SAMARA UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF HEALTH INFORMATICS

PROJECT PROPOSAL TITLE:-DEVELOPING WEB-BASED TUBRCLOSIS FOLLOW-UP

INFORMATION SYSTEM AT DUCTI GENERAL HOSPITAL IN 2015E.C

Submitted in the partial fulfillment of the requirement for the award of degree B.Sc. In health informatics

GROUP MEMBER’S

NAME ID

1.ABREHAM BIRHAN su/1200103

2.ALEBACHEW GETNET su/1200178

3.ALEMAY TESHOE su/1200187

4.ATSEDU NIGUSIE su/1200299

5.BANCH YIGZAW su/1200344

6.DESALEW ABEBE su/1200575

7.ENDALEW MELKAMU su/1200640

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Advisor:- Mr. SHIMELS DERSO(MPH in health informatics)

Examainer:-1.

2.

3.

4.

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ACKNOWLEDGMENT
First of all, we would like to thank almighty God who gave us the ability to prepare this project proposal.

Next, we would like to express our great thank and respect to our respected advisors SHIMELS
DERSO(MPH) for their optimistic encouragement, inspiring advice, valuable support, and contact with us
in every challenge we faced during the preparation of this project proposal.

Next, we would like to express our sincere gratitude to the samara university department of Health
Informatics staff members for their giving us chance to prepare this project proposal. And we would also
like to say thank our families, friends, and relatives for their financial support.

The end but not the last, we need to express our prince gratitude to dupti general hospital management
bodies and TB department staff members who give us background information for our project proposal.

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ABSTRACT
Background: Tuberculosis commonly known as TB continues to be a major health problem in the world,
particularly in developing countries. Health information system is one of the important tools for the health
sector which involves stakeholders situated at national, regional, district, service delivery and community
levels. Web-based applications provide the power of desktop and server applications with the flexibility
and accessibility of the web. Health-system-related obstacles to follow up treatment for tuberculosis
include, dissatisfaction with in health services, need for repeated visits, and delays in receiving the results
of sputum smears.

Objective: The objective of this project is designing a web based TB Patients follow up information
system at Dubti General Hospital .

Methodology: This Proposed system conducted using a design science research method. This method is
use to develop innovative artifacts that solve societal problems. The investigator used interview,
observation and document analysis to elicit user requirements and evaluate the proposed system. Analysis
and design of the proposed system was performed using unified modeling language diagrams (use case
diagram, activity diagram, sequence diagram and class diagram). The proposal will be carried out after
getting permission from the ethical clearance committee of Samara Universty collage of Medical and
health science department of health informatics.

Discussion of Result: The investigator review the current system of the health facility problems in data
process, communication, procedures, people, software and hardware. The system was designed by
identifying the entire process and system boundary proposed in the use cases. The system design includes
user interface, business logic and backend database design. The user interface has different interfaces
such as patient registration, display diagnosis result, prescription, follow up, remind medication and
report generate to facilitate user and system interactions. The proposed system is evaluated for its
effectiveness and usability to support health service delivery.

Conclusion: the system did not show the entire product of the system, rather provides to facilitate health
care services for TB patients. It also improves patients’ data record and report generation

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Chapter One

1. Introduction
Tuberculosis, commonly known as TB, continues to be a major health problem in the world,
particularly in developing countries (1). Tuberculosis is a major contributor to the global
burden of disease and has received considerable attention in recent years, particularly in low-
and middle-income countries where it is closely associated with HIV/AIDS (2).

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Ethiopia is one of the 22 HBCs (High Burden Countries) (3). The national population based
TB prevalence survey 2010/11 revealed that the prevalence of smear positive TB among
adults and all age group was found to be 108 and 63 per 100,000 populations, respectively(WHO).
According to Federal Ministry of Health (2011), health and health related indicators are
tuberculosis the third leading cause of death in Etiopia (4). Health Information System is one of the
important tools for the health sector which involves
stakeholders situate at national level, regional, district, service delivery and community
levels (5). Health Information System is one of the important tools for the health sector which involves
stakeholders situate at national level, regional, district, service delivery and community
levels. Web-based applications provide the power of desktop and server applications with the
flexibility and accessibility of the web (6). Using web browsers, users can securely access
applications from anywhere within the reach of the organization intranet or extranet .The
special issue strives to explore the advanced web-based information systems and database
applications in healthcare area (6). A web based system to support TB patients follow up
information system in healthcare organizations are undergoing major reorganizations and
adjustments to meet the increasing demands of improved healthcare access and quality, as
well as lower costs. The system enable by searching and identifying patients‘ schedules
for those schedule date is approached, and generate the appropriate Short Message Text
reminder message and send to the appropriate patients and Health Extension Workers. Web-
enable information technologies use of Information Technology (IT) to process medical data
increases, much of the critical information necessary can provide the means for greater access
and more effective integration of healthcare information system from disparate computer
applications and other information resources (6).

Dubti General hospital is one of general hospital in Ethiopia, Afar Region specifically zone one, in Dubti
town. Dubti General Hospital is one of the biggest Hospitals in Dubti which is found in North east of
Ethiopia, 603 km from Addis Ababa. In this hospital there are different wards among them our groups
want to address about TB care department. The existing system of TB care department in Dubti referral
hospital has no advanced computerized system so it is difficult to manage a number of patients, which
visit the hospital. Besides, it takes a lot of time to retrieve the patient history and register a number of
patients who have TB.Because of poor management information in Dubti General hospital especially TB
care department there is a high rate of transmission of TB between patients and other patients who
haven’t TB or stakeholder/staff

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1.2.Statement of the Problem
Tuberculosis (TB) is a major contributor to the global burden of disease and it receive considerable
attention in recent years, particularly in low and middle income countries where TB is closely associate
with HIV/AIDS(7). Health-system-related obstacles to follow up treatment for tuberculosis include
dissatisfaction with long waiting times in health services, the need for repeat visits, and delays in
receiving the results of sputum smears (8).

