my masters thesis paper
TRANSCRIPT
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Associated college of
A technical comparison of Patient Record Management System used in the
National Health Service, United Kingdom with that of Bangladesh Public
Health Sector, the People's Republic of Bangladesh
Conducted By:
MOHAMMAD BADRUL ALOM CHOWDHURY
ID: 20069794
Supervised By:
DR. UMA MOHAN
Senior Programme Leader, Department of Information Technology
London School of Commerce
The dissertation is submitted to fulfil the requirements of the degree of Master of Science in
Information Technology
November 26, 2015
CARDIFF METROPOLITAN UNIVERSITY
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Abstract
The dissertation presents an overview of Patient Record Management System (PRMS) which
is a method to determine the Patient Record (PR) in an organised structure. Different
countries or hospitals follow numerous PRMS because of the technological advancement of
Information Technology. Nowadays, PR is the principal storehouse for pertaining health care
of a patient. It concerns in many ways, every one related with health care services by
offering, accepting or compensating.
The suitable approach for this dissertation is deductive regarding their type of reasoning
deduction, objectivity and causation. Also which is used for the reason that quantitative
research method is related with this and from the sample it can evaluate the occurrence of
different views and opinions. Moreover, it can explore for further findings. However,
comparative research is the most relevant design to be chosen. Because this research type
prefers to discover, examine and describe similarities and differences between NHS, UK and
BPHS, Bangladesh. In addition, research crosses the national boundaries because this does
not care what the research method is being used.
Data were collected by the leaflet questionnaire and face-to-face interview. Two sets of
questionnaire (both open-ended and close-ended) ware set for the participants, one of this was
for Bangladeshi citizen and other was for British citizen who is aware of the PRMS in
Bangladesh. Moreover, all the interviews were conducted in Royal London Hospital from the
NHS staffs.
Data was analysed by quantitative approaches and the result has demonstrated in pie charts
for British respondents, bar charts for Bangladeshi respondents and radar chart from the
response of interviews given by medical staffs of Royal London Hospital. Overall from the
feedback of all the respondents, it can be said that the PRMS of NHS is well developed and
already the government of BPHS have taken initiatives to improve their PRMS, however, at
present there is a huge difference between NHS and BPHS. Finally, if BPHS follows the
procedure of PRMS in NHS it would be easier for them to improve their system quickly.
The dissertation has a few limitation in data collection part. As the data were collected among
17 Bangladeshi and 16 British respondents by the leaflet questionnaire as well as only 5
interviews taken from the NHS staffs where more respondents were needed for getting
accurate results. So in future data will be collected by the interviewing, questioning as well as
by observing in a large group of people.
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Acknowledgement
I would like to thank my honourable supervisor Dr. Uma Mohan for her guidance throughout
the process. She exposed me to the real professional research world with her precious
experience. I really cherish for the time working with her on such an important topic. Also I
would like to thank those who participates to fill up survey questionnaire and interviews for
data collection of the research process. Last but not least, thanks to the Almighty Allah for
helping me in every steps of this dissertation work.
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Table of Contents
Abstract _________________________________________________________________ iv
Acknowledgement __________________________________________________________ v
Table of Contents __________________________________________________________ vi
List of Figures _____________________________________________________________ ix
List of Charts ______________________________________________________________ ix
List of Tables ______________________________________________________________ ix
List of Screenshots _________________________________________________________ ix
List of Abbreviations & Symbols _______________________________________________ x
Chapter 1: Introduction ______________________________________________________ 1
1.0 Introduction ________________________________________________________________ 1
1.1 Research Domain ____________________________________________________________ 2
1.2 Problem Domain ____________________________________________________________ 2
1.3 Significance of the Study ______________________________________________________ 3
1. 4 Research Questions __________________________________________________________ 4
1.4.1 Main Question _____________________________________________________________________ 4
1.4.2 Sub Questions _____________________________________________________________________ 4
1.5 Aims and Objectives of the Study _______________________________________________ 5
1.5.1 Aims _____________________________________________________________________________ 5
1.5.2 Objectives ________________________________________________________________________ 5
1.6 Organisation of the Research Work _____________________________________________ 6
1.6.1 Chapter 1 _________________________________________________________________________ 6
1.6.2 Chapter 2 _________________________________________________________________________ 6
1.6.3 Chapter 3 _________________________________________________________________________ 6
1.6.4 Chapter 4 _________________________________________________________________________ 6
1.6.5 Chapter 5 _________________________________________________________________________ 6
1.7 Time Management Aspects ____________________________________________________ 7
1.8 Chapter Summary ____________________________________________________________ 8
Chapter 2: Literature Review __________________________________________________ 9
2.0 Introduction ________________________________________________________________ 9
2.1 Patient Record Management System ___________________________________________ 10
2.1.1 Patient Record ____________________________________________________________________ 10
2.1.2 Definition of PRMS ________________________________________________________________ 10
2.1.3 Types of PRMS ____________________________________________________________________ 10
2.1.3.1 Dedicated Patient Health Records ________________________________________________ 10
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2.1.3.2 Paper-Based Record System _____________________________________________________ 10
2.1.3.3 Hybrid and Paper Record System _________________________________________________ 11
2.1.3.4 Health Summaries _____________________________________________________________ 11
2.1.4 Benefits and Challenges of PRMS _____________________________________________________ 12
2.1.4.1. Benefits _____________________________________________________________________ 12
2.1.4.2 Challenges ___________________________________________________________________ 12
2.1.5 Technical Aspects of PRMS __________________________________________________________ 13
2.1.5.1 Accessibility __________________________________________________________________ 13
2.1.5.2 Scalability ____________________________________________________________________ 13
2.1.6 Technical Requirements of PRMS ____________________________________________________ 14
2.1.7 Functions of PRMS ________________________________________________________________ 15
2.1.8 Types of System Available for Use ____________________________________________________ 15
2.2 NHS, UK ___________________________________________________________________ 19
2.2.1 Current Scenario _________________________________________________________________ 19
2.2.2 NHS ____________________________________________________________________________ 19
2.2.3 Record Management System in Europe ________________________________________________ 20
2.2.4 Issues of Record Management System ________________________________________________ 20
2.2.5 Guidelines of Record Management System _____________________________________________ 21
2.2.6 Current Architecture of PRMS _______________________________________________________ 21
2.2.7 Challenges of PRMS in NHS, UK ______________________________________________________ 22
2.2.8 Effective PRMS for NHS, UK _________________________________________________________ 22
2.2.9 Costs of PRMS ____________________________________________________________________ 22
2.3 BPHS, Bangladesh ___________________________________________________________ 23
2. 3.1 Current Practice __________________________________________________________________ 23
2.3.2 Ministry of Health and Family Welfare (MOHFW), Bangladesh _____________________________ 23
2.3.3 Patient Record Management System in Developed (EU) and Developing Country ______________ 24
2.3.4 Patient Record Management System in Developed Country and Bangladesh __________________ 24
2.4 Comparison of PRMS between NHS, UK and BPHS, Bangladesh ______________________ 25
2. 5 Chapter Summary __________________________________________________________ 27
Chapter 3: Research Methodology ____________________________________________ 28
3.0 Introduction _______________________________________________________________ 28
3.1 Research Methodology ______________________________________________________ 28
3.2 Types of Study _____________________________________________________________ 29
3.2.1 Study in Current Work _____________________________________________________________ 29
3.3 Preparing the Research Design ________________________________________________ 30
3.3.1 Research Design in Current Work _____________________________________________________ 30
3.4 Research Approaches ________________________________________________________ 31
3.4. 1 Research Approach in Current Work __________________________________________________ 31
3.5 Research Methods __________________________________________________________ 32
3.5.1 Research Method in Current Work ___________________________________________________ 32
3.6 Data Collection Methods _____________________________________________________ 33
3.6.1 Data Collection Method in Current Work ______________________________________________ 34
3.6.2 Target Population _________________________________________________________________ 35
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3.6.3 Sampling ________________________________________________________________________ 35
3.6.4 Data Analysis ____________________________________________________________________ 36
3.7 Chapter Summary ___________________________________________________________ 36
Chapter 4: Results and Data Analysis __________________________________________ 37
4.0 Introduction _______________________________________________________________ 37
4.1 Profile of Bangladeshi Respondents to Questionnaire ______________________________ 37
4.1.1 Analysing Answers Given by Bangladeshi Respondents ___________________________________ 38
4.2 Profile of British Respondents to Questionnaire __________________________________ 46
4.2.1 Analysing Answers Given by British Respondents ________________________________________ 47
4.3 Profile of Medical Staff Respondents to Interviews ________________________________ 53
4.3.1 Analysing Answers Given by Medical Staff Respondents __________________________________ 53
4.4 Chapter Summary ___________________________________________________________ 54
Chapter 5: Conclusion, Recommendation, Limitation and Scope for further Research ___ 55
5.0 Introduction _______________________________________________________________ 55
5.1 Revisit the Main Findings _____________________________________________________ 55
5.2 Discussion of the Findings ____________________________________________________ 57
5.2.1 In the Context of Literature Review __________________________________________________ 57
5.2.2 In the Context of Research Objective _________________________________________________ 58
5.3 Recommendations and Justification ____________________________________________ 58
5.3.1 Recommendation from Survey Questionnaire __________________________________________ 58
5.3.2 Recommendation from Interviews ____________________________________________________ 59
5.4 Limitations of the Research Work ______________________________________________ 59
5.5 Scope for further Work in Research ____________________________________________ 59
5.6 Reflection of the Research Process _____________________________________________ 60
5.7 Conclusion ________________________________________________________________ 60
References and Bibliography _________________________________________________ 61
Appendices _______________________________________________________________ 66
Appendix 1: Research Questionnaire for Bangladeshi Respondents ______________________ 66
Appendix 2: Research Questionnaire for British Respondents __________________________ 68
Appendix 3: Interview Questionnaire for Medical Staffs at Royal London Hospital __________ 70
Appendix 4: Sample Bangladeshi Respondents Feedback ______________________________ 71
Appendix 5: Sample British Respondents Feedback ___________________________________ 76
Appendix 6: Time Management Aspects ____________________________________________ 81
Appendix 6: Declaration Forms ___________________________________________________ 82
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List of Figures
Figure 1. Adastra 111 ............................................................................................................................ 17
Figure 2. Data analysis Procedure ......................................................................................................... 36
List of Charts
Chart 1. Computer Preference .............................................................................................................. 38
Chart 2. Awareness of Managing Personal Documents ........................................................................ 39
Chart 3. Awareness of Managing Health Records ................................................................................ 40
Chart 4. System Preference .................................................................................................................. 41
Chart 5. Awareness of PRMS................................................................................................................. 42
Chart 6. Importance of PRMS for BPHS ................................................................................................ 43
Chart 7. PRMS Ensuring a Quality of Health Care ................................................................................. 44
Chart 8. Necessity of Introducing a New System for PRMS .................................................................. 45
Chart 9. Awareness of Managing Health Records ................................................................................ 47
Chart 10. System Preference ................................................................................................................ 48
Chart 11. Awareness of PRMS .............................................................................................................. 49
Chart 12. Necessity of PRMS ................................................................................................................. 50
Chart 13. Assurance of Better Performance to BPHS ........................................................................... 51
Chart 14. Satisfaction of Current PRMS in NHS, UK .............................................................................. 52
Chart 15. Analysing Answers Given by NHS Staff Respondents ........................................................... 53
List of Tables
Table 1. Time Management Aspect ........................................................................................................ 7
Table 2. Profile of Bangladesh Respondents to Questionnaire ............................................................ 37
Table 3. Profile of British Respondents to the Questionnaire .............................................................. 46
List of Screenshots
Screenshot 1. Research Questionnaire for Bangladeshi Respondents(1) ............................................ 66
Screenshot 2. Research Questionnaire for Bangladeshi Respondents(2) ............................................ 67
Screenshot 3. Research Questionnaire for British Respondents(1)...................................................... 68
Screenshot 4. Research Questionnaire for British Respondents(2)...................................................... 69
Screenshot 5. Interview Questionnaire for Medical Staffs at Royal London Hospital .......................... 70
Screenshot 6. Bangladeshi Respondent Feedback via Facebook Messaging(1) ................................... 71
Screenshot 7. Bangladeshi Respondent Feedback via Facebook Messaging(2) ................................... 72
Screenshot 8. Conversation to the Participant via Facebook Messaging ............................................. 73
Screenshot 9. Bangladeshi Respondent Feedback via Leaflet Questionnaire(1) ................................. 74
Screenshot 10. Bangladeshi Respondent Feedback via Leaflet Questionnaire(2) ............................... 75
Screenshot 11. British Respondent Feedback via Facebook Messaging(1) .......................................... 76
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Screenshot 12. British Respondent Feedback via Facebook Messaging(2) .......................................... 77
Screenshot 13. Conversation to the Participant via Facebook Messaging ........................................... 78
Screenshot 14. British Respondent Feedback via Leaflet Questionnaire(1) ......................................... 79
Screenshot 15. British Respondent Feedback via Leaflet Questionnaire(2) ......................................... 80
Screenshot 16. Time Management Aspects ......................................................................................... 81
Screenshot 17. Student Declaration Form ............................................................................................ 82
Screenshot 18. Supervisor Declaration Form ....................................................................................... 83
List of Abbreviations & Symbols
PRMS Patient Record Management System
PR Patient Record
NHS National Health Service
BPHCS Bangladesh Public Health Care Sector
BPHS Bangladesh Public Health Sector
MOHFW Ministry of Health and Family Welfare
CIS Clinical Information System
ECR Electronic Clinical Records
DI Demographic Information
PI Personal Information
BR British Respondents
BDR Bangladeshi Respondents
GP General Practitioner
EU European Union
ICT Information & Communication Technology
EMIS Education Management Information System
RIS Radiology Information System
CRS Care Records Service
SCR Summary Care Records
RIMS Records Information Management System
RMS Record Management System
PAS Patient Administration System
HPSP Health & Population Sector Programme
HIS Health Information System
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Chapter 1: Introduction
1.0 Introduction The Information Technology (IT) has enhanced extraordinary modification of healthcare
services over many years. Patient Record Management System (PRMS) is used to store
Clinical Information System (CIS) on a computerised system. This replaces the Paper-based
Record (PR) which was used regularly long-ago (Nisar & Said, 2011). The PRMS has all the
nursing and medical data of a patient, it collects this information (AAFP, 2015). The record
includes notes and comments from doctors and nurses with reference to the in progress
treatment (Allen, 2009). Statistics illustrate that PR cannot maintain the work of patient care
in an efficient manner (Pairon, 2007).
