Case Study: DigiHealth Medical Services Essay.

Background

Case Study: DigiHealth Medical Services

DigiHealth Medical Devices is a local company that specialises in medical monitoring through remote, mobile telecommunication devices. One of the newly developed devices in their range of products is a portable and wearable glucose monitor embedded in a wristband which transmits results to a designated medical center in real time. Providers and patients can incur significant costs when glucose levels are not maintained within acceptable tolerances. Episodes of high or low glucose can results in expensive medical costs and possible hospitalisation. These episodes if left unchecked can then lead to more severe and expensive long-term ailments like vision, circulatory and renal problems. The device is known as the Real-Time Glucose Monitoring device (RTGM) and it is approximately the same size as the current model Apple iWatch. The data collected by the device is sent to MyHealth Medical Centres, which has partnered with DigiHealth in the development of this product.

The RTGM currently works very well with Apple iPhones, but it does not integrate with all the Android phones. DigiHealth plans to develop the app further for improved integration in the Android operating system. Once the updated version is completed, MyHealth Medical Centre patients will have free use of the app across all popular smart phones and DigiHealth will resell the app to other health care providers and possibly the government.

Background

According to the Australian government budget spending, health (in the form of medical/ healthcare/ hospitals) is the 3^rd most expensive component of the national budget. At $81.8 billion it is nearly 2.5 times larger than the national defence budget and 2.2 times larger than national education budget (Commonwealth of Aust, 2019). According to a 2019 Deloitte analysis report on the Global Healthcare Outlook, Green (2019) stated that the global cost of health care is projected to increase at an annual rate of 5.4% per year till 2022. So, with growing expenditures forecasted in the global health care area the ability to reduce the costs and improve efficiencies within the health system is an imperative for both government and private medical providers.

Health care stakeholders besieged with the challenges of managing the clinical, operational, and financial challenges envision a future in which new business and care delivery models will be aided by data rich driven digital technologies (Green, 2019). By using digital technologies this may help to solve today’s problems and contribute to the construction of a sustainable foundation for affordable, accessible, high-quality health care. Green (2019) stated that the vision of a sustainable, accessible and affordable health care model may have a greater probability of becoming a reality if all stakeholders actively participate in shaping the future. This can be done by shifting focus away from a system of sick care in which we treat patients after they fall ill, to one of health care which supports well-being, prevention, and early intervention.

With the development of information technology and people’s increasing concerns on healthcare, the healthcare wearable technology has been gaining additional attention in recent years. The concept of wearable technology is relatively simple and a natural extension of how existing mobile devices (mainly the smart phone) can be used as a central hub for low powered, short distance network ancillary devices that can be used to support and add value back to the users. Commercially available wearable devices started to become available in 2012, when Google Glass came into public view and set off an upsurge of wearable devices. There are many kinds and brands of wearable devices, such as iWatch, Fitbit and the Samsung Active range of wristbands and smart watches, etc. According to Chan et al (2012) that one of the biggest application of wearable devices is in the healthcare and medical fields and according to a report released by P&S Market Research, the global healthcare wearable device market is predicted to reach 1630.3 million dollars by 2020 with a growth rate of 46.6% during the years 2015–2020. The healthcare wearable device has combined health attributes together with technology attributes and has unique advantages on tracking and transforming users’ health information in real-time (Chan et al, 2012).

The tasks for this assignment will be divided into two main parts.

Part A: Will focus on defining the stakeholders also how to elicit requirements as well as identify some functional and nonfunctional requirements. You will also be required to provide recommendations (with evidence) for further developments of future products for the health care industry.

Part B: Will focus on the technical and data requirements of the product, including the development of a context diagram, creating an events table, creating DFD fragments and an ERD diagram.

Please follow the standard report writing format and structure. (See Assignment Guide for further information)

Answer the following questions with clear statements and evidence.

1. Define the RTGM’s stakeholders? Should patients be included in defining the system requirements? Why or why not? Should RTGM interact with medical professionals other than physicians? Why or why not?
   
   
2. If you were the lead analyst for RTGM, how would you determine the requirements? Be specific in your answer. List several questions you need answered.
   
   
3. What are the primary functional requirements for the system as described so far in the case?
   
   
4. Construct a proposed activity diagram to show the potential flow of activities if low or high glucose was measured by the device.
   
