University of Ghana http://ugspace.ug.edu.gh SCHOOL OF PUBLIC HEALTH COLLEGE OF HEALTH SCIENCES UNIVERSITY OF GHANA DEVELOPMENT OF A PERSONAL HEALTH RECORD SYSTEM BY AMENYO, GEORGE ETORNAM (10701091) THIS PROJECT WORK IS SUBMITTED TO THE SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF GHANA IN PARTIAL FULFILLMENT FOR THE AWARD OF THE MASTER OF HEALTH INFORMATICS (MHI) DEGREE. August, 2019 University of Ghana http://ugspace.ug.edu.gh DECLARATION I hereby declare that this thesis (practicum) was composed by myself, that the work contained herein is my own except where explicitly stated otherwise in the text, and that this work has not been submitted for any other degree or professional qualification. ……………………………….. Date: …………………………… Amenyo, George Etornam (Student) ……………………………….. Date: …………………………… Dr. Afagbedzi, Seth Kwaku (Supervisor) i University of Ghana http://ugspace.ug.edu.gh DEDICATION My first dedication goes to God Almighty, through Him I am what I am. To my family for contributing and supporting me throughout this program. I also dedicate this project to my friends who stood by me, supported and rallied me on. I also extend my dedication to University of Ghana, School of Public health for given me this opportunity to be part of this program. This project is dedicated to all of you. ii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT My foremost gratitude and acknowledgement goes to the Almighty God for His guidance, protection and travelling mercies each day to campus. To my supervisor, I am most grateful for accepting to supervise my project work, my unflinching gratitude and appreciation go to you for your directions and guiding me through my work. Thank you. I wish to acknowledge the entire staff at the Biostatistics Department, School of Public Health, University of Ghana. I appreciate all the efforts and grooming processes I had the opportunity to enjoy. My immense gratitude goes to TechAce (Frank Asefuah and Georgina Diana Maison) for their assistance in the coding process. Lastly my heartfelt gratitude goes out to my family and every individual who has contributed in diverse ways to get me here. May the Almighty God bless you all iii University of Ghana http://ugspace.ug.edu.gh ABSTRACT In an era where many advancements and accomplishments in information technology over the past decades has been tremendous, health and healthcare delivery has not been left out; quite a number of diverse forms of Electronic Information Systems have been designed and implemented in different institutions and countries. The field of health care has been transformed globally as a result of Information and communication technology (ICT). The need of a system that can aid individuals store their own health records is on the ascending. The personal storage of one’s health-related data is termed as Personal Health Record (PHR) (Roehrs, Da Costa, Da Rosa Righi, & De Oliveira, 2017). It is has become universal to access your personal information of all types online, from academic grades, to financial and banking statements, bills, and profiles, just to identify a few. One major form of data/information that has been slow to adaption to the digital environment is personal health record (PHR). It is gathered that most individuals do not possess any form of personal health record system, some rely on the manual form of storage where some hard copies of hospital reports, x-rays and laboratory results are kept at home in a paper file or some folder or cupboard. The development of PHR system is to draw attention to the need for personal health record system. In the developing process, the SDLC was followed. Requirements was gathered through interview, analyzed and used to identify the processes the system would go through. The development platform was chosen based on the available time for coding, debugging, testing and deploying. An application that runs in a web browser environment was developed relying on a localhost system to support the database system. iv University of Ghana http://ugspace.ug.edu.gh Acceptance of PHR by physicians and tech savvy individuals would influence the adoption of PHR. v University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENT DECLARATION ............................................................................................................................ i DEDICATION ............................................................................................................................... ii ACKNOWLEDGEMENT ............................................................................................................ iii TABLE OF CONTENT ................................................................................................................ vi LIST OF TABLES ........................................................................................................................ ix LIST OF FIGURES ....................................................................................................................... x LIST OF ABBREVIATIONS ......................................................................................................xii CHAPTER ONE .............................................................................................................................. 1 INTRODUCTION ......................................................................................................................... 1 1.1 Background .................................................................................................................... 1 1.2 Problem Statement ......................................................................................................... 4 1.3 Justification .................................................................................................................... 6 1.4 Study Objectives............................................................................................................. 7 1.4.1 General Objective .................................................................................................. 7 1.4.2 Specific Objectives ................................................................................................. 7 1.5 Research Questions ........................................................................................................ 7 1.6 Scope/Delimitation ......................................................................................................... 8 1.7 Study limitation .............................................................................................................. 8 CHAPTER TWO ........................................................................................................................... 10 2 LITERATURE REVIEW ........................................................................................... 10 2.1 Introduction .................................................................................................................. 10 2.2 Strength and weakness of the existing health record system ................................... 10 2.3 Requirement Analysis .................................................................................................. 12 2.3.1 User Requirements............................................................................................... 12 2.3.2 Functional Requirement ...................................................................................... 13 2.3.3 Non-functional Requirement .............................................................................. 15 2.3.4 Open source software requirements and Web-based system requirements. .. 15 vi University of Ghana http://ugspace.ug.edu.gh 2.4 Money saving and Importance.................................................................................... 16 2.5 System Architecture ..................................................................................................... 16 2.6 Information Input Technique ..................................................................................... 18 CHAPTER THREE ....................................................................................................................... 20 3 METHODOLOGY ...................................................................................................... 20 3.1 Introduction .................................................................................................................. 20 3.2 System Development Life Cycle (SDLC) ................................................................... 20 3.2.1 Requirement gathering and analysis .................................................................. 22 3.2.2 System Design ....................................................................................................... 22 3.2.3 Implementation and coding ................................................................................ 29 3.2.4 Testing ................................................................................................................... 30 CHAPTER FOUR.......................................................................................................................... 31 4 RESULTS ..................................................................................................................... 31 4.1 Introduction .................................................................................................................. 31 4.2 Results from Observation ............................................................................................ 31 4.3 Results from Interviews ............................................................................................... 33 CHAPTER FIVE ........................................................................................................................... 37 5 DISCUSSION ............................................................................................................... 37 5.1 Introduction .................................................................................................................. 37 5.2 Targeted Population .................................................................................................... 