[Phpwm] Potential PHP Project

Philip Kelley philip.kelley at polarisedirect.com
Mon Aug 24 20:51:34 UTC 2009


I have a requirement for a php programmer for a reasonably sized  
project for a client.

I am the Director of a Marketing Communications Agency based in Bath -  
I was put in touch with Bronwen Reid by a mutual contact, who  
suggested I circulate the outline of the project to the members of  
your group, so that anyone with the right interest, skills and  
availability can get in touch to discuss further.

This outline should provide enough information to give an idea of the  
nature of the requirement. Exact details can be spec'd out after  
further discussion.

I can be reached on this email address, or via the contact details  

I look forward to hearing from you.

Best regards

Philip Kelley / Director / Polarise Ltd /  7-9 North Parade  
Buildings / Bath / BA1 1NS
T: +44(0)1225 430912 M: +44(0)7789 866889 W: polarisedirect.com
Polarise Limited Registered in England & Wales Number 3461541  
Registered Office 37 Great Pulteney Street Bath BA2 4DA

Independent Health Group: 'Online Management Tool'

Brief/Outline Specification

Independent Health Group (IHG) are a company that currently provides  
four surgical services: Carpal Tunnel Surgery, Hernia Surgery,  
Vasectomy and Podiatric Surgery under contract to four Primary Care  
Trusts: Swindon PCT, Wiltshire PCT, Gloucestershire PCT and South  
Gloucestershire PCT.

Patients are referred to IHG by their GP. The service is paid for by  
the NHS: the four PCTs all have tariffs agreed for each service with  

Patients can be seen for initial consultation at one of five clinics:  
Tetbury, Westbury, Chippenham, Amesbury and Swindon. Operations are  
then carried out in Tetbury or Westbury.

There are approximately 220 GP Practices within the four PCTs who  
could refer patients.

The administration of IHG's business currently requires a lot of  
repeat data entry across various files and spreadsheets. The company  
requires one integrated system through which to manage Patients'  
clinical records; the billing and reporting of the accounts, and the  
company's Marketing communication needs with PCTs, GPs and potentially  

A number of off-the-shelf software products have been considered, but  
each have their limitations, so it has been decided that a bespoke  
online solution could be tailored to IHG's exact needs, which would  
offer real-time multiple-access synchronisation of the company's  
business data, and maximum flexibility for future development.

There are a number of distinct areas to cover:

1. Login Access

Each surgical service has clinical staff who will need to access  
patient details, but should not necessarily be able to access the  
company's financial and business management data.

Conversely, each individual requiring access to the financial and  
business management data should not necessarily have access to  
sensitive patient data.

Administrative staff should be able to add admin notes but not  
clinical notes

2. Security

IHG would like some reassuring evidence of the chosen partner's  
credentials in developing such a system, and their ability to deliver,  
as well as IHG's proprietary ownership of the system once developed.

3. Master Data

Certain categories of 'static' data will need to be added as the main  
categories to be interrogated, when entering the 'live' ongoing record  
of patient treatments (booking the appointments and recording the  
outcomes), i.e.:

- Patients
- GPs
- Practices
- PCTs
- Services
- Sessions
- Practitioners
- Place (i.e which Clinic, plus 'telephone')
- Type (i.e. Initial Appointment / Follow Up Appointment / Operation)
- Codes (certain official medical terms related to each service, so  
that incidences of specific conditions can be searched for)
- Users (i.e. who has what level of access to the system)

Each of these will have a number of pre-set fields to enter, including  
contact details etc (allow approx 10 fields for each). Each Practice's  
details should include a field for 'Nearest IHG operative centre', and  
'Distance to the nearest IHG operative centre', for interrogation for  
the purposes of Marketing. Apart from codes where we could use an  
exhaustive list

All bar 'Patients' will require editing relatively infrequently, but  
new patients will be added to the system much more regularly.

PCTs/Practices/GPs/Patients will be linked / heirachically implied by  
each other. (i.e each Practice will only be in one PCT area; and each  
GP will only be in one Practice etc) Locum GP’s could work at a number  
of practices

The Administrator will need to be able to edit all of these.

4. Clinical Record

The pathway from initial patient referral through to the issue of a  
post-operative questionnaire (three months after any operation) needs  
to be captured, with each subsequent contact with the patient logged  
and date-stamped, to create a record searchable for both clinical and  
audit purposes.

Administrative Note/Clinical Note
There should be a distinction made between an 'Administrative' note;  
and a 'Clinical note'. These should be combined into one record that  
can be visually scanned under each patient's record (using different  
colours for at-a-glance ease of recognition), but which can be  
'filtered' to only show the Clinical notes, if required by the  

The patient record will also need to be able to have a number of  
'assets' added to it - eg the scan of a patient letter (containing the  
Doctor's signature), the .mp3 of a Doctor's dictation of that letter  
(for audit purposes), and potentially the patient's completed post- 
operative questionnaire (although these may need to be manually keyed  
in, potentially to flow through to the aggregated data on the public  
website). Typically there will be four or five such assets added to  
any patient record. Occasionally up to 20.

To book patient appointments, the administrator will first need to  
create a diary 'session' into which appointments can be slotted. For  
each service, these would be a set-length (eg four hours), containing  
set appointment lengths (eg half an hour each), with a set  
Practitioner, at a specified location. Need to be able to configure a  
session how wish in minimum intervals of 5 minutes.

