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Online Appointment System

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SAMIHA TABASSUM HAQUE (TP034305) 1
ONLINE PATIENT SCHEDULING SYSTEM
Acknowledge
My sincere gratitude to my Supervisor Mr. ...
SAMIHA TABASSUM HAQUE (TP034305) 2
ONLINE PATIENT SCHEDULING SYSTEM
Table of Contents
Acknowledge ...........................
SAMIHA TABASSUM HAQUE (TP034305) 3
ONLINE PATIENT SCHEDULING SYSTEM
Chapter 4: System Architecture
4.1 Introduction..........
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Enhancing patient care management is one of the aims of healthcare industry to improve the healthcare system worldwide. This goal is to be equally if not more important as the other keys of improving the heath of the population and managing per capita cost of care. (Berwick et al, 2008) As the population continues to grow, so too does the need for healthcare services and options. (The Benefits Of Online Appointment Scheduling. 1st ed) Patient Scheduling System is an important component of scheduling and managing appointments. Especially online scheduling software has simplified and automated the process of hospital management for all-size organizations.
The proposed system advances with online facilities that eliminate the chaos of traditional appointment services. This system offers online appointment booking, to view doctors list, to cancel and update appointments with an administrative portal to manage all the sections. It provides advanced functionality to streamline the process thus easy access to personal hospital services that help organizations to stay connected with their customers, clients, students and most importantly patients and can result in significant time and monetary savings.
Aim:
The aim of patient scheduling service is to provide patients full access to manage their hospital appointments which, facilitates with an online service for appointment reservation, updating and canceling management minimizing customer inconvenience and assuring a better healthcare.

Enhancing patient care management is one of the aims of healthcare industry to improve the healthcare system worldwide. This goal is to be equally if not more important as the other keys of improving the heath of the population and managing per capita cost of care. (Berwick et al, 2008) As the population continues to grow, so too does the need for healthcare services and options. (The Benefits Of Online Appointment Scheduling. 1st ed) Patient Scheduling System is an important component of scheduling and managing appointments. Especially online scheduling software has simplified and automated the process of hospital management for all-size organizations.
The proposed system advances with online facilities that eliminate the chaos of traditional appointment services. This system offers online appointment booking, to view doctors list, to cancel and update appointments with an administrative portal to manage all the sections. It provides advanced functionality to streamline the process thus easy access to personal hospital services that help organizations to stay connected with their customers, clients, students and most importantly patients and can result in significant time and monetary savings.
Aim:
The aim of patient scheduling service is to provide patients full access to manage their hospital appointments which, facilitates with an online service for appointment reservation, updating and canceling management minimizing customer inconvenience and assuring a better healthcare.

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Online Appointment System

  1. 1. SAMIHA TABASSUM HAQUE (TP034305) 1 ONLINE PATIENT SCHEDULING SYSTEM Acknowledge My sincere gratitude to my Supervisor Mr. Debashish Das for guiding me throughout the planning and development phase of the system. Without his strategic guideline and counselling I would not have reached the final stage of the development. I would like to thank Mr. Dhason for briefing the student regarding the Final Year Project. Mr. Dhason’s sincere guidance and always cooperating nature has provided us with proper knowledge and directions on how to prepare for the final documentation. I would like to thank my close peers and my classmates for being supportive and encouraging throughout my three-year journey here in Asia Pacific University. My sincere gratitude goes to Asia Pacific University for providing the platform where I was able to cherish and nurture my compassion and improve my technical skills. Much appreciation to APU for great support and all necessary academic materials that has taught me great helpful academic as well as life lessons. Finally, yet importantly, I would like to thank my family. Their endless support has been unconditional. Their hopes and faith on me had me keep going even when days were challenging.
  2. 2. SAMIHA TABASSUM HAQUE (TP034305) 2 ONLINE PATIENT SCHEDULING SYSTEM Table of Contents Acknowledge .................................................................................................................................. 1 Chapter 1: Introduction to the Study 1.1 Background to the Project....................................................................................................... 11  1.2 Problem Context ..................................................................................................................... 12  1.3 Rationale ................................................................................................................................. 14  1.4 Potential Benefits.................................................................................................................... 14  1.4.1 Tangible benefits ............................................................................................................................ 14  1.4.2 Intangible benefits ......................................................................................................................... 15  1.5 Target Users............................................................................................................................ 15  1.6 Scope and Objectives.............................................................................................................. 15  1.6.1 Aims................................................................................................................................................ 16  1.6.2 Objectives....................................................................................................................................... 16  1.7 Deliverables –Functionality of the proposed system.............................................................. 16  1.8 Nature of Challenges............................................................................................................... 17  1.9 Overview of this report and Project Plan................................................................................ 17 Chapter 2: Literature Review 2.1 Introduction............................................................................................................................. 18  2.2. Domain Research:.................................................................................................................. 19  2.3 Technical Research:................................................................................................................ 23  2.3.1 Similar Systems: ............................................................................................................................. 24  2.3.2 Architecture of Similar Systems ..................................................................................................... 28  2.4 Conclusion .............................................................................................................................. 33 Chapter 3: Development Methodology 3.1 Identification of Chosen Methodology: Agile........................................................................ 34  3.2 Justification to Agile Approach .............................................................................................. 34  3.3 Description of the System Development Methodology:......................................................... 35  3.3.1 Agile Manifesto .............................................................................................................................. 36  3.4 Agile Methodologies............................................................................................................... 38  3.4.1 Scrum Approach for Online Patient Scheduling ............................................................................. 38  3.5 Scrum Implementation:........................................................................................................... 40  3.6 Conclusion: ............................................................................................................................. 42
  3. 3. SAMIHA TABASSUM HAQUE (TP034305) 3 ONLINE PATIENT SCHEDULING SYSTEM Chapter 4: System Architecture 4.1 Introduction............................................................................................................................. 43  4.2 Abstract Architecture.............................................................................................................. 44  4.3  System Design ................................................................................................................... 45  4.3.1  Use Case Diagram: .................................................................................................................. 45  4.3.2  Use Case Specification ............................................................................................................ 49  4.3.3  Class Diagram .......................................................................................................................... 52  4.3.4  Activity Diagram ...................................................................................................................... 54  4.3.5  Sequence Diagram .................................................................................................................. 54  4.3.6  Entity Relation Diagram .......................................................................................................... 59  4.3.7  Database Table Structure ........................................................................................................ 60  4.4  User Interface..................................................................................................................... 64  4.5  System Development ......................................................................................................... 68  4.5.1 Programming Language: ................................................................................................................ 68  4.5.2 IDE: ................................................................................................................................................. 69  4.5.3 Database Management System: .................................................................................................... 69  4.5.4 Operating System: .......................................................................................................................... 