Design of Architecture for a Terrestrial LAN & VSAT-

based National Telemedicine Network in Ethiopia

Fikreyohannes Lemma+, Solomon Atnafu++, Samuel Kinde Kassegne+++,1
+
MS degree candidate, Department of Computer Science, Addis Ababa University, Addis Ababa,
Ethiopia
++
Assistant Professor, Department of Computer Science, Addis Ababa University, Addis Ababa,
Ethiopia
+++
Visiting Scientist, Henri Samueli School of Engineering, University of California at Irvine, Irvine,
CA 92697. External Faculty, Dept of CS, Addis Ababa University.

Abstract
For a developing country such as Ethiopia with a difficult mountainous terrain and limited
transportation infrastructure coupled with one of the lowest patient-doctor ratios anywhere in the
world (almost 30,000 to 1), telemedicine offers a cost-effective health-care system. This awareness
is slowly gaining traction in the country with a pilot program entering a trial and implementation
stage. Looking forward, however, we argue that telemedicine should play a more prominent role in
the national health-care plan mainly due to its cost-effectiveness and the availability of a
substantial number of Ethiopian physicians living abroad - in some accounts more Ethiopian
physicians live outside Ethiopia than inside - whose expertise can be tapped.

Further, we propose a comprehensive design of network architecture for a nation-wide

telemedicine network that connects all regional hospitals and health centers with the urban public
and government hospitals. Specifically, we propose a high level telemedicine network architecture,
which can be implemented over the existing/emerging ICT infrastructure in Ethiopia. The network
connects all regional clinics with public/government urban hospitals for the purpose of data
transmission in the form of text and images, as well as instantaneous access to patient information.
We also propose a web based telemedicine system, which provides basic services for medical tele-
consultation. The system can be used by health care providers to store and retrieve patient
information, to write referrals and give feedback to referrals, by using a web based Graphical User
Interface (GUI) specifically designed for Telemedicine.

The core technical contributions of our study include a Web-interface for a hierarchical model
based LAN architecture that enables design of the inter-network devises in layers and a WAN
architecture – both fine-tuned for the conditions in Ethiopia. The hierarchical model adopted for
the LAN is a preferred model due to its ease of expandability and improved fault isolation
characteristics. The WAN design considers the currently existing VSAT-based WAN
infrastructure in the country, namely the WoredaNet and SchoolNet.

The study also demonstrates a prototype network architecture that provides ability for the growing
number of private hospitals to be able to join the network. VSAT and terrestrial LAN will form the
backbone of the network architecture. This will enable the provision of Internet Protocol interface
that will feature a seamless integration of a trans-national telemedicine component for Ethiopian
physicians and other health professionals currently practicing outside Ethiopia.

1
Address correspondence to Samuel Kinde Kassegne • University of California at Irvine,
Department of MAE, Henri Samueli School of Engineering, 4200 Engineering Gateway Building,
Irvine, CA 92697. E-mail: [email protected] • Tel: (760) 402-7162.

1
1. Introduction
People want to get access to proper health care, which meets their needs at affordable costs. Health
care has to be available when they need it to their proximity. Physical separation between the
people and health care facilities must not pose any limitation to the efficient health care delivery to
remote areas. Information Technology (IT) is a best choice to offering access to health care service
to the expectation of people, when there is limited access to health care. In this regard,
Telemedicine has developed during recent years with the development of technologies such as
Integrated Services Digital Network (ISDN) and Asynchronous Transfer Mode (ATM) networks
[1]. Both the health care providers and patient can benefit from those networks. In Ethiopia, such a
technology is emerging. The development of telemedicine has to follow the same truck.
IT based horizontal and vertical communication between the health care facilities following the
organizational structure of the health system is essential. It facilitates efficient information
exchange and hence helps delivering health care to underserved rural areas. Such communication
is possible by implementing a nation wide Telemedicine network, based on affordable
telecommunications infrastructure. The network should connect all regional clinics to urban area
hospitals in the country for the purpose of:
• Establishing a reliable horizontal and vertical communication between the health care

•
facilities driving a quality and an improved health care delivery to all citizens.
Achieving e-health commitment and bring health care closer to underserved and un-served

•
rural areas.
Strengthening collaboration efforts among hospitals and facilitating information exchange

•
and experience sharing among medical professionals practicing in remotely located clinics.
Minimizing long distance travels of rural people to urban areas or to the capital city

•
seeking proper medical care during trauma.
Providing medical information to the medical practitioners, which will help them to keep
themselves up to date with the current technology.

