UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCES

INSTITUTE OF PUBLIC HEALTH

DEPARTMENT OF HEALTH INFORMATICS

Project title: Web-based Patient Handover Information System in Gondar

University comprehensive specialized hospital, northwest, Ethiopia, 2022

BY: 1.Abubakir hajbegen

2.Astier Meseret

3.Eliyas Addisu

4.Gashaw Ashebir

5.Marta Derbie

6.Robel Girma

7.Zewdu Fentie

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Table of content

Content page

1.Chapter on
e
1.1 Background of the organization...........................................................5
1.2 BACKGROUND OF THE STUDY..............................................................5
1.3 Statement of problem................................................................................ 7
1.3.1 THE PROPOSED SYSTEM ....................................................................9
1.4 Project objective ......................................................................................10
1.5. Significance of the project...................................................................10
1.6 Scope and limitation of the project...................................................12
1.7Methodology ............................................................................................... 12
1.8 Feasibility study ...................................................................................... 15
1.9 Work plan.................................................................................................... 16
1.10 Budget........................................................................................................ 16
2 chapter two
2.1 Overview of the Existing/current System ....................................18
2.2 Requirements ............................................................................................ 19
2.4 MODELLING SYSTEM REQUIREMENT
2.4.1 USE CASE IDENTIFICATION ..........................................................20
3.4.2 Activity diagram....................................................................................24
3.4.3 Sequence diagram................................................................................36
Reference.....................................................................................................39

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List Abbreviations/Acronyms
ETB Ethiopia Birr

EMR Electronic Medical Record

HIV Human Immunodeficiency virus

TB Tuberculosis

TUTAPE Tulane University Technical Assistance Project in Ethiopia

UML Unified modeling language

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INTRODUCTION
1.1 Background of the organization

The University of Gondar Hospital is located in north-western Ethiopia, 721 km away from
Addis Ababa. The current College of Medicine and Health Sciences grew out of the Gondar
Public Health College and Training Center (PHC and TC), established in 1954. The hospital has
a 400-bed capacity and acts as the referral center for four district hospitals in the area. The
hospital has a range of specialties, including emergency care, pediatrics, surgery, gynecology,
psychiatry, HIV care, and an outpatient clinic. We are currently constructing a G+5 maternal and
child care hospital, a best-standard TB ward, a laboratory, a G+2 eye hospital, and a Fistula
center. One of the biggest and most challenging service units in the hospital is the emergency
department, which is again subdivided into medical emergencies, surgical emergencies,
psychiatric emergencies, gynecology and obstetric emergencies, and pediatric emergencies. The
emergency department provides many curative and preventive services to perform these services
efficiently and effectively. The department is staffed with a total of 27 staff members, among
whom 27 are nurses and 10 are medical doctors. The departments also have 6 rooms and 53
beds. Based on this data, our proposed system will be focused on automating the emergency
department patient handover system.

1.2 BACKGROUND OF THE STUDY

Health care is complex. The processes necessary for communicating health care information are
a continuous challenge for health care professionals and health care institutions. Deficient
communication processes create the potential for errors when caregivers fail to transfer complete
consistent information (1). Patient handover is the transfer of professional responsibility and
accountability for some or all aspects of care for a patient, or group of patients, to another person
or professional group on a temporary or permanent basis (2, 3). Patient handover may occur
between members of the same profession, for example during nursing shift change, or between
individuals belonging to different medical professions or even different organizations (4). This

