Change Management: The Komatsu Case

Organizations are in constant interactions with their environments.   A change in the environment will subsequently cause a change in the organization that interacts with it.   This change can be positive or negative, and in both cases, it alters the organization’s status on many different levels.   Dealing with this change on all the levels is a key factor in minimizing disruptions to the organization’s functioning and growth.   In other words, change management is â€Å"a managerial and organizational process that realigns an organizations strategy, structure and process in pro-action or reaction to chaos in the environment† (Worthy et. al., 1996, p. 16).   The process of change management, and how it influences an organization’s strategy and management, is analyzed herewith in context of the Komatsu company.Brief HistoryKomatsu Iron Works was a subsidiary of Takeuchi Mining Industry, manufacturing industrial tools for the parent company.   I n 1921, the founder of the company, Mr. Takeuchi, incorporated Komatsu Ltd. as an independent company.   Komatsu originally manufactured mining equipment, but started making agricultural equipment such as tractors by 1931.   During the second world war, it was an important manufacturer of tanks, bulldozers, and other heavy machinery.   Post-war, Komatsu began focusing on the earth moving equipment (EME market).   In the 1950s, the company’s machinery was in demand because of the ongoing postwar construction in Japan.   Although its customer base was strong at that time, Komatsu did not command a significant market share, and the quality of its machines was inadequate.   This was a major factor in customer dissatisfaction, however, the Japanese manufacturers operated in a protected environment at that time, with no significant foreign competitors.In 1963, the Japanese Ministry of Trade allowed the entry of foreign EME manufacturers in Japan.   This signaled a com plete change in Komatsu’s market environment.   Now the competition extended to foreign counterparts, most of whom had long been established as market leaders in the EME category.   The following sections discuss Komatsu’s strategies for managing these challenges, and how they dealt with change in the process.CompetitionMajor heavy machinery manufacturers like Caterpillar, J.I. Case, Fiat-Ellis and John Deere were all technologically more advanced than Komatsu, and had widespread dealer networks and manufacturing bases.   The most formidable competitor in the EME segment was Caterpillar, the world’s largest manufacturer of heavy machinery.   Caterpillar’s equipment was much more sophisticated and of a higher quality, and its distributor and dealer network was very solid.   Komatsu realized then that it was imperative for the company to upgrade its products and operations, in order to survive the competition.The company was headed at the time by Yashinari Kawai, who recognized the urgent need to revamp the company’s product quality, both technically and functionally.   In order to bring Komatsu products up to date, the company signed licensing arrangements with two major EME manufacturers, International Harvester and Bucyrus Erie.   This gave Komatsu the opportunity to improve the equipment quality for the agricultural and the industrial sector.In addition, Kawai implemented the Japanese concept of TQC (Total quality Control), which led to a huge improvement in the performance, reliability, and durability of the equipment.   This was one of the major change management challenges that Kawai handled successfully.   Kawai realized that in order to change the customers’ perception of Komatsu products, it was first necessary to change the employees’ own view of the kind of products that the company made.Changing the mindset of every employee and incorporating the philosophy of uncompromised quality a t every level in the company required a strong, skillful leader.   Kawai manouvered this change implementation by open communication, reward, and most importantly, setting an example for all employees by involving everyone from the top management to the shopfloor workers, in this endeavor.  Ã‚   When Komatsu was awarded the Deming Prize for quality control just 3 years later, it served as a huge morale booster for the company.Another major change measure implemented at this time was Project A.   In the first phase of this project, the employees were instructed to ignore costs and concentrate solely on achieving the best possible quality for their equipment.   Once this goal was achieved, the second phase of Project A was implemented, focusing on cost reduction.   Each and every aspect of design and manufacturing was closely scrutinized, checking for bottlenecks and wastage of resources.This resulted in a lean, finely-tuned manufacturing process, that complemented the high quality of Komatsu’s equipment.   From 1965 to 1970, the company’s domestic market share grew from 50% to 65%, despite the presence of Mitsubishi-Caterpillar.   According to Kawai, this feat was achieved largely due to the employee morale and drive at Komatsu.   In his words, â€Å"the prevailing atmosphere was that of a crisis, resulting in a spirit of unity between the management and the staff†.   This company-wide presence of a common goal took precedence over management and labor issues, and resulted in highly successful change management.Komatsu had implemented a two-pronged strategy to achieve success – vertical integration and TQC.   Vertical integration meant that the entire line of business had to be perfectly aligned and free of defects, right from the bottom.   To ensure this, they started with quality raw materials.   The second aspect was TQC – incorporating the philosophy of quality control everywhere and within everyone in the company.   Komatsu also extended the TQC strategy to its dealerships, encouraging them to implement the system.   This strategy of tackling the problem at the root and improvising upon it was the key to strong growth, and enabled Komatsu to offer formidable competition to Caterpillar – accomplishing what other companies such as J.I. Case and John Deere could not.Business EnvironmentFrom the time Komatsu started implementing change, the business environment was constantly shifting, in terms of demand, cost advantage, and regulations.   By mid-1970s, the domestic market for EME was stagnating, with Komatsu having 60% of the market, and the Mitsubishi-Caterpillar partnership having 30%.   Growth was slowing down in the less developed countries too.   Komatsu’s management responded by developing the V 10 plan, aiming to reduce costs by 10% while improving quality.   In 1976, an unexpected event in the financial markets caused further concern.   The Ja panese Yen was appreciating rapidly against the dollar, rising from 293 in 1976 to 240 in 1977.   To cushion the company’s exports, Komatsu’s management followed an internal exchange rate of 180 yen to the dollar.   This ensured that Komatsu’s costs and pricing were well-adjusted to the market conditions, and their exports did not suffer.   Komatsu’s policy of anticipating change and fortifying the company against any adverse effects again worked to its advantage.Problems faced by KomatsuExporting their equipment to other countries had always been a part of Komatsu’s vision.   This goal constituted the company’s Project B.   With their improved and technically capable equipment, by 1970 Kawai was eager to launch major international operations for the company.   However, there were considerable barriers to this end – Komatsu’s limited international recognition and dealer base, fierce competition, and legal regulation s.The technology license that it had obtained from International Harvester and Bucyrus Erie had imposed export restrictions on them.   Komatsu recognized this as an impediment, and established its R&D laboratory in 1966.   But there were still significant requirements for establishing an international market presence.   Caterpillar, for example, had its dealership centers across the globe, some of which were exclusive dealerships.   This made it difficult for Komatsu, with its relatively limited product line and manufacturing base, to create the required dealer network.   In order to overcome this obstacle, Komatsu priced its products 30 to 40 percent below Caterpillar’s.   This allowed them to get the intial foothold in the international markets.   Komatsu also benefited from the increased demand for construction machinery in less developed countres in Asia and Mexico, and in Saudi Arabia.In the 1970s, Komatsu had also started expanding its product line.   Ry oichi Kawai, now the president of Komatsu, made special efforts to build and develop international client and dealer relationships.   He also instructed managers to regularly visit customers, and get first hand information on their requirements and issues.   Keeping abreast of technological changes and being one of the first to adopt and incorporate new technology in its equipment was a key factor to success.Komatsu incorporated electronic technology into all its machinery, creating differentiated, high quality products.   In 1979, the worldwide construction industry was at a low.   To combat the depressed economy, Komatsu’s management launched the â€Å"F and F† or Future and Frontiers program, formulated to develop new products and new businesses.   Once again, a companywide buzz was created, and suggestions were welcomed from every level within the company.   These suggestions resulted in the production of diverse new products such as arc-welding robots and an excavating system for deep-sea sand.In the early 1980s, Komatsu objected to the export restrictions which still continued to be imposed on it by Bucyrus Erie.   Komatsu won this appeal and gained export rights from Bucyrus Erie.   It also managed to free itself from the agreement with International Harvester, and gained full freedom to export its equipment worldwide.   This was a major milestone for Komatsu, and the company took full advantage of its established quality and dealerships.   It also capitalized on the embargo that prevented Caterpillar from exporting to Russia in the early 1980s.   In 1981, the Siberian Natural Resource Project was handed over entirely to Komatsu.   In a short while, Komatsu was expected to outperform Caterpillar in the Russian market.As their international customer base increased, so did the need for customized equipment for different countries, based on the type of work, environment, and legal regulations.   Designing customized equipment for each customer separately was not cost effective.   To counter this, the management adopted the policy of EPOCHS – Efficient Production-Oriented Choice Specifications.   The idea was to save costs by standardizing production modules for core projects along with the required number of parts, and adding different specifications as necessary.Around this time, the increasing freight and shipping costs, and Japan’s strained trade relations with the US and Europe were increasingly becoming a cause for concern.   It was during this time that the US automakers opposed the import of Japanese cars in the market, and Komatsu was fearful that a similar plea might be raised by Caterpillar and other heavy-machinery manufacturers. In order to curb these potential problems, Komatsu manufactured the core parts of its equipment in all its plants.   This reduced the shipping frequency as well as the freight costs.   It also developed assembly bases in Brazil and Me xico, and was working on a joint venture proposal with its dealer in Indonesia.Current Situation and OptionsThe case refers to the scenario in 1984, a period of recession around the world.   The building and construction industry was also affected, with most players assuming some losses.   The biggest source of concern for Komatsu, however, was Caterpillar.   Caterpillar had experienced its third consecutive year of losses, and was in the midst of a major labor strike.   Kawai knew that this was an opportunity to take over where Caterpillar faltered – but it was also an indication of the increasingly difficult   business environment.   Witnessing a large, successful company like Caterpillar struggling to retain its position in the market, Kawai became concerned about Komatsu, and what it could do to avoid being in a similar situation.Komatsu’s options were centered around keeping a close watch on the market and on Caterpillar.   Komatsu employees were in the habit of reading Caterpillar’s monthly news bulletins and press releases, in order to stay informed regarding their competitor’s activities and plans.   Komatsu also realized the need to keep its labor force functioning, and continue keeping the costs down.   Their international operations also had to be strengthened at this time, capitalizing on Caterpillar’s compromised position.  Ã‚   These options are evaluated in the following section.RecommendationsIn keeping with its established policy, Komatsu should place particular emphasis on anticipating change and devising measures to optimize the benefits while curbing the negative effects.   To an extent, it was complacency that had cost Caterpillar – the managers’ priority was on increasing the customer base without addressing customer value or employee needs.   Therefore, managing labor relations is one of the most important issues for Komatsu.   The workers at Komatsu earn signific antly lesser than their counterparts at Caterpillar.   However, this is offset by high employee morale and  Ã‚   strong labor-management relations.   Maintaining this status is extremely important for Komatsu, both in terms of employee productivity and controlling costs by minimizing overhead.The second recommendation for Komatsu would be to strengthen its international presence.   With the capital that it has accumulated, Komatsu is in a position to either buy out a number of smaller competitors, or acquire a successful ally.   This would further consolidate Komatsu’s manufacturing operations and distributor channels.   It should also continue its R&D efforts and product diversification plans, and stay ahead of the competition.   If necessary, Komatsu can form a joint venture with a company to ease the manufacturing and operations of diversified products.ReferencesWorley, C.G., Hitchen, D.E., & Ross, W.L. (1996). Integrated strategic change: How OD builds a com petitive advantage. Reading, MA: Addison-Wesley.