71  4.5.5 Web Server:.................................................................................................................................... 71  4.5.6 Web Browser: ................................................................................................................................ 71  4.5.7 AES Encryption for Security Code: ................................................................................................. 72  4.5.7.1 Justification to AES Encryption ............................................................................................... 73  Chapter 5: Requirement Validation 5.1 Introduction............................................................................................................................. 75  5.1.1 Questionnaires ............................................................................................................................... 75  5.1.2 Interview ........................................................................................................................................ 77  5.2 Analysis of Data collection through Questionnaire:............................................................... 77  5.2.1 Analysis of the Data gathered through Questionnaire: ................................................................. 85  5.3 Conclusion: ........................................................................................................................................ 86  5.4 Analysis of Data through Interviews: ..................................................................................... 86  5.4.1 Conclusion from the Data collected through Interview: ............................................................... 90  Chapter 6: Implementation 6.1 Screenshots ............................................................................................................................. 91 
  4. 4. SAMIHA TABASSUM HAQUE (TP034305) 4 ONLINE PATIENT SCHEDULING SYSTEM 6.1.1 Home page ..................................................................................................................................... 91  6.1.2 About page ..................................................................................................................................... 92  6.1.3 Events page .................................................................................................................................... 93  6.1.4 Partners page ................................................................................................................................. 93  6.1.5 Login page ...................................................................................................................................... 93  6.1.6 Register new account page ............................................................................................................ 94  6.1.7 My account page ............................................................................................................................ 95  6.1.8 New appointment page ............................................................................................................. 95  6.1.9 Appointment Update Page: ........................................................................................................... 96  6.1.10 Make payment page .................................................................................................................... 97  6.1.11 My appointment page ................................................................................................................. 98  6.1.12 Consultation rating page .............................................................................................................. 99  6.1.13 Doctor record page ...................................................................................................................... 99  6.1.14 Patient record page .................................................................................................................... 100  6.1.15 System record page ................................................................................................................... 100  6.1.16 Register new staff page.............................................................................................................. 101  6.1.17 Encryption .................................................................................................................................. 101  6.1.18 Password strength checker ........................................................................................................ 102  6.2 Sample codes ........................................................................................................................ 102  6.2.1 Login page .................................................................................................................................... 103  6.2.2 Register new account page .......................................................................................................... 104  6.2.3 My account page .......................................................................................................................... 104  6.2.4 Doctor record page ...................................................................................................................... 105  6.2.5 New appointment ........................................................................................................................ 105  6.2.6 Make payment ............................................................................................................................. 107  6.2.7 Automatic notification email ....................................................................................................... 108  6.2.8 Consultation rating ...................................................................................................................... 109  6.2.9 Security features .......................................................................................................................... 110  Chapter 7: System Validation 7.1 Unit Testing: ......................................................................................................................... 112  7.2 Integration Testing:............................................................................................................... 117  7.3 System Testing:..................................................................................................................... 120 
  5. 5. SAMIHA TABASSUM HAQUE (TP034305) 5 ONLINE PATIENT SCHEDULING SYSTEM 7.4 User Acceptance Test: .......................................................................................................... 121  7.5 Conclusion: ........................................................................................................................... 126 Chapter 8: Reflection & Conclusion 8.1 Personal Reflection and Critical Evaluation:........................................................................ 127  8.2 Conclusion: ........................................................................................................................... 128  References................................................................................................................................... 130  APPENDIX................................................................................................................................. 135  Table of Figures Figure 2: System flow chart for online appointment registration. (Zhan, X. and Liu, X. (2013)) 24  Figure 3: System flow chart for online appointment registration. (Zhan, X. and Liu, X. (2013)) 24  Figure 4: HSC Medical Center Appointment System interface. (http://www.hsc.com.my) ........ 25  Figure 5: Takaful Appointment System. (https://www.takaful.com.my)..................................... 26  Figure 6: Xpert Appointment System. (http://www.getacoder.com)............................................ 27  Figure 7:Signing up process for simplybook.me (https://simplybook.me)................................... 27  Figure 8: System Configuration proposed by MD Zahidur Rahman. (Rahman, M. (2015)) ....... 30  Figure 9: Doctors’ Interface Output. (Rahman, M. (2015)) ......................................................... 30  Figure 10: Management Interface Output. (Rahman, M. (2015))................................................. 30  Figure 11: Simplybook.me interface for medical center. ............................................................. 31  Figure 12: Patient Interface. (Mypatientscheduler.com. (2016)).................................................. 31  Figure 13:Front Desk Interface. (Mypatientscheduler.com. (2016))............................................ 32  Figure 14: Admin log in interface. (Mypatientscheduler.com. (2016))........................................ 32  Figure 15: NHIS Online Appointment System Architecture. (Idowu, A., Adeosun, O. and Williams, K. (2014))..................................................................................................................... 32  Figure 16: User case diagram for the proposed NHIS system. (Idowu, A., Adeosun, O. and Williams, K. (2014))..................................................................................................................... 33  Figure 17: Agile overall Process. (www.tutorialspoint.com, (2016))........................................... 35  Figure 18: Agile Manifesto Model. (AGILE MODELING AND PROTOTYPING. (n.d.)) ....... 36  Figure 19: Agile Basic Principles. (AGILE MODELING AND PROTOTYPING. (n.d.))......... 37  Figure 20: Scrum Methodology Overview. (COHEN, D., LINDVALL, M. and COSTA, P. (2004)) ....................................................................................................................................................... 38 