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includes not only the ‘telling of the story’ by the person giving the handover, but also
interpretation and confirmation of the story, and the development of a mental model by the
recipient of the handover, which allows seamless transition of care.
Handovers, therefore, are a critical clinical and organizational process that occurs at all levels of
the hospital; starting from an individual level (e.g. between nurses) to an organizational level
(e.g. between hospitals during patient transfers) (5). Communication errors are a leading cause of
sentinel events, unexpected occurrences involving death or serious physical injury, or the risk
thereof. The effects of end-of-rotation or service transitions in care may be equally detrimental to
patient care but have received substantially less attention (6). During this transition, one
physician permanently transfers the care of an entire list of patients to another physician. Unlike
shift handovers, times at which the original physician resumes care during his/her next shift,
service transition is permanent—the clinician signing out has no further contact with these
patients or their new physician. While early studies show patients affected by these transitions
suffer increased length of stay (LOS) and cost, multiple large-scale studies have suggested a
significant increase in mortality in patients exposed to these
transitions (7, 8).
In the Fourth Health Sector Development Plan, the Ethiopian Government had insisted that
EMR must be implemented at the major hospitals. the ministry of health in collaboration with
Tulane University Technical Assistance Project in Ethiopia (TUTAPE), developed
comprehensive EMR system called SmartCare (9). The system has been deployed in more than
eleven hospitals and clinics in Diredawa, Bahirdar, Harar, and Addis Ababa city administrations
of Ethiopia as a pilot, and the Ministry of Health planned to scale it up to other hospitals and
regions (7, 9). The design of the system is desktop-based application with SQL server at back
end which enable to work at local area network. The team has limited data about the model,
design and programing language used but a little information is available about design from our
experience when working on the system (9).
Gondar University Hospital is advanced in many clinical areas, but they still use manual
medical record systems, with the exception of a few standalone electronic systems such as ART
data, laboratory, and pharmacy stock management systems. Emergency medical care services
require fast, correct, and curious services for clients as they present with acute problems. in

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Gondar University hospital, the quality of emergency medical care has not been supported by
electronic medical record systems. The aim of these projects will be to develop a web-based
EMR for the University of Gondar hospital emergency department that can improve the quality
of care by decreasing waiting time, avoiding illegible handwriting, increasing data quality,
improving information, and increasing cost-effectiveness.

1.3 Statement of problem

Dynamic and complex clinical environments present many challenges for effective
communication among health care providers (10). The omission of accurate, timely, easily
accessible vital information by health care providers significantly increases risk of patient harm
and can have devastating consequences for patient care. An effective nursing handoff
supportsthe standardized transfer of accurate, timely, critical patientinformation, as well as
continuity of care and treatment, resulting in enhanced patient safety (4).
A handoff between health care providers is the key factor in fostering continuity of care and
providing safe patient care (11). The handoff from one health care provider to another is
recognized to be vulnerable to communication failures (10). Effective communication is
therefore central to safe and effective patient care (11). The Joint Commission reviewed a total of
936 sentinel events during the year of 2015; communication was identified as the root cause in
more than 70% of serious medical errors (11). The consequences of failed communication during
handoff are medication errors, inaccurate patient plans, delay in transfer of a patient to critical
care, delay in hospital discharge, and repetitive tests among others .
An effective handoff supports the standardized transfer of accurate, timely, critical patient
information, as well as continuity of care and treatment, resulting in enhanced patient safety.
Ineffective handoffs contribute to gaps in communication and increased risk to patient safety(4).
Currently the communication and information exchange between emergency health care
providers and other related departments were via the manual transport, so it consumes time, loss
of health record and reduce productivity.
Shift-to-shift medical and nursing handovers have been identified as high risk areas in which
improved clinical handover solutions are urgently required (11). Clinical handover requires a
transfer of information, responsibility and accountability for patient care. Unless the receiver of
the information during handover understands and acts upon the information given, continuity of
patient care will not be achieved. Major factors inhibiting handover improvements include the
lack of basic understanding of handover processes and the absence of a common structure (4).
Medical shift-to-shift handover remains poorly defined and poorly understood. Many hospitals
do not have clear policies on how to conduct effective handover, and the transfer of
responsibility and accountability is not well practiced (11). At the same time, the nursing