Information system includes manual and computerize data technologies. But, the current paper-based
record systems inadequate in terms of documentation, disruption, and substantial delay in the health
services. Advanced information technologies, on the other hand, provide clinicians with real time
information access (9).
Tuberculosis patients monitoring is mainly carried out by means of “notices” generate when patients miss
schedule appointments, the issuing of pre-appointment reminders, registration errors and identification of
absentees (10).

Electronic systems maintain quality and accurate data, and make reporting potentially more flexible and
efficient (11).
To the contrary, in paper-based systems the data is collect and compile manually at each site where the
data is collect, a process that hinders managers and decision makers at higher levels of the hierarchy from
viewing the disaggregate data coming from lower levels of the system (12). Besides this, accessibility of
data in the paper-based system is time consuming, potentially unreliable and inefficient when the number
of records becomes very large (13).

Therefore, Ethiopia is one of the highest TB burden in the world (14). TB is among the leading causes of
morbidity and mortality (15). For this reason, the aim of this study is designing a web based TB Patients
follow up information system to enable sending reminder text messages for medication and reminding
scheduled date for patients and HEWs (16) The system can improve communication and treatment
success, generate quality data and aggregate report (17). The system also enables to reduce waiting time
and registration error, and the system facilitates fast service in ith hospital (18).

1.3 Overview of the existing system

The Current System of TB patient follow up information system was managed by manual methods. The
Hospital information existing data flow system shows as follow.

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Figure 1:dubti general hospital TB existing data follow up system

The investigator try to review the current system of the hospital to identify gaps in the current system.
The findings shows problems in data process, reports or communication, procedures, people, software and
hardware.

1.3.1.Data and Process

The main services deliver in the hospital include Out Patient Department (OPD), Maternal and Child
Health Care (MCH), Family planning (FP), Expand Program of Immunization (EPI);Tuberculosis (TB),
Eye Care (EC), Voluntary Counseling and Testing (VCT), AntiRetroviral Treatment(ART) service.
Information process in the current system held manual or paper-based record system. This sub-system

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maintains data about individual TB patients history , clinical data. The patients need day to day follow-up
and counseling (19).
1.3.2. Communication

Reporting is used to systematically monitor and evaluate progress of patients and treatment outcome as
well as the overall program performance. The report generate from previously recorded TB registration
book.

1.3.3. People
The health center TB focal person can access and modify any information system concerning
Tuberculosis patient data in existing system (20). During patient data recording, the focal person is a
responsible for any errors and missing values. The TB focal person is accountable and responsible to
make reports as acquire to stakeholder (21).

1.3.4. Procedure
TB control staff in the hospital is familiar with the existing health information policies and
procedures .The existing systems contains the following procedures.

 Patient sputum smear examination request should be register ,

 Laboratory diagnosis result should be register,
 TB suspect patient shall be register in log book,
 The TB patient shall take the medication every morning at hospital ,

1.3.5. Software
The hospital will plan to train their health workers about computer skill to improve health information
system and specific software application. But, currently there is no any applicable software to improve
TB patients follow up system and no computer network for sharing information.

1.3.6. Hardware
The hospital currently has few computers which located in facility head, ART, X-RAY, Labratory, HMIS
and secretary. They use this computer for the purpose of preparing report, data records and writing letters.

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1.4. Overview of the new proposed system

After we observe the existing system, we propose a web based Tuberculosis follow-up information
system for Dubti general hospital. The proposed system is used to eliminate the existing system or manual
system problems. The proposed system deals with automating activities in the TB care department.

The current system has similar work flow with the existing system and it is available for TB patient who
follows their follow up in Dubti general hospital TB care outpatient department. The system will
interconnect to central triage and also medical record unit. The medical record unit fill socio demographic
data of patient/client but the nurse in central triage assess the patient and fill necessary medical record
(i.e. vital sign) then send to Doctors for further investigation.

Then the Doctor sends laboratory request and if it is necessary to radiology request for further diagnose
the patient. Then by receiving the laboratory result and radiology result, he gives appropriate prescription
and sends this prescription that holds treatment/drug to Pharmacy. Then the Pharmacist dispenses the
drug that is ordered by Doctors. But if the patient goes into Inpatient in TB care department he/she is
assessed or follows up by nurse or Doctors.

The appointment also managed by Doctors. The new system prevents unauthorized user from performing
certain task and the System used to manage the recorded information by storing, updating, searching, and
deleting the information efficiently.

The proposed system is efficient in file handling mechanisms. The other thing in the proposed system is
an authenticated user that means an authorized one can only access the system and prevented by user
name and password mechanism. In general, the proposed system has the following purpose.

 Allows well-ordered handling of data rather than error prone records;

 Avoiding mistakes due to human error (Accurate);
 Reduce wastage of resources and time and
 Allow to improve the effectiveness and efficiency of the DGH.

1.4.1. User Requirements

User requirements (also called Stakeholder requirements) describe the tasks the users must able to
accomplish with the product (22). It is defines abstract requirements describing the system services which
people need to use the system and to integrate it with their business processes. User requirements are

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usually captured in use cases or scenario descriptions. Apparently the user requirements represent the
system‘s behavior from the user‘s point of view.

1.4.2. Stakeholders
Stakeholders are individuals or organizations that could influence or be influence directly or indirectly in
the system.

Stakeholder role and Responsibility

s.n Stakeholders Role and Responsibilities

1 System Responsible for organizational structure, creating and
Administrator updating user account, set up registration form, set up patient
identification number, set up patient treatments.
2 TB focal Person Responsible for TB patient’s information registry
Responsible to record TB treatment on patient cards.
Responsible for reminding the patients. Responsible for
requesting the system to generate reports.
3 doctors Responsible for patients to inform about the dangers of
irregular or incomplete treatments.
Responsible for providing follow up every patient takes the
recommended drugs in the right combination, on the correct
schedule, and for the appropriate duration

4 Patients Responsible to provide appropriate information and address.

Responsible for coming at schedule.
Responsible to take a medication on recommended duration
and time.
Responsible to consultation with health worker for the status
of his/her health

5 nurse Responsible to train and support TB treatment supporters.

