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BREAST CANCER CARE SYSTEMP. KHIDMAT MAKLUMAT AKADEMIK
UNIMAS
IlIllIllIllIllIll 11111111111 1000165872
BEATRICE CHIN
This project is submitted in partial fulfillment of the requirements for the degree of Bachelor of Computer Science with Honours
(Software Engineering)
Faculty of Computer Science and Information Technology UNIVERSITI MALAYSIA SARAWAK
2006
ACKNOWLEDGEMENTS
I would like to express my appreciation and sincere gratitude towards the people who
have spent time in assisting me to successfully complete this final year project
First of all, I would like to thank Miss Chai Soo See for being a good and dedicated
supervisor all the way through this final year project. Throughout the process of
completing this project, she had given me advices and ideas on developing Breast Cancer
Care Systm. Without her guidance, I believe I will not be able to complete this project
successfully.
I would also like to extend my gratitude to my family members and friends who have
given me all the support and encouragement throughout the development of this project.
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Fusat K1 idmat Makiuniat Akacienus. UNIVERSITI MALAYSIA SARAWAK
04301 Kota Samarahan
TABLE OF CONTENTS
Page
DECLARATION
ACKNOWLEDGEMENTS
TABLE OF CONTENTS
LIST OF FIGURES
LIST OF TABLES
ABSTRACT
ABSTRAK
CHAPTER 1: INTRODUCTION
1.1 Problem Statement
1.2 Objectives
1.3 Methodology
1.3.1 Object-Oriented Analysis (OOA)
1.3.2 Object-Oriented Design (OOD)
1.3.3 Implementation
1.3.4 Testing
1.4 Scope
1.5 Significance of Project
1.6 Project Schedule
1.7 Outcome
1.8 Outline of Project Report
1.8.1 Chapter 1 - Introduction
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1.8.2 Chapter 2 - Background
1.8.3 Chapter 3 - Requirement Analysis and Design
1.8.4 Chapter 4 - Implementation and Testing
1.8.5 Chapter 5 - Conclusion
CHAPTER 2: BACKGROUND
2.1 Introduction
2.2 Review on Existing Systems
2.2.1 iHealthRecord
2.2.2 CapMed
2.2.3 GlobalMedic
2.2.4 iValley
2.2.5 Comparisons of Reviewed Systems
2.3 Review on Implementation Tools
2.3.1 Programming Tools
2.3.1.1 Hypertext Preprocessor 4.0 (PHP4)
2.3.1.2 Active Server Pages+ (ASP+)
2.3.1.3 Comparisons between Different Programming Tools
2.3.2 Databases
2.3.2.1 MySQL
2.3.2.2 Oracle8
2.3.2.3 Comparisons between Different Databases
2.3.3 Web Servers
2.3.3.1 Apache Web Server
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2.3.3.2 Microsoft Internet Information Services (ITS)
2.3.3.3 Comparisons between Apache and ITS
2.4 Reviews on Methods Used for Calculating Breast Cancer Risk
2.5 Conclusion
CHAPTER 3: REQUIREMENT ANALYSIS AND DESIGN
3.1 Introduction
3.2 Object-Oriented Analysis (OOA)
3.2.1 System Requirements Specification
3.2.2 Requirement Analysis
3.2.2.1 Use Case Model
3.2.2.1.1 Manage PHR Use Case Diagram
3.2.2.1.2 Access Message Center Use Case Diagram
3.2.2.1.3 Maintain Account Information Use Case Diagram
3.2.2.1.4 Retrieve Patient's PHR
3.2.2.2 Use Case Specification: Manage PHR
3.2.2.3 Use Case Specification: Login
3.2.2.4 Use Case Specification: Retrieve Patient's PHR
3.2.2.5 Use Case Specification: Register As Member
3.3 Object-Oriented Design (OOD)
3.3.1 Designing of Classes, Relationships, Attributes and Methods
3.3.2 Activity Diagram
3.3.3 Interface Design
3.3.4 Database Design
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3.3.4.1 Business Rules and Entity Relationship Diagram
3.3.4.2 Identify Attributes and Primary Keys
3.4 Conclusion
CHAPTER 4: IMPLEMENTATION AND TESTING
4.1 Introduction
4.2 Implementation of System Module
4.2.2 Login Module
4.2.3 Registration Module
4.2.4 Patient Module
4.2.4.1 Personal Home Page
4.2.4.2 Personal Health Record (PHR)
4.2.4.3 Account Information
4.2.4.4 View/Print PHR
4.2.4.5 Delete PHR
4.2.5 Health Professional Module
4.2.5.1 Search for Patient
4.2.6 Message Center Module
4.2.7 Contact Us/Help Desk Module
4.2.8 Breast Cancer Quiz Module
4.2.9 Breast Cancer Risk Assessment Tool Module
4.2.10 Forum Module
4.2.11 Search Function
4.2.12 Encryption Feature
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4.2.13 Interface Agent Feature
4.3 Testing
4.3.1 Functionality Test
4.3.2 Graphical User Interface (GUI) Test
4.3.3 Usability Testing
4.4 Conclusion
CHAPTER 5: CONCLUSION
5.1 Introduction
5.2 Achievements
5.3 Contributions
5.4 Limitations
5.4.1 Limited Element in Personal Health Record
5.4.2 Limited Interface Agent Abilities
5.4.3 Search Engine
5.4.4 Uses Only Single Language
5.4.5 Address Book Not Available
5.4.6 Limited Information
5.5 Future Works
5.5.1 More Elements in Personal Health Record
5.5.2 A More Interactive Microsoft Agent
5.5.3 A More Sophisticated Search Engine
5.5.4 Dual Language
5.5.5 Address Book
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5.5.6 Library of Sources
