Patient Healthcare Using SMS Technology Application

Patient Healthcare Using SMS Technology Application Chapter 1 Introduction to Patient Care Using SMS Application Patients travel longer distances for the opinion of consultant which is not possible either due to patient situation or due to distances. Enhancement of health care in different locations and other remote areas can be achieved using mobile phone applications [1]. 1.1 Problem Statement Development of mobile communication networks playing an important part in the enhancement of a mobile medicine. Patient Care Using SMS Application represents a feasible solution of patient care such as text messaging and booking appointments using mobile phones, which are best aspects of mobile medicine. The main idea is improve patient access to healthcare; encouraging patients to use mobile health application and supporting people with long term conditions [5]. 1.2 Objectives Incredible growth of mobile communication and recognition of new generation Wireless protocols has initiated the advance SMS based medical applications. Following that facts Patient care using SMS based application for mobile application for patient is good solution [5 6]. * To design and develop a WAP enabled wireless applications that will enhance the feature of mobile device by incorporating the features of a digital diary. The application should be able to get integrated with the existing application vis-à  -vis Exchange Server etc * Main aim of this application is to achieve â€Å"greater quality communication between GPs and consultants using mobile medicine, which will results in enhancement of patients care â€Å"[5 6]. 1.3 Scope The goal of Patient Care Using SMS Application is based on two major conditions. First, is to achieve proficient means to exchange message between General Practitioners and consultants care have to be provided. The second is sufficient exchange of patients information have to be provided. Additionally, privacy of communication and stored information has to be guaranteed. Both ethical and technical aspects are equally important [7]. 1.4 Existing Systems The existing system of treatment consists of two different systems. They are as follows: * Traditional or manual system * Online application 1.4.1 Traditional or Manual system The present system of treatment consists of manually consulting a doctor by taking prior appointment or else registering at that instant of time, waiting to get register themselves and then consulting the doctor which is a time consuming process. 1.4.1.1 Drawbacks * Time consuming * Patient need to stand in long queues to make appointments * Patients not follow prescription directions once they leave the surgery or hospital. Research has showed that more than 50 percent of patients not follow the management advised by their doctors may be due to lack of time and interest. 1.4.2 Online System Online application is also available where the user is provided a login and password through which he can access the website, make appointments, clarify their queries etc. The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. The online systems are discussed below are: * EMIS * VISION System 1.4.2.1 EMIS System EMIS ® stands for Egton Medical Information Systems Limited. EMIS provides a service that enables you access to your healthcare online [9]. After registering with the surgery, patients are able to book or cancel their appointments with the doctor. Patient can also request repeat prescription, send messages to their practice and update personal information if practice has set up these features online [10]. This example has been explained in detailed in chapter 2. 1.5.2 Example 2: Vision System Vision [14] is the most famous system in use UK, within the GPs sector today, due to its market leading features, functionalities and first class support from INPS. There are currently more than 1,800 GP practices which are using Vision system across the UK each day. â€Å"Vision system version 3 is fully RFA 99 acquiescent, includes, support for the encryptedEDIFACT pathology v1.1 message, MIQUEST and DTS. The Vision application is stable, proven and reliable. The strong product-base has allowed other features such as advanced-scanning, PDAs support and incorporated voice dictations as well as extension to core functionality such as XML based clinical-messaging, allowing integrations with third party systems† [14]. In this project we are more concentrating on EMIS rather than Vision system. Key Features Messaging Incorporated External system Appointments Consultation Manager Problem Orientated Views Community Caseload Search and Reporting 7. Clinical Audit Vision and the National Applications [14] Few of the above features are explain below [14]: 1. Messaging This system offers unparallel flexibility with the wider health community via its highly supple and adaptable in-built messaging and web-services. These allow patients data from number of external sources including the NHS Spine or local CPRs to be easily accessed and used within Vision, supporting the requirements of the NHS IT-strategy. Vision also manages a range of clinical messages from third party systems to support the patient care as follows: * Choose and Book Referrals (electronic booking) * E- Discharge Summaries * Radiology reports and Encrypted pathology reports * OOH Summaries With a powerful XML event and messaging engine, Vision is designed to ensure the performance of new messages require no changes to the core Vision product. In a single, clear and simple interface, all message types are managed. 2. Incorporated External System In the Vision tabbed views, external web enabled application can now be well-established, allow access patient information from number of sources to be seamlessly from the Vision desktop. The patient is automatically recognised in the target system, when the required data is passed to the third-party application. For integration into the patient record when required, important data may also be written back to Vision 3. Patients Appointments This Vision system allows user full access to the appointment screen. â€Å"Using session templates developed by the practice† the appointment books are defined in advance. The view of appointment book can be defined by user: all significant doctors and other Healthcare professionals can be added or deleted as requirements. To denote, each slots can be assigned in different colours. As the patients arrives at reception, enters the doctors room or leave the surgery, their status is recorded. Our evaluations are based on EMIS system, its features and limitation which have been explained in later chapters. 1.5 Thesis Organisation In chapter 1 we have explained Patient care using SMS application and its aim, objectives and scope. The existing systems such as manual and online systems are briefly explained in this chapter along with it features and disadvantages. The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. This chapter 3 gives brief overview of problems associated with online medical systems with examples. Problems of online medical system such as internet connection, email, prescription, Electronic Patient records and read codes are explained. In the chapter 4 we have focussed on Patient Records and how they are managed at General Practices and hospitals. The traditional paper based practices and its limitations have been explained with examples. The paper less practices and its pros have been explained and the reasons why practice should follow this have explained with examples. The advantages and disadvantages of Electronic patient records with s and examples are discussed in this chapter. The chapter 5 focuses on Read codes and its structures. In this chapter 3 versions of read codes are explain with examples. Maintenance of read codes i.e. internal process and external interaction and hierarchy has been explained with s. The example case study represents the limitations associated with 3 versions, its results and solutions. The chapter 6 is about EMIS database, i.e. patient database and focuses on its usability and security. It explains structure of database and its solutions. Secure Patient data transfer within the PCT has been explained. Storage Area Network is used by EMIS to store patient records. How the GPs and other Healthcare Professional access patient records has been explained. Advance system and its features are discussed in this chapter 7. Waterfall Models activities have been explained. The structure of advance system with s is discussed in this chapter. The conceptual and technical design of this project has been briefly explained. UML language is used in this project to represent user and admin operations. The chapter 8 explains the SMS system requirements such as Specification requirements, Functional requirements, Performance requirements, and hardware and software requirements. About operating system and languages used in this projects are discussed in this chapter. Wireless application protocol architecture and WAP server are explained using diagrams. Database requirements and its uses are explained using diagrams. Open wave SDK and its functions are discussed in this chapter. Chapter 2 Egton Medical Information Systems EMIS ® and EMIS intellectual technology are trading names of â€Å"Egton Medical Information Systems Limited†. EMIS had begun 18 years ago in a rural area dispensing practice in Egton near Whitby in North Yorkshire [11]. EMIS ® head-offices are based in Leeds, including Development and Support departments. Training for general practices is localised and headed by Provincial Operations Directors [11]. 