The Electronic Clinical Record (ECR) consists of together CIS, for example, medicines,
diagnoses as we as allergies; in addition to Demographic Information (DI), in particular,
Personal Information (PI) for non-clinical exercise, for instance, doctors be able to utilize the
ECR for therapeutic decisions and diagnostic (Nisar & Said, 2011).
In general, automation acts a significant part into the worldwide market and in everyday
practice (Fahad, et al., 2009). Programmers struggle to join automated devices with numerical
as well as managerial gears to construct structures for a hastily growing variety of functions
or applications (Docstar, 2015).
The PRMS is an automated system that is utilized to control information of its patient and
organization (Department of Health, 2009). It is intended to present the administration with
employees, with information in instantaneous to formulate employment interesting and not as
much of hassling (Fahad, et al., 2009).
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1.1 Research Domain This dissertation will discuss in depth about the fundamental areas of Patient Record
Management System and as part of the National Health System (NHS), UK will be
comparing the main features between the system of NHS's PRMS and the PRMS of
Bangladesh Public Health Care Sector (BPHCS). The NHS is the largest health system in
England, and it has built a success in many parts of health care. However, the health system
in Bangladesh differs from public and private sectors. The private sector is much more
developed in terms of the systems used and patient facilities, whereas the public sector has
limited services to offer patients but is looking to make significant improvements within the
health care system and ICT facilities.
In addition, the Bangladesh PRMS can adopt and make improvements by following the major
features, systems and services NHS, UK has within their health system. There are various key
features such as online patient support and resources; impatient functionality, regional and
local support, general data or information capture, mobile application for instant suggestions
from doctors, online appointment system, emergency services, patients can get access for
their records through NHS website and so on.
1.2 Problem Domain The comparison of the Patient Record Management System between NHS, UK and Public
Health Sector in Bangladesh. Key features such as the advantages and disadvantages of the
PRMS will be outlined in the dissertation. Different types of technology is used around the
world for PRMS, the systems used in the NHS, UK and Bangladesh have similarities,
however comparing both countries, the key factors will be highlighted to discover what
improvements could be made for the Bangladesh Public Health Sector and NHS Patient
Record Management System.
As a developing nation Bangladesh is mainly based on paper system and a few parts are
related with software system for patient records. Whereas, NHS, UK follows a good quality
system for PRMS and they are launching a new integrated system this year. This system will
integrated so all the patient details will have stored in this system. By comparing two
different developed and developing countries PRMS from the data analysis, the focal point
concerning Bangladesh needs an efficient PRMS to improve patients health care within short
time which can deduct expense as well as put off health sector corruption.
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1.3 Significance of the Study The Patient Record Management System can supervise all the patients record efficiently as
well as apparently and also by using this the chance of data lost (data redundancy) will be in
zero percent (Pairon, 2007). The system combine the whole range of patient records a patient
or a medical needs. Moreover, PRMS can ensure each and every records in high-performance
management (Sun Ridge Systems, 2015). In addition, The PR is the chief repository for in
sequence pertaining to health care of a patient (Pairon, 2007). It concerns in many ways,
every one related with health care services by offering, accepting or compensating.
Regardless of the several technological progresses, over the past few decades in health care,
the distinctive PR of nowadays is not comparable to Bangladesh Public Health Care System
(Bangladesh Computer Council, 2002). At present the breakdown of PR to develop is
generating supplementary strain inside the loaded BPHCS since the requirements information
of consultants, patient, administrator, moderator payer, researcher as well as policy makers.
Meanwhile, Bangladesh government have already taken necessary steps to make effective
PRMS for the People's Republic of Bangladesh as a part of digital Bangladesh (Karim,
2010). Their target is to provide the correct information is in the right hands at right time.
However, PRMS of NHS, UK offers safe storage of medical records to search easily and
accumulate to put out necessary patient information. In addition, there structure intended to
boundary managing systems in large practises (Dick, et al., 1997). Nowadays in the era of
information technology, every nation has taking advantages of using available technologies
for patient record and they are serious about their own medical industry (Rudin, 2007).
Because getting treatment in other countries are really expensive as well as take time.
Moreover, each and every single nation wants to see their nation in the top list by providing
health care for their citizen as it is the prerequisite to lead a happy life which is closely related
with patient record and proper patient record can lead a good health care of a patient.
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1. 4 Research Questions
1.4.1 Main Question
How does the Patient Record Management System in the NHS, UK compare with that in the
Public Health Sector in Bangladesh? What lessons if any, could be learned by the Health
Sector in Bangladesh to make patient record management system more effective?
1.4.2 Sub Questions
1. What are the key similarities and differences in PRMS in the Public Health Sector in
Bangladesh and in NHS, UK?
2. What are the difficulties in current PRMS and the impact in developing countries like
Bangladesh?
3. What are the currently available technologies for PRMS?
4. What recommendation can be made towards the choice of the technology for PRMS
in the Public Health Sector in Bangladesh?
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1.5 Aims and Objectives of the Study
1.5.1 Aims
The aims of this dissertation is to introduce Patient Record Management System with
different types including the benefits and drawbacks of existing PRMS for National Health
Service, UK and Bangladesh Public Health Sector. Moreover, the comparison between two
countries PRMS, from the comparison suitable information for better PRMS will be revealed.
1) To come up with the view of both two countries current system of recording patient
details and currently different available technologies is used around the world will be
compared with these countries PRMS. The different countries point of view about
PRMS will give a good organization and overview of the PRMS.
2) Highlighting the key factors to discover what improvements could be made by the
comparison for Bangladesh Public Health Sector.
3) A recommendation for a new integrated hybrid system where paper record system
will not exist. Patients or general people will have access their information through
online and immediate suggestions or resources can get from online support.
1.5.2 Objectives
The objectives are to ensure that there is adequate and sufficient knowledge of challenges and
dealing with service delivery in health, especially in the health care sector in Bangladesh and
the underlying IT infrastructure and PRM might be expected to assist in meeting these
challenges. The core objectives are as follows:
a) The evaluation of PRMS between BPHS, Bangladesh and NHS, UK and from the
evaluation some new functions or steps would be revealed and can realise the missing
points of initialising an efficient PRMS for Bangladesh.
b) To identify and recognise difficulties of patient record system in Bangladesh from
rural areas to the urban areas by leaflet questionnaire as a method of survey analysis.
Also, by asking questions to the people of various professional fields such as doctors,
engineers, students, retired people, teachers, administrators, nurse, labourers and so
on.
c) Investigation of available technologies for PRMS and how these system would be
well-organized and takes short time to figure out patient details.
d) At the end a recommendation for a new integrated hybrid system where paper record
system will not exist in BPHS, Bangladesh. Patients or general people will have
access their information through online and immediate suggestions or resources can
get from online support team.
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1.6 Organisation of the Research Work 1.6.1 Chapter 1 This chapter contained the overall research introduction of the current dissertation such as
problem domain, research domain, significance of the study, research questions as well as
aim and objectives of this dissertation.
1.6.2 Chapter 2
This chapter focused on literature review of the PRMS. It begins with the definition of patient
record and patient record management system. Then different types of PRMS defined with
their benefits and challenges. Technical aspects such as scalability and accessibility outlined
in the next part. Moreover, health management system in Europe with issues and guidelines.
The detailed about NHS, UK along with their PRMS, for instance, current scenario,
architecture of PRMS currently, advantages as well as disadvantages, and effective PRMS for
NHS, UK. After that, types of PRMS available for use, costs and technical requirements.
Finally, comparison of NHS,UK with developed and developing countries especially
Bangladesh.
1.6.3 Chapter 3
This chapter is all about implementation of the dissertation. Initially the definition of research
methodology, objectives, research design, approaches, methods and the techniques for the
collection of data are outlined. Achieving the particular objectives such as, literature review,
questionnaires, system analysis and design, modelling of data is applied.
1.6.4 Chapter 4
The target of this chapter is results and data analysis of the dissertation. Profile of
respondents to the questionnaire and analysing responses to this are presented to complete
this chapter.
1.6.5 Chapter 5
This chapter illustrated conclusion of the PRMS, recap and discussion of the main findings,
recommendations and their benefits, limitations of the research work and scope for further
research of the dissertation.
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1.7 Time Management Aspects
Table 1. Time Management Aspect
Activity Activity Description Duration
(Days)
Preceding
Activities
a Formulate research questions and sub-questions 3 -
b From the research question decide on a possible title
and discuss with supervisor 2 a
c Then concept mapping generated from the possible title 2 b
d After that detailed concept mapping identified 3 c
e At this point of time reading, making notes, planning
and writing introduction 15 d
f Then writing literature review 30 b, d
g After that decide research methods 3 f
h As a sequence refining or writing up research methods 7 g
i Collecting data through survey questionnaire and face-
to-face interview 20 b
j After that analysing data 7 i
k Writing conclusions and compiling bibliography as
well as appendices 13 -
l Finally proofreading, correcting and binding 10 -
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1.8 Chapter Summary As a result of information technology that patient record staffs are facing problems day by
day as PRMS has become a vital and challenging technology in the health care environment.
