User guide

Before you start

Sign in with the account created when the system was installed. The default is admin with the password 123456, and you should change it on day one.

The menu is grouped by what you are doing rather than by which table the data sits in.

Clinical work is at the top of the menu, money in the middle, administration at the bottom. You only see the entries your role is allowed to open, so a receptionist's menu is shorter than an administrator's.

Load the demonstration data

An empty system is hard to judge. If you are evaluating ICTHospital, load a small set of believable records first:

php artisan db:seed --class=DemoDataSeeder

That gives you four departments, four doctors, five patients, a ward with someone in it, a part reported lab request and an invoice that is half paid. It is safe to run twice and it never overwrites anything, but keep it off a live system.

The dashboard

Counts across the top, money in the middle, recent patients underneath.

Nothing here is stored as a running total. Every figure is worked out when you open the page, so it cannot drift away from the records it is counting.

Patients

The front desk starts here. Admissions, prescriptions, lab requests and invoices all hang off a patient record, so this is the first thing you will create.

One search box covers name, patient ID, phone and email.

One box rather than a filter per column, because the person on the phone gives you whatever they can remember.

Only the name is required.

Someone walking in at two in the morning with no paperwork still has to be registerable, and a form that refuses that record just gets worked around with junk data.

Two things worth knowing. Age is worked out from the date of birth rather than typed, so it cannot go stale the way it did in the system this replaces. And the patient ID comes from the highest one already issued, so deleting a record never hands the next patient a number somebody else is using.

Medical history

Allergies, past operations, chronic conditions, with a scan attached where you have one.

This is the first thing worth reading before a consultation, so it has a screen of its own rather than being buried in the patient record.

The patient's name, address and phone are copied onto each entry when you write it. That looks like duplication and it is deliberate: a note written two years ago should still read correctly after the patient moves house.

Doctors and departments

Every clinical screen picks a doctor from this list.

Add at least one doctor before you try to book anything. The list shows how many upcoming appointments each one has, which answers the question you actually have when you are looking at it.

A doctor with appointments on file cannot be deleted. The appointment record points at the doctor by id, so removing them would leave every past appointment pointing at nothing.

Renaming a department moves every doctor in it to the new name.

If you are upgrading from an older install, the departments your doctors already use show up as unlisted, and one button adopts them onto the list.

Staff

Nurses, pharmacists, laboratory staff, receptionists and accountants share one screen.

They share a screen because they share a shape: a name, contact details and a photo. Nurses have their own permission, so you can let ward staff manage the nursing list without handing them the accounts list.

Appointments

A day view, filtered by doctor and by status.

The system will not let you double book a doctor, but it will let you book back to back, because that is how a clinic actually runs. Cancelling or marking a no-show frees the slot again straight away.

If two clerks try for the same slot at the same moment, one gets it and the other is told. That is a database lock rather than a polite check, so it holds under real pressure.

Beds and admissions

A bed is free when no admission points at it with an open discharge time.

There is a status column on the bed record and it is kept in step, but the admission is the truth. In the system this replaced, a clerk set both by hand and they drifted apart within weeks.

Two rules the old system never enforced: one patient per bed, one bed per patient.

Prescriptions and medicines

Each drug on a prescription is its own row.

That is what makes "which patients are on this drug" a question you can answer, and it was the main reason the database schema changed during the rebuild.

You can still prescribe something that is not in the catalogue.

A doctor should not be blocked because the pharmacy has not added a line yet.

Laboratory

Each test carries its own result and status, so a request can be part reported.

The bloods come back, the culture is still growing, and the screen shows exactly that instead of pretending the whole request is either done or not.

Fill in the reference range. It is copied onto the test when it is requested.

That way a result from last year is still readable against the range that applied when it was measured.

Pharmacy

Stock comes out of the catalogue in the same transaction as the sale.

The quantity on the shelf follows what was actually handed over. A sale that fails leaves the stock untouched, reversing a sale puts it back, and two people dispensing the last few units at the same time cannot both succeed.

Invoices and prices

Invoice lines are raised against this list, so fill it in before you bill anyone.

The price here is the current one. It is copied onto the invoice line when the charge is raised, so putting a price up next month does not rewrite what somebody was billed last month.

Payments are rows, so a deposit now and the balance later is something the system can express.

Whether an invoice is unpaid, part paid or settled is worked out from those payments. Nobody types it, so it cannot be wrong. You cannot overpay an invoice, and a refused payment is not recorded at all.

Reports

Four questions a hospital asks most weeks.

Tests requested and not yet reported, oldest first, with anything past three days marked.

What was prescribed next to what was actually dispensed.

The gap between the two columns is the part worth reading. A drug prescribed and never dispensed here is usually a stock problem, or a script being filled somewhere else.

Who owes what, aged into the usual buckets.

The age comes from the patient's oldest unsettled invoice rather than their most recent one, so a long standing balance does not look fresh just because something new was added to it.

Occupancy per day, the busiest day, discharges and average length of stay.

Users and permissions

Accounts and the role each one belongs to.

Ninety permissions across Admin, Doctor, Nurse and Accountant.

Admin is granted everything when the system is installed. Everyone else starts with nothing and is given what they need on this grid. The menu hides what a role cannot open, so nobody is offered a link that bounces them.

php artisan hospital:sync-permissions

Payment gateways

Credentials are stored ready for the online payment work still to come.

Credentials are write only. They are never shown back to you, because a settings page that prints an API password puts it in every browser cache and every screenshot. Leave a field blank when you are editing and whatever is stored stays.

Questions people ask