2.1 Practice Care System Enterprise Due to the growing number of EPRs held in both GP and Secondary Care, the requirement for a whole EHR has never been greater. The EMISs Primary Care System Enterprise edition for PCTs has been designed to meet all the challenges. EMIS PCS will maintain the patient information at many levels and ease safe access 24/7 by the wider health care-community [11]. PCS Enterprise for PCTs has been designed with capability of future technological and keeping development in mind, such as sharing data between General Practices. This includes GP to GP records transfer and inter-operability between in- and OOH PCSs. Using a HL7 Version 3 the patient data is transferred between dedicated health care systems directly [11]. 2.2 An overview of PCS Enterprise This edition has been designed to develop EMIS provision of an absolute system solution for primary care. The system is scalable, multi-practice, and multi disciplinary with shared EPRs and seamless data exchange. This system is based on three-tier architecture, while utilising MS Dot Net technologies, this system has the flexibility to increase numerous clients with its ability to scale to thousands of instantaneous user connections [11]. EMIS Primary Care System Enterprise edition is designed to meet GP needs as closely as possible, while supporting specialties related to medicine. See in 2.1 below gives the overview of PCS Enterprise system: 2.3 EMIS Primary Care System Practice edition Health information system plays an important role in how practice operates. The good and right clinical system can help to save practice valuable time, assist in practice management and ultimately lead to improved patient care. The EMIS PCS Practice edition has been designed to meet GP needs, combining functionality with simplicity of use [11]. Key features of EMIS PCS * Complete patient record management * Quick and good prescribing * Formulary managements * Incorporated consultation mode * Incorporated appointments * Mentor Library * Integrated with MS Word support * User defined templates * Drug Explorer 2.4 EMIS LV Version 5.2 In the PCS market, EMIS Live Version [11] is the main text based medical system. Approximately 5000 GPs currently using EMIS LV system (which is shown below) in the UK. The system offers GPs consultation mode option, medical record, search and reports option, prescription and booking appointments. 2.5 Population Manager This system enables General Practices to effortlessly meet the requirement of the new GMS Contract. Population Manager [11] has a set of more than 160 searches that extract the data require for the new Contracts and present it in an understandable format. It also contains a set of specially designed templates to help speedy and standardised information entry. Population manager is an incorporated part of EMIS LV system. 2.6 Version 5.2 features This is the most recent release of EMIS LV. This LV offers users the following key features [11]: 2.6.1 MS Word incorporation Patient data is easily transferred between EMIS system and MS Word enabling the clinician or staff to create patient related letters in MS Word easily. To create consultation references for simple retrieval, documents are created in MS Word which is saved back into EMIS. 2.6.2 Referral template for Cancer patients If cancer is suspected GPs requires produce and fax or e-mail suspected cancer referrals within 24 hours of seeing the patient (this is according to the NHS Plan). These patients have to be seen by the Hospital Trust within 2 weeks; hence these referrals are named as â€Å"two week rule referrals†. EMIS has included a suite of MS Word templates for each cancer type into EMIS LV5.2. 2.6.3 Electronic Insurance reports One of the most common and time taking medical information requests for GPs is the PMA form for the claim companies. A familiar format for General Practitioner Report has been decided and computer-based reports (eGPR) are accepted by insurers. The electronic GPR can be generating within the EMIS system, integrating all related patient information. The eGPR template is installed by default in this system. 2.6.4 Scanning and attachments This module enables to scan corresponding or images and attaches them directly to a patients record in consultation mode. These documents are instantly available during consultation. 2.7 EMIS Clinical Communication Modules The following Clinical Communication Modules are available with EMIS LV5.2, providing links with Secondary Care [11]. 1 Online Referrals with Booked Admissions 2 Electronic Referrals 3 Incoming Reports including Electronic Discharges 4 Online Results Ordering With an approved list of suppliers this Clinical Communication Modules work. Using the common set of messaging standards currently being developed by the National Design Authority, links to other suppliers will become available, an arm of the National Programme for IT in the NHS. For this reason that EMIS are not progressing, with the further testing of links with other suppliers using proprietary messaging standards. The Clinical Communication Modules are explained below [11]: 2.7.1 Online Referrals and booked admissions Traditionally referring patients from doctors at general practices to hospital or Secondary Care consultants has been a paper based with its problems of delays (slowness) and occasional loss. The EMIS Online Referrals with Booked Admissions module enable us to create a referral on a Secondary Care website using protocols created by Secondary Care consultants, adding patient demographics and clinical information and in some cases booking an appointment. Requirements: Each EMIS practice must have: * EMIS LV 5.2 * NHS Net connectivity * Router access for EMIS * Version 2 clinical terms (5 byte Read Codes) The Secondary Care Provider will need: * An EMIS approved website 2.7.2 Electronic Referrals This module enables us to create a referral letter within EMIS LV and transmit it electronically to a secondary care consultant [11]. The way electronic referrals work You can use MS-Word Integration in EMIS LV to create a referral letter. When you save the referral letter, you are prompted to link with EDI for an electronic transmission: answer ‘Yes and the referral letter is placed in the Communications outbox (CO, OD). From here, you can check the letter before authorising the transmission. When you have authorised the transmission, you can either send the referral letter immediately or wait until the next scheduled transmission. Upon receiving the referral letter, the secondary care software system will transmit an acknowledgement that you can view within the EMIS Communications screen. Requirements Each EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS Support * SMTP or DTS mailbox * MS-Word Integration The secondary care provider will need: * SMTP or DTS mailbox * Suitable software capable of sending and receiving XML messages and acknowledgements * SMTP/DTS and EDI code addresses of the practices involved the trust should obtain these from the health authority or national tracking database 2.7.3 Incoming Reports including electronic discharges Use this information sheet to give you an overview of the Incoming Reports module and the requirements to get you started. The communication of patient information from out of hours services and secondary care used to be paper system, which has been unmanageable and untrustworthy with discharge notes being illegible, incomplete and often late in delivery. The paper-based system replaced by Incoming Reports module which receives electronic discharge notes or other patient related reports from an OOH service or a secondary care provider [11]. How does the Incoming Reports module work? Incoming Reports is a one-way process whereby the out of hours service or secondary care provider sends a message containing the incoming report to EMIS LV. However, EMIS LV will send an acknowledgement of receipt back to the provider. When EMIS LV receives a report, it is matched to the correct patient and placed on a list ready for viewing, and then filing. If EMIS LV cannot match a report to a patient automatically, you can match a patient manually. When viewing a report, you can match the clinical information in the report to clinical terms before you file it. You can link a report to a past consultation (for example, the consultation during which the original referral was made) or create a new consultation specifically for the report. You can view filed incoming reports using the *RL function in Consultation Mode. Requirements To use Incoming Reports, an EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS * A DTS address To use Incoming Reports, a secondary care provider must have: * A DTS address. * The DTS addresses and EDIâ‚ ¬Ã‚   codes for all required practices this information is available from the health authority or from the national tracking database. * Software to create and send XML messages and receive acknowledgements 2.7.4 Online Test Ordering Requesting and processing pathology samples were traditionally paper-based systems, with their inherent problems of slowness and occasional loss of information. Pathology labs can now provide web-enabled IT systems to produce a far more efficient and streamlined service. The EMIS Online Test Ordering module, available for EMIS PCS and EMIS LV systems, enables GPs, via a secure NHSnet connection, to access the pathology lab and exchange information regarding requests, samples and results [11]. Online Test Ordering can be access from Consultation Mode or Medical Record, and then access the website of a compatible laboratory. The current patients demographic and GP details are transferred to the laboratory system when you request the required tests. After you have ordered the tests, the test information is transferred to your EMIS system and filed in the patients record. At this point, you can continue with other work or take the test sample(s). When you take a sample, you can print a bar-coded label to attach to the sample, ready to send to the lab. Use the Online Test Ordering menu options to monitor the progress of the sample and view the results as soon as they are available, although you will still receive the results through the Clinical EDI or Pathology Links modules, as before [11]. Requirements Each EMIS practice must have: * EMIS LV 5.2 or EMIS PCS * NHSnet connectivity * Router access for EMIS * Version 2 clinical terms (5-byte Read codes) Support issues The overall Online Test Ordering process relies on different services and software all working in conjunction with each other: the EMIS software, the laboratory website and the NHSnet network. Unless a problem occurs with the EMIS software, EMIS is improbable to be able to resolve issues with the two areas; therefore, the secondary care trust and/or the practice should ensure that support facilities are in place for these eventualities. 