When technology is progressing PRMS and CPR systems are able to provide improved
performance and functions such as expenditure efficient to a further absolute and precise data
of patients to meet those IT demands.
Moreover, PRMS could improve patients receiving better quality with supporting technical
base of medical practices. PRMS also can supply to the administration and temperance of
healthcare expenses. Finally, PRMS will help to improve staff to be more effective and
efficient when working in order to give an effective service to the people needed (Fahad, et
al., 2009).
In the next chapter, literature review will be outlined very smoothly. In this a proper
descriptive knowledge of PRMS and this in NHS,UK and BPHS, Bangladesh along with
differences of these two countries system at the end of the chapter.
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Chapter 2: Literature Review
2.0 Introduction The chapter will outline and focus on several different factors of PRMS. This will include the
definitions of patient records and patient record management system, the types of PRMS and
facilities as well as challenges that will be involved. Technical aspects such as platforms,
accessibility will also be discussed in this chapter. Moreover, the current health management
system in Europe and for NHS in the UK and what structure they are following. Lastly, the
comparison between the PRMS in the NHS and Bangladesh Public Health sector will be
discussed in brief.
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2.1 Patient Record Management System
2.1.1 Patient Record
A patient record includes all the personal and medical treatment a patient has had over the
years and from now (Dick, et al., 1997). The data handled by different specialized who has a
straight communication between a patient and those people who encompass private
acquaintance. By tradition PR have been paper-based and data or records have stored by hand
(Allen, 2009).
It is important to understand how to identify patients and their stay, as they may have been
admitted to many times during the period in which the data was collected (Clifford, et al.,
2012).
2.1.2 Definition of PRMS
Patient Record Management System is a structure of supervise several administrators to
assign into the accurate track. It is a method to determine the patient record and admittance
record which is when patients are admitted for treatment (Fahad, et al., 2009). This system
will ensure the administrators to access all patients’ records within a few seconds and high
level of secure data storage (EPA, 2013).
2.1.3 Types of PRMS
According to Jose (2015), there are four types of Patient Record Management Systems
available, such as Dedicated Patient Health Records, Paper-Based Record System, Hybrid
and Paper Record System and lastly Health Summaries.
2.1.3.1 Dedicated Patient Health Records
In order for Health practices and organisations to store patient’s health data in a secure
patient health record they need to have an effective system. Health records need to include
various information of the patient such as their addresses, contact details, medical history,
and consultation notes for health professions some may out hours care and home visits
(Pairon, 2007). Also clinical letters received from hospitals or consultants, referrals and
results that is related to clinical correspondence. Furthermore, the patient health record may
also contain such as any work cover or insurance information or important legal reports
(RACGP, 2015).
2.1.3.2 Paper-Based Record System
In order to support different tasks, paper based records are exercised in the similar pattern
like electronic records. In association with the quality, various studies do not report of the
methods used (Stausberg, et al., 2003). However, fewer discuss about the patient.
Alternatively, most studies look at the paper-records called gold standards. Focus on
excellence criterion, a revision has evaluated paper-based and electronic record patient-by-
patient, assuming they might embrace exceptional compensations (Anderson, 2010).
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However, Electronic records are most effective today as they have many benefits for
healthcare unlike paper- based records. For example, ER can be accumulated in computer
driver that need much fewer space and less assets to manufacture (EPA, 2013).Whereas,
Paper based records are not eco-friendly and when kept in storage can logically depreciate in
excess of period, apart from how glowing the atmosphere managed. ER can as a result be
accumulated and entranced forever, deterioration (Jose, 2015).
Recently a committee of the American institute of Medicine believed the paper-based record
was weak. A group of practicing clinicians held a survey to test whether they could agree to
the committee's conclusion, however the clinicians were more positive about the quality of
the paper-based record (Stausberg, et al., 2003).
2.1.3.3 Hybrid and Paper Record System
Hybrid records is a record of patients to facilitate papers and e-documents which utilises
physical as well as e-processes to right to use data of the patient. For instance, the results
such as x ray may be accessible electronically, although patient's progress notes and doctors
orders are on paper. Information of patient is also tracked in multiple formats and stored
several places (Jose, 2015).
Statistics show that in USA, hybrid record system is the popular to be considered. Moreover,
the record administrator will need to use manual and electronic processes determine which
data is vital such as e-documents, imagery, acoustic and videotape files must turn into
component of the authorized patient records. The administrator needs also to note the location
of the data is the evidence in order to contact quickly (Rouse, 2015).
According to Robert N. Mitchell, "No matter how "paperless" health care organisations
become, hospitals will still need to deal with handwritten information, making it necessary to
have strong policies and procedures in place." Furthermore, Hybrid records are very costly
for staff but they do not realise the financial benefits of a fully electronic system.
2.1.3.4 Health Summaries
Health summary is a identifier of distinctive record of the information given by the patients.
The record includes data such as physically or mentally patients health condition, therefore
with this they could be easily recognized from the information recorded by the health
profession in relation to treating that patient (Peterborough and Stamford Hospitals, 2015).
In addition this could contain image sound text or paper and also is important for it to contain
the adequate information in order to help the diagnosis, rationalize the treatment and also
support the ongoing patient care which it refers (Anderson, 2010).
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2.1.4 Benefits and Challenges of PRMS
Typically management system has been improving excellence of patient care through time.
Below are the important facilities and drawbacks for PRMS:
2.1.4.1. Benefits
Some of the benefits of PRMS is succeeding to relocate records of patient's, saving time used
up on handling paper record and electronic information shared with patients and clinicians is
more easy and secure (Clifford, et al., 2012).Also the information PRMS provides precise,
modern information to patients at the point of care (Pairon, 2007).
In England people have the right to access their medical records through online as a patient,
which can create equality and improve the relationship with the health profession and patient
(Crown, 2009). When a doctor is having a medical consultation with a patient PRMS will
enable fast access to the patient's records co-ordinately and by the proficient care. This
enhances confidentiality as well as security by the easy control access of records (Gavin,
2014).
It facilitates contributors to progress competence and meet up business goals and improves
patient and contributor relations as well as healthcare expedience (Rouse, 2015).
Effortlessness of gathering or recovery of particular information such as, data review evokes
of safety product, rapid data entry and patient management. Quality of data can be upgraded
anytime, and help encourage logical, entire citations and perfect, rationalized programming and
costing (Civica, 2015).
2.1.4.2 Challenges
Protection of data could be a major problem if for example, data is lost or the system goes
down, it can affect and cause trouble to the backup data.
When managing documents, experience of awkward scanning may happen, the layout and
information could come out unclear and unable to read. Also, reading clinical letters and
documents on screen can be very time consuming for clinicians (Pairon, 2007).
It is compulsory to train new staff at the workplace; however it is costly and can take time for
maintaining standardisation. Moreover, when training, information shared superficially may
in some cases cause doubts and guilt.
Patients can exercise the data protection act to observe remarks which can have momentous
workload implications. Shortage of nationalized protocol, panic of modify and the unfamiliar
system and shortage of interior protocol within an exercise. Also, spent more time concerning
health and safety issue and fewer efficient consultations as conquered by technology
(Basher & Roy, 2011).
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2.1.5 Technical Aspects of PRMS
In this part two types of technical aspects such as accessibility and scalability are discussed
for Patient Record Management System:
2.1.5.1 Accessibility
In the UK patients have the right to access their medical records. This is usually used to
manage their treatment which they are comfortable with. Health professions should give
patients the relevant facts and advice to understand and control decisions in relation to their
healthcare. This is one method of sharing important information support them in making
informed decisions.
Moreover patients should get the encouragement to access their health records as
it will help them to improve their care and their safety, although in exceptional cases
withholding information allowed by law. Hospitals, GP’s and other health services should
commit to provide a safe method for patients to enable direct access and informing them of
the service, and giving instructions to patients of how to use. Also, access to records should
not be at any cost to the patient (Docstar, 2015).
The health professions should hold back any third party information from patients, before
allowing access to the records. In order for patients to access their records securely those who
expertise in system suppliers should create tools such as usernames and passwords to
maintain a strong and secure access (Crown, 2009).
2.1.5.2 Scalability
Fast and rapid expansion of IT, PR is growing in the direction of a modern and latest step.
PRMS manages multiple operators at the same time for functioning patient record tasks.
Helpful information is not only for healthcare employees, but also for the patients as well as
general people regarding the information technology. It is a requirement when implementing
and designing the system (Nisar & Said, 2011).
Moreover, it has become a vital challenge to create a extraordinary formation to allow
exchange of data that involves several simultaneous clients. It is also important to decide a
method to make sure security of data while sustaining a high performance (Zhang & Zhang,
2013).
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2.1.6 Technical Requirements of PRMS
There are a lot of technical requirements exist. Among them some of them are mentioned in
the following:
Life Cycle Management: During the life cycle system should supervise records and
differentiate this with no record objects.
Metadata: It deals with and classify every documentation to allow approved employees to
recover, defend and bring out the temperament of the documentation in a structure.
Integrity: The access is allocated only for approved employees to the files in a system.
Moreover, integrity reduces the risk of possibility of hazards to unofficial modification or
elimination of the record (EPA, 2013).
Retrieval: Make sure record can access by person who has a company require information in
a file. Basically, authorize simple recovery in a suitable approach.
Security: Security is a very important concern of patient record management system. As this
is system or online based multiple user have a chance to access it. So user restriction as well
as bit locker is implemented.
Backup: Backup should allow as it is computer based, if a system collapse the entire system
will goes down. So that multiple backup is necessary
Migration: Keep the record in a format which can be used for essential maintenance and
awaiting permitted temperament period (Gavin, 2014).
Permanent Records: Offer for transferring the record as well as whichever documentation is
associated and index to NARA at particular period in the appropriate record schedule.
Procedures: A pattern to assure and retrieve same types of standard record produced along
with accumulated automatically. Usual reemitting, reconfiguring also previous essential
preservation to make sure the association and capability of automatic record all through the
approved life cycle.
Training: The operational concern as well as managing equipments and software's used in the
conference (EPA, 2013).
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2.1.7 Functions of PRMS
According to Melongoza (2002), there are three types of functions execute for PRMS
depending on technical and business components which are integrated on the basis of health
care services.
1. Transactional Functions: Administrators operate this function everyday by entering
order, servicing schedule, handling with further private enrolment and arrangement.
2. Control Reporting and Operating Function: Supplies summarised data for the
organisational operation with professional health care that allows watching different
activities to the. The responsibilities including tracking records, therapeutic inspection
along with gaze reassess.
3. Strategic Planning Function: Offer a framework to extensive collection of
implication from assessment building that includes approach of patient care such as
caring level, possession and stipulate of service, necessity and study expense.
Thus patient management information method in the project preferably consists of integrated
methods to preserve patients interrelated managerial and medical data allowing for the
continuum care of dependent service given (Fahad, et al., 2009).
2.1.8 Types of System Available for Use
1. MAXIMS Spinal EPR System
MAXIMS Spinal EPR System offers charge free for NHS, UK as a source code open which
includes EPR and PAS. It commenced in June, 2014 (IMS MAXIMS, 2014).
The MAXIMS Spinal Electronic Patient Record (EPR) System allows providers to not only
save their staff time and improve patient care, it is also able to automatically extract
information to meet 95 per cent of requirements set by the National Spinal Injury Cord
Database in order to trigger payments. The system, which is currently deployed in 20% of the
UK’s spinal injury centres, is a product of IMS MAXIMS, a provider of an established,
highly configurable, user-friendly electronic patient record.
a) All important information about a patient is accessible in a single way therefore it
supports workers to carry out their duties effectively.
b) Information being lost or misplaced from the record that may include times and dates.
c) Improves the sharing of information between healthcare staff, such as doctors and
nurses, who may work on various shifts and find it hard to meet.
d) Enables records to be updated immediately and care plans to be made, helping to
support the consistent documentation of medical records.
e) It is scalable, meaning you can extend or add functionality when required (NHS Web,
2015).
