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    Title:     continuous part A part A was 568414

    Paper Details


    part A was 568414


    i  have included part A which is already done. now , we will work on partB. i have attached file for that as well and rubrics which is very important to check.

    i need a combine report part a and part b


Subject Nursing Pages 16 Style APA



Table of Contents

Background Information. 3

Business Functions. 4

System Vision Document 5

Fact Finding & System Requirements – Systems Requirement Document 6

Risk and Cost Benefit Analysis. 8

Expected Costs of the New System.. 10

Fact finding for the New system…………………………………………………………… .10

CBA Techniques …………………………………………………………………………….11

Use case diagram ……………………………………………………………………………………………….14

Activity Diagram for a ues case scenario ……………………………………………………15

ERD Diagram ………………..………………………………………………………………………………16

DataBase Design……………………………………………………………………………………..…17

List of References ……………….………………………………………………………………………………18









                                             BACKGROUND INFORMATION

Good Health clinic is health facility that was started by two cardiologists, Tim jones and Daniela Smith in 2010. The idea was born out of a desire buttress Traditional medical care with preventive care by emphasizing physical fitness. The dream was realized when two more doctors joined and the hired permanent employees.

Good Health Clinic Organizational Chart







                                              BUSINESS FUNCTION 

It is envisaged that upon roll out, the system will streamline operations of the clinic. This is important in order to minimize duplication of duties while at the same time improving general efficiency. The finance department will be affected in a major way as it facilitates other departments. The system will link the finance department with the office accounts, supply chain management, Insurance claims department and the partners. The system will aid in preparation and updating of accounts, scheduling of appointments, handling of insurance claims, facilitation of supply chain management, preparation and updating of patient records, preparation, storage, retrieval of accounting documents and billing (Myers 2017). The clinic currently has a manual system which handles daily operations. As a result, there is over-reliance on paperwork as evidenced by the hiring of one dedicated staff member to handle the paper work. This may include physical retrieval of files, filling documents, among other paperwork. A similar trend is witnessed by the partners who, incidentally are doctors who may find it laborious to access patient records. In the same way, Julie Wilson, the office manager, may have to physically walk to Fred brown to obtain information on accounts and payroll issues. Acquisition of a system may also necessitate adjustments in the structure of organization. The clinics should be recognized to include the following functions: board of management for oversight and policy directions, manager in charge of administration, manager of medical services to head the clinic section. The position of IT manager should also be created to allow easy coordination of the departments. The position should be under the leadership of an ICT manager. The positon currently occupied by Susan Jackson of keeping patient records will need to be scrapped as health records will be digitized. Monthly reports, accounts and claims may also be automatically generated by the system to free department members from these manual tasks (Hoffer 2012).





                                           SYSTEM VISION DOCUMENT

Information systems vary in scope and purpose. In variably, such systems are a reactive response to organizational challenges such as increased costs from excessive paper work, redundancy and revenue loss (Rodrigues et al. 2013) the system vision document answers these two questions by providing three critical system details: overview of the system which focuses on what the systems and what it intends to solve. It then outlines the purpose of the system. Finally, it provides a graphical representation of the system in form of a block diagram (Rodrigues et al. 2013). The system under consideration is an enterprise resource planner to simplify operations at the clinic. Its purpose is to significantly reduce expenditure by managing the finance department in the areas of insurance claims, keeping up to date financial records, limiting access to crucial documents through data protection among others benefits. A graphical representation of the system’s vision document is provided below:

Adopted from: http://www.profmax.com/pbs/solutions/erp/healthcare/healthcare.aspx             


Fact finding and system requirements- systems requirement document

In the selection of a system, stakeholder is often confronted with a choice between different subtle systems which appear similar on face value. As already observed, the system vision document provides valuable insight in to the systems functionality. However, documentation of critical details such as property and feature of a system are important as far as the choice of system is concerned. This is what system’s requirement document is about. Proper documentation of systems requirements begins with making a listing of all separate tasks and their durations:



Generation of reports

Daily, weekly as need may arise

Printing of mailing labels and appointment cards

1 Day

Production of weekly insurance company report

1 Week

Production of monthly claim status summary

1 month

Development of custom-made System

12 weeks

Acquisition of ready-made system


System configuration

Immediately upon payment

System testing and troubleshooting

3 months

Training on System support

10 hours

Annual technical support





In systems analysis and design, it is necessary to identify two main types of tasks: Predecessor tasks and Dependencies. Tasks which must be completed before the others can be commenced are referred to as predecessor tasks.  In the Good Clinic, for example, generation of daily reports precede weekly and monthly reports, just as weekly reports come before monthly reports.  Similarly, systems configuration must precede testing even as rollout comes after testing. Successful completion of predecessor tasks gives way to dependencies (Bahill & Madni 2017).  Monthly claims status summary is considered as a dependency task to weekly insurance records. Some predecessor tasks and their respective dependencies are tabulated below:

Predecessor tasks


Daily reports

Weekly reports

Training of IT technical support staff

Availability of funds for training

System testing

System configuration

System configuration

System rollout




Detailed Project Management Gantt Chart and PERT chart are attached in the following files.


