ABSTRACT

Lack of adequate management and access to the patients’ previous health records especially in event of emergency makes health care sector inefficient. The aim of this research is to develop and implement an efficient emergency healthcare management model for storing both present and previous health related records of patients in Nigeria such that a wide range of hospitals could share the stored information for the purpose of making prompt decisions about patients in times of emergency. Object Oriented Analysis and Design Methodology (OOADM) was employed to design the system. MySQL database engine was employed to implement the database used in this work. PHP, JavaScript programming environment and association rule data mining technique were employed to implement the software model. The result of this work is an efficient emergency healthcare management model that can be deployed in hospitals, healthcare centres, ministry of health and other healthcare parastatals. Test run of the software using confusion matrix showed an improved delivery of healthcare data by 93% using K-mean classification algorithm as against 83% using K-Nearest Neighbour Classification algorithm and 81% using Apriori classification algorithm and has the capacity to reduce time in delivering service to patients in cases of emergency by providing real time health information on patients across Nigeria.

CHAPTER ONE INTRODUCTION

1.1              Background of the Study

Health administration or healthcare administration is a field relating to leadership, management, and administration of hospitals, hospital networks, and health care systems. Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by practitioners in allied health, dentistry, midwifery (obstetrics), medicine, nursing, optometry, pharmacy, psychology and other health professions. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as in public health (Health Administration, 2018).

Access to health care varies across countries, groups, and individuals, largely influenced by social and economic conditions as well as the health policies in place. Countries and jurisdictions have different policies and plans in relation to the personal and population-based health care goals within their societies. Health care systems are organizations established to meet the health needs of target populations. Their exact configuration varies between national and sub national entities. In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others, planning occurs more centrally among governments or other coordinating bodies. In all cases, according to the World Health Organization (WHO), a well- functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained health facilities and logistics to deliver quality ‘medicines and technologies (Health topics, 2013). Innovation in healthcare continues to be a driving force in the quest to balance cost containment and health care quality. Innovation is considered to be a critical component of business productivity and competitive survival (Omachonu and Einspruch, 2010).

Before independence in 1960, a 10-year developmental plan (1946–1956) was introduced to enhance health care delivery. Several health schools and institutions

(Ministry of Health, several clinics and health centers) were developed according to this plan. By the 1980s, there had been great development in health care—general hospitals and several other health centers (over 10,000) had been introduced (Healthcare, 2014).

In August 1987, the Federal government of Nigeria launched its primary health care plan with the following major objectives: improve collection and monitoring of health data, improve personnel development in the health care, ensure the provision/ essential drug availability, improve on immunization programs, promote treatment of epidemic diseases, improve food supply and nutrition, improve maternal health and child care, and family planning, educate people on prevailing health problems and the methods of preventing and controlling them (Awosika, 2005). This health care plan made little impact on the health sector, as it continued to suffer major infrastructural and personnel deficit, in addition to poor public health management.

Another effort also by the Federal government to revitalize the worsening state of health was the establishment of the Nigerian Health Insurance Scheme (NHIS) in 2005 by Decree 35 of 1999 provided for the establishment of a governing council with the responsibility of managing the scheme (NHIS Decree No 35 of 1999). The objectives of the scheme were to: ensure that every Nigerian has access to good health care services, protect Nigerians from the financial burden of medical bills, limit the rise in the cost of health care services, ensure efficiency in health care services, ensure equitable distribution of health care costs among different income groups; equitable patronage of all levels of health care, maintain high standard of health care delivery services within the scheme, improve and harness private sector participation in the provision of health care services, ensure adequate distribution of health facilities within the Federation, ensure the availability of funds to the health sector for improved services. (Senate, Federal Republic of Nigeria National health bill, 2008).The objectives and functions of the NHIS (Akande, 2004), according to this present review have hardly attained any height as health care delivery continues to be limited; not equitable and does not meet the needs of the majority of the Nigerian people. This is manifest in the high infant mortality rate/poor maternal care, very low life expectancy as at 2010, and periodical outbreak of the same disease, as well as the long period of time spent for control of the various outbreaks.

