VCS: AN OPEN SOURCE WEB-BASED VACCINATION

MANAGEMENT INFORMATION SYSTEM

Carlos Theobaldo Renck, Leandro Sorgetz, Francisco Assis Moreira do Nascimento

Faculdades de Taquara- FACCAT

R. Oscar Martins Rangel, 4500, Taquara, Brazil

Keywords: Information systems, Vaccination control, Web applications, Health management systems, Open source.

Abstract: This work presents VCS (Vaccination Control System), a Web based application implemented using the

PHP script language, the PostgresSQL DBMS and the Apache web server under a GNU/Linux platform.

VCS is a management information system tool for the vaccination process control, which was modelled and

designed towards the necessities of the Brazilian public health system. The current version of VCS includes

the management of vaccines, patients, mass immunization campaigns, access control to the recorded

information, record of immunizations and history of immunizations per individual, and many statistical

reports. An important social benefit provided by VCS is the improvement in the strategic planning for the

public vaccination system, which results in a better assistance to the population in general and resources

savings by governments with the reduction of vaccine lost.

1 INTRODUCTION

Nowdays there are many health management

information systems commercially available (STC,

2006) (HCS, 2006). However most of these tools

provide no modules to manage and control the

vaccination process tasks. Moreover most of the

available tools are not implemented as Web

applications.

In the Brazilian Unified Health System (SUS -

Sistema Único de Saúde) the vaccination process

control is based on printed cards, which are

manually updated, and only the distribution control

of the vaccine is automatized. So to make the SUS

more efficient it is very important to implement a

vaccination control information system.

This work presents VCS (Vaccination Control

System), a Web based application implemented

using the PHP (PHP, 2006) (Gutmans, 2005) script

language, the PostgresSQL DBMS (Postgres, 2006)

and the Apache web server under a GNU/Linux

(GNU, 2006) platform. VCS is proposed as a

solution to the vaccination control process in the

scope of the Brazilian SUS.

As already mentioned the current vaccination

control process is based on printed cards that are

manually updated. Since many cards are lost and

there is no standard format for the information on

these cards, it is almost impossible to produce

statistical reports about the immunization status of

the population as well as to manage and control

efficiently the vaccination process.

One of the consequences of this situation is the lack

of precise data, which could be used to obtain a

precise profile of the individuals and to map the

immunization status of the population in order to

identify the critical geographical areas and possible

expansion of specific diseases due to failures on the

vaccination system.

In the next section, it is presented a comparison of

health information systems oriented to the

vaccination control process. The section 3 describes

the analysis, design and implementation phases of

the software engineering process applied in the

development of our VCS tool. In the section 4 the

social benefits to the population and the

improvements in the public health system are

discussed. The section 5 presents some future

directions for the present work and the section 6

makes some conclusions.

242

Theobaldo Renck C., Sorgetz L. and Assis Moreira do Nascimento F. (2007).

VCS: AN OPEN SOURCE WEB-BASED VACCINATION MANAGEMENT INFORMATION SYSTEM.

In Proceedings of the Third International Conference on Web Information Systems and Technologies - Society, e-Business and e-Government /

e-Learning, pages 242-246

DOI: 10.5220/0001283002420246

 SciTePress

2 RELATED WORKS

One of the commercially available vaccination

control systems is IMS (STC, 2006), a Web based

application developed by Scientific Technologies

Co. Currently the IMS is adopted by the government

of many states in USA, including Arizona,

Washington, and Idaho. IMS has some modules to

manage mass immunization, remote vaccination

registry, patient records, etc. Since IMS is not an

open source application it would be difficult to adapt

it to the Brazilian reality. For instance, IMS has no

support to internationalization and so it can not

provide support to the Brazilian Portuguese

language. Moreover, IMS has a very high

acquisition cost, which is not acceptable to the

Brazilian health system.

In the seventies, the Brazilian public health system

already started the use of a national immunization

program (PNI – Programa Nacional de Imunização

(Datasus, 2006). Only in the nineties, it was

developed an Information System for the PNI (SI-

PNI – Sistema de Informação do PNI). One of the

many sub-systems in the SI-PNI is the Evaluation of

the PNI (API – Avaliação do PNI), which is able to

record the quantity of applied vaccines on each

group of individuals, distributed according to their

age, and to calculate the immunization coverage per

basic unit (health care facilities). Thus there is no

possibility of control per each individual or some

kind of more precise control.