Even if urban areas are relatively better equipped with adequate ICT technology such as Internet
access and digital telephone networks, the communication infrastructure is not as developed in
many other rural regions. These regions have to be equipped with an access to urban areas. In this
regard the newly emerging state owned, low cost VSAT networks such as SchoolNet and
WoredaNet provide the rural areas with suitable means of communication to urban areas and
further to the world.

2. Telemedicine Network Design Considerations

2.1. Design Goal
The overall goal of the nation wide telemedicine network design is to provide a system which
meets the needs as outlined in the previous paragraphs. The system implements connectivity
among rural clinics and urban area hospitals to be used mainly for tele-consultation, and
maintaining patient information.
As the main design goals, the network should be cost effective, expandable, secure which provides
state-of-the-art ICT access scheme to rural area clinics. Existing ICT infrastructure will be given
priority to minimize cost of implementing the network. In this design the following specific design
goals were given priority.
2.1.1. Expandability
Expandable system is one in which additional inputs and outputs (such as the number of incoming
data, the number of simultaneous users served, the number of clinics to get connected, etc) can be
added without a major reworking of the network design. So the design should consider the

2
network's ability to continue to function well as it is changed in size or volume to meet new traffic
or application requirements [2]. In this regard expandability is a concern in the telemedicine
network design for the following reasons:
• The number of hospitals built in the county is few in number. However there are more

•
clinics being added to the health system of the country every year.
There is also a chance to incorporate private hospitals in the nation wide telemedicine
network as necessary, which will ultimately increases the number of sites to be connected

•
in the future.
The area of telemedicine applications will not be limited to some specific diseases, but

•
will be expected to increase in type and number in the future.
The network should also support advanced applications, which require real time
connectivity such as video conferencing in the future.
2.1.2. Security
During consultation or patient referral, most of the data exchanged over the network is sensitive
patient information. Confidentiality of patient information must always be respected. For a secure
communication, protocols such as Secure Socket Layer (SSL) could be used. SSL permits users to
conduct secure communication over web-based applications. This provides the ability to safely
exchange patient information across the network [17].
When doctors exchange patient information, they should adhere to medical protocol that defines
the rules to be followed during this process. In addition to these the network and involved servers
should be protected by firewall against external invader. Firewalls could be software or hardware
for the sole purpose of keeping digital pests such as viruses, worms, and hackers out of the
network [3, 4].
2.1.3. Cost
Implementing a nation wide telemedicine network may seem to be more expensive than building
clinics or equipping existing regional clinics with medical personnel and medical instruments. A
cost benefit analysis, comparing various approaches has to be done, to come up with a lower cost
solution to the problem of delivering proper health care to rural areas. However, network
connectivity among the health care facilities, both in the urban and rural areas over an existing ICT
infrastructure is considered as a cost-effective solution.
Considering the installation cost, our design will consider an already existing WAN, provided by
the Ethiopia Telecommunication Corporation. Set-up costs depend on the type of WAN to be used
in the telemedicine network design. But cost is taken as one of the selection criteria to choose from
the existing/emerging ICT infrastructures in the country.
2.2. Design Requirements
Most of the inter-hospital communications used to be by telephone and hand delivered referral
messages in this country. During referrals patients have to travel to one of the referral hospitals
urban areas, carrying the referral messages written by referring physician. Clinics located in the
telephone coverage areas communicate using telephone to exchange information about availability
of specialist or bed in another hospital. However, the communication needs of hospitals are beyond
what have been practiced so far.
Geographically dispersed clinics need telecommunication technology for the following purposes:
2.2.1. Data Transmission
The data is in the form of both text and image about patients that need to be exchanged between
clinics during remote consultations. Textual data may contain referral messages and feedback,
clinical notes of patients etc. Medical image files such as x-rays and dermatology pictures acquired
by digital cameras have to be accessed for remotely diagnosing a patient.

