compare Database
Private Sub CmdNo_Click() 
IbAbort. Visible = True 
cmdyes. Visible = False 
Command25. Visible = False 
DoCmd.Beep 
End Sub
Private Sub CmdYes_Click()
CONFIRMATION = "CONFIRMED" 
lbUpdate.Visible = True 
cmdno. Visible = False 
Command25.Visible = False 
DoCmd.Beep 
End Sub
Private Sub Command25_Click()
ConfirmMessage. Visible = True 
cmdyes. Visible = True 
cmdno.Visible = True 
DoCmd.Beep 
End Sub
Private Sub Command45_Click()
CONFIRMATION = " "
ConfirmMessage. Visible = False 
cmdyes. Visible = False 
cmdno.Visible = False 
lbUpdate.Visible = False 
Command25.Visible = True 
IbAbort. Visible = False 
DoCmd.Beep 
End Sub
Private Sub UPDATE_Click()
On Error GoTo Err UPDATE Click
ConfirmMessage. Visible = False 
cmdyes.Visible = False 
cmdno.Visible = False 
lbUpdate.Visible = False 
Command25.Visible = True 
IbAbort.Visible = False 
DoCmd.Beep
DoCmd.DoMenuItem acFormBar, acRecordsMenu, acSaveRecord,, acMenuVer70
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Err_UPDATE_Click:
MsgBox Err.Description 
Resume Exit_UPDATE_Click
End Sub
Private Sub Command50_Click()
On Error GoTo Err Command50 Click
ExitUPDATEClick:
Exit Sub
DoCmd.Close
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "STARTUP"
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_Command50_Click:
Exit Sub
Err_Command50_Click:
MsgBox Err.Description 
Resume Exit_Command50_Click
End Sub
Codes for navigating through the system
Option Compare Database
Private Sub NEW_FOLDER_Click()
On Error GoTo Err_NEW_FOLDER_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "PATIENTS RECORDS" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
ExitNE W_F OLDERClick:
Exit Sub
Err_NEW_FOLDER_Click:
MsgBox Err.Description___________________
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Resume Exit_NEW_FOLDER_Click 
End Sub
Private Sub FOLDER_SEARCH_Click()
On Error GoTo Err_FOLDER_SEARCH_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "FOLDER REQUEST UPDATE" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
ExitF OLDER_SE ARCHClick:
Exit Sub
Err_FOLDER_ SEARCHClick:
MsgBox Err.Description
Resume Exit FOLDER SEARCH Click
End Sub
Private Sub Command4_Click()
On Error GoTo Err_Command4_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "PATIENT REQUEST INFORMATION" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_Command4_Click:
Exit Sub
Err_Command4_Click:
MsgBox Err.Description 
Resume Exit_Command4_Click
End Sub
Private Sub Command5_ClickO 
On Error GoTo Err_Command5_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "ADMISSIONS AND DISCHARGE" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_Command5_Click:
Exit Sub
Err Command5 Click:
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MsgBox Err.Description 
Resume Exit_Command5_Click
End Sub
Private Sub Command6_Click()
On Error GoTo Err_Command6_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "ADMISSION AND DISCHARGE INFORMATION" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_Command6_Click:
Exit Sub
Err_Command6_Click:
MsgBox Err.Description 
Resume Exit_Command6_Click
End Sub
Private Sub Command7_Click()
On Error GoTo Err_Command7_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "FOLDER REQUEST INFORMATION" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_Command7_Click:
Exit Sub
Err_Command7_Click:
MsgBox Err.Description 
Resume Exit_Command7_Click
End Sub
Private Sub Command8_Click()
