Digital transformation in public health: a software tool for efficient health record management and improved healthcare delivery

Introduction

In today’s fast-paced world, the drastic increase in the production of data in various areas of society has created a growing demand for efficient technological tools that facilitate the analysis and presentation of this data in an accurate and understandable manner.¹ Web-based technology has changed the way we access information and accomplish tasks. It allows us to do things faster and with greater security on any device.² These systems, which you can access through web browsers, provide a wide variety of applications and services. These range from managing data to automating processes.³ En este sentido, el desarrollo de sistemas web ha creado nuevas oportunidades para la colaboración y el trabajo en equipo, permitiendo una mayor conectividad y productividad en diversos contextos, tanto a nivel local como global.⁴ Furthermore, storing and processing vast amounts of data has facilitated knowledgeable, evidence-centered decision-making across various fields, including scientific investigation and data analysis.⁵ Key advantages of online systems consist of ensuring safety, confidentiality, and equal access to data.⁶

In this context, technology has greatly affected all areas of our society, including medical practice. To improve health services and provide more efficient and safe medical care, healthcare professionals rely on web-based health record (HHR) systems as an essential tool.^7,8 According to Ministerial Resolution No. 214-2018-MINSA, electronic health records (EHRs) are digital records of a patient’s medical history and treatment that include organised and detailed information about the patient’s health.⁹ These records are electronic and stored on computer systems only accessible to authorized healthcare professionals. This ensures fast and secure management, access, and exchange of medical information.¹⁰

Most research has shown that the development of web-based health record (H.R.) management systems has the potential to have a positive impact on the efficiency, accuracy, coordination and safety of health care, which in turn improves the overall quality of health services.^11–13 A report by Ref. 14, has highlighted a current issue in the Peruvian healthcare industry due to the insufficient use of Electronic Health Records (EHR). In order to tackle this problem, the “Dr. Phuyu” project proposes to be implemented. “Phuyu” is the Quechua word for “cloud”. This project aims to bring together the medical records of the public and private sectors on a modern and compatible software platform that is completely integrated with the Ministry of Health (MINSA). This will make it easy to manage medical records transparently. Alternatively: On the other hand,¹⁵ describes a system for healthcare workers to obtain medical records online via handheld gadgets, removing dependence on desktop or laptop computers. Attaining this goal necessitates the integration of blockchain technology to oversee medical data archival. A sample produced with Hyperledger Composer and security measures regulates medical information’s secrecy and protection. Their article¹⁶ shows that Health Information Technology (HIT) has a major role in today’s medicine, giving astonishing advantages in healthcare, like improved access to information and tracking, combining records from different episodes of care, ongoing coordination, clinical decision support and efficient prescriptions. It also¹⁷ introduces an Electronic Health Record (EHR) that utilizes a standardized model. This has helped reduce process discrepancies, enhance end results, and pave the way for potential digitization advancements in medical facilities.

However, there is still not enough trustworthy and current proof in the scientific community about using online systems to manage medical records (MR). This shortage includes concerns like interoperability, privacy and security issues, reluctance to change among medical staff, and limitations in technology infrastructure. Further research is required to assess and verify the impact of this tool on health records and real-time decision making. The demand for such systems is because of the growing complexity of medical information, the significance of easing access to clinical data, and the crucial requirement for a centralised and current database that enables comprehensive and effective care.

This research helps to fill the information gap by exploring the advantages and struggles of using a web-based system in a public health centre. It gives important data to enhance medical attention and administrative procedures related to medical records. The goal is to examine how this system can enhance medical record management, improve medical care efficiency, aid decision making based on data, and enhance coordination among health professionals at the health centre.

The aim of this study is to introduce an online system to boost productivity in overseeing patients’ files, thereby enhancing medical assistance quality and optimizing clinical data management at San Juan de la Libertad Health Centre in Bagua Grande, Amazonas, Peru.

