Using the interview transcript below of the Dermatology Practice case study, answer the following questions. (a) Model the existing process activities of the medical practice described below, in the following way: I. Draw a Context Diagram. 5 marks II. Draw a Functional Decomposition Diagram for the whole system.

(b) Having identified all the data entities described below, draw an entity relationship diagram. You do not need to specify keys or other attributes.

(c) Discuss how the systems analyst, Wojciech Czalka, has performed in his work. In your discussion consider how well, or otherwise, he directed and controlled the interview.

A Dermatology Practice Dr. Claire Washington has recently taken over a dermatology practice from an older physician, Dr. Halwell, with whom she has practised for the past ten years. A recently qualified physician, Dr. Frank Jefferson, will be joining the practice shortly. Claire and Frank will run the practice as a partnership. The other staff are: Ms. Teresa Liu, office manager. Ms. Jennifer Carrington, secretary. Ms. Sally Farnham and Ms. Trudy Hynes, nurses. The practice operated reasonably well but is creaking under the weight of antiquated procedures. The old patient record software system in use is called Patient CarePlus but it has been very slow and inflexible as the practice has developed. Furthermore, many procedures remain manual and they would like to automate these where possible. Thus to improve efficiency and profitability, Dr. Washington has decided that many office practices will need to be changed. She has contacted Computer Consultants with a view to commissioning a computer-based system to help with patient scheduling, ordering supplies, accounts receivables (billing), reminder 3 generation and patient treatment. Wojciech Czalka, Senior Systems Analyst of Computer Consultants has been assigned to the project. The following describes a summarised outcome of interviews held by Wojciech with staff of the office in a study of the operations of the existing system. The study begins with Wojciechs interview of the office manager, Ms. Liu, who describes the billing process in detail. When a patient arrives for an appointment, the daily appointment schedule is annotated with a circle to indicate that the appointment was kept. After each patient visit, the doctor completes a Patient Visit Form to indicate the diagnosis and what services were performed. Two copies are placed in the current weeks stack for subsequent processing. The original white copy is filed as a permanent record of the office visit. The patient gets the yellow copy. The pink copy is used by Jennifer Carrington to enter the details from the Patient Visit Form into the software system. At this time, a patient is requested to pay in full for the office visit unless the patient is covered by health insurance. If they are able to pay at that time then an invoice and receipt is issued. If they are covered the Patient Visit Form together with the third-party insurance form is then posted to the insurance company. Ideally Dr. Washington would like this process to be automated since she is aware of another practice that uses online Web forms to submit their insurance claim directly. The amount charged for each service is determined by locating the procedure in the Charge Reference Book. Once insurance claims are filed by the office, the payments are sent directly to Dr. Washington. Most claims are only partially reimbursed by the insurance cover, thus the patient must be billed later for the remaining amount. At the start of each week, Ms. Liu prepares patient invoices for the patients treated during the previous week that have not paid or for whom a claim has been made to their insurer. Regardless of the patients insurance coverage, the invoice is prepared for the full amount and mailed to the patient. For those for whom an insurance claim has been made, a note is attached that payment is awaited from the insurer and that the patient is liable for any shortfall. Until full payment is received, the invoice record status is pending payment. Thus the office manager occasionally reviews these outstanding invoices and issues follow-up notices. Complaints have been received from patients that they have sometimes sent in payments for invoices that their insurer has already paid and that they are often confused as to what balance they have to settle. The office manager continues her discussion with an explanation of the payroll system - PayRight. Payroll requires a concentrated effort on her part to prepare the cheques for pay-day. Since all the employees are on monthly salary rather than hourly wage, it is not too difficult to check over all the figures. But every time the tax laws change, she faces extra work until she understands the new regulations. The PayRight software application is very basic and no maintenance support contract is in place to make the necessary changes when tax rates and band changes are introduced. This part of the business needs urgent remedial attention. Ms. Liu is keen that a new payroll application is implemented. The next problem areas on Wojciechs list are appointment scheduling and patient recalls. In order to understand these activities, he arranges to meet with the receptionist early the next day. Jennifer Carrington is glad to answer Wojciechs questions about the appointment scheduling system. She is familiar with the procedure for booking appointments. A first appointment usually follows a call or email from a patient requesting to see a dermatologist having been referred to the 4 practice by their own doctor. (A Referral Letter is brought in by the patient when the appointment takes place.) Other patients will arrive unscheduled and if time is available, the patient will be given an immediate appointment, otherwise they will be scheduled for some later date. In both cases Jennifer enters patient details (if it is a new patient) and the appointment date and time. This is achieved by searching the doctors diary in the system and identifying suitable dates for the patient. The appointment is created and communicated to the patient over the phone or by email. The next days daily appointment schedule is printed off at close of business the day before and distributed to all staff so that a clear picture of the next days activities are known by all. For some patient visits, Dr. Washington marks on the form that the patient should return in a certain length of time. These appointments, perhaps several months ahead, are usually scheduled before the patient leaves the office. Dr. Washington tried to establish a patient appointment reminder system, but the receptionist was just too busy to notify patients about their appointments in advance. Ideally, patients should be called and reminded about appointments, especially those scheduled a long time ago. Unfortunately, most patients are never called, so some of them simply forget about their appointments. Later on, they usually call to reschedule their appointments, often because the condition has recurred. Dr. Washington is particularly concerned about this situation because timely intervention can often prevent serious medical problems. Whenever Dr. Washington is called away due to a medical emergency, Jennifer must reschedule appointments for several patients. Before the patients can be contacted, their phone numbers and/or email addresses must be located by searching the file records. It is a laborious task, but she asserts that she always accomplishes the appointment rescheduling in a satisfactory way. Finally, Wojciech investigates the record-keeping system for patient histories. A physical file folder exists for each patient. After each patient visit, Dr. Washington enters her own notes about the ailment and the treatment prescribed as well as essential details into the Patient CarePlus system. Unless the patient has a long medical history, this system seems to be satisfactory for Dr. Washington. However patients with complicated histories are troublesome because Dr. Washington needs to review both the physical patient file and the Patient CarePlus system to be sure that no vital information is overlooked. The nurses express a different view of the patient history system. When patients call, they have to pull the correct file folder, search for the information in the computer, and answer their questions. They feel that a single source for all the information is important. Having obtained an in-depth view of the various systems pertinent to Dr. Washingtons practice, Wojciech also examines the accounts payable system and drug records. Although the accounts payable system is functioning well, Wojciech becomes concerned about controls in this area. He discovers that an audit has never been performed on accounts payable. Ms. Liu has the authority to pay bills without any supervision from Dr. Washington, since these amounts, apart from drugs, are relatively small compared to the monthly salaries. Ms. Liu writes cheques on a separate current account designated for this purpose. The payments from the patients are placed in a second (deposit) account from which only Dr. Washington is authorised to withdraw funds, which she does so every so often to float the current account. Since Ms. Liu can draw funds only from the first account, Dr. Washington believes that the patient receipts placed in the second account are secure from fraud. 5 Wojciech is not satisfied with the controls in this area, however, and marks this matter for discussion with Dr. Washington. Wojciech then interviews the nurses about the procedures for issuing drugs. The nurses both agree that the record-keeping system is adequate. The distribution of controlled substances, drugs that are strictly regulated by law, is recorded in a special book. The inventory of other drugs is simply checked once a week by one of the nurses - drugs are reordered by writing the drug name and quantity on an order form. From there Ms. Liu takes over, ordering the drugs and paying the bills. There have never been any problems in this area. The quantity of each drug in stock is written in the Drug Book. The nurses are emphatic in their disapproval of any change to this system.