When I visited my local dental surgery I noticed that they use a manual filing system and I felt that they could benefit from having computerised version, as it would save both time and effort for the receptionists.
Problem identification.
When I visited my local dental surgery I noticed that they use a manual filing system and I felt that they could benefit from having computerised version, as it would save both time and effort for the receptionists.
The organisation
The Dent Care Ltd is a medium size dental surgery based in Burnt Oak. The clinic deals with all aspects of primary dental care that includes regular inspection checks (every 6 months), teeth extraction, fillings, capping and bridging to denture fitting. All work is carried out under local anaesthetic. Where major prolonged work is required they are referred to specialist dental clinic where work can be carried out under sudation.
The clinic is owned in partnership by the three dental surgeons and each has a dental nurse and two receptionists all of whom are computer literate and can operate the PC without much difficulty.
At the moment, the clinic has an 80386 Compaq PC and a HP desk Jet Printer that the receptionist use for typing letters, invoices using Microsoft Word. The patient's appointments are hand written in a yearly planner that they use. The planner simply has a day and times of 15 mins intervals and 5 columns. The columns are headed with the names of the three Dental surgeons.
Data collection
To understand the current system, three methods of data collections were considered.
. Questionnaire to all staff
Advantages
Disadvantages
Quick way of collecting information from large number of people.
Difficult to plan questions to collect complex data
Useful if people are not available for interviews
Cannot probe responses.
Useful if people work in different parts of the office.
Some find it easier to give honest accurate answers.
2. Interview the staff
Advantages
Disadvantages
If well planned and questions are structured in advance lot of detailed information can be captured.
People may not be fully truthful.
Allows probing of responses to seek clarification or ask additional questions.
People may not feel comfortable being interviewed.
Takes up lot of time.
3. Observe the staff doing their job.
Advantages
Disadvantages
See unusual things that users may not be aware of.
Takes up lot of time.
See the efficiency of the system.
People suspicious of being watched.
See which user needs access to what information
See what people do with the information
Understand the whole process easily, as different users carry out different parts of the process.
Technique used
As this is a small friendly dental surgery, questionnaire technique was rejected, as everyone was happy to be observed and interviewed.
Questions planned for the interview are available in appendix A.
Notes from the interview are available in Appendix B.
Observation notes are available in Appendix C.
Customer documents collected are available in Appendix D.
Current system
Process of making an appointment.
When a patient calls to make an appointment, they normally speak to the receptionist. The receptionist asks which consult they are registered with, date & time they wish to attend and checks in the yearly planner if the requested time slot is available on that day. If the slot is not available then the receptionist suggests alternate times that available either on that day on another day in that week. Once the appoint is agreed, the patient name is written in the book at the agreed time and a patient appointment reminder card is filled out by hand and given to the patient.
Process of seeing the dental surgeon.
When the patient arrives at the clinic, they see the receptionist and say either their name or time of appointment or say which surgeon they are here to see and at what time. The receptionist looks at the yearly planner and confirms the appointment. She marks the planner with a tick to indicate the patient has arrived and asks the patient to wait. She checks her manual file system and take out the patient's records.
Seeing the dental surgeon
The patient record is passed to the dental surgeon who looks at last appointment notes in the patient's records and then the dental nurse calls the patient in.
After the treatment
The dental nurse shows what treatment was carried out and passes the patient records back to the receptionist. The receptionist looks at the work sheet and any other notes and books a follow-up appointment if required or discharge the patient. The receptionist looks up the chart that shows the process of various treatments that is written on a page and tells the patients how much they need to pay.
Processing patient payment
The customer has the option of paying by cash, by credit card or delaying payment until the end of their treatment where follow-up appointments are needed.
If payments are paid she writes paid next to the treatment detail else leaves it blank if it is to be paid later. The receptionist then hand writes a receipt for the payment received and hands it to the patient.
The problem
The problems with the way the surgery runs at the moment are:
. When making an appointment for the patient, the receptionist ...
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Processing patient payment
The customer has the option of paying by cash, by credit card or delaying payment until the end of their treatment where follow-up appointments are needed.
If payments are paid she writes paid next to the treatment detail else leaves it blank if it is to be paid later. The receptionist then hand writes a receipt for the payment received and hands it to the patient.
The problem
The problems with the way the surgery runs at the moment are:
. When making an appointment for the patient, the receptionist has to go through a whole column of untidy hand written appointments and to look for time slots. This is keeping the patient on the telephone far longer then is necessary.
2. When the surgery is very busy, time is wasted as one receptionist is kept waiting with a patient until the other receptionist has finished using the yearly planner.