The appendage program of the NHIS launched in October 2008—Millennium Development Goals—also reported little positive effect a year later. The Nigerian National Health Conference in 2006 which was attended by more than 400 participants, including high cadre dignitaries ranging from the presidency to local governments and their agencies were aimed at ensuring effective, qualitative, affordable, and accessible health care for all Nigerians beyond 2007 (Nigeria National Health Conference, 2009). According to the 2005 January issue of CARE-NET limited health insurance report concerning the NHIS, the Nigerian national health policy objective was the attainment of a level of health that will enable all Nigerians to achieve socially and economically productive lives (A CARE-NET Limited Publication, 2014). Since its lunching primary health care has not gained its right place in the priority of things. As part of the struggle to advance health care, the Nigerian senate in 2008 launched a bill for an act to provide a framework for the regulation, development, and management of a national health system and set standards for rendering health services in the federation and other matters connected with it. (Senate, Federal Republic of Nigeria National health bill 2008). In spite of the several failures of the Nigerian health care system, study had suggested that if managed well, the NHIS could be a useful ground for good health care delivery (Okaro et al., 2010) At its present state, it is true that the scheme does not adequately account for the needs of the Nigerian people.

In spite of the huge development in the health care in relation to the last decades, much is still needed to be done in the health care system (Adeyemo, 2005) and (Omoruan et al., 2009). Although the total expenditure in health amounts to 4.6% GDP, (The Library of Congress Country Studies, 2010) financial managerial competency, besides inadequate funding, remains a major problem. Current statistics show that health institutions rendering health care in Nigeria are 33,303 general hospitals, 20,278 primary health centers and posts, and 59 teaching hospital and federal medical centers (Omoruan et al., 2009). This represents a huge improvement in regards to the last decades; nonetheless, health care institution continues to suffer shortage.

However, the various reforms to increase the provision of health to the Nigerian people notwithstanding, percentage access to health is only 43.3% (Onwujekwe et al., 2010). The inadequacy of the health care delivery system in Nigeria could be

attributed to the peculiar demographics of the Nigerian populace. About 55% of the population lives in the rural areas and only 45% live in the urban areas (Omoruan et al., 2009). About 70% of the health care is provided by private vendors and only 30% by the government. (Banjoko et al., 2010). Over 70% of drugs dispensed are substandard. Hence, the ineffectiveness of the NHIS had recently been attributed to the fact that the scheme represents only 40% of the entire population, and 52-60% are employed in the informal sector. Over half of the population live below the poverty line, on less than one dollar a day and so cannot afford the high cost of health care. (Steinberger et. al, 2008) Also, study by Akande (2004) had reported a poor referral system between the various tiers of health care which probably tells on the poor managerial functions of the health care delivery system.

The scope of the service in Nigerian hospital is basically curative and preventive and is offered in clinic unit x-ray/ ultra sound, laboratory and dental unit in the hospital. Other services include admission (ward) inpatient, physiotherapy and family planning. The records of patients in Nigerian hospitals have over time been inefficiently managed due to large numbers of patients. This usually leads to poor record keeping since it is a paper based system. The reason why the current system, efficient emergency healthcare model is used is that manual operation has led to a variety of problems and these include; unnecessary duplication of the data especially for inpatients and outpatients, inconsistency may occur since data is held more than once and hard to analyze; hence it is difficult to trace the patients’ past medication data. There are several departments in the Nigerian hospital which include medicine and surgery, psychiatry, public health, ear, nose and throat, casualty, obstetrics and gynaecology among others. The emergence of computer based information system has changed the world a great deal; both large and small businesses have adopted the new technology (Jantz, 2001). This means the use of personal computers to fulfill several roles in the production of information. Therefore the documentation of patient record can now be computerized to enable easier manipulation of hospital information to bring us to this existing new world of information system. Examining the document system that is in existence at the hospital that is mostly manual, much importance has been placed on creating a system that documents the inpatient records using a computerized database system with a secure procedure for accessing it. The

integration of hospital databases would pave way for Data Mining and Knowledge Discovery to further help health-related decision makers.

Healthcare industry today generates large amounts of complex data about patients, hospitals resources, disease diagnosis, electronic patient records, medical devices etc. The large amounts of data are a key resource to be processed and analyzed for knowledge extraction that supports for cost-savings and decision making. These can only be achieved using data warehouse and data mining techniques. Patients information, past and present, is extremely vital and guides the physician in making the right decision and diagnosis.

This dissertation will explore how a wide range of hospital, and blood banks information could be useful to medical practitioners for making decisions about patients. A framework from prior research work was used to consider, devise and examine medical practitioner use of information systems for improving response services and outcomes.

1.2              Statement of the Problem

The healthcare industry generates large amounts of complex data on patients, hospitals resources, disease diagnosis, electronic patient records, medical devices, etc. It has therefore become necessary to find a way of storing these information for future use.

Often times most patients go to different hospitals for medical attention, and each of these hospitals collect and maintain its own patients’ health records. As the same patient visits another hospital different health records are also collected and kept for the same patient such that different hospitals have different information for same patient, leading to a lot of redundancies and inconsistencies. But with the emergence of effective health management software these problems of inconsistencies and redundancies are expected to be reduced to the barest minimum.

