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DEVELOPMENT OF A FORMAL
FRAMEWORK FOR USABLE OPERATIONS
SUPPORT IN E-HEALTH BASED SYSTEMS
Ph.D FINAL DEFENSE
BY
IKHU-OMOREGBE NICHOLAS
(CU03GP0021)
DEPARTMENT OF COMPUTER AND INFORMATION SCIENCES,
COVENANT UNIVERSITY, OTA, AFRICA
EXAMINERS
 Dr.
Ayo C. K.
- Chief Examiner
 Dr. Ehikioya S. A. - Supervisor
 Dr. Ayo C.K.
- Co-Supervisor
 Prof. Katende J.
- College Examiner
 Dr. Adebiyi E. F.
- Departmental Examiner
 Prof. Sofulowe A. B - External Examiner
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CONTENTS
 INTRODUCTION
 STATEMENT
OF THE PROBLEM
 AIM/OBJECTIVES
 METHODOLOGY
 RESULTS/DISCUSSIONS
 SUMMARY AND CONCLUSION
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INTRODUCTION

Information and Technologies have been introduced
in different dimensions of health care
(Intel 2003, infoDev & Alcatel 2005).
 OSS
solution for e-Health takes advantage of the
state-of-arts information technology to address
health care enterprise-wide needs and requirements
to reduce cost, provide reliable, flexible, mobile
timely and secure health care delivery to patients by
care provider and centers.
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STATEMENT OF THE PROBLEM
 Although
the health care community is
embracing mobile technology and realizing its
benefits, mobile computing usage is still being
faced with significant number of obstacles such
as (Gregg M., 2005):
Ease
of use (usability)
Confidentiality of mobile data and
the management of newly mobile health care
workers
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STATEMENT OF THE PROBLEM

The level of an e-Health based system’s usability does
not only influence the users acceptance of the system
but may also greatly influence the diagnosis and
treatment processes in a health care centre.

The usability of OSS is vital since its issues in software
products cannot be resolved without major changes to
the software architecture [Roger P., 2005]. This thesis
provides answers to usability issues in mobile devices
for e-Health based systems.
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USABILITY OF MOBILE HEALTH
CARE DEVICES
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AIM/OBJECTIVES OF THE STUDY

Provide a formal framework for usable operations support
for e-Health based systems . (AIM)
1. Provide a formal framework for e-Health based systems
2.Provide a robust architecture which ensures that best
clinical practices are followed in a health care centre in
the administration of patient care.
3.Provide a support system that distributes patient medical
information amongst medical practitioners in a healthcare
environment across mobile devices.
4.Implement some of the functionalities in an e-Health
system to empirically validate the usability of the
operations support system in the application domain.
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METHODOLOGY- OBJECTIVE 1
 To
assure the quality, acceptability, and
usability of the system, we used OCL and the
Unified Modeling Language (OMG 2003,
CMU/SEI 2004) for the specification,
analysis, design, and verification of the
system’s functionalities.
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Introduction-Definition
 The
Encyclopedia of Software Engineering
defines Formal methods as “ A mathematical
based technique for describing system
properties”
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Definition
 Formal
Methods "refers to mathematically
rigorous techniques and tools for the
specification, design and verification of
software and hardware systems”. (Ricky W.
Butler, 2001, NASA)
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Importance of Formal Methods
 System
specification may contain contradictions,
ambiguities, incomplete statements etc.
 When
used well, a formal method should yields
specifications that have significant advantages over
natural language and variety of graphical notation.
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Importance (Cont.)
A
formally verified system can be used unto
greater reliability.