5.6 Conclusion
REFERENCES
BIBLIOGRAPHIES
APPENDIX A: USE CASE SPECIFICATIONS
APPENDIX B: ATTRIBUTES AND PRIMARY KEYS
APPENDIX C: GRAPHICAL USER INTERFACE (GUI) TEST
APPENDIX D: USABILITY EVALUATION
APPENDIX E: QUESTIONNAIRE RESULTS
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LIST OF FIGURES
Figure 2.1: Screen shots of personal health record for iHealthRecord
Figure 2.2: Screen shots of personal health record for CapMed
Figure 2.3: Screen shots of GlobalMedic features
Figure 2.4: Screen shots of Walley website
Figure 3.1: Use Case diagram for Breast Cancer Care System
Figure 3.2: Use Case diagram for Manage PHR
Figure 3.3: Use Case diagram for Access Message Center
Figure 3.4: Use Case diagram for Maintain Account Information
Figure 3.5: Use Case diagram for Retrieve Patient's PHR
Figure 3.6: Sequence diagram for Manage PHR basic flow
Figure 3.7: Sequence diagram for Manage PHR alternative flow
Figure 3.8: Sequence diagram for Login basic flow
Figure 3.9: Sequence diagram for Login alternative flow I
Figure 3.10: Sequence diagram for Retrieve Patient's PHR basic flow
Figure 3.11: Sequence diagram for Retrieve Patient's PHR alternative flow
Figure 3.12: Sequence diagram for Register an Account basic flow
Figure 3.13: Sequence diagram for Register an Account alternative flow I
Figure 3.14: Sequence diagram for Register an Account alternative flow 2
Figure 3.15: Class Diagram for Breast Cancer Care System
Figure 3.16: Activity Diagram for Breast Cancer Care System
Figure 3.17: Interface design for login page
Figure 3.18: Interface design for registration page
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Figure 3.19: Interface design for cancer record page
Figure 3.20: Interface design to display search result for patient
Figure 3.21: Interface design to display patient's PHR
Figure 3.22: Interface design for main page of BCCS
Figure 3.15: Entity Relationship Diagram for Breast Cancer Care System
Figure 4.1: Patient's login page
Figure 4.2: Patient's registration page
Figure 4.3: Patient's personal home page
Figure 4.4: Patient's personal health record
Figure 4.5: View PHR printable page
Figure 4.6: Delete PHR confirmation page
Figure 4.7: Health Professional's personal home page
Figure 4.8: Search for patient's record page
Figure 4.9: Inbox for Message Center page
Figure 4.10: Form to be filled in to compose message
Figure 4.11: Contact Us page
Figure 4.12: Breast Cancer Quiz
Figure 4.13: Breast Cancer Risk Assessment Tool page
Figure 4.14: Graph that depicts risk calculation results
Figure 4.15: Breast Cancer Care Forum
Figure 4.16: Search function for BCCS
Figure 4.17: Summary of GUI test results
Figure 4.18: Graph that summarizes usability evaluation testing results
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LIST OF TABLES
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Table 1.1: Project schedule 7
Table 2.1: Comparisons between existing systems 16
Table 2.2: Comparisons between PHP4 and ASP+ 20
Table 2.3: Comparisons between MySQL and Oracle8 22
Table 2.4: Comparisons between Apache and IIS 24
Table 2.5: Comparisons between Gail and Claus model 25
Table 3.1: Tables required for User database 55
Table 3.2: Tables required for Search database 56
Table 3.3: Tables required for Forum database 56
Table 4.1: Code segment to upload mammograms 63
Table 4.2: Code segment for generating line graph 71
Table 4.3: Code segment that shows how to obtain keywords from specified URLs 73
Table 4.4: Code segment for keyword matching 76
Table 4.5: Code segment for encryption method 77
Table 4.6: Code segment to show how Interface Agent is embedded in each webpage 78
Table 4.7: Test plan for login function 80
Table 4.8: Test plan for registration function (email address validation) 80
Table 4.9: Test plan for registration function (date validation) 80
Table 4.10: Test plan for registration function (phone number and postcode validation) 81
Table 4.11: Test plan for Breast Cancer Risk Assessment Tool function 81
Table 4: 12: Test plan for logout function 82
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ABSTRACT
The emergence of the Internet has impacted the health information and the healthcare
industry. The information revolution has reduced the distance between the healthcare
providers and consumers. It permits easy dissemination of information and fast
accessibility of data. With the rising cases of breast cancer among women in our country,
an idea to develop a web-based system to manage breast cancer patient's health record
evolves. The development of this system is expected to not only altered the way that
medical information is stored, shared, and generated across and within healthcare
organizations but it also promises to increase the efficiency and cost-effectiveness of
healthcare, specifically in the realm of breast cancer.