37 5.3 Review of current Manual System ............................................................................. 37 5.4 Need for Personal Health Record System .................................................................. 37 5.5 Functional Requirements ............................................................................................ 38 5.6 Non-Functional Requirement ..................................................................................... 39 5.7 Product Function ......................................................................................................... 39 5.8 User Problem Statement .............................................................................................. 39 5.9 System Architecture ..................................................................................................... 40 5.10 System Design and User Interface .............................................................................. 40 CHAPTER SIX .............................................................................................................................. 52 vii University of Ghana http://ugspace.ug.edu.gh 6 CONCLUSION AND RECOMMENDATION ......................................................... 52 6.1 Introduction .................................................................................................................. 52 6.2 Conclusion .................................................................................................................... 52 6.3 Recommendation .......................................................................................................... 53 REFERENCES............................................................................................................................. 54 APPENDICES ............................................................................................................................... 57 Appendix A: Programming codes for Login Screen ...................................................................... 57 Appendix B: Detailed programming code for registration interface ............................................. 60 Appendix C: Programming codes for the main dashboard ............................................................ 63 Appendix D: Programming codes for Medical Profile interface ................................................... 69 Appendix E: Programming codes for Medical Visit ...................................................................... 86 Appendix E: Programming codes for Prescription Interface ......................................................... 93 Appendix F: Programming codes for Vitals interface ................................................................... 99 Appendix G: Programming codes for Logout interface............................................................... 105 Appendix H: Interview questions ................................................................................................ 106 Getting Started ............................................................................................................................. 107 viii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 1: PERSONAL /USER DETAIL ............................................................................ 24 Table 2: VISITATION ...................................................................................................... 25 Table 3: Vital Stats............................................................................................................ 25 Table 4: PRESCRIPTION ................................................................................................ 26 Table 5: APPOINTMENTS .............................................................................................. 26 Table 6: INSURANCE ..................................................................................................... 27 Table 7: IN CASE OF EMERGENCY CONTACT PERSON ......................................... 27 ix University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Figure 1: PHR systems evaluation model. ........................................................................ 14 Figure 2: PHR system functional model overview ........................................................... 14 Figure 3: System Architecture .......................................................................................... 17 Figure 4: PHR and EHR relationships. IoT: Internet of Things. ...................................... 18 Figure 5: SDLC Waterfall model ...................................................................................... 21 Figure 6: Typical System Development Life Cycle ......................................................... 21 Figure 7: Flowchart for personal health record system .................................................... 23 Figure 8: Entity relationship diagram ............................................................................... 40 Figure 9: Login Screen ..................................................................................................... 41 Figure 10: Registration screen .......................................................................................... 42 Figure 11: Initial dashboard .............................................................................................. 43 Figure 12: Dashboard after populating detail ................................................................... 43 Figure 13: Medical Visit ................................................................................................... 45 Figure 14: Add medical visit information ......................................................................... 45 Figure 15: Prescription screen .......................................................................................... 46 Figure 16: Prescription Information ................................................................................. 47 Figure 17: Vitals ............................................................................................................... 48 x University of Ghana http://ugspace.ug.edu.gh Figure 18: Vitals ............................................................................................................... 48 Figure 19: Medical Profile screen ..................................................................................... 49 Figure 20: Personal details form ....................................................................................... 50 Figure 21: Insurance details .............................................................................................. 50 Figure 22: Emergency contact .......................................................................................... 51 Figure 23: Log out ............................................................................................................ 51 xi University of Ghana http://ugspace.ug.edu.gh LIST OF ABBREVIATIONS  PHR(s) – Personal Health Record (system)  EHR – Electronic Health Record  EMR – Electronic Medical Record  ICT – Information and Communication Technology  URD – User Requirement Document  GUI – Graphic User Interface  SDLC – System Development Life Cycle  HL7 - Health Level Seven  ISO – International Organization for Standardization  IEC – International Electrotechnical Commission  SPHR – Standalone Personal Health Record  IOT – Internet of Things  CPU – Central Processing Unit  GPU – Graphics Processing Unit  PHP – Hypertext Preprocessor (earlier called Personal Home Page)  FOSS – Free and open-source software  BMI – Body Mass Index xii University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION 1.1 Background According to the Ghana’s Patient Charter, a patient is entitled to full information on his/her condition and management and it is the responsibility of the patient to ask for these information (Ghana health service, 2017). In bid to facilitate partnership between healthcare providers and patients/clients, patients are required to have access to their health records and possibly have a copy (paper format or electronic format), this would contribute to reduction in the parent-child sort of relationship that exist between healthcare providers and patients. This partnering also empowers patients/clients to have interest and control over their health and healthcare record, patients are encouraged to show greater concern about their health and healthcare record. In an era where many advancements and accomplishments in information technology over the past decades has been tremendous, health and healthcare delivery has not been left out; quite a number of diverse forms of Electronic Health Records have been designed and implemented in different institutions and countries. Some countries and health authorities are now planning the introduction of a countrywide electronic health record. Others on the hand have gone ahead to implement some form of Electronic Health Record system. There are variations in the EHR type and what one country may call as an Electronic Health Record (Watson, 2006). The field of health care has been transformed globally as a result of Information and communication technology (ICT). Health record, Medical chart and Medical record 1 University of Ghana http://ugspace.ug.edu.gh are terms that are used interchangeably. What then is Health Record/Medical Record? Medical record is described as the organized documentation of a patient's medical history and care over time within one particular health care provider's practice (WHO Western Pacific Region, 2006). Electronic Health Record is defined by Healthit.gov as a digital version of patient’s paper chart “What is an electronic health record (EHR)? | HealthIT.gov,”(2018), while Healthcare Information and Management Systems Society (US) describes it as a longitudinal (birth to death) electronic record of patient health information generated by one or more encounters in any care delivery setting (“Electronic Health Records | HIMSS,” 2004). An Electronic Health Record is a more comprehensive report of the patient's overall health, while an Electronic Medical Record is a narrower view of a client/patient's medical history. Electronic medical record (EMR) systems, defined by Waithera, Muhia, & Songole, (2018) as "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care facility," As health and healthcare service delivery is developing through the use of EHR, one of the silent challenges that is going unnoticed is its constant one-sided view by healthcare professionals leaving the patient with less information and less control over their data. Over the years, we have witnessed the extraordinary push for the development and implementation of electronic health records (EHRs), same cannot be said for personal health record (PHR) systems. Personal health record (PHR) systems have received lesser attention when compared with other EMRs. EHR systems are more 2 University of Ghana http://ugspace.ug.edu.gh oriented to serve the needs of healthcare professionals, PHR systems accepts and stores healthcare data entered by patients/clients and provides information for caring for patients. In 2010, the then Minister of Health Dr. Benjamin Kunbuor, launched the National E-Health Strategy, the national e-health strategy was the first stage of a long term goal, aimed at raising the levels of performance of the health sector (Kunbuor et al., 2009). The adoption and implementation process for EHR has been inadequate and at this moment leaving the development of a personal health record system at bay. There is no or inadequate information on any available PHR system in Ghana. The need of a system that can aid individuals store their own health records is on the ascending. The personal storage of one’s health-related data is termed as Personal Health Record (PHR) (Roehrs et al., 2017). Personal health record (PHR) is an electronic, lifelong resource of health information needed by individuals to make health decisions (Roehrs et al., 2017). Individuals own and manage health data gathered from various healthcare providers. The PHR is maintained in a secure and private environment, with the individual determining rights of access. The PHR does not replace the legal record of any provider (Burka, Deline, Holroyde, & Eyre, 1976). Health information such as diagnoses, medications, immunizations, family medical histories, and provider contact information contained in Personal health record (PHR) is the same information contained in EHRs - but designed to be set up, accessed, and managed by patients. 3 University of Ghana http://ugspace.ug.edu.gh Personal Health records system can be classified into two major types. The Standalone Personal Health Records and Tethered/Connected Personal Health Records. Standalone Personal Health Records: The standalone PHR allows patients to fill in their information from their own records, and the information is stored on patients' computers/mobile device or the Internet. In rare cases, a standalone PHR may also accept data from external sources, including providers and laboratories. The decision to share health information solely lies with the patient. Examples of a standalone PHR are My Medical, Track My Medical and Medical Records. Tethered/Connected Personal Health Records: A link is established between PHR and a specific healthcare provider’s electronic health record (EHR) system. Tethered PHR allows patients to access their own records through secure portal (HealthIT.gov, 2018). Some examples of PHR systems are HealthVault, Healthspek, Medfusion plus and GenexEHR 1.2 Problem Statement One-sided view by Health professionals: As health and healthcare service delivery is developing through the use of EHR, one of the silent challenges that is going unnoticed is its constant one-sided view by healthcare professionals leaving the patient with less information, less ability to control or interact with their data. Limited or inadequate access to health information by patient/client: Limited or inadequate access to health information by patient/client is not just a problem but also infringes the right to full information on his/her condition and management and the possible risks involved except in emergency situations when the patient is unable to make a decision and the need for treatment is urgent. 4 University of Ghana http://ugspace.ug.edu.gh As human as we are, accurately recollecting our last visit to a healthcare facility, treatments we were given, medications and name of health professional who attended to us is inadequately reliable. We cannot accurately recollect health records at the top of our head and when a healthcare provider does not have the information, they have to search for it which takes away time that they could be spending with patients. Occasionally, patient become forgetful and forget when to take their medications and even forget review dates. Continuity of care is affected as patients/clients cannot fully recollect accurately treatments and medications they are undergoing and no information is readily available for them to present to the an alternate health facility they are visiting, Personal health record system is not popular in our part of the world and has left patients solely relying on healthcare practitioners to have access and control over patient’s health data. Creating an over reliance situation in which healthcare providers are superior and hold on to patients healthcare records. Patients/clients rely heavily on practitioners creating the parent-child sort of relationship, leaving the patient knowing a little or nothing about their condition. As result of lack of access to patient’s records by patients some healthcare providers do not capture the correct information, details are omitted and health information are used without the patients consent. According to Kaelber et al, (2008) studies suggested, physicians may exhibit some hesitancy in adoption of PHRs than other health professionals. This hesitancy may be due to the concerns of extra work created by adoption of PHRs, which is likely that is not reimbursed. In bridging the gap and respecting the right of a patient, healthcare providers, researchers and health informaticians must apply technology in mitigating patient’s access to health record. A technology that will allow patients/clients to manage data on 5 University of Ghana http://ugspace.ug.edu.gh their own medical conditions, prescription and medications, and behaviors pertaining to self-care and monitoring of their health. Technology must be applied to improve patients’ access and storage of their personal health data. This technology will aid in improving communication and the understanding and management of health conditions by patients. Introduction of a technology would improve efficiency in health care delivery. Healthcare delivery will become a partnership between the provider and the patient/client. 1.3 Justification This study is to design a computer based/mobile application for patients to enable a self- storage and maintenance of personal health data. Through the development of a Standalone Personal Health Records system change and advancement will take place within healthcare and healthcare service delivery. For patients/clients, there is a better access to a wide collection of credible health information and knowledge. Patients/clients can utilize their access to improve and manage their health conditions. Patients/clients with protracted illnesses have the ability to track their diseases, promoting a quicker response when they encounter a health problem or an emergency. Individuals own and manage health data gathered from various healthcare providers. This application will empower patients and entreat them to show more interest and be responsible for their health and health data. Knowledge will be acquired through the interaction with the application and communication with the healthcare provider. Healthcare service delivery becomes a partnership between the healthcare professional and the patient/client. 6 University of Ghana http://ugspace.ug.edu.gh This application will help to reduce duplicated test such as blood type since this information will be stored in the PHR. Healthcare service providers and professionals can fall on data in PHR in situations where access to EHR is limited. 1.4 Study Objectives PHRs are essential for allowing patients to control their healthcare information and for acting as an engagement tool with their health practitioners. Healthcare service has started using accessible and affordable self-monitoring technologies to help patients become more connected with their health data. 1.4.1 General Objective The main objective is to design and develop a Personal Health Record system which would allow individuals to store and maintain their health records. 1.4.2 Specific Objectives a. To develop a functional flow chart for the designing and development of a personal health record system b. To develop functional requirements for designing application for personal health data monitoring c. To develop an architectural system for personal health records d. To develop a standalone personal health record system that can be accessed through the use of a web browser 1.5 Research Questions a. What are the strength and weakness of the existing system? How do patients store personal medical information? 7 University of Ghana http://ugspace.ug.edu.gh b. What are the functional requirements for developing a Personal Health Record system? c. How does keeping a personal health record save you money? Why are personal health records important? d. What kind of PHR system will be developed? What are the architectural model types of PHR? e. What are the input techniques or methods used in PHR? 1.6 Scope/Delimitation The scope of this study is limited to personal health records. The Personal Health Record system is intended for creation, gathering, managing, and consulting health records from various healthcare providers. It is not for diagnosing a patient, prescribing medication, cure or treat medical conditions. It will help in the storage of vital signs, logging of visits to health facility, and logging of allergies, medications and personal identification information, insurance details, laboratory results and medical notes. 