Early Psychosis Intervention: A Culturally Adaptive Clinical Guide

32. Database Design and Management

Healthcare is one of the most information-intensive and information-demanding industries. Healthcare workers, including doctors, nurses, and other allied health workers, require large amounts of information about their clients in order to make clinical decisions and select appropriate care for clients. At the same time, healthcare planners need comprehensive service data to evaluate existing services and to implement new service strategies. The application of information technology to healthcare industries is therefore an essential element to ensure that timely and up-to-date client information is maintained and accessible when necessary. Information Needs for Daily Operation of Early Psychosis Intervention In Hong Kong’s Early Assessment Service for Young People with Psychosis (EASY), case managers of each team handle copious phone enquires and referrals from different sources every day. They conduct first-stage assessments and arrange clinical assessments for potential clients if needed. Hence, a system is necessary to keep track of the phone enquires and referrals they handle. Case managers need to maintain regular contact with existing clients and their caregivers in order to provide appropriate psychosocial intervention and psychoeducation . Therefore, they need to keep a complete register of their clients, which includes basic demographic and essential clinical information. At the same time, different clinical and service data need to be collected via various clinical measuring scales at different intervals of the treatment programme. Moreover, as educational talks are conducted in schools and the community on a regular basis to promote public awareness of the illness, each team needs to 32 Database Design and Management Kin-sheung Wong 360 Kin-sheung Wong submit various statistical reports to head office regularly so that the convener can monitor progress and effectiveness of services. System Analysis User requirements A computerized system to manage the information processing of EASY is in place to meet the following needs: 1. Keep a complete and comprehensive register of clients in the service. 2. Keep a complete record of the number of phone calls received. 3. Keep a complete record of educational talks conducted. 4. Collect service-related data, such as number of relapses, admissions, and suicidal attempts. 5. Generate statistical reports on a regular basis. Existing information infrastructure Nowadays, most of the healthcare authorities in modern countries have already taken advantage of computerized systems to enhance efficiency and effectiveness of services. Major service providers may have their own enterprise -wide information systems, for example the Clinical Management System (CMS) in Hong Kong, to manage key healthcare information. Ideally, such information systems are multifunctional so as to support daily operations in hospitals and clinics. System Design System architecture The EASY system is composed of individual databases and a master database. Each team has its own local database in the site office, which only stores that team’s client information. The data from individual databases is incorporated into the master database located in the head office. A designated worker visits different site offices to collect up-to-date client information and synchronize it with the master database when he/she returns to the head office. The advantages of such an approach are: Database Design and Management 361 • Each team is only able to access the information of its own clients (but not other teams’ clients), enhancing privacy and confidentiality of clients’ information. • The size of individual databases is relatively small, making it easier to maintain. • Individual system failure will not affect the integrity of the master database at head office. • Likewise, the master database can easily be rebuilt by integrating the four individual databases in case of system failure at head office. Table Design A set of core data is identified and defined, and the resulting dataset is finalized and normalized into different tables in the database accordingly. The tables could be grouped into four categories as below and in Figure 32.1: 1. Client demographic data • Client table: stores basic demographic data of clients (e.g., name, sex, date of birth, address) • Contact table: stores clients’ contact information 2. Client clinical data • Engagement table: stores the engagement works done with clients • Intervention table: stores the intervention done with clients • Clinical psychologist intervention table: stores information about intervention by clinical psychologists with clients • Medication table: stores the details of medications prescribed for clients • Admission table: stores the admission information of clients • Relapse table: stores the relapse information of clients • Suicide table: stores the suicide information of clients • Violence table: stores the violence records of clients • Works...