3
 2.2.2. Instantaneous access to patient information
When consulting a general practitioner, specialists need to get access to patient information
instantaneously. This requires a system, which maintains patient information in a standardized
format and be accessible through a secure communication means by authorized users.
2.2.3. Access to Medical Information
Doctors need to get access to medical information databases to get informed on the current
medical practices. This helps them to stay up to date with the new development in the field and get
experience from similar cases when they come across difficult patient case.
2.2.4. Access to the Internet
In the Internet doctors need to visit web sites related to the medical field. Medical expert systems
and Medical databases are some examples among the sources of information in the Internet. They
can also use e-mail to communicate among themselves and benefit from sharing experience of
senior specialists.
These and other communication needs of healthcare providers also require the development of
telemedicine application software backed by electronic patient record systems. Design of such
communication networks will also require the understanding of organizational structure of the
clinics involved in the network. Since the government/public clinics are owned and organized
under their respective regions, the WAN design should follow the organizational structure of the
administrative regions in the country.

3. Proposed LAN / WAN Design

A detailed study about the inclusion of various clinics, their locations relative to the nearest access
point to existing ICT infrastructure, traffic load and its characteristics, security, LAN/WAN
protocol, topology and bandwidth requirements and utilization, allocation of bandwidth etc, have
to be considered while trying to design telemedicine network. In addition to these, issues of
communicating patient information electronically may raise question of medical ethics, and a need
for developing medical protocol to be used in the day-to-day activity using telemedicine network.
In this section the proposed LAN and WAN for the nationwide telemedicine network are
described. The necessary internetworking devices to be used will be presented in logical diagrams.
The decision to make which specific internetworking device is yet to be identified. We will start
with hospital LAN design.
3.1. Hospital LAN Design
To design the LAN for each hospital, we will consider the central site, Tikur Anbassa Specialized
Hospital as a sample. The hospital is organized in to 16 departments. Each department will have
units as necessary. For instance, the Internal Medicine department has units such as Renal Unit,
Cardiology Unit, Neurology Unit, etc. The physicians in these departments/units need to
communicate whenever a patient visits more than one of the units. The proposed LAN will follow
the hierarchical structure of the hospital.
A variety of LAN technology can be employed. The decision to make the selection between the
technologies depends on:
• Expected application to run on the network and their traffic patterns.
• Physical locations of the offices and users to be connected in campus.
• The rate of network growth.
• The abundance of the network technology in the market.
• Simplicity of installation and maintenance.
Currently we expect a web-based telemedicine application to run on the network. The application
will use a central database server where all the user and patient information will be stored. The
type of data to be transmitted on the network shall be in the text and image formats. Since all
4
communication shall be through the server, the traffic pattern around the center is expected to be
heavy. Higher speed devices will be used at the center of the LAN where there will be servers.
The sample hospital (Tikur Anbassa) is composed of 5 buildings (Block A-E). The blocks are not
physically separated. They are built on a number Square meters area. All the departments and
offices are located in either of the blocks. Having routers switches in each of the departments is
ideal to design a high speed and expandable LAN, but makes it expensive. A cost effective choice
is to put switches per building and then have the departments be connected and form groups by
using Virtual LAN technology.
The rate of the hospital LAN growth depends on the level of computerization in the hospital. In
this design it is anticipated that as the application is used and becomes familiar, there is a chance to
add more applications and connect more computers and offices to the LAN. The switches/routers
selected in this design should have many free ports to help cascade the growing number of
connections in the future.
To design the LAN architecture we have selected the hierarchical model. It enables us to design
and arrange the inter-network devise in layers. It is a model preferred by most of network design
experts for its ease of understanding, expandability and improved fault isolation characteristics [3].
The model required the following three layers
At the first layer – Core layer high performance switches that are capable of switching packets as
fast as possible should be deployed. This layer connects the LAN backbone media. It also connects
to the outside world to WAN via a firewall.
In this design the devices in the core layer will be placed at a central location in the hospital. The
devices in this layer will be connected with high-speed cables such as fiber optics, or fast Ethernet
cables. The servers necessary for the applications will be connected to switches in this layer
shielded by a firewall.
The second layer – Distribution layer will contain switches and routers capable of VLAN
switching and allow defining departmental workgroups and multicast domains. The devices should
also support connectivity of different LAN technologies since they also serve as the demarcation
point between the backbone connections in the core layer and the access layer.
In this hospital LAN design the distribution layer represents switches/routers at each building
connected to the core layer on the on end and to the access layer on the other end. Use of
redundant links will be used for maximum availability. The departments could be grouped forming
their own Virtual LAN.
The third layer – Access Layer is where the end users are allowed in to the network. This layer
contains switches/hubs from which PCs in each department get access to the Hospital LAN. Each
department will have at least one switch/hub, which in turn will have redundant links to more than
two of the switches in the distribution layer.
Figure 1 represents the hospital LAN design.