Miss: 21st Century and Young People

Fashion is becoming more and more important to young people. However, some argue that this has negative impact on young people and on society. Do you agree or disagree?In the 21st century, It is difficult to ignore the immense popularity of fashion, which could be found anywhere and everywhere, on the street, television, internet and magazines. Its influence have extended to younger consumers. However, some argue that this trend has an adverse effect on youngsters and even the whole society. Personally, I agree with this view to some extent.Having appealing appearance help youngsters to express their individuality and build their confidence. Firstly, fashion is a form of art, which changes constantly and requires creativity. It inspires these young people to express their personality and taste in a unique way. Without fashion, they miss a sound opportunity of expressing themselves. Secondly, by wearing trendy clothing the way they like, youngsters may feel comfortable and pleasure; m eanwhile, they are more likely to become attractive. As a result, their confidence level could be boosted.This trend also benefits the whole society, namely, creating more job opportunities. Youngsters love for fashion, which is an integral part of their lives, produces numerous new job opportunities, related to fashion industry. For instance, a fashion magazine , called Seventeen, is published for young girls who love to keep up with the latest trend. This is helpful to relieve employment pressure, which is extremely severe in the economic recession.Despite of this, it is undeniable that this trend may distract teenagers from study and generates the social problem of fashion bullying. Firstly, if teenagers involves themselves too much with fashion, they may find it difficult to concentrate on study because there is insufficient time for study. This is especially true for those student who are not good at time management. Secondly, youngsters may judge their friends based on their c lothing, jewelry and hair style. Those students who look unfashionable may  be isolated or even bullied. This damages their psychological development.In conclusion, it is advantageous for youngsters to follow fashion; however, the disadvantages should not be ignored. The school and parents should guide young adult to view fashion in a appropriate way.

Methodology Dissertation Example | Topics and Well Written Essays - 2750 words

Methodology - Dissertation Example Methodology Qualitative research methodology gives a detailed picture of the data that needs to be a part of the research (Adler 1994). Due to qualitative methodology, the information that needs to be incorporated in the research is descriptive and informational. According to Merrigan and Huston (2004), the qualitative research method functions fine at the preliminary phases of a project as it permits the researcher to bring together information in a way that is evocative and coarse. It is also said that by employing qualitative means, the researcher is not capable to have an unchanging or wholly distinct plan; he may only have an approximation about the plan of the project (Ader, Mellenbergh and Hand 2008). The researcher is capable to identify about the upshot of the project or some measurement of the project with the passage of time, as he constantly employs the qualitative approach for compilation of data (Patton 1990). 1.1 . Research Methodology Qualitative research method and quantitative research methods are very influential in terms of collection of suitable data for any kind of research. Qualitative methods for data collection are used to gather qualitative data. The techniques that are employed for data collection through qualitative methodology are qualitative interviews that are also called in-depth interviews, direct observation, case studies, literature reviews and focus groups (Adler 1994). Qualitative research techniques are used for many educational disciplines for gathering of suitable research data required for the research. These disciplines include history, sociology, anthropology, geography and other social disciplines. (Adler 1994). It is not essential that qualitative research methodology is necessarily adopted for the above-mentioned disciplines but it suits these disciplines more as compared to other disciplines. The restrictions and peripheries of any research can be clearly recognized with the help of qualitative research (Patton 1990). Quantitative research method is used for collection of quantitative data. As far as qualitative research techniques are concerned, they are used for collection of data or information that is uncountable and descriptive but quantitative research techniques gather data or information in a countable order as the collected data is in numeric format. Like qualitative methodology, quantitative methodology also suits some disciplin es or educational areas. These disciplines include accounting, physics, taxonomy, statistics and social sciences (Roessner 2000). The data collection techniques used in quantitative research methodology are with the help of survey forms, tabulations, questionnaire designing, statistical model designs and much more (Roessner 2000). Survey forms and questionnaires are much more used as compared to other techniques of data collection and gathering as they are much convenient to develop and distribute for numeric data collection. The objectives associated with a research are already known to the researcher and he/she works in according to a set plan (Saris and Gallhofer 2007). According to Saris and Gallhofer (2007), the researcher is already aware that the data will be gathered in shape of number format and can be easily employed for statistical evaluation for progress in the research. 1.2. Qualitative Research Method According to Byram and Feng (2006), â€Å"

Tort law essay Example | Topics and Well Written Essays - 1500 words

Tort law - Essay Example Tort law is one of the most important aspects of the legal industry. In simple words, tort law can be defined as a specialised body of law that provides solution for the mis – doings or wrong doings that are basically civil in nature and does not arise from any contractual obligations. In other words, tort law is the set of laws that are used to get legal damages by the accusers in case the accused is legally responsible for the damage caused. The prime difference in between any criminal case and a case of tort is that of motif and punishment. While criminal cases involve those that are motivated to hurt the other party in some way or the other, the cases that are of tort in nature does not hurt other knowingly. In most of the cases, damage is caused by chance. Therefore, also there is a major difference in case of punishment in between both the cases. Criminal cases basically involve harsh punishment as the intention was to hurt the other party while tort cases predominantly attract only compensation on the loss that has been caused because of the hurt. The tort cases primarily have two important pillars upon which the entire set of law revolves namely ‘the standard of care’ and ‘negligence’. ‘Standard of care’ is a legal phrase that helps the honourable court to identify if the case is of tortious in nature or not. The underlying point of contention for the ‘standard of care’ is that who actually suffers the actual loss from the injury, is it the person himself or is it transferred to some other party. The other important consideration is that of negligence. The charging party i.e. the accuser needs to prove in the court of law that the damage incurred was because of the negligence on the part of the other party. If is not proved that the damage was because of the negligence, one cannot be held responsible under the tort law. Compensation culture is an ongoing trend especially in the states of England

Central Banks & Monetary Policy Research Paper Example | Topics and Well Written Essays - 3250 words

Central Banks & Monetary Policy - Research Paper Example If compared to a case where objectives included both dimensions of public policy and commercial, such statement significantly increased the clearness of the direction given to bankers with central banks. There was an identity of logic of purpose. They were mandated with the role of discharging their functions in a way that is related to the interest of the public, considering state agencies’ functions and coordinating them. It is to the degree that the interest of the public could be provided by the addition of functions not assigned to the better (Callaghan, 2009). Hence, most central banks started to assume roles for financial sector’s development; payment system oversight and money operation, foreign exchange, capital market and debt oversight. From the present objective, such an interest objective exposes itself to understanding and provides directions on what is to be done when views or functions as to nation’s interest. It is only in the recent past that at tention has been awarded to objectives identification for function of individual and to objectives potential to conflict. Specifying objective trends have emerged, but functions of many banks are not directed by legal objectives. Objectives of Monetary Policy Price stability dominates the objective of monetary policy that is made specific in legislation. The stability of currency purchasing power is dominating legal objective. In most situations, it is always superior to other objectives. In contrary, if stability of price is not specific, the legally specified objectives tend to be general. In fact, if the stability of price is not stated specifically as a goal, then there is no objective that legally dominates, and instead definition of value of currency is used (Cecchetti, 2011). There are conflicts which arise if various actions of monetary policies are driven by various objectives. For instance, objectives that regard stability of price and variables of the real economy are con cerned with such conflicts. Secondly, is about rate of exchange regimes- local stability of price and stability in the exchange rate requires adjustment of interest rates in directly opposite positions. The conflicts raise interpretation issues of objectives that are legal where both currency and price stability are specific as objectives of monetary policy. If the stability in price would be equal to stability in currency, then conflict potential would be solved. Other ways of solving potential conflicts are; making sure that precedence orders are among objectives, recognition of lower levels to be in a position to clarify and interpret legislation’s higher level, use of extra-statutory agreement, which provide law interpretation on which the central bank agree, and lastly, taking into accountability the technical feasibility. Objectives Financial Stability Most of central banks presume that financial stability has policy responsibility. In a few situations where the central bank is faced with legal objective that is explicit for stability in finance, objective is of a wide range and the responsibility of central banks far reaching. However, in other situations where there are well set objectives for functions of financial stability, the language’s implication is an extent of results responsibility, with these banks charged with stable, safe or sound system of finance. Making a financial stability specific entails confrontation of issues discussed relating them to objectives of monetary policy. It is not an objective that is absolute- financial stability is always flexible. The extent is what varies. There is no

Comparative criminal justice Essay Example | Topics and Well Written Essays - 500 words