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ABSTRAK
Perkembangan Internet telah memberi kesan kepada bidang kesihatan dan penyebaran
maklumat kesihatan. Revolusi teknologi makiumat telah mempermudahkan cara
berkomunikasi di antara pihak kesihatan dan pengguna dan juga mempercepatkan
penyebaran dan pencapaian makiumat. Dengan kes kanser payudara yang semakin
meningkat di negara kita, telah timbttl satu idea untuk membina sistem yang dapat
mengurus rekod-rekod kesihatan para pengguna yang menghidap penyakit kanser
payudara. Sistem ini bukan sahaja mengubah cara maklumat perubatan dan kesihatan
disimpan dan diurus, ia juga dapat meningkat keberkesanan dan mengurangkan kos
dalam industri kesihatan, terutamanya dalam bidang kanserpayu dara.
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CHAPTER 1: INTRODUCTION
Breast cancer is the most common cancer among Malaysian women from all
ethnicities and it is also the most common cause of cancer death among women in
Malaysia. In an effort to improve the quality of healthcare delivery to breast cancer
patients, Breast Cancer Care System (BCCS) is providing the online availability of
breast cancer patient's health record, where a patient not only can record and retrieve
her own personal health information but also able to upload their digital
mammograms. In addition, BCCS also provides concise information for people with
breast cancer concerns, breast cancer quiz to test user's knowledge about breast
cancer, risk assessment tool that calculates the risk of getting breast cancer based on
specified risk factors and forum that discusses any topics related to breast cancer.
1.1 Problem Statement
At present, every time a patient goes to a doctor's office, staffs have to put together a
chart, often involving phone calls to different specialties, including surgery, oncology
and radiology. "It takes an enormous amount of time to pull it all together, " said Dr.
Marisa Weiss, president and founder of nonprofit organization BreastCancer. org [15].
Besides, many of breast cancer patients, who travel or move frequently, find it a
major problem to ensure that their medical records follow them. Patients often have
numerous health appointments and every time patients have to attend an appointment,
they would have to bring their mammograms along. Unfortunately, patients are not
able to retain their mammograms. Patients would have to go and physically get the
images from the facility storing them, take them to their appointment, and later return
them to the original facility. Furthermore, women are often interested to know their
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risk of getting breast cancer. They would have to pay for a high medical cost for a
doctor's visit just to know their risk. Also, women normally do not talk to their
families about their breast cancer problem and should they have questions regarding
breast cancer, they do not normally discuss with doctors, whereas it is important to
talk about it.
1.2 Objectives
At the core of this project is a system that puts together the important services as well
as general information for people with breast cancer or breast health concerns. The
main focus of this application is the electronic patient personal health record (PHR).
The objective of this feature is to enable breast cancer patients to store and manage
their own health records electronically and make them accessible by health providers
anywhere and at anytime in a secure way. It also allows patients and their health
providers to interact among each other to discuss further on patient's health or to
make appointments. The breast cancer quiz that is included in this application is to
enable users to test their knowledge about breast cancer. The goal of breast cancer
risk assessment, on the other hand, is to personalize management strategies for all
women, with the aim of increasing survival in high-risk women while decreasing cost
and complications in low-risk women. The application also provides forum, where
patients and caregivers can debate and exchange information regarding their personal
experiences with disease and health care.