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profession has a long tradition of practicing shift-to-shift handover (11).Recently, the efficiency
and effectiveness of nursing handovers have been scrutinized, and the need to improve and
optimize the accurate transfer of information, responsibility and accountability has been
identified (11). More importantly,, the need to improve clinical handover has been recognized as
important for reducing errors, improving patient safety and responding to the increasing use of
information technology (12).
In the University of Gondar Specialize comprehensive hospital Emergency ward all works of
patient transfer is done by manual (paper based system). And this system have a lots of problems
.for example.
Data duplication: in the existing system there is duplication of emergency patient medical
records because very difficult to retrieve patient information, one patient may have many file.
This problem is occurred due to missing of file and boringness of finding/retrieving the desired
file from huge documents. In addition, since retrieving file is very tiring, providers are obligated
to generate new medical record which increases the accumulations of records and make
retrieving, updating patient information or renewal patient of record more complex.
Illegible hand writing: usually health care providers’ including doctors and nurses hand
writing is difficult to read. so that future medication which recommended by the first shift is not
provided effectively and this leads to wrong decisions and inappropriate care for the patient .This
wrong information may intern results to the death of the patient.
Data security and confidentiality problem: Most Patient information’s in emergency
department were exposed to access by unauthorized person. So, there was loss of security and
confidentiality. This
can increase the chance that client’s information is being theft, damaged etc. This way of
handling data is also more susceptible for unauthorized access, which greatly contradict with
data confidentiality. Someone may come to the ward and format the medical history.
Poor error handling mechanism: in existing system the data handling method is
manual. In this system is it is difficult to detect and correct errors easily. If error occur during
recording it is more likely to be tolerated and looks like correct data. For example some no can
inter numbers on the field of text or vice versa.
Data or file missing: This is because of there is no appropriate or safe room to store those
data. The files are stored simply on the table. This increase the probability, that forms containing
sensitive data are lost from their attachment. This loose of file has negative impact on continuity
of service provision.
Space requirement: The current system requires high amount of space for storing data
recorded in paper form. This large storage space requirement create overcrowded and
uninteresting work environment, and lead to additional space requirement.
Resources requirement: currently the system needs extra manual effort to give the
service. In addition paper and other materials take up a massive amount of resources wastage.
Event thought when and what medication given is recorded by the paper, there may be
forgetting of the time when the medication is given. Due to the documentation is paper based

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their is storage issue. Sometimes future medication is is note documented effectively the life of
the patient may be left.
Developing patient handover information system can solve most of the problems mentioned
above and save the life of patients in the ward. Due to the the ward is very crowded and
insensitive care is provided to the patient, timely and correctly recording of hours when the
medication is given is very crucial. Small error in the recording can be the cause of life lost. In
general the past the current and future medication is dot documented defectively or all process of
documentation of patient handover is done in paper based system. This recording have many
problems rather than what we mentioned.
1.3.1 THE PROPOSED SYSTEM
The proposed system will have greater advantage to solve problems observed in the emergency
ward. The system will provide totally new approach that automates the manual system to the
electronic system. The system will replace almost all manual patient hand overin the department
like registration, patient emergency history taking; recording current and future medication, vital
sign record drug prescription, laboratory prescription, report generating and storage of the file.
Our proposed system will have several advantages.

 Record past current and future medication

 Fast access to a database
 User-friendly interface
 Increase patient safety
 Reduces error in data entry
 Fast searching mechanism
 Enhance security of patient data
 Avoided duplication of record
 Easy to handle and feasible,
 Increase accountability of the health care professionals

1.3.2 System Architecture

system architecture describes the system’s hardware, software, and network environment,which
is the plan for how the information system components will be distributed acrossmultiple
computers. In our proposed system Three-tier Client/Server Architecture will beused because it
is commonly used for web-based application and enhance security.
1.4 Project objective
1.4.1 General objective
To develop, Web Based Patient Handover information system to improve shift-to-shift clinical
handover by medical and nursing staff in University of Gondar comprehensive Specialize
Hospital Emergency Department Northwest Ethiopia2022.

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1.4.2 Specific Objectives

 To Identify the problem in the current system

 To determine the requirement of patient handover information system
 To model UML diagram for our system
 To design database for patient handover information system.
 To design user interface patient handover information system.
 To implement patient handover information system.

1.5. Significance of the project

The proposed system has advantages for facility, client and for health care professionals by
streamlining the work flow of emergency department. The system will increases the validity and
completeness of patient information, increase confidentiality of health care provider increase
accountability and responsibility of the health care providers, allows only authorized users to
access patient information. It reduces duplication of records, time to retrieve client information
and allows us to store client information for a long time. This system will provide very easy way
to generate report by different period and serve as source of relevant information for decision
making process. So this system will increase service quality. Thus it assist in protecting patients
from the risk of treatment associated complications, and also it reduce patient, morbidity and
mortality.it prevent the provision of mistimed medication and the forgetting of future medication
which is recommended by the first shift to the second shift. In general the proposed system has
vital roles for different stakeholders. Example:-
For Health care facility: the system is important for facility in many ways.
The system reduce work load for providing emergence service, provide Permanent storage of
records. Increase data security in the hospital, provide easy way of managing information and
increase the ability of hospital to retain information for a long time. In addition to this it reduce
physical space and other resource requirement for paper based folders. Through this system
organization can provide right care at right time to the right patient and also generate relatively
accurate report. Organization can use it as source of relevant information for adequate planning
and budgeting. Generally it helps organization to provide better quality service.
 It could be used as a source of relevant information.
 Data could be kept for long period of time for the purpose of doing research.
 The system ensured security and confidentiality through only authorized user’s
 Login to the system so the system prevents the facility from being accountable by
patients.
 Used to manage the activities done in Emergency department and the ward will be became
trusted by patient.it also used for efficient use of data for reporting and planning.