Comparative criminal justice - Essay Example The common law believes that law should rest on intuition and reason and on consent and force. The common law tradition was made part of the American Constitution. For example, the freedom of speech is a mark of rationality and an adaptation to the prevailing circumstances of the British position on seditious libel. For instance, on the right to abortion, the Supreme Court's strong refusal in Casey to overrule Roe v. Wade was a clear example of common law respect for precedent. It is possible that modern jurists and legal scholars reject that the kind of knowledge upheld by the common law is really knowledge. Public necessity created civil law. If there were no necessity for law, then there would be no civil law. The term, civil law means the combined laws on civil and criminal law. There is no instance where the duty is to civil law only. The aim and objective of the civil government is to ensure good morals all of the transactions and relationships of its citizens. Morality is the primordial principle in the workings of government and public necessity. Arkansas. Art. 2, Sec. 25, Constitution 1874: "Religion, morality, and knowledge being essential to good government, the General Assembly shall enact suitable laws to protect every religious denomination in the peaceable enjoyment of its own mode o

A region in the developing world faces water supply problem Essay

A region in the developing world faces water supply problem - Essay Example er provision; interlinking of rivers and rainwater harvesting and their comparison based on cost involved in the method and the impact of the method to the environment. It is found that rainwater harvesting is the cheaper method to be used to provide water in India. Despite the fact that India has quite a number of rivers like; Ganges, Krishna, Brahmaputra, Tapti, Yamuna, Narmada, Godavari, Mahanadi and a good climatic weather condition characterized by availability of rainfall throughout the year which amounts to 4000 billion cubic meters of rainfall, it still has to contend with the issue of water shortage (Bombay, 2010 p 47). 1This can be linked to the following factors: 1. Increased demand for water by households, industries and for irrigation in farms: In 2006, it had been found that India used about 829 billion cubic meters by volume of water. This was shared such that irrigation consumed between 89 to 92 percent, industries used between 2 to 5 percent and the households used between 3 to 9 percent of to total volume from both underground and surface water sources as per the records of World Resource Institute, Earth Trends 2001. This consumption is expected to rise to about 1.4 trillion cubic meters or to double by the year 2050. This increase results from the rapidly growing population which will result into the need of more grains which are the products from the farm industries. This in return adds pressure onto the need of high production quantity and efficient irrigation methods (Shahan, 2009).2 2. Population growth rate: The population of India is expected to hit the 1.6 billion mark by the year 2050. Such a drastic increase in population is going to add stress on the existing water. The increase in population implies the need for more industries to meet the need of the people and increased reliance on the agricultural sector for both the raw material and food. The firms would need more water for irrigation and this increases shortage in the

Summarizing articles Essay Example | Topics and Well Written Essays - 750 words

Summarizing articles - Essay Example He offers that such can be achieved through building relationships and complementing customers in brand marketing. In this article, the author observes that emotions supersede reason and logic whenever customers make a decision on what to buy. He points out that effective management of B2B should be focused on creating a personal relationship with the business. Here, Julie Davis, the author, points that the age of technology has enabled businesses to reach their customers through various online platforms. He advises that both B2B and B2C should listen to customers’ feedback that would enable them improve their customer service. In this article, Larry Myler focuses on B2B strategies for improved sales. Myler offers that focusing on an established goal is the first step. He proceeds to outline that such a goal should address different buyers, establish trust and reduce cost of operation amongst others. Davis argues that in order for a B2B to benefit from online marketing, it has to improve its SEO. He offers that doing so would entail trying to understand customer search habits, investment in a competent IT department and expand its SEO terms to have more traffic. Garvin Finn asserts that many B2B fail to innovate owing to the fear of change of strategy. He offers that many cling to a strategy that is not working owing to a kind of fear he terms cognitive dissonance. He advises that B2B should just explore alternative solutions. In this article, Peter Friedman observes that although millennials are techno-savvy, they should not be entirely left in charge of social media marketing. He advises that millennials would impart a B2B positively by allowing them work under a senior who directs their efforts and skills appropriately. The articles have helped me understand the topics addressed in B2B in the following ways. To begin with, the articles have helped me

Obtaining services within community Essay Example | Topics and Well Written Essays - 1250 words

Obtaining services within community - Essay Example ing the notable move from the medical based models for care to the social models, which incorporate an interdisciplinary approach to identification, support and delivery of support services and recourses within the community (Sheppard & Unsworth, 2011). However, despite these milestones in the care services and resources in the community, considerable barriers to the entire integration and establishment of maximum independence for the developmental disability care. Nonetheless, within the community setting, several structures, resources and services are evident for supporting the development of the disability cases. The Washington state facilitates a vast composition of resources to assist the parents and families of children and youth among other individuals with developmental disabilities (Sheppard & Unsworth, 2011). The course entails focusing on the successful support for the individuals with developmental disabilities to achieve independence in their lives. The vast composition of developmental disability cases in the community demands a comprehensive establishment of support services and resources that enable the care within the community. There are vast services and resources for support across the Washington State, allowing for the families and individuals to make a choice of the intermediary support best fitting for the needs. For instance, there is the Division of Disability and Aging Services, whose partnership with the developmental disabilities support systems is significant component (Moore, Washington, Ningning, Johnson, Davis, Eugene-Cross & Quinn, 2015). The Division facilitate s funding which is a key resource for developing the systems and, training, quality assurance and technical assistance entailed in the disability care programs. Additionally, the Division is also key in its conceptual support through providing guardianship services to the individuals with developmental disabilities and who the court determines that they need the guardianship

Critically evaluate two language teaching styles and indicate, with Essay - 1

Critically evaluate two language teaching styles and indicate, with examples, their potential use within a specific teaching context with which you are familiar - Essay Example This study is being undertaken in order to assess the usage of these learning styles as part of the teaching process, in the hope of seeking improvements and updating strong points for the benefit of the teacher and, most especially, the learner or student. There are eight known approaches to language teaching. These approaches have been conceptualized in view of the fact that teachers and education institutions have recognized the fact that there is no right and single way to teach foreign languages. The Center for Applied Linguistics acknowledges the fact that there is no superior means of language teaching which would also fit all students in all settings. It identified eight language teaching methods which are being used today. According to Doggett (2003, p. 165), these methods include the Grammar Translation Method which focuses on improving student’s participation in the target literature the teacher’s method in teaching the language. Doggett (2003, p. 165) discusses that students are given target language lines and are then asked to answer the questions which follow. This class is structured with the teacher exerting much control over the learning process. Doggett (2003, p. 165) goes on to discuss another method wh ich is the direct method. She discusses that this method gives students the ability to perceive meaning directly through language, since no language translation is allowed. She also emphasizes that visual aids and pantomime are incorporated in the learning process in order to clearly express the meaning of words and concepts. Doggett (2003, p. 165) also discusses the audio-lingual method of language teaching, which is based on the behaviourist concept which suggests that learning language is about gaining the right language habits. In this case, the learner repeats patterns until he can produce such patterns naturally. According to Doggett (2003, p. 165), the silent way is based on

Jury and Group Think Essay Example for Free

Jury and Group Think Essay A jury is a sworn group of citizens gathered to provide a reasonable and unbiased verdict and a finding of fact on a legal inquiry presented to them officially or set a penalty based on the evidences and the law. This practice is considered to have originated from England where nobles and freeman were accorded the right to be tried by a committee of the same class as they are rather than be subjected to the judgment of the king. The right to jury trial in both state and federal proceedings is guaranteed by the Sixth Amendment to the United States Constitution. The Seventh Amendment also accords explicitly the right to jury trial for all parties involved in civil cases at the district level. In the United States, only juries can provide a verdict and set a penalty for the accused if found guilty. This is especially true for cases when the penalty decided is capital punishment (Jury, 2006). This power vested in a jury makes it important to analyze how verdicts are formed in the environment of jury deliberations. One way to do this is through jury simulation research. Jury simulation research involves the methods of research used to understand how a jury would react to statements made by parties involved in court cases and how they would arrive at the verdict. Some of the methods used are prospective juror demographic research, mock trials, jury selection, shadow jury and post-trial jury interviews. The usual market research techniques are also used such as phone surveys, focus groups and feedback sessions. The results of these researches are used by parties involved in court proceedings for settlement negotiations and setting up a defense or prosecution strategy that would be compelling to the jury (Jury research, 2007). The main strength of jury research is that it presents interested parties possible combinations of strategies that could possibly influence the jury verdict in their favor. Visual exhibits, witnesses, metaphors, timeline of events and other techniques in the presentation of evidence are tested to understand the viability of each and combinations of these for the benefit of the interested party. Psychological and sociological analysis is used to give parties an edge on jury trials. Research of this type has been successfully utilized in some landmark cases such as the IBM antitrust trial of 1969 and the O. J. Simpson murder case (Jury research, 2007). The main limitation is that it is impossible to predict exactly what needs to be done for a jury to make a decision in favor of the party. In the methods involved in jury research, questions are often general demographic ones that will not accurately predict the outcome of the jury deliberations. Surrogate jurors and not the actual jury members are used to represent the jury pool in the research. Jury research is simply no guarantee for victory in a case (Jury research, 2007). Mock juries are used in jury research to try to analyze in a controlled experiment how a verdict is reached in an actual jury. However, they cannot accurately mimic the behavior of actual juries. The behavior of the jury is based on the personal perspective of the individual jurors and external factors that may affect the behavior and decision making capabilities of the individuals and the whole jury in general. For instance, the pressure provided by the high stakes of a case, the stress from time constraints and routine disruption and other psychological stresses may not be exactly replicated in mock juries. â€Å"Group thinking† is the term used to describe tendencies of groups to base their decision not on their personal judgment but on the collective and single unanimous decision that may not always be the best given the biases and desires of the members of the group to come up with the decision at the soonest possible time. It is defined as â€Å"a way of deliberating that group members use when their desire for unanimity overrides their motivation to assess all available plans of action† (Janis, 1972). This very commonly affects the verdict of a jury. This is because, following the framework prepared by Janis (1983) on Group Thinking, the antecedents such as structural faults (insulation, lack of impartial leadership, lack of norms and procedures) and provocative context (high stress from external threats) are commonly characteristics of a presiding jury. This tendency to seek unanimity over proper assessment leads to bad decision-making. Some of the symptoms that often characterize defective decision making stemming from group thinking include the incomplete analysis and consideration of alternatives and objectives, failure to examine risks from choice and reappraise rejected ones, poor information search and selective information bias and failure to contingency plan. Because of the high stakes involved in jury cases, it is important to ensure sound decision-making by steering away from the tendency to group think. The most effective way to prevent group thinking is promoting vigilance against it. The first step is to recognize when symptoms of group thinking are starting to appear. Group members must strive to retain status equality to prevent a single member from influencing the entire group. New information must always be sought to challenge a reigning agreement to test its strength. Norms must be set to retain vigilance such as having a devil’s advocate, instituting dialectical inquiry and assigning a specific member to remind against bias and group thinking (Meade, 2003). The tendencies of group thinking may be uncovered through jury research. There is a danger that certain parties that rely on jury research may prey upon these tendencies. Therefore, it is important that jury retain its impartiality and sound decision making capability to effectively perform its duty to uphold justice in any court proceeding. Bibliography Janis, I. (1972). Victims of groupthink, Boston: Houghton – Mifflin Janis, I. (1982). Groupthink (2nd edn. ), Boston: Houghton – Mifflin Janis, I. (1983). Groupthink model. Retrieved 19 May 2007 from http://choo. fis. utoronto. ca/FIS/Courses/LIS2149/Groupthink. html.