2.8 Storage area network (SAN) Using the highest industry standard storage area network (SAN) configuration EMIS data centres are run [11], on which EMIS stores data [Detail explanation in later chapter]. Chapter Summary The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. Chapter 3 Drawbacks of Online systems Although online application provides many services the challenges associated with are given below. All the drawbacks are explained taking EMIS as an example. 3.1 Patient Record  ¨ Time required to put all relevant information onto system  ¨ Possible security issues  ¨ Doctor can focus too much on patient information onscreen which could intimidate the patient  ¨ Scanning and entry of data is more time consuming. Important information lost can when overlooking the record.  ¨ Medical record print-outs are frequently of poor quality and difficult to understand necessary information  ¨ In spite of using EPR, Paper records need to be kept back or scanned material become unmanageable.  ¨ Often using computer and paper records together will make patient data look very difficult.  ¨ Currently between GPs there is no electronic transfer as it is due to having a risk of data lost and duplication of data[16] 3.2 Appointments  ¨ Patients have to be checked into appointment system by receptionist  ¨ Problematic if patients cant read, or unable to view sign (e.g. blind people) 3.3 Prescriptions  ¨ Relies on drug information being up to date  ¨ Aptitude of doctor in using computer effectively  ¨ Some times doctors issue hand written prescription; they may not be available on computer. The acute and repeat prescribing registers can make it more confused. Printouts of Pharmacy still required [16]. 3.4 Email  ¨ Relies on doctor checking their mail daily  ¨ Troublesome patients abusing the system  ¨ Hospital letters not emailed (would be preferred) 3.5 Security issues  ¨ Doctors have to go to bother of signing on and off EMIS  ¨ Forgetting passwords  ¨ Passwords can be troublesome, staff or anyone can abused or swapped it, if they are lost the system can be absolutely in-operable  ¨ Leaving computer on  ¨ Locum doctors  ¨ Experts are need to show computer frauds and misuse [16] 3.6 Internet connection  ¨ Continuous internet connection required  ¨ The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. 3.7 Backup  ¨ System backed up every night onto tape  ¨ Two copies:- Fireproof safe Remote location 3.8 Read codes Maintenance of enormous clinical expressions or codes is very complex, and the Read Codes present many challenges. In addition, structure of controlled terminologies has been learned about the principle because of the structure of the earlier versions. Version 3, the existing read code systems have been design keeping in mind the previous, simple versions, and to achieve forward compatibility [17]. The problems associated in steps in read coding the medical problems are explain below in s step 1 and step2 The Read Codes are used for many purposes such as clinical audit, searches, source allocation, and for the making of central government statistical returns. Problems arise from different uses and from the different views of Healthcare professional. [17]. Statistical classifications like ICD and OPCS4 may cause inconvenience so they are cross map. Version 2 with its diagonal section closely mirrors ICD9, even though this doesnt always reflect a clinicians view, and correct hierarchy placement of a concept according to ICD9 rules may appear anomalous to a clinician. Besides this Version 2 initial aim is for a code, with its preferred term and it offers a single cross-map to these classifications, and its and all its synonyms, to map correctly to ICD9 [17]. Version 3 came with its directed acyclic graph structure, greater synonym purity, and much easy cross-mapping design, incorporating default maps and alternative maps, avoids the previous version limitations. However this came with other possible problems. Therefore, the two processes, authoring and mapping are closely incorporated [17]. Read/SNOMED Codes Read/SNOMED codes are used by the doctors at hospitals because medical records in future can be transferred through GP2GP links. â€Å"Unlike the principal of Linnaean classification of species in the 19th Century, James Read brings in an international categorization of medical activity to contain disease names, operations and procedures. The main aim of this classification was to allow easy transfer of data between GPs, hospital and PCTs and easy to use by clinical staff, administrators and planners† [24]. Read codes has been explained more clearly in chapter 4. 3.9 GP2GP Record transfer The experience of the GP2GP record transfer and the clinical involvement are explained this section. 3.9.1 The underlying principle for electronic GP-GP record transfer The vast majority of UK GPs (greater than 96 percent) are computerised in some way or other. A sizeable proportion of these practices use their computer systems for recording patient record information in whole or in part [33]. This results from a variety of causes whose main headings are: * Patient records that are an unpredictable mix between paper and electronic. * The net effect of the above is to place difficulties on new practices in identifying salient information in transferred records and in incorporating that information within the new record. This is to known to have significant (but un-quantified) resource implications for practices. There is also widespread anecdotal evidence of resulting adverse effects on patient care. The rationale for the electronic transfer of records is therefore: * As a support for electronic records in general practice and their general benefits in terms of decision support and audit/governance abilities. * To obviate the need, as far as possible, for re-keying of paper-based information for new patients and thus reduce resource implications * To reduce the risks to patients arising from the transfer of confusing records. 3.9.2 The nature of electronic GP-GP record transfer Electronic patient record systems in general practice in England are provided by the commercial sector. At the time of writing this annex to the Good Practice Guidelines, eleven different commercial suppliers are known to be involved in this provision. In simple terms is that it is a common convention for the representation of [33]: * Record encounters; what constitutes a single transaction with the record like a doctors consultation, a letter received from hospital or outside, an examination result etc * Names for these encounters; e.g. home visit, * Headings within these encounters * Complex clinical constructs * Read code mappings; such medication codes sets * Codes and associated text * Major modifiers of clinical meaning 3.9.3 The Problems of electronic GP-GP record transfer There are four particular aspects of current GP-GP records where the transfer process of that record information needs to be supported by additional rules or processes if fully safe and usable records are to be reconstituted on receiving systems and are explain below [33]. Medication information There are currently three different coding schemes for the representation of medication information on GP systems. The principal reasons for failure to reach 100% reliability are: * The multiple coding schemes used and * Failure of previous code mapping exercises (see chapter 5 on data transfer). 3.10 The Problem Oriented Medical Record (PMOR) Electronic health records (EHR) are more used in UK General Practice despite continuing improbability about its legality and admissibility. The transfer of electronic record is currently in demand by the practices when the patient moves i.e. GP2GP transfer. The EHR implementations differ from a simple sequential list of medical concepts in an out of date coding system to sophisticated Problem Oriented Medical Records (POMR) [31]. 