For health care provider: the system is also advantageous for health care providers in the
following way. It will provide complete information about patients past present and future
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medication, and increase the confidence of emergency service provider. In addition it will
encourage team spirit of workers and reduce burden of writing on paper and problem of illegible
hand writing. The system also saves work
time and also it increases the accountability of the health care providers for their own work. In
general:
 The system solved the problem of illegible hand writing in records.
 Facilitated their work and reduced work load.
 Users managed the patient using their user account.
 The system tells future medication with is correct time .
 Healthcare professionals could access patient’s data located in central data base.
 It was very easy to generate report to make the right decisions.
 It enhances the accountability and responsibility of the service in the department

For Patients: Since the primary goal of the health industry was to give quality service for
patients, patients were benefit able from the system by:
To model UML diagram for our system

 The system provided good documentation of their records.

 The system prevents their data from damage or loss or any authorized modification.
 The proposed system ensured security and confidentiality through only
authorized user’s login to the system.
 Got better health service.
 Trust on facility.

1.6 Scope and limitation of the project

1.6.1 Scope
The proposed system design will be a web-based patient handover information system in Gondar
comprehensive specialized hospital. It focused on the emergency department with actors Doctor,
Nurse, Data clerk and Administrator. The general Scopes of the system which can be performed
by the different actors were create and delete users account, view previous ,current and future
medication, generate report, record patient’s history(add previous, current and future medication
and vital sign), register and give appointment.
1.6.2 Limitation of project
Even if our system can perform many activities but it had some limitation such as:
 Our systems could not inter operable with other departments which were linked with emergency
department.
 The system did not support languages other than English language.
 The system is only accessible when the internet was available.
 This is because of the following reasons:
 Lack of time.

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  Lacks of available resource.

1.7Methodology
1.7.1Datacollectiontechniques
To collect the data for the development of the our system, we use different data
collection techniques. These are:
Interview
First, we prepared different questions which helps for preparation of our project. From
those we asked the Emergency department head and he shared the general overview of the
existing system then we asked academicians head like the background of Emergency, when the
department was start in University of Gondar comprehensive specialized hospital and how to
work, their problems and challenges. Moreover, we asked staff workers, health care
professionals and patients to collect information in order to gather the data flow of current
system.
Observation
Secondly, we observed the entire Emergency department work flow and logic in order to
simulate the manual system (i.e. requests are recorded manually).
Review Documentation
Finally, we were review documents in Emergency department to collect information about the
current system how they document patient hand over information .because most information’s
are transfer to shift verbally there is no more documentation. Paper based approach of patient
hand over is not implemented formally. But we see some paper format which used for handover
the patient. This helps to how to register hand over information. But the documents were having
incomplete data.
1.7.2 Analysis and design model tool
To develop patient hand over information system, we used the object oriented system analysis
and design methods because we are familiar with object oriented approach. This methodology
helps to adapt the use of object and class in the system development life cycle. It uses formal
unified modeling techniques to describe a system basic data flow.
1.7.3 Implementation Tool Software Requirement
We will use the following Implementation tools at the front end

 HTML: to create each web page in the project

 CSS: to style the page what we want
 JavaScript: to give notification and ensure validation

We will use the following Implementation tools at the back end

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  MY SQL: primarily used to create database, table, relationship, store data, toquery
data and import and export data.
 We will use the following Implementation tools at sever side
PHP: to create a dynamic connection between web page and database

Table 1: Analysis, design and implementation tools for web-based patient handover Information
System in Gondar University comprehensive specialized hospital, northwest, Ethiopia.