Pick a Quote from the Book To Kill a Mockingbird Essay Example for Free

Pick a Quote from the Book To Kill a Mockingbird Essay During the depression in Alabama, many people, no matter what race, were encountering hard times. In the novel To Kill a Mockingbird by Haper Lee, Scout learns life lessons through experiences throughout her childhood. In her community and her household, Scout watches and interacts with all kinds of people. In the book, Scout learns something new about the people of Maycomb in each chapter and realizes that people are more than what they perceive to be by interacting with three main characters in the novel, Atticus, Mr. Cunningham, and Boo Radley. In the beginning of the book, Scout’s interpretation of these characters changed throughout the story. At the beginning of the book, Scout’s dad, Atticus, was not like the fun hunting loving father that the other kids had. Atticus was a fifty year old lawyer that didn’t have time or energy to even play football with Scout brother, Jem. Scout felt like she had nothing to brag or be proud of her father about that is shown in this quote, because his daily life was either in the office or into a book. â€Å"If your father was thirty you’d find life quite different† â€Å"It sure would. Atticus can’t do anything†¦. † (Lee 120) Later on in the story, Scout and Jem see a stray crazy dog. Atticus is asked to shoot it. Scout not knowing that her dad was the best shooter in Maycomb had doubts of letting her dad shoot the dog. Atticus shot the dog on the first bullet. â€Å"When we went home I told Jem we’d really have something to talk about at school on Monday. † (Lee 130) Scout’s first impression of her dad in the beginning of the story changed when she found that she could be proud of her father for being the best shooter in Maycomb. Another main character in the novel was Mr. Cunningham who was a farmer and one of Atticus clients. Atticus was also representing Tom Robinson, who was a black man being prosecuted for rape by Bob Ewell. Bob Ewell had gathered a bunch of men to go down to the jail house to kill Tom Robinson. Scout, who was hiding and watching everything from afar, could not recognize any of the men. Later on when she ran through the men to Atticus she then recognized one man, and that was Mr. Cunningham. At the beginning of the novel, Atticus told Scout that Mr. Cunningham was a good honest hard working man that did not take anything from anyone unlike Mr. Ewell. After she realized what was taking place at the jail house and what the men were there to do, she had doubts about Mr. Cunningham being the good man that her father had told her about at the beginning of the novel. Lastly, Boo Radley probably impacted Scout the most in what she learned. At the beginning of the novel, Scout, Jem, and Dill all were curious of the monster that lived at the Radley’s house. He was always kept away and never came out. All kinds of stories about Boo Radley had been told as Scout grew up, made by different people in her community. Scout was so scared of Boo that she would run past his house every time she would pass it. The town would not even eat the fruit off the trees by their house because they believed Boo had poisoned them. It was obvious that Boo Radley had a bad rep in the town. Later on in the story, Scout and Jim find out someone is leaving them things in a tree hole. They start to believe it is Boo, who was leaving it for them, but they are still not convinced that Boo is safe. Later on while Miss Maudie’s house was burning and Scout was watching it from afar, someone had put a blanket on her. They come to the conclusion it was Boo Radley and are confused why he would do so. When Boo Radley had saved them from Mr. Ewell in the last few chapters of the book, it had become clear that Boo was not bad at all but afraid of the outside world beyond his house. Scout’s original perception of Boo Radley was all wrong because of the people she interacted with day to day. In the novel To Kill a Mockingbird by Haper Lee, Scout learns life lessons through experiences throughout her childhood. Three main characters in this book impacted her life the most. Atticus, Mr. Cunningham, and Boo Radley showed Scout to not judge a book by its cover. Not everyone is who they first perceive to be. Like Atticus said â€Å"You never really understand a person until you consider things from his point of view — until you climb into his skin and walk around in it. † (Lee 30) Atticus was right, Scout did not really know any of these people until she put herself in their place and saw who they really were.