   
5. Are the parameters for alerting patients and medical personnel the same for every patient? Can they vary over time for the same patient? What are the implications for the system’s functional requirements?
   
   
6. Briefly describe some possible non-functional requirements for RTGM.
   
   
7. By reviewing the background, provide a brief argument with evidence to persuade the managers at DigiHealth to where (which medical problem or issue) they should focus their development off the next wearable healthcare device.

Please use the appropriate modelling tools (Visio or similar) to complete the requirements.

1. Develop a context diagram encompassing all the use cases in Figure 1

By using the provided level 0 Data Flow Diagram (DFD) (Figure 2). Complete the Event Table.

1. Based on the diagram provided (Figure 2) and the creation of the event table (task 2) develop a DFD fragments for the following use cases.

1. View history
2. Send message to the doctor
3. Send message to patient
4. Develop a complete ERD for the identified entities and relationships. Must show correct cardinalities as well as entity attributes.

1.

The RTGM stakeholders are the ones who would be connected directly with the RTGM systems. The outcomes of the system would also be defining outcomes in the lives of the stakeholders. The main stakeholders are the patients and the caregivers who make use of the systems for the benefit of the health of the patients. Doctors are the one who would be transferring the information into the devices for the care givers and the persons who would be updating the database in the systems are also associated directly with the systems. The main list of stakeholders includes:

• Patients (users of the monitoring device and of the phone application)
• Doctors (users of the information transmitted)
• Other hospital medical staff (those who enter patient medical information on phone app)
• Medical equipment engineers (developers of the mobile monitoring equipment)
• Technical staff (developers of the central server system, and the database)
• Project team members (developers of the actual phone app itself)

The patients the most important stakeholders of the system. They are ones who would be affected directly with the system and hence, they are the ones who are to be included in defining the requirements of the system.

The RTGM should be interacting with medical professionals as they would be able to provide an input to the system after a thorough analysis of the data in the system. In addition to this, the inputs from the other medical professionals can be used up very effectively by the physicians.

2.

Requirements gathering are very much essential as this helps in ensuring that the system developed is efficient and capable of meeting the needs of the customers (Silva, 2019). Requirement gathering is referred to the process that helps in collecting the essential requirements that will be efficient for meeting the needs of the stakeholders. The steps that are associated with requirement gathering understand the main requirement, eliminating the errors, identifying the corner cases and creating a definition of completed. Requirement gathering must be carried out for analyzing the resources effectively (Chanin et al. 2019). The main benefits that are offered with requirement gathering are that it offers fewer defects while delivering products, reduces the project chaos and high level of satisfaction towards the stakeholder (Ghanghro et al. 2018). In these requirements are gathered from the stakeholders so that it can be implemented within the product for managing the services. The RGTM device will be designed in such a way that it offers better way for managing the data sets (Ghanghro et al. 2018). At present the designed system works efficiently with Apple iPhones. However, the system fails to provide better facility while used with the android phones (Chanin et al. 2019). There are wide number of requirement gathering techniques that help in collecting property information related to a system or a business function. The different types of requirement gathering techniques are brainstorming, interview, observation, and questionnaire. The selected technique for the purpose of gathering the data for the system is questionnaire (Ghanghro et al. 2018). The main reason behind selecting questionnaire technique for gathering the requirement is that it helps in carrying out the analyses regarding a system within time and under the budget. This helps in gathering data of wrong use amount of people within limited time period (Chanin et al. 2019). Therefore, it can be stated that questionnaire is the best tool for evaluating the performance of the RTGM system. The RTGM system is designed for offering better services towards the customers.

Stakeholders and Requirements Gathering

Below are the set of questionnaire that is developed for understanding the components associated with the RGTM system.

Q1. What features are needed for implementing the RTGM in the android phones?

Q2. How health will be improved with the use of RTGM devices?

Q3. How much time will be needed for developing the RTGM device for the android system?

Q4. What operating system will be included in the Android system?

Q5. What features will be offered towards the patients?

3.