1.7 Study limitation Certain factors can lead to limitation in PHR system adoption process. The hesitation by individuals to adopting PHR to manage and store their health record. Understanding and addressing attitudes and physical adoption barriers among patients and healthcare providers represents an important key to achieving widespread implementation and use of PHRs Privacy and security are major limitation faced by PHRs. Patients' greatest concern about nearly every type of electronic healthcare applications, including PHRs, is security and 8 University of Ghana http://ugspace.ug.edu.gh privacy. Ninety-one percent of people report they are “very concerned” about the privacy and security of their personal health information (Kaelber, Jha, Johnston, Middleton, & Bates, 2008b). Another limitation is access to medical records; there is the likelihood of hesitation from the healthcare service provider to supply a patient with all needed health record. Due to lack of standards interoperability might also become a hindrance. Wrong entry and incomplete data capture is likely to be another form of limitation. Limited time for the completion of the project. In an attempt to overcome this, the application has a user name and password system in place to authenticate and authorize a user. This is to prevent unauthorized users from having access to private health information. Through user sensitization and education entry errors will be minimized and the possible linkage between a providers EHR and a PHRs in the near future. 9 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO 2 LITERATURE REVIEW 2.1 Introduction This chapter aims at providing a clear explanation and a better understanding of personal health record system in terms of its processes, input, strength and weaknesses. To be more involved in your healthcare, keep a personal health record, the more involvement the better results. An effective approach to stay involved and manage treatment for better health outcome is through a PHR. 2.2 Strength and weakness of the existing health record system Universally the ability to access your personal information of all types online, from coursework grades and results, to online banking and financial activities, e-commerce, billing, and profiles, just to list a few. One major category of information/data that has taking a lot of time in adaption to the digital realm is the personal health record (PHR). Keeping a personal health record is not a brand new concept. Many people over the years kept and are keeping their own paper based health records organized and stored at their homes Detmer et al (2008). These paper-based record kept by individual patients are only centered on part of health information that are available to them, many health information such as doctor’s charts, medical-notes and lab-test results are not always given out to patients/clients. Paper-based documents such as medical/clinical notes, laboratory reports and health histories accumulated from various care providers are often compiled by patients/clients. These documents are mostly kept in files, shoe boxes, envelopes, or loose-leaf binders (Detmer et al., 2008a). 10 University of Ghana http://ugspace.ug.edu.gh As weakness, without the knowledge and input of a healthcare professional, paper-based records are susceptible to misinterpretation, damage and misplacement or storage issues. Paper-based records are not shareable and accessible to both physicians and consumers. On the other hand paper-based record does not need electrical power for access, low cost involved and the speed of data entry is an added advantage. Another existed form is the basic electronic personal health record. This began as a result of individuals accumulating and capturing their personal health information into computers using applications such as spreadsheet applications and word processing documents. At one point CD ROMs, smart cards, USB flash drives and other mass storage devices were used for storing and managing personal health information. The earliest form of web-based PHR was an online emergency medical record system making information such as diagnoses, medications, and allergy entered manually by patients available to emergency care professionals. (Gearon, 2007). One major weakness with this system is accuracy of data captured by patients. In existence are the standalone, tethered and integrated PHR models Detmer, Bloomrosen, Raymond, & Tang,(2008), Amongst the three models the most advanced is the integrated. This model makes a compilation of a patient’s medical records, insurance information, prescriptions and pharmacy information. The tethered personal health record is a limited version of the integrated model. This model has its record provided by the healthcare provider, and information provided may be limited and not include entire record from previous providers. The standalone PHR model depends entirely on or almost entirely on patient’s data input. With this model patients can enter incorrect data. This model has limited efficacy and data may not be as reliable as medical records kept 11 University of Ghana http://ugspace.ug.edu.gh by healthcare professionals and healthcare facilities. The integrated PHR model is a two- way communication tool. It aids communication between healthcare professionals and patients/clients (Zuniga, 2015). 2.3 Requirement Analysis This portion of the research work looks at the analysis of requirements for the development of a PHR system. To achieve the goals and objectives of developing a successful PHR, these requirements formulated must be met and they act as an evaluation model for PHR systems evaluation (Genitsaridi, Kondylakis, Koumakis, Marias, & Tsiknakis, 2015). 2.3.1 User Requirements User requirements or user needs is defined as what a user will do with the system, such as the activities users can perform. A documented user requirements is referred to as User Requirements Document (URD). User Requirements Document (URD) using narrative text. User requirements are generally signed off by the user and used as the primary input for creating system requirements. An important and difficult step of designing a software product is determining what the user actually wants it to do. Some requirements users would appreciate as part of the PHR are their ability to access up-to-date information, usability and accessibility needs, ability to share information, ability to record and manage progress, Provide clear directions to guide users through the system and efficiency and reliability. Ability to enter daily vital statistics, ability to import health data from provider into PHR. Some users also wished for a system that can be accessed without the need for installation. An easy to use system, a system that requires minimal assistance in usage. 12 University of Ghana http://ugspace.ug.edu.gh 2.3.2 Functional Requirement According to Margaret Rouse “functional requirements are the desired operations of a program, or system as defined in software development and systems engineering” (“What is functional requirements? - Definition from WhatIs.com,” n.d.). For a secured and completely functional PHR system to be recognized, the application’s standards must be of high quality. For functional specifications and standardization, three different major entities provided the needed models. The first organization is International Organization for Standardization ISO/IEC 25000 series. Personal Health Record System Functional Model is the second model that was proposed by Health Level Seven (HL7) organization, the last model is the Specification of Meaningful Use criteria established by the U.S. Office of the National Coordinator for Health IT. Based on the study of Personal Health Record System Functional Model and a systematic analysis of its functionality and other PHR implementations by Genitsaridi et al, (2013), a simplified functional evaluation model was formulated. The composition of the functionality evaluation model consist of a five coarse-grained functional groupings and description of services in higher quality of small details (Genitsaridi et al., 2013), ( Genitsaridi et al., 2015). Quality properties of a system/software are classified into eight characteristics: usable, compatible, functionally suitable, performance efficiency, maintainable, reliable, and portable, security, product quality model (ISO/IEC 25040) (ISO, 2017). Some recommended functionality features to be considered in designing a personal health record system are capturing of personal details of healthcare professionals such name, phone, email, and addresses, capturing of a patient conditions or an incident, educational resources and capturing of diagnosis. 13 University of Ghana http://ugspace.ug.edu.gh Figure 1: PHR systems evaluation model. Source: (Genitsaridi et al., 2013) Figure 2: PHR system functional model overview Source: Genitsaridi et al., 2015 14 University of Ghana http://ugspace.ug.edu.gh 2.3.3 Non-functional Requirement Non-functional requirements defines system attributes such as reliability, usability, performance, maintainability, security and scalability. They serve as restrictions on the design of the system. This section identifies the qualities that can be used to judge the operation of the system (Cremers, 2004). Non-functional requirements such as the graphical user interface must be consistent and usable. User must be able to use system with ease and minimal training. The use of dashboards and icons makes a GUI very easy to adopt to. System must be reliable; patient’s access to system, data entry and retrieval must be available all the time and accessible from any location at any time. Mandatory and optional fields are used to enforce data quality. The system performance must always be smooth and fast with no interruptions. It is important that the system performs consistently and above reproach. Security needs will be addressed through password protection and locking of system when left idle. Error reporting should be sent to the technical team by system for fixing (“My Health Record - Non-Functional and SDLC REQUIREMENTS DOCUMENT - ITC412: System Analysis PG - StuDocu,” n.d.). 2.3.4 Open source software requirements and Web-based system requirements. According to Genitsaridi et al., (2013) the usage of PHR systems are simplified by the Free and Open Source Software (FOSS). This concept of open license sets users free, from registered software which has cost and distribution limitations. The aim of the open source concept is to provide the means and ability of modifying a PHR software according to personal requirements. Due to the worldwide community involvement, open source solutions provide better quality and technical support. 