5
 .
Figure 1: Hospital level LAN for Tikur Anbessa hospital

4. Telemedicine WAN Design

The design of the WAN for the nation wide telemedicine network raises the issue of WAN service
provider. Unlike LAN, WAN connectivity depends on the availability of WAN infrastructure in
the country. The sole WAN service provider is the Ethiopian Telecommunications Corporation
(ETC). ETC provides a number of services [5] among which we have to select the WAN
infrastructure that is suitable for the nationwide telemedicine network. The following services are
considered in this design.
•
•
Internet Services

•
Digital Data Network

•
SchoolNet VSAT network

•
WoredaNet VSAT network
Broadband Multimedia Network
4.1. Internet
ETC started providing Internet Services in 1997 using one gateway in Addis Ababa. Currently the
server capacity is 10Mbps uplink and 4Mbps downlink [5]. The Internet service is provided to the
customer in either by dialup or leased line connectivity.
4.1.1. DialUp
This connectivity is the cheapest Internet connectivity provided by ETC. It uses the exiting
telephone line, which was originally setup for voice transmission. A maximum of 56Kbps
bandwidth is provided to the dialup subscribers, but usually on can get 28 – 33Kbps in the daytime
and 35 – 45Kbps during the night-time.

6
 This service covers the telephone coverage areas in the country. The telephone network is
concentrated in the urban areas in Ethiopia, with 505 exchanges, out of which only 159 are
automatic digital exchanges. 58.6% of the exchanges serving the capital city Addis Ababa [3].
4.1.2. Leased Line
Unlike the dialup Internet connectivity, leased line subscribers can get access to the Internet on the
7 day 24 hour (7/24) basis, dedicated, fixed bandwidth connectivity [5]. Bandwidth can go up to
1Mbps [6]. The infrastructure used for leased line connectivity is a data network.
Currently there are very limited subscribers to the leased line Internet. As we have learned from
engineers in ETC, the reason for this few number of customers is lack of awareness and high
connectivity costs.
4.2. Digital Data Network
In 2001 ETC established a digital data network, which is capable of providing dedicated (leased
line) Internet, ISDN and Frame Relay services. As it was announced by ETC, DDN supports
digital lease at multiples of 64Kbps, to be used by a variety of applications [5, 7].
But still the DDN covers the urban areas where there are other means of WAN services such as
dialup Internet service. The ISDN service is not matured and has not been affordable. DDN is
known to have a number of limitations as the provider itself specified them [6].
•
•
It can only give up to a maximum speed of 1Mbps.