As we can see from the PERT chart the critical path is 79 days or 13.6 weeks approximately.    

                             RISK AND COST BENEFIT ANALYSIS

In systems analysis and design, it is prudent to pore over potential threats to successful completion and rollout of a project. These negative outcomes may arise at any stage in the project cycle from conception to implementation. Stakeholders may also pose a serious threat to the project. In the planned transition of Good Health Clinic from a manual system to a digital one, many risks have been identified.  First, there is the danger of getting entangled in a learning curve which may lead to cost over-runs. A training of this kind may not yield much as the scope of the training is not defined. Secondly, implementation may suffer from poor quality training due to challenges in accessing the best trainer of systems administrator (Fitzpatrick & Devshop 2007).  Another risk factor is unrealistic user expectations. In the case of Good Health Clinic, workers are already fronting the inclusion of email and text message service.  This project may fail at implementation stage, if the employees’ preferences are at variance with employer or the developers. Employees may also pose a risk to the system’s implementation. This may result from fear that the projects implementation may lead to job losses. Some managerial actions or inaction may portend badly for the project. Lapses in costing through inaccurate cost forecasting can be dangerous. With regard to Good Health Clinic, the actual cost of either system is unknown, especially after system testing and rollout. The actual cost of technical support for the tailor-made system still remains unknown.  Likelihood of Stakeholder turnover resulting from employees leaving the organization after being trained may compel the organization to incur additional expenditure in training costs. Another common risk from the management side is the thinking that on the job training can substitute professional competence: trained staff on such stop-gap arrangements doesn’t always perform optimally (Nas 2016).

Certain risks can arise from the system itself. Systems which are inflexible in architecture are often unscalable, inadaptable, and non-interoperable.  An attempt to configure them may require complete overhaul to accommodate new changes. This option is unrealistic and untenable should the clinic opt for buying a ready- made system. Failure to integrate with existing systems may affect Good Health clinic as transition from manual system may be difficult for employees.  In addition, the manual system may not be exactly replicated electronically (Fitzpatrick &Devshop 2007).

Transiting to a new system may be messy for some organizations, leading to reduced sales. This may arouse opposition from organizational leaders, who may in turn oppose the system. Finally, the systems so far considered have a relatively short lifespan of 5 years. This may be a deterrent as the systems require huge considerable financial outlay.

Despite the many risks to the project, there are immense benefits embedded in management systems. To start with, systems manage organizational resources efficiently, thereby producing optimum output at minimum cost. As already pointed out, the practice’s system can streamline communication, and payroll issues across all departments. Better coordination between departments, improved efficiency, for instance decentralizing of reports (Pietrabissa & Oddi 2013). Doctors, accountants and section heads can generate reports from their offices, using user friendly interfaces. These will  effectively end the old system which requires 3 hours overtime for each employee, totaling to 72 hours a week of ‘’lost’’ time. Further, the additional 12 hours spent by employees each week to catch up on critical timelines will be erased (Brixius and Microsoft Corporation). The system will also prevent the need to hire a full time staff member. While costs clearly outweigh the financial benefits, it is envisaged that the system will greatly improve workers’ morale thereby translating to real tangible benefits in the long term.

                      EXPECTED COST OF THE SYSTEM

Two systems are fronted with different cost implications. The first option is to developing a new system from scratch. This will initially require 12 weeks to implement. When an 8-hour working, day is considered, and confined to 5 days a week, then cascaded to 12 weeks, the result is 480 hours. When considered in the context of $240 per hour, then the initial outlay is $115,200. When additional cost of $3000 for the DBMS is factored in, then the figure rises to $118,200 before training of staff to handle routine maintenance. Instead of the custom-made alternative, the practice has an option of buying a ready-made system for about $10,000. Upon configuration and testing, the practice will be required to spend $2500 per year, beginning from the second year after rollout. However, the duration of technical support should this route be chosen remains unclear. Additionally, 10 hours of training, at cost of $250 will raise the costs by $2500 irrespective of the acquisition plan adopted.  Mandatory support for the first 3 month of installation will help erase any problems but will attract costs that are yet to be determined. Hardware will also require $10,000 to install. A consideration of the two plans at the clinic’s disposal reveals that the in-house development plan will spend at least $130,700. The second option will be operationalized with an initial cost of $22500 and other yet to be known costs. However, this system will be useful for only 5 years.