Functional requirements are referred to the features that will offer with the use of a product. It is important to determine the functional requirements efficiently so that it can offer a better way of identifying the requirements. With the use of functional requirement analysis, it becomes easy to define the expected system behavior (Eckhardt, Vogelsang and Fernanadez 2016). Therefore, it is important to determine the functional requirement associated with every system so that the customers can understand the accessibility features that will be offered towards them (Shah et al. 2018). It is essential to identify the functional requirements associated with the Real-Time Glucose Monitoring device (RTGM) so that it becomes easy to understand the features that will be offered towards the users. The implemented system is capable of providing better facility towards the patients (Wadwa et al. 2018) The below list describes the primary functional requirements associated with the system.

• The user needs to login within the monitoring devices so that they can get a real-time about the glucose level in their body.
• The user must provide the personal details within the application so that it becomes easy to understand the health condition of the patient (Wadwa et al. 2018).
• Patients will be capable of viewing the current glucose level within their body
• Patients will be able to view the history and trends associated with the glucose levels in their body
• Patients will receive alert related to high or low glucose level in their body
• The medical personnel will set alert threshold
• Medical personnel will be capable of communicating with patient through the use of these applications
• Medical personnel will be capable of viewing the patient history for providing them proper treatment
• The patients will be capable of setting up alerts based on beta glucose the floor will be deter mind (Wadwa et al. 2018).
• Patients will be capable of requesting for emergency help in case of sudden glucose fall
• Patients will set alert regarding their appointments with the doctors
• Patient can generate monthly health record about the glucose level with the use of this system
• Patients will be capable of setting alarm for taking medicines

5.

No the parameters for the measurement should not be same for every patient. The alerts are to be scheduled manually by the doctors and additionally, each of the schedule for the alert is to be set up as per the requirement of the patient (Wadwa et al. 2018). In fact, a measurement which can be low for patient can be high for another. However, the measurement system would be same for the each of the patients (Gia et al. 2017). The readings and the measurement criteria are same for all the devices.

The measurement and alert reading might vary over a particular time period as the health condition of a person is ever changing. Hence, the medical history of the person would also change accordingly (Zhou et al. 2018). Therefore, the doctor is also required to regulate the alerts as per the requirements. The functional requirement of the doctor setting up the alert system identifies that.

The change in the health condition of the patient would not have much implication on the functional requirements as the system would be developed with the possibilities of the changes in mind.

Questionnaire

6.

Non-functional requirements are referred to the quality attributes that are associated with the system. It is important to determine the non-functional requirements associated with the system so that it becomes easy to identify the overall performance related to the system (Eckhardt, Vogelsang and Fernanadez 2016). It is essential for a system analyst to determine the non-functional requirements so that it becomes easy to understand the key features that will be offered with the use of the application (Eckhardt, Vogelsang and Fernanadez 2016). The non-functional requirements that are offered with real-time glucose monitoring system are discussed below:

• Secured: the real-time glucose monitoring system will offer secure encrypted communication towards the patients and will ensure that all the data are stored efficiently. This will offer high security towards the data sets and will ensure that proper control is offered towards the users.
• Accuracy: The real-time glucose monitoring system has the ability to collect accurate data for providing better facility towards the patients.  Once the data are collected accurately then it becomes easy to evaluate the performance of the system (Edelman et al. 2018). The accuracy within the data is much needed as this helps in ensuring that proper services are offered towards the users.
• Accessibility: This system is designed with the easy interface so that every patient can access the system without any issue. Great accessibility will help in providing better service towards the users.
• Flexibility: the developed system is flexible so that it can be used through both android as well as the iOS interface. The system will be designed with the proper flexibility so that every user can have proper access to the data sets.
• Efficient: the system will be capable of producing efficient data after evaluating the past records of the patients. Therefore, it can be stated that with the use of real time glucose monitoring system it will become easy to determine the overall glucose level within the patients.
• Physical attributes: the designed system will be in wearable format with stylish color and comfortable and durable design. This will be easily accessible by the users and will be capable of generating proper results towards the patients.
• Integrity: With the use of glucose monitoring app it will become easy to offer better integrity towards the users as this will ensure that all the essential data are maintained privately within the system.
• Transparency: The designed system will be capable of providing better support towards the system. Huge transparency will be offered so that it becomes easy to manage the overall performance of the system. The transparency will be maintained within the system so that proper services can be offered towards the patients.

7.