•
It cannot provide bundle (voice, data, and video) services
It does not support multicasting, etc
4.3. VSAT Networks
Very Small Aperture Terminals have been used by ETC as a means of transmission link to reach
remote areas. So far 292 VSAT terminal stations have been operational and are being used by the
telephone network [5].
In addition to these, there is a plan to install VSAT terminals in every secondary schools and
higher learning institutions to form a broadcasting VSAT network called SchoolNet [19]. There is
also another VSAT network to connect about 600 Woreda administration centers forming a
government network called WoredaNet. Since our focus in this design is to have low cost but wide
coverage connectivity among the regional clinics and urban hospitals across the country, these
VSAT networks were considered as candidates of our WAN infrastructure selection.
4.3.1. SchoolNet
SchoolNet is a VSAT network, which is designed for broadcasting multimedia data to all
secondary schools and higher learning institutions in Ethiopia. The network is owned by ETC.
Though the network currently supports only one-way traffic, it can be upgraded to have up to
384kbps upstream, to support two way interactivity.
4.3.2. WoredaNet
WoredaNet is also a VSAT based network, which is designed for integrated services of voice, data
and image. Currently the WoredaNet covers 571 Woreda administration centers.
The network supports two way interactivity of 45Mbps down to all the Woreda administration
centers and 256kbps upstream from each Woreda. The network is expected to scale up and include
many government offices in each Woreda. The switches installed in each Woreda consist of more
than 10 free ports to support more connections cascading out of the network point of presence.
4.4. Broadband Multimedia Network
A new Broadband Multimedia Network (BMN), which has been fully operational by the end of
June 2004, is announced by ETC. The network interconnects the capital city with high speed
Optical metropolitan Network and 13 other provisional towns using radio digital systems [5,6].

7
As the name indicates, BMN is a high bit rate network, which supports voice as well as full motion
video, on the same network infrastructure, with better quality and availability as well as relatively
low price to customers [5, 6].
4.5. Summary of ICT Selection
To pick one of the infrastructures for telemedicine the following factors were considered:
• The geographical coverage
• The bandwidth
• Two way interactivity
• Rental cost of WAN connection
• The capacity to add more LANs
Table 1 summarizes the process of WAN infrastructure selection.

4.6. Recommendation
Based on the comparison we have made, we submit that WoredaNet will be best suited to the
national telemedicine network, as long as the existing infrastructures are concerned. But as can be
observed in the table, whereas the coverage is good, the capacity is limited. BMN will be the ideal
choice because it represents state-of-the art service and higher bandwidth. However, it is centered
in the urban areas only. It is also under development and we have considered it as a potential to be
used integrated with the VSAT based networks to enhance nationwide telemedicine network. The
SchoolNet needs to be upgraded to support two way interactivity.
The solution we propose is that of a nationwide telemedicine network that uses the combination of
VSAT network that is cost effective and which goes down to the public even in the rural areas and
urban area terrestrial network that provides modern but economical connectivity to hospitals. In
this regard, we propose connectivity via the emerging BMN to connect urban area hospitals in the
capital city and in the regions where the network can easily be accessible. The WoredaNet VSAT
network is proposed to be used to connect rural area clinics to the telemedicine network. Figure 3
represents our proposed telemedicine network.
This WAN connectivity requires that urban hospitals have two WAN connections. Getting more
than one WAN connection may be more expensive. If the two WAN infrastructures could be
integrated, an alternative WAN design will require only one WAN connection to the urban
hospitals through which the hospitals will be connected to BMN and the rural are clinics to the
WoredaNet. The second alternative of the WAN design is shown in Figure 4.
A typical simple scenario where the network is used for telemedicine consultation between a
practitioner in the rural area clinic and a specialist in the urban hospital can be viewed in Figure 5.
The practitioner inputs patient data and referral messages using the graphical user interface
provided by a telemedicine application. On the other end, a specialist reads the referral massage,
displays the patient information, after which the specialist can input the referral feedback to advice
the practitioner.

8
Table 1: Summarized comparison of existing ICT infrastructure

Internet DD N SchoolNet WoredaNet BMN

Coverage based on Telephone coverage The capital and About 500 schools 571 Woredas out of The Capital city and
the network's areas only regional Urban areas covered. There are 594 are covered 13 regional towns.
ability to go down only wordas that do not
to Woreda have schools

Maximum of 56k Maximum of 1Mbps Can be upgraded to Downstream/ upstream ADSL Services:
dialup and 1Mbps in 384k upstream
45Mbps/ 256k Variable bandwidth
Leased line
Bandwidth downlink
Downstream/upstream:
512k/128k and
1024k/256k

Interactivity Two way Two way One way broadcasting Two way Two way

0.11birr/min dialup Free for schools Free For Woredas Not yet determined,
Cost under development
1000birr/month leased
line

Not scalable Not scalable enough Will have more than Can be expanded
Capacity to scale 10 ports free at each
Woreda

9
Figure 2: Logical WAN design based on BMN and VSAT networks alternative one.

Figure 3: Logical WAN design based on BMN and VSAT networks alternative two.