  6. 6. SAMIHA TABASSUM HAQUE (TP034305) 6 ONLINE PATIENT SCHEDULING SYSTEM Figure 21: Scrum Methodology Simplified. (Sharma, S., Sarkar, D. and Gupta, D. (2012))....... 39  Figure 22: Sample of a Sprint Burn-down Chart. (Williams, L. (2007))...................................... 39  Figure 23: Brief picture of Scrum Process. (Williams, L. (2007)) ............................................... 40  Table 1: Scrum Implementation Table ......................................................................................... 41  Figure 23: Simple Patient Scheduling Architecture...................................................................... 44  Figure 24: 2-tier Online Patient Scheduling System Architecture. (S, N. and Sarda, E. (2014)). 45  Figure 25: Previous Version of Use Case Diagram...................................................................... 46  Figure 26: New Version of Use Case. .......................................................................................... 47  Figure 27: Use Case Diagram for Patient. .................................................................................... 48  Figure 28: Use Case for Doctor/Staff and Admin Login............................................................. 49  Table: Use Case Specification for Login...................................................................................... 49  Table: Use Case Specification for Admin .................................................................................... 50  Table: Use Case Specification for Patient Register...................................................................... 50  Table: Use Case Specification for Manage Appointment............................................................. 51  Table: Use Case Specification for System Log. ........................................................................... 51  Figure: Use Case Specification for Post Review.......................................................................... 52  Figure 29: First Version of Class Diagram................................................................................... 52  Figure 30: New Version of Class Diagram................................................................................... 53  Figure 31: Showing Base Cases.................................................................................................... 53  Figure 32: Activity Diagram for Online Patient Scheduling System. .......................................... 54  Figure 33: First Version of Sequence Diagram. ........................................................................... 55  Figure 34: Sequence Diagram for Login. ..................................................................................... 56  Figure 35: Sequence Diagram for New Account Register............................................................ 57  Figure 36: Sequence Diagram for Register New Staff. ................................................................ 57  Figure 37: Sequence Diagram for Patient Manage Appointment................................................. 58  Figure 38: Sequence Diagram for System logs............................................................................. 58  Figure 39: Previous Version of ERD Online Patient Scheduling................................................. 59  Figure 40: New Version of Entity Diagram.................................................................................. 60  Table: Database table for Account................................................................................................ 61  Table: Database table for Appointment........................................................................................ 61  Table: Database table for Credit Card. ......................................................................................... 61 
  7. 7. SAMIHA TABASSUM HAQUE (TP034305) 7 ONLINE PATIENT SCHEDULING SYSTEM Table: Database table for Doctor.................................................................................................. 62  Table: Database table for Hospital................................................................................................ 62  Table: Database table for Specialty. ............................................................................................. 62  Table: Database table for Rating................................................................................................... 63  Table: Database table for Payment. .............................................................................................. 63  Table: Database table for Staff. .................................................................................................... 64  Table: Database table for System Email....................................................................................... 64  Figure 41: Home Page Online Patient Scheduling ....................................................................... 64  Figure 42: Patient Login ............................................................................................................... 65  Figure 43: Department List........................................................................................................... 65  Figure 44: Specialize Doctor Selected.......................................................................................... 66  Figure 45: Booking an appointment ............................................................................................. 66  Figure 46: Physician Login Interface............................................................................................ 67  Figure 47: Physician Activity Interface........................................................................................ 67  Figure 48: Admin/ Staff Login ..................................................................................................... 68  Figure 49: Staff Activity Interface................................................................................................ 68  Figure 50: Data Flow of Online Patient Scheduling..................................................................... 70  Figure 51: Chrome Architecture. (Burstyn, J., Barleta, K., Berk, L., Cole, P. and Franzon, T. (2009))........................................................................................................................................... 72  ....................................................................................................................................................... 74  Figure 52: Question 1.................................................................................................................... 78  Figure 53: Question 2.................................................................................................................... 78  Figure 54: Question 3.................................................................................................................... 79  Figure 55: Question 4.................................................................................................................... 79  Figure 56: Question 5.................................................................................................................... 80  Figure 57: Question 6.................................................................................................................... 80  Figure 58: Question 7.................................................................................................................... 81  Figure 59: Question 8.................................................................................................................... 81  Figure 60: Question 9.................................................................................................................... 82  Figure 61: Question 10.................................................................................................................. 82  Figure 62: Question 11.................................................................................................................. 83 
  8. 8. SAMIHA TABASSUM HAQUE (TP034305) 8 ONLINE PATIENT SCHEDULING SYSTEM Figure 63: Question 12.................................................................................................................. 83  Figure 64: Question 13.................................................................................................................. 84  Figure 65: Question 14.................................................................................................................. 84  Figure 66: Question 15.................................................................................................................. 85  Table: Interviewee 1 Table. .......................................................................................................... 86  Table: Interviewee 2 Table ........................................................................................................... 88  Table: Interviewee 3 Table ........................................................................................................... 89  Figure 67: Screenshot for “Home” page....................................................................................... 92  Figure 68: Screenshot for “About” page....................................................................................... 92  Figure 69: Screenshot for “Events” page...................................................................................... 93  Figure 70: Screenshot for “Partners” page.................................................................................... 93  Figure 71: Screenshot for “Login” page....................................................................................... 94  Figure 72: Screenshot for “Register new account” page. ............................................................. 94  Figure 73: Screenshot for “My account” page.............................................................................. 95  Figure 74: Screenshot for “New appointment” page.................................................................... 96  ....................................................................................................................................................... 96  Figure 75: Select Appointment Record to Update........................................................................ 96  Figure 76: Appointment Update Page........................................................................................... 97  Figure 77: Appointment Successfully Updated............................................................................ 97  Figure 78: Screenshot for “Make payment” page......................................................................... 98  Figure 79: Screenshot for “My appointment” page...................................................................... 98  Figure 80: Screenshot for “Consultation rating” page.................................................................. 99  Figure 81: Screenshot for “Doctor record” page. ......................................................................... 99  Figure 82: Screenshot for “Patient records” page....................................................................... 100  Figure 83: Screenshot for “System record” page........................................................................ 100  Figure 84: Screenshot for “Register new staff” page.................................................................. 101  Figure 85: Encryption for security code. .................................................................................... 101  Figure 86: Password strength checker. ....................................................................................... 102  Figure 87: Objects in the system................................................................................................. 103  Figure 88: Sample code for “Login” page.................................................................................. 103  Figure 89: Register new account page........................................................................................ 104 