3. Client information is sometimes not written down.
4. Records are sometimes left on the receptionist desks.
5. Time is wasted moving records around from the receptionist to the dental nurse to the dental surgeon and back again.
6. Time is looking for records that have not been filed away.
7. Time is wasted when record sheets are sometimes left out of the patients records file.
8. Sometimes appoints are not recorded on the yearly planner.
9. Sometimes the writing is difficult to read.
0. Having to look up a treatment cost item on a page of paper leads to mistakes.
1. A PC was purchased but is not fully utilised (used for word-processing only).
Current computer specification:
80386 33Mhz processor
32 Mb RAM
.44Mb floppy Disk drive
EGA graphs adaptor, EGA monitor
00Mb hard disk drive
Mouse, Keyboard
Windows 95, Microsoft Word, Excel, PowerPoint
HP ink jet printer.
Problem with this hardware & software
Supplier does, not support software, the motherboard is too slow to run modern software and upgrading with more hard disk and memory is too costly.
User Requirements
The people that would use the new system are: the two receptionists, the three Dental Surgeons and sometimes the three Dental Nurse.
Both receptionists will have the ability to:
. Register new patients.
Check which surgeon has least number of patients?
If all full, refer patient to another clinic.
Otherwise take down following data for each member of the family being registered:
Medical number, full name, gender, age, address, postcode, contact numbers
A menu form needs to have a selection button to add new record.
Access will be used for this data.
2. Delete patient's record if they fail to attend two of the six monthly check-ups.
Need to add two six-monthly check indicators. Letters needs to go out to them requesting them to make appointment if it's been six months since last check date.
Date of last appointment needs to be recorded.
3. Edit patient record.
The menu form needs to have a button to update an existing record.
Receptionist need to search for a record based on patients full name and be able to select to view full patient details. She can change data and the record must be resaved before they exit.
A save exit button is required on the edit patient details form.
4. View patient records using surname.
A query menu form button is needed to allow viewing of records by surname.
5. View patients by surgeon.
A query menu form button is needed to allow viewing of patients by surgeon.
6. Record payment state (paid, postpone payment, no charge)
The patient record needs to have payment field, and amount outstanding, with three options for data. (paid, deferred, free). If amount is paid, a receipt must be printed.
7. A appointment form is required that allows new appoints to be booked, existing appoints to be confirmed, existing appointment to be deleted. The Appointment data record is needed that records, patients name. The record needs to have, surgeon name, date, time with 15 mins intervals. Beginning at 9.00 and ending with 6.00P.M. These should be set defaulted to available, a patient name is entered in this field if appoint is made and reset to available if appointment is cancelled. Appointment menu form must have two options a phone appointment or surgery follow-up appointment. The surgery follow-up appointment must print the appointment card. (This may be better done in spreadsheet, this will not be implemented)
8. View available appointments must show all available time slots at a glance for that day.
It needs to show only what is available by surgeon. (Will not be implemented)
9. Training: require short training on how to use the newly developed system.
Project Plan.
The overall project is to be carried out in three phases, and only phase 1 will be implemented at this time:
Phase1 : A single user system for the two receptionist to share.
Phase2: A multi user system allowing both receptionists the use of the system at
the same time.
Phase3: A multi user records access for the dental surgeons.
Proposed solution:
A small and effective database system is to be developed that can handle the above user requirements. The user requirements 7 and 8 will not be implemented at this stage due to timescales available.
Database software options: Access or Excel
What are the similarities between excel and Access?
* They both have a form view and a table view
* They can input data
* They can produce tables
* They have Form view
* They can both do queries
* They can add or delete records
* They can both have Validation, which is when the computer checks the information being put in the computer is sensible. i.e. if it has 11 spaces for a telephone or mobile number and you enter twelve it won't let you move on. It also changes mistakes if it thinks they are wrong.
What are the differences?
* In Access you have to chose a field
* In access you have to make the first field the key field which is a unique number so that you can not mistake it for anything else
* In Access you have wizards to help you create tables, forms, and reports
* Access is a relational database which means you can link together tables
* In Access it's easier to do Mail Merge and produce reports.
* Excel specializes in number processing and modeling where as access special in data management.
Proposed hardware
A suitable specification I think they need is:
* 512mb RAM, 80 Gb Hard Drive
* 2.8 GHz processor
* 56K modem, Keyboard, Mouse
* 128Mb 3D Video graphics adaptor, 17" flat screen monitor
* Ink jet printer
* CD RW drive, 1.44Mb floppy
* 100Mbit Ethernet network card.
Reasons for choosing this specification:
Computer is fast and can run all modern software.
Large amount of RAM to allow multiple tasks to be run.
CD RW drive allows reliable backing ups of data.
Network card will be required for multi user system.
A large flat screen monitor is selected to save space in a small reception room.
A small ink jet printer is selected because the demand for printing is quite small.
Proposed Software Specifications
* MS Office 2000 professional software suite - MsWord, Excel, PowerPoint, Access, Outlook,
* Operating System - Windows XP
I have chosen Windows XP, as it is the latest of the Windows. It is easy to use, allows multi-access accounts to be setup for different users.