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Functionality
a. Tracks the patient’s pathway from the initial spinal injury to admission and to
outpatients, including specialist outpatient appointments such as erectile dysfunction
and fertility
b. Supports information from medical and nursing staff, therapists, social workers and
psychologists
c. Flexibility to be extend to/ add other assessment tools if required
d. Search facility to easily retrieve information and select relevant patients
e. Displays a summary of the history of care and all clinical contacts recorded for the
patient
f. Provides noting tools for medical and nursing staff, supported with summary screens,
clinical notes forms, and specialist clinic forms
g. Gives multidisciplinary teams access to goal planning meetings, goals and targets
recordings, and needs assessments
h. Offers a therapies section to facilitate the recording of therapist notes, including area
of needs noting, which may be shared with clinical notes from other disciplines
(Advanced Health & Care, 2015).
Flexible Options
We can offer a number of flexible ways to deploy and pay for a spinal injuries EPR system
that matches your requirements and availability of resources. These include deploying the
EPR as a standalone system or integrating into existing systems.
We are also offering our spinal injuries system as an open source solution, meaning providers
can develop and modify the software in-house, whilst the initial capital outlay associated with
the licensing of off-the-shelf products is reduced (Granton Medical Centre, 2015).
2. Simple-to-use Patient Records System
Important records, notes and uploaded documents are stored with the simple-to- use patient
records software; this will allow them to be accessible and available 24/7. This also means
there is no need to keep file or user remark in a diverse database.
Basically this system is completely incorporated through record or exercise managing
software; and it keeps correct latest user record such as descriptive remarks or whichever
papers that are chosen for uploading (Clinic Appoinments, 2012).
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3. Adastra
Adastra 111 supports four of the NHS core principles to carry out an effective service for
patients. The system supports NHS 111 service with various key functionality’s to ensure the
value as well as effectiveness of this system.
Figure 1. Adastra 111
(Advanced Health & Care, 2015)
4. Education Management Information System (EMIS)
It is a system of medical web that delivers incorporated health care. In order to provide an
efficient service and care, it enables staff to records, allocate and exercise vital information.
Throughout the NHS healthcare organisations can assess vital information which will
improve patient safety and security. Different groups are accessing vital information such as
patient allergies, history and medication (Jose, 2015). At present EMIS Web is developing
rapidly and helping NHS organisations in the UK deliver care more professionally and
efficiently (Emis Health, 2015).
5. Radiology Information System (RIS)
A RIS can follow a patient's whole working flow inside the department of radiology; this
department supplier be able to include image and report to EHR, they can be repossessed and
observed by official staffs of radiology department (Rouse, 2015).
Scheduling: Staff can make inpatient as well as outpatient appointments using RIS.
Patient Tracking: Using RIS, staff can track a patient’s whole radiology history from the day
they were admitted to the day they were discharged. Also, they can look up the history with
past, present and future appointments.
Results Reporting: Statistical reports can be generated by RIS.
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Image Tracking: Conventionally, radiology suppliers apply RIS to trail specific film and
the related data of them. However, EHR have turn into model crosswise the health care
business, digitised image and PACS have been extensively accepted, the department of
radiology and their PACS of radiology information system have been more haggard into the
experimental working flow of the total medicinal activity.
Billing: Radiology information system offers comprehensive economic record keeping and
procedure of electronic payment and programmed claim, although this function is flattering
integrated into medicinal organization over the system of electronic health record (Rouse,
2015).
6. NHS Care Record Service (CRS)
In England the NHS is launching the NHS Care Records Service (CRS) This will
provide patients a more quicker access to reliable information to help with their
treatment this may include for example in an emergency. In South Birmingham GO
practices are the first to implement and introduce CRS (Granton Medical Centre, 2015).
7. Summary Care Records (SCR)
In order to provide better care for patient’s the NHS is changing how patient’s information is
stored and shared. Staff who treat patients in A&E or out-of-hours, have faster access to
important clinical information using SCRs (HSCIC, 2015).
8. RiO
This is EPR software that is used for recording and documenting the terms of health care
services. RIO is mainly operational in Mental Health and Community Health settings (RiO,
2015).
9. Records Information Management (RIMS) System
An efficient way to organize, and access a large amount of information that runs through your
police department every day.
Product Information
Operation: Installed
Preparation: Credentials
Individual
Maintain: Online
Company Hours
Twenty four by seven live rep
(Rouse, 2015)
10. Record Management (RMS)
Internet-base record managing system including patient record management, case
management, customs form and exposing (Sun Ridge Systems, 2015).
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2.2 NHS, UK
2.2.1 Current Scenario
PRMS could be quite complex when accomplishing at any medical practices. It is also
priceless, however the record document management is accessible, fast and easy to execute.
Also it improves the practice effectiveness and lowers records retention costs (Pairon, 2007).
There are many different ways how PRMS benefits Europe, for example users can remotely
access patient information and view charts from several locations such as the hospital, office,
satellite location and may even be the physician’s home. Scanning batch of documents and
indexing of fast click allows user scanning and proficient price for files. In addition,
automatic tasking supplies medical working flow potentiality to recover effectiveness and
modernize interactions, customisable user-define setting for safety, protection and
confidentiality settings are customizable for protection, patient information is kept
confidential with security compliance (Civica, 2015).
2.2.2 NHS
Publically the National Healthcare Service is the largest funded healthcare system in the
United Kingdom. It provides most services free of charge as it is funded through the taxation
system, which provides healthcare to all legal citizens in the UK (Crown, 2009). Moreover,
the NHS constantly deals several people every 36 hours and treats for inpatient care, health
checks, emergency treatment and care for end- of0life etc.
Free Healthcare of the NHS was founded by the Labour Government in 1948. Legal citizens
and immigrants can fully access a wide variety of clinical and non-clinical medical care
without spending their own money. However some services patients will need to pay, for
example prescriptions, eye tests, dental treatment etc. On the other hand, those who earn
benefits and are vulnerable are entitled to these charges for free. Alternatively, there is
private healthcare that patients can seek which is not free, if they do not wish to see this
registered General Practitioner (GP) (NHS Education for Scotland, 2015).
The National Health Service Act 1946 began on 5 July 1948. Private health care is used by
about 8% of the population and is generally used for speciality services and funded by private
insurance. Private health care was used by the NHS rapidly in the 21st century, as they
wanted to strongly build competence. According to the British Medical Association (BMA)
several people thought differently and therefore opposed this move. The Department of
Health that is responsible for the NHS, which is leaded by the Secretary of state for Health.
As a result, in 2013-14 the department of Health had a £110 billion budget they spent on the
NHS. (Gavin, 2014).
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2.2.3 Record Management System in Europe
PRMS could be quite complex when accomplishing at any medical practices. It is also
priceless, however the record document management is accessible, fast and easy to execute.
Also it improves the practice effectiveness and lowers records retention costs (Docstar,
2015).
There are many different ways how PRMS benefits Europe, for example users can remotely
access patient information and view charts from several locations such as the hospital, office,
satellite location and may even be the physician’s house. Scanning batch of documents as
well as immediate directory of single click enables user to examine with also proficient
charge for files and also making it accessible to health professions regardless of their location
(Allen, 2009).
In addition, automatic-tasking offers experimental working flow ability to get better efficacy
and rationalize contact, modifiable users define setting for protection and confidentiality
settings are customizable for protection, patient information is kept confidential with security
compliance (Azuan, 2005).
2.2.4 Issues of Record Management System
The main objective is to make sure information is accessible in an efficient, secure and good
and sustainable environment. It is important for Health Services such as GP surgeries,
Hospitals and Mental Health Centres etc that their records are as follows:
Authentic: It’s important to ensure keeping a track of records of their condition example, if
they are legitimate and who created them. The information must be signed and dated when
included to a current document within a record. When doing audit trails, adjustments,
changes must be identifiable (Department of Health, 2009).
Accurate: The transactions records document must be accurately reflect.
Accessible: When it is required records must be allowed to access.
Complete: Records must be adequate in content, context and structure for them to restructure
the significant performance and transactions they document.
Comprehensive: Records have to document the organisations business in a complete range.
Compliant: They should fulfil the compliant requirements such as audit rules, legislation and
other relevant policies.
Effective: For particular reasons the information records hold needs to meet those reasons and
also have to be maintained (AAFP, 2015).
Secure: In order to prevent the use of unauthorised access, alteration, or damage, records must
be securely maintained and stored in a secure place to prevent anyone from accessing.
When there are adjustments in technology, the evidence for records conserved must stay
genuine and correct (EPA, 2013).
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2.2.5 Guidelines of Record Management System
The guidelines of record management system depends on navigation of electronic health records
which are following:
i. Documentation - Documentation narrates to a nationalized endeavour to "endorse" a
variety of needs for EHR system.
ii. Electronic Health Records (EHR) - Basically EHR demotes to computer system that
administrators exercise to follow the entire areas for caring patients.
iii. Electronic Medical Records (EMR) - EMR was very popular in the recent past which is
generally using nowadays for inspection of drug relations, checking of allergy and so on
(Clifford, et al., 2012).
iv. Incorporated EHR - Basically it denotes the management system which is practical basis
integrated system.
v. Structure and unstructured data entrance - Data input can be in many ways for both
controlled structure and which has no formation . Such as voice recognition and hand
writing recognition.
vi. Templates - Customisation of a standard form of data for particular appointment, the
template fill up (Anderson, 2010).
2.2.6 Current Architecture of PRMS
Each NHS board in England, organisation or service will have a design of record folder and
clinical documentation which is suitable for delivery of clinical care. Users should familiarise
themselves and understand the design and architecture of health records which they use in
their job. The main requirements for recording of clinical data are as follows:
The clinical record should be structured and entries should be made immediately after the
event, be dated, timed and signed. The record should have the name of the entry author, needs
to be legible and made in black ink (Sun Ridge Systems, 2015). There should be patient
identification on each page, have any deletions or alterations countersigned, diagnostic test
results should be signed before filing, the record should be structured, there should be a
system for recording alerts, and a system for identifying information supplied by a third
party, use of standard abbreviations, clearly identify the patient, and each record entry should
recognize the main senior doctor the time the entry was complete (Crown, 2009).
At least once every 24 hours there should be an entry in the records for acute medical care
and twice a week for rehabilitative care. The admissions for acute medical care, the record
entry includes a number of things such as the name and address of the GP the patient is
registered with, when they were admitted, reason for clinical encounter, the current and
history of the presenting problem, allergies, results etc. A patient has the right to know get
involved in making decisions about their care. When they are involved it should be noted in
the case record. The content of each record should meet the terms of the clinical guidance
provided by the institutions, for instance, Royal Colleges and nurture (Rouse, 2015).
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2.2.7 Challenges of PRMS in NHS, UK
In this code of practice the guidelines set out apply to every type of records including NHS
private healthcare sector. Electronic or paper based health records may be included, other
specialities and GP medical records that will uphold this is private patients who were seen,
A&E, and all other services etc.
2.2.8 Effective PRMS for NHS, UK
There are some efficient Patient Record Management System for NHS, UK which are
mentioned in the following:
i. Patient online support and resources
ii. Regional and local support
iii. Inpatient functionality
iv. CPA functionality and compliance
v. Mental Health Act functionality and compliance
vi. Registration/demographics
vii. General data/information capture
viii. Operational reporting
ix. Corporate/statutory reporting
x. Caseload management
xi. Assessments
xii. Process notes
xiii. Case notes (EHR)
(NHS Education for Scotland, 2015)
2.2.9 Costs of PRMS
1. The majority of extensively used justification of the kinds of interior SLAM
application.
2. Each year around thirty five billion pound of NHS, UK funding throughout for
deployment processing.
3. Delivers sophisticated, client responsive resolution, corroboration as well as
methodical purpose.