  9. 9. SAMIHA TABASSUM HAQUE (TP034305) 9 ONLINE PATIENT SCHEDULING SYSTEM Figure 90: Sample code for update account details. ................................................................... 105  Figure 91: Sample code for doctor record page.......................................................................... 105  Figure 92: Sample code for new appointment past date validation............................................ 106  Figure 93: Sample code for appointment 7 days’ advance rule.................................................. 106  Figure 94: Initial status of a new appointment............................................................................ 106  Figure 95: Sample code to validate credit card details. .............................................................. 107  Figure 96: Sample code to validate credit card........................................................................... 107  Figure 97: Sample code for update appointment status.............................................................. 108  Figure 98: Sample notification email.......................................................................................... 108  Figure 99: Sample code to send appointment confirmation email. ............................................ 109  Figure 100: Rating scale for consultation session....................................................................... 109  Figure 101: Sample code for rating point. .................................................................................. 109  Figure 102: Sample code to insert rating record......................................................................... 110  Figure 103: Sample code for encryption..................................................................................... 110  Figure 104: Sample code for decryption..................................................................................... 111  Figure 105: Sample code to implement password strength checker........................................... 111  Figure 106: Unit Testing Process of Registration Sprint of the Online Patient Scheduling....... 112  Table: Unit Testing for Login..................................................................................................... 113  Table: Unit Testing for “Register”.............................................................................................. 113  Table: Unit Testing for “Update Personal Information”............................................................. 114  Table: Unit Testing for “Make New Appointment”. .................................................................. 115  Table: Unit Test for “Update My Appointment”........................................................................ 115  Table: Unit Testing for “Make Appointment”............................................................................ 116  Table: Unit Testing for “Consultation Rating”........................................................................... 116  Table: Unit Testing for “Doctor Record”. .................................................................................. 116  Table: Unit Testing for Patient Record for Staff Only. .............................................................. 117  Table: Unit Testing for “Register New Staff”. ........................................................................... 117  Table: Integration for Register Account and Account Login. .................................................... 118  Table: Integration for New Appointment and My Appointment Page. ...................................... 119  Table: Integration for My Appointments and Make Payment.................................................... 120  Table: System testing for all the functions. ................................................................................ 121 
  10. 10. SAMIHA TABASSUM HAQUE (TP034305) 10 ONLINE PATIENT SCHEDULING SYSTEM Table: User Acceptance Test for GUI. ....................................................................................... 122  Table: User Acceptance Test for Human Computer Interaction. ............................................... 122  Table: User Acceptance Testing for overall System................................................................... 123  Table: User Acceptance Test for GUI. ....................................................................................... 123  Table: User Acceptance Test for Human Computer Interaction. ............................................... 124  Table: User Acceptance Testing for overall System................................................................... 124  Table: User Acceptance Test for GUI. ....................................................................................... 125  Table: User Acceptance Test for Human Computer Interaction. ............................................... 125  Table: User Acceptance Testing for overall System................................................................... 126 
  11. 11. SAMIHA TABASSUM HAQUE (TP034305) 11 ONLINE PATIENT SCHEDULING SYSTEM Chapter 1: Introduction to the Study 1.1 Background to the Project Information System has become an important aspect for any developing business in recent years. As the growing business needs to have accurate information and necessary technology for solving problems and to catch up with ever growing customer needs, Information System Technology has been a key force for organizations to determine their business criteria. Businesses today use information system and use the available technologies because they understand the importance of maintaining and updating data electronically (Davis and Yen, 1998) Using Information System for managing information in the health care such as patient record, patient appointment system, patients scheduling appointment and doctor schedule is not only a simpler way to save time and reduce cost, but also a way to support and improve the health care information to be more accessible and flexible (modifying, saving, deleting, updating) for system users and storing data efficiently. In addition, it improves the quality of data control (Liu and Zhu, 2007). Enhancing patient care management is one of the major aims of healthcare industry today to improve the healthcare system worldwide. This goal is to be equally if not more important as the other keys of improving the health of the population and managing per capita cost of care. (Berwick et al, 2008) As the population continues to grow, so too does the need for healthcare services and options. (The Benefits Of Online Appointment Scheduling. 1st ed) Health Care Service providers globally are experiencing an increase in pressure to concurrently reduce cost and improve accessibility and quality of care they deliver especially resolving long waiting times, delays and queue of patients. (Mardiah, F. and Basri, M. (2013)) Thus a Patient Scheduling System is launched as an important component of scheduling and managing appointments. Especially online scheduling software has simplified and automated the process of hospital management for all size of organizations.
  12. 12. SAMIHA TABASSUM HAQUE (TP034305) 12 ONLINE PATIENT SCHEDULING SYSTEM This project aims to introduce a Patient Scheduling Online Service for health care institutions that would ease off the appointment-scheduling journey for users and pave the path of a better doctor-patient experience. The proposed system advances with online facilities that eliminate the chaos of traditional appointment services. This system offers online appointment booking, to view doctors list, to cancel and update appointments with an administrative portal to manage all the sections. It provides advanced functionality to streamline the process thus easy access to personal hospital services that help organizations to stay connected with their customers, clients and most importantly patients and can result in significant time and monetary savings In to order to develop a successfully running online Patient Scheduling, the system is required to interact with system database, scheduling module and the administrative module for example, to achieve the best implementation, the scheduling system would be able to interact with several medical health care staff such as physicians, nurses admin staff and patients. 1.2 Problem Context Online Patient Scheduling also commonly known as Online Appointment booking system an optimized phase of medial healthcare service to improve patient healthcare journey in hospitals and clinics. Motivated by the rising popularity of electronic appointment booking system, this project aims to develop an appointment-scheduling model that takes into account the patient preferences regarding when they would like to be seen. Currently, it is rational to establish the fact that, very few hospitals provide online scheduling doctor-patient session. In fact, majority of the medical centers in Kuala Lumpur provide traditional patient scheduling routines. In traditional appointment scheduling process, patients are scheduled for a future appointment time and the number of patient granted an appointment has an upper limit each time period. The appointment lead-time could be very long for example, several weeks or a month in advance, which could result in a high number of no-show. [Dai, X. (2013). Online Clinic Appointment Scheduling. 1st ed.] According to a case study by the Commonwealth Fund Commission on a High Performance Health System, six attributes were identified for an ideal health care delivery system. The report determined and examined the problems engendered by fragmentation in the health care system and offered policies to stimulate greater organization for high performance. (Mccarthy, D., Mueller, K. and Wrenn, J. (2009))
  13. 13. SAMIHA TABASSUM HAQUE (TP034305) 13 ONLINE PATIENT SCHEDULING SYSTEM The Six Attributes of an Ideal Heath Care Delivery System are discrete guidelines for a better health care organizational structure and customer satisfactory. The Six Attributes are:  Information Continuity: Patients’ clinically relevant information is accessible to the health care providers at the point of care and to patients through the Online Website.  Care Coordination and Transition: Patient care is coordinated among different departments and transitions across care setting are actively managed.  System Accountability: The clear accountability for the Patient Scheduling System is defined with care coordination.  Peer Review and Teamwork for High-Value Care: Physicians, nurses and other members of the health care team among departments have accountability to each other to reliably deliver high quality care.  Continuous Innovation: The Appointment Scheduling system is continuously innovating in order to improve the quality of patient experiences of health care delivery.  Easy Access to Appropriate Care: The Patient Scheduling System allows patients to have easy access to appropriate care and information at all information. (Mccarthy, D., Mueller, K. and Wrenn, J. (2009)) In many ‘Open Access Appointment Scheduling’, the number of patients request is selected in random. A patient is assigned to a time bucket within a relatively short time period such as one or two day in advance from the time requested. Though the theory behind this process is to reduce no-show probability, patient inconvenience and waiting time, communication error still holds back the facility. In classical systems, patients are to go to the hospital and wait in the queue to make a reservation and get an appointment. [Sherly, I. (2016). Online Appointment Reservation and Scheduling for Healthcare- A Detailed Study. 2nd ed.] This process is time-consuming where generally patients end up waiting for very long time intervals. Even though the patient might choose to fix an appointment, this option is infeasible at all times and does not likely work well for general public involved in the system. Online scheduling facilitates patients with quick response service and convenient and accessible time.