Patient Healthcare Using SMS Technology Application

Patient Healthcare Using SMS Technology Application Chapter 1 Introduction to Patient Care Using SMS Application Patients travel longer distances for the opinion of consultant which is not possible either due to patient situation or due to distances. Enhancement of health care in different locations and other remote areas can be achieved using mobile phone applications [1]. 1.1 Problem Statement Development of mobile communication networks playing an important part in the enhancement of a mobile medicine. Patient Care Using SMS Application represents a feasible solution of patient care such as text messaging and booking appointments using mobile phones, which are best aspects of mobile medicine. The main idea is improve patient access to healthcare; encouraging patients to use mobile health application and supporting people with long term conditions [5]. 1.2 Objectives Incredible growth of mobile communication and recognition of new generation Wireless protocols has initiated the advance SMS based medical applications. Following that facts Patient care using SMS based application for mobile application for patient is good solution [5 6]. * To design and develop a WAP enabled wireless applications that will enhance the feature of mobile device by incorporating the features of a digital diary. The application should be able to get integrated with the existing application vis-à  -vis Exchange Server etc * Main aim of this application is to achieve â€Å"greater quality communication between GPs and consultants using mobile medicine, which will results in enhancement of patients care â€Å"[5 6]. 1.3 Scope The goal of Patient Care Using SMS Application is based on two major conditions. First, is to achieve proficient means to exchange message between General Practitioners and consultants care have to be provided. The second is sufficient exchange of patients information have to be provided. Additionally, privacy of communication and stored information has to be guaranteed. Both ethical and technical aspects are equally important [7]. 1.4 Existing Systems The existing system of treatment consists of two different systems. They are as follows: * Traditional or manual system * Online application 1.4.1 Traditional or Manual system The present system of treatment consists of manually consulting a doctor by taking prior appointment or else registering at that instant of time, waiting to get register themselves and then consulting the doctor which is a time consuming process. 1.4.1.1 Drawbacks * Time consuming * Patient need to stand in long queues to make appointments * Patients not follow prescription directions once they leave the surgery or hospital. Research has showed that more than 50 percent of patients not follow the management advised by their doctors may be due to lack of time and interest. 1.4.2 Online System Online application is also available where the user is provided a login and password through which he can access the website, make appointments, clarify their queries etc. The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. The online systems are discussed below are: * EMIS * VISION System 1.4.2.1 EMIS System EMIS ® stands for Egton Medical Information Systems Limited. EMIS provides a service that enables you access to your healthcare online [9]. After registering with the surgery, patients are able to book or cancel their appointments with the doctor. Patient can also request repeat prescription, send messages to their practice and update personal information if practice has set up these features online [10]. This example has been explained in detailed in chapter 2. 1.5.2 Example 2: Vision System Vision [14] is the most famous system in use UK, within the GPs sector today, due to its market leading features, functionalities and first class support from INPS. There are currently more than 1,800 GP practices which are using Vision system across the UK each day. â€Å"Vision system version 3 is fully RFA 99 acquiescent, includes, support for the encryptedEDIFACT pathology v1.1 message, MIQUEST and DTS. The Vision application is stable, proven and reliable. The strong product-base has allowed other features such as advanced-scanning, PDAs support and incorporated voice dictations as well as extension to core functionality such as XML based clinical-messaging, allowing integrations with third party systems† [14]. In this project we are more concentrating on EMIS rather than Vision system. Key Features Messaging Incorporated External system Appointments Consultation Manager Problem Orientated Views Community Caseload Search and Reporting 7. Clinical Audit Vision and the National Applications [14] Few of the above features are explain below [14]: 1. Messaging This system offers unparallel flexibility with the wider health community via its highly supple and adaptable in-built messaging and web-services. These allow patients data from number of external sources including the NHS Spine or local CPRs to be easily accessed and used within Vision, supporting the requirements of the NHS IT-strategy. Vision also manages a range of clinical messages from third party systems to support the patient care as follows: * Choose and Book Referrals (electronic booking) * E- Discharge Summaries * Radiology reports and Encrypted pathology reports * OOH Summaries With a powerful XML event and messaging engine, Vision is designed to ensure the performance of new messages require no changes to the core Vision product. In a single, clear and simple interface, all message types are managed. 2. Incorporated External System In the Vision tabbed views, external web enabled application can now be well-established, allow access patient information from number of sources to be seamlessly from the Vision desktop. The patient is automatically recognised in the target system, when the required data is passed to the third-party application. For integration into the patient record when required, important data may also be written back to Vision 3. Patients Appointments This Vision system allows user full access to the appointment screen. â€Å"Using session templates developed by the practice† the appointment books are defined in advance. The view of appointment book can be defined by user: all significant doctors and other Healthcare professionals can be added or deleted as requirements. To denote, each slots can be assigned in different colours. As the patients arrives at reception, enters the doctors room or leave the surgery, their status is recorded. Our evaluations are based on EMIS system, its features and limitation which have been explained in later chapters. 1.5 Thesis Organisation In chapter 1 we have explained Patient care using SMS application and its aim, objectives and scope. The existing systems such as manual and online systems are briefly explained in this chapter along with it features and disadvantages. The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. This chapter 3 gives brief overview of problems associated with online medical systems with examples. Problems of online medical system such as internet connection, email, prescription, Electronic Patient records and read codes are explained. In the chapter 4 we have focussed on Patient Records and how they are managed at General Practices and hospitals. The traditional paper based practices and its limitations have been explained with examples. The paper less practices and its pros have been explained and the reasons why practice should follow this have explained with examples. The advantages and disadvantages of Electronic patient records with s and examples are discussed in this chapter. The chapter 5 focuses on Read codes and its structures. In this chapter 3 versions of read codes are explain with examples. Maintenance of read codes i.e. internal process and external interaction and hierarchy has been explained with s. The example case study represents the limitations associated with 3 versions, its results and solutions. The chapter 6 is about EMIS database, i.e. patient database and focuses on its usability and security. It explains structure of database and its solutions. Secure Patient data transfer within the PCT has been explained. Storage Area Network is used by EMIS to store patient records. How the GPs and other Healthcare Professional access patient records has been explained. Advance system and its features are discussed in this chapter 7. Waterfall Models activities have been explained. The structure of advance system with s is discussed in this chapter. The conceptual and technical design of this project has been briefly explained. UML language is used in this project to represent user and admin operations. The chapter 8 explains the SMS system requirements such as Specification requirements, Functional requirements, Performance requirements, and hardware and software requirements. About operating system and languages used in this projects are discussed in this chapter. Wireless application protocol architecture and WAP server are explained using diagrams. Database requirements and its uses are explained using diagrams. Open wave SDK and its functions are discussed in this chapter. Chapter 2 Egton Medical Information Systems EMIS ® and EMIS intellectual technology are trading names of â€Å"Egton Medical Information Systems Limited†. EMIS had begun 18 years ago in a rural area dispensing practice in Egton near Whitby in North Yorkshire [11]. EMIS ® head-offices are based in Leeds, including Development and Support departments. Training for general practices is localised and headed by Provincial Operations Directors [11]. 2.1 Practice Care System Enterprise Due to the growing number of EPRs held in both GP and Secondary Care, the requirement for a whole EHR has never been greater. The EMISs Primary Care System Enterprise edition for PCTs has been designed to meet all the challenges. EMIS PCS will maintain the patient information at many levels and ease safe access 24/7 by the wider health care-community [11]. PCS Enterprise for PCTs has been designed with capability of future technological and keeping development in mind, such as sharing data between General Practices. This includes GP to GP records transfer and inter-operability between in- and OOH PCSs. Using a HL7 Version 3 the patient data is transferred between dedicated health care systems directly [11]. 2.2 An overview of PCS Enterprise This edition has been designed to develop EMIS provision of an absolute system solution for primary care. The system is scalable, multi-practice, and multi disciplinary with shared EPRs and seamless data exchange. This system is based on three-tier architecture, while utilising MS Dot Net technologies, this system has the flexibility to increase numerous clients with its ability to scale to thousands of instantaneous user connections [11]. EMIS Primary Care System Enterprise edition is designed to meet GP needs as closely as possible, while supporting specialties related to medicine. See in 2.1 below gives the overview of PCS Enterprise system: 2.3 EMIS Primary Care System Practice edition Health information system plays an important role in how practice operates. The good and right clinical system can help to save practice valuable time, assist in practice management and ultimately lead to improved patient care. The EMIS PCS Practice edition has been designed to meet GP needs, combining functionality with simplicity of use [11]. Key features of EMIS PCS * Complete patient record management * Quick and good prescribing * Formulary managements * Incorporated consultation mode * Incorporated appointments * Mentor Library * Integrated with MS Word support * User defined templates * Drug Explorer 2.4 EMIS LV Version 5.2 In the PCS market, EMIS Live Version [11] is the main text based medical system. Approximately 5000 GPs currently using EMIS LV system (which is shown below) in the UK. The system offers GPs consultation mode option, medical record, search and reports option, prescription and booking appointments. 2.5 Population Manager This system enables General Practices to effortlessly meet the requirement of the new GMS Contract. Population Manager [11] has a set of more than 160 searches that extract the data require for the new Contracts and present it in an understandable format. It also contains a set of specially designed templates to help speedy and standardised information entry. Population manager is an incorporated part of EMIS LV system. 2.6 Version 5.2 features This is the most recent release of EMIS LV. This LV offers users the following key features [11]: 2.6.1 MS Word incorporation Patient data is easily transferred between EMIS system and MS Word enabling the clinician or staff to create patient related letters in MS Word easily. To create consultation references for simple retrieval, documents are created in MS Word which is saved back into EMIS. 2.6.2 Referral template for Cancer patients If cancer is suspected GPs requires produce and fax or e-mail suspected cancer referrals within 24 hours of seeing the patient (this is according to the NHS Plan). These patients have to be seen by the Hospital Trust within 2 weeks; hence these referrals are named as â€Å"two week rule referrals†. EMIS has included a suite of MS Word templates for each cancer type into EMIS LV5.2. 2.6.3 Electronic Insurance reports One of the most common and time taking medical information requests for GPs is the PMA form for the claim companies. A familiar format for General Practitioner Report has been decided and computer-based reports (eGPR) are accepted by insurers. The electronic GPR can be generating within the EMIS system, integrating all related patient information. The eGPR template is installed by default in this system. 2.6.4 Scanning and attachments This module enables to scan corresponding or images and attaches them directly to a patients record in consultation mode. These documents are instantly available during consultation. 2.7 EMIS Clinical Communication Modules The following Clinical Communication Modules are available with EMIS LV5.2, providing links with Secondary Care [11]. 