15 University of Ghana http://ugspace.ug.edu.gh PHR system has a web based nature which is an important requirement. It is flexible in usage and interoperable. A patient can access his/her PHR data, at any time and location through the web based solution, by the use of an internet connectivity and a web browser. The process of downloading and running an installation is eliminated by the web based nature of a PHR system. A web based PHR system is easy to integrate with mobile devices, making it possible to access PHR through smart phone or a tablet pc Genitsaridi et al., (2013). 2.4 Money saving and Importance The usage of PHRs by patients/clients saves cost through the reduction of health care cost. PHRs prevents possible repetition of tests, decreasing costs. Research has shown that 10% of laboratory tests requested by healthcare professionals are redundant. Through aiding patients with chronic conditions, PHRs lowers cost involved in chronic disease management. Some other potential cost reducing areas include medication and wellness programs (Etzioni, n.d.). Reduce Administrative Costs: Through prescription refill and appointment scheduling, healthcare facility can cut down administrative cost by using PHR. With PHRs, healthcare professionals can spend lesser time searching for patient information. Monitoring the PHR regularly keeps health data organized and ready to be used, it ensures that everything is organized and ready to be put to good use. PHRs encourage patients to become more involved with their own care. 2.5 System Architecture In system's development process, architectural and technical decisions are very important requirements. In order to guarantee a system that is interoperable, maintainable and 16 University of Ghana http://ugspace.ug.edu.gh expendable, the system's architectural design should be planned and implemented on an ultra-modern frameworks. In developing a personal health record systems, three architectural models are used; the standalone, tethered and interconnected models. It is the responsibility of patients/clients to keep Standalone PHR systems updated, SPHR does not interact with other electronic health record systems automatically or directly. A Tethered PHR system is a sub system of an EHR, controlled by healthcare provider. Tethered systems allows records to be transferred with ease, within the system's infrastructure. Interconnected PHR systems are sophisticated and can communicate with other electronic medical record systems. They can collect data from multiple sources due to their interconnectivity and interoperability with other systems, and as well as serving as a data source from which other health systems can access needed resources. Figure 3: System Architecture 17 University of Ghana http://ugspace.ug.edu.gh Figure 4: PHR and EHR relationships. IoT: Internet of Things. Source: (Roehrs et al., 2017) 2.6 Information Input Technique Data collaboration is one of the data input techniques that is used to capture data into a PHR. Ellen Children defines data collaboration as analysis of multiple independent datasets to gain a combined insight. It produces the same output as stitching the datasets together, without the data privacy, trust and implementation barriers (“What is data collaboration? – InfoSum – Medium,” n.d.). Collaboration between multiple health care professionals to organize data for populating a PHR. Health care providers are the owners of such data. Patient report is another method of inputting information. Patients capture information through typing, voice notes, and pictures. Another information input technique stated from a research conducted by Roehrs et al., (2017) is Adaptive platforms. Adoptive platforms aggregate sources, provisioning individualized personal eHealth devices. To input data into PHR, patients collaborate with healthcare providers to attain a successful data entry. 18 University of Ghana http://ugspace.ug.edu.gh Today, on the international scene and somewhat on national health policy level, PHR is commanding attention. Engaging patients/clients in health promotion and disease management is critical to quality health improvement and health care cost management strategy. PHRs is positioned to strengthen and empower patients to take greater control and be more active in self-care. 19 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODOLOGY 2.7 Introduction This chapter looks at the various stages system development goes through. Waterfall model is a methodology considered as the traditional model for explaining software development processes in software engineering. Waterfall model is one of the most popular software development life cycle models (SDLC). A software development life cycle model is a structured methodology used in the development of a software. A number of ordered activities are performed to arrive at the end product. Each stage is linked to the next stage and the preceding stage becomes an input to the subsequent stage of SDLC. The stages in SDLC are requirement gathering and analysis, system design, implementation, testing, deployment of system and maintenance. 2.8 System Development Life Cycle (SDLC) System development life cycle is defined as a software development and management model that breaks down the various phases involved in beginning a project and completing a project (Systems & Life, n.d.). In the design and development of the personal health record system the waterfall model of SDLC process was followed. The waterfall model ensures that a phase is completed before beginning the next phase and there is no overlapping of phases. For each phase, a deliverable is created and passed down as a required piece for inputting into the next phase of SDLC. Requirements are gathered and analyzed then used to design a system, then implemented (coding), after 20 University of Ghana http://ugspace.ug.edu.gh coding or implementation testing is the next stage then leads to deployment and maintaining of the system. Figure 5: SDLC Waterfall model Source: (Acodez, 2018) Figure 6: Typical System Development Life Cycle 21 University of Ghana http://ugspace.ug.edu.gh 2.8.1 Requirement gathering and analysis The first most important part of an SDLC is requirement gathering and analysis. This first stage is usually performed by an experienced and skilled individual in software development lifecycle and software engineering. At client-end when requirement gathering is completed, the project’s scope is determined and a requirement specification document is generated. In gathering requirements for the development of the PHR, the mode of data collection used was interview. Five individuals from the master of health informatics and fifteen other individuals, comprising of students from master in public health and people who are tech-savvy were interviewed. The interview was carried out in an informal format; where it seemed like just a chat about personal health record. The five persons from MHI demonstrated some knowledge in PHR, what they expect the application to do and what they wish to see in a PHR. The remaining fifteen demonstrated lesser knowledge of PHR. All 20 people were asked 15 questions based on PHR, each individual was taken through this questions in Appendix H. Some user requirements were gathered through brainstorming and analyzing some online PHR systems. Systems such as MTBC PHR by MTBC (an iOS platform based, IPhone), GenexPHR (android and iOS platform based) and Healthspek (web based) 2.8.2 System Design The requirements gotten from the previous stage are studied in this stage and applied to the preparation of system design. The system design is used in identifying and specifying hardware and system requirements and helps in defining the overall system architecture. This stage helps to identify the sequence of work flow of the application. A flowchart is 22 University of Ghana http://ugspace.ug.edu.gh the first stage in the designing process. A PHR flowchart was designed in order to identify the various processes that are involved. To ensure the security of the application, the first stage is registering as a new user or logging into the system when an existing user. If loop is utilized here to ensure when a user is an existing user then the system allows user to log in. Figure 7: Flowchart for personal health record system 23 University of Ghana http://ugspace.ug.edu.gh 2.8.2.1 ENTITY TABLES, ATTRIBUTES AND DATA TYPES Table 1: PERSONAL /USER DETAIL ENTITY – PERSONAL DETAILS ATTRIBUTE DATA TYPE Name of Patient/User (First name, second name, middle name) Varchar (50) Email Varchar (70) Address Varchar (100) Phone Varchar (20) Date of birth Varchar(20) Sickle Varchar(5) Blood type Varchar(5) Allergies Text Phote Varchar(50) Enc_password Varchar(50) Salt Varchar Last_login Varchar(20) Status Varchar(30) 24 University of Ghana http://ugspace.ug.edu.gh Table 2: VISITATION ENTITY – Visitation ATTRIBUTE DATA TYPE ID Integer User_eamil Varchar(50) Hospital Varchar(50) Visit Date Varchar(15) Doctor Varchar(50) Speciality Varchar(50) Comments Text Table 3: Vital Stats ENTITY – Vitals ATTRIBUTE DATA TYPE User ID Integer User_email Varchar(20) Temperature Double Weight Double Blood pressure Double Heart Rate Double Bmi Double Height Double 25 University of Ghana http://ugspace.ug.edu.gh Table 4: PRESCRIPTION ENTITY – Prescription ATTRIBUTE DATA TYPE ID Integer(11) User_email Varchar(50) Name Varchar(100) Dosage Text Expiry_date Varchar(20) Status (Done/taking/pending) Varchar(20) Table 5: APPOINTMENTS ENTITY – APPOINTMENTS ATTRIBUTE DATA TYPE User email Varchar(50) ID Varchar Hospital String Type (follow up/consultation) Varchar DrName String Specialty string Date and time Date Status (upcoming/cancelled/past) String 26 University of Ghana http://ugspace.ug.edu.gh Table 6: INSURANCE ENTITY – INSURANCE ATTRIBUTE DATA TYPE Id Integer (11) User_email Varchar(50) Type Varchar(50) Number Varchar(20) Expiry Varchar(20) Table 7: IN CASE OF EMERGENCY CONTACT PERSON ENTITY – I.C.E (in case of