Methods

In this segment, we provide an in-depth and comprehensive analysis of the strategies used in the development and implementation of our IT tool specifically designed for public health records management.

Operation

We opted to use the agile extreme programming (XP) approach, which consists of four structural activities implemented in sequential phases.¹⁸ Refer to Figure 1 for a visual representation.

Figure 1. XP methodology phases.

NOTE: Figure 1 illustrates the phases of software development using four central figures with solid fill. In addition, all the rectangular figures with rounded corners provide details of the activities to be carried out in each phase.

Planning phase

All customer requirements were considered during this planning phase, resulting in essential system features. The first feature allows users to access the system and register. Users can choose from three roles: administrator, support user, or client user. The second feature enables user registration in triage, as well as recording diagnoses and care details. The third need allowed making reports, producing medical records and notifying via email or text message (SMS).

Design stage

The best user stories were chosen using a straightforward approach. Also, we made CRC (Class-Responsibility-Collaboration) tasks or cards, which helped us understand the system better. See Table 1 for more details.

Table 1. Model of CRC card.

User history		User history
Number: HU01	User: Administrator and Client Users	Number: HU02	User: Administrator
History Name: System Access		Story Name: User Management
Priority: High	Risk: High	Risk: High	Risk: Medium
Estimated Points: 3	Task Assigned: First Task	Estimated Points: 2	Task Assigned: First Task
Programmer responsible: Jose Dilmer Olivera Burga		Programmer responsible: Jose Dilmer Olivera Burga
Description: All users including the administrator will have their username and password to access the system where the administrator will be responsible for the creation of other users required for the process.		Description: The system will have registered by default the user known as Super Administrator who will have full access to all the functionalities of the system, in addition to the creation, update, deletion and assignment of permissions of other users.
Remarks: Only the users that are defined in the system will have access to its functionalities.		Remarks: The Super Administrator will be the only user who will be able to access all the functionalities of the system, including changing passwords for security reasons.

Codification phase

The system code is hosted in the following repository.¹⁹ The website design was created using HTML and CSS for appearance, and JQuery was used for movement and interaction. Other components like Vanilla JS, Axios, Datatable, Sweet Alert, Ladda, and APIs were included in Json format to deliver the patient history via text message. To ensure the web system operates correctly, we used PHP programming language version 7.2 supported by Codeigniter 8.002 framework. MySQL v.10.0 was used to administer the database.

Test phase

A thorough verification of the system was carried out by running unit tests to identify any bugs in the code and enhance its quality. Acceptance testing was also carried out in conjunction wikth the customer to ensure the application was approved. Figure 2 shows the architectural design of the web system, which provides a comprehensive view of how the system works in relation to all the components involved.

Figure 2. Coding of medical record emailing.

Results

In order to facilitate the use and replication of the project, all resources, including system files and test data, are hosted in the Zenodo.org repository. These resources are available for immediate download without any restrictions.^19–21

Presentation of the dashboard

Figure 3 shows the user interface of the “super administrator”, which displays the web system dashboard, which provides a summarised and visually appealing view of key information related to the medical care of a set of patients. the features displayed on the dashboard are the following: a) Number of medical staff, patients, care, diagnoses and medical records. b) Statistical graph of information on the type of services provided. c) Statistical graph of care information for the last 3 days. d) Number of users with their photos.

• • Entry:

  • ○ Login with password and user previously assigned.

  • ○ Access to the main control panel (dashboard).

• • Output:

  • ○ Static view of users

  • ○ Statistical view of types of healthcare services.

  • ○ Statistical view of patients seen in the last three days.

Figure 3. Web-based medical record management system architecture.

Care registration, triage and medical records process

Figure 4 illustrates the care process, Figure 5 the triage process and Figure 6 the recording of a new patient’s history. The first step in the care process is to search for the patient by name or surname, which automatically fills in the patient’s first and last name fields on the form. Information is then entered into the relevant fields, such as the type of service, the healthcare professional who will be attending the patient, the amount to be paid and a description of the care to be provided. The patient is then directed to the triage area, where data such as blood pressure, temperature, heart rate, respiratory rate, oxygen saturation, weight and height are recorded. Finally, the assigned medical staff will complete the patient’s medical history according to the symptoms and conditions presented.