Provide timely feedback to health workers.

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 responsible for Supply anti TB drugs.
Facilitate adequate supply of recording and reporting
materials.

Table 1:stakeholder roll and responsiblity

1.5.Objective of the project proposal

1.5.1. General objective

To develop a web based Tuberclosis follow up information system at Dubti General hospital.

1.5.2. Specific Objectives

To achieve the general objective mention on the above it is necessary to use the following specific
objective:
 To develop and implement the designed system;
 To assess the existing system problem;
 To assess and identify requirements for developing the system;
 To develop and implement the designed system;
 Design and implement a database for the proposed system and
 To test the functionality and usability of the developed system.

1.6 Scope and limitation of the project proposal

1.6.1 Scope of the project proposal
Our project scope is focusing on TB follow-up information system for TB care department in Dubti
general hospital.

 Our propose system gives a service only for TB care and it can be used to record new TB
patient’s data who confirm to start TB care follow up to Dubti general hospital.TB care outpatient
department and also record the clients to be detect TB voluntarily.
 The users on this system are staffs who work in the TB care: Admin, doctors and nurses, lab
technicians, pharmacist, radiologist and data clerk.

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  Generally, the propose system manages TB patient data starting at patient confirm to start
ongoing follow up to the end of life.

1.6.2. Limitation of the project

 The system requires internet connection: if there is no internet connection, the system can’t work.
 The system requires electric power: the system is dependent on the electric power.
1.7. Significance of the project proposaL

The benefit of this project proposal is mainly for the TB care department and also to the entire Dubti
general hospital. The DGH can also manage the customers/patients easily. Therefore, it minimizes their
cost, time and labor of the customers and the system will be change the manual-based system in to web-
based information system, that allow easily accessing, maintaining and managing the system.

The proposal system will increase the accuracy, consistency, completeness, reliability and reduces and
make it best health care delivery, follow up, improve getting of the right treatment at the right time with
the right health care provider and generating reports and used to produce

more timely information. In addition, it also reduce the errors greatly and at the same time providing the
greatest level of security.

Moreover, the proposal system increase the satisfaction the TB care department clients, since the proposal
system contain all in one service that decrease the unnecessarily delay of time in the hospital. In general,
the main significant of this project are:

 Care providers give quality of healthcare to patients easily and efficiently

 Enable TB care provider to develop timely, efficiency and reliability information
 Increase satisfaction rate of stakeholders that work in TB care department
 Allow worker to perform their work accurately
 Give Technological advancement of the TB Follow-up Information System
 Allow suitable storage and wise use of clients information
 Allow quality and complete record and prevent their records from damage or loss
 Support security by protecting unauthorized access
 Avoid duplication of data in the organization
 Reduce time wastage and
 Enable patients /clients to get timely, efficiency and reliability services.

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1.8. Methodology

1.8.1.Study Design and Analysis

In systems analysis and design methodologies we are using object-oriented system. Object-oriented
approach combines data and processes (called methods) into single entities called objects. The goal of
object-oriented approach is to make system elements more reusable, thus improving system quality and
the productivity of systems analysis and design.

To understand and express the essential and interesting features of an application in the complex real
world, an object-oriented model is built around objects. An object encapsulates both data and behavior,
implying that analysts can use the object-oriented approach for both data modeling and process modeling.
In the analysis phase, we use use-case diagram, sequence diagram, analysis level class diagram, activity
diagram, in the design phase, the project team uses design level class diagram, deployment diagram .

We used OOSAD because of the following important features: - increase reusability, extensibility,
improved quality, financial benefits, reduced maintenance cost, managed complexity etc.

1.8.2. Data collection method

There are different information gathering/ data collection methods that help us to develop this digitalized
web based system. We try to assess, observe and overview of documents as well as some of the forms that
illustrate TB management information system in Dubti General hospital.

1.8.2.1 Interview

The interview session will conduct in group and individual, face-to-face interview in working place.The
response of respondent will recored in audio based and talking a short note which is important input for
designing a web based TB patient follow up information system.

All health workers who were working in the TB department ,TB focal person, TB inpatients and HMIS
focal person were all involved in the study.

1.8.2.2 Observation

As we are observe and overview the Dubti general hospital TB care outpatient department observe
different information from existing system, and we will see different forms and also the pathway that
follow by patients and their waiting time to get access. Number of patients/clients that are close each
other so this event is boring for staff members.

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1.8.2.3 Document review
we also collect certain relevant information from written documents in the Dubti general hospital. Not
only that but also, we try to review other relevant documents to identify the gap and to know what we
must include in our system.

1.9. Data Analysis Procedure

The Unified Modeling Language (UML) technique is the primary modeling language used to analyze,
specify, and design new proposed systems .The data collected through interview, observation and
document review were summarized by UML modeling at varies phases.

1.10. Analysis and Design Technique

During designing this system were used Unified Modeling Language (UML modeling) for modeling the
components of the system. Such as:-

 Contextual diagram:-It shows the entire system in context with its environment. It shows the
overall business process as just one process and also shows how a system that is being modeled is
positioned in an environment with other systems and processes.
 Use case model: - It is the simplest and most effective technique for modeling system
requirements from a user‘s perspective.
 Design class model:-It shows attribute and methods of the each class.
 Sequence diagram:-It used to describe patterns of communication among set of objects which are
participated in the use case. Communication between objects is represented by message passing
between the objects.
 System Architecture: - The system uses dynamic web technology, i.e., adding and retrieving data
to and from the data store whenever requested is possible.

