ENRS: an Object Oriented ApproachBy Faris KatebFriday, April 1, 2011What is ENRS?!ENRS( Electronic Nursing Record System)Computer-based documentation associated with nursing careIt will be the cornerstone of a new way of managing nursing informationdata collected at the point of care can be used to assist nursing care at all levels of aggregationNursing terminologyThe need of standardized terminologyFacilitate the description, comparison, and communication of nursing-care activities across settings, population groups, and countriesFriday, April 1, 2011Presentation PurposeHow object-oriented analysis and design can be used in developing and implementing a terminology-based electronic nursing record system (ENRS).How to design domain models and implement a model database that allows greater expressiveness and reuse of data.this study can be used to improve a multidisciplinary development team’s understanding of the functions and data processing procedures in the design and development stage, as well as of future maintenance procedures. Friday, April 1, 2011Introductionthe main problem in ENRChow to transform information from concepts in the nurses’ minds to codes in the computer’s databaseCurrent solution nursing information systems enter and retrieve structured data using so-called interface terminologies–terminologiesunavailable to sharehas not authority levelsFriday, April 1, 2011What terminologies we have ?International Classification for Nursing Practice(ICNP) by International Council of Nurses (ICN)Difficult to use directly and becomes a barrier to acceptance by nurse usersFriday, April 1, 2011The Study:The initiation of an ENRS designThe study experiment:By the Department of Nursing at the Seoul National University HospitalNursing information modelSix nurse managers They decided to use standard nursing terminologyTo make it easy for nursing applications to be adapted Nursing data such as quality improvement, decision support, and comparison of nursing services.Friday, April 1, 2011The Study:The initiation of an ENRS designFriday, April 1, 2011The Study:The initiation of an ENRS designThe figure has: Data flow between the front-end and back-end of ENRS“Nursing Records” shows the nursing process.The components and roles of a terminology server and a clinical data repositoryFriday, April 1, 2011The Study:The initiation of an ENRS designFriday, April 1, 2011Types of Terminology Three types of TerminologyClinicalAdministrativeReferenceICNP terminology was used in the study, which consistNursing diagnosisNursing activitiesNursing outcomesFriday, April 1, 2011The Study:Object-oriented system designWhy we need OOP in healthcare system?Clinical data and the rules for manipulating the data are built within the applications. Nursing information is shared by other applications e.g.Clinicians with various professional orientationsDifferent software modules of the system were created to access and manipulate the same dataChanges in requirements and system growth prefer Object-Oriented more than Algorithmic perspective .High costs of maintain data consistency because of Complications in the health care systems.Friday, April 1, 2011The Study:Object-oriented system designGOALClearly separate data from the applications that manipulate them.e.g. hospital front desk and insurance sectionHOWAllocating the data to a specific class of data objects that protects it (encapsulating principle)An example of data that have to be encapsulatedPatient's diagnose and symptom that taken by a nurse should be prevented from other system’s users such as people at hospital reception.Friday, April 1, 2011To perform operations Messages (commands) used by objects Objects includes methods (functions) Object’s states are changed (attributes or data values)Limit the access to these objects (private methods) and “authorized” object It includes methods ensures accessing to objects are accuracy and consistency.the object-oriented technique well suited to the design and development of complex applicationsThe Study:Object-oriented system designFriday, April 1, 2011Participants Different stakeholders and different authority nursesnurse managersanalystsDevelopersSystem integratorsproject managersFriday, April 1, 2011UML and RUPUnified Modeling Language (UML) (not used in the study)To specify the system components and their behaviorUML is not a standard for the development process, but a standard for the artifacts of developmentRational Unified Process (RUP)improving UML to be wide range of projects and organizationsRUP has four phases:Inception, elaboration, construction, and transitionFriday, April 1, 2011RUP four phasesInception:Establish a system and identify the beneficiariesElaboration:Determine requirements and establish an architectural baseline Construction:Check the built system and see other iterations Transition:Evaluate and use the system by end userFriday, April 1, 2011The study main focus was on requirements and (analysis and design) on the Elaboration phase The study crate a case, activity, and class diagram as we will see next slides.Friday, April 1, 2011Beside RUPCase modelsTo identify what the system is supposed to do and the system environment. Class diagrams As a design model describing the realization of the use cases Friday, April 1, 2011Activity diagramshow one of the sequence of activities in the scenario of nursing note taking Activities and information exchange Define potential use casesFriday, April 1, 2011We identify the relationships between classesWe have internal and external class diagram for the system.External:How to exchange information outside the ENRSInternal view Deal with elements from the ENRS onlyThe Study:Object-oriented system designFriday, April 1, 2011Use Casesshows the behavior of a nursea nurse managera physicianand the relationship of 8 use cases for a nurse6 for a nurse mangerFriday, April 1, 2011Use Case DescriptionDescribe the scenario’s actionscame from stories and identified use case propertiesUse Case Description includes:name, a brief description, the event flows, alternative flows, special requirements, and the pre-and postconditionsFriday, April 1, 2011The authorization required to add, modify, or delete arecord.• The system logs for tracing changes to a record.• The requirement for a digital signature for legal reasons.Design ViewNursing Records Friday, April 1, 2011Shows the functional requirements of the systemit describesentity,