To actualize the above, it becomes a matter of concern and necessity to mine and integrate healthcare data using a functional software model such that as the world is becoming a global village, health care industry in Nigeria is turned into a global data mine that can be readily available for instant use by whomever it may concern especially in cases of emergency.

Lastly, it is worthy of note to state here that one of the strengths of western world in health care delivery is their well-managed integrated health care records. It will therefore not be out of place if Nigeria, in its quest to catch up with the current trends in technological advancement implements an information system that is capable of improving the quality of healthcare delivery.

1.3              Aim and Objectives of the Study

The aim of this work is to design and implement an efficient emergency healthcare management model using integrated database and data mining technique. The specific objectives are to:

1. Design a system model using integrated database and data mining technique for efficient emergency healthcare
   1. Use JavaScript and PHP scripting language to implement the emergency healthcare management model which can track patients’ medical history using data mining and fingerprint technology.
   1. Implement an integrated database using MySQL database engine
   1. Evaluate the performance of the new system compared with the existing system

1.4              Significance of the Study

The new system will be of immense benefit to hospital management, patients and government in the following ways.

1. It will help to boost the electronic tracking of patient’s medical history thereby reducing the time it takes to retrieve patient’s medical history and spell less work for the staff.

1. It will help in identifying patients allergy especially in critical conditions can be achieved without waiting for patients to be questioned for those information

1. It will help to secure the hospital database server. This will prevent loss of vital information.

Patients:

i           The new system will help save patients life as the emergency healthcare management system will provide the needed patient’s medical history to aid timely treatment and avert death.

Government:

1. The new system enables government to achieve better health care system for its citizens which will in turn translate to a better economy.

1. The mortality rate will be reduced drastically as there will be timely intervention in emergency situations and thereby lives will be save.

1.5              Scope of the Study

In Nigeria, there are many health sectors which include maternity, clinics, general hospital, health centres, etc. The scope of this dissertation will concentrate on developing an efficient emergency healthcare management model that can be used by the emergency department of the above mentioned health sectors. The system will concentrate on collating data from various hospitals and storing the information on a centralized database server. This information will be accessible to medical practitioners whenever there is emergency situation via internet. The system will use data mining technique to perform interference on the current data in order to extract the patients related medical records.

1.6              Limitations of Study

In the course of the research, many constraints were encountered. These constraints were partly technical and partly man made.

Some of the constraints include:

1. The procurement of classified documents from hospitals was a very difficult task.
2. The poor network in Nigeria delayed the work further.

1.7              Definition of Terms

Algorithm:      This is a process or set of rules to be followed in calculations or other problem-solving operations, especially by a computer.

Allergy: This is a condition in which the immune system reacts abnormally to a foreign substance.

Bio data: Bio data is biographical data. It is factual kind of questions about life and work experience, as well as items involving opinions, beliefs, values and attitudes that reflect a historical perspective.

Biometric Technology: This is the process by which computerized methods are used to identify person by unique physical or behavioural characteristics.

Blood group: A blood group also known as blood type is a classification of blood based on the presence and absence of antibodies and also based on the presence or absence of inherited antigenic substance on the surface of red blood cells.

Database: A database is a collection of information that is organized so that it can easily be accessed, managed and updated.

Database Design: Database design is the organization of data according to a database model. What data must be stored and how the elements interrelate is determined by the designer.

Data Integration: This involves combining data residing in different sources and providing users with a unified view of them.

Data Mining: Data mining can be defined as the process of finding previously unknown patterns and trends in databases and using that information to build predictive models.

Database Model: A database model is a type of data model that determines the logical structure of a database and fundamentally determines in which manner data can be stored, organized and manipulated.

Electronic Medical Record (EMR): An electronic medical record is a digital version of a paper chart that contains all patient’s medical history from one practice.

Fingerprint: A fingerprint in its narrow sense is an impression left by the friction ridges of a human finger.

Genotype: The genotype is the part of the genetic makeup of a cell and therefore of an organism or individual which determines one of its characteristics.

Health Care: Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments inhuman beings. Integrated Database: This is a database which acts as the data store for multiple applications and thus integrates data across these applications.

Healthcare Management: This is a field relating to leadership, management and administration of public health systems, health care systems, hospitals and hospital networks.

Information System: This is a system composed of people and computers that processes or interprets information.

Knowledge Discovery: This is an interdisciplinary area focusing upon methodologies for extracting useful knowledge from data.

Management Information System: A management information system is a computerized database of financial information organized and programmed in such a way that it produces regular reports on operations for every level of management in a company.

Model: A model is a graphical, mathematical (symbolic), physi

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