1.11. Analysis, design, and implementation tools

1.11.1. Analysis and Design Tools

At system development the implementation and test phase will be use:-

 HTML hyper- text markup language is used to create electronic documents (called pages) that are
displayed on the World Wide Web (www).
 CSS (cascading style sheet) allows specifying things. It is the part that lets control the appearance
of the web page.

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  HTML also provide a basic structure of the page, up on which CSS are overlaid to change its
appearance one could HTML as the bones (structures) of the web page, and CSS as its skin
(appearance).

 PHP (Hypertext preprocessor) is maintaining personal home page which is communicate with
databases. it combined with MY SQL cross -platform.
 SQL is a database language that lets you store and retrieve the data as efficiently as possible.
There are many databases that support the use of SQL to access their data.

1.11.2.System Implementation tools

To develop the proposed system for the future we will use implementation tools. Some tools that are used
to develop the system are:

Software development tools

Tools Activities

wamp server we use it as server

Google Chrome: to run the system

MS office 2010: used for documentation part of our project.

Edraw-max: to draw different diagram

Snipping tools: to screen shoot the picture

MySQL To create database

Table 2:software development tools

Hardware development tool:

Tools Activities

Flush disk for backup and file transfer

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Data cables to transfer files from mobile to PC

Printer to print the document and

Laptop To store and edit file

Table 3:hardware development tools

Programing Language tools

Tools activities

HTML to make Web Pages

CSS to make style for the webpage

JavaScript to give notification and ensure validation

PHP to accept information from client and store from server side, it is server side scripting
language.

MY SQL helps us to store and retrieve the data as efficiently as possible.

Table 4:programing language tools

1.12. Feasibility Study

The feasibility study is the preliminary study that determines whether a proposed system project is
financially, technically, Politically, Schedule and operationally viable. The alternative analysis usually
include as part of the feasibility study, identifies viable alternatives for the system design and
development. During feasibility analysis for this project, following primary areas of interest are to be
consider.

1.12.1.Technical Feasibility

Our group member were having the capacity to develop the system. The technical resources meet
capacity, and our group is capable of converting the proposed system into working systems. There are
hardware and software requirements to develop the proposed system in the Samara University under

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graduate our lab class. This system will develop with our skill that we have, such as internet programming
(IP), MYSQL, OOSAD and so on. By this reason the proposed system is technically feasible. So we will
accomplish this system by our knowledge successfully.

1.12.2. Operational Feasibility

The system That we will develop is register and store TB patient information update the details, guide
users and generate reports perfectly and quickly. The system manages user account and keeps security
and control from confidentiality breach of patient information by giving role to the authorized users. The
system is support by different browsers like Mozilla Firefox, chrome, opera etc…and it can be run

1.12.3. Economic Feasibility

The proposed web based TB management information System is specific to TB care due to this reason it
does not require much amount of money to be developed. The system does not need additional
equipment; the system can run on currently available computer. The system reduces the cost for buying
paper, patient chart, request form, prescription paper and report form. so the weight of the cost that we
were spent for development of our proposed system was not exceed the benefit’s associate with the
develop system.

1.12.4.Political Feasibility

Political feasibility analysis is used to predict the probable outcome of a proposed solution to a policy
problem through examining the actors, events and environment involved in all stages of the policy-
making process. It is a frequently used component of a policy analysis and can serve as an evaluative
criterion in choosing between policy alternatives.Political feasibility is a measure of how well a solution
to a policy problem, will be accepted by a set of decision makers and the general public. For a policy to
be enacted and implemented, it must be politically acceptable, or feasible. A policy alternative's lack of
political feasibility can often be attributed to its lack of political support or the result of controversy that
may surround the issue the policy seeks to address. Alternatively, a politically feasible alternative is one
that has the greatest probability of "receiving] sufficient 1.12.5. Schedule Feasibility

The time schedule require for the development of this project is very feasible since the time schedule for
this project efficiently plan and every activity is done according to the schedule. We believe that the web
based TB management information system develop in the considerable amount of time.

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1.13. Operational Definition Diagnosis

It is systematic assessment of all the evidence derived from a carful history, clinical examination and
relevant investigation.

 Evaluation Usability: is itself a process that entails depending on the method employed.
 Follow Up: should be assessed two weeks after treatment initiation, at the end of the intensive
phase and every two months until treatment completion.
 Health Facility: are places that provide health care. They include hospital, specialized care center,
health centers, and clinics.
 Information System: a transformation of data consists of basic fact into an output that is valuable
to users.
 Patient: people who get service from health facilities.
 Treatment Completed: a patient who completed treatment, but who does not have a negative
sputum smear or culture result in the last month of treatment and on at least one previous
occasion.
 Treatment of TB: cure the TB patient and restore quality of life and productivity, prevent death
from active TB, prevent the development and transmission of drug resistance.

1.14. Ethical Consideration

. The proposed system will be carried out after getting permission from the ethical clearance committee of
Samara University, Medical Faculty through School of Public Health. Data were collected after getting
permission from Dupti hospital. Information sheet and consent forms deliver along each interview and all
interviewees/respondents had been asked their willingness to participate in requirement gathering; and
informed verbal consent would also be obtained from all study participants and from every interviewee
after the objective of the study informed.

Chapter two

2. System analysis
Software requirements consist of all the requirements the software must demonstrate for the system to
meet the user requirements (23). They are deriving from analysis of user requirements. Software
requirements include the so-called functional requirements and nonfunctional requirements (24).