Application Suite, as it is cheaper than buying each program separately.
It also allows strong data portability between various applications for example, create process models on spreadsheets, Use Access for patient's records storage and queries and do Mail Merge with Word for generating payment receipts and printing follow-up appointment card. Access has the additional advantages of being able to validate data, sort data by various options, perform searches, create a standard reports and merge with other packages like a word processor to allow standardized letters.
Hardware Options:
A lap top and a Desk top similar spec computers were compared to determine the best value.
Desktop : Pentathlon Thunderbird ( Supplier: http://www.pentathlondirect.co.uk )
* 266MHz FSB Motherboard with Athlon XP2000 Processor
* 64Mbmax Integrated 3D graphics,
* 256mb RAM, 40GB, 17 inch monitor
* CD Re-Writer , CD-ROM Drive
* 56K Modem
* 3.5" Floppy Disk Drive
* Keyboard , Mouse
3 years parts and labour return to manufacturer. Supplied with original Microsoft XP installation CD and all drivers for Windows 95/98/ME/2000 and XP
Price: £ 475 including VAT
Laptop
Supplier: http://www.thelaptopsite.com
Reference
LAP03-829021
Manufacturer
Hewlett Packard
Model
Evo NX9005
Processor
AMD Athlon 2000
Memory
256mb
HDD
30gb
FDD
.44 FDD
CDROM/DVD
DVD/CDRW
Operating System
Windows XP Professional
Display
4.1" tft
Condition
New - Manufacturer's Warranty
Price: £ 799 including VAT
I have decided to recommend a desktop tower computer rather then a lap top because:
Desktop comes with a larger screen size, it can be placed on the floor under the desk and out of sight; it is much cheaper then a similar spec laptop. The price of the desktop recommended will be approximately £1200.
DESIGN
All forms will be designed in this style. This will ensure everything looks similar for the user.
Item
Text details
Text Position
Colour
Background
Main Heading
Font:20:Italic:Bold
Centered
Blue
Form colour
Labels
Font: 14: Bold
Left aligned
Black
Form colour
Buttons
Font:12:Bold
Centre
Black
grey
Forms
N/A
N/A
N/A
Dark Cyan background
Compulsory data
Font:12:
Left
Black
Light orange
Optional data
Font:12
Left
Black
Light green
Diagram showing the major components of the inputs and outputs
User FORMS Design:
Query1.
Purpose: View patients belonging to a specified surgeon.
Input: Surgeon name
Process: Query database to look all patients against name given.
Output: shows gender, forename, surname, contact numbers for all patients found.
Query 2. View patient details.
Input: Patient forename and surname
Process: Query database to look for all patients against forename and surname.
Output: Show full record details about the patient
Pressing new patient Button brings up this form
Database design
New patient record
Field Name
Type
Length
Required
Indexed
Validation
Duplicates
Record ID
Auto Number
Primary key
Yes
No
No
No
Medical No
text
20 chars
Yes
No
No
No
Gender
text
char
Yes
No
M/F
Yes
Forename
text
20chars
Yes
No
Type Check (cap first letter)
Yes
Surname
text
20 char
Yes
Yes
Type Check (cap first letter)
Yes
House No
text
0 char
Yes
No
No
Yes
Address1
text
50 chars
Yes
No
Type Check (cap first letter)
Yes
Address2
text
20 char
Yes
No
Type Check (cap first letter)
Yes
Address3
text
20 char
Yes
No
Type Check (cap first letter)
Yes
Address 4
text
20 char
Yes
No
Type Check (cap first letter)
Yes
Post code
text
9 char
Yes
No
Type Check (ccnn ccnn)
yes
Day time No
text
2 char
Yes
No
Character check
Yes
Mobile No
text
2 char
Yes
No
Character Check
Yes
DOB
Date
0 char
Yes
No
Type Check
Yes
Last appointment
Date
0 char
Yes
No
Type Check
Yes
Expiry date
date
0 Char
Yes
No
Type Check
Yes
Reminder status
Text
char
Yes
No
Y/N
Yes
Payment status
Text
0 chars
Yes
No
Paid, Defer, Free
Yes
Amount due
Currency
Integer
No
Yes
Type Check
Yes
Surgeons table
Field Name
Type
Length
Required
Indexed
Validation
Duplicates
Surgeon ID
Auto Number
Primary key
Yes
No
N/A
No
Title
Text
4 char
Yes
No
Dr, Mr, Mrs, Miss
Yes
Forename
Text
20 Char
Yes
No
Type Check (cap first letter)
Yes
Surname
Text
20 Char
Yes
Yes
Type Check (cap first letter)
Yes
Address1
Text
50 Char
Yes
No
Type Check (cap first letter)
Yes
Address2
Text
20 Char
Yes
No
Type Check (cap first letter)
Yes
Address3
Text
20 Char
Yes
No
Type Check (cap first letter)
Yes
Address4
Text
20 Char
Yes
No
Type Check (cap first letter)
Yes
Post Code
Text
9 Char
Yes
No
Type Check (ccnn ccnn)
Yes
Home No
Text
2 char
Yes
No
Character Check
Yes
Mob No
Text
2 char
Yes
No
Character Check
Yes
Surgery Table
Field Name
Type
Length
Required
Indexed
Validation
Duplicates
Patient ID
Number
Long Integer
Yes
Yes
field key
No
Surgeon ID
Number
Long Integer
Yes
Yes
field key
No
Diagram showing how the tables are linked together by key fields.