Once a 'session' has been created, the administrator can then book an  
appointment within it.

Practitioners will also need to manually add 'telephone'  
consultations, which won't necessarily be pre-booked by the  
administrator as an appointment in a 'session'.

The record of how long it takes from the patient making initial  
contact with IHG to the consultation taking place, through to any  
operation happening needs to be captured for audit purposes (an NHS  
monitor known as Referral To Treatment - RTT) - but if the patient  
interrupts the process by failing to attend appointments, this needs  
to 'stop the clock', hence why 'date-stamping' is important and needs  
to be captured. The server will therefore need to be set to GMT (BST).  
If we can monitor each patients `clock` with a possible series of  
starts/ pauses/ re starts/ pauses / stop with print out/ screen for  
this that would be great-a must in fact.

Details to be captured at each appointment
After each appointment, the Practitioner then needs to record the  
outcome, under the following headings/fields:

1. Diagnosis
2. History
3. Examination
4. Investigations
5. Treatment Plan
6. Prescriptions
7. Procedures

The record should then ignore any field left blank (where these aren't  
relevant to the appointment).

In addition, the system needs to differentiate between insignificant  
or speculative 'free text' entered in these fields, and the specific  
official record of a certain medical diagnosis or condition, according  
to a database of recognised 'codes'.  In EMIS (another off-the-shelf  
piece of software), Practitioners use F4 to make a 'coded' record of  
certain terms, which can then be searched (it sounds like it does the  
equivalent of adding html tags to a term, but referencing a separate  

If the appointment is an 'Initial Appointment', the next step needs to  
be specified. If an 'Operation' is specified as the next appointment,  
then 'Local Anaesthetic' or 'General Anaesthetic' will need to be  
specified (LA or GA).

Practitioner confirming the details
Each appointment should contain the following information:
Date / Time / Patient / Practitioner / Location / Type

Where applicable, these should each read off the separately specified  
database (i.e. Patients, Practitioners, Location, Type)

Before submitting the completed 'form' to be added to the patient's  
record, the Practitioner should be required to confirm certain details.

All of these can be pre-populated, with a default date/ time/  
location/ type for that log in (practitioner will be recorded when log  
in), but the Practitioner should have to confirm these.

Recording DNAs
If the consultation doesn't go ahead, it needs to be recorded, with  
the reason (i.e. Patient cancelled or IHG cancelled or DNA – no reason  

Appointments View
When logging into the system, the Practitioner should be able to  
access a Calendar view for any given Session.  When first going in I  
suggest everyone sees either whole day or week for all, which could  
then go to just show individual practitioners and they could look at  
day, week or that session. John Budd for instance may do three  
different types of sessions.  It should be possible to view a whole  
week, or just one day's Session.

This Session view should also be able to be printed out to go on the  
wall at Operative sessions, which should offer a list/report containing:

Date  I  Patient ID  I  Name  I  Operation Description      I   LA/GA

Patient Letters
The system should have the facility to generate standard Patient  
Letters according to pre-set templates, following each consultation.

The Administrator will need to draft these in a 'form', and the  
Practitioner will then need to review these and either edit the  
wording, or confirm approval for it to be printed off and sent to the  
Patient and their GP.

Insurance Company printouts
Should IHG move into Private Practice, there may be a requirement to  
produce printouts for Insurance Companies for claims.This is a future  
rather than current requirement. Indeed, we do however need to  
occasionally print a complete patient record i.e. all consultations,  
all attachments etc. This is a separate issue to needing to bill for  
private patients which may go to the insurers or an individual patient.

Exporting Data
As the business grows, it may prove worthwhile to export the data for  
migration into an alternative system. Should that prove necessary, it  
should remain possible to export all the relevant data in as simple a  
way as possible, eg by csv.

5. Business Record

The details from the Clinical Record information entered above should  
flow through into the financial management side of the business, by  
generating invoices to a predetermined template, in line with the  
PCTs' specified tariffs, and according to the format specified/ 
requested by each PCT. These should then be able to be printed and  
posted to the PCT, or potentially submitted by email. At the end of  
the month, this invoice/report should be automatically generated.

In order to fulfil the system's potential as a complete management  
tool, the costs for each service will also need to be entered, so that  
reports can be run on the financial performance of the business as a  
whole, or specific aspects of the business - eg any given service /  
Practitioner / PCT / Practice etc over any given period of time.

It should be possible to reconcile these P&L figures with IHG's bank  
balance to create cash flow statements.

The specific reports required to be generated will be provided by  
IHG's Accountants.

It should also be possible to generate reports of the number of  
referrals for each service from any given Practice and individual GP,  
over any given period of time, to inform the Marketing communication  
process: both to identify the Practices that may need offline  
attention, and to automate feedback to GPs about the cases that they  
refer - especially after the post-operative questionnaire is received  
and logged, three months after the operation.

If the patient provides an email address, the post-operative  
questionnaire could even be sent to them by email as a form for  
completion online (like Google Forms), to save re-keying by the  

Philip Kelley / Director / Polarise Ltd /  7-9 North Parade  
Buildings / Bath / BA1 1NS
T: +44(0)1225 430912 M: +44(0)7789 866889 W: polarisedirect.com
Polarise Limited Registered in England & Wales Number 3461541  
Registered Office 37 Great Pulteney Street Bath BA2 4DA

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