4. Allows CSU, CCG and GP supplier trusts to commune through a tasking exposing
entrance.
5. The most up-to-date generation is cost master PLC where level of patient and
orientation costing result, expanded particularly to assist the needs of NHS for
converging, clinical engagement along with the management of local cost (Civica,
2015).
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2.3 BPHS, Bangladesh
2. 3.1 Current Practice
Nowadays Bangladesh Public Health Sector have been improving their Patient Record
Management System by the use of IT. Bangladeshi Prime Minister announces to make digital
Bangladesh by 2021, as part of this every public hospital under National Health Sector in
Bangladesh start following computerised system especially for patient record (Karim, 2010).
Where in recent past hospital administrative staffs used to write only patient name and date of
birth in a document sheet for patient record which was not reliable as well as insufficient
information of patient. For example, doctors used to write prescriptions by their hand in the
past though still some of the pharmacy doctors have writing prescriptions by hand.
However, BPHS start using auto prescription printing and patient record management
software system for doctors and administrative routine use. Now the history of patients
started recording perpetually and can check anytime for any type of investigation. Moreover,
in this system no need to input same data again and again and a lot of analytical and statistical
reports will make doctors to think and decide more confidently.
2.3.2 Ministry of Health and Family Welfare (MOHFW), Bangladesh
In 1998, the first initiation of e-health in Bangladesh began when the MOHFW commenced
the Health & Population Sector Programme to increase effectiveness of executing program.
At present, the organisation is running with -
a. Across the entire service delivery points compilation and swap of health service data,
various levels of health managers and executives at MOHFW to maintain supervising
of improvement of health program as well as guidelines decisions.
b. Carrying out the yearly household survey
c. Telemedicine centres.
d. E-records.
e. In many hospitals, approximately 64 districts provide computers to the health
managers.
f. To ensure a health care system that is effective and meets the needs of a healthy
nation, a health policy provides the vision and mission for development.
In order to assess HIS in Bangladesh the MOHFW is currently carrying out a project under
the support of health metrics network. This is also to allow them to develop a plan for HIS in
the future for Bangladesh. Furthermore, conducting this project will examine and also issues
with Governmental and nongovernmental organization, and within a short period of time
planning the introduction of e-record systems in Bangladesh (Basher & Roy, 2011).
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2.3.3 Patient Record Management System in Developed (EU) and Developing Country
In the world of technology different types of PRMS have been using in each and every
country. As there are no limitation for using the system some countries are preferring to use
different types of systems at the same time. Where developing countries are still suffering for
using PRMS. Because developed countries has proper infrastructure, good knowledge of
technology, enough source and asset, especially no corruption in the health sector. However,
in developing countries have several problems with their mentality, less resource, lack of
education and corruption in health care system.
If compare to developed countries like Australia, Denmark, Germany, Sweden etc. and
developing countries like India, Bhutan, Nepal, Myanmar, Kenya etc., a huge difference can
occur (Basher & Roy, 2011).
2.3.4 Patient Record Management System in Developed Country and Bangladesh
The comparison of Patient Record Management System between developed country and
Bangladesh has a huge difference. As Bangladesh is a developing country and most of the
health care sector in Bangladesh are not concerned about PRMS, but some of the recognised
public hospitals are following paper-based record system and a few private health sector
maintaining PRMS in a proper system. However, the countries in EU have been using well
implemented PRMS for serving their patient efficiently. Following are some common
problems mentioned for PRMS in Bangladesh
1. Education Awareness: Almost half of the population in Bangladesh are uneducated
(Anon., 2015). They do not have any idea about PRMS. They believes the traditional
system that when they feel sick they will go to "kobiraj" that means the village doctor.
They do not bother about any system.
However, for the last couple of years the education rate has been increasing in
Bangladesh and people are thinking about PRMS especially young people are
interested to use computerised system.
2. Web-Portal Information: The majority of Bangladeshi people are not familiar with
online activity even the computerised system. They are a far behind from European
nations in compare.
3. Technological Structure and Supply of Electricity: Lack of technical support from
government as well as frequent load shading are another problems. Even some places
in Bangladesh did not get the electricity supply. But, in developed country have
technological support with high power of electricity supply.
4. Poverty and Social in Advancement: Around 30% people in Bangladesh have been
living below poverty line and their social life is miserable. Meanwhile, in developed
countries life style is westernised as well as they are self-employed (Access to
Information Programme, 2009).
5. Vaccination and Awareness for Health Diseases: Bangladesh government have been
given vaccination every year by free of cost but even though some people do not
bother about this (Basher & Roy, 2011).
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2.4 Comparison of PRMS between NHS, UK and BPHS, Bangladesh The key comparison of PRMS between NHS and BPHS are mentioned below-
1. BPHS have been stirring to accomplish their environment to ICT-based for recovering
efficiency and transparency of PRMS, for example, National Institute of Kidney
Diseases & Urology (NIKDU), Bangladesh Secretariat Clinic, Azimpur Maternity
Hospital, Government Employees' Hospital and so on are recently transformed into an
automated system (Access to Information Programme, 2009) where the PRMS of
NHS is already using automated system which is transparent as well as efficient.
2. NHS patient record management system consists of
a. past medical history
b. illness, surgeries, allergies, and current medications
c. family medical history
d. social history (diet, exercise, smoking, use of drugs and alcohol)
e. occupational history
f. current patient complaint recorded in patients own words
g. physical examination results
h. results of laboratory and other tests
i. records from other physicians or hospitals
j. include a copy of the patient consent authorising release of information
k. text messages (both outgoing from the NHS and incoming responses from the
patient).
However, the PRMS of BPHS contains only
a. electronic or paper-based patient records
b. records of private patients
a. accident & emergency, birth and all other registers
b. theatre registers, minor operations and other related registers
c. X-ray and imaging reports
d. photographs, slides and other images
e. e-mails
f. scanned records
3. Most of the public hospitals in Bangladesh have been following paper-based PRMS
(Bangladesh Computer Council, 2002) where NHS, UK have been maintaining both
paper-based and electronic PRMS (Crown, 2009).
4. NHS provides high-performance management of every patient record throughout its
entire life cycle from admission through discharge, then from archival storage through
mandated destruction (NHS Web, 2015). On the other hand, BPHS only keep their
patient records for wealthy people and politician along with high quality service for
them (Basher & Roy, 2011).
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5. Though BPHS recruits graduate administration staffs for maintaining PRMS, some of
the brilliant candidates do not get chance due to political interference. But in NHS,
their recruitment process is free and fare from corruption and they look forward to
highly experienced administration staff at all time. Meanwhile, maintaining PRMS is
easy for them so that NHS staff can give better service to their patient.
6. As still some of the BPHS have been following only paper-based PRMS, they need
extra staffs to keep their patient details which is good in a sense of Bangladesh
perspective as it is developing country and a lots of educated people are unemployed.
Meanwhile, Bangladesh government can use them to reduce unemployment rate in the
country as well as a source of maintaining PRMS of BPHS. However, UK is one of
the best technologically advanced country in the world and their intension is to reduce
staffs because of technology gives best and proper service instead of increasing staffs
as well as a huge amount of salary expense every year though system maintenance
cost is high. Overall it is less rather than expense of extra staffs salary every year for
maintaining PRMS.
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2. 5 Chapter Summary Overall, the discussion of this chapter is the basement of the dissertation. As the dissertation
about PRMS, initially from Patient Record to Patient Record Management System,
consequently the types, facilities and challenges discussed. The overview of current PRMS
including the comparison of NHS, UK and Bangladesh Public Sector is also mentioned in a
systematic process. The important part is function of PRMS also outlined in a details. Finally,
a short summary of MOHFW, Bangladesh discussed for better comparison between two
countries PRMS.
In the next chapter research methodology will be illustrated including types, research design,
approaches, research and data collection methods regarding current study. Then target
population and sampling from this will be in the chapter.
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Chapter 3: Research Methodology
3.0 Introduction Initially the definition of research methodology, objectives, research design, approaches,
methods and the techniques for the collection of data will be outlined. Achieving the
particular objectives such as, literature review, questionnaires, system analysis and design,
modelling of data will be applied.
This is carried out at two countries PRMS: NHS, UK and Public Health Sector, Bangladesh.
Bangladesh has been chosen because of a good example of a developing country (also
densely populated) where IT is still to be initiated for keeping patient record. Moreover, a
strong political commitment in Bangladesh to convert it to digital Bangladesh by 2021 and
initialising in 1998 the MOHFW instigated e-health in Bangladesh. According to the National
ICT Policy of Bangladesh, the core focus in the use of IT in healthcare will be to deliver new
capabilities for healthcare providers (Bangladesh Computer Council, 2002). However, NHS,
UK is an excellent example for a developed country where electronic PRMS has been
maintaining for a long ago.
3.1 Research Methodology Research is the procedure of meeting information for the function of commencing, adapting
or concluding a specific venture or collection of reserves (Garg, 2012).
According to (Rajasekar, et al., 2013), when different events, designs as well as algorithms
used in research are called research methods (RM). Every methods used by a researcher for
the duration of a research study is termed as RM. They are fundamentally intended, technical
as well as assessment neutral. This includes speculative processes, investigational study,
statistical scheme, numerical approach and so on. RM assist to accumulate samples, statistics
and discover an explanation of a problem. Specifically, scientific RM identify for
rationalizations base collection of evidence, dimensions as well as interpretations and not one
way of thinking unaccompanied. They understand only those descriptions confirmed by
experimentation.
Furthermore, research methodology is an efficient way to resolve a problem. How research is
to be conceded is a science of studying. In essence, the processes by which researcher
describes, explains along with predicts occurrence of employment known as RM. Research
methodology also described as the learning methods by which acquaintance is expanded. The
aim of this is to give the research work plan (Rajasekar, et al., 2013).
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3.2 Types of Study There are different types of study depending on research such as case study, field study,
survey study, experiments etc. Each study has some positive and negative sights (Study.com,
2015). Following are mentioned these with a brief description:
1. Case Study: A case study examines an existing occurrence within its real-life
perspective particularly when the limits between occurrence and circumstance are not
obviously clear and also an experimental investigation. It relies on several sources of
proof as well as remuneration from preceding improvement of hypothetical
proposition to conduct data collection with analysis (Yin, 2013).
2. Field Study: Field study is a study where as a replacement for enquiring participant to
arrive to an eccentric lab to be considered, the experimenter studies the participant in
the natural environment. The study is also known as naturalistic study.
3. Survey Study: A set of questions prepared by the researchers for a group of people,
where answers have to be done by the participants. In particular, a question could be
like your opinion of PRMS which is beneficial or not for the doctors as well as
patients.
4. Experiments: This type of research is a scientific approach where researchers
manipulate one or multiple variables along with control and measure other variables if
there is any change. It is also a systematic research in a casual relationship in which
priority of time, consistency and the magnitude is enormous.
3.2.1 Study in Current Work
In this dissertation case study is the most suitable one. The reason for choosing case study is
as the dissertation is about PRMS: a technical comparison between NHS, UK and Bangladesh
Public Health Sector, there is a technically descriptive sound, need a lot to study for the topic.
Also by the study a proper comparison should be revealed. An exact system difference would
be revealed so case study is selected for the dissertation.
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3.3 Preparing the Research Design Design of the research is a strategy or scheme which consists of fundamental approaches
completed by the earlier associates as well as preferring contributors for the collection of data
in order to preceding responds to the research question and to manage the inconsistencies
(Alreck & Settle, 2004). Following are some common research designs
a) Experimental Design
b) Co-relational Design
c) Comparative Research Design
d) Historical Design, and
e) Ethnographic Research Design
Also there are some other common designs for research such as action, explanatory,
exploratory, and descriptive. Action research find the facts for improving action quality in
social life. Another type of research design is explanatory, which means pointing explanation
for proceedings as well as happenings and revealed further information on the topic, for
instance, searching answer for the reason of similar looks of the thing. Then exploratory, this
research design accomplished for an issue that has not been obviously cleared. It frequently
happens before knowing sufficient to construct abstract distinction or hypothesize an
explanatory connection. Finally descriptive or statistical research, which discover and
describe a new meaning which exists, frequency determine and the information categorise
(Rajasekar, et al., 2013).