  14. 14. SAMIHA TABASSUM HAQUE (TP034305) 14 ONLINE PATIENT SCHEDULING SYSTEM 1.3 Rationale When on Online Patient Scheduling System is replaced with traditional appointment reservation service, patients are the prime benefit holders. Hospitals and medical centers would definitely have a better appointment management process as well as sophisticated control over doctors’ schedule and employee productivity. The advantages will be time saving for both patients and doctors and much convenient for the administrative staffs to manage all the appointments and paper work. Online appointment scheduling would reduce the workload of the administrative staff and provide much better customer satisfaction. 1.4 Potential Benefits Online Patient Scheduling has its tangible and intangible benefits to both users who would book appointments and the hospital management including doctors and staffs. 1.4.1 Tangible benefits  Flexibility: Online scheduling features advanced functionalities that are automated and improve the appointment reservation process and provide customers a simple healthcare flow. For example, time-saving.  Security: Maintains patient confidentiality and provide information protection. For example, protected health information are not shared or discussed within even hearing distance of other patients.  Connectivity: Keeps organizations better connected with their customers and patients. By staying connected with their customers, institutions get a better view of their management process. For examples, reviewing and rating doctor-patient experience flow that helps the hospital management to overview doctors’ average performance.  Monetary Savings: Automated scheduling benefits large-scale medical centers monetary savings. It lifts the burden of assigning staff members to manage scheduling appointments and reduce employee pay in the form of over-time or hiring new staff.  Accessibility: Online scheduling software is accessible for all type of users. All that’s required is an Internet connection and users can access a vast range of facilities.
  15. 15. SAMIHA TABASSUM HAQUE (TP034305) 15 ONLINE PATIENT SCHEDULING SYSTEM 1.4.2 Intangible benefits  Patients are able to schedule for various medical procedures and treatments.  Daily, weekly and monthly patient scheduled are easily viewed.  Patient records and Appointments reports are created.  Helps to track Patient Flow based on arrival, visit and departure time.  No-show, missing, over-booking patients and other conflicts can be avoided.  All appointments are assembled from the website. 1.5 Target Users The targeted users range from the population having internet access and are familiar with various online services available. This group of targeted users are eager to ease out their daily life through online facilities provided by various online organizations. The developer has targeted 4 types of users:  General Users who are seeking online service to avoid the chaos of traditional appointment booking system.  Physicians working with large scale medical organizations who attend a large number of patient every day.  Physicians running independent small scale clinic in suburban areas.  Large scale healthcare institutions who are looking for simple cost-effective appointment scheduling. 1.6 Scope and Objectives Patient growth certainly is beneficial for healthcare business but it also creates challenges for facility admins and staff. Procedures that were previously adequate may no longer be effective in handling a rise in new patients. (The Benefits Of Online Appointment Scheduling. 1st ed.) The appointment process especially in large organizations is challenging. It is often burdensome task that requires significant time and staff resources to manage. The proposed patient scheduling system replaces traditional booking chaos with online facility in addition with automated e-mail and text message reminders. Patient scheduling system allows the users the power to book their own appointments with respective doctors online that benefits organizations to manage a
  16. 16. SAMIHA TABASSUM HAQUE (TP034305) 16 ONLINE PATIENT SCHEDULING SYSTEM tremendous amount of time that would otherwise have been spent answering phone, responding to e-mails and voice messages. This online platform improves flexibility of healthcare service with customized reporting and security features. 1.6.1 Aims The aim of patient scheduling service is to provide patients full access to manage their hospital appointments which, facilitates with an online service for appointment reservation, updating and canceling management minimizing customer inconvenience and assuring a better healthcare. 1.6.2 Objectives  To develop a system that allows users to have control over their appointment making service.  To facilitate the patients with real time healthcare scheduling.  To manage staff resources needed for managing appointments.  To maximize operation hours.  To make the use of online platform for less customer inconvenience and high productivity among staff.  To optimize time savings and monetary savings as both staff time and services translate into expenses and revenue. 1.7 Deliverables –Functionality of the proposed system The intelligent Online Patient Scheduling System aids simple and easy appointment reservation online as long as the specific device is connected to the Internet. This service will minimize patient waiting time as well as the chaos of managing tons of appointments everyday by hospital management. Once a patient has booked a schedule, he or she would also be allowed to make changes, even cancel their appointment according to their convenience. The website should view list of doctors with their respective specializations where users are able to select their certain physician. The system also consists of an administrative panel where the system admin is able to monitor the number of patient attended by the doctors daily, weekly and monthly. The core functions of the system are listed below:  Allows end-users to register, login and logout from the system.
  17. 17. SAMIHA TABASSUM HAQUE (TP034305) 17 ONLINE PATIENT SCHEDULING SYSTEM  Allows users to view doctors list according to departments as well as doctors’ specifications.  Allows users to book update and cancel their appointments.  Allow the doctors to view the number of patients to be attended for the day.  Allows respective management staff to be updated about the day’s activities.  Allow patients to review and rate their experience with the respective doctors.  Once an appointment is booked, the system notifies the users by email one day prior to the appointment.  Patient will be able to make Online Payment for their appointment. (Stimulation Only) 1.8 Nature of Challenges To initiate the first phase of this project, I need to master web-developing concepts and user browsing experience. Different screen-resolutions for different types of devices are to be understood. As for selecting the programming language, I need to make a choice between using java or ASP.net since I do not have brief knowledge about ASP.net. While developing the web- application, security of the website would definitely be considered since I would like to add Online payment transaction as an extra feature. Not only that other security measures such as prevention from SQL Injection, Encryption of patient information are to be taken under consideration. 1.9 Overview of this report and Project Plan The proposed system aims to deliver an online patient scheduling facility for clinics and hospital management. This case study provides a brief research on various factors and hypothesis of Online Patient Scheduling. Chapter 2 would thoroughly evaluate literature review of the case, Chapter 3 would draw a guideline on the Agile Methodology and how the Agile approach has guided the developer during the development of the system. Chapter 5 is designed with primary research tools such as Questionnaires and Interviews. Chapter 6 would describe the system implementation and system screenshots. In Chapter 7, integration testing, unit testing plan and user acceptance testing is formatted according to the Agile approach. At last, the documentation ends with conclusion and personal reflection of the developer in Chapter 8.