1 Online Referrals with Booked Admissions 2 Electronic Referrals 3 Incoming Reports including Electronic Discharges 4 Online Results Ordering With an approved list of suppliers this Clinical Communication Modules work. Using the common set of messaging standards currently being developed by the National Design Authority, links to other suppliers will become available, an arm of the National Programme for IT in the NHS. For this reason that EMIS are not progressing, with the further testing of links with other suppliers using proprietary messaging standards. The Clinical Communication Modules are explained below [11]: 2.7.1 Online Referrals and booked admissions Traditionally referring patients from doctors at general practices to hospital or Secondary Care consultants has been a paper based with its problems of delays (slowness) and occasional loss. The EMIS Online Referrals with Booked Admissions module enable us to create a referral on a Secondary Care website using protocols created by Secondary Care consultants, adding patient demographics and clinical information and in some cases booking an appointment. Requirements: Each EMIS practice must have: * EMIS LV 5.2 * NHS Net connectivity * Router access for EMIS * Version 2 clinical terms (5 byte Read Codes) The Secondary Care Provider will need: * An EMIS approved website 2.7.2 Electronic Referrals This module enables us to create a referral letter within EMIS LV and transmit it electronically to a secondary care consultant [11]. The way electronic referrals work You can use MS-Word Integration in EMIS LV to create a referral letter. When you save the referral letter, you are prompted to link with EDI for an electronic transmission: answer ‘Yes and the referral letter is placed in the Communications outbox (CO, OD). From here, you can check the letter before authorising the transmission. When you have authorised the transmission, you can either send the referral letter immediately or wait until the next scheduled transmission. Upon receiving the referral letter, the secondary care software system will transmit an acknowledgement that you can view within the EMIS Communications screen. Requirements Each EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS Support * SMTP or DTS mailbox * MS-Word Integration The secondary care provider will need: * SMTP or DTS mailbox * Suitable software capable of sending and receiving XML messages and acknowledgements * SMTP/DTS and EDI code addresses of the practices involved the trust should obtain these from the health authority or national tracking database 2.7.3 Incoming Reports including electronic discharges Use this information sheet to give you an overview of the Incoming Reports module and the requirements to get you started. The communication of patient information from out of hours services and secondary care used to be paper system, which has been unmanageable and untrustworthy with discharge notes being illegible, incomplete and often late in delivery. The paper-based system replaced by Incoming Reports module which receives electronic discharge notes or other patient related reports from an OOH service or a secondary care provider [11]. How does the Incoming Reports module work? Incoming Reports is a one-way process whereby the out of hours service or secondary care provider sends a message containing the incoming report to EMIS LV. However, EMIS LV will send an acknowledgement of receipt back to the provider. When EMIS LV receives a report, it is matched to the correct patient and placed on a list ready for viewing, and then filing. If EMIS LV cannot match a report to a patient automatically, you can match a patient manually. When viewing a report, you can match the clinical information in the report to clinical terms before you file it. You can link a report to a past consultation (for example, the consultation during which the original referral was made) or create a new consultation specifically for the report. You can view filed incoming reports using the *RL function in Consultation Mode. Requirements To use Incoming Reports, an EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS * A DTS address To use Incoming Reports, a secondary care provider must have: * A DTS address. * The DTS addresses and EDIâ‚ ¬Ã‚   codes for all required practices this information is available from the health authority or from the national tracking database. * Software to create and send XML messages and receive acknowledgements 2.7.4 Online Test Ordering Requesting and processing pathology samples were traditionally paper-based systems, with their inherent problems of slowness and occasional loss of information. Pathology labs can now provide web-enabled IT systems to produce a far more efficient and streamlined service. The EMIS Online Test Ordering module, available for EMIS PCS and EMIS LV systems, enables GPs, via a secure NHSnet connection, to access the pathology lab and exchange information regarding requests, samples and results [11]. Online Test Ordering can be access from Consultation Mode or Medical Record, and then access the website of a compatible laboratory. The current patients demographic and GP details are transferred to the laboratory system when you request the required tests. After you have ordered the tests, the test information is transferred to your EMIS system and filed in the patients record. At this point, you can continue with other work or take the test sample(s). When you take a sample, you can print a bar-coded label to attach to the sample, ready to send to the lab. Use the Online Test Ordering menu options to monitor the progress of the sample and view the results as soon as they are available, although you will still receive the results through the Clinical EDI or Pathology Links modules, as before [11]. Requirements Each EMIS practice must have: * EMIS LV 5.2 or EMIS PCS * NHSnet connectivity * Router access for EMIS * Version 2 clinical terms (5-byte Read codes) Support issues The overall Online Test Ordering process relies on different services and software all working in conjunction with each other: the EMIS software, the laboratory website and the NHSnet network. Unless a problem occurs with the EMIS software, EMIS is improbable to be able to resolve issues with the two areas; therefore, the secondary care trust and/or the practice should ensure that support facilities are in place for these eventualities. 2.8 Storage area network (SAN) Using the highest industry standard storage area network (SAN) configuration EMIS data centres are run [11], on which EMIS stores data [Detail explanation in later chapter]. Chapter Summary The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. Chapter 3 Drawbacks of Online systems Although online application provides many services the challenges associated with are given below. All the drawbacks are explained taking EMIS as an example. 3.1 Patient Record  ¨ Time required to put all relevant information onto system  ¨ Possible security issues  ¨ Doctor can focus too much on patient information onscreen which could intimidate the patient  ¨ Scanning and entry of data is more time consuming. Important information lost can when overlooking the record.  ¨ Medical record print-outs are frequently of poor quality and difficult to understand necessary information  ¨ In spite of using EPR, Paper records need to be kept back or scanned material become unmanageable.  ¨ Often using computer and paper records together will make patient data look very difficult.  ¨ Currently between GPs there is no electronic transfer as it is due to having a risk of data lost and duplication of data[16] 3.2 Appointments  ¨ Patients have to be checked into appointment system by receptionist  ¨ Problematic if patients cant read, or unable to view sign (e.g. blind people) 3.3 Prescriptions  ¨ Relies on drug information being up to date  ¨ Aptitude of doctor in using computer effectively  ¨ Some times doctors issue hand written prescription; they may not be available on computer. The acute and repeat prescribing registers can make it more confused. Printouts of Pharmacy still required [16]. 3.4 Email  ¨ Relies on doctor checking their mail daily  ¨ Troublesome patients abusing the system  ¨ Hospital letters not emailed (would be preferred) 3.5 Security issues  ¨ Doctors have to go to bother of signing on and off EMIS  ¨ Forgetting passwords  ¨ Passwords can be troublesome, staff or anyone can abused or swapped it, if they are lost the system can be absolutely in-operable  ¨ Leaving computer on  ¨ Locum doctors  ¨ Experts are need to show computer frauds and misuse [16] 3.6 Internet connection  ¨ Continuous internet connection required  ¨ The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. 3.7 Backup  ¨ System backed up every night onto tape  ¨ Two copies:- Fireproof safe Remote location 3.8 Read codes Maintenance of enormous clinical expressions or codes is very complex, and the Read Codes present many challenges. In addition, structure of controlled terminologies has been learned about the principle because of the structure of the earlier versions. Version 3, the existing read code systems have been design keeping in mind the previous, simple versions, and to achieve forward compatibility [17]. The problems associated in steps in read coding the medical problems are explain below in s step 1 and step2 The Read Codes are used for many purposes such as clinical audit, searches, source allocation, and for the making of central government statistical returns. Problems arise from different uses and from the different views of Healthcare professional. [17]. Statistical classifications like ICD and OPCS4 may cause inconvenience so they are cross map. Version 2 with its diagonal section closely mirrors ICD9, even though this doesnt always reflect a clinicians view, and correct hierarchy placement of a concept according to ICD9 rules may appear anomalous to a clinician. Besides this Version 2 initial aim is for a code, with its preferred term and it offers a single cross-map to these classifications, and its and all its synonyms, to map correctly to ICD9 [17]. Version 3 came with its directed acyclic graph structure, greater synonym purity, and much easy cross-mapping design, incorporating default maps and alternative maps, avoids the previous version limitations. However this came with other possible problems. Therefore, the two processes, authoring and mapping are closely incorporated [17]. Read/SNOMED Codes Read/SNOMED codes are used by the doctors at hospitals because medical records in future can be transferred through GP2GP links. â€Å"Unlike the principal of Linnaean classification of species in the 19th Century, James Read brings in an international categorization of medical activity to contain disease names, operations and procedures. The main aim of this classification was to allow easy transfer of data between GPs, hospital and PCTs and easy to use by clinical staff, administrators and planners† [24]. Read codes has been explained more clearly in chapter 4. 3.9 GP2GP Record transfer The experience of the GP2GP record transfer and the clinical involvement are explained this section. 3.9.1 The underlying principle for electronic GP-GP record transfer The vast majority of UK GPs (greater than 96 percent) are computerised in some way or other. A sizeable proportion of these practices use their computer systems for recording patient record information in whole or in part [33]. This results from a variety of causes whose main headings are: * Patient records that are an unpredictable mix between paper and electronic. * The net effect of the above is to place difficulties on new practices in identifying salient information in transferred records and in incorporating that information within the new record. This is to known to have significant (but un-quantified) resource implications for practices. There is also widespread anecdotal evidence of resulting adverse effects on patient care. The rationale for the electronic transfer of records is therefore: * As a support for electronic records in general practice and their general benefits in terms of decision support and audit/governance abilities. * To obviate the need, as far as possible, for re-keying of paper-based information for new patients and thus reduce resource implications * To reduce the risks to patients arising from the transfer of confusing records. 3.9.2 The nature of electronic GP-GP record transfer Electronic patient record systems in general practice in England are provided by the commercial sector. At the time of writing this annex to the Good Practice Guidelines, eleven different commercial suppliers are known to be involved in this provision. In simple terms is that it is a common convention for the representation of [33]: * Record encounters; what constitutes a single transaction with the record like a doctors consultation, a letter received from hospital or outside, an examination result etc * Names for these encounters; e.g. home visit, * Headings within these encounters * Complex clinical constructs * Read code mappings; such medication codes sets * Codes and associated text * Major modifiers of clinical meaning 3.9.3 The Problems of electronic GP-GP record transfer There are four particular aspects of current GP-GP records where the transfer process of that record information needs to be supported by additional rules or processes if fully safe and usable records are to be reconstituted on receiving systems and are explain below [33]. Medication information There are currently three different coding schemes for the representation of medication information on GP systems. The principal reasons for failure to reach 100% reliability are: * The multiple coding schemes used and * Failure of previous code mapping exercises (see chapter 5 on data transfer). 3.10 The Problem Oriented Medical Record (PMOR) Electronic health records (EHR) are more used in UK General Practice despite continuing improbability about its legality and admissibility. The transfer of electronic record is currently in demand by the practices when the patient moves i.e. GP2GP transfer. The EHR implementations differ from a simple sequential list of medical concepts in an out of date coding system to sophisticated Problem Oriented Medical Records (POMR) [31]. 3.10.1 Limitations of the PO Medical Record The limitations of POMR are explain below [31] * It is very easy to pick up but very difficult to maintain. * In the strict way of the word not all headings are problems. For example, the heading of Immunisation is used usually to indicate where all the entries related to a immunization history may be found. * Many different problems may be discussed within a single consultation * To check scanned documents is very difficult especially when patient record is too big * Problems are frequently linked in a fundamental way. * The PO Medical Record only gives a basic measure of the state of a problem. * Different clinicians, view the clinical record, required different information from the medical record as well as with different views. * Some of problems are complex and they are difficult to read. Those records which have few entries are conversely are easy to read, hence POMR is meant to avoid comes to the fore again. Though POMR have above limitation but it is a popular medium for data entry and viewing, there is indeed room for enhancement and progress [31]. 3.11 Other Disadvantages * Typing skills required for doctors and other clinicians. They are using ever more abbreviations and acronyms. * Many screen need to be changes to find results and mouse activity * Information can be hidden as only the informati Patient Healthcare Using SMS Technology Application Patient Healthcare Using SMS Technology Application Chapter 1 Introduction to Patient Care Using SMS Application Patients travel longer distances for the opinion of consultant which is not possible either due to patient situation or due to distances. Enhancement of health care in different locations and other remote areas can be achieved using mobile phone applications [1]. 