HYBRID DENTAL CHARTING SYSTEM (HyDeCS)€¦ · Dental charting is a process which describes the...

E-PROCEEDING OF THE 8TH INTERNATIONAL

CONFERENCE ON SOCIAL SCIENCE RESEARCH 2019

E-PROCEEDING OF THE 8TH INTERNATIONAL CONFERENCE ON SOCIAL SCIENCE RESEARCH 2019 (ICSSR 2019). (e-ISBN 978-967-0792-36-1). 18 -19 November 2019, Imperial Heritage Hotel, Melaka,

Malaysia. Organized by https://worldconferences.net

HYBRID DENTAL CHARTING SYSTEM (HyDeCS)

Muhammad Awis Jamaluddin Johari ([email protected]), Muhammad Azlan Shahariman

Ahmad, ([email protected]), Nur Izyan Nadhirah Faizulnizam

([email protected]), Lee Chee Kiam ([email protected])

Healthcare and Education Solution, Corporate Technology Division, MIMOS Berhad

ABSTRACT

The electronic medical record (EMR) has become an important technology in healthcare. EMR is a

digital version of the patient record consisting of the history of medical, diagnoses, appointment dates,

prescriptions, lab results, dental history, dental charting, doctor notes and many more. EMRs save time

and space by eliminating the usage of paper records. The system is also a medium of communication

between service providers within the same organization to pass accurate information around.

Community-based programs have been introduced to reaching out to the communities besides school’s

outreach programs to achieve same objective, which is to provide dental/health treatment outside of the

clinic. Most EMR systems are complex. They include a combination of health and dental modules.

Some of these modules are not required for the community-based program. Thus, the objective of this

paper is to present a system by making use of the functionalities of EMR to create a lightweight and

hybrid electronic record management system for community-based program. This system, from here

and onward to be referred as Hybrid Dental Charting System (HyDeCS).

Field of Research: Hybrid Dental System, Electronic Medical Record, Dental Charting, Hybrid

Dental Charting, Dental System.

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Introduction

Dental charting is a process which describes the health of the teeth and gums. The charting is usually

done during dental check-ups. It is a graphic method of organizing information about the dental health.

(Mary Ellen Ellis, 2018). It deals with the management of information, communication and application

of new technologies in clinical practice and research. Information management involves the storage and

use of information generated in direct work with patients in a dental clinic, it includes the organization

of work and arranging visits and operation of dental practice. (Masic, 2012)

HyDeCS is developed using common components which are used by the dentist to make it useful and

improve the quality of care for the patients. The HyDeCS include processes from registration until the

treatment is completed for the patient. Most dental systems using web application base need network

but the HyDeCS can used in online (with network) and offline (without network). HyDeCS consists of

modules including patient information, patient treatment, patient appointment, dental disease and dental

charting. HyDeCS supports three different modes which is online mode, offline mode and outreach

mode. The online and offline mode will be used in the workspace and the outreach mode was used for

community or school program. The advantage of the HyDeCS is it is able to record all the data needed

for the dental treatment. Improved access including easy retrieval and recording with technology have

considered a significant advancement in managing dental care. (Betan, 2016). The electronic patient

records are also capable of unifying the different clinical data, which can reduce the cost of filling paper

records, and can eliminate problems such as illegible notes, lost charts and illegible prescription

orders.(Betan, 2016) HyDeCS can search data during offline (without network) which means that there

is no need to use pen and paper as the system is available all the time. Electronic patient records provide

a more reliable and refined basis for outcomes management since various patient data can be easily

combined in making clinical decisions. It can include various data formats aside from text including

imaging as part of the patient’s chart and dental history. Big data analysis can be done as various forms

of patient data is available for preventive and predictive care. Besides that, dental treatment and disease

module provide information about the cause of tooth extraction and tooth filling. (FADZHILA BINTI

SABRI, 2011). HyDeCS provides customizable charting symbols that can used by dentist based on the

dental check-ups. The graphics provide easy visualization of the dental treatment for the patient. It also

has the outreach module which allows the system to be brought out to the school or community area

and can be accessed without any network.






Methodology

This chapter will discuss about the methodology that will be used in the development of the HyDeCS.

