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 Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 14  |  Issue : 2  |  Page : 155-157

Computerized patient record system: Free software for the ophthalmic clinic


1 Department of Ophthalmology, The Edith Wolfson Medical Center, Holon; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
2 Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel

Date of Web Publication21-Nov-2015

Correspondence Address:
Asaf Achiron
Department of Ophthalmology, The Edith Wolfson Medical Center, 62 Halochamim St., Holon-58100
Israel
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2384-5589.170201

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How to cite this article:
Achiron A, Hamiel Y, Bartov E, Burgansky-Eliash Z. Computerized patient record system: Free software for the ophthalmic clinic. Afr J Med Health Sci 2015;14:155-7

How to cite this URL:
Achiron A, Hamiel Y, Bartov E, Burgansky-Eliash Z. Computerized patient record system: Free software for the ophthalmic clinic. Afr J Med Health Sci [serial online] 2015 [cited 2021 Mar 8];14:155-7. Available from: http://www.ajmhs.org/text.asp?2015/14/2/155/170201

Sir,

Keeping patients' record in a paper format can no longer meet the demands of modern health care and clinical research. [1] Ideally, health information software would be able to sort incoming clinical data and aid in presenting these data to physicians and patients. [2] However, creating such software is a time-consuming process, and its implementation may affect work routines, behaviors, and cultural habits. [3] With this in mind, we have designed a free software (EyeDB) for the ophthalmology. [4] Our main goals were to build a simple software design for patients' records management and to facilitate adaptation of emerging clinical recommendations.

We used the free, open source WampServer software to create an accessible web development environment on laptops and personal computers (www.wampserver.com). WampServer provides database storage, options for working both online and offline, with user-password protection. The web service was developed in JavaScript (client-side), PHP (server-side), and MySQL (database). The EyeDB can be installed on a PC or laptop to provide a local database and can be accessed with a web browser, allowing for easy installation and distribution. The service can be installed and accessed on multiple operating systems (Windows, Linux, and IOS) and web browsers (IE, Firefox, Chrome, and Safari). The client-side utilizes libraries such as jQuery and Twitter Bootstrap to provide an interactive and intuitive user experience. All of the technologies used in this project are widely used, free, cross-platform, and actively maintained. The software design was built by a volunteer user-interface designer (https://se.linkedin.com/in/jaclyneclarke). The EyeDB software can be downloaded from: http://wtf.co.il/eyedb/eyedb.zip. Installation and configuration manual can be downloaded from http://wtf.co.il/eyedb/install.docx.

Practically, the software is quickly and easily installable. First, installing the WampServer on a personal computer in the clinic turned it into a web server that stored the database. Then, EyeDB software was downloaded and exported to the WampServer directory. Database configuration was conducted by running a semi-automated script. It took 30 min to complete these three steps. After installation, EyeDB was accessible by typing http://localhost/eyedb into the web browser. We tested EyeDB's functionality by evaluating the usability of a known clinical recommendation (a preoperative risk-assessment scoring system) by filling in the EyeDB form and obtaining an automatically calculated result. The EyeDB preoperative module consists of a form-filling medical module that includes a patient's demographics, history, information gathered from all physical exams, and a specific peri-operative risk assessment. The risk scoring system, which stratifies patients into one of four risk groups, was developed by Muhtaseb et al. based on analysis of intra-operative cataract surgery complications from 1441 cases. [5] We implemented Muhtaseb et al.'s system of stratification to assign a preoperative risk grade to each patient facing a cataract removal surgery [Figure 1]. Software users (three physicians, each in a different year of his residency) evaluated the software in real time and reported that mean time to complete the scoring system was less than 5 min and that the system was easy to manipulate. User feedback and suggestions were easily addressed by managing data variables in the program's WinWord templates [Figure 2].
Figure 1: An example of preoperative risk assessment, an example of preoperative risk assessment for a 90-year-old patient with deep set eyes, 2.8 mm dilated pupils, and pseudoexfoliation (deep set eyes are judged by the surgeon to contribute 2 risk points)

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Figure 2: WinWord template of the EyeDB software. This template can be easily changed. Contrast between rows and spaces was made using an alternating gray and white pattern

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Integrating newly health care system into the clinician's daily routine could be more straightforward. Our software is free to use and provides several solutions for local adjustment and new clinical recommendations integration. In addition, the daily routine of the clinician is busy and stressful; strategies to overcome cognitive biases include interventions to simplify tasks, use of algorithms, and computer-based support system. [6],[7] Following a structured form to assess the risks of cataract surgery rather than relying on memory alone would free the physician from having to make time-consuming calculations and reduce his number of errors. The design of EyeDB was based on a lean and agile development process that reduces unnecessary code by focusing on clear requirements and getting feedback from users. [8] The original software setup was very easy, and new clinical modules can be added and manipulated with few lines of code as necessary.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Van Ginneken AM. The computerized patient record: Balancing effort and benefit. Int J Med Inform 2002;65:97-119.  Back to cited text no. 1
    
2.
McMahan R. Operationalizing MTM through the use of health information technology. J Manag Care Pharm 2008;14:S18-21.  Back to cited text no. 2
    
3.
Iversen J, Ngwenyama O. Problems in measuring effectiveness in software process improvement: A longitudinal study of organizational change at Danske Data. Int J Inf Manage 2006;26:30-43.  Back to cited text no. 3
    
4.
Nadkarni PM, Miller RA. Service-oriented architecture in medical software: Promises and perils. J Am Med Inform Assoc 2007;14:244-6.  Back to cited text no. 4
[PUBMED]    
5.
Muhtaseb M, Kalhoro A, Ionides A. A system for preoperative stratification of cataract patients according to risk of intraoperative complications: A prospective analysis of 1441 cases. Br J Ophthalmol 2004;88:1242-6.  Back to cited text no. 5
    
6.
Phua DH, Tan NC. Cognitive aspect of diagnostic errors. Ann Acad Med Singapore 2013;42:33-41.  Back to cited text no. 6
    
7.
Vickrey BG, Samuels MA, Ropper AH. How neurologists think: A cognitive psychology perspective on missed diagnoses. Ann Neurol 2010;67:425-33.  Back to cited text no. 7
    
8.
Ahmed Z, Zeeshan S, Dandekar T. Developing sustainable software solutions for bioinformatics by the "Butterfly" paradigm. F1000Research. 2014;3:71. doi:10.12688/f1000research.3681.2.  Back to cited text no. 8
    


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