1.1 Problem Statement Development of mobile communication networks playing an important part in the enhancement of a mobile medicine. Patient Care Using SMS Application represents a feasible solution of patient care such as text messaging and booking appointments using mobile phones, which are best aspects of mobile medicine. The main idea is improve patient access to healthcare; encouraging patients to use mobile health application and supporting people with long term conditions [5]. 1.2 Objectives Incredible growth of mobile communication and recognition of new generation Wireless protocols has initiated the advance SMS based medical applications. Following that facts Patient care using SMS based application for mobile application for patient is good solution [5 6]. * To design and develop a WAP enabled wireless applications that will enhance the feature of mobile device by incorporating the features of a digital diary. The application should be able to get integrated with the existing application vis-à  -vis Exchange Server etc * Main aim of this application is to achieve â€Å"greater quality communication between GPs and consultants using mobile medicine, which will results in enhancement of patients care â€Å"[5 6]. 1.3 Scope The goal of Patient Care Using SMS Application is based on two major conditions. First, is to achieve proficient means to exchange message between General Practitioners and consultants care have to be provided. The second is sufficient exchange of patients information have to be provided. Additionally, privacy of communication and stored information has to be guaranteed. Both ethical and technical aspects are equally important [7]. 1.4 Existing Systems The existing system of treatment consists of two different systems. They are as follows: * Traditional or manual system * Online application 1.4.1 Traditional or Manual system The present system of treatment consists of manually consulting a doctor by taking prior appointment or else registering at that instant of time, waiting to get register themselves and then consulting the doctor which is a time consuming process. 1.4.1.1 Drawbacks * Time consuming * Patient need to stand in long queues to make appointments * Patients not follow prescription directions once they leave the surgery or hospital. Research has showed that more than 50 percent of patients not follow the management advised by their doctors may be due to lack of time and interest. 1.4.2 Online System Online application is also available where the user is provided a login and password through which he can access the website, make appointments, clarify their queries etc. The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. The online systems are discussed below are: * EMIS * VISION System 1.4.2.1 EMIS System EMIS ® stands for Egton Medical Information Systems Limited. EMIS provides a service that enables you access to your healthcare online [9]. After registering with the surgery, patients are able to book or cancel their appointments with the doctor. Patient can also request repeat prescription, send messages to their practice and update personal information if practice has set up these features online [10]. This example has been explained in detailed in chapter 2. 1.5.2 Example 2: Vision System Vision [14] is the most famous system in use UK, within the GPs sector today, due to its market leading features, functionalities and first class support from INPS. There are currently more than 1,800 GP practices which are using Vision system across the UK each day. â€Å"Vision system version 3 is fully RFA 99 acquiescent, includes, support for the encryptedEDIFACT pathology v1.1 message, MIQUEST and DTS. The Vision application is stable, proven and reliable. The strong product-base has allowed other features such as advanced-scanning, PDAs support and incorporated voice dictations as well as extension to core functionality such as XML based clinical-messaging, allowing integrations with third party systems† [14]. In this project we are more concentrating on EMIS rather than Vision system. Key Features Messaging Incorporated External system Appointments Consultation Manager Problem Orientated Views Community Caseload Search and Reporting 7. Clinical Audit Vision and the National Applications [14] Few of the above features are explain below [14]: 1. Messaging This system offers unparallel flexibility with the wider health community via its highly supple and adaptable in-built messaging and web-services. These allow patients data from number of external sources including the NHS Spine or local CPRs to be easily accessed and used within Vision, supporting the requirements of the NHS IT-strategy. Vision also manages a range of clinical messages from third party systems to support the patient care as follows: * Choose and Book Referrals (electronic booking) * E- Discharge Summaries * Radiology reports and Encrypted pathology reports * OOH Summaries With a powerful XML event and messaging engine, Vision is designed to ensure the performance of new messages require no changes to the core Vision product. In a single, clear and simple interface, all message types are managed. 2. Incorporated External System In the Vision tabbed views, external web enabled application can now be well-established, allow access patient information from number of sources to be seamlessly from the Vision desktop. The patient is automatically recognised in the target system, when the required data is passed to the third-party application. For integration into the patient record when required, important data may also be written back to Vision 3. Patients Appointments This Vision system allows user full access to the appointment screen. â€Å"Using session templates developed by the practice† the appointment books are defined in advance. The view of appointment book can be defined by user: all significant doctors and other Healthcare professionals can be added or deleted as requirements. To denote, each slots can be assigned in different colours. As the patients arrives at reception, enters the doctors room or leave the surgery, their status is recorded. Our evaluations are based on EMIS system, its features and limitation which have been explained in later chapters. 1.5 Thesis Organisation In chapter 1 we have explained Patient care using SMS application and its aim, objectives and scope. The existing systems such as manual and online systems are briefly explained in this chapter along with it features and disadvantages. The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. This chapter 3 gives brief overview of problems associated with online medical systems with examples. Problems of online medical system such as internet connection, email, prescription, Electronic Patient records and read codes are explained. In the chapter 4 we have focussed on Patient Records and how they are managed at General Practices and hospitals. The traditional paper based practices and its limitations have been explained with examples. The paper less practices and its pros have been explained and the reasons why practice should follow this have explained with examples. The advantages and disadvantages of Electronic patient records with s and examples are discussed in this chapter. The chapter 5 focuses on Read codes and its structures. In this chapter 3 versions of read codes are explain with examples. Maintenance of read codes i.e. internal process and external interaction and hierarchy has been explained with s. The example case study represents the limitations associated with 3 versions, its results and solutions. The chapter 6 is about EMIS database, i.e. patient database and focuses on its usability and security. It explains structure of database and its solutions. Secure Patient data transfer within the PCT has been explained. Storage Area Network is used by EMIS to store patient records. How the GPs and other Healthcare Professional access patient records has been explained. Advance system and its features are discussed in this chapter 7. Waterfall Models activities have been explained. The structure of advance system with s is discussed in this chapter. The conceptual and technical design of this project has been briefly explained. UML language is used in this project to represent user and admin operations. The chapter 8 explains the SMS system requirements such as Specification requirements, Functional requirements, Performance requirements, and hardware and software requirements. About operating system and languages used in this projects are discussed in this chapter. Wireless application protocol architecture and WAP server are explained using diagrams. Database requirements and its uses are explained using diagrams. Open wave SDK and its functions are discussed in this chapter. Chapter 2 Egton Medical Information Systems EMIS ® and EMIS intellectual technology are trading names of â€Å"Egton Medical Information Systems Limited†. EMIS had begun 18 years ago in a rural area dispensing practice in Egton near Whitby in North Yorkshire [11]. EMIS ® head-offices are based in Leeds, including Development and Support departments. Training for general practices is localised and headed by Provincial Operations Directors [11]. 2.1 Practice Care System Enterprise Due to the growing number of EPRs held in both GP and Secondary Care, the requirement for a whole EHR has never been greater. The EMISs Primary Care System Enterprise edition for PCTs has been designed to meet all the challenges. EMIS PCS will maintain the patient information at many levels and ease safe access 24/7 by the wider health care-community [11]. PCS Enterprise for PCTs has been designed with capability of future technological and keeping development in mind, such as sharing data between General Practices. This includes GP to GP records transfer and inter-operability between in- and OOH PCSs. Using a HL7 Version 3 the patient data is transferred between dedicated health care systems directly [11]. 2.2 An overview of PCS Enterprise This edition has been designed to develop EMIS provision of an absolute system solution for primary care. The system is scalable, multi-practice, and multi disciplinary with shared EPRs and seamless data exchange. This system is based on three-tier architecture, while utilising MS Dot Net technologies, this system has the flexibility to increase numerous clients with its ability to scale to thousands of instantaneous user connections [11]. EMIS Primary Care System Enterprise edition is designed to meet GP needs as closely as possible, while supporting specialties related to medicine. See in 2.1 below gives the overview of PCS Enterprise system: 2.3 EMIS Primary Care System Practice edition Health information system plays an important role in how practice operates. The good and right clinical system can help to save practice valuable time, assist in practice management and ultimately lead to improved patient care. The EMIS PCS Practice edition has been designed to meet GP needs, combining functionality with simplicity of use [11]. Key features of EMIS PCS * Complete patient record management * Quick and good prescribing * Formulary managements * Incorporated consultation mode * Incorporated appointments * Mentor Library * Integrated with MS Word support * User defined templates * Drug Explorer 2.4 EMIS LV Version 5.2 In the PCS market, EMIS Live Version [11] is the main text based medical system. Approximately 5000 GPs currently using EMIS LV system (which is shown below) in the UK. The system offers GPs consultation mode option, medical record, search and reports option, prescription and booking appointments. 2.5 Population Manager This system enables General Practices to effortlessly meet the requirement of the new GMS Contract. Population Manager [11] has a set of more than 160 searches that extract the data require for the new Contracts and present it in an understandable format. It also contains a set of specially designed templates to help speedy and standardised information entry. Population manager is an incorporated part of EMIS LV system. 2.6 Version 5.2 features This is the most recent release of EMIS LV. This LV offers users the following key features [11]: 2.6.1 MS Word incorporation Patient data is easily transferred between EMIS system and MS Word enabling the clinician or staff to create patient related letters in MS Word easily. To create consultation references for simple retrieval, documents are created in MS Word which is saved back into EMIS. 2.6.2 Referral template for Cancer patients If cancer is suspected GPs requires produce and fax or e-mail suspected cancer referrals within 24 hours of seeing the patient (this is according to the NHS Plan). These patients have to be seen by the Hospital Trust within 2 weeks; hence these referrals are named as â€Å"two week rule referrals†. EMIS has included a suite of MS Word templates for each cancer type into EMIS LV5.2. 2.6.3 Electronic Insurance reports One of the most common and time taking medical information requests for GPs is the PMA form for the claim companies. A familiar format for General Practitioner Report has been decided and computer-based reports (eGPR) are accepted by insurers. The electronic GPR can be generating within the EMIS system, integrating all related patient information. The eGPR template is installed by default in this system. 2.6.4 Scanning and attachments This module enables to scan corresponding or images and attaches them directly to a patients record in consultation mode. These documents are instantly available during consultation. 2.7 EMIS Clinical Communication Modules The following Clinical Communication Modules are available with EMIS LV5.2, providing links with Secondary Care [11]. 