The managers of Digi heath should note that the RTGM system currently does not work well with the android system and hence, it becomes difficult for the organization to allocate devices to the patients who does not have a Iphone. Hence, this is one of the major drawbacks of the system. The system should be able to integrate with the android devices in the release as per the planning by the organization (Hienemann et al. 2018). Hence, the managers are required to hire some android developers, along with some experts having skills for handling the database using sqlLite. Additionally, the database platforms are required to be integrated with the main cloud storage system storing all the data for the organization (Pettus and Edelman 2017). This would mean that user can have proper access to the data sets.

1.

The DFD corresponding to the Use case diagram has been provide below:

The event table corresponding to the use case diagram has been provided below:

Event	Trigger	Source	Activity	Response	Destination
View alert	Alert	System	Check the alert	Respond to alert	Doctor
Conditions	Set condition	Doctor	Alert to patient	Respond to alert	System
Patient Message	Check history	Doctor	Send Message to patient	Wait for patient	Patient
Respond to alert	Alert	Doctor	Response	Alert doctor	System
View alert	Alert	System	Check the alert	Respond to alert	Patient
Respond to alert	Alert	Patient	Response	Alert doctor	System
Doctor response	Message Alert	System	View/Hear from doctor	Send message to doctor	Patient
View History	Check online	System	View History	Check history	Patient
Annotate History	Check online	Patient	Annotate history	Store data	System
Doctor Message	Send message	Patient	Send message to doctor	Wait for doctor	Doctor
Patient response	Message Alert	System	View/Hear from patient	Send message to patient	Doctor

2.

View History:

Send Message to the doctor:

Send Message to patient:

3.

References

Chanin, R., Pompermaier, L., Sales, A. and Prikladnicki, R., 2019, May. Collaborative practices for software requirements gathering in software startups. In 2019 IEEE/ACM 12th International Workshop on Cooperative and Human Aspects of Software Engineering (CHASE) (pp. 31-32). IEEE.

Eckhardt, J., Vogelsang, A. and Fernández, D.M., 2016, May. Are" non-functional" requirements really non-functional? an investigation of non-functional requirements in practice. In Proceedings of the 38th International Conference on Software Engineering (pp. 832-842).

Edelman, S.V., Argento, N.B., Pettus, J. and Hirsch, I.B., 2018. Clinical implications of real-time and intermittently scanned continuous glucose monitoring. Diabetes Care, 41(11), pp.2265-2274.

Ghanghro, S.A., Tunio, M.H., Lal, V. and Soomro, M.R., 2018. Ontology Based Requirements Gathering Elcitation Techniques. International Journal of Computer Science & Emerging Technologies, 2(1), pp.14-18.

Gia, T.N., Ali, M., Dhaou, I.B., Rahmani, A.M., Westerlund, T., Liljeberg, P. and Tenhunen, H., 2017. IoT-based continuous glucose monitoring system: A feasibility study. Procedia Computer Science, 109, pp.327-334.

Heinemann, L., Freckmann, G., Ehrmann, D., Faber-Heinemann, G., Guerra, S., Waldenmaier, D. and Hermanns, N., 2018. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. The Lancet, 391(10128), pp.1367-1377.

Pettus, J. and Edelman, S.V., 2017. Recommendations for using real-time continuous glucose monitoring (rtCGM) data for insulin adjustments in type 1 diabetes. Journal of diabetes science and technology, 11(1), pp.138-147.

Shah, V.N., Laffel, L.M., Wadwa, R.P. and Garg, S.K., 2018. Performance of a factory-calibrated real-time continuous glucose monitoring system utilizing an automated sensor applicator. Diabetes technology & therapeutics, 20(6), pp.428-433.

Silva, P.A., 2019. The sailboat exercise as a method for user understanding and requirements gathering. Adjunct Proceedings INTERACT.

Wadwa, R.P., Laffel, L.M., Shah, V.N. and Garg, S.K., 2018. Accuracy of a factory-calibrated, real-time continuous glucose monitoring system during 10 days of use in youth and adults with diabetes. Diabetes technology & therapeutics, 20(6), pp.395-402.

Zhou, J., Zhang, S., Li, L., Wang, Y., Lu, W., Sheng, C., Li, Y., Bao, Y. and Jia, W., 2018. Performance of a new real?time continuous glucose monitoring system: A multicenter pilot study. Journal of diabetes investigation, 9(2), pp.286-293.