3.10.1 Limitations of the PO Medical Record The limitations of POMR are explain below [31] * It is very easy to pick up but very difficult to maintain. * In the strict way of the word not all headings are problems. For example, the heading of Immunisation is used usually to indicate where all the entries related to a immunization history may be found. * Many different problems may be discussed within a single consultation * To check scanned documents is very difficult especially when patient record is too big * Problems are frequently linked in a fundamental way. * The PO Medical Record only gives a basic measure of the state of a problem. * Different clinicians, view the clinical record, required different information from the medical record as well as with different views. * Some of problems are complex and they are difficult to read. Those records which have few entries are conversely are easy to read, hence POMR is meant to avoid comes to the fore again. Though POMR have above limitation but it is a popular medium for data entry and viewing, there is indeed room for enhancement and progress [31]. 3.11 Other Disadvantages * Typing skills required for doctors and other clinicians. They are using ever more abbreviations and acronyms. * Many screen need to be changes to find results and mouse activity * Information can be hidden as only the informati Patient Healthcare Using SMS Technology Application Patient Healthcare Using SMS Technology Application Chapter 1 Introduction to Patient Care Using SMS Application Patients travel longer distances for the opinion of consultant which is not possible either due to patient situation or due to distances. Enhancement of health care in different locations and other remote areas can be achieved using mobile phone applications [1]. 1.1 Problem Statement Development of mobile communication networks playing an important part in the enhancement of a mobile medicine. Patient Care Using SMS Application represents a feasible solution of patient care such as text messaging and booking appointments using mobile phones, which are best aspects of mobile medicine. The main idea is improve patient access to healthcare; encouraging patients to use mobile health application and supporting people with long term conditions [5]. 1.2 Objectives Incredible growth of mobile communication and recognition of new generation Wireless protocols has initiated the advance SMS based medical applications. Following that facts Patient care using SMS based application for mobile application for patient is good solution [5 6]. * To design and develop a WAP enabled wireless applications that will enhance the feature of mobile device by incorporating the features of a digital diary. The application should be able to get integrated with the existing application vis-à  -vis Exchange Server etc * Main aim of this application is to achieve â€Å"greater quality communication between GPs and consultants using mobile medicine, which will results in enhancement of patients care â€Å"[5 6]. 1.3 Scope The goal of Patient Care Using SMS Application is based on two major conditions. First, is to achieve proficient means to exchange message between General Practitioners and consultants care have to be provided. The second is sufficient exchange of patients information have to be provided. Additionally, privacy of communication and stored information has to be guaranteed. Both ethical and technical aspects are equally important [7]. 1.4 Existing Systems The existing system of treatment consists of two different systems. They are as follows: * Traditional or manual system * Online application 1.4.1 Traditional or Manual system The present system of treatment consists of manually consulting a doctor by taking prior appointment or else registering at that instant of time, waiting to get register themselves and then consulting the doctor which is a time consuming process. 1.4.1.1 Drawbacks * Time consuming * Patient need to stand in long queues to make appointments * Patients not follow prescription directions once they leave the surgery or hospital. Research has showed that more than 50 percent of patients not follow the management advised by their doctors may be due to lack of time and interest. 1.4.2 Online System Online application is also available where the user is provided a login and password through which he can access the website, make appointments, clarify their queries etc. The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. The online systems are discussed below are: * EMIS * VISION System 1.4.2.1 EMIS System EMIS ® stands for Egton Medical Information Systems Limited. EMIS provides a service that enables you access to your healthcare online [9]. After registering with the surgery, patients are able to book or cancel their appointments with the doctor. Patient can also request repeat prescription, send messages to their practice and update personal information if practice has set up these features online [10]. This example has been explained in detailed in chapter 2. 1.5.2 Example 2: Vision System Vision [14] is the most famous system in use UK, within the GPs sector today, due to its market leading features, functionalities and first class support from INPS. There are currently more than 1,800 GP practices which are using Vision system across the UK each day. â€Å"Vision system version 3 is fully RFA 99 acquiescent, includes, support for the encryptedEDIFACT pathology v1.1 message, MIQUEST and DTS. The Vision application is stable, proven and reliable. The strong product-base has allowed other features such as advanced-scanning, PDAs support and incorporated voice dictations as well as extension to core functionality such as XML based clinical-messaging, allowing integrations with third party systems† [14]. In this project we are more concentrating on EMIS rather than Vision system. Key Features Messaging Incorporated External system Appointments Consultation Manager Problem Orientated Views Community Caseload Search and Reporting 7. Clinical Audit Vision and the National Applications [14] Few of the above features are explain below [14]: 1. Messaging This system offers unparallel flexibility with the wider health community via its highly supple and adaptable in-built messaging and web-services. These allow patients data from number of external sources including the NHS Spine or local CPRs to be easily accessed and used within Vision, supporting the requirements of the NHS IT-strategy. Vision also manages a range of clinical messages from third party systems to support the patient care as follows: * Choose and Book Referrals (electronic booking) * E- Discharge Summaries * Radiology reports and Encrypted pathology reports * OOH Summaries With a powerful XML event and messaging engine, Vision is designed to ensure the performance of new messages require no changes to the core Vision product. In a single, clear and simple interface, all message types are managed. 2. Incorporated External System In the Vision tabbed views, external web enabled application can now be well-established, allow access patient information from number of sources to be seamlessly from the Vision desktop. The patient is automatically recognised in the target system, when the required data is passed to the third-party application. For integration into the patient record when required, important data may also be written back to Vision 3. Patients Appointments This Vision system allows user full access to the appointment screen. â€Å"Using session templates developed by the practice† the appointment books are defined in advance. The view of appointment book can be defined by user: all significant doctors and other Healthcare professionals can be added or deleted as requirements. To denote, each slots can be assigned in different colours. As the patients arrives at reception, enters the doctors room or leave the surgery, their status is recorded. Our evaluations are based on EMIS system, its features and limitation which have been explained in later chapters. 1.5 Thesis Organisation In chapter 1 we have explained Patient care using SMS application and its aim, objectives and scope. The existing systems such as manual and online systems are briefly explained in this chapter along with it features and disadvantages. The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. This chapter 3 gives brief overview of problems associated with online medical systems with examples. Problems of online medical system such as internet connection, email, prescription, Electronic Patient records and read codes are explained. In the chapter 4 we have focussed on Patient Records and how they are managed at General Practices and hospitals. The traditional paper based practices and its limitations have been explained with examples. The paper less practices and its pros have been explained and the reasons why practice should follow this have explained with examples. The advantages and disadvantages of Electronic patient records with s and examples are discussed in this chapter. The chapter 5 focuses on Read codes and its structures. In this chapter 3 versions of read codes are explain with examples. Maintenance of read codes i.e. internal process and external interaction and hierarchy has been explained with s. The example case study represents the limitations associated with 3 versions, its results and solutions. The chapter 6 is about EMIS database, i.e. patient database and focuses on its usability and security. It explains structure of database and its solutions. Secure Patient data transfer within the PCT has been explained. Storage Area Network is used by EMIS to store patient records. How the GPs and other Healthcare Professional access patient records has been explained. Advance system and its features are discussed in this chapter 7. Waterfall Models activities have been explained. The structure of advance system with s is discussed in this chapter. The conceptual and technical design of this project has been briefly explained. UML language is used in this project to represent user and admin operations. The chapter 8 explains the SMS system requirements such as Specification requirements, Functional requirements, Performance requirements, and hardware and software requirements. About operating system and languages used in this projects are discussed in this chapter. Wireless application protocol architecture and WAP server are explained using diagrams. Database requirements and its uses are explained using diagrams. Open wave SDK and its functions are discussed in this chapter. Chapter 2 Egton Medical Information Systems EMIS ® and EMIS intellectual technology are trading names of â€Å"Egton Medical Information Systems Limited†. EMIS had begun 18 years ago in a rural area dispensing practice in Egton near Whitby in North Yorkshire [11]. EMIS ® head-offices are based in Leeds, including Development and Support departments. Training for general practices is localised and headed by Provincial Operations Directors [11]. 