1 Online Referrals with Booked Admissions 2 Electronic Referrals 3 Incoming Reports including Electronic Discharges 4 Online Results Ordering With an approved list of suppliers this Clinical Communication Modules work. Using the common set of messaging standards currently being developed by the National Design Authority, links to other suppliers will become available, an arm of the National Programme for IT in the NHS. For this reason that EMIS are not progressing, with the further testing of links with other suppliers using proprietary messaging standards. The Clinical Communication Modules are explained below [11]: 2.7.1 Online Referrals and booked admissions Traditionally referring patients from doctors at general practices to hospital or Secondary Care consultants has been a paper based with its problems of delays (slowness) and occasional loss. The EMIS Online Referrals with Booked Admissions module enable us to create a referral on a Secondary Care website using protocols created by Secondary Care consultants, adding patient demographics and clinical information and in some cases booking an appointment. Requirements: Each EMIS practice must have: * EMIS LV 5.2 * NHS Net connectivity * Router access for EMIS * Version 2 clinical terms (5 byte Read Codes) The Secondary Care Provider will need: * An EMIS approved website 2.7.2 Electronic Referrals This module enables us to create a referral letter within EMIS LV and transmit it electronically to a secondary care consultant [11]. The way electronic referrals work You can use MS-Word Integration in EMIS LV to create a referral letter. When you save the referral letter, you are prompted to link with EDI for an electronic transmission: answer ‘Yes and the referral letter is placed in the Communications outbox (CO, OD). From here, you can check the letter before authorising the transmission. When you have authorised the transmission, you can either send the referral letter immediately or wait until the next scheduled transmission. Upon receiving the referral letter, the secondary care software system will transmit an acknowledgement that you can view within the EMIS Communications screen. Requirements Each EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS Support * SMTP or DTS mailbox * MS-Word Integration The secondary care provider will need: * SMTP or DTS mailbox * Suitable software capable of sending and receiving XML messages and acknowledgements * SMTP/DTS and EDI code addresses of the practices involved the trust should obtain these from the health authority or national tracking database 2.7.3 Incoming Reports including electronic discharges Use this information sheet to give you an overview of the Incoming Reports module and the requirements to get you started. The communication of patient information from out of hours services and secondary care used to be paper system, which has been unmanageable and untrustworthy with discharge notes being illegible, incomplete and often late in delivery. The paper-based system replaced by Incoming Reports module which receives electronic discharge notes or other patient related reports from an OOH service or a secondary care provider [11]. How does the Incoming Reports module work? Incoming Reports is a one-way process whereby the out of hours service or secondary care provider sends a message containing the incoming report to EMIS LV. However, EMIS LV will send an acknowledgement of receipt back to the provider. When EMIS LV receives a report, it is matched to the correct patient and placed on a list ready for viewing, and then filing. If EMIS LV cannot match a report to a patient automatically, you can match a patient manually. When viewing a report, you can match the clinical information in the report to clinical terms before you file it. You can link a report to a past consultation (for example, the consultation during which the original referral was made) or create a new consultation specifically for the report. You can view filed incoming reports using the *RL function in Consultation Mode. Requirements To use Incoming Reports, an EMIS practice must have: * EMIS LV 5.2 * NHSnet connectivity * Router access for EMIS * A DTS address To use Incoming Reports, a secondary care provider must have: * A DTS address. * The DTS addresses and EDIâ‚ ¬Ã‚   codes for all required practices this information is available from the health authority or from the national tracking database. * Software to create and send XML messages and receive acknowledgements 2.7.4 Online Test Ordering Requesting and processing pathology samples were traditionally paper-based systems, with their inherent problems of slowness and occasional loss of information. Pathology labs can now provide web-enabled IT systems to produce a far more efficient and streamlined service. The EMIS Online Test Ordering module, available for EMIS PCS and EMIS LV systems, enables GPs, via a secure NHSnet connection, to access the pathology lab and exchange information regarding requests, samples and results [11]. Online Test Ordering can be access from Consultation Mode or Medical Record, and then access the website of a compatible laboratory. The current patients demographic and GP details are transferred to the laboratory system when you request the required tests. After you have ordered the tests, the test information is transferred to your EMIS system and filed in the patients record. At this point, you can continue with other work or take the test sample(s). When you take a sample, you can print a bar-coded label to attach to the sample, ready to send to the lab. Use the Online Test Ordering menu options to monitor the progress of the sample and view the results as soon as they are available, although you will still receive the results through the Clinical EDI or Pathology Links modules, as before [11]. Requirements Each EMIS practice must have: * EMIS LV 5.2 or EMIS PCS * NHSnet connectivity * Router access for EMIS * Version 2 clinical terms (5-byte Read codes) Support issues The overall Online Test Ordering process relies on different services and software all working in conjunction with each other: the EMIS software, the laboratory website and the NHSnet network. Unless a problem occurs with the EMIS software, EMIS is improbable to be able to resolve issues with the two areas; therefore, the secondary care trust and/or the practice should ensure that support facilities are in place for these eventualities. 2.8 Storage area network (SAN) Using the highest industry standard storage area network (SAN) configuration EMIS data centres are run [11], on which EMIS stores data [Detail explanation in later chapter]. Chapter Summary The chapter 2 explains EMIS system and its features. Features of EMIS explained in this chapter with examples, their functionality and requirements. Chapter 3 Drawbacks of Online systems Although online application provides many services the challenges associated with are given below. All the drawbacks are explained taking EMIS as an example. 3.1 Patient Record  ¨ Time required to put all relevant information onto system  ¨ Possible security issues  ¨ Doctor can focus too much on patient information onscreen which could intimidate the patient  ¨ Scanning and entry of data is more time consuming. Important information lost can when overlooking the record.  ¨ Medical record print-outs are frequently of poor quality and difficult to understand necessary information  ¨ In spite of using EPR, Paper records need to be kept back or scanned material become unmanageable.  ¨ Often using computer and paper records together will make patient data look very difficult.  ¨ Currently between GPs there is no electronic transfer as it is due to having a risk of data lost and duplication of data[16] 3.2 Appointments  ¨ Patients have to be checked into appointment system by receptionist  ¨ Problematic if patients cant read, or unable to view sign (e.g. blind people) 3.3 Prescriptions  ¨ Relies on drug information being up to date  ¨ Aptitude of doctor in using computer effectively  ¨ Some times doctors issue hand written prescription; they may not be available on computer. The acute and repeat prescribing registers can make it more confused. Printouts of Pharmacy still required [16]. 3.4 Email  ¨ Relies on doctor checking their mail daily  ¨ Troublesome patients abusing the system  ¨ Hospital letters not emailed (would be preferred) 3.5 Security issues  ¨ Doctors have to go to bother of signing on and off EMIS  ¨ Forgetting passwords  ¨ Passwords can be troublesome, staff or anyone can abused or swapped it, if they are lost the system can be absolutely in-operable  ¨ Leaving computer on  ¨ Locum doctors  ¨ Experts are need to show computer frauds and misuse [16] 3.6 Internet connection  ¨ Continuous internet connection required  ¨ The problem with online application is we cannot access from remote areas, compulsory web connection should be there and we cannot get alerts [4, 5]. 3.7 Backup  ¨ System backed up every night onto tape  ¨ Two copies:- Fireproof safe Remote location 3.8 Read codes Maintenance of enormous clinical expressions or codes is very complex, and the Read Codes present many challenges. In addition, structure of controlled terminologies has been learned about the principle because of the structure of the earlier versions. Version 3, the existing read code systems have been design keeping in mind the previous, simple versions, and to achieve forward compatibility [17]. The problems associated in steps in read coding the medical problems are explain below in s step 1 and step2 The Read Codes are used for many purposes such as clinical audit, searches, source allocation, and for the making of central government statistical returns. Problems arise from different uses and from the different views of Healthcare professional. [17]. Statistical classifications like ICD and OPCS4 may cause inconvenience so they are cross map. Version 2 with its diagonal section closely mirrors ICD9, even though this doesnt always reflect a clinicians view, and correct hierarchy placement of a concept according to ICD9 rules may appear anomalous to a clinician. Besides this Version 2 initial aim is for a code, with its preferred term and it offers a single cross-map to these classifications, and its and all its synonyms, to map correctly to ICD9 [17]. Version 3 came with its directed acyclic graph structure, greater synonym purity, and much easy cross-mapping design, incorporating default maps and alternative maps, avoids the previous version limitations. However this came with other possible problems. Therefore, the two processes, authoring and mapping are closely incorporated [17]. Read/SNOMED Codes Read/SNOMED codes are used by the doctors at hospitals because medical records in future can be transferred through GP2GP links. â€Å"Unlike the principal of Linnaean classification of species in the 19th Century, James Read brings in an international categorization of medical activity to contain disease names, operations and procedures. The main aim of this classification was to allow easy transfer of data between GPs, hospital and PCTs and easy to use by clinical staff, administrators and planners† [24]. Read codes has been explained more clearly in chapter 4. 3.9 GP2GP Record transfer The experience of the GP2GP record transfer and the clinical involvement are explained this section. 3.9.1 The underlying principle for electronic GP-GP record transfer The vast majority of UK GPs (greater than 96 percent) are computerised in some way or other. A sizeable proportion of these practices use their computer systems for recording patient record information in whole or in part [33]. This results from a variety of causes whose main headings are: * Patient records that are an unpredictable mix between paper and electronic. * The net effect of the above is to place difficulties on new practices in identifying salient information in transferred records and in incorporating that information within the new record. This is to known to have significant (but un-quantified) resource implications for practices. There is also widespread anecdotal evidence of resulting adverse effects on patient care. The rationale for the electronic transfer of records is therefore: * As a support for electronic records in general practice and their general benefits in terms of decision support and audit/governance abilities. * To obviate the need, as far as possible, for re-keying of paper-based information for new patients and thus reduce resource implications * To reduce the risks to patients arising from the transfer of confusing records. 3.9.2 The nature of electronic GP-GP record transfer Electronic patient record systems in general practice in England are provided by the commercial sector. At the time of writing this annex to the Good Practice Guidelines, eleven different commercial suppliers are known to be involved in this provision. In simple terms is that it is a common convention for the representation of [33]: * Record encounters; what constitutes a single transaction with the record like a doctors consultation, a letter received from hospital or outside, an examination result etc * Names for these encounters; e.g. home visit, * Headings within these encounters * Complex clinical constructs * Read code mappings; such medication codes sets * Codes and associated text * Major modifiers of clinical meaning 3.9.3 The Problems of electronic GP-GP record transfer There are four particular aspects of current GP-GP records where the transfer process of that record information needs to be supported by additional rules or processes if fully safe and usable records are to be reconstituted on receiving systems and are explain below [33]. Medication information There are currently three different coding schemes for the representation of medication information on GP systems. The principal reasons for failure to reach 100% reliability are: * The multiple coding schemes used and * Failure of previous code mapping exercises (see chapter 5 on data transfer). 3.10 The Problem Oriented Medical Record (PMOR) Electronic health records (EHR) are more used in UK General Practice despite continuing improbability about its legality and admissibility. The transfer of electronic record is currently in demand by the practices when the patient moves i.e. GP2GP transfer. The EHR implementations differ from a simple sequential list of medical concepts in an out of date coding system to sophisticated Problem Oriented Medical Records (POMR) [31]. 3.10.1 Limitations of the PO Medical Record The limitations of POMR are explain below [31] * It is very easy to pick up but very difficult to maintain. * In the strict way of the word not all headings are problems. For example, the heading of Immunisation is used usually to indicate where all the entries related to a immunization history may be found. * Many different problems may be discussed within a single consultation * To check scanned documents is very difficult especially when patient record is too big * Problems are frequently linked in a fundamental way. * The PO Medical Record only gives a basic measure of the state of a problem. * Different clinicians, view the clinical record, required different information from the medical record as well as with different views. * Some of problems are complex and they are difficult to read. Those records which have few entries are conversely are easy to read, hence POMR is meant to avoid comes to the fore again. Though POMR have above limitation but it is a popular medium for data entry and viewing, there is indeed room for enhancement and progress [31]. 3.11 Other Disadvantages * Typing skills required for doctors and other clinicians. They are using ever more abbreviations and acronyms. * Many screen need to be changes to find results and mouse activity * Information can be hidden as only the informati