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2.1. Requirements

2.1.1 Functional requirement

Functional requirements are the intended behaviors of the system that capture the intended behavior of a
system. This behavior may be expressed as services, tasks or functions that the system is required to
perform. The functional requirement of the system should satisfy the system need and be acceptable by
the system stockholders. The functional requirement of our proposed system includes the following:-

 The system enables the doctors and nurses to record patient data.
 The system enables the doctors and nurses to manage patient data.
 The system enables the doctors to generate requests.
 The system enables the doctors to view results.
 The system enables the doctors to generate prescription.
 The system enables the doctors to manage appointment.
 The system enables the TB focal person to register
 The system enables the TB focal person to diagnosis request
 The system enables the TB focal person to prescription drug
 The system enables the nurse to login
 The system enables the nurse to follow up treatment
 The system enables the nurse to generate report
 The system enables the laboratories and radiologist to view request.
 The system enables the laboratories and radiologist to generate result.
 The system enables the pharmacist to view prescription.
 The system enables the admin to manage user account.
 The system enables the admin to create account
 The system enables the admin to delete account
 The system enables the admin to update account
 The system enables the data clerks to register patients.
 The system enables the data clerks to login page
 The system enables the data clerks to change pasward
 The system enables the data clerks to generate repor
 The system enables the patients to registration
 The system enables the patients to remind medication
 The system enables the patients to schedule medication

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2.1.2 Non-functional requirements

Non-functional requirements are requirements that specify criteria that can be used to judge the operation
of the system rather than specific behaviors. System must exhibit software quality attributes, such as:-.

 Performance: -The response time is better also. The system provides accurate, consistent patient
data to the system users.
 Easy to use: unlike manual the web based is easy to use because it is just pressing a simple
and single keys or symbols.
 Speed and Performance consideration

The system can serve multiple users at a time since it is web based system if it is connected computer.

 Usability
 Easier to learn operation can be learned by observing the object and more satisfying to
usersSecurity Requirements

The user is allowed to access the page if and only if he/she have an account which is created by
Admin.anybody cannot access the page unless he/she is a user or have user account. For confidentiality
and privacy purpose only the system administrator can create, update user accounts and delete user
accounts.there are specific tasks assigned for specific users regarding of respective role. The system is
generating error messages when the user attempts to enter invalid User Name and password.

 Availability consideration

It can be available whenever the user wants to access the needed data because it does not use internet so
the system is available for 24 hours.

 Integrity

Only an authorized user of the system can able to update, modify or access patient data. Access is denied
for unauthorized and unauthenticated users of the system.

2.2 Modelling system requirements

The model helps us to visualize a system and specify the system structure. UML is a standard language
for specifying, visualizing, constructing, and documenting the artifacts of software systems (25). For
modeling the proposed system proposal, we used different types of UML standard diagrams to show

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clearly the system (26). Such as Use case diagrams, activity diagrams, sequence diagrams, class
modeling, and user interface. Let us see each diagram detail.
Requirements modeling is the process used in software development projects where requirements
and solutions constantly evolve through collaborative efforts and teamwork. By using this method
of cross-functional and self-organizing teams, you can ensure that your team meets the exact needs
of the stakeholders.
The main aim of requirements modeling is to support the end goals of software development. It also
aims to achieve these objectives:
1. Identify and establish the best practices required to create an effective model
2. Outline the ways you intend to put said practices into action

3.Always have alternatives to improve the overall modeling approach to use the new
system.

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Figure 2:modeling system requirments diagram of the proposed system

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2.2.1. UML use case diagram
A use case illustrates a unit of functionality provided by the system. The main purpose of the use-case
diagram is to help development teams visualize the functions of a system, including the relationship of
"actors" (human beings who will interact with the system) to essential processes, as well as the
relationships among different use cases. Use-case diagrams generally show groups of use cases either all
use cases for the complete system, or a breakout of a particular group of use cases with related. (27).The
following actors have identified to interact with the proposed system:

 Data Clerk
 Administrator
 TB Focal Person
 doctor
 nurse
 Patient
 Pharmacist
 Labratorist
 Radiologist
Additionally the designer has identified the following use cases for the new proposed system:

 Login
 manage user account
 Registration TB patient
 Request diagnosis result
 prescription drug
 Remind medication
 Remind patients schedule dates
 Generate TB patient reports

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Figure 3:UML usecase diagram of data clerk

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Figure 4:UML usecase diagram of admin

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Figure 5:UML usecase diagram of TB focal person

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Figure 6:UML usecase diagram of physician

Figure 7:UML usecase diagram of health professional

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Figure 8:UML usecase diagram of patients

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Figure9:UML usecase diagram of labratorist

Figure10:UML usecase diagram of radiologist

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Figure11:UML usecase diagram of pharmasist

Use case ID UC-1

Use Case Title Manage user account
Use case Description This use case describes the user to administer their
personal information.
Primary Actor System Administrator
Trigger The administrator login into the system
Pre-Conditions The account of user must exist and authorized
Post-Conditions The system manage the user account
Main scenario 1. The system displays main menu user interface
2. The administrator open user account option

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 3. The system displays user account list
4. The administrator select the list user account
information
5. The system confirms the inserted
/updated/removed records
6. Ends use case
Alternative courses 4a. If the user wants to create account for user
records.
a. The user click on create account button.
b. The system displays a form to create the user
account.
c. The user fills the required information and click
on submit button.
d. The system confirms the inserted data.
e. The system saves new account.
4a.1. If the user wants to remove the user account.
a. Select and click the user account.
b. The system displays confirm account remove
c. The user clicks confirm remove button.
d. The system removes the selected user account
from the database

Table 5:Managment User Account use case

Use case ID UC-2

Use Case Title Login
Use case Description This use case describes the user enable to enter into
the system
Primary Actor Users ( TB focal person, Data clerk, system
administrator, pharmacist,radiologist, nurse and
doctor )
Trigger The users of the system logs into the application
with the user username and password
Pre-Conditions The user has known user name and password which

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 is existed within the system.
Post-Conditions The system displays system main menu interface
Main scenario 1. The system display main menu login window
2. The users click login button.
3. The system displays login interface
4. The users enters the username and password
5. The system verifies the username and password
6. The user logged in to the system then system
will display the main menu interface.
7. Use case ends
Alternative courses 4a. If the username or password is wrong
4a.1.The user is returned to step 3 and re-enters
user name and password
Table 6:Login usecase