10
 Figure 4: Scenario of the telemedicine network.

5. The Prototype
With the specified network requirements and architecture design, we have developed a working
prototype for a national telemedicine network. The operations of the prototype telemedicine
network are summarized below:
5.1. Overview
The prototype is a Basic Telemedicine Service (BTS), which provides a web based Graphical
User Interface (GUI) for healthcare providers. BTS facilitates the information exchange between
remotely located healthcare providers for the purpose of medical consultation, as well as for
maintaining patient information. We have tried to reproduce electronically, the traditional paper
based forms and patient cards used in the hospitals.
We have selected the web-based technology for its universality. Using web-based technology
constitutes not only a network that can be used universally but also system independent platforms
providing access to many different computer systems at client site [8]. The only requirement in
the client site is web browser software installed and network connectivity.
To secure the system, we have used password protected system where the users have to login to
get access to the functionalities provided by the system. In addition to that, user types are defined
so that there will be a role based access to database and system functions in BTS. We have used a
centralized database to store user and patient information. Unlike e-mails, this approach allows us
to insure structured information exchange between the communicating healthcare providers.
5.2. Major Features of BTS
Basically BTS is a database driven web site, the major features of which can be described as
follows:
• Provide user management services where administrator can register users, assign

•
username and password, and define user type, as well as search and edit user information.
Provide patient management services where health care providers can register patients,
search patients and view patient information on a traditional patient card like interface,
when necessary.
11
 • Provide referral systems where physicians can write referral messages to a particular
department and hospital, and on the other hand provides a system by which a physician
can see the list of referrals forwarded to the department she/he is working and allow the
physician to write feedback after examining the referral message and patient information

• Provides a system by which physicians can request lab test to any hospital laboratories so
instantaneously.

• Provides list of lab test requests to laboratory technicians and allow them to input lab test
that patients can get tested in the clinic/hospital they are being treated.

results.
In the prototype we have tried to implement the above list of functionalities.
5.3. BTS System Architecture
The architecture of BTS is a three-tiered Client Server architecture. It is a web-based application,
which will have a web server to provide all the interfaces of the system and database server to
contain all information required in the system.
The prototype is constructed with a combination of open source products and freely available
software components. The web server we have used is the Apache Jakarta's Tomcat web server
[9]. The functionalities as well as the business rules necessary are programmed in Java [10]. The
user interface and text of web pages are implemented by the Java Server Pages (JSP) [11,12].
Some scripting is included on the web pages in JavaScript. JSP has a capability to import java
classes and run them from the web pages when the pages are downloaded to client machine [12].
Unlike other server side languages such as Active Server Pages (ASP), JSP makes the system
platform independent. JSP also allows us to use the full power of java programming language
which other scripting languages such as PHP lacks [12].
The database we have used is the open source MySql to back up our database driven application.
MySql works on may different operating system platforms and is known for its speed of data
retrieval [13]. It provides Application Program Interfaces (API) for many programming languages
including Java. Passwords are secure because all password traffic is encrypted when connecting to
the MySql server. For database connectivity we have used mm.mysql driver, which is a Java
Database Connectivity (JDBC) driver, from MySQL AB, implemented in 100% native Java. [14].
Figure 6 shows the BTS system architecture.

Web Browser

HTTP

Web Server Application Server

Mysql:JDBC

Database

Figure 5: Architecture of BTS

The first layer is where the client machines run web-browser software. This layer is used to
display the user interface (web-pages) of the system and send secure HTTP request to the web
server in the second layer. Along with the web-server, application server resides in the second
layer. This application server manages the clinical business logic. The bottom layer contains the
persistent data of the system. All the data of patient's information, doctors and messages will be
stored and maintained in this third layer. This layer runs the database management system
software.