No open source tool was found that could be able to

manage and control the tasks in the immunization

process. This is one of the motivations to develop a

new open source web based application oriented to

the immunization process control.

3 VACCINATION CONTROL

SYSTEM - VCS

VCS is an information system tool for the

vaccination process control, which was modelled

and designed towards the necessities of the Brazilian

public health system. The current version of VCS

includes the management of vaccines, patients, mass

immunization campaigns, access control to the

recorded information, record of immunizations and

history of immunizations per individual, and many

statistical reports.

The VCS development was completely based on

methods and techniques from object oriented

software engineering (Pressmann, 1995), including

analysis, design, implementation, tests and

deployment phases and the use of UML (Unified

Modelling Language (Scott, 2003) and design

patterns oriented to web applications (for instance,

the Model/View/Controller design pattern) (Gamma,

2000).

Since the main objective of VCS was to give support

to as many individuals as possible and to be

available to all primary healthcare facilities, it was

adopted only open source and free technologies and

tools.

The VCS was developed on a GNU/Linux platform

using the PHP script language on an Apache web

server and a PostgresSQL DBMS. Thus, VCS can be

adopted according to the originally proposed goals

as well as to other future necessities. I can be easily

adapted to other realities, since its source code is

freely available and well documented.

3.1 Analysis

In the analysis process it was used UML in order to

produce a standard documentation for the future

VCS developers.

The analysis process started with a study of the

activities related to the Brazilian public

immunization system and the identification of the

system requisites. Several interviews with health

specialists were conducted in order to collect data,

identify existing problems and determine how a

management information system could help to solve

the problems.

Based on the obtained information, use case

diagrams were modelled using the Poseidon for

UML Community Edition (Gentleware, 2006),

where are represented the expected functionalities

and the interaction of the users with the system,

among another aspects. Based on the use case

diagrams and all collected information, class

diagrams were modelled using UML to capture the

concepts and structure of the information system.

The figure 1 shows part of the main class diagram.

VCS: AN OPEN SOURCE WEB-BASED VACCINATION MANAGEMENT INFORMATION SYSTEM

243

Figure 1: Part of the main class diagram.

As shown in the figure 1, there are two kinds of

person (pessoa class): “user” (usuario class),

responsible for the vaccination (vacina class), and

“patient” (paciente class). Then, at this point,

sequence diagrams were modelled to represent the

main behaviours of the information system.

An OO-ER mapping (Object Oriented to Entity-

Relationship mapping) was performed, the

DBDesigner tool (Fabforce, 2006) was used to edit

the obtained ER model and to generate the SQL

scripts for the database and tables creation. In the

figure 2 it is shown the ER diagram edited in the

DBDesigner4.

Figure 2: Part of the main E-R diagram.

As illustrated by the figure 2, for most of the class

diagrams, the OO mapping was one-to-one.

3.2 Design

In the design phase, the modules of the system were

defined. The first one, patient module, allows to

record personal information of each individual,

including address, phone, email, etc. This module

also provides the history of vaccinations of the

patient, which can be viewed and updated via Web.

Another module, vaccine module, provides the

registry for the different kinds of existing vaccines.

For each kind of vaccine specific information is

recorded by the vaccine module, which also

provides the vaccination history of each patient in

the system. In the vaccination history is included all

vaccines taken by a given patient, as illustrated in

the figure 3.

Figure 3: Patient's vaccination history.

As illustrated in the figure 3, the vaccination history

of a patient includes the already applied vaccines

and the vaccines yet to be applied, according to the

patient’s birthday. The vaccination history is the

start point to the application of the vaccines on a

patient.

In the design phase, user and permission modules

were also defined. These modules allow managing

the accesses to the system functionalities by the

users. A user can only access the functions enabled

for the group of the user. For instance, it is possible

to define specific permissions for users that only are

enabled to apply vaccines, for others which can

manage the personal information of patients, etc.

This is illustrated by the figure 4.

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Figure 4: User permissions control.