Before involving in the development of the proposed system, the prior works are finding the problem

statement that occur from users. The information is derived from dentists and nurses who have the

expertise in this field where after this to be referred as users. Most of them, complained that the current

system is only accessible within their workspace. Besides that, they also need the system that can be

accessible when doing outreach visits either in school or community event, which is out of their

workspace. After doing some investigation and comparing with the existing dental system, most of the

current systems are only focusing on online mode which needs internet connection between client and

server as implemented by authors (Hussain, Aziz, Mohammed, & Mohtar, 2011) and certain author

implemented standalone application as author (Dhanore & Ramtekkar, 2016). Figure 1 is showing the

architecture for most of the existing system. Figure 2 is showing the architecture that have been

implemented on HyDeCS. HyDeCS system cover from outreach programme to clinic workspace. For

this paper, the author will explain more on the outreach portion.

Figure 1: Architecture: Existing System

Figure 2: Architecture: HyDeCS






Hybrid System

Definition of hybrid system is a system that can dynamically exhibit both continuous and discrete

dynamic behaviour. This feature is mostly implemented in a system that is classified as a critical system

which relates with safety, mission, business and security as mention in this paper (Hinchey & Coyle,

2010). When working in the operational field, the most critical factor is what will happen if the system

breaks down. This event will result in a lot of chaos within an organization and sometimes will affect

the production process. The most important information is the patient historical data. If the organization

is using a manual process which is pen and paper, the impact is minimal. However, when there is a

system and the data is not available when needed, it will make the process more inefficient and

unmanageable.

On this matter, author believes that most organizations have a business continuity planning (BCP) that

already includes the standard operation procedure (SOP). These plans will ensure that the organization

will continue to operate when the system breaks down.

For this paper the author will only discuss more the outreach session rather than in workplace part. As

we know, some urban areas have poor internet connection, and the method of using a mobile service

provider like simcard to get an internet is not practical to solve this problem. The method that have been

implemented in HyDeCS is by using local storage and browser called as application cache. Before going

further on how it works, HyDeCS is a web-based application client which uses HTML5 technologies.

HyDeCS is written using NW.js (previously known as node-webkit) which enables a new way of

writing applications with all Web technologies. In HyDeCS, not all information is stored in local storage

to avoid of unnecessary data and wastage of resource. Even though the main purpose of local storage is

to make the application faster by downloading only data which is required. For HyDeCS, we utilize this

technology when the user is using the system in offline mode which is no internet connection. When

the user is able to get internet connection, user need to trigger the system to upload all data that have

been entered during offline mode. All data will be up sync up to datacentre by using database replication

technology.

The way the system uploads and downloads the data will be described here onward. The author has

already done some comparison on a few tools of database replication and have been selected two tools

which is RabbitMQ and SymmetricDS, both of this tool is open source.

Typically, most of database replication built-in feature is copying of data from a database in one

computer or server to another database that might be at the same site or at different geographical

locations. The source and the target database have exactly the same amount of data. Database replication

provides a consistent copy of data across all the database nodes. However, this approach is not suitable

for outreach operation as the machine (normally laptop) that host the system has smaller amount of

CPU, memory and hard disk space. A laptop may not have enough resources to hold and process the

number of data same as Data Center. Besides, during outreach operation that is outside of premise, it

cannot access physical security like a physical exclusion zone, limited access by authorised personnel,

lock-and-key protection of assets, and always-on Heating, Ventilation, and Air Conditioning (HVAC).

It is also not possible to provide high network security feature like firewall network limitation, IDS

(Intrusion Detection System), IPS (Intrusion Prevention System) and content-level filtering. The

workaround to mitigate this risk is to reduce the amount of data to be stored in outreach system. By

introducing Messaging Queue system (in our implementation is RabbitMQ), each outreach system has

their own queue and only data relates to the outreach activity (e.g. students info of School A) is

published to its queue and is consumed to persist in that particular outreach system.






In general, most database replication built-in feature is meant for real time purpose, where the master

and the slave nodes need to be up and connected to network at the same time. This behaviour may not

be suitable for outreach system as not all the time the outreach machine is on and connects to network.

SymmetricDS allows data to be synchronized across nodes on remote networks with low bandwidth

usage and automatically handle periods of disconnected operation. With asynchronous replication in

the background and an efficient communication protocol, SymmetricDS guarantees replication by

tracking batch data through automatic recovery and retry attempts. Data can be synchronized in one

direction or both directions in a multi-master configuration. This fit very well to outreach requirements

where a clinic may have different outreach machines to cover different locations.