1.3 Methodology
The methodology used in this project is based on the Object-Oriented System
Development, which consists of 4 activities: object-oriented analysis, object-oriented
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design, implementation and testing. This methodology is chosen because it involves
incremental development, which best suits this project.
1.3.1 Object-Oriented Analysis (OOA)
This phase of software development is concerned with determining the system
requirements and identifying classes and their relationships to other classes in
the problem domain. To understand the system requirement, users or actors of
the system is identified. Use Case model, which represents users' view of the
system and users' needs are developed in this phase. Each Use Case is
described in a use case specification that contains pre- and post-conditions that
must be met and also basic and alternative flows of the use case scenario. Each
flow is followed by a sequence diagram. Chapter 3 explains in more details the
activities involved in this phase.
1.3.2 Object-Oriented Design (OOD)
In OOD, classes and relationships between classes are identified. Attributes
and methods for each class are also discovered in this phase. The classes
identified are then modeled in a UML class diagram that shows the
relationship between classes, its attributes and its operations. In addition, the
flow of the system is also designed in this phase and it is modeled in an
activity diagram shown in Figure 3.16. The interface design of the system is
also outlined in this phase. A medium-fidelity is developed for the interfaces
of the system based on the requirements obtained from OOA. Also, design of
the databases used in the development of this system is also discussed briefly
in OOD, whereby the entity, attributes and primary key are identified and
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shown in a table. All the activities involved in this phase is further discussed
in Chapter 3.
1.3.3 Implementation
This phase is where the activity to develop the real system is carried out. This
involves a strong programming because this is the phase where designing
program specification, detailed coding and debugging of programs are done.
Chapter 4 describes more on the activities involved in this phase. In this
chapter, how the system works will be explained in brief by segregating the
system into few modules. The user interface for each module is also presented
in this chapter. Some of the complicated source codes will be included in this
chapter for further explanation.
1.3.4 Testing
System is tested to determine whether it conforms to the specifications of
requirements. Testing is carried out on a continuous basis and this refining
cycle is continued throughout the development process until the result is
satisfied. During this iterative process, prototypes are transformed
incrementally into the actual application. The actions involved for testing of
BCCS is discussed in Chapter 4. Functionality and usability testings are
carried out in this phase by employing few users to test the system, who are
then required to answer post-questionnaires.
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1.4 Scope
The system developed in this project is mainly for breast cancer. As mentioned,
earlier, the features of this system include electronic personal health record for
patients, risk assessment tool and forum. Breast cancer patients are able to create their
own breast cancer record via the system. Health professionals, however, can use the
system to retrieve patients' record in case of emergency or for other purpose.
Researchers can also use this application to search for patients who are eligible for a
subject of a research or even for clinical trials. However, this system only provides the
facility to create health record that is related to breast cancer. Patient's medical
records that consist of family history, immunization and so on are not covered in this
application. Breast cancer information provided in this application only explains
general information about breast cancer, which includes the overview, stages and
treatment options. The breast cancer quiz, however, only tests users on basic
knowledge about breast cancer. Nonetheless, the breast cancer risk assessment tool,
simply calculates one's risk of getting breast cancer in 5 years and to 90 years. This is
because the formula used in Gail model [13] (a model that is used to calculate breast
cancer risk) is only to calculate risk of 5 years and lifetime. Calculation of risk in 10
years, 20 years and so on needs a different formula which are not presented in the
Gail model and therefore it is outside the scope of this project.
1.5 Significance of Project
Breast Cancer Care System is important to facilitate people with breast cancer or
breast cancer concerns to get all the services they want in a single system. Personal
health record for patients offered in this application ensures appointments with
doctors can proceed as planned with necessary data about patients easily accessible
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and enables patients and their families to be more involved in their treatment. "With a
centralized resource, you can go from doctor to doctor in a much more powerful way.
You can streamline an inherently inefficient process", said Dr. Weiss [15]. Besides,
designing a format for organized, standardized health information, which can be
shared by patient-to-physician -to-researchers will increase the quality of healthcare
delivery. Moreover, this coordination of care between physicians and patients
improves the ability to achieve a more accurate diagnosis. Besides patients, doctors
and researchers, this application also benefits the clinicians to identify patients who
are eligible for clinical trials, whereby they could greatly reduce the cost and time
needed to search through medical records if they were available in an electronic
format. The feasibility of such an approach is becoming increasingly realistic as more
and more patient-specific medical data is being stored in electronic medical records.