2.1 Practice Care System Enterprise Due to the growing number of EPRs held in both GP and Secondary Care, the requirement for a whole EHR has never been greater. The EMISs Primary Care System Enterprise edition for PCTs has been designed to meet all the challenges. EMIS PCS will maintain the patient information at many levels and ease safe access 24/7 by the wider health care-community [11]. PCS Enterprise for PCTs has been designed with capability of future technological and keeping development in mind, such as sharing data between General Practices. This includes GP to GP records transfer and inter-operability between in- and OOH PCSs. Using a HL7 Version 3 the patient data is transferred between dedicated health care systems directly [11]. 2.2 An overview of PCS Enterprise This edition has been designed to develop EMIS provision of an absolute system solution for primary care. The system is scalable, multi-practice, and multi disciplinary with shared EPRs and seamless data exchange. This system is based on three-tier architecture, while utilising MS Dot Net technologies, this system has the flexibility to increase numerous clients with its ability to scale to thousands of instantaneous user connections [11]. EMIS Primary Care System Enterprise edition is designed to meet GP needs as closely as possible, while supporting specialties related to medicine. See in 2.1 below gives the overview of PCS Enterprise system: 2.3 EMIS Primary Care System Practice edition Health information system plays an important role in how practice operates. The good and right clinical system can help to save practice valuable time, assist in practice management and ultimately lead to improved patient care. The EMIS PCS Practice edition has been designed to meet GP needs, combining functionality with simplicity of use [11]. Key features of EMIS PCS * Complete patient record management * Quick and good prescribing * Formulary managements * Incorporated consultation mode * Incorporated appointments * Mentor Library * Integrated with MS Word support * User defined templates * Drug Explorer 2.4 EMIS LV Version 5.2 In the PCS market, EMIS Live Version [11] is the main text based medical system. Approximately 5000 GPs currently using EMIS LV system (which is shown below) in the UK. The system offers GPs consultation mode option, medical record, search and reports option, prescription and booking appointments. 2.5 Population Manager This system enables General Practices to effortlessly meet the requirement of the new GMS Contract. Population Manager [11] has a set of more than 160 searches that extract the data require for the new Contracts and present it in an understandable format. It also contains a set of specially designed templates to help speedy and standardised information entry. Population manager is an incorporated part of EMIS LV system. 2.6 Version 5.2 features This is the most recent release of EMIS LV. This LV offers users the following key features [11]: 2.6.1 MS Word incorporation Patient data is easily transferred between EMIS system and MS Word enabling the clinician or staff to create patient related letters in MS Word easily. To create consultation references for simple retrieval, documents are created in MS Word which is saved back into EMIS. 2.6.2 Referral template for Cancer patients If cancer is suspected GPs requires produce and fax or e-mail suspected cancer referrals within 24 hours of seeing the patient (this is according to the NHS Plan). These patients have to be seen by the Hospital Trust within 2 weeks; hence these referrals are named as â€Å"two week rule referrals†. EMIS has included a suite of MS Word templates for each cancer type into EMIS LV5.2. 2.6.3 Electronic Insurance reports One of the most common and time taking medical information requests for GPs is the PMA form for the claim companies. A familiar format for General Practitioner Report has been decided and computer-based reports (eGPR) are accepted by insurers. The electronic GPR can be generating within the EMIS system, integrating all related patient information. The eGPR template is installed by default in this system. 2.6.4 Scanning and attachments This module enables to scan corresponding or images and attaches them directly to a patients record in consultation mode. These documents are instantly available during consultation. 2.7 EMIS Clinical Communication Modules The following Clinical Communication Modules are available with EMIS LV5.2, providing links with Secondary Care [11]. 1 Online Referrals with Booked Admissions 2 Electronic Referrals 3 Incoming Reports including Electronic Discharges 4 Online Results Ordering With an approved list of suppliers this Clinical Communication Modules work. Using the common set of messaging standards currently being developed by the National Design Authority, links to other suppliers will become available, an arm of the National Programme for IT in the NHS. For this reason that EMIS are not progressing, with the further testing of links with other suppliers using proprietary messaging standards. The Clinical Communication Modules are explained below [11]: 2.7.1 Online Referrals and booked admissions Traditionally referring patients from doctors at general practices to hospital or Secondary Care consultants has been a paper based with its problems of delays (slowness) and occasional loss. The EMIS Online Referrals with Booked Admissions module enable us to create a referral on a Secondary Care website using protocols created by Secondary Care consultants, adding patient demographics and clinical information and in some cases booking an appointment. Requirements: Each EMIS practice must have: * EMIS LV 5.2 * NHS Net connectivity * Router access for EMIS * Version 2 clinical terms (5 byte Read Codes) The Secondary Care Provider will need: * An EMIS approved website 2.7.2 Electronic Referrals This module enables us to create a referral letter within EMIS LV and transmit it electronically to a secondary care consultant [11]. The way electronic referrals work You can use MS-Word Integration in EMIS LV to create a referral letter. When you save the referral letter, you are prompted to link with EDI for an electronic transmission: answer ‘Yes and the referral letter is placed in the Communications outbox (CO, OD). From here, you can check the letter before authorising the transmission. When you have authorised the transmission, you can either send the referral letter immediately or wait until the next scheduled transmission. Upon receiving the referral letter, the secondary care software system will transmit an acknowledgement that you can view within the EMIS Communications screen. Requirements Each EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS Support * SMTP or DTS mailbox * MS-Word Integration The secondary care provider will need: * SMTP or DTS mailbox * Suitable software capable of sending and receiving XML messages and acknowledgements * SMTP/DTS and EDI code addresses of the practices involved the trust should obtain these from the health authority or national tracking database 2.7.3 Incoming Reports including electronic discharges Use this information sheet to give you an overview of the Incoming Reports module and the requirements to get you started. The communication of patient information from out of hours services and secondary care used to be paper system, which has been unmanageable and untrustworthy with discharge notes being illegible, incomplete and often late in delivery. The paper-based system replaced by Incoming Reports module which receives electronic discharge notes or other patient related reports from an OOH service or a secondary care provider [11]. How does the Incoming Reports module work? Incoming Reports is a one-way process whereby the out of hours service or secondary care provider sends a message containing the incoming report to EMIS LV. However, EMIS LV will send an acknowledgement of receipt back to the provider. When EMIS LV receives a report, it is matched to the correct patient and placed on a list ready for viewing, and then filing. If EMIS LV cannot match a report to a patient automatically, you can match a patient manually. When viewing a report, you can match the clinical information in the report to clinical terms before you file it. You can link a report to a past consultation (for example, the consultation during which the original referral was made) or create a new consultation specifically for the report. You can view filed incoming reports using the *RL function in Consultation Mode. Requirements To use Incoming Reports, an EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS * A DTS address To use Incoming Reports, a secondary care provider must have: * A DTS address. * The DTS addresses and EDIâ‚ ¬Ã‚   codes for all required practices