 Thus the use of formal technique helps to
achieve a high degree of confidence that a
system has conformed to its specifications
 This is particularly significant in the health
care domain
 We modeled the system as follows:
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Hospital/Clinic
-Name : char
-Idno : int
-Address : string
+AddClinic()
+DelClinic()
+UpdateClinic()
1
Patients
Medical Personnel
-StfId
-Name
-Address
-ClinicID
-Status
-Tel
+Add()
+Update()
+View()
1..1
-PatId
-Name
-Address1
-Age
-Status
-Tel
Out-patient
In-Patient
1
1
Nurse
1
Doctor
Pharmacist 1
Lab Technician 1
Specialist
Rooms
Appointments
+AddAppt()
+FindAppt()
+UpdateAppt()
+ViewDgns()
Diagnosis
Medications
Lab Test
+AddDgns()
+UpdateDgns()
+ViewDgns()
+AddMed()
+UpdateMed()
+ViewMed()
+AddTest()
+UpdateTest()
+ViewTest()
0..1
0..1
Surgery
Rights
-RoomID
-Charges
0..1
0..1
0..1
0..1
Medical Record
-PatientID
-Date
-Diagnostic Info
-Test Result
-Encounter
+viewAppt()
+ViewLab()
+ViewPatient()
+ViewMed()
+FindPatient()
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Use Cases
Patient Treatment Use Case
Retrieve patient's
info
Book appointment
Nurse
Patient
Take clinical
measurements
«uses»
Doctor
Diagnose and treat
«extends»
«extends»
Perform lab test
«extends»
Refer case
Specialist
medication
Lab Technologist
Pharmacist
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Sequence Diagram
CareGiver
Mobile Device
WAP Gateway
WebServer
Servlet Engine
Database Server
RequestInfo()
Connect through WAP
Authenticate()
Activate Servlet
ExecuteQuery()
RetrieveInfo()
WMLContent
Response Info
Send through channel
DisplayInfo()
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State Chart
Visit clinic
Appointment
Treat patient
Under treatment
Medication
Clinical measurement
(pre-treatment)
Diagnosis
H
X
Continue treatment
Suspend treatment
Lab test
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Pay bill
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Collaboration Diagram
make diagnosis()
prescribe drugs()
request treatment()
performs surgery
refer
Patient
Doctors
Specialist
request test
request test
Nurse
retrieve patient records ()
take clinical measurements()
schedule appointment()
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Pharmacist
dispense drug()
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Lab Technologist
performs test()
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Deployment Diagram
MOBILE DEVICES
-802.11b
-WIRELESS LAN
Doctor’s Point
of Access
*
*
WAP, SMS
SERVER
-TCP/IP
*
*
APACHE WEB SERVER
DBSERVER
-ODBC-JDBC
*
PATIENT DB
E-HEALTH APP.
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WAP/UML Extension
<application>
EhealthDatabases
<<deliver>
<<deck>>
PatientRecord
<<card>>
UpdatePatientPage
<<next>>
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<<previous>>
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An Overview of Object Constraints Language
(OCL)
 OCL
was developed as a modeling language
within the IBM insurance division.
 OCL
is a pure expression language, an OCL
expression is guaranteed to be without side
effects. When an OCL expression is
evaluated, it simply returns a value. It cannot
change anything in the model.
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An Overview of OCL (Cont.)
Fully type language
- Boolean, Integer, Real and String as basic
types
- Collection such as Sets, Sequences and Bags
are included
-OCL expressions can be verified
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Where to Use OCL
 To
specify invariant on classes and types in the
class model
 To describe pre and post condition on operations
and methods
 To describe Guards
 As a navigation language
 To specify constraints on operation
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Notations
All OCL statements, must take place
within a context. This might be a class or
a use case. The statement themselves can
be invariant, pre condition or post
condition
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Invariant , Pre-Condition
An invariant is a property that must remain true
throughout the life of a model element, such as
an object
A pre-condition is property that must be true
before a particular part of the system is executed.
This can be applied to operation during design
and implementation and to use cases during
analysis.
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Post-Condition , Constraints
A post condition is something that must be true
after particular part of the system is executed, if
that execution was legal
A constraint is a rule that allows you to specify
some limits on a model (Warmer and Klepper,
1999) describe it as a restriction on one or more
values of (part of) an object-oriented model
system.
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Patient
Requirements Specification: Every patient is unique
context clinic
inv:
Patient->forAll(p1,p2/p1<>p2
implies p1.pid <> p2.pid)
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Patient
Requirements Specification:
To add a new patient the patient must not exist before.
context patient::regpat(p:patient)
pre:
not patient->include (p)
post: patient->size=([email protected]>size ) +1 and
patient->include (p)
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Doctor
Requirements Specification:
Each Staff has permissible operations to perform
context medicalpersonnel inv:
Self.medicalpersonel.staffid.right->exist(p/
p.diagnose() or p.addrecords () or
p.updatepatientrecord() or p.viewmedication()
implies medicalpersonnel.asType(doctor))
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Pharmacist
Requirements Specification:
Each Staff has permissible operations to perform
context medicalpersonnel inv:
self.medicalpersonel.staffid.right->exist(p/
p.viewmedication() or p.dispense ( ) ) implies
medicalpersonnel.asType(pharamacist)
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Medication-Allergic
Requirements Specification:
The systems keep track of drugs a patient is allergic to:
context medication::AllergicAdd(d:drug)
pre:
not allergic ->include (d)
post:
allergic ->include (d )
and allergic ->size =([email protected] ) + 1
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Administrator
Requirements Specification:
Each Staff has permissible operations to perform
context medicalrecords inv:
self.medicalpersonel.staffid.right->exist (p/p.create( )
or p.delete()) implies
medicalpersonnel.asType(administrator)
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Appointment
Requirements Specification:
No two patients will be directed to the same doctor at the same
time on the same day.