BCCS benefits non-patients as well, whereby they can calculate their risk by using the
risk assessment tool featured in the application. Apart from that, all system users will
get to participate in the forum, where they can discuss and suggest any topics related
to breast cancer. This is important as nowadays, people tend to keep their problems to
themselves. Besides, some are even afraid to raise questions regarding breast cancer
to anyone. Therefore, with this forum, they can express their problem or questions
freely and discuss it with others who might experience the same problem or have a
better knowledge in breast cancer.
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1.6 Project Schedule
The project schedule for the development of BCCS is shown below:
Activities Start date Date of completion
Introduction 16/04/2005 29/04/2005
Background 02/05/2005 27/05/2005
Requirement analysis and design 27/12/2005 27/02/2006
Implementation and testing 28/02/2006 2/05/2006
Conclusion and future works 20/04/2006 26/04/2006
Table 1.1: Project schedule
1.7 Outcome
The outcome of this project is a system that integrates web-based technology with the
healthcare industry, specifically breast cancer. It provides facility to create online
personal health record particularly for breast cancer patients and also combines the
breast-cancer related features that are useful for both patients and non-patients. This
system could support the breast cancer awareness campaign held in Malaysia and also
to improve the quality of healthcare industry in the country.
1.8 Outline of Project Report
This report consists of five chapters, which are: -
1.8.1 Chapter 1 - Introduction
This chapter provides an overview of the Breast Cancer Care System, which
consists of the introduction of the project, problem statement, objectives,
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methodology, scope, significance of the project and expected outcome of the
project.
1.8.2 Chapter 2 - Background
This chapter, presents the literature review that has been done before the
development of the project. All the information regarding this project that has
been gathered will be stated here in this chapter and this includes the review of
the existing systems, comparison between this system and the existing systems
and also the comparison between the methods and techniques used in the
existing system.
1.8.3 Chapter 3 - Requirement analysis and design
This chapter explains on the requirement analysis and the design of the
project. The requirement analysis part comprises user requirement as well as
hardware and software requirement for the project. On the other hand, the
design part includes input and output design of the project.
1.8.4 Chapter 4 - Implementation and testing
This chapter will describe the implementation and testing phase that has been
done during the development of this project. This implementation includes the
explanation on the execution of the module that has been developed in this
project. The testing part, however, involves the evaluation of the project and
also provides various topics such as system testing, system evaluation, result
analysis and system limitations.
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1.8.5 Chapter 5 - Conclusion and future work
This chapter concludes the project that has been developed. Accomplishment,
contributions and recommendations regarding the future work of the project is
stated in this chapter.
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CHAPTER 2: BACKGROUND
2.1 Introduction
Web-based technology has not only altered the way medical information is stored,
shared, and generated across and within healthcare organizations; it also promises to
increase the efficiency and cost-effectiveness of healthcare. There are a vast number
of websites that provides health services and information, specifically in the realm of
breast cancer. Hence, reviews have been done to obtain sufficient information
regarding the existing systems as well as to assess the viability of web-based
technology in the healthcare industry before developing a similar application
successfully. Important information which includes reviewing of existing system, in
terms of features, functionalities, user interfaces and technologies used will be
examined closely and discussed in this chapter. In-depth explanation of various
concepts and technologies that will be used in developing Breast Cancer Care System
will also be included in this chapter. The technologies that will be reviewed are the
programming tools, databases and graphic tools. This review will be the core for the
development of Breast Cancer Care System for it provides better understanding and
knowledge about the concept and tools used to develop the proposed system. Besides,
problem areas that are found in the current system can be discovered, thus solutions to
the problems can then be provided and subsequently applied to the proposed system.
2.2 Review on Existing Systems
Based on review done, there is no system that provides personal health record
especially for breast cancer patients. Therefore, this review is based on existing
personal health record systems. The systems that are going to be reviewed are
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iHealthRecord, CapMed, GlobalMedic and Walley. The following subsections
summarize the features provided by each application and technologies used to
developed them.
2.2.1 iHealthRecord
iHealthRecord is an application that solely provides an interactive personal
health record service to users. It is developed using Java Servlets and it uses
MySQL as the database. iHealthRecord enables users to either build personal
health record for their own or for their family members. Among the
information that can be stored in user's personal health record are patient's
immunizations, clinicians, medical histories, emergency contact, surgeries and
so on. In addition, registered users are able to enroll for various types of
programs listed in this application to help users to manage their health and
medications. Also, there is a Secure Messaging feature provided in this
application, whereby users can communicate with their clinicians, who are
also registered to the application. The following figure shows the screen shots
of some of the features provided by the system.
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