this information is available from the health authority or from the national tracking database. * Software to create and send XML messages and receive acknowledgements 2.7.4 Online Test Ordering Requesting and processing pathology samples were traditionally paper-based systems, with their inherent problems of slowness and occasional loss of information. Pathology labs can now provide web-enabled IT systems to produce a far more efficient and streamlined service. The EMIS Online Test Ordering module, available for EMIS PCS and EMIS LV systems, enables GPs, via a secure NHSnet connection, to access the pathology lab and exchange information regarding requests, samples and results [11]. Online Test Ordering can be access from Consultation Mode or Medical Record, and then access the website of a compatible laboratory. The current patients demographic and GP details are transferred to the laboratory system when you request the required tests. After you have ordered the tests, the test information is transferred to your EMIS system and filed in the patients record. At this point, you can continue with other work or take the test sample(s). When you take a sample, you can print a bar-coded label to attach to the sample, ready to send to the lab. Use the Online Test Ordering menu options to monitor the progress of the sample and view the results as soon as they are available, although you will still receive the results through the Clinical EDI or Pathology Links modules, as before [11]. Requirements Each EMIS practice must have: * EMIS LV 5.2 or EMIS PCS * NHSnet connectivity * Router access for EMIS * Version 2 clinical terms (5-byte Read codes) Support issues The overall Online Test Ordering process relies on different services and software all working in conjunction with each other: the EMIS software, the laboratory website and the NHSnet network. Unless a problem occurs with the EMIS software, EMIS is improbable to be able to resolve issues with the two areas; therefore, the secondary care trust and/or the practice should ensure that support facilities are in place for these eventualities. 2.8 Storage area network (SAN) Using the highest industry standard storage area network (SAN) configuration EMIS data centres are run [11], on which EMIS stores data [Detail explanation in later chapter]. Chapter Summary The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. Chapter 3 Drawbacks of Online systems Although online application provides many services the challenges associated with are given below. All the drawbacks are explained taking EMIS as an example. 3.1 Patient Record  ¨ Time required to put all relevant information onto system  ¨ Possible security issues  ¨ Doctor can focus too much on patient information onscreen which could intimidate the patient  ¨ Scanning and entry of data is more time consuming. Important information lost can when overlooking the record.  ¨ Medical record print-outs are frequently of poor quality and difficult to understand necessary information  ¨ In spite of using EPR, Paper records need to be kept back or scanned material become unmanageable.  ¨ Often using computer and paper records together will make patient data look very difficult.  ¨ Currently between GPs there is no electronic transfer as it is due to having a risk of data lost and duplication of data[16] 3.2 Appointments  ¨ Patients have to be checked into appointment system by receptionist  ¨ Problematic if patients cant read, or unable to view sign (e.g. blind people) 3.3 Prescriptions  ¨ Relies on drug information being up to date  ¨ Aptitude of doctor in using computer effectively  ¨ Some times doctors issue hand written prescription; they may not be available on computer. The acute and repeat prescribing registers can make it more confused. Printouts of Pharmacy still required [16]. 3.4 Email  ¨ Relies on doctor checking their mail daily  ¨ Troublesome patients abusing the system  ¨ Hospital letters not emailed (would be preferred) 3.5 Security issues  ¨ Doctors have to go to bother of signing on and off EMIS  ¨ Forgetting passwords  ¨ Passwords can be troublesome, staff or anyone can abused or swapped it, if they are lost the system can be absolutely in-operable  ¨ Leaving computer on  ¨ Locum doctors  ¨ Experts are need to show computer frauds and misuse [16] 3.6 Internet connection  ¨ Continuous internet connection required  ¨ The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. 3.7 Backup  ¨ System backed up every night onto tape  ¨ Two copies:- Fireproof safe Remote location 3.8 Read codes Maintenance of enormous clinical expressions or codes is very complex, and the Read Codes present many challenges. In addition, structure of controlled terminologies has been learned about the principle because of the structure of the earlier versions. Version 3, the existing read code systems have been design keeping in mind the previous, simple versions, and to achieve forward compatibility [17]. The problems associated in steps in read coding the medical problems are explain below in s step 1 and step2 The Read Codes are used for many purposes such as clinical audit, searches, source allocation, and for the making of central government statistical returns. Problems arise from different uses and from the different views of Healthcare professional. [17]. Statistical classifications like ICD and OPCS4 may cause inconvenience so they are cross map. Version 2 with its diagonal section closely mirrors ICD9, even though this doesnt always reflect a clinicians view, and correct hierarchy placement of a concept according to ICD9 rules may appear anomalous to a clinician. Besides this Version 2 initial aim is for a code, with its preferred term and it offers a single cross-map to these classifications, and its and all its synonyms, to map correctly to ICD9 [17]. Version 3 came with its directed acyclic graph structure, greater synonym purity, and much easy cross-mapping design, incorporating default maps and alternative maps, avoids the previous version limitations. However this came with other possible problems. Therefore, the two processes, authoring and mapping are closely incorporated [17]. Read/SNOMED Codes Read/SNOMED codes are used by the doctors at hospitals because medical records in future can be transferred through GP2GP links. â€Å"Unlike the principal of Linnaean classification of species in the 19th Century, James Read brings in an international categorization of medical activity to contain disease names, operations and procedures. The main aim of this classification was to allow easy transfer of data between GPs, hospital and PCTs and easy to use by clinical staff, administrators and planners† [24]. Read codes has been explained more clearly in chapter 4. 3.9 GP2GP Record transfer The experience of the GP2GP record transfer and the clinical involvement are explained this section. 3.9.1 The underlying principle for electronic GP-GP record transfer The vast majority of UK GPs (greater than 96 percent) are computerised in some way or other. A sizeable proportion of these practices use their computer systems for recording patient record information in whole or in part [33]. This results from a variety of causes whose main headings are: * Patient records that are an unpredictable mix between paper and electronic. * The net effect of the above is to place difficulties on new practices in identifying salient information in transferred records and in incorporating that information within the new record. This is to known to have significant (but un-quantified) resource implications for practices. There is also widespread anecdotal evidence of resulting adverse effects on patient care. The rationale for the electronic transfer of records is therefore: * As a support for electronic records in general practice and their general benefits in terms of decision support and audit/governance abilities. * To obviate the need, as far as possible, for re-keying of paper-based information for new patients and thus reduce resource implications * To reduce the risks to patients arising from the transfer of confusing records. 3.9.2 The nature of electronic GP-GP record transfer Electronic patient record systems in general practice in England are provided by the commercial sector. At the time of writing this annex to the Good Practice Guidelines, eleven different commercial suppliers are known to be involved in this provision. In simple terms is that it is a common convention for the representation of [33]: * Record encounters; what constitutes a single transaction with the record like a doctors consultation, a letter received from hospital or outside, an examination result etc * Names for these encounters; e.g. home visit, * Headings within these encounters * Complex clinical constructs * Read code mappings; such medication codes sets * Codes and associated text * Major modifiers of clinical meaning 3.9.3 The Problems of electronic GP-GP record transfer There are four particular aspects of current GP-GP records where the transfer process of that record information needs to be supported by additional rules or processes if fully safe and usable records are to be reconstituted on receiving systems and are explain below [33]. Medication information There are currently three different coding schemes for the representation of medication information on GP systems. The principal reasons for failure to reach 100% reliability are: * The multiple coding schemes used and * Failure of previous code mapping exercises (see chapter 5 on data transfer). 