3.3.1 Research Design in Current Work
Comparative research design is the suitable one among all of the above mentioned research
design. As the research is simple and objects are cases in several similar respects like both
NHS, UK and BPHS, Bangladesh are using paper-based PRMS and differ in other respects,
for example, functions of using PRMS in each of them. Thus, the dissimilarities become
spotlight of assessment. The purpose is to search why NHS and BPHS are following different
functions and finally to expose fundamental structure that permits or creates such a disparity.
In addition, the methods of comparative design is used to discover, examine and describe
similarities and differences between NHS and BPHS. Research crosses the national
boundaries because this does not care what the research method is being used. Trouble occurs
in supervising and financial support cross-national projects. In achieving entree to equivalent
datasets and gaining conformity over abstract and efficient correspondence as well as
research parameter. Then challenges to search solutions of problems through intercession
with cooperation and a sound knowledge of various national perspectives. Finally, the
advantages to be followed from cross-national effort consist of a deeper consideration of
other research processes.
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3.4 Research Approaches Basically research approaches are used in the research regarding their types, such as inductive
and deductive. Qualitative research method associated with inductive approach where
quantitative research method relating to deductive approach. The brief description of
approaches mentioned bellows:
1) Inductive: The approach starting with observing and theories are prepared on the way
to the ending of the research as a consequence of observations (Goddard & Melville,
2004). According to (Bernard, 2011, p.7) “involves the search for pattern from
observation and the development of explanations – theories – for those patterns
through series of hypotheses”. Inductive approach informally called bottom-up
approach.
The starting point of the research has no theory but theories may develop as an
outcome of the research:
2) Deductive: The approach workings from all-purpose to particular. Informally the
approach is known as top-down approach. The research may start with a theory on
researchers choice of topic. Then the topic narrowing to more particular hypothesis
for testing. Narrowing even further when observations collect to address the
hypotheses. Ultimately this guides to analyse the hypotheses with particular data
which is a confirmation of actual theories.
3.4. 1 Research Approach in Current Work
Between inductive and deductive research approaches, the current dissertation follows
deductive approach. Because the concepts of the technical comparison of PRMS between
NHS, UK and BPHS, Bangladesh associated with quantitative research method regarding
their type of reasoning deduction, objectivity and causation. As the deductive approach is
often called top-down approach, so the theory of PRMS comes first with their technical
differences. Then the hypothesis of two countries system. After that the observation of actual
differences and finally from the comparison confirmation comes out. However, the set of
questionnaire is pre-specified which is outcome-oriented and analysis type is numerical
estimation with statistical interference. So all the requirements of dissertation topic matches
with deductive approaches.
The reasons for not choosing inductive approach is an inductive approach is associated with
generation of new theory rising from the data whilst deductive approach is intended and
testing theory.
Observation Theory Pattern
Hypothesis Observation
Tentative Hypothesis
Confirmation Theory
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3.5 Research Methods There are three types of research methods use to the need of researchers. These are follows -
1. Quantitative Research Method: This type of research method collects data into
numerical type such as categories, rank or unit measurement which can be used to
formulate graphs and tables of raw data. Moreover, experiment usually capitulates
quantitative data regarding the concern of measuring things. On the other hand, other
type of research methods like questionnaire and observation can construct both
qualitative and quantitative information. For instance, a ranking range or a closed
question on a questionnaire produces quantitative data as this produces either
numerical data or data that can be put into yes or no type of category. While an open-
ended question produces qualitative information as this is a descriptive response.
Below mentioned are a few common quantitative data collection methods -
a. Internet- based survey
b. Telephone survey
c. Mail survey
d. Content analysis
e. Comment card and feedback form (Survey questionnaire)
f. Frequent shopper program tracking
2. Qualitative Research Method: This type of data collection method produces in-detail,
excellence understanding of public opinion, however, qualitative research is not
statistically generalise. It is extremely valuable because it gives truly experience of
learning, the values and public viewpoints. It is particularly practised at answering
questions from public relations practitioners that began with how or why. Some of the
qualitative data collection methods mentioned below -
i. In-depth interview
ii. Case study
iii. Focus group
iv. Participant observation
v. Monitoring complaints by email and letter
3. Mixed Research Method: Each of qualitative and quantitative research methods has
distinctive strengths. When possible to use conjunction of both research
methodologies in Public Relations Management, thus both public and issues can be
completely implicit. Both of these research methods using together is called mixed
research method.
3.5.1 Research Method in Current Work
In the current dissertation, quantitative research method has used in terms of research needs.
Because the data collected by survey questionnaire of 17 Bangladeshi participants as well as
16 British respondents which can quantify and the results can simplify from a sample to the
population of interest. From the sample it can evaluate the occurrence of different views and
opinions. Another important reason for choosing this is to explore for further findings.
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3.6 Data Collection Methods Generally the methods of data collection are based on data source and type of data to be
measured for identifying its nature.
Different types of research use different methods of data collection according to their
requirements. Few research just use one method for data collection where others use a
combination of methods. There are three important data collection methods mentioned in the
following:
1) Interview: It is one of the data collection methods where a communication between a
respondent and researcher exist. It can be happened any quite places according to their
choices. Basically it takes to authenticate the collection of information by a sequence
of questionnaire. There will be a linked between each and every question (Rajasekar,
et al., 2013).
2) Questionnaire: The most common and popular method is questionnaire. Generally a
collection of prearranged questions asked to a particular group of respondents or
arbitrary group using congregation data. Mainly, researcher had a model of answer for
each question in the questionnaire to formulate the research intention simple (Alreck
& Settle, 2004). Consequently, for completion of statistical analysis this type of
method mainly used for quantitative data collection. There are different type of
questionnaire such online survey questionnaire, leaflet questionnaire and so on.
3) Observation: An extremely helpful method to determine activities of the populace
from a specific group of people and organisations. Researcher examines on people,
their working processes, news, actions etc. in the actual operational atmosphere as an
alternative of rely on the data got from the replies of respondents (Alreck & Settle,
2004).
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3.6.1 Data Collection Method in Current Work
In this dissertation leaflet questionnaire and face-to-face interview have implemented.
Basically two sets of questionnaire have set for Bangladeshi people and British people who is
aware of PRMS in Bangladesh as well as a few interviews taken from the NHS staffs at
Royal London Hospital for collecting both primary and secondary data. The reasons for
prepared two set of questionnaires are- data collection happened between only Bangladeshi
people and the British people who knows about PRMS in Bangladesh, the majority of
Bangladeshi people do not know about NHS, UK that is why a separate set of questionnaire
created for them whereas some British are concerned about developing countries PRMS
specially Bangladesh. Because a large group of Bangladeshi people have been living in
United Kingdom for a long ago and they got British nationality. The leaflet questionnaire has
distributed only these two groups of people. Moreover, face-to-face interview chosen because
it gives an accurate screening, capture verbal quest with emotion and behaviour, keep focus
and finally practical experience of using the PRMS or knowledge about PRMS from the
staffs of NHS.
The respondents filled the form of questionnaire by themselves. For Bangladeshi participants,
13 questions have formed in three parts such as personal questions including name, age, sex,
and occupation, then basic questions which is yes or no type about computer preference,
awareness of personal documents management, awareness of health records management,
and manual or computerised system preference. Finally in part 3 is all about PRMS, first 4
questions are also yes or no type and last question is comment type where participants have to
write down their suggestions. For British respondents, first two parts of questionnaire is
almost similar to Bangladeshi respondents. But in part 3, the focused is to identify the
information of the comparison between BPHS and NHS. Moreover in face-to-face interview,
16 or 17 questions have formulated for the NHS staffs. Among these first 6 questions about
participant details and rest of the questions asked regarding PRMS and comparison between
two countries system.
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3.6.2 Target Population
The dissertation targeted Bangladeshi people at three main districts in Bangladesh such as
Dhaka, Chittagong and Sylhet in different professions like doctors, engineers, teachers, job
holders, students and labourers in ages between 23 and 42. At least 5 participants were
targeted from each district. So in total 17 (7 respondents from Sylhet and 5 each from Dhaka
and Chittagong). Moreover, British citizen at East and West London, Manchester and
Birmingham in different fields such as nurse, hospital administrative, students, accountants,
labourers and other job holders in different ages between 24 and 37. For British people 16
respondents were targeted where 4 participants from each places. Thus in total, 33
respondents (both Bangladesh and British people together) who formed the target population
of the survey questionnaire. Moreover, 5 interviewees participated from NHS staffs at Royal
London Hospital.
3.6.3 Sampling
In the data collection methods, this dissertation preferred leaflet questionnaires and face-to-
face interview as a research method. Throughout the data collection, two sets of questionnaire
has been set for the data collection, one of this for the general people of the People's Republic
of Bangladesh and other is for British people who is aware of PRMS in Bangladesh. Leaflet
questionnaire has distributed by hand and via facebook messaging to British and Bangladeshi
people. However, interviews taken from NHS staffs at Royal London Hospital. Meanwhile,
among different types of survey sampling methods judgement sampling has chosen because it
is common non-probability method and researcher can select the sample based on judgement
or convenience.
In addition, before starting the data collection, a group of people were selected for collecting
data. As the participants ware working full-time or full-time student it was very difficult to
meet them for data collection. But as informing them before the data collection is going to
take around 8-10 minutes they willingly participated in this part in different places such as
cafe, library, offices and via facebook messaging.
Among the 33 respondents for both Bangladeshi respondents and British respondents who is
aware of PRMS in Bangladesh, 10 Bangladeshi and 8 British participants selected for
sampling who are from different fields as well as different places and the perfect respondents
of getting proper feedback. And among 5 interviews, 3 interviewees selected as they have
experienced of using PRMS.
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3.6.4 Data Analysis
In this dissertation, quantitative data analysis is used for analysis data. The reasons for using
quantitative analysis is the data of leaflet questionnaire is stored electronically in a
spreadsheet that is like Microsoft Excel. Gathering statistical comparative data for the
responses of questions, in particular, frequency counts of both open and close ended
questions, allocation of multiple choice questions. Moreover, generating graphical
representations of data of leaflet questionnaire for reporting, presentation or publication.
Finally, discovering relations between responses and questions. Collating responses of open
question where there is no word limit.
Also from the figure below it can be easily seen that the procedure is also following
quantitative data analysis which is the systematic process for analysing data as deductive
approaches also used in the current research.
Figure 2. Data analysis Procedure
3.7 Chapter Summary In the data collection methods, this dissertation preferred leaflet questionnaire and interviews
as research method. Throughout the data collection, two sets of questions has been set for the
questionnaire, one of this for the general people of the People's Republic of Bangladesh and
other is for British people who is aware of PRMS in Bangladesh. Moreover, interviews taken
from the NHS staffs at Royal London Hospital to get a rich information from the participant.
By distributing leaflet questionnaire to British and Bangladeshi people by hand and via
facebook messaging. Overall, this chapter was all about research methodology.
In the next chapter all the respondents profile will be presented and the results from data
collection as well as the analysis of this will be included.
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Chapter 4: Results and Data Analysis
4.0 Introduction This chapter contained results of the study as well as representation of the analysing data or
result. Two sets of questionnaire has been set for Bangladeshi people and British people who
is aware of Bangladeshi PRMS. Initially the profile of both Bangladeshi and British
respondents as well as the profile of interviewees of NHS staffs are mentioned. And then
analysing those responses to the questionnaire and interview representing by the pie, bar and
radar charts accordingly.