Figure 4. Super Admin main menu interface.

Figure 5. Registration process for patient care.

Figure 6. Registration process for patient triage.

Imput

• ○ Login with a previously assigned user name and password.

• ○ Access the Surgical module and select the different options according to the procedure: Nursing - Triage - Clinical History.

• ○ Nursing: Select ‘New’.

• ○ Triage: Select ‘Pending Triage’ and then ‘Triage’.

• ○ Clinical History: Select ‘No attention’ and then ‘Attention’.

Output

Care process

• ○ “Care” Register the patient for care (name, doctor, type of service, etc.).

Triage process

• ○ “Triage” and record the patient’s vital signs (temperature, weight, height, blood pressure, etc.).

Clinical history process

• ○ “Clinical history” and record your diagnosis, clinical pathology, pathological anatomy, prescription and other necessary data.

Medical record notification process via e-mail and text message

Figure 7 shows two alternatives for providing the patient with their medical records. The first alternative is to send it by email, as shown in Figure 8. The second option is to send a text message to the patient’s mobile phone number, as shown in Figure 9. This ensures that the patient receives all information relevant to their medical care in a personalised manner.

Figure 7. Process for patient medical records.

Figure 8. SMS and email medical history notification process.

Figure 9. E-mail notification.

Input

• • Access the main control panel (dashboard).

• • Select the “Surgery” module, then “Medical History”.

• • Scroll to the top and select the “With Attention” type.

• • Then select the “View” option and click on the tab to the side.

Output

Send email

• • A window will appear where we will check the email and file to send.

Send SMS

• • A window will appear where we verify the phone number and press “Send”.

Daily reports

In Figure 10, the Super Administrator user has the ability to generate a variety of reports related to daily care, daily medical records, diagnoses and service types using various selection criteria such as start and end date and patient name. These reports can be exported in PDF and Excel formats. In addition, the super administrator can carry out the corresponding configurations and operations, and also has access to the exchange rate of the dollar to the Peruvian sol, as well as the general sales tax (IGV), which is 18%.

Figure 10. Notification by SMS.

Input

• • Enter the “Reports” module and select the different types of reports: Daily History, Daily Attendance, Diagnoses and Type of Service.

• • Select the export format: Excel or pdf “Print”.

Output

• • View the file with the information organised according to the previously selected format.

Discussion

Figure 4 shows how dashboards can improve the efficiency, clinical decision-making and quality of care. This tool presents essential information comprehensively, allowing for quick, detailed comprehension and analysis with meaningful implications. The dashboard monitors progress, supports strategic decision-making, identifies and manages risks and enhances productivity. These factors are essential for ensuring an institution’s competitiveness.²² The medical industry clearly illustrates the usefulness of this tool, emphasising its significance in improving processes and making informed decisions. This observation is consistent with the earlier study by Ref. 23, which outlines that dashboards allow for the sharing of important data in a consolidated and visual format, streamlining decision-making. Dashboards are a useful tool for improving clinical interactions as they simplify information, enable the sharing of data, and streamline decision-making processes. This is achieved by visually displaying the transfer of information. Dashboards make the most of data, allowing them to play a significant role in decision-making across several sectors.²⁴ Overall, these findings emphasise the importance of dashboards as vital tools that increase efficiency, aid clinical decision-making and enhance the quality of care, making them valuable resources for healthcare professionals.