context Appointment inv:
not(Self.appointment->
exist(x,y/(x.doctor=y.doctor) and
(x.time=y.time) and (x.date=y.date))
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Appointment
Requirements Specification:
A request for an appointment to see a doctor must not be for a date
earlier that the date of registration of patient at the clinic.
context appointment inv:
Self.dateofrequest.after(registrationdate)
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Booking Appointment
context Appointment::addapt (patId, stafid, startTime,
endTime, date)
pre:
startTime <endTime
post:
duration=endTime – startTime >0
startTime = preStart + duration
prevEnd = startTime
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The User
Requirements Specification:
The password and username of every user of the system
must be unique.
context registeredUsers inv :
not(self.users->exists(a,b/a.username=
b.username ) and (a.password =b.password))
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OCL CHECKER
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ACCOMPLISHING OBJECTIVE 2
Provide a robust architecture which ensures
that best clinical practices are followed in a
health care centre in the administration of
patient care.
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SOFTWARE ARCHITECTURE
Security and Authentication
Support Service
Presentation Layer
Cell Phone
Smart Phone
Documentation Support
Service
View and Report Service
USERS INTERFACE
Web Server
WAP Gateway
Apache Server
SMS, MMS Server
Middleware
Data Access and Update
Support Service
Pharmacy and Billing Support
Service
Diagnostic Support Service
Laboratory Test Support Service
Patient Medical Record
Support Service
CARE SUPPORT SERVICES
Data Layer
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Logon DB
Lab. Test DB
Medication DB
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Patient DB
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SOFTWARE ARCHITECTURE
A
3-tiered C/S architecture consisting of client interface,
middle-tier, and database repository
 Components of the client =SASS, DSS, VRS
 Server-side processing carter for resources constraints
 Middle-tier contains most of the application logic and
translate client request into database queries =DAUSS,
PMRSS, DSS, PBSS, LTSS
 The data layer is responsible for the storage, retrieval,
maintenance and integrity of data
 Communication between the application server and
database is performed by the JDBC-ODBC bridge
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HARDWARE ARCHITECTURE
SmartPhone
Terminal
Firewall
E-Health Database
Server
Firewall
AP
Web server
E-Health Server
Laptop
Database
PDA
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A Medical Diagnostic
Device
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HARDWARE ARCHITECTURE
 Consist
of complete range of robust high
performance clients and servers
 Clients system include, PDAs, Cell Phones, other
hand-held medical devices
 The servers are used to maintain connectivity to
enterprise resources
 Servers provide, real-time access to point of care
data base
 Firewalls are set to filter all network traffic moving
in an out the e-Health system
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ACCOMPLISHING OBJECTIVE 3
Provide a support system that distributes
patient medical information amongst medical
practitioners in a healthcare environment
across mobile devices.
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PATIENT’S SUPORT
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WELCOME PAGE
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ADMINISTRATOR’S SUPPORT
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PHARMACIST’S SUPPORT SERVICE
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DOCTOR’S SUPPORT SERVICE
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MS ACCESS DATABASE
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ACCOMPLISHING OBJECTIVE 4:
Implement some of the functionalities in an
e-Health system to empirically validate the
usability of the operations support system in
the application domain.
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DISCUSSIONS/RESULTS
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USABILITY MEASUREMENT
 ISO
( 9241) Definition
 The “extent to which a product can be used
by specified users to achieve specified goals
with effectiveness, efficiency and satisfaction
in a specified context of use”
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USABILITY MEASUREMENT



Users – Medical Practitioners
- Doctors
- Nurses
- Lab Technologist
- Pharmacist
- IT Professional
- Patient ( Students + Others )
- Goal – Improve Health Care Delivery
- Context – Clinic (Health Care Setting)
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USABILITY ATTRIBUTES
 Effectiveness:
-The accuracy and completeness with which
specified users can achieve specified goals in
particular environment
 Efficiency:
The resources expended in relation to the
accuracy and completeness of goals achieved
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USABILITY ATTRIBUTES
 Satisfaction:
The “freedom of discomfort, and positive
attitude to the use of the product” The
comfort and acceptability of the work system
to its users and other people affected by its
use
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Usability Framework
 We
used the following seven metrics to represent
the usability dimensions of the application.