3.10 The Problem Oriented Medical Record (PMOR) Electronic health records (EHR) are more used in UK General Practice despite continuing improbability about its legality and admissibility. The transfer of electronic record is currently in demand by the practices when the patient moves i.e. GP2GP transfer. The EHR implementations differ from a simple sequential list of medical concepts in an out of date coding system to sophisticated Problem Oriented Medical Records (POMR) [31]. 3.10.1 Limitations of the PO Medical Record The limitations of POMR are explain below [31] * It is very easy to pick up but very difficult to maintain. * In the strict way of the word not all headings are problems. For example, the heading of Immunisation is used usually to indicate where all the entries related to a immunization history may be found. * Many different problems may be discussed within a single consultation * To check scanned documents is very difficult especially when patient record is too big * Problems are frequently linked in a fundamental way. * The PO Medical Record only gives a basic measure of the state of a problem. * Different clinicians, view the clinical record, required different information from the medical record as well as with different views. * Some of problems are complex and they are difficult to read. Those records which have few entries are conversely are easy to read, hence POMR is meant to avoid comes to the fore again. Though POMR have above limitation but it is a popular medium for data entry and viewing, there is indeed room for enhancement and progress [31]. 3.11 Other Disadvantages * Typing skills required for doctors and other clinicians. They are using ever more abbreviations and acronyms. * Many screen need to be changes to find results and mouse activity * Information can be hidden as only the informati

Memorable Experience with Writing and Reading Essay

â€Å"You cannot open a book without learning something† (Confucius). About two months before school started, the weather became extremely hot. I stayed at home to enjoy the air-conditioning and to do some reading. I grabbed an arbitrary book which had probably sat on my shelf during the whole summer. On the cover, it read â€Å"Voices and Values: A Reader for Writers by Janet M.Goldstein and Beth Johnson†. On the inside, a few carelessly folded pages indicated that the book had ever been used. This book, a collection of effective essays, was a requirement for one of my classes. It theoretically served as a key to succeed both in reading and writing, but I had only read ten essays in an attempt to finish my homework assignments enough to maintain a fair grade in the course. That was how I approached school, getting the highest possible grade with the lowest possible effort. However, after reading several more essays in â€Å"Voices and Values†, my attitude toward studying changed. In my family, education plays a serious role. My parents taught me to study hard. Nevertheless, I personally viewed these ideas childishly and impractically. I told myself that it would be a waste of time to try too hard and fully absorb any of the material I was studying. What I did was to study enough to gather the facts. I used to taste ideas, chew on them for as long as it took to survive in class, and then, after tests, spit them out. Grades, after all, had served as the most powerful element in my educational view. As a matter of fact, while my grades were thriving, my mind was stagnating. As I opened the book that day, looking for some interesting essays that I might have missed, I found more than that. This book is much more than an academic book designed to teach critical reading and writing skills. â€Å"Voices and Values†, in some ways, introduces its readers to higher moral lessons. The essays, â€Å"Dare to Think Big† by Dr. Ben Carson, â€Å"From Nonreading to Reading† by Stacy Kelly Abbott, â€Å"Reading to Survive† by Paul Langan, and â€Å"Learning Survival Skills† by Jean Coleman, are different stories written by different authors, but they all exude the same ideas resurrecting lost hope to people, encouraging people not to surrender, and imparting how important education is to people’s lives. Their words did not so much sound new to me as they reminded me of some ideas that I had known, some concepts I had held. However, I had stored them somewhere in my head and never used them. â€Å"As I look back over the past for years, I see all the things that have happened to make me see how important reading is. I am not where I want to be yet, but I will be in a year or two† (Abbott). Abbott’s words moved around and enli ghtened me. Looking back over twelve years in school, I found myself nothing more than a revolving machine: receiving data, keeping it in short-term memory to cope with the tests, and then removing it as soon as possible. What I did, indeed, never could be called â€Å"studying† or â€Å"learning,† but using a basic skill to achieve the best grade possible. Chemistry, World History, National History, World Geography, National Geography, Agricultures, and Biology, these subjects never seemed strange to me. I had undertaken, struggled, and passed through them years before in Vietnam. Unfortunately, none of them managed to set up roots in my mind. These things, which were supposed to be general information for a long term student, had come and gone like a visitor. I did not change; I did not grow; I did not accumulate any useful knowledge for myself. Worse than that, I was still too innocent to realize I had been on the wrong path and had the wrong attitude. The misconception I had about education eventually prevented me from opening my eyes and my mind. â€Å"And that is how we have to learn to think about life! With a long-term view. A Big-Picture perspective!† (Carson). There are times, when a person’s mind encounters the right philosophies, and self-discovery happens. In a flash, I visualized an uncertain future, where I could see myself was holding a materialistic degree with spiritual ignorance, knowing nothing about the world, and being completely empty of practical knowledge. Then, I knew that if there were ever a time for me to abandon the misconception about education, it was at that moment. As Peck stated in his essay â€Å"Responsibility†, â€Å"This is because we must accept responsibility for a problem before we can solve it. We cannot solve a problem by hoping that someone else will solve it for us.† Using education as a key to succeed is my responsibility. I realized that I am the person who has to deal with my future, and it was time for me to solve it. â€Å"I feel passionately that all of us can control our own destinies. Students should plan for a realistic career, get themselves organized, learn to persist, be positive, and open themselves to growth† (Coleman). I was determined to change, to create a new attitude. I wanted to learn not just for the grades, but also for the knowledge. From that moment, I told myself to be more concerned with the information than with the grades. The information is what education really is, while the grades are sometimes merely an outward factor. I began refusing to use the phrase â€Å"just study enough† as an excuse for not trying. However, several times, when I felt regretful for having held the wrong attitude for such a long time, again, I found my concerns reflected in â€Å"Voices and Values†. Most of the people in that book started their education a little late and faced many difficulties. Even so, they were seriously struggling, combating, and they overcame their own obstacles. At the age of nineteen, I am ready to be a go-getter, to thrive with a new passion which has been redefined. I will always cherish the moment that I touched that book, â€Å"Voices and Values†, that has spiritually changed who I am.†

Ethical behaviour in business Essay

In this task I will be explaining how my business (Ben and Jerry’s) could change or alter some of its practices and showing how these changes would contribute to improved ethical behaviour. The ethical issues I will be working on are CSR and trading fairly. Corporate social responsibility: Businesses do not exist in isolation nor is it simply just to make money; a lot of factors come into play. Customers, suppliers and the local community are all affected by the business and its operations. Ben and Jerry’s products, and the way they produce them all have an impact on the environment. CSR is all about businesses understanding the effects that they have on the community/wider world. Businesses will use this impact in a positive way to benefit both their business and the wider world. CSR means that business such as Ben and Jerry’s will have to take responsible attitude, going beyond the minimum legal requirements (as being ethical is strictly something you don’t have to do by law) and following basic principles that apply. How Ben and Jerry’s are responsible to society? Ben and Jerry’s take on corporate social responsibilities, taking action to achieve more desired goals to expand their business growth and also maintaining open line communication with employees to gain a better outcome. Ben and Jerry’s conduct various CSR activities, some of these include: Use of Fairtrade ingredients- Ben and Jerry’s first started using Fairtrade certified ingredients in 2005; they pledged in 2010 that by the end of 2013 they will go fully Fairtrade. Ben and Jerry’s work with dairy farmers and other farmers from third world countries, they source ingredients like cocoa, vanilla pods and various other ingredients. Fair Trade standards ensure that employees in these countries have good and safe working conditions, work reasonable hours and paid a fair amount for their work. Corporate Philanthropy- Corporate philanthropy in simple terms means a