4.1 Profile of Bangladeshi Respondents to Questionnaire In data collection, the current dissertation followed leaflet questionnaire for both open-ended
and close-ended questions among 10 Bangladeshi citizens who are from different parts of the
country with different fields and different ages. First 12 questions was close-ended among 13
questions and only the last was open-ended. Following are the list of Bangladeshi
respondents along with their age, sex and occupation, but for the data protection act their
names are not mentioned, instead of names BDR is used which means Bangladeshi
respondents:
Name Age Sex Occupation
101 BDR1 31 Male Software Programmer at Arrow Soft, Bangladesh
102 BDR2 23 Male Post Graduate Student at SUST, Bangladesh
103 BDR3 32 Female Lecturer at Leading University, Bangladesh
104 BDR4 41 Male Doctor at Ragib-Rabeya Medical College and Hospital
105 BR5 24 Female Administrative at Diana Medical Tourism, Bangladesh
106 BDR6 42 Male Labourer
107 BDR7 29 Female Lecturer at Leading University, Bangladesh
108 BDR8 30 Male System Analyst at Staff India, Bangladesh
109 BDR9 27 Female Receptionist at Women's Medical College and Hospital
110 BDR10 26 Male Student at Dhaka University, Bangladesh
Table 2. Profile of Bangladesh Respondents to Questionnaire
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4.1.1 Analysing Answers Given by Bangladeshi Respondents
For easy to analyse, the respondents are divided into four age groups, for instance, young
group is between 23 and 27, mature group is between 28 and 32, well mature group is
between 33 and 37, and adult group is between 38 and 42. The each question represents by
the pie chart.
34%
28%
24%
14%
Computer Preference
23-27
28-32
33-37
38-42
Age Group
Chart 1. Computer Preference
The first technical question is to know their preference to use computer. Among 10
Bangladeshi respondents, young group is 100% agreeing to use computer where mature
group is 80%. Continuously the percentage is falling down according to the old age group,
70% of well mature group preferring computer. Last group is the adult group where majority
of the respondents are disagreeing (60%) to use computer.
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19%
33%26%
22%
Awareness of Managing Personal Documents
23-27
28-32
33-37
38-42
Age Group
Chart 2. Awareness of Managing Personal Documents
Next question is to know the awareness of how to manage personal documents. Here the
highest percentage is for mature group (90%) who is aware of managing personal documents.
Whereas, half of the young group are aware and half of them are not. Moreover, 70% and
60% of well mature and adult group respectively aware of managing their personal
documents.
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Chart 3. Awareness of Managing Health Records
Adult group takes the highest percentage (70%) of consciousness to their health records
where well mature is the less percentage (40%). However, half of the young people are
aware and half of them are not aware of health records (50%). 60% of the people in mature
group is also aware of this.
23%
27%18%
32%
Awareness of Managing Health Records
23-27
28-32
33-37
38-42
Age Group
P a g e | 41
31%
28%
25%
16%
System Preference
23-27
28-32
33-37
38-42
Age Group
Chart 4. System Preference
All the people in young group prefer computerised system where 50% of the people in adult
group refer to manual system and rest of them are follow computerised system. Mature and
well mature group are 90% and 80% respectively refer to use computerised system.
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Chart 5. Awareness of PRMS
Bangladeshi people are not fully aware of PRMS. The highest number of percentage takes the
young group, 70%. On the other hand, adult group takes the less percentage, 30%.
Furthermore, 60% respondents in mature group are aware of PRMS where only 40% of the
people in well mature group are conscious.
35%
30%
20%
15%
Awareness of PRMS
23-27
28-32
33-37
38-42
Age Group
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34%
30%
23%
13%
Importance of PRMS for BPHS
23-27
28-32
33-37
38-42
Age Group
Chart 6. Importance of PRMS for BPHS
The majority of the people in young, mature and well mature group think PRMS is essential
for the Bangladesh Public Health Care Sector currently. 100% of the young people are
dominated for the PRMS and 90% of the mature people are interested to see the PRMS for
Bangladesh Public Health Care Sector. The percentage of well mature of group are not very
far away to mature group, 70% of them are concerned. However, only the adult group are not
worried about PRMS for BPHCS, 40% of them are thinking to implement PRMS in BPHCS.
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31%
28%
24%
17%
PRMS Ensuring a Quality of Health Care
23-27
28-32
33-37
38-42
Age Group
Chart 7. PRMS Ensuring a Quality of Health Care
PRMS will ensure the quality of health care system throughout the country. Almost all
groups of people are agreed with this. Percentage from 90%, 80%, 70% and 50% for young,
mature, well mature and adult group respectively.
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Chart 8. Necessity of Introducing a New System for PRMS
Among the 4 groups, 3 groups of people are dominated to see that government initialise a
new system for PRMS. But unfortunately, adult group are not interested about this except
10% respondents of this group. On the other hand, 90% for both young and mature group and
60% for well mature group want to see a new PRMS for Bangladesh Public Health Sector.
32%
32%
22%
14%
Necessity of Introducing a New System for PRMS
23-27
28-32
33-37
38-42
Age Group
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4.2 Profile of British Respondents to Questionnaire The leaflet questionnaire has been set for both open and close ended among 8 British citizens
who are aware of PRMS in Bangladesh. They are from throughout the United Kingdom with
different fields and different ages. Following are the list of British respondents along with
their age, sex and occupation, but for the data protection act their names are not mentioned,
instead of their names BR is used which means British respondents:
ID Name Age Sex Occupation
201 BR1 27 Female Administrative at Royal London Hospital, UK
202 BR2 29 Female Receptionist at SSP, UK
203 BR3 30 Male Customer Service Assistant at M & S, UK
204 BR4 37 Male Labourer
205 BR5 36 Male Customer Service Assistant at One Canada Square, UK
206 BR6 32 Male Accountants at UAE Exchange, UK
207 BR7 29 Female Nurse at Kings Cross Hospital, UK
208 BR8 24 Male Student at Cardiff Metropolitan University, UK
Table 3. Profile of British Respondents to the Questionnaire
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4.2.1 Analysing Answers Given by British Respondents
For easy to analyse, the respondents are divided into three age groups, for instance, young
group between is between 23 and 27, mature group is between 28 and 32 and adult group is
between 33 and 37. The each question represents by the bar chart.
2.2
2.4
2.6
2.8
3
23-27 28-32 33-37
Awareness of Managing Health Records
Age Group
Chart 9. Awareness of Managing Health Records
According to the bar chart, both mature and adult group of British respondents are 90% aware
of managing their health records. But for the percentage of young group is less then these
groups, only 80% of young British group are conscious about health records.
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0
0.5
1
1.5
2
2.5
3
3.5
23-27 28-32 33-37
System Preference
Age Group
Chart 10. System Preference
According to the statistical information from the bar chart, 100% of British young
respondents prefer computerised system as the world is depend on Information Technology.
This group is in the commanding position to utilise the proper technological advancement.
Where the number of percentage is not very far for the mature as well as adult group,
consequently they got 90% and 80%.
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Chart 11. Awareness of PRMS
The chart illustrates that 80% of British young group are aware of PRMS and they know the
current condition of PRMS in Bangladesh. Whereas, mature group is more serious then
young group, 90% of them are aware of this. But adult group is far behind from young and
mature group. They are not fully conscious about PRMS (only 70%).
0
0.5
1
1.5
2
2.5
3
23-27 28-32 33-37
Awareness of PRMS
Age Group
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0
0.5
1
1.5
2
2.5
3
3.5
23-27 28-32 33-37
Necessity of PRMS
Age Group
Chart 12. Necessity of PRMS
As expected from the British people, they think Patient Record Management System is very
important nowadays because of time saving and apparent previous records which can save a
patient's life along with money. The percentage of both young and mature group is 100% and
90% for adult group.
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0
0.5
1
1.5
2
2.5
3
23-27 28-32 33-37
Assurance of Better Performance to BPHS
Age Group
Chart 13. Assurance of Better Performance to BPHS
According to the graph, the majority of the respondents think introducing PRMS of NHS,
UK will brings positive changes in the PRMS of Bangladesh Public Health Sector. The
percentages are 80% for young, 70% for mature and 90% for adult group which is the highest
percentage of positive response for BPHS.
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2.2
2.25
2.3
2.35
2.4
2.45
2.5
23-27 28-32 33-37
Satisfaction of Current PRMS in NHS, UK
Age Group
Chart 14. Satisfaction of Current PRMS in NHS, UK
Majority of British people are happy with the present condition of NHS, UK. Rest of them
especially young group thinks to improve the current system or bring a new PRMS for NHS,
UK. But, 70% people of young group are satisfied with the present system. However, same
percentage for both mature and young group, 80%.
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4.3 Profile of Medical Staff Respondents to Interviews The interview questions has been set for medical staffs of NHS at Royal London Hospital. A
set of 22 interview questions formulated for them. Following are the list of participants along
with their age, sex and occupation, but for the data protection act their names are not
mentioned, instead of their names NSR is used which means NHS Staff respondents:
Name Age Sex Occupation
301 NSR 1 29 Male Administrative at Royal London Hospital
302 NSR 2 31 Male Administrative at Royal London Hospital
303 NSR 3 32 Female Administrative at Royal London Hospital
4.3.1 Analysing Answers Given by Medical Staff Respondents
Experience of using PRMS in NHS
System Preference
Comparison between NHS and
BPHS
Recommendattion towars the choice
of technology
Interviewee1
Interviewee2
Interviewee3
Chart 15. Analysing Answers Given by NHS Staff Respondents
The radar chart demonstrates 4 main responses among 3 interviewees. First interviewee
preferred automatic system as already have experienced of using PRMS in NHS. However,
the participant has a few knowledge of PRMS in Bangladesh as the answer got Bangladesh
follow paper-based system where NHS follow both paper and hybrid system. The
recommendation was better to follow NHS system for improving PRMS in Bangladesh.
Second interviewees also have good knowledge of PRMS in NHS and preferred system is
automatic as expected. But the respondent thinks both NHS and BPHS following almost
same system where the only difference is Bangladesh have lack of skilled and reliable
administrative staffs at their health sector where NHS have skilled and strong administrative
staffs. Human resource of BPHS needs to contribute a lot to improve the proper as well as
experienced PRMS service. Finally, last interviewee followed first and second interviewees
as their experienced level is same as well as system preference. However, this participant has
P a g e | 54
no idea of developing countries like Bangladesh and their PRMS and is fully satisfied with
the NHS. So according to the participants recommend following PRMS of NHS would be the
best solution for the PRMS of developing countries PRMS especially Bangladesh.
4.4 Chapter Summary In conclusion, the results of the study as well as representation of the analysing data
illustrated in this chapter. According to the result from current data, it can be easily said that
British people are more interested and aware of PRMS. However, Bangladeshi people are not
fully aware of the system but they are looking for a new system which can change their
current system. So as the PRMS of NHS, UK is developed and beneficial for the patient, they
are interested to follow this system because it can contribute to reduce present problems of
Bangladesh Public Health Sector.
In the last chapter overall conclusion of the dissertation, the recommendation of it as well as
the limitation and the further plan of the research will be outlined.
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Chapter 5: Conclusion, Recommendation, Limitation and Scope for further Research
5.0 Introduction In this chapter, the overall research study will conclude in a short summary. Revising the
findings regarding literature review and research objectives. Then what recommendation
could be made from the current study will be considered. Also some limitations occurred
during the study. Last but not least, reducing the limitation of current study what could be the
future expectation to expand the dissertation will be mentioned.
5.1 Revisit the Main Findings Before starting the dissertation the aim was to introduce PRMS with various types. The
advantages and disadvantages of the current PRMS of NHS, UK and BPHS, Bangladesh.
Moreover, the comparison between two countries PRMS and from the comparison what
recommendation could be made to improve PRMS between any of this two countries PRMS.