emergency) ID Int(11) User email Varchar(50) Name Varchar(50) Phone Number Varchar(20) Relation Varchar(50) Address Varchar(100) Email Varchar(50) 2.8.2.2 Functional Requirements specification This point is dedicated to describing the various elements the system user will encounter. The personal health record system is designed to support individuals who desire to store and manage their health information. This application can be downloaded and run in a web browser found on any device. System requires a XAMMP control panel to mount the 27 University of Ghana http://ugspace.ug.edu.gh database and the program files to run smoothly. The system will allow user to update their health information and capture new information. At the start of the application, a user will see the register or log-in screen. A new user is required to create an account by clicking on register and filling out a form and selecting a user name and password. A previous user fills in the details (username and password) and clicks on log in. This process verifies and authenticate the user. The system will only permit access when the user credentials are correct The dashboard is the next screen a user who has successfully logged in will see. The dashboard organizes the various tabs a user will come across. Tabs such as Upcoming appointments, Visitation Log, Vitals, Prescription and medication, Personal details, settings and log out button can be located on the dashboard. The application allows users to enter details about their visitation to a health facility under the visitation log. Vital stats such as blood pressure, weight and temperature are logged under vitals. A log out button has been provided to allow users to log out after entering their health information. 2.8.2.3 Non-functional Requirement Specification The quality of a project depends on non-functional requirements. This represents quality measures the system abides by. Some of the quality attributes a system must have are reliability, performance, privacy and security (Daimi, Li, Lu, & El-nazeer, n.d.). A well- crafted interface to make the experience of a user a pleasant one. A well combined color usage and font type and size was used in the development process to enable a good reading and interaction with the system. Some of other non-functional requirements that was considered during the development of the PHR was speed of executing commands, security and privacy of user’s health 28 University of Ghana http://ugspace.ug.edu.gh information, user friendliness of the system, performance and less error and a maintainable system. The performance and speed of the phone was considered to ensure that the PHR system does not have an adverse effect on it. 2.8.2.4 System Architecture In designing the systems architecture, various entities relevant to the PHR development was identified and their attributes were listed. The various tables were normalized to and MySQL workbench was used to design the architecture, relationships were identified and both primary keys and foreign keys were assigned. The PHR is a standalone web based PHR which is installed onto a device with its data locally stored on the device. 2.8.2.5 System Requirement  Platform – (Operating System): Windows/IOS  Application Access point– Web browser  Display: 480 x 800 pixel, Multi-touch 2.8.2.6 Developing Environment  Builder: Brackets  Local server: Xampp  Language: PHP and HTML  Internal Memory: 2 GB 2.8.3 Implementation and coding At this stage of the cycle, system design is converted into source code. All identified modules of the system are programmed at this stage. At this coding point, PHP and HTML are the programing language that was used. The Implementation stage is where we installed the PHR in a windows environment using google chrome web browser to 29 University of Ghana http://ugspace.ug.edu.gh launch the application. System was deployed to check the workings of it. In bid to find possible errors and debug before moving to testing. This stage allowed for checking for syntax error and logic error. 2.8.4 Testing The testing stage is where the system is tested to see whether it meets the user’s requirements. To ensure that the system works, a new user was allowed to create an account, logged in and enter health information. The user went through thoroughly to fill in every data possible. There were no errors recorded. 30 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR 3 RESULTS 3.1 Introduction This chapter is dedicated to the results from the interviews conducted, observation of a current PHR in Ghana, discussion of the manual format of personal health record storage and the need for a personal health record system. Requirements such as user requirements, functional and non-functional requirements are derived from the interview. 3.2 Results from Observation In “A Review of Ghana’s E-health Strategy” by Afagbedzi, Obuobi, Aryeetey, & Bosomprah, (2013), its stated that in the space of ten years, five documents were developed on e-health policies and strategies. These documents are ICT for Accelerated Development (ICT4AD) Policy document, proposals for Ghana eHealth Strategy, Health Sector’s ICT Policy and Strategy, eHealth plan: 2007 – 2011 and Ghana E-health strategy 2010. It’s been observed that after the launch of these documents, the developmental rate of eHealth in Ghana has been quite slow. Various factors had and have contributed to the slow pace of development of eHealth. A few number of hospitals around the country adopted and are using customized EHR systems. The inadequate knowledge of eHealth and slow nature of adoption and deployment of EHRs has contributed to the absence of a PHR in Ghana. It is observed that people do not have any form of electronic storage system for their personal health records. Patients and individuals rely heavily on the medical practitioners 31 University of Ghana http://ugspace.ug.edu.gh and health facility for their health record. Some people have some knowledge about PHRs but do not use any form, others do not have any knowledge or have never heard of PHR. Individuals who are interested in keeping some form of health record keep laboratory reports, and some medical reports in files and folders at home. Health facilities are the major custodians of people’s health record, and health practitioners become gods over this records and are unwilling to grant access to this records. It is observed that due to more attention being given to the development of EHR across the country no one is paying attention to the development of a PHR. Patients find difficulty in remembering the last time there were in a hospital for treatment, what treatment they underwent, the medication the were given and even at times forget review dates. This process of remembering health details causes some sort of delays in healthcare delivery. It is difficult for patients to remember the names of the doctors that attended to them when they were in the hospital. Individuals, patients and clients of health facilities would like to have a system that would allow them to store some health information on their own. They would love to have some details on the go and can refer to them anytime. Currently there is no or inadequate information on any working PHRs in the Ghana. No locally designed and developed PHRs can be identified due to nonexistence or lack of information or advertisement about the PHR. Keeping a personal health record is not a new concept. Many individuals kept and are keeping their own health records organized and stored in a paper based format at home Detmer et al (2008). Paper-based records aren’t easily shared and it’s not accessible to both physicians and consumers. 32 University of Ghana http://ugspace.ug.edu.gh Treating a patient becomes a chore when there are no readily available information on the patient. Health practitioners struggle to get information in order to provide the best care for their client. The search for health record consumes all the time needed to save the life of the patient. 3.3 Results from Interviews In an effort to gain insight into what people know about PHRs and gather user requirements, people from diverse background were selected. As part of the selection process, some were selected from post graduate students studying Health Informatics, another group was selected from post graduate students studying Public Health. The remaining were people who are medical doctors and individuals who are tech-savvy. In total 20 people were selected and interviewed. The age bracket for these people fall between 26 to 60 years. In gathering user requirements for the development of the PHR, the mode of data collection used was interview. The interviews were carried out in an informal format; informal interviews are interviews that are carried out in a casual setting. This method was applied to possibly get the best response and ideas from the interviewee. It is a very flexible and comfortable way of interviewing. The first group of people interviewed individually were post graduate students studying Health Informatics, this group was made of three males and two females. When quizzed about how each of them stored health/medical data, their responses showed they do not actually have a storage for their health records, some couple of x-rays and prescription forms are what some of them kept at home. They usually rely on the hospitals to keep their health record either manually or digitally. 