12
 5.4. Database Design
Basic Telemedicine Service needs to keep track of information about patient and related medical
records, user’s information, and messages for both medical referral requests and feedbacks. A
well-designed minimal database should be employed to manage this information. A relational
database model is selected to store the persistent data of the system, as it could be easier to
manage, and provides better management for complex query of such data [15]. Our database
contains the following basic entities:
Person: The generic information of each person: user, patient or relatives are stored in the person

• Personal bio data such as Name, data of birth, gender, etc

entity. The generic information includes:

• Address data such as: region, town, Woreda, kebele, telephone etc
• Occupation data such as: hospital, department, job title, etc
Users: This entity will contain user’s information. Keeping users’ information is needed for
authentication and authorization purpose. User's type and authentication information such as
username and password are stored in User entity.
Patient: This entity will be used to maintain patient record. It will be used to identify the patient.
The patient medical information and associated medical record should always be available during
consultation. Each patient is represented by a medical record entity.
Medical Record: This entity represents the medical information associated with each patient. It
will contain Lab results; medical images such as x-rays, clinical notes written by doctors, follow
up information and medical certificates as sub entities.
Each component of the medical record of a patient is composed of different type of data which are
to be stored in the database. In the traditional paper based system, medical record of a patient is
identified by an Out Patient Card (OPCard) Number, which is usually called patent record
number. OPCard is a four page hard paper card, which contains patient’s generic information,
such as name, sex, age, address on the first page and a table of two columns for date and clinical
note to record chronological list of clinical notes. All other components such as Lab Test Results,
x-ray reports, etc are stored inside the hard paper card referenced by the card number or name of
the patient. The lab test results may contain zero or more test request forms along with the results
for Urine, Parasitology, Blood Chemistry, Haematology, Serology, Bacteriology, Fine Needle
Aspiration Cytology and Biopsy.
When a patient is admitted to the hospital, Admission and social data information is stored. The
admission data includes identification information and name and address of next of kin, marriage
and children information if any, occupational information etc. Then follow up data such as Vital
Sign measurements, Fluid Balance information will be collected and recorded. Order sheet, which
contains list of treatments to be ordered after admission is also part of inpatient medical record.
In addition to these, information about the hospitals, departments and laboratories are stored in
respective entities. The entities and the relationship existing among them are presented in the
following Figure 7 below.

5.5. Graphical User Interface

BTS is accessed by opening the initial web page where user authentication is performed. The
initial page contains a login screen to submit username and password of users. There is no need of
menu or different buttons to be submitted based on the user types. Since the user types are defined
in the database when the user registered, the page corresponding to the specific user type will be
opened upon successful login. Currently Administrator, physician and lab technician user types
are defined and all the user types will have their own main page as described in the following
paragraphs. Figure 8 shows the login screen.

13
 Figure 6: The database tables used in BTS.

Figure 7: BTS login screen.

5.5.1. Administrator's Main page

The administrator's main page is used for managing users. The functionalities accessible
from this page are: Register New User and Search User by either or a combination of
Name, Father Name, and User Name. Figure 9 shows the Administrator's main page.

14
 Figure 8: Administrator's main page of BTS

The registration function, invoked by clicking a button (Register New User), opens up a user
registration form where the administrator can input all the information necessary about the user
and define the user type. Figure 10 shows the second half of the user registration page. The form
is divided in to four parts where the admin can input the Generic user information, Address
information, Profession information and Authentication information. One of the authentication
information is the user type, where the admin can select from the list of user types.

Figure 9: User registration page.

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The other function provided to administrators is the Search User function. It is possible to search
users using any combinations of Name, Father Name and User Name. If username is provided,
there is no need to search for users by name and father name. This is because username is unique
in the user table.
The search result is displayed in the table below the search criteria input boxes. Figure 11 shows
the admin page after including a search result.

Figure 10: Administrator's main page showing search result.

As it can be seen in the search result, the full name of the search result is a link. The link leads to
a page containing user information from which the admin can edit that particular user.

5.5.2. Physician's Main page

The physician's main page contains a button to open Patient Manager Page, and list of referrals
forwarded the department where the physician is working. The physician could either click the
Manage Patients button or a link to one of the referrals. In each case new pages will be opened.
Figure 12 shows the physician's main page showing one referral forwarded to the department
where physician called Dr. Aman is working.
If the physician chooses to treat the patients in the hospital where she/he is working or if there is
no referral forwarded to the department she/he is working, the physician can then open the patient
manager page by clicking the 'Manage Patients' button.
The Patient Manager Page has two buttons namely, Register New Patient and Search Patient. The
physician will have two options:
•
•
To register a new patient.
To search a previously registered patient or

Figure 12 shows the patient manager page.