CBA Techniques

Evaluation is a continuous part of the project life cycle. Cost benefit analysis (CBA) is one of the most employed evaluation techniques. It is concerned with net dollar value of a project or a system (Mishan 2015). In this context, two systems are considered in terms of net financial rewards they attract. The financial rewards mentioned are different and forms the basis of two techniques of CBA. 

The first technique considers present and tangible net benefits of the system. Based on this method, the non-scalable system is preferred. The second technique, however, takes intangible rewards into consideration. It considers future benefits of the system as may arise from efficiency in service delivery and improved revenue collection (Nas 2014).

Looking at the two information systems from a purely ‘’net profit’’ perspective, it is clear from the observation that both confer no immediate rewards and should be discarded. However, when intangible benefits are considered in light of the two systems, then the following scenarios arise: The ready-made system is not scalable but cheaper. The customized, in-house system is more expensive, gobbling up to$ 130,000, yet it is scalable and still customizable. If the organization would opt not to introduce any of those systems into their operations, then they would have to hire a new worker and still spend the overtime money on a growing wage bill. Of the three scenarios, I would recommend the more expensive, custom-made system.

Available data suggests that Good Health Clinic is growing. With a clientele of 3500 and the current staff straining to meet deadlines, the organization should invest in a system that will take care of its growth aspirations. Going by the present trend, it is safe to assume that the clientele will keep growing. It is also anticipated that the workload will keep growing and the practices’ revenue will grow to exceed ha amount of money spent to acquire it. Continued efficiency will help smoothen operations, and broaden the revenue base. The capital spent on acquiring the system – $130,000 will be recouped by the influx of clients in appreciation of efficiency in the clinic.

Conclusively, owing to the fact that Good Health clinic has registered steady growth in profitability over the years, buoyed by a growing clientele, there is need to invest in the right technology   to manage all aspects of the organization.







Fact Finding for the New System

Fact-finding is an important step in identifying organizational weaknesses to be addressed by the new system. Interviews provide the best way to obtain information for the systems analysts and designers. Other methods can be used to obtain both subjective and objective data (Loucks 2015). Some of these methods include:

  • Sampling existing documentation, forms, databases, research and site visits
  • Discovery prototyping
  • Questionnaires
  • Joint requirements planning

Staff member identified as primary users are the Office administrator and clinic head. Their primary roles effectively make it imperative that they are interviewed to reveal systemic inefficiencies that the new system will address.

Interview Questions

The interview questions for office administrator include the following;

  1. Explain your views on the process of claims processing in your facility.
  2. Identify some common data entry errors experienced in this organization.
  • How do you receive complaints from customers, suppliers, or staff?
  1. Identify common issues which arise from customer interactions.

The following question may suffice as interview questions for the clinic head:

  1. Briefly describe the claims processing procedure for patients under health insurance
  2. Describe your company’s data storage methods
  • Explain the most common outputs generated from the current system
  1. Who reserves the right of authorization to access organizational data?
  2. Identify the procedures available in processing discharge of patients
  3. Identify instances where employees have failed to follow procedures
  • State the procedures available for effecting overtime payments for clinicians
  • What complaints mechanisms are available for nurses and clinicians?
  1. What are the most common complaints received from the medical team
  2. What is the turnover of medical staff in the organization?

Recommendation of other Fact-Finding Techniques:

Sampling Existing Documentation, Forms, and Databases

 Useful data may be obtained by gleaning on organizational chart, memos and other internal communique that describe the problem, standard operating procedures, and flow carts.

Discovery Prototyping

 A representation of the working model on a smaller scale may be adopted by system designers to help users to discover their requirements. A justification of this approach is when development team cannot adequately define system requirements, hence have to rely on users to recognize requirements when they see them.


This a document used by systems analysts and designers for the express purpose of collecting information and opinions of respondents. Questionnaires guarantee privacy to respondents.

Joint Requirements Planning (JRP)

This is a process in which structured meetings consisting of sponsors, facilitators, users, managers, and IT staff are conducted to explore difficulties, and outline requirements. This is particularly useful for creating group consensus on problems, objectives, and requirements.

Main Functions to be handled by the New System:

Roles that Interact with the System

    • Staff duties (receptionists, nursing duties, doctors responsibilities including consultation, diagnosis, treatment, prescription, prognosis, review and many others),
    • Management of information system which include updates of patients records, generation of reports such as daily, weekly, and monthly claims
    • Records system: updates staff, patient, insurance, and supplier details. This is made possible in the following ways:
    • When a patient is admitted, or discharged, the system adds or removes them from the records.
    • When a suppliers contract ends or is terminated, the details are captured by adding into the records system.
    • Further, if a doctor or nurse leaves the organization, the details are updated accordingly.
    • Finance management which includes income from services offered at the clinic, and expenditure, from staff salaries, overhead costs, and payments to suppliers.      