Software requirement
No Tools Activities Phase

1 MS office word 2010 For documentation Analysis, design

To draw UML Diagram and

2 Edraw max for Analysis, design
designs

3 MYSQL or XAMP Server Back-end (store data) Implementation

HTML,

CSS Front-end (graphical

4 Implementation
interface)
PHP

Hardware requirement
5 Toshiba, HP or Lenovo For implementation Implementation

RAM 2gb and above

CPU speed 2.2 GH and above

Processor Intel Pentium

CORE i3 and above

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 Flash disk

1.8 Feasibility study

1.8.1 Operational feasibility
The proposed system provided best services for emergency department professionals and it kept
the security of patient information by gave role to the authorized users. The system was also
being on behalf of origination’s goal and user satisfaction, because the system was being
possible to run and use in the organizations LAN internet. So, the system was being
operationally feasible or it was operationally acceptable to users. The system gave better user
interface registration form and storage of user information, easy updating, deletion and
modification etc. Therefore, the system had positive impact on the Emergency department
workflow.
1.8.2. Technical feasibility
The proposed system was highly compatible for the present applications. The system user
interface was user friendly and did not require much expertise and training. It just needs mouse
click to do operations and to generate reports. The proposed system could be easily maintained
and repaired technically. There was no need for the developer involvement in almost all
implementation of the entire system. It was easily accessible by the people who can easily
understand natural languages. So, the system was technically feasible.
1.8.3. Economic feasibility
The system reduce the cost for purchasing paper-based guideline, patient chart, request form,
prescription paper and report form. We were not needed additional equipment; the system could
run on currently available computer and reduce human resource (porter) hiring cost.in addition
the system can easily maintained and repaired with minimum cost. As we said our project was
economical feasible the minimum cost to develop a system was 33,548.5 Ethiopian Birr. After
we finished the project came up with more benefit than beginning cost. Due to this we can say it
was economically feasible.
1.8.4. Ethical feasibility

The proposed system had no conflict with any government directives and it gave
services for the people effectively and efficiently within the specified scope so the
organization was profitable and the system was ethically feasible.

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7. Work plan

We planned and organized to develop Emergency information system by identifying the resource
and task in our system by assign time for each activity through Gant chart schedule then we
complete the project within expected time. There for our project was
feasible in terms of schedule time.

Table 2: work plan of a of the project on web-based patient handover Information System in
Gondar University comprehensive specialized hospital, northwest, Ethiopia

S.no Activities Time schedule

April June June June July August
2022 2022 2022 2022 2022 2022

26-30 7-12 13-18 20-30 2-30 12

1 Title selection
Requirement
2
gathering
3 System analysis

4 System design

5 Implementation
Project
6
submission

1.9 Budget

Table 3: Budget breakdown of the project on web-based patient handover Information

System in Gondar University comprehensive specialized hospital, northwest, Ethiopia

Total cost in
List of material Type Amount Unit Cost
ETB

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Laptop HP 1 32,000 32,000

Paper A4 size 1 packet 180 180

Pen Bic 1 packet 15 650

Flash T-max 16-GB 350 280

Exercise book Sinner line 1 dozen 40 480

For printing _ 100 1 100

Total cost 37,390

Contingency 15% of Total 3739.00

Grand total 41129.00

CHAPTER TWO
2. SYSTEM ANALYSIS

2.1 Overview of the Existing/current System

Gondar university hospital uses a manual system to record all transactions related to
the emergency department. The patients who come to an emergency may get basic
lifesaving treatment before register as a new client or retrieving his previous folder
but if the patient is not critical ill, his/her relative may be brought medical record for
him. The emergency department and medical record department has close relations as
the patient first should be registered to receive medical care.

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As soon as the patient completes financial related service his folder or chart transfers
to the emergency department by a porter. Currently, the emergency department has
workflow relation with MRD, laboratory, pharmacy, OPD, IPD, Surgical ward, ICU,
gynecology, psychiatry and HMIS department. Then Emergency department physician record
vital sign, observe the previous history, document current and past medication. The physician
takes patient history, perform physical examination and also if the physician need lab result,
radiology result and/or pathology result the doctor sent request to laboratory, radiology and/or
pathology department respectively to diagnosis patients. Then the physician decided whether the
patient requires admission or not and record in their appropriate form. Finally, the health record
was store on medical record room.
When we evaluate the existing system of Emergency department, patient handover information
system all activities are done manually and some information's are passed from shift to shift
verbally, due to this the current system requires numerous paper forms, lead to the need of space
to store the paper-based file, filing form properly, past, current and future medications and
laboratory and other medical requests are not properly documented. In the existing system there
is a loss of records, luck of proper documentation of clinical findings. Due to most of
information’s are transferred verbally there physicians may forget future medication. And patient
information was not secure. Almost most of the patient hand over is not documented and
transferred verbally.