Appendix A Questions for the interview
. When patients joins the clinic what information do you record.?
2. When patient makes an appointment what information do you take down?
3. When patient arrives for his treatment, how do you note who is waiting for which surgeon?
4. When a person needs a follow-up appointment what do you record?
5. What additional tasks do you perform for a follow-up appointment?
6. How do you record information about patient payments of treatment?
7. What difficulties do you experience when you become very busy?
8. What happens to patients that you cannot deal with?
9. How do you track patients for different surgeons?
0. How many people are there working at the surgery?
1. How do you know how much to charge for different treatments?
2. Do patients cancel appoints?
3. What happens when they do this?
Appendix B Answers given at interview
A.1 When a new patients comes to register with us, we know the number of new patients that each surgeon will take.
If they can take on new patients, then, we ask them to fill in a form about their medical details otherwise we refer them to another dental surgery.
We then check the form and ask them to sign their declaration.
We ask for their medical card and record the number as well as their names and address details. We also ask for details about their family members and their details.
A.2 We take down their first name and surname and record it in our appointment planner against the surgeon's name and time of appointment. The planner allows us to make appointments every 15 mins.
A3. Yes, when a patient arrives, they usually say the time of their appointment and their name.
We write a tick against their name, which indicates they are wait in reception.
A4. We do the same as we did before as if the patient is making a new appointment but we know their name and surgeons name so simply agree on suitable time?
A5. When we agree on the appointment time and day, we fill in a appoint card with the date and time details and hand it to the patient.
We also ask about them to see if they wish to pay today or pay for everything at the end of the treatment. Most patients prefer to pay as treatment is being carried out. Some do decide they will pay the total amount at the end. We also have patients that don't have to pay if they are on job seeker allowance or social security benefit.
A6. We make a note on the treatment card, if they have paid or deferred payment or no charge.
If they pay we write out a receipt for them.
A7. I find it very frustrating when we have people making queries and we have to wait for the appointment planner to be freed up before we can deal with the patient. We sometimes spend time looking for patient sheets in the filing cabinet which one of us has not filed and may be lying on the desk.
Sometimes we don't get the treatment sheet and have to ask the dental nurse to look for it the surgeons treatment room and the customer is kept waiting.
A8. The dental surgeon refers the patient to the specialist clinic. This involves writing to the clinic and requesting an appointment. It can three to four weeks for the appointment to come.
A9. We file each patient records in different filing cabinet and on the planner we write down the name of the surgeon so that his patients are under his named column.
A10. There are the three surgeons, three medical nurse and two of us at reception.
A11. We have a list of treatments and prices against them. The surgeon writes down what treatment he has carried out and calculates the total.
A12/13. Yes, quite often, all we do is put a diagonal line across it and make a new appointment. If they cancel before 48 hours, we do not charge them, otherwise we charge them £20.
Appendix C Notes taken during observation
Observing the surgeon:
Receptionist takes the notes from the filing cabinet and passes it to the nurse. The surgeon checks his last notes. The nurse calls the patient in. The treatment is carried out and the surgeon writes, the treatment he carried out and indicates if follow-up appointment is needed, he makes a brief notes about what he needs to do next time. The patient leaves the treatment room and the nurse returns the patient file to the receptionist desk. The next patient is the called in.
Observing the Dental Nurse:
Dental nurses are only involved in fetching and returning the patients records to and from the surgeon and assisting the surgeon. They do not write anything on the patient's notes.
Observing the Receptionist:
Confirmed what the receptionist said she did with customer handling process. All information given during the interview was correct. Also observed the time wasted when the clinic becomes busy and how frustrated they become having to share a single appointment planner. The times they take to write out the receipt and appointment card is quite effective, but it takes a lower priority to ensuring surgeons receives the patients records and are not waiting. This means keeping the customer waiting longer then is necessary.
Customer are frequently kept waiting as they try to pay for treatment or make follow-up appointments. New people arriving are given higher priority.
Appendix D: customer Documents collected.
Pic of form
Dental pics, teeth record
Medical history form
Appointment list
Practice record form
Return card for next appointment