Case Diagram for Good Health Clinic

            The use of case diagram is a schematic representation of users’ interaction with the system. It functions through modules which generate unique ID whenever a process is initiated. Typically the process initiated include login, patient registration, and so on. From the Good Health Clinic, various use cases are identified as follows:

  • Registration of patients: is a module that aids the registration of new patients by capturing information, and is the initial step in recording a patient’s medical history.
  • Patient Records: this module captures patients’ medical history as provided by doctors.
  • Add Doctor/Staff and Delete Doctor/Staff: this component helps update staff information in times when a member of staff is joins or leaves.
  • Edit Doctor/Staff
  • Update Claims: this module manages activities in the claims department, including generation of daily, weekly, and monthly claims and reports.
  • Doctor Appointments: this modules helps in scheduling of appointments at the front office through the generation of unique IDs that specify the time of appointment, appointment number, place of meeting, and other details as may be preferred.
  • Login: through this module, the system segregates users accordingly by granting different levels of access into the system. A doctor may have the privilege of accessing patients’ medical history, while the accountant may not.

In order to effect these use cases, there are actors (individual staff members, fields, and systems) that actualize them. These include:

  • Doctors
  • Staff/ Nurses/ Physiotherapists
  • Records System
  • Information Systems: to manage calls, internal emails,


Considered Use Case:

Doctor appointments: when a patient arrives for a scheduled visit, registration is done by the system.  The patient then pays the consultation fee which is captured by the addApptcharges method. A receipt is then produced containing the date, time, amount paid, and the affirmation of the appointment. The patient then proceeds with the receipt to see the doctor.










Full use-case diagram:


Doctor’s Appointment activity diagram


Review of Good Health Clinic’s Fact Finding Summary

From the interviews with the respective heads of the clinic and the office, the following is a review of the fact finding summary:

  • The organization relies on manual processing of claims, payments, pays lips, admission into the clinic, and referral.
  • The amount of paperwork has necessitated the employment of a dedicated employee
  • Towards the end of the month, all 6 employees in the office have to do accounts and reports. This inevitably shuts down the entire section at month end.
  • The security of data is compromised, as they have to rely on physical security of the computers.

Further, information emanating from interviewing the clinic head revealed the following:

  • The company stores data in respective workstations, thus compromising security.
  • Complaints handling mechanisms by staff, is mainly through suggestion box, which do not render timely response from the management.
  • Most common complaints from clinicians emanate from late processing of payments and
  • A brief description of the claims processing by the head of clinic section reveals challenges emanating from claims, such as inaccurate capture of patients details

From interviewing the office administrator, the following challenges were observed:

The common outputs have been identified as daily appointment list, daily call lists, weekly reports from insurance companies, monthly statements given to clients after every appointment, weekly insurance reports and monthly claim reports to the associates, and generated emails and texts to remind patients of appointments. However, the system has proved ineffective due to incessant errors in documentation, and prolonged delays.

ERD Diagram for Database Design

The clinic facility should be designed with the following tables:

Patients, practitioners, procedures, costs, appointment, dates, times just to mention.

                                                    Adopted from: https://i.stack.imgur.com/epW9Q.gif

In a server, database data is in the form of tables. The tables, then contain records which are identified by keys: primary and foreign keys respectively. The primary keys uniquely identify a record in the table. Examples of primary keys in the database include doctor_code in table_doctor, registration_number in table_registration, diagnose_code in table_diagnose, and clinic_code in table_clinic. Foreign keys, commonly employed in integration of tables, are fields which are primary keys in other tables. Some of the primary keys are actually foreign in other tables. For instance, from the above schema, the doctor_code, clinic_code, doctor_code, and diagnose_code are foreign keys in Transaction_history.





Bahill, A.T. and Madni, A.M., 2017. Discovering system requirements. In Tradeoff Decisions in System Design (pp. 373-457). Springer International Publishing

Brixius, N., Microsoft Corporation, 2004. Explaining task scheduling for a project. U.S. Patent        Application 10/881,900.

Fitzpatrick, C., Devshop Inc., 2007. Method for project management.           

Harrington, J.L., 2016. Relational database design and implementation. Morgan Kaufmann.

Loucks, E., 2015. Practitioner Interview.

Myers, L., 2016. Department of Social Work 2015-2016 Organizational Chart (Doctoral dissertation, Florida A&M University).

Nas, T.F., 2016. Cost-benefit analysis: Theory and application. Lexington Books. Mishan, E.J., 2015. Elements of Cost-Benefit Analysis (Routledge Revivals).Routledge.

Rodrigues, P., Oliveira, A., Alvarez, F., Cabás, R., Crosnier, M., Boutry, P., Vladimirova, T., Pietrabissa, A. and Oddi, G., 2013. D2. 2–System Requirements Document. European Commission Seventh Framework Programme-Space Theme. Bahr, N.J., 2014. System safety engineering and risk assessment: a practical approach. CRC Press.

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