The results shown in Figure 5, 6 and 7 stress the significance and advantages of adopting a web-based system for health care registration, triage, and medical records (MR). This system enables healthcare experts to swiftly and centrally retrieve patient information, hence facilitating the production of precise and comprehensive medical documents. This is crucial for ensuring proper medical treatment and enabling efficient clinical decision-making. MR systems can get patient info faster and more precise.²⁵ Digital medical records are a significant upgrade, giving quick access to records and enhancing readability, safety and organisation in medical data management. It shows how different specialities and hospitals can communicate better, acting as a necessary tool to aid primary and hospital care to communicate, solving a major issue with paper records.^26,27 The main benefits include effective care, good medical records and smoother, coordinated communication between various medical fields. Moreover²⁸ stresses the need to keep and share patient data with relevant professionals to enhance patient care. These findings demonstrate the benefits of using an online system to store medical records, improving communication between healthcare professionals and ultimately leading to better medical care.

In Figure 8, 9 and 10, it is emphasised that sending patients medical history updates through emails and text (SMS) is an efficient way of communication. These methods aid in conveying medical care information and even allow for tailored prescription sharing, thereby improving patient interaction. Connecting these communication means to the web system is also considered crucial for providing patients with high-quality care. This connection is clear and emphasises the significance of employing these avenues to improve medical attention. It is crucial to stress the trustworthiness of SMS messages, which are direct, accurate, brief, affordable, and permit instant data viewing.²⁹ SMS is known for being fast and reliable, making it useful even in areas with limited coverage. This benefits a wide range of users. Research³⁰ has shown that SMS delivery of information has a significant impact, as it allows for accurate and personalised data transmission. It is an effective strategy for improving communication with patients. These methods offer a cheap, clear, and efficient way of spreading healthcare knowledge. Email has become an essential tool in work and communication procedures, making it easier to exchange information.³¹ Providing precise digital information can be particularly valuable in teaching patients how to manage their health conditions. Furthermore, email is a cost-efficient and productive method of preserving continuous contact with patients, which is vital in the care of chronic diseases.

Figure 11 demonstrates how the reports produced by the web system, using filters applied by the super administrator, contribute to better daily care. The system offers comprehensive information on the daily care provided, showing how closely the web system performance relates to health professionals’ output. It is clear that more effective reporting leads to improved health worker results. This research agrees with study,³² which found that reports about daily care filtered through a web-based system play a vital part in coordinating medical teams. This tool improves communication and avoids doing the same work twice by showing the actions taken. Using web-based systems in healthcare can boost efficiency, encourage team coordination and, in turn, enhance the quality of care. In addition, it is vital to report medical records on the web nowadays, as stated by Ref. 16. This approach provides valuable advantages to healthcare, including better access to and follow-up of information, integration of records from varying care sessions, continuous coordination, and clinical decision support. This study highlights the significance of reporting in electronic health records, which leads to enhanced medical care and better collaboration among health professionals.

Figure 11. Daily care reports.

Conclusion and future work

This study has created a web system for managing medical records in a health centre that before relied on paper records. The challenge of modernising patient medical data collection, storage and accessibility in the traditional healthcare environment has been addressed and overcome.

At first, we found issues with the paper-based record system such as inefficiency, trouble accessing and organising information, and the potential for critical data loss. We tackled these challenges by implementing a web-based system which made it easier to manage medical records. This switch to digital also enabled faster access, better readability, and more secure medical information. Ultimately, this transition significantly improved the quality of medical records.

Moreover, the introduction of the internet-enabled programme has eased information exchange and organisation among different healthcare sectors. The capacity to access patient data centrally has streamlined the production of precise and elaborate files, ultimately boosting the effectiveness of medical practitioners. The capacity to access patient data centrally has streamlined the production of precise and elaborate files, ultimately boosting the effectiveness of medical practitioners. What’s more, the seamless cooperation between medical specialities and hospitals has emerged as a primary benefit, surmounting a major weakness of the printed layout.

Finally, experts suggest utilizing state-of-the-art information technologies to enhance research results, for instance by implementing systems that employ artificial intelligence and exploit device connectivity via the Internet of Things (IoT). In addition to this, developing evaluation tools to measure the advantage and disadvantage of applying this new module on the patient practice is crucial.