Another designed module is the campaign module,

which allows the definition of mass immunization

activities. This module can send messages to inform

the patients about the next applicable vaccination.

3.3 Implementation

For the VCS implementation, the database was

created by the SQL script, which was automatically

generated by the E-R modelling tool DBDesigner.

The dynamic web pages were codified using the

PHP scripting language conforming to the

Movel/View/Controller design pattern. The view

part of the system was implemented using the

Smarty framework (Smarty, 2006), which includes a

template language, and CSS style sheets.

In the collaborative development work was adopted

the control version system SVN (Subversion, 2006)

as source code repository and the Eclipse platform

(Eclipse, 2006) as IDE tool, including plugins for

the PHP language and for the access to the SVN

repository.

4 SOCIAL BENEFITS

One of the VCS goals is to contribute to the

improvement of the Brazilian public health system.

Thus, it is important to describe the social benefits

that VCS can provide. In the next sections, some

main social benefits due to the VCS features will be

pointed out.

4.1 Better Assistance

One of the more important social benefits provided

by VCS is a better assistance to the population in

general. This improvement is due to the fact that the

information system allows a more personalized and

faster assistance, since there is no need to manually

search for printed cards. The wasted time in the

current situation is one of the main problems of the

Brazilian public health system.

4.2 Improvement in the Strategic

Planning of the Public Vaccination

System

Another important social benefit provided by a

information system based on the Web is the

improvement in the strategic planning for the public

vaccination system. Currently, the SI-PNI has no

individual control for patients. The control is based

only on groups of individuals, according to some

criteria as age or sex. Personal data of patients are

recorded manually on printed cards at each primary

health care facility.

Using VCS, which is a web based application

accessing a unique database, the public vaccination

system obtain an unified, secure, consistent and

precise source of information about the

immunization status of the population in general.

Applying some filters and data mining techniques, it

is possible to obtain precious information and

patterns that can be very useful for the public helath

system planning.

By means of simple queries to the VCS database, it

is possible to identify, for example, the geographical

regions with lesser or greater engagement to mass

immunization campaigns, or to identify the necessity

of implementation of regional or specific mass

immunization campaigns. This example is just one

illustration of how the use of data mining techniques

on the VCS database can help significantly in the

strategic planning of the public health system.

4.3 Better Rendering of Accounts

With precise information and control, not merely

based on estimates, the rendering of accounts on the

public resources by the governments can be more

efficient and transparent. This makes difficult the

improper use of these resources.

All information in the VCS can be made available

on the Web in the form of reports about cities,

regions, states, or nationwide.

VCS: AN OPEN SOURCE WEB-BASED VACCINATION MANAGEMENT INFORMATION SYSTEM

245

4.4 Reduction of Vaccine Lost

Another benefit provided by VCS is the reduction of

the vaccine lost, which results in the public resource

savings. Currently it is not possible to determine

with a good precision how many vaccines will be

necessary for a certain period of time at each

primary health care facility due to the manual

control of the patient information. With VCS this

estimates can be easily performed based on simple

queries on the VCS database. It is also possible to

perform comparisons between vaccinations that

were applied on geographically near health care

facilities and to send the excess of vaccines to the

places where the demand yet exists.

5 FUTURE WORK

One of the services to be implemented is the export

of data in a format compatible with the systems of

the SI-PNI. This will allow the integration of the

systems and the sharing of information between

them. In order to adopt worldwide accepted

standard, VCS will incorporate the Health Level

Seven (HL7, 2006) (Health Level standard in future

versions.

Another future work is the exploration of data

mining techniques to produce reports that will help

in the strategic planning for the public health system.

6 CONCLUSIONS

The VCS is one of the open source tools developed

by the Nidus Project team. The Nidus Project is

supported by FACCAT (Faculdades de Taquara), a

small university of the Rio Grande do Sul State in

the South of Brazil, and is oriented to the

development of free and open source techniques and

technologies to improve the social and economics

aspects of the region.

In the present paper it was presented some problems

of the current reality of the Brazilian public

vaccination system and described the VCS, a Web

based application which copes with some of these

problems. VCS is an open source tool based

exclusively on free technologies with a very low

cost of ownership and easily adaptable to other

realities on other countries, since the VCS source

code is freely available and well documented.

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