Use case ID UC-3

Use Case Title Registration
Use case Description This use case describes the process of patient
registration information system.
Primary Actor Users (Data clerk , TB focal person )
Trigger User open new patient registration form to record
Pre-Conditions The user is logged into the system.
Post-Conditions The system registered patient information in to the
database
Main scenario 1. The system displays user interface or user home
page
2. The user click registration link from the user
main menu
3. the system displays registration form
4. The user fills patient information on the patient
registration form and save the records
5. The system verifies the information
6. Use case ends

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Alternative courses 4a.If the patient is already registered on the system
4a.1. The system shows messages to enter patient
Id and retrieved previous patient records.
4b. If the patient is a new
4b.1.The user add the registration form
5a. If the user clicks on cancel button
5a.1 The system return to the main menu

Table 7:Registration usecase

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 Use case ID UC-4
Use Case Title Prescription medicine
Use case Description This use case describes the physician
provided/prescribed medicine to the patients.
Primary Actor The user receives and access detail patient history
information to prescribed drug
Pre-Conditions The user is logged into the system
Post-Conditions The patient detail information is available in the
database system and retrieves prescription.
Main scenario 1. The system displays prescription medicine main
menu user interface
2. The user selects prescription medicine from the
main menu option
3. The system displays the prescription medicine
form
4. The user click on Add button
5. System displays the prescription medicine detail
form
6. The user fills and marks prescription medicine
records and click save button
7. The system saves or stored the prescription
medicine records on the database.
Alternative courses 4a.If the patient is already provided the
prescription medicine records
4a.1 The user search previous prescription
medicine records from the system
6a. If the user clicks on cancel button
6a.1 The system return to the main menu
6a.2. If the user clicks on reset button
6a.2.1. The system clear the input box

Table 8:Presccription drug usecase

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Use case ID UC-5
Use Case Title Diagnosis request
Use case Description This use case describes the processes of
relevant investigation patient information
recording system
Primary Actor Users (Nurse, TB focal person and doctor )
Trigger The system display assessed patient detail
information from the database system
Pre-Conditions The user is logged into the system.
Post-Conditions The diagnosis request information is available
in the database system
Main scenario 1. The system displays users main menu or user
home page
2. The user selects diagnosis from the user
main menu option
3. The system displays diagnosis recording
form
4. The user fills and marks in diagnosis form
with complete information and click save
button.
5 The system save or stored the diagnosis
information on the database
6. Use case ends
Alternative courses 4a. If the patient is new admitted ,
4a.1 The user adds new diagnosis form.
4a.2 if the patient already exist on the
database,
4a.2.1 the user enter diagnosis no
4a.2.2 The system retrieves previous patient
records on the database.
5a. If the user clicks on cancel button
5a.1 The system return to the main menu 5a.2.
If the user clicks on reset button

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 5a.2.1. The system clear the input box

Table 9:diagnosis request use case

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Use case ID UC-6
Use Case Title Treatment follow up
Use case Description This use case describes the processes of the
assessment and management of patient information
system
Primary Actor Users (nurse, TB focal person, doctor )
Trigger 1. The system assess patients history registered in
database system
Pre-Conditions 1. The user is logged into the system.
2. The system display treatment intervention
information.
Post-Conditions The patients treatment follow up information is
available in the database system
Main scenario 1. The system displays users main menu or user
home page
2. The user selects treatment follow up link in the
user main menu option
3. The system displays intensive and continues
treatment follow up phase form
4. The user fills in treatment follow up form with
complete records and click on the save button
5. The system save or stored the treatment follow
up records on the database
6. Use case ends
Alternative courses 4a. if the patient already exist on the database 4a.1
the system retrieve records from database 4b. if the
user new admitted
4b.1 the system adds and updates the existing
information on the patient Database.
5a. If the user clicks on cancel button
5a.1 The system return to the main menu
Table 10:usecase for patients treatment follow up

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Use case ID UC-9
Use Case Title Generate Standard report
Use case Description This use case describes the process of producing an
electronic standard report
Primary Actor Users ( TB focal person and nurse)
Trigger The user logged into the system The user able to
generate report by selecting the report option
Pre-Conditions 1. The user is logged in to the system.
2. All data registered in data base system to
generate report
Post-Conditions The system generate standard reports
Main scenario 1. The system displays main menu user interface
2. The users selects the report from menu option 3.
The system displays all data records
4. The users selects and marks the data records to
be generated and click on generate button
5. The system generates the report from the
database system and displays documented report. 6.
The user click save button.
7. The system saved the data on data base
8. End use case
Alternative courses 7a. If the user clicks on export button
7a .1.The system export the report
7b.If the user clicks on print button
7b .1.The system print out the report
7c. If the user clicks on cancel button
7c .1.The system return to the main menu

Table 11:Usecase for patients report

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2.2.2 UML Activity Diagram
Activity diagram describes activities and flows of data or decisions between activities (28). It shows the
procedural flow of control between two or more different entities (people, things, and data) while
processing an activity. It provides a very broad view of business processes and it can be used to break out
the activities that occur within a use case. This diagram is useful in showing work flow connections and
describing behavior that has a lot of parallel processing. When you use an activity diagram you can
choose the order in which to do things. It states the essential sequencing rules to follow. It is different
from a flow chart in that it shows parallel processes, not just sequential processes .The following figure
show us the proposed activity diagrams.

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Figure12:activity diagram for patients registration

Figure13:activity diagram for search patient

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Figure14:activity diagram for update user account

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Figure15:activity diagram for create user account

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Figure16:activity diagram for add patient

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Figure17:activity diagram for generate report

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Figure18:activity diagram for manage request

2.2.3. UML Sequence Diagram

A sequence diagram is an interaction diagram that details exchange of messages among classes..
Sequence diagrams are organized according to time. Time progresses as you go down the page. Each
vertical line is labeled at the top with the class name followed by a colon followed by the instance name.
The objects involved in the operation are listed from left to right according to when they take part in the
message sequence (29).