Project Implementation

Before installing the application, ensure that the hardware and software is meets the recommended

system requirements of:

a. A laptop with at least 2 GHz speed i7 or i5 processor

b. Operating system: Windows 10

c. Minimum 8 GB of RAM (memory) for the server.

d. Hard disk drive with at least 100GB of free disk space.

e. Support Chrome browser.

For laptop that act as client can be lower requirement on memory rather than the server specification.

Laptop server can be laptop client which is 2 in 1 purpose. An agent has been developed using Java

programming language that can manage cluster mode or stand-alone mode and installed in laptop as a

server. The difference between cluster mode and stand-alone mode is cluster mode can have more than

one user using the system simultaneously while stand-alone laptop will be the server and user at the

same time Figure 3 is showing the agent that will be used for switching the mode of the server.

In the server laptop, the software that is required to be install is Apache Tomcat Server 9.0, PostgreSQL

Server 9.4, and SymmetricDS 3.7. All the applications will start after the laptop is brought up except

Apache Tomcat which is will start up after user trigger the operation mode.

Figure 3: Outreach Agent






HyDeCS Module

HyDeCS have same modules as other dental systems which are queue management, dentist profile,

patient information which includes patient personal detail, patient treatment, patient appointment,

patient billing, dental treatment, dental disease and dental charting. But to make HyDeCS lightweight,

only certain modules will be enabled during outreach session. This is designed to limit the resources

used and to make it simple as is. Here the list of modules that is considered for outreach purpose.

a. Patient information – patient demographic and related information

Figure 4 : Patient Information (Basic)

b. Patient treatment – treatment history done for patient

Figure 5 : Patient Treatment History

Figure 6 : Patient Treatment History (Charting View)






c. Patient appointment – appointment for patient

Figure 7 : Patient Appointment (Make Appointment)

d. Dental disease – dental diseases/condition of patient

Figure 8 : Dental Disease (Diagnosis)

e. Dental charting – dental charting including base, treatment and final chart

Figure 9 : Dental Charting (Base)






Figure 10 : Dental Charting (Treatment)

Figure 11 : Dental Charting (Final)






Conclusion & Future Scope

HyDeCS not only provides an opportunity to the clinic to enhance their patient care within workspace

or outreach, but can also increase the profitability of the organization. Dentists would be able to

significantly improve the operational control and thus streamline operations. This would also improve

the response time to the demands of patient care because it can automate the process of collecting,

collating and retrieving patient information. HyDeCS is successfully developed using the required

features cross the various modules. It is fully developed using Java for backend, JavaScript and CSS

for frontend and also the PostgreSQL Server as the database. However, the future enhancements can be

carried out by adding in additional functionalities to the system. For example, the system could be more

flexible to add on more features in order to make it usable in a large dental clinic such as; adding new

modules without effecting the current system and adding a potable queue system so that dentists can

treat a larger community of patients.

References

1. Atkinson, J. C., Zeller, G. G., & Shah, C. (2002). Electronic patient records for dental school

clinics: more than paperless systems. Journal of Dental Education, 66(5), 634–642.

2. Betan, A. (2016). Free and Open Source Software for Dental Information Management System.

(July).

3. SABRI, F. B. (2012). DECISION SUPPORT SYSTEM FOR DENTAL CLINIC.

4. Mary Ellen Ellis. (2018). Dental and Periodontal Charting. Retrieved from

https://www.healthline.com/health/dental-and-periodontal-charting

5. Masic, F. (2012). Information systems in dentistry. Acta Informatica Medica, 20(1), 47–55.

https://doi.org/10.5455/aim.2012.20.47-55

6. Dhanore, P., & Ramtekkar, P. (2016). Dental Clinic Management System- A New Approach.

International Journal of Computer Science Engineering and Technology, 6(5), 176–178.

7. Hinchey, M., & Coyle, L. (2010). Evolving critical systems: A research agenda for computer-

based systems. 17th IEEE International Conference and Workshops on the Engineering of

Computer-Based Systems, ECBS 2010, 430–435. https://doi.org/10.1109/ECBS.2010.56

8. Hussain, A. R., Aziz, A. A., Mohammed, N., & Mohtar, S. (2011). ELECTRONIC PATIENT RECORD

FOR DENTAL CHARTING. 2(June), 43–54.


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