Now the main findings are mentioned according to the four sub-questions:
5.1.1 What are the key similarities and differences in PRMS in the Public Health Sector in
Bangladesh and in NHS, UK?
a) Management Information Systems (MIS): Both NHS and BPHS follow the three level
of MIS for PRMS from strategic to the operational level.
b) IT-based Automated System: Some of the public hospitals in Bangladesh are ICT-
based for improving efficiency and transparency of PRMS and recently these
hospitals are transformed into an automated system where PRMS of NHS is already
using automated system which is transparent as well as efficient.
c) Maintenance: Though maintenance process is same for both countries PRMS, there is
a difference between two countries maintenance staffs. NHS administrative staffs are
well trained, experienced as well as reliable compare to BPHS.
d) Resources: The government of UK supports a lot to NHS every year to keep their
PRMS up-to-date with proper resources where Bangladesh government also supports
to their health sector with resources but corruption occurs in the meantime.
e) Paper-based or Electronic PRMS: Most of the BPHS follow paper-based patient
record system where in NHS follow both electronic and paper-based PRMS.
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f) Public or Private: General people and patient in UK believe in NHS for keeping their
records where Bangladeshi citizen prefer private health sector rather than public
though it is expensive.
5.1.2 What are the difficulties in current PRMS and the impact in developing countries like
Bangladesh?
Nowadays the most common difficulties for PRMS are education awareness, web-portal
information, technological structure and supply of electricity, poverty and social in
advancement, vaccination and awareness of health diseases etc. The impact of these fully
obstruct to use the modern PRMS in the developing countries especially Bangladesh because
of insufficient resources.
5.1.3 What are the currently available technologies for PRMS?
There are four types of PRMS, such as dedicated patient health records, paper-based record
system, hybrid and paper record system and health summaries. Among these nowadays
hybrid and paper record system is more popular and useable in terms of technology, for
example, MAXIMS Spinal EPR System, Simple-to-use Patient Records System, Adastra,
EMIS, RIS, CRS, SCR, RiO, RIMS System, RMS and so on are the modern technologies for
PRMS.
5.1.4 What recommendation can be made towards the choice of the technology for PRMS in
the Public Health Sector in Bangladesh?
Nowadays different types of PRMS is available but among all of these hybrid and paper
record system is more popular and has tremendous benefits on it. Previously, paper record
system was gold standard, however, hybrid patient records are most effective today as they
have many benefits for PR because the records administrative have to use electronic and
manual processes together to decide data essentials, images, electronic documents, auditory
and video recorder should turn into the electronic health record (ibid) and unlike paper-based
records. For example, electronic records can be stored in a software system or in a integrated
website or a computer drives. All these three systems are efficient, secure and easy to use.
But everything has some advantages and disadvantages as like a few hospitals or institution
of Bangladesh Public Health Sector has been using integrated software system which has also
some benefits and drawbacks. For instance, it is efficient, secure and easy to use but it needs
the software supported system as well as patients or general people cannot access this system
because of user restriction. On the other hand, NHS has been using different types of website
for different purposes. The benefits of this are also effective, highly secure, easily accessible,
and no extra space is required for using this. Patients or general people can access their
records from the website. But the problem for NHS is they are using different types of
website, some of these are for commercial purpose and not their own website.
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5.2 Discussion of the Findings Discussion of the findings are discussed in the context of literature review and research
objectives below-
5.2.1 In the Context of Literature Review
a) The key similarities of PRMS is between NHS, UK and BPHS are some of the clinics
in Bangladesh have been following hybrid and paper record system for PRMS as like
NHS, UK and other important similarity is they store a few records for the patient in
their website so that patients can access their information and get immediate
suggestions from the doctors. However, there is a huge difference between these two
countries PRMS. The majority of BPHS have been following paper record system
where NHS, UK have been following hybrid and paper record system. Meanwhile,
Bangladesh government initiated a few steps to make their PRMS much more
effective as well as world class as a part of digital Bangladesh concept (Access to
Information Programme, 2009). However, in NHS, UK patients can get online
support and resources where no online supports and resources in BPHS yet, even no
regional and local support whereas NHS, UK supports locally and regionally.
b) Evaluating with NHS in UK and BPHS, several problems acknowledged in PRMS for
BPHS. because lacking of educational responsiveness, information about web portal,
technical configuration and electricity supply, scarcity in development, vaccination
and consciousness for health diseases etc. stuck to develop their PRMS. So that they
have following paper record system where records security is a major issue.
Moreover, corruption also occur in this sector. So that patients as well as general
people prefer to go abroad for their treatment instead of treatment in Bangladesh
which is very costly and takes time, however, only wealthy people can afford it.
c) Currently there are a lot of technology available for PRMS, such as MAXIMS Spinal
EPR System, Simple-to-Use Patient Records System, Education Management
Information System, Adastra, Records Information Management System and so on.
d) By the comparison of PRMS in between NHS, UK and BPHS, Bangladesh; it can be
said that Bangladesh should ignore the paper-based patient record system and as some
parts of their record system is software based which has restricted access for general
public or patient. Definitely they have to have launch a new PRMS including all the
necessary components and benefits as soon as possible to make their patient records
accurate. Moreover, accurate patient records can save hustle, money, time, and
patients lives.
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5.2.2 In the Context of Research Objective
a) The objectives are ensuring to identify and recognize the system benefits and faults of
using current PRMS for both NHS, UK and Bangladesh Public Health Sector. To
know the current condition of PRMS, leaflet questionnaire has distributed by hand
and via facebook messaging (Microsoft word copy) between Bangladeshi citizen and
British citizen who are aware of PRMS in Bangladesh. Survey questionnaire has
conducted with different sorts of people in different professional fields. Moreover, a
few interviews has taken at Royal London Hospital to the NHS staffs to get rich
information from the interpretation of the participants.
b) The purpose of the study is to recognise suitable PRMS. As Bangladesh is a
developing country and their PRMS is mainly based on paper system and a few parts
are software system, they need to improve their PRMS. On the other hand, NHS, UK
follows a good system for PRMS and they are going to launch a new integrated
system for PRMS this year. This system will integrated all the patient details in a
system. By comparing two different developed and developing countries PRMS from
the data analysis, the focal point concerning Bangladesh needs an efficient PRMS to
improve patients health care within very short time which can deduct expense as well
as put off health sector corruption.
5.3 Recommendations and Justification The dissertation topic "Patient Record Management System: A technical comparison between
National Health Service, United Kingdom and Bangladesh Public Health Sector, the People's
Republic of Bangladesh" is a good research area. Lots of new things came out during the
study and realised it is a huge area where as a IT student can learned different technical fields
to justify the PRMS.
5.3.1 Recommendation from Survey Questionnaire
a. Feedback from Bangladeshi Respondents: Almost every young person preferred to
use computer at the same time they want computerised system. Though they are
happy to manage their personal documents but far behind of managing health records.
They aware of PRMS and think PRMS is necessary for BPHS for ensuring the quality
of health system. Finally, Bangladesh government should launch a new system for
PRMS. On the other hand, middle age and older people are almost opposite of young
people thinking accept medical staffs and well educated people regarding PRMS of
Bangladesh.
b. Feedback from British Respondents: Most of the British people are aware of
managing health records as well as they preferred computerised system. They think
PRMS is beneficial for both doctors and patients. Moreover, English people believe
introducing PRMS of NHS will bring positive outcomes in the PRMS of BPHS. Also
they understand managing records of patient data can contribute to reduce current
problems of BPHS. Last but not least. they satisfied with the PRMS of NHS.
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5.3.2 Recommendation from Interviews
All the NHS staffs preferred automatic system as they are using this in the NHS but they have
quite bad experienced about the system because sometimes system fail that is why they
cannot access any data until it has been fix out otherwise everything is fine. However, a few
NHS staffs think PRMS in Bangladesh are progressing day by day by the government
initiatives where other think Bangladesh is only based on paper record system and need to
follow any developed countries PRMS like NHS, UK.
For any country whether developed or developing, PRMS depends on the authenticity,
accuracy, accessibility, completeness, comprehensiveness, compliance, effectiveness as well
as security. If these features are included in a PRMS, it would be the perfect system.
5.4 Limitations of the Research Work a) Shortness of Time: A huge research topic like Patient Record Management System
covers during a short time is really difficult though the dissertation completed
successfully, however, it would of been much better if more time was given for the
dissertation.
b) Lack of Source: There is enough information and research relating to the PRMS in
UK, although there is inadequate information about PRMS in Bangladesh.
c) Not much Response: Only 33 responses given by Bangladeshi and British citizen who
is aware of PRMS in Bangladesh. And only 5 interviews have taken from the NHS
staffs at Royal London Hospital. As the topic depends on public feedback, a large
group of people should have involved in data collection by participating in survey
questionnaire and interviews.
d) Lack of Medical Participants: Following the busyness of medical staffs there were
number of less participants. However, implementation of three data collection
methods in a large different group of medical staffs could have given more accurate
results.
5.5 Scope for further Work in Research Working in a good research topic hardly is always can get a positive outcome. As the current
research area covers public sector in Bangladesh which is a developing country and a large
number of patients are in a deadlock condition of choosing their place of treatment.
Meanwhile, implementation of a good PRMS can give them a hope to get better treatment
according to their previous record. As already got enough knowledge from the study, the plan
is to implement a new PRMS for the People's Republic of Bangladesh in the future.
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5.6 Reflection of the Research Process At first, research methodology is defined to know the proper research processes. Then, type
of study is mentioned to expand the dissertation. Continuously why the current topic has been
chosen, after that, preparation for research design including research approach and methods;
and data collection with sampling and data analysis.
From the research process, now knowledge gained about research methodology of PRMS, the
different types of research design could be implemented for PRMS, idea about various
research approach as well as research methods. The different methods of data collection
could be implemented for any project to get the expected result. Overall, now have good idea
to complete any type of research.
5.7 Conclusion To sum up, the chapter outlined the summarisation of overall research area. The review of the
main research findings and discussed these findings in the context of literature review and
research objectives. Moreover, what recommendation can be made to improve the system
along with the justification. As this is huge research area some limitations came out which is
also discussed in this chapter. Last but not least, future plan with this study with the reflection
of research process has been outlined.
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Appendices
Appendix 1: Research Questionnaire for Bangladeshi Respondents
Screenshot 1. Research Questionnaire for Bangladeshi Respondents(1)
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Screenshot 2. Research Questionnaire for Bangladeshi Respondents(2)
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Appendix 2: Research Questionnaire for British Respondents
Screenshot 3. Research Questionnaire for British Respondents(1)
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Screenshot 4. Research Questionnaire for British Respondents(2)
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Appendix 3: Interview Questionnaire for Medical Staffs at Royal
London Hospital
Screenshot 5. Interview Questionnaire for Medical Staffs at Royal London Hospital
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Appendix 4: Sample Bangladeshi Respondents Feedback
Screenshot 6. Bangladeshi Respondent Feedback via Facebook Messaging(1)
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Screenshot 7. Bangladeshi Respondent Feedback via Facebook Messaging(2)
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Screenshot 8. Conversation to the Participant via Facebook Messaging
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Screenshot 9. Bangladeshi Respondent Feedback via Leaflet Questionnaire(1)
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Screenshot 10. Bangladeshi Respondent Feedback via Leaflet Questionnaire(2)
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Appendix 5: Sample British Respondents Feedback
Screenshot 11. British Respondent Feedback via Facebook Messaging(1)
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Screenshot 12. British Respondent Feedback via Facebook Messaging(2)
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Screenshot 13. Conversation to the Participant via Facebook Messaging
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Screenshot 14. British Respondent Feedback via Leaflet Questionnaire(1)
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Screenshot 15. British Respondent Feedback via Leaflet Questionnaire(2)
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Appendix 6: Time Management Aspects
Screenshot 16. Time Management Aspects
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Appendix 6: Declaration Forms
Screenshot 17. Student Declaration Form
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Screenshot 18. Supervisor Declaration Form