33 University of Ghana http://ugspace.ug.edu.gh The remaining fifteen consisting of six post graduate students studying Public Health, three medical practitioners, six tech savvy individuals. Among these group the medical practitioners and the post graduate students studying public health know about EHRs but have limited information on PHRs. Individually they confirmed minimal record keeping on their health. They all don’t have any proper form of personal health recording keeping system. Some can boost of some few copies of hospital cards, weighing cards, x-rays, prescription and laboratory results but cannot readily show pin point where they are keeping it. The remaining six are tech savvy individuals with diverse backgrounds ranging from retired persons to cake making. Most people in this group prior to their interview had no knowledge of PHR. They rely on health facilities to keep their health records. Among the twenty people interviewed, none can confidently say they a purposefully keeping a personal health record be it manual or digital. During the interview, it was observed that individuals in health informatics program have heard of PHR and know what a PHR is. The medical practitioners and some of the public health students have heard of PHR but they only know very little about it. The remaining exhibited inadequate or lack knowledge in PHR. The culture where patient-doctor relationship is a parent-child relationship and the excessive power in the hands of the medical practitioner is one factor that holds patients back from seeking for their medical information. CapMed, one of the oldest PHR vendors undertook a study in 2002, it studied the primary use of PHRs by end-users. From the study it was gathered that 26.4% would like to access family medical record, 21.4% track 34 University of Ghana http://ugspace.ug.edu.gh their visits to the doctor, 18.7% would like to track laboratory results and 13.5% would like to track their health status (Cronin, 2006). It was gathered from the interviewees that a system that can offer protection for their health information is what they look to seeing in the PHR. All the people that were interviewed wished to see a system that allows a user to have access to the system through the use of username and password. Without the username and password one must not have access to the system. Username and password must be encrypted. All participants wish to see the system allowing for the logging of visitation to a health facility, ability to capture the details of medical professionals that attends to them. The ability to use the PHR to capture reason for the visit, ailment, and treatment received. Some of the interviewee requirements they wished to see in the PHR were the ability to capture allergies, vital statistic (capturing of weight daily, blood pressure daily recording), capture personal details, blood group, height, medications they are currently on and previous medications. Laboratory results, review dates and medical notes and reminders were also some of the requirements that was stated. Some people wished to see the system being able to capture and manage previous medical data and current medical health status data. The medical doctors in the interviewee wanted requirements such as easy access to patient data, interoperability with hospital EHRs. PHR should allow for the entering of details on admission and discharge to and from the health facility. To specify whether it was an emergency or a visit to the OPD/ambulatory service. Some wished to see the system allowing for the entering of emergency contact persons details. System should be able to capture insurance details and allow for the uploading of a profile picture. System 35 University of Ghana http://ugspace.ug.edu.gh should log user out when the system is left idle for some seconds. System must function on any platform and must allow for the registration of new users. The user interface must be clear to make reading an ease for the user. The font size and font color must blend well with the background color to make inscriptions legible. User’s information must be protected and secured at all times, privacy and confidentiality must always be respected. The tech savvy individuals wanted the PHR not to have effect on the performance of the device that the application would run on. At the end of usage, user must be able to log out of the system. 36 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE 4 DISCUSSION 4.1 Introduction This chapter is dedicated to the discussion of the interviews conducted, observation from the current PHR situation in Ghana, discussion of the manual format of keeping personal health record and the need for a personal health record system. 4.2 Targeted Population The targeted population is the average individual who has the need to store a personal health record. Any individual who is tech savvy and has the need and wish to have, store and manage their personal health record and for usage during consultation and emergency situations would find PHR as a helpful health record keeping system. 4.3 Review of current Manual System From observation and interviews it is determined that the current manual system is not used by majority of patients/clients or individuals. This current system is a manual system where by a patient tries to keep some copies of reports received from the hospital at home in a box, file, booklets or paper folders. Some of the possible reports that are stored via the manual system are x-rays, prescriptions and at times laboratory results. 4.4 Need for Personal Health Record System An effective way to increase patient involvement is through the introduction of a personal health record (PHR). The introduction of PHRs would cause the need for patients/clients to monitor their health, availability of information when needed and ensures accuracy of data. To encourage and increase partnership between doctors and their patient rather than 37 University of Ghana http://ugspace.ug.edu.gh the current child-parent sort of relationship. PHRs is needed to improve communication between medical practitioners and their clients. 4.5 Functional Requirements  The Personal Health Record System would be used to record individuals’ health information. o Description: PHRs would allow for the entering of medical and personal details. The PHR will allow users to have access, store and manage their health record, prescription and visit to health facilities. o Criticality: This is the most important aspect of the system and one of the major ones a user will adopt PHR. o Risks: Device might require lots of memory for storage and information may not be saved when device runs out of memory space. o Technical Issues:  The PHR will allow user to identify and edit information in their medical record that is out of date or incorrect. o Description: The system shall allow user to audit personal records that are incorrect and out of date o Criticality: This is important to the system as it ensures accurate data in the system. o Risk: Changes cannot be made to medical records that do not need updating. 38 University of Ghana http://ugspace.ug.edu.gh  The PHR will allow user to capture vital statistics; on daily basis or according to their preference 4.6 Non-Functional Requirement  The system shall have a user friendly Graphical User Interface (GUI)  The security of the system is paramount  The information shall be stored locally on the device (computer/ mobile phone)  Adoptive to any system were application is assessed  The application shall not affect the performance of the device on which it is accessed. 4.7 Product Function Personal Health Record system will store data based on the inputs a user feeds into the system. It will allow users to store information on their prescriptions, vital stats, and health facilities. 4.8 User Problem Statement There are no or not many personal health record systems in Ghana. Individuals rely on files to store some of their health information, majority rely heavily on the health facility to manage their health information. Unavailability of personal health record system has led many people leaving their health issues in the hands of a health practitioner. 39 University of Ghana http://ugspace.ug.edu.gh 4.9 System Architecture Figure 8: Entity relationship diagram 4.10 System Design and User Interface The Application is accessed through a web browser, a localhost system that stores its data in a database that resides on the device being used. The first screen a user will come into contact with is the Login screen. The user login screen also doubles as the registration screen for first time users. A user requires an email and a password to logion into the system. This screen also makes available a register button, this button allows a user to create an account. The login button sends a user to the dashboard. 40 University of Ghana http://ugspace.ug.edu.gh Figure 9: Login Screen (See Appendix for detailed code for Login Screen) Registration Screen On the click of the registration button, a user is directed to the registration form. This form allows a user to create an account. The user is required to fill out a form that is available. User must enter first name, last name email address and password then proceed to click on register to submit form for registration on the system. When the register button is clicked after form has been filled, a user is able to view the dashboard 41 University of Ghana http://ugspace.ug.edu.gh Figure 10: Registration screen (See Appendix for detailed code for Registration Screen) location.href='login.php'"; } ?> Medical Visit The medical visit page allows a user to add records about their visit to a health facility, the date of visitation and who attended to them. The main medical visit screen displays information that has been entered into the system and also displays an “add new record” button. This button allows for the addition of new record. 44 University of Ghana http://ugspace.ug.edu.gh Figure 13: Medical Visit When add new record button is clicked a new form in figure 13 is displayed. This form allows you to fill in the details required. At the end of entering data the add button is clicked to add data/save to the systems database. Figure 14: Add medical visit information 45 University of Ghana http://ugspace.ug.edu.gh (See Appendix for detailed code for Add Medical Information) Personal Health Record 57 University of Ghana http://ugspace.ug.edu.gh $(document).ready(function() { $("#err").html("'.$errorMsg.'"); $("#err").show(); }); '; } ?>
59 University of Ghana http://ugspace.ug.edu.gh Appendix B: Detailed programming code for registration interface Login Here"; } } ?> Personal Health Record 60 University of Ghana http://ugspace.ug.edu.gh $(document).ready(function() { $("#err").html("'.$errorMsg.'"); $("#err").show(); }); '; } ?>
62 University of Ghana http://ugspace.ug.edu.gh Appendix C: Programming codes for the main dashboard location.href='login.php'"; } ?> Personal Health Record 63 University of Ghana http://ugspace.ug.edu.gh
Personal Health Record