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 Figure 11: Physician's main page of BTS.

Figure 12: Patient manager page.

When 'register new patient' is selected, a patient register form, similar to the user registration page
will be opened. The patient information is grouped in to three categories namely: General, Home
Address and Occupation information. Figure 14 shows the first half of the Patient registration
page.

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 Figure 13: Patient registration page.

On the other hand if the physician wants to look for a patient, she/he can input one of the search
criteria namely Name, Father Name or Record Number of the patient. After providing the search
criteria, the physician clicks the search patient button to display the list of search result. The
search result contains the record number, Full name and the hospital where the patient was first
registered. Figure 15 shows the Patient manager page including a search result.

Figure 14: Patient manager page showing a search result.

The patient full name is a link that leads to patient information page similar to the traditional
Patient Card used in the hospitals. An example of the patient card, which opens up when the full
name link in the previous interface is selected, can be seen in Figure 16 below. The patient card
contains patient's general information, address information and clinical notes. The clinical notes
ordered in descending order. In addition to the information displayed on the patient card,
laboratory test results and medical images related to the patient are accessible by clicking
corresponding buttons from the patient card interface.
The physician can add clinical notes or refer or admit the patient. All the functionalities are
provided by buttons from the patient card. These buttons open the corresponding input pages.
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From the physician's main page, the other option provided to the physician is to see referrals
forwarded to her/his department. This is possible by clicking the link that opens a referral page
corresponding to the patient. The patient referral page contains the referral messages and buttons
that lead to patient information, as well as a button that lead to the feedback input page. Figure 17
shows the patient referral information page.

Figure 15: Patient card page of BTS.

Figure 16: Patient referral information page.

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If the physician wants to view the patient information, she/he will click the View Patient Card
button to open the patient card shown above in Figure 15. On the other hand the physician can
give feedback to the referral using the feedback slip, which will be opened by clicking the Open
Feedback Slip button. The feedback slip is an input form where the physician can input feedback
information related to the current referral.
The physician can also request laboratory test after viewing the patient laboratory information
page, which is accessible from the patient card page by a button called Laboratory Tests. The
Laboratory information page and a parasitological test request pages are shown in the Figure 18.
When a physician wants to request lab test, she/he need to click the button corresponding to the
type of test required from the Laboratory Information page. The specific lab test request page
provides the physician with dropdown list from which the physician can select where the lab test
should be performed. This was found to be important in order to forward the lab test request to the
other user types called, the Lab technicians.

Figure 17: Laboratory information and parasitological test request page of BTS.

5.5.3. Lab Technician's Main Page

The third type of user, Laboratory Technician sees a list of laboratory requests to the department
she/he is working, on the Lab Technician's main page. The list contains a link to open lab test
result input form where the lab technician can enter her/his report. See Figure 19, for the Lab
Technician’s main page.

Figure 18: Lab technician’s main page of BTS.

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The lab technician can either click the on of the links to report the lab request or close the
window, if there is no request forwarded to her/his department.
In addition to these interfaces, the application consists of many other pages containing forms
similar to that of the paper forms used in the hospitals.
6. References
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Biomed., vol. 3, pp. 166-175, Sept. 1999
[2]. Ya Wen, Networking: Enterprise IP LAN / WAN Design version 1.1, Taos 2001: available at
www.taos.com.
[3]. Cisco documentation available at: www.cisco.com.
[4]. Andrew S. Tanenbaum, Computer Networks, 3rd edition, Prentice Hall Inc. 1996,
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[11]. Java Server pages documentation, available at http://java.sun.com/products/jsp, accessed on
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[12]. Marty Hall, Core servelet Core Servlets and JavaServer Pages, online version, Sun
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[17]. Netscape's web site: available at: http://home.netscape.com/newsref/std/SSL.htm, accessed
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2003.

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