The diagram captures the behavior of a single use case. It shows objects and the messages that are passed
between these objects in the use case. A good design can have lots of small methods in different classes.
Because of this it can be difficult to figure out the overall sequence of behavior. This diagram is simple
and visually logical, so it is easy to see the sequence of the flow of control.

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Figure19:Sequence diagram for login

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Figure20:Sequence diagram delete user account

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Figure21: Sequence diagram for update user account

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Figure22: sequence diagram for search patient

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Figure23: Sequence diagram for generat report

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2.2.4. UML Domain class diagram
Class: is a description of a set of objects that share the same attributes, operations, relationships, and
semantics. Graphically, a class diagram is drawn as a rectangle with three compartments holding theclass
name, attributes, and operation.

 Class Names: Every class must have a name that distinguishes it from other classes. A name is a
textual string. That name alone is known as a simple name; a qualified name is the class name
prefixed by the name of the package in which that class lives.
 Attributes: An attribute is a named property of a class that describes a range of values that
instances of the property may hold. A class may have any number of attributes or no attributes at
all. An attribute represents some property of the thing you are modeling that is shared by all
objects of that class.
 Operations: An operation is the implementation of a service that can be requested from any object
of the class to affect behavior. In other words, an operation is an abstraction of something you can
do to an object that is shared by all objects of that class. A class may have any number of
operations or no operations at all.

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Figure24: UML Domain class diagram

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 Chapter three

3. Design of the new system

After we observe the existing system, we propose a web based Tuberculosis follow-up information
system for Dubti general hospital. The proposed system is used to eliminate the existing system or manual
system problems. The proposed system deals with automating activities in the TB care department.

The current system has similar work flow with the existing system and it is available for TB patient who
follows their follow up in Dupti general hospital TB care outpatient department. The system will
interconnect to central triage and also medical record unit. The medical record unit fill socio demographic
data of patient/client but the nurse in central triage assess the patient and fill necessary medical record
(i.e. vital sign) then send to Doctors for further investigation.then the Doctor sends laboratory request and
if it is necessary to radiology request for further diagnose the patient. Then by receiving the laboratory
result and radiology result, he gives appropriate prescription and sends this prescription that holds
treatment/drug to Pharmacy. Then the Pharmacist dispenses the drug that is ordered by Doctors. But if the
patient goes into Inpatient in TB care department he/she is assessed or follows up by nurse or Doctors.the
appointment also managed by Doctors. The new system prevents unauthorized user from performing
certain task and the System used to manage the recorded information by storing, updating, searching, and
deleting the information efficiently.

The proposed system is efficient in file handling mechanisms. The other thing in the proposed system is
an authenticated user that means an authorized one can only access the system and prevented by user
name and password mechanism.

3.1. Deployment Diagram

A UML deployment diagram is a diagram that shows the configuration of run time processing nodes
and the components that live on them. Deployment diagrams is a kind of structure diagram used in
modeling the physical aspects of an object-oriented system. They are often be used to model the static
deployment view of a system (topology of the hardware).

Deployment diagram elements

 Artifact: A product developed by the software, symbolized by a rectangle with the name and the
word “artifact” enclosed by double arrows.
 Association: A line that indicates a message or other type of communication between nodes.

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 Component: A rectangle with two tabs that indicates a software element.
 Dependency: A dashed line that ends in an arrow, which indicates that one node or component is
dependent on another.
 Interface: A circle that indicates a contractual relationship. Those objects that realize the interface
must complete some sort of obligation.
 Node: A hardware or software object, shown by a three-dimensional box.
 Node as container: A node that contains another node inside of it—such as in the example below,
where the nodes contain components.
 Stereotype: A device contained within the node, presented at the top of the node, with the name
bracketed by double arrows.

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Figure25: Deployment diagram of hospital managment system in UML

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3.2. System Architecture
A network architecture in which each computer or process on the network is either a client or a server
(30). Servers are powerful computers or processes dedicated to managing disk drives (file servers),
printers (print servers), or network traffic (network servers )(31). Clients are PCs or workstations on
which users run applications. Clients rely on servers for resources, such as files, devices, and even
processing power (31).

3.3 Design class diagram

Design Class Diagram The class diagram shows how the different entities (people, things, and data) relate
to each other; in other words, it shows the static structures of the system (32). A class diagram can be
used to display logical classes.

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Figure26: design class diagram

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3.4. Database Design
Database Design is a collection of processes that facilitate the designing, development, implementation
and maintenance of enterprise data management systems. Properly designed database are easy to
maintain, improves data consistency and are cost effective in terms of disk storage space. The database
designer decides how the data elements correlate and what data must be stored (33).
The main objectives of database design in DBMS are to produce logical and physical designs
models of the proposed database system. The logical model concentrates on the data requirements
and the data to be stored independent of physical considerations. It does not concern itself with how
the data will be stored or where it will be stored physically.

Field Data type Size Default value Key

Doctor-id Int 10 Pk Not null

First-name Varchar 20 - Not null

Last name Varchar 20 - Not null

Sex Char 1 - Not null

Email Varchar 20 - Null

Phone-number Int 10 - Null

Account Varchar 10 - Not null

TBfocal person-id Int 10 Fk Not null

Admin-id Int 10 Fk Not null

nurse-id Int 10 Fk Not null

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Patient-id Int 10 Fk Not null

Table 12 :database table for the doctor

Field Data type Size Default value Key

nurse-id Int 10 Pk Not null

First-name Varchar 20 - Not null

Last-name Varchar 20 - Not null

Sex Char 1 - Not null

Email Varchar 20 - Not null

Phone-number Int 10 - Not null

Account Varchar 10 - Not null

System admin-id Int 10 - Not null

doctor-id Int 10 Pk Not null

Patient-id Int 10 Fk Not null

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Table 13: database table for the nurse