On Error GoTo Err_Command8_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "FOLDER REQUEST INFORMATION" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_Command8_Click:
Exit Sub
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Err_Command8_Click:
MsgBox Err.Description 
Resume Exit_Command8_Click
End Sub
Private Sub Command9_Click()
On Error GoTo Err_Command9_Click
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "ADMISSIONS AND DISCHARGE UPDATE" 
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
Exit_Command9_Click:
Exit Sub
Err_Command9_Click:
MsgBox Err.Description 
Resume Exit_Command9_Click
End Sub
Private Sub WARD STATE ClickO 
On Error GoTo ErrWARDSTATEClick
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "CURRENT ADMISSIONS"
DoCmd.OpenForm stDocName,, ,  stLinkCriteria
ExitWARDSTATEClick:
Exit Sub
ErrWARDSTATEClick:
MsgBox Err.Description 
Resume Exit_WARD_STATE_Click
End Sub
Private Sub Command47_Click()
On Error GoTo Err_Command47_Click
DoCmd.Close
Dim stDocName As String 
Dim stLinkCriteria As String
stDocName = "PATIENTS RECORDS"
DoCmd.OpenFomi stDocName,, ,  stLinkCriteria___________
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Exit_Command47_Click:
Exit Sub
Err_Command47_Click:
MsgBox Err.Description 
Resume Exit_Command47_Click
Some codes to generate admissions and discharge report________
=Count([DATE ADMITTED])-[TEXT24]
=IIf([DEATH]="DECEASED","DECEASED",IIf([DATE 
DISCHARGED]=Date(),"OUT",IIf([DATE ADMITTED]=Date(),"IN")))
=Count([DATE DISCHARGED])
=Count([DEATH])_______________________________________________
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6.1 Major Windows in the Automated Tracking System
Folder Creation W indow Figure 6.0
j ENTER PATIENT ID | J]
P A T T I E N T S  I D  |  [ J
P A T I E N T  N A M E : )  |ASANTEKYEIBAFOUR 
D A T E  O F  B I R T H :  |  | 1 4 - N o v - 8 8
REG: |5
Acid New Record | Update Record | Folder Request | Bat To  Main Menu |
01245
Folder Request W indow
23 October 2003
Figure 6.1 
l E N T E R  P A T I E N T  I D  H
FOLDER  R EQUES T  INFORMATION
PATIENT ID | 
PATIENT NAME 1 
NftME OF USER | 
DATE OF REOUESTi 
PURPOSE I 
TRANSIT POINT I
| 001245
|ASANTE KYEI BAFOUR
I---------------------- J
REG: foMmx
Update  Records Admissions A n d  Discharge I Exit To  Main M enu
Record: H  I 4 IT 1.1
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Folder Tracking Window Figure 6.2
1“  FOLDER MOVEMENT RECORDS
I EN TER  PATIENT ID f  I - J
PATIENT ID I 1012487 |
PATIEN T NAMEi (ADOWA KW EKU HENEKU
NAME OF USER  I [EMMANUEL SACKEY _ J
D ATE  OF R EQ UESTl |02-Aug-02
D A TE  R ETUR N ED  | |10-0ct-03
PURPOSE I [TRACER DRUGS j J  v er if y  fr o m  s u r g ic a l  I
WARD/UNI I
VIP - I TO iSURGlCAL “
H p W r i , :  temmmMmmmmmm*  1 3
Update Record | Create New Folder | FoldBr Request | Exit To Main Menu ]
Folder Transfer Form Figure 6.3
TR A N SFER  FO LD ER
| 24 O c to b e r  2003
**“ • ■ *:''-
P A TIEN T IP|
P A TIEN T NAME|
D A TE  OF m
TR A N S FE R  FROM| 
-R A N S F E R E D  BY| 
TR A N SFER ED  TP| 
R ECIEVED  BY| 
PURPOSE OF T?RANSFER|
jEN TER  P A TIEN T ID
(a d o w a  KW ^KU  HENEKU
I 19-Sep-03
j vip
|e v a  o s e i
-d
SURGICAL
IVY QUAVE
~u
[BILLING _ll
UPDATE I NEW TRANSFER EXIT TO  MAIN MENU
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Folder Transfer Confirmation Form Figure 6.4
|  f o l d e r  t r a n s f e r  c o n f i r m a t i o n
I ENTER PATIENT ID |
P A T IE N T  ID] | TTW flB
P A T IE N T  NAM E j |ADOWA KW EK U  H E N E K U
D A T E  O F  TR A N S F ER !