  18. 18. SAMIHA TABASSUM HAQUE (TP034305) 18 ONLINE PATIENT SCHEDULING SYSTEM Chapter 2: Literature Review 2.1 Introduction Appointment scheduling has become a complex task especially for healthcare professionals in hospitals and clinics. Few reasons that could cause these complications range from a heavy flow of patient traffic to a physician that practices in a number of clinic and moves from one medical facility to others. An ineffective appointment management could also cause overlapping appointments, rise in number of no-shows, patient dissatisfaction in general and revenue loss for healthcare institutions. In recent days, many medical institutions use a combination of phone-based scheduling and computerized appointment scheduling. Even though this combo along with out-sourcing services make a better efficient system, few gaps for technical and human error still remains. This online facility is an effective add-on to any hospital or clinic’s website. It lightens the hard work associated with managing a medical facility. More time on hand to commit to patient care, better patient compliance and fiscal viability are other rewards. (NIMS Institute of Management & Computer Sciences, (n.d)) The key mission of an efficient online patient scheduling is to reflect patient satisfaction and revenue gains. An active appointment scheduling a bridge that connects efficient healthcare services and timely access to the services. The proposed Patient Scheduling system aims to even out workflow and reduce the thronging of people in waiting rooms. Any medical center that handles patients’ scores and healthcare responsibilities are at risk of wasting too much time and money on patient scheduling. Especially small size clinic where physicians manage their own medical office, it is not worthwhile to continue with primitive paper based scheduling system. Since appointment books are limiting and time consuming, the more cancellations and scribbles the more this process confuse and frustrate the staff who are managing these. In comparison to paper-based appointment scheduling, web-based patient scheduling is faster that allows multiple user access at any given time. Web-based appointment scheduling enables to generate appointment reports and email appointment reminders and minimizes no- shows.
  19. 19. SAMIHA TABASSUM HAQUE (TP034305) 19 ONLINE PATIENT SCHEDULING SYSTEM 2.2. Domain Research: Outpatient Management: The combination of time, technology and the rapid increase in population has been the drive force to introduce an online patient scheduling. Outpatient management is one key factor that has been influential for developing an online appointment system. Outpatient services have become an essential component of healthcare industry. The objective of outpatient scheduling is to provide an appointment system service that measures optimized performances in a clinical environment.  Waiting Time: Long waiting times are an alarming problem for patients using urban health centers in developing countries. According to a case study conducted for NHIS Outpatient in Nigerian teaching hospitals, a bock appointment system was introduced and evaluated in a large South African health center. Waiting times of patients were measured over one-week period during the research before and after the implementation of appointments. Groups and individual interviews were conducted with management staff and patients. After launching the appointments system, patients with acute and chronic illnesses and having appointments had significantly shorter waiting time than similar patients without appointments. (Idowu, A., Adeosun, O. and Williams, K. (2014)) Research carried out based on patient health care service requirements appointment could be divided into three major sections such as Primary Care Clinic, Specialty Clinic and Surgery Appointment Scheduling. (Gupta & Denton, 2008)  Primary Care Clinic Appointment: This section falls under the initial care fields that are provided by a single physician or a group of physicians running a medical facility. One prime example under this section is small size clinics. For wider scale clinics running by multiple physicians and multiple departments, patients prefer time slots and physicians’ availability. Efficiency in clinic and patient satisfaction could be improved by assigning a patient to a preferred time slot and a physician who is familiar with the patient’s medical issues. The number and length of available appointment time slots are settled based on the type of service request, medical urgency and provider’ panel.  Specialty Care Clinic Appointment: This section focuses on diagnoses, treatment and recovery for certain specialties such as neurosurgery, cardiology, and Endocrinology etc. particular related tests could be provided to
  20. 20. SAMIHA TABASSUM HAQUE (TP034305) 20 ONLINE PATIENT SCHEDULING SYSTEM complete the diagnoses. Sometimes specialists require a referral from a primary care physician for patients’ first appointment. The length of available appointment time slots are fixed for these services and the availability for examination facilities such as X-rays, Scans are taken into consideration. Considerations of Patient Scheduling: The major aim of patient scheduling is to provide an optimal policy and to gain a positive balance between patients’ satisfaction and the performance of medical institutions. Generally certain factors influence on the performance of an appointment such as urgency of patients, punctuality, no-shows and cancellations and service processes. These criteria are taken a base line while developing a well-designed web-based appointment system. (Cayirli & Veral, 2003).  Unpunctuality: Difference between patient arrival time and actual appointment time lead to a dysfunctional clinic management. Nuffield Trust studies (1955) implied that more than half of 8 the patients arrive early, which could cause the congestion of the patient’s waiting room and increase patients’ waiting time. Wijewickrama & Takakuwa (2008) discussed how the impact of no-shows on patients’ waiting time is higher than that of punctuality. Moreover, some studies also show, the impact of physicians’ unpunctuality where the physician caused delay for the appointment. Vissers (1979) pointed out patients’ waiting time and physicians’ idle time were affected by the unpunctuality of both patients and physicians.  No-show and Late Cancellations: This section prioritized who are late and miss their appointments. This results in no-show problems that increase under-utilization of clinic capacity. Generally, 5-30% is used as a no-show probability in past studies (Ho and Lau, 1992 & 1999; Klassen and Rohleder, 1996; Yang, Lau and Quek, 1998; Cayirli, Veral, and Rosen, 2006 & 2008; Kaandorp and Koole, 2007). Certain papers analyzed real data from clinics and pointed out that patients with relatively high no-show probability are younger, male, unmarried, uninsured, with psychosocial problems, of lower socioeconomic status, divorced or widowed and have a history of missed appointments (Neal, Hussain-Gambles, Allgar, Lawlor, and Dempsey, 2005). Daggy et al. (2010) pointed out transportation and appointment lead time affected the no-show probability as well. Some papers implied that long appointment lead times increase the no-show rate. Dove and Schneider (1981), Lee et al. (2005) and Gallucci et al. (2005) reported that no-shows were the most