business’s care/love of humanity. Ben and Jerry’s a portion of its pre-tax profits to corporate philanthropy in attempts to become more socially responsible. Corporate philanthropy is led by employees through the B&J’s foundation and community action teams. Ben and Jerry’s award 1.8 million dollars to a philanthropy (an organisation that helps communities and the welfare of others) every year in and around Vermont, where Ben and Jerry’s  was initially set up. Engaging the Community through Community-based Projects- Another way in which Ben and Jerry’s is engaging in corporate responsibility to society is by setting up community –based development projects. The Vermont Dairy Farm Sustainability Project, which was launched by Ben & Jerry’s in 1999, set out to develop practical methods that could be used on day-to-day dairy operations to keep the water quality safe from nitrogen and phosphorus while not sacrificing the economic viability of the farm and making the farm a sustainable business. How can Ben and Jerry’s change/alter corporate social responsibilities (listed above) to contribute even more to improved business ethical behaviour? Ben and Jerry’s do all they can to make sure that they are socially responsible to stakeholders. They have engaged in a wide variety of activities/projects to insure that they do what they claim to do and that is to be as responsible to the wider community as much as they can, this includes Fairtrade, good working conditions, humanitarian concerns and other key factors in making sure that the community is affected in a positive manner. There is no denying that Ben and Jerry’s are very successful in their business operations and also their responsibility toward the society. But there are instances where they can improve on certain things. First of all the business follow all ethical procedures from Sourcing ingredients fairly to protecting the environment to the best of their ability’s, but if you were to be p icky Ben and Jerry’s are unethical in the sense that they are promoting unhealthy food. Now to most people this will not seem like a huge deal, but because obesity levels are on the increase and campaigns have been set up to tackle obesity and unhealthy eating, it seems somewhat of a contradictory move by Ben and Jerry’s to promote and sell Ice cream. This is being very, very picky however as they, like mentioned earlier, they ensure various factors are done ethically. You can argue that their advertisements and marketing techniques do not in any way state the products are healthy, so it’s not that they are misleading people. Some people may say that all Ben and Jerry’s do is sell unhealthy, fattening, chocolate rich ice creams, which can be considered a bit unethical. So in order to tackle this issue and make the company an even more ethically operating organisation, they can introduce healthier ice-cream or produce something alongside their standard ice-creams which is significantly healthier. They can use ingredients that  are healthier/low fat and implement a recipe that is just as good if not better than the original. This would contribute to better ethical behaviour by Ben and Jerry’s because it allows them to give people concerned an option of purchasing healthy (healthier) ice-cream. This will also mean that they are somewhat promoting healthier eating as people will look at them and think highly of them as they are taking these obesity concerns into consideration and doing something about it. Trading fairly: Trading fairly is a movement which strives for fair treatment for farmers. In a fair trade agreement, farmers will negotiate with the purchasers in order to receive a fair price for their products. Farmers who engage in fair trade also aim to pay their workers a fair price, and engage in environmentally-friendly practices. How Ben and Jerry’s trade fairly? Ben and Jerry’s have multiple tasks/missions they conduct to ensure that their operations are done fairly. First of all they are using fair trade. Using the Fairtrade method means that farmers who supply the ingredients get a fair pay, working and living environment. Another way in which they trade fairly is that they give back to society. This may seem like it is not directly trading fairly but Ben and Jerry’s do give something back to society. What they do is that they â€Å"operate the company in a way that actively recognizes the central role that business plays in society by initiating innovative ways to improve the quality of life locally, nationally and internationally† ( Source Ben and Jerry’s website). So while they are producing high quality ingredients at the same time they are giving back to society locally, nationally and internationally. How can Ben and Jerry’s change/alter trading fairly (listed above) to contribute even more to impro ved business ethical behaviour? Like with the previous point I struggled to really find an area within Ben and Jerry’s that they need improving on so I had to be picky, the same goes for trading fairly. Ben and Jerry’s seem to tick all the boxes when it comes to trading fairly; I mean they do everything from Fairtrade to providing the community that little something back. But If I were to be picky I think there is one thing that they might have to improve on ever so slightly and that is the marketing of  the products. The criticism that I have for their marketing is that they have allegedly a couple of times offended customers with the names of their ice creams. Now this may not seem like it has nothing to do with trading fairly but it is. The reason as to why it is because customers are ultimately the ones keeping your business going, now if they were offended with the marketing techniques such as naming then they will be put off in the future. Although Ben and Jerry’s have admitted to using â€Å"cheeky names† on their ice creams they do not do this with the intention of offending people although they have mislead/offended a few. Although they have now changed the names of those products and it was a one off incident they’ll be keen to make sure that this does not happen in the future. (The source where I found out about the names of products offending customers- http://www.huffingtonpost.com/2014/09/19/hazed-and-confused_n_5845650.html) So in order to alter the trading of products Ben and Jerry’s can make sure that in future releases of new Ice cream they choose names carefully and make sure that they do not refer to anything in a bad light . Ben and Jerry’s are known for their innovative names but in order to prevent people from getting offended they can make sure they choose names that are simple in the sense that people won’t get offended. They will have to take into consideration various factors that could offend people and make sure that names that are obvious to offend people are not used and well away from the products they make.

The phenomenon Doctor Who Free Essay Example, 2000 words

This particular study focuses on understanding the increasing active role of the prosumers in today’s digital world, taking into consideration the phenomenon of Doctor Who. Role of the Audience in Cultural and Creative Industries The media is significantly associated with the cultural and creative industries. In regard to this, it has been obtained that the meaning of any context presented through the media depends on the sole interpretations of the individuals watching it. Hence individuals tend to construct meanings as per their understanding and interpretation. While it is possible for the culture and creative industries to create a culture with their intentions of the use of the media, the viewers or the audiences have the right to interpret the media contents according to their understanding and wishes (Hinton and Hjorth, 79). With digital shows, the audiences are becoming more involved and engaged with the shows and hence they are considered to have become more active (Jones and Salter, 65-67). Over the years the market place seems to have become more complex than before. The proactive consumers are better described as prosumers. It also describes the relation between the consumer and the producer, which is significantly changing and developing over the recent years. We will write a custom essay sample on The phenomenon Doctor Who or any topic specifically for you Only $17.96 $11.86/pageorder now Their participation and role in the production of the products have increased that also make them professional consumers fitting them in the category of prosumers. Thus for the prosumers, producers have to assure higher quality of products, as they are more involved in giving their feedbacks and advocacies, thereby indulging the need for new ideas (Everard, 86-87). With the advent of new technologies, particularly reflected through the information technology, it has become easier and more comfortable for the consumers to communicate either with themselves or with the producers as well (Boundless). The twentieth century has seen rise in the studies on audiences in particular. Earlier the relation of the audience with the media was less direct than what can be observed in the present times. With higher interactions and greater modes of interpretation, it is also relevant that audiences can change the meaning of the media context that has been presented to them, depending on their own interpretation. This has increased the role of the individuals in the digital world or the media (Brooker and Jermyn, 5-16). It is over the recent years that television programs have significantly become popular among the ordinary people, which include reality shows, confessional programs, interviews, documentaries, and others.