Your Profile

Emergency Contact



Prescription


  • 67 University of Ghana http://ugspace.ug.edu.gh

Medical Visit



68 University of Ghana http://ugspace.ug.edu.gh Appendix D: Programming codes for Medical Profile interface location.href='login.php'"; } ?> Personal Health Record 70 University of Ghana http://ugspace.ug.edu.gh $(document).ready(function() { $("#err").html("'.$errorMsg.'"); $("#err").show(); }); 71 University of Ghana http://ugspace.ug.edu.gh '; } ?>
Personal Health Record
72 University of Ghana http://ugspace.ug.edu.gh
74 University of Ghana http://ugspace.ug.edu.gh

Your Profile

Change your Password

78 University of Ghana http://ugspace.ug.edu.gh

Emergency Contact


  • 79 University of Ghana http://ugspace.ug.edu.gh

Insurance



85 University of Ghana http://ugspace.ug.edu.gh Appendix E: Programming codes for Medical Visit location.href='login.php'"; } ?> Personal Health Record 86 University of Ghana http://ugspace.ug.edu.gh
Personal Health Record

Medical Visit(s) Records

89 University of Ghana http://ugspace.ug.edu.gh
"; } ?>
Name of Medical Facility Date of Visit Name of Doctor Doctor's Speciality Comments and Details
".$visitRecords['hospital']." ".$visitRecords['visit_date']." ".$visitRecords['doctor']." ".$visitRecords['speciality']." ".$visitRecords['comments']."
Name of Medical Facility Date of Visit Name of Doctor Doctor's Speciality Comments and Details
90 University of Ghana http://ugspace.ug.edu.gh
92 University of Ghana http://ugspace.ug.edu.gh Appendix E: Programming codes for Prescription Interface location.href='login.php'"; } ?> Personal Health Record 93 University of Ghana http://ugspace.ug.edu.gh
Personal Health Record

Prescription Records

96 University of Ghana http://ugspace.ug.edu.gh "; } ?>
Prescribed Drug Name Dosage Status Expiry Date
".$drugRecords['name']." ".$drugRecords['dosage']." ".$drugRecords['status']." ".$drugRecords['expiry_date']."
Prescribed Drug Name Dosage Status Expiry Date
98 University of Ghana http://ugspace.ug.edu.gh Appendix F: Programming codes for Vitals interface location.href='login.php'"; } ?> Personal Health Record 99 University of Ghana http://ugspace.ug.edu.gh
Personal Health Record

Vitals Records

102 University of Ghana http://ugspace.ug.edu.gh "; } ?>
Date Temperature Weight Blood Pressure Heart Rate Body Mass Index Height
".$vitalRecords['date']." ".$vitalRecords['temp']." ".$vitalRecords['weight']." ".$vitalRecords['blood_pressure']." ".$vitalRecords['hrtRate']." ".$vitalRecords['bmi']." ".$vitalRecords['height']."
Date Temperature Weight Blood Pressure Heart Rate Body Mass Index Height
104 University of Ghana http://ugspace.ug.edu.gh Appendix G: Programming codes for Logout interface require("funcs/db_connect.php"); session_destroy(); echo ""; ?> 105 University of Ghana http://ugspace.ug.edu.gh Appendix H: Interview questions Selected individuals were asked the following questions in an informal interview settings 1. Do you know what personal health record is? a. Kindly explain PHR (if interviewee answers yes for question 1) 2. Do you have any form of PHR? 3. How do you store your health information? 4. If electronically stored; how or which e-health system or which application or system do you use to store it 5. If manual, how and where do you keep this hard copy reports? 6. Do you know what personal heath record system is? 7. Have you ever used any form? 8. What does it do? 9. What personal health information would you like to store and manage 10. What features would you like to see in a PHRs 11. What would functions would you like to see a PHR perform 12. Would you like to install an application on your device or access your PHR through the web? 13. Do you have easy access to your health information that is kept by your health professional/ facility? 14. Do you know it is your right to have access to your health information and it is your responsibility to ask 15. Would you recommend a PHR to a family and friend 106 University of Ghana http://ugspace.ug.edu.gh Getting Started 1. Using Xammp as localhost server, connect Personal health record system database 2. Copy PHR db and Dashboard folder 3. Go to local disk Drive c: 4. Locate and Open the Xampp folder, create a folder called health in htdocsand paste your PHR db and Dashboard folder 5. Open Xampp control panel, Initialize xampp by clicking start by apache and mysql 6. Click on admin by mysql start button, this will open the admin platform in a web browser. 7. Under the Databases tab, create database; enter database name Health and click on create 107 University of Ghana http://ugspace.ug.edu.gh 8. Go to import tab on the php admin browser page, navigate to your database PHR db in the health folder, located in htdocs under xampp folder and click go 9. Open a web browser, type in localhost/health, click on templates, click on admin1 10. Localhost page will load. 11. New user are required to create an account 108