Field Data type Size Default value Key

System admin-id Int 10 Pk Not null

First-name Varchar 20 - Not null

Last-name Varchar 20 - Not null

Sex Char 1 - Not null

Email Varchar 20 - Null

Phone-number Int 10 - Not null

Account Varchar 10 - Not null

TB focal person-id Int 10 - Not null

Data clerk-id Int 10 Fk Not null

nurse-id Int 10 Fk Not null

doctor-id Int 10 Fk Not null

Table 14: database table for the system admin

Field Data type Size Default value Key

Data clerk-id Int 10 Pk Not null
First-name Varchar 20 - Not null

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Last-name Varchar 20 - Not null
Sex Char 1 - Not null
Email Varchar 20 - Null
Phone-number Int 10 - Null
Account Varchar 20 - Not null
System admin-id Int 10 Fk Not null
Patient id Int 10 Fk Not null

Table 15:database table for the data clerk

Field Data type Size Default value Key

MRN Int 10 Pk Not null
First-name Varchar 20 Not null
Middle-name Varchar 20 - Not null
Last-name Varchar 1 - Not null
Age Int 20 - Not null
Sex Char 10 - Not null
Phone number Int 10 - Not null
Region Varchar 20 - Not null
Zone Varchar 20 - Not null
Woreda Varchar 20 - Not null
Keble Varchar 10 - Not null
City Varchar 10 - Not null
Gott/ketene Varchar 10 - Not null
Registration date Date 10 - Not null
Data clerk-id Int 10 Fk Not null
nurse-id Int 10 Fk Not null
doctor-id Int 10 Fk Not null

Table 16: data base table for the patient

Field Data type Size Default value Key

TB focal person-id Int varchar 10 Pk Not null

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First-name Varchar 20 - Not null
Last-name Char 20 - Not null
Sex Varchar 1 - Not null
Email Varchar 10 - Null
Phone number Int 10 - Null
Account Varchar 10 - Not null
System admin-id Int 10 Fk Not null
doctor-id Int 10 Fk Not null

Table 17: database table for the health focal person

Table 18: database table for the radiologist

Field Data type Size Default Key

value
Lab-technician- Int varchar 10 Pk Not null
id
First-name Varchar 20 - Not null
Last-name Char 20 - Not null
Sex Varchar 1 - Not null
Email Varchar 10 - Null
Phone number Int 10 Fk Null
Account Varchar 10 Fk Not null
System admin- Int 10 Fk Not null
id
doctor-id Int 10 Fk Not null

Table 19: database table for the lab-technician

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Field Data type Size Default value Key

Pharmacist-id Int 10 Pk Not null

First-name Varchar 20 - Not null

Last-name Varchar 20 - Not null

Sex Char 1 - Not null

Email Varchar 10 - Null

Phone number Int 10 - Null

Account Varchar 10 - Not null

System admin-id Int 10 Fk Not null

doctor-id Int 10 Fk Not null

nurse-id Int 10 Fk Not null

Patient-id Int 10 Fk Not null

Table 20: database table for the pharmacist

Chapter four

4. Planning for system implementation

4.1. Project Proposal Schedule
The main tasks of this project are identified and based on the task available time is offered. The expected
duration of this project is described in the next Gantt chart. All project activities will be done based on a
defined period. The main tasks of the project were identified and based on the task available time is
offered.

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ACTI
VITI Year 2015 E.C
ES month
December January February March April May
W W W W W W W W W W W W W W W W W W W W W W W W
e e e e e e E E E E E E E E E E E E E E E E E E
e e e e e e E E E E E E E E E E E E E E E E E E
k K k k k k K K K K K K K K K K K K K K K K K K
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Intro
ducti
on
Meth
dolog
y
Data
collec
tion
Feasi
bility
study
Requ
irme
nt
analy
sis
Mode
ling
syste
m

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Syste
m
desig
n
Concl
usion

Table 21: Gantt chart for project proposal schedule

4.2. Project Proposal Budget

In order to accomplish this project proposal it needs some hardware and software requirements and those
requirements is full field by the required budget. The overall cost estimation for this project proposal is
18,881 ETB the specific detail is listed in the next table

NO material amount Unit price(birr) Total cost

1 laptop 1 28500 28500
2 flash 1 450 450
3 pen 2 20 40
4 paper 20 2 40

total 29,030
Table 22:material requirments for project proposal

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Conclusion
This proposed system conducte with a design of TB patients follow up information system which is
significant to improve TB patient treatment in Dubti General Hospital.
The current system is performing paper based system. In the Hospital the system uses manual method
which causes many problems such as duplicate data storage and difficult retrieval,patients do not take
medication at the right time, poor patient follow up, patient data lost, wastage of time in maintaining
paper work and more.
Based on the finding of this research project, the designed TB patient follow up information system is
contribute a better understanding to solve the problem being performed by the current manual approach
keeping patient data record and follow up.

The study identify critical requirements from the health facility which the information includes, diagnosis,
prescription, follow up and remind medication associate with electronically record. The system support
store mind patient medication and schedule date, provide fast services and enhance health worker
performance and speedy retrieve records. Additionally,in this study the national TB prevention and
control guideline were used as an input in order to determine the requirements for the new system.
Designing TB patient follow up information system met specific objective of the project proposal. This
proposal conducte using design research method. The system undertake gathering user requirement
analysis and design phase.

The system is analyze using diagrams such as business use case diagram and context diagram.
Additionally, the design phase emphasize how the system collaborate to fulfill the requirements using
UML artifacts of class diagram, sequence and activity diagram.

The investigator evaluates the effectiveness of the system to improve the TB patient follow up system.
The investigator evaluate the effectiveness of the system includes different factor ,such as performance
of the users, to improve medication error, treatment outcome, standardized health service, perceive
friendly use and timely delivered to the health workers of the study in the hospital.

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