TR A N S F E R  FROM
TR A N S F E R E D  BY ] |EVA OSEF 
T R A N S F E R E D  TO| [SURG ICAL  ~ 2 J
~ 3
R E C IE V E D  BY ] ||VY Q UAYE ~3
C O N F IR M E D C L IC K  H E R E  T O  C O N F IR M
Ex it to  M ain  M en u
Record: l<  I < 11_________ I ► I H  l » * l  of I <1
Folder Transfer Verification Window Figure 6.5
F O L D E R  T R A N S F E R  C O N F I R M A T I O N
PATIENTJ
PATE OF TRANSFEI|20-Sap-03 
[s u r g ic a l TRANSFERED FROM]
iMMANUEL SACKEV
IANSFERED TO'"TERNITY
RECEIVED B1lYANKEY ISAAC
C O N F I R M E D
’ H * !  PATIENT ID
DATE OF TRANSFER 
■TR AN SFER  FROM 
RANSFEREU BY 
iTRANSFER jpTO  
K sX r e c e iv e d  by
ora 14 h  II ~  > l » l l M s | o n
| ENTER PATIENT ID | ' i M U .  7
202020 
20-s«p-Q3lrj]  
SURGICAL |
EMMANUELSACKEY 
MATERNITY . •
YANKEY ISAAC
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Admissions and D ischarge Records W indow (editable) Figure 6.6
| ADMISSIONS AND DISCHARGE RECORDS
23-Qct-03  [ENTER PATIENT ID |BSHH H
|REG |T"
PATIENT ID | j 024025
PATIENT NAME | |aNEIKI ABENA MEHTA
ADMISSION WARD| Im ob ile  _ll
DATE ADMITTEDl |23-0ct-03
DATE DISCHARGED | 1
TRANSFERl 1 • 1 DEATH II -1
Update Record Create New Foldet ! FaldBr Request i Exit T o  Main Menu [
Recoid. H i  < I I ' j J l L j M e ]  of i j J _________________ ________________________________________________________________ | j J
Admissions and Discharge Records Window (read only) Figure 6.7
ADMISSI0N9 AND DISCHARGE UPDATE
23 October 2003
!ret<t  j r
| S E A R C H  | PATIENTS ID !l012445
p/marsel
| .............. II
PATIENT NftME t (ANSA EMMANUEL
ADMISSION WARD| (MATERNITY z i
PATIEJfT NAME |
DATE ADMITTEDl H 5-Dec-15
J DATE DISCHARGED | |23-0ct-03
TRAFERED TO | |FEMALE -  I DEATH | |DECEASED j J
Update Record | Add Record j Exit To Main Menu
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Admissions and Discharge Report Window Figure 6.8
ADMISSIONS AND DISCHARGE j 23 October 2003
PATIENT NAME WARD STATUS TRANSFERED
► |ANEIKI ABENA MENTA | MOBILE _d  | IN I _rj
|ANIMOU HASNAH WEKIOSE | VIP | IN 1 - d
|ANSA EMMANUEL | MATERNITY _ ij  | DECEASED | FEMALE
1ASANTE MICHAEL | SURGICAL _d  ) DECEASED I
|HARUNA IDRISU | VIP I IN | CHILDREN _zA
|MENSAH OKYERE DARKO | CHILDREN’S _zJ ] IN 1 JLl
IOKVERE DARKO | MATERNITY _ ij ] . OUT I JJ
|SASARE EVANS | CHILDREN'S _ ij  j IN 1 JLi
ITVVUMASI EVANS | SURGICAL _ lj j IN | _d
* 1 1 - d  1 I JlA
TO TA L  ADM ITTED f 6
TO TA L  DISCHARGED f 3
TO TA L  DEATH  T 2
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