Completion
Time
Easy to Learn
Effective Support
Error Recovery
Comfortable
Easy to Use
Satisfaction
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USABILITY EVALUATION
 Data
-
-
Collection Technique –
Questionnaires were administered to users
after interacting with the system
150 Responses were received and analyzed
The response format used a five-point,
Likert-type scale
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DATA ANALYSIS
 Usability
studies suggest that system with
“good usability” typically have a mean rating
of 4 on a 1-5 scale rating and 5.6 on a 1-7
scale (Jeff Sauro et al, 2005)
 The
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mean rating as follows:
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Values of Usability Attributes
 Completion
Time = 4.52
 Easy to Learn = 4.53
 Effective Support = 4.31
 Error Recovery 4.55
 Comfortable = 4.59
 Easy to Use = 4.60
 Satisfaction = 4.39
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COMPARATIVE USABILITY
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Usability Test Graph
4.8
4.7
4.6
4.5
4.4
Medical Professional
IT Professsional
Patients
4.3
4.2
4.1
4
3.9
Completion
Time
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Easy to Learn
Effective
Support
Error Recovery Comfortability
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Easy to Use
Satisfaction
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SUMMARY
By this thesis we have been able to:
 Practically demonstrate the feasibility of using
mobile devices such as mobile phones and
PDAs in enhancing the effectiveness of
health care professionals in the delivery of
services to patients
 Identify the various support services in an eHealth based systems which conform to the
treatment process followed by medical
professionals in delivery health care delivery.
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SUMMARY
 Further
more, the support services were
adequately depicted in a robust software and
hardware architecture for easy
implementation.
Used Wireless Mark-up Language, Java server
pages and other tools to provide the required
functionalities for the system, while ensuring
that the application is usable and deployable
across various platforms.
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SUMMARY
 Move
from informal specifications to formal
specifications, thus ensuring that ambiguities
and incorrectness in specification were
tactically handled to guarantee a dependable
system adjudge as usable by the end users.
 Provide a framework for measuring the
usability of mobile heath care application by
adapting the usability attributes specified by
ITU, ISO and ANSI into a seven metrics
questionnaire based measurement.
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SUMMARY
 Finally
though, mobile health care application
are still at it very early stage of
implementation and adoption in Nigeria, the
work provide a good specification document
that will aid software developers in realizing
suitable applications in this domain.
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CONCLUSION
 In
this thesis, we were able to demonstrate
the practicability of deploying usable
operation support services for care givers and
other users in health care sector for the
purpose of effective and productive health
care delivery in care centres.
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CONCLUSION
 The
support services implemented were
formally analyzed and designed to eliminate
ambiguities and incorrectness in the product.
The application was measured with the
usability dimensions suggested by ISO /
ANSI / ITU and extended to satisfy to meet
the context in a clinic setting and found to
have a “good usability” by the potential users
of the final product.
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CONCLUSION
 Finally,
the adoption of the product of this
research in care centres offers a good
contribution for countries to meet the
millennium development goals centred on
health care by providing an effective IT-based
support for care givers.
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PUBLICATIONS
[1] Ikhu-Omoregbe N. A., Ehikioya S.A. and Ayo C. K., “Modelling,
Design, and Deployment of Mobile Health Care Application”
International Journal of Computer Sciences and its Application.
(To Appear).
[2] Ikhu-Omoregbe N. A., Ehikioya S.A. and Ayo C. K., “A Formal
Framework for Deployable Mobile HealthCare Applications”,
MEDNET, 11th World Congress on Internet in Medicine, Canada,
October, 2006. Available at: {www.mednetcongresss.com}
[3] N.A Ikhu-Omoregbe, C. K. Ayo, S.A. Ehikioya, “A Deployable
Framework for Mobile Telemedicine Applications”, Medical and Care
Compunetics 3, L. Bos et al (Eds.), IOS Press, The Netherlands, 2006,
pp. 36-41. Available at:
www.booksonline.iospress.nl/Contents/SSSH2Book/Article.aspx?
[4] Ikhu-Omoregbe, N.A, Atayero A.A., Ayo, C.K, Olugbara, O.O.,
“Design and Deployment of Hybrid Telemedicine Applications”, SPIE
conference proceedings, Internet Imaging VI, San Jose, U.S.A., 2005, pp
191-196. Available at
:www.imaging.org/store/physpub.cfm?seriesid=24&pubid=700
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PUBLICATION/AWARD
[5] Ikhu-Omoregbe N. A., Ehikioya S.A. and Ayo C. K., “Implementing
Operations Support Systems in E-Health Based Systems, Proceedings of
The International Conference & Workshop on 3G GSM & Mobile
Computing: An Emerging Growth Engine for National Development,
Covenant University, Nigeria, 29-31 January, 2007, pp. 191-198

Microsoft Research Inspire Programme–PhD Proposal Award
2006 (One of six recipients in the world)
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APPRECIATION
 God
– Gift of Life
 Supervisors
 Examiners
 External Examiner
 University Management and All Staff
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THANK YOU FOR
LISTENING
&
GOD BLESS YOU
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