2.2 Requirements
System requirements were all of the capabilities and constraints that the new system must met.
Generally, analysts divided system requirements into two categories: functional and
nonfunctional requirements.
2.2.1 Functional Requirements
Functional requirements were a system requirement that describes an activity or process
that the system must perform called quality of the system. Some of the functional requirements
that the proposed
system exhibits were: -

 User management ❖ Patient Management

✓ Create user account ✓ Register new patient data and Search existing
✓ Assign a role to the new user patient data
✓ Update user account ✓ Retrieve current and past patient medical
✓ delete user account history
✓ Delete patient record
✓ Edit patient record
✓ Update patent record
❖ Record lab order/request
❖ view, edit, delete and update lab request

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❖ Record Prescribe drug electronically
❖ View, edit, delete and update a prescription
❖ Export
✓ Export patient record to (. XLSX.CSV.pdf) format

2.2.2 Nonfunctional Requirements

Non-functional requirements were a requirement that helps our system for well-functioning.
Those types of requirement are not the main part of the system requirement and
can be used to judge the operation of a system, rather than specific
behaviors. This should be contrasted with functional requirements that define
specific behavior or functions. Those are: -
User Interface:

 The proposed system could be user friendly and attractive.

 All forms could be easy to use.
 The appropriate color will use to fit with the nature of the message and action.

Performance:
✓ We will use the simplest and shortest algorism so the system will
respond within a second.
Availability:

 The system could be accessible all time.

Time Efficiency: -

 The system generates responses with in the short period time

Exception handling: -

 The system displayed an error message when the user attempted to enter invalid data.

Security: -

 Patient information secured from unauthorized user and accessed by giving

username and password for each user.
 the team will use algorism to encrypt the password
 The system will be protected from SQL injection
 Each and every user can access the page only if having a user account
created by the system administrator
 User access to the system will have specific role-based security

Backup and restore: -

✓ The system will take specific table backup

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✓ The system also able to take full database backup

2.3 Modeling System Requirements

Actors of the system are the following: -
Doctor: - is a person who is responsible to control patient history, prescription,
request and result on the system.

Nurse: - is a person who can record vital sign and give a medication.
Admin: - a person who is responsible for create, update, delete account and
generate report
Data Clerk: -person who is responsible for register, search, and update patients
demographic data.
2.4 MODELLING SYSTEM REQUIREMENT
2.4.1 USE CASE IDENTIFICATION

UML use case diagram is a diagram that summarizes the details of system user (actors) and
their interactions with the system. We use Case diagram to describe the functionality of a new
system. A use case represents a unit of interaction between user and the system. Each Use Case
describes the functionality to be built in the proposed system. Which can include another Use
Case functionality or extended another Use Case with its own behavior. To draw use case
diagram first we analyzed the existing system and identify actors and activities that is performed
by those actors ( Doctor, Nurse, Administrator, Data clerk),.Then we draw use cases all together
for complete system separately as follow.

The figure below shows use case diagram for the Administrator with major roles (Create
account, search account, Update account, and delete account).

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Figure 2.3 UML use case diagram for administrator

The figure below shows use case diagram for the data clerk with major roles (register client,
search client, Update client, delete client and generate report).

Figure 2.4 UML use case diagram for data clerk

The figure below shows use case diagram for a doctor with major roles (record history, record
lab order, record drug prescription, record diagnosis).

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Figure 2.4 UML use case diagram for Doctor
The figure below shows use case diagram for a Nurse with major roles (record vital sign, record
drug administer).

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Figure 2.4 UML use case diagram for Nurse

3.4.2 Activity diagram

Data clerk register patient

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figure data clerk update patient register

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Doctor activity diagram for recording history

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Figure admin below creating a user

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Figure below Admin generate report

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Figure above Admin update users

Figure below doctor update patient history

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Figure below nurse administering drug

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Figure below nurse update vital sign

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3.4.3 Sequence diagram

for login to the system

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admin edit user account

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