  21. 21. SAMIHA TABASSUM HAQUE (TP034305) 21 ONLINE PATIENT SCHEDULING SYSTEM influential factor on performance of Appointment Scheduling among three environmental factors reviewed (Ho and Lau, 1992). To reduce no-show probability, changing patient behavior or applying overbooking and short lead-time scheduling are suggested. (Daggy, etal. 2010)  Patient Preference: Few case studies states that accommodation of patients’ preferences could help to ensure the quality of services provided by primary clinic physicians and increase clinics’ revenues. (O’hare and Corelett, 2004) No-show rates could also be reduced if patients’ preferences are matched.  Arrival Characteristics: Size of arrival units are important for clinic-patient management success. A single arrival is taken as only one unit, the smallest number handled that arrive at the system and wait for services. This is typically a single patient. A group arrival is said to be several unit entering the system at the same time. In such scenario, the time between successive arrivals of the groups could be probabilistic as well as the number of patients in the group. (Dai, X. (2013))  Service Characteristics: Number of Services: There are two types of queuing process for the number of service provided by any medical center. Single stage queuing means when only one type of service is requested at the patient arrival. Multi stage queuing refers to a series of branched services that are requested in the whole service process. Number of Physicians: According to queuing theories, queuing system are two kinds: single server and multiple server systems. In a doctor-patient scenario, physicians are servers. In primary multi-physician clinics, doctors have their own panels as a result, patients are able make appointments to different physicians based on their different specializations. In such cases, appointment systems are multi- server systems. When studying the performance of an appointment system, multi-server systems are taken into consideration in some papers such as Wijewickrama & Takakuwa, (2008) and Chao et.al (2003). Service Time: Service times could be random or constant. Majority of the time, it could be assumed that the service time of routine appointment at primary care clinics is constant. Queue Discipline:
  22. 22. SAMIHA TABASSUM HAQUE (TP034305) 22 ONLINE PATIENT SCHEDULING SYSTEM This process determines the priority order for patients to be scheduled for an appointment. According to general queuing theory, queue discipline is divided into four main classes, first come, first serve, last come first served, service in random order, and priority ranking. In the appointment scheduling problem, it is assumed that patients are served FCFS in most of papers. In the real world, some clinics apply a priority ranking discipline when they scheduling appointments. For example, clinics give the first priority to emergent patients and second priority to readmission patients. Walk-in patients are usually given to the lowest priority. (Dai, X. (2013)) Measurements of an Appointment System Performance: A case study provided by Cayirli and Veral (2003), patient scheduling’s performance are measured according to patients’ waiting time, providers’ overtime and idle-time and cost of the management.  Cost-Based: There are three factors that are to be considered: cost of patients’ waiting time. Physicians’ idle time and overtime. In most of cases, costs of patients’ waiting time and physicians’ idle time are the main considerations, such as in Vanden Bosch, Dietz and Simeoni (1999), Lau and Lau (2000), Robinson and Chen (2003). Few of studies focus on minimizing appointment cost based on these three factors.  Time-Based: The three factors mentioned above are measured in terms of mean, maximum, variance and frequency distribution. Patients’ waiting is the difference between the scheduled appointment time and patients’ actual service time and waiting time due to early arrival is not counted. Doctors’ idle time defines the waiting time caused by no patients waiting to be seen. Overtime is the difference between actual and planned finish time of consults. O’Keefe (1985), Walter (1973), Vissers and Wijingaard (1979) have submitted papers on appointment system problem with time-based measurements.  Fairness: Fairness is measures by the uniformity of performance of a patient scheduling system. By evaluating the mean waiting time of patient according to their place in the queue (Bailey, 1952), variance of waiting time and queue size (Blanco Whit and Pike, 1964, Fetter and Thompson, 1966, Yang, Lau and Quek, 1998), any patient scheduling system’s fairness is determined.  Developing Algorithm:
  23. 23. SAMIHA TABASSUM HAQUE (TP034305) 23 ONLINE PATIENT SCHEDULING SYSTEM After a gathering a brief understanding on the issues and factors mentioned above, the final phase is to develop an algorithm for the proposed patient scheduling system. Robinson and Chen (2003) tried to balance waiting time and idle time using Monte Carlo integration, solved the problem approximately as a stochastic linear program and developed a theoretic closed-form heuristic policy. Mancilla and Storer (2012) developed a stochastic scheduling problem considering waiting and idle time and overtime cost for operation room and surgery scheduling. A multi-stage stochastic integer program using sample average approximation was applied to solve this problem. 2.3 Technical Research: During this stage of research, more technical information and requirements are gathered about the proposed system. System Requirement Analysis: For any software development, the initial phase is to conduct a demand analysis. Demand analysis is the process of discovery, refinement, modeling, specification and review. The process is directly related to the quality of the software and subsequently studies significant impacts on the design and implementation. For this analysis, functional requirements and technical requirements are analyzed. Another way of gathering system requirements is to analyze the Demand versus Capacity study. This study helps to understand whether the right number of appointments are offered, the suitable mix between same-day and pre-bookable and to check whether these components are spread correctly across the week. (Improving access, responding to patients. (2016)) Functional Requirements: Based on the research conducted for the proposed system, there are two sets of functions for an online appointment system. The first set of functions is online registration including sign up and log in, selection of department, date, physician and other online booking registration functions.
  24. 24. SAMIHA TABASSUM HAQUE (TP034305) 24 ONLINE PATIENT SCHEDULING SYSTEM Figure 1: System flow chart for online appointment registration. (Zhan, X. and Liu, X. (2013)) The next set of functions is data management that allows the database administrator to add, delete, modify and back up the data. Data addition, deletion and modification are the basic functions that are to be effectively maintained the consistency of the database to meet actual requirements. Data restore and back up are the system’s security enhancer. Figure 2: System flow chart for online appointment registration. (Zhan, X. and Liu, X. (2013)) Technical Requirement Analysis: In software development, system architecture is built according to the functions of the system. The system architecture determines system development model development environment and tools. Taking into account the system security and simplicity, Windows 10 would be used as operating system, Visual Studio 2015 as developing environment, C#.Net as developing platform. As the back-end database, Microsoft SQL Server will be used. 2.3.1 Similar Systems: HSC Medical Center Appointment System: Nowadays the need to queue up for a long time to consult a medical officer has minimized by technological facilities available over the Internet. One such organization that has adapted the recent technological era is HSC Medical Center. The appointment system used by HSC Medical
  25. 25. SAMIHA TABASSUM HAQUE (TP034305) 25 ONLINE PATIENT SCHEDULING SYSTEM Center does not require any ID and password to log-in before making any appointment and the appointment is valid within 24 hours only. The users are required to complete a form and click the submit button to finalize the appointment. Figure 3: HSC Medical Center Appointment System interface. (http://www.hsc.com.my) Takaful Appointment System Takaful Insurance provides an Online Appointment System. It was developed to decrease the higher cost by using phone and impractical. In this system, the user is able to enter the time of the appointment at any-time. There is no ID and password required for this system, the user only has to provide his/her details and submit the form. (Abd Wahab, M., Hassan, N., Wali Mohd, Z. and Hanaf, H. (2009))
  26. 26. SAMIHA TABASSUM HAQUE (TP034305) 26 ONLINE PATIENT SCHEDULING SYSTEM Figure 4: Takaful Appointment System. (https://www.takaful.com.my) Xpert Fitness Center Appointment System Xpert Fitness Center has a similar appointment scheduling system to make an appointment with the trainers. This system offers an interactive environment especially during the time and date selection for each session in a week. This weekly schedule would respond depending on the calendar selected by the user. Clients would have to log in before allowing to use the system, so the ID and password is required.
  27. 27. SAMIHA TABASSUM HAQUE (TP034305) 27 ONLINE PATIENT SCHEDULING SYSTEM Figure 5: Xpert Appointment System. (http://www.getacoder.com) Online Appointment for Medical Services by MD Zahidur Rahman This is a proposed researched system by MD Zahidur Rahman. The proposed system is designed to save effort, time and money of patients from waiting to make appointments as well as to reduce the work of the doctor and the hospitals and clinics to manage appointments easily. Simplybook.me This is an online booking system for various service providers such as medical services, hair and beauty salons, repair services, event planners, rental agencies, government agencies, educational services and many more. The system does require users to sign up to enjoy a vast range of services that they provide. Figure 6:Signing up process for simplybook.me (https://simplybook.me)
  28. 28. SAMIHA TABASSUM HAQUE (TP034305) 28 ONLINE PATIENT SCHEDULING SYSTEM For medical facilities, the system specifically asks users such as physicians to provide detailed information about available time slots and consultations. This system also allows users to group related services under categories such as diagnostic, therapy, prophylaxis etc. (Mike Benkovich, C. (2016)) MyPatientScheduler: This is also an online appointment scheduling, appointment confirmation, reminder and automated recall system. This system offers flexible appointment templates, procedures that are code driven and powerful patient control. The system is designed to increase appointment confirmation rates while decreasing labor costs with their automated appointment confirmation tools such as email, phone call and SMS. The proposed facility also offers flexible recall system with fully customizable automated reminders to patient when it is time for their appointment. (Mypatientscheduler.com. (2016)) DEPENDABLE ONLINE APPOINTMENT BOOKING SYSTEM FOR NHIS OUTPATIENT IN NIGERIAN TEACHING HOSPITALS This research based system is consist of Patient registration menu, patient activity menu, weekly calendar, patient appointment menu, patient report menu and administration login menu. The system offers a user-friendly interface for capturing valid registration code, username and password. In each patient account, data pertain to the patient and available doctor are entered and appointment booked are submitted. All this captured information is stored in the database. 2.3.2 Architecture of Similar Systems HSC Medical Center Appointment System: This is web-based appointment automation system that does not require ID and password prior to making appointments.  Owner Side’s Server: Appointment automation system server is developed to operate the system. The server is running the system.  Web-server: The web-server is to deliver contents such as web pages, using HTTP over the WWW
  29. 29. SAMIHA TABASSUM HAQUE (TP034305) 29 ONLINE PATIENT SCHEDULING SYSTEM  Desktop Computer: This tool is for user interact the appointment automation system GUI or interface. Users done all the process of appointment automation system with communicate and interact with GUI or interface provided by the system.  Client-Side Web Browser: Client side requires a desktop with web browser to access the appointment automation system GUI.  Internet Access: Client side is required to have internet access to connect with web server and application of appointment automation system. Internet is a bridge to connect the client and the appointment automation system. (EssayMonster.net - essays, research papers, dissertations & etc. (2016)) Online Appointment for Medical Services by MD Zahidur Rahman This system contains three modules:  Patient: Can easily view the schedule to make any appointment.  Doctor: Are able to view number of patients to be attended. To view patient details, to update doctor specification details, to view appointment records, to update appointment record. Example: status of appointment from “New” to “Completed”.  Management: To register new user in the system: Doctor, Nurse & staff. Update system control records (Example: Email address of the system to send automatic Emails). System Implementation: Web Forms Application is developed using HTML, CSS, JavaScript, jQuery. PHP is chosen as a programming language and MySQL for the database management.
  30. 30. SAMIHA TABASSUM HAQUE (TP034305) 30 ONLINE PATIENT SCHEDULING SYSTEM Figure 7: System Configuration proposed by MD Zahidur Rahman. (Rahman, M. (2015)) Figure 8: Doctors’ Interface Output. (Rahman, M. (2015)) Figure 9: Management Interface Output. (Rahman, M. (2015))
  31. 31. SAMIHA TABASSUM HAQUE (TP034305) 31 ONLINE PATIENT SCHEDULING SYSTEM Simplybook.me Interface: Figure 10: Simplybook.me interface for medical center. MyPatientSchedule Interface: This system offers three interfaces for patients, reception and management interface. Figure 11: Patient Interface. (Mypatientscheduler.com. (2016))
  32. 32. SAMIHA TABASSUM HAQUE (TP034305) 32 ONLINE PATIENT SCHEDULING SYSTEM Figure 12:Front Desk Interface. (Mypatientscheduler.com. (2016)) Figure 13: Admin log in interface. (Mypatientscheduler.com. (2016)) DEPENDABLE ONLINE APPOINTMENT BOOKING SYSTEM FOR NHIS OUTPATIENT IN NIGERIAN TEACHING HOSPITALS Figure 14: NHIS Online Appointment System Architecture. (Idowu, A., Adeosun, O. and Williams, K. (2014)) MySQL is deployed as the database for this system. MySQL in wampserver is used to create and populate the database. The system is implemented using dream weaver and PHP. Apache is used as the server to provide basic functionality of the web GIS. PHP is used as a scripting language to program the server side to manipulate knowledge in the database.
  33. 33. SAMIHA TABASSUM HAQUE (TP034305) 33 ONLINE PATIENT SCHEDULING SYSTEM Figure 15: User case diagram for the proposed NHIS system. (Idowu, A., Adeosun, O. and Williams, K. (2014)) 2.4 Conclusion The adaptability of an online patient scheduling structure enhances services provided by medical institutions. This is a great way of assembling all the appointments from website. It delivers flexibility and simplicity to patients, that’s the reason online appointment systems are becoming popular these days. During the research process, various articles and similar systems have been analyzed. Based on the content found during the research, a new Online Patient Scheduling System has been proposed in the following chapters.
  34. 34. SAMIHA TABASSUM HAQUE (TP034305) 34 ONLINE PATIENT SCHEDULING SYSTEM Chapter 3: Development Methodology 3.1 Identification of Chosen Methodology: Agile During a system development lifecycle, there are two main factors that are considered: to emphasize on process and the quality of the software and process itself. (Sharma, S., Sarkar, D. and Gupta, D. (2012)) Since software development is a complex filed that contains countless variables impacting the system, any develop would always seek for an organized structure that could be used as a base for developing a system. All software systems are imperfect because they cannot be built with mathematical or physical certainty. Thus, system development methods are introduced in order provide developer a base line of processes and sequences to follow while building a system. Different software developing methods have different characteristics of processes to reach completion of a system. Based on the research carried out and analysis of system requirements for the proposed Online Patient Scheduling System Agile Method is selected by the developer. In general terms, Agile process is an iterative approach that prioritizes customer satisfaction and customers have direct involvement evaluating the software. Agile method follows the Software Development Lifecycle that includes requirement gathering, analysis, design, coding and testing. As a result, the approach delivers a partially implemented software and waits for customer feedback. 3.2 Justification to Agile Approach Agile Method is programming centric. While other methodologies are mainly based on the premise that software development processes are to be repeatable thus predictable, Agile framework emphasizes on unit-by-unit development. The aim of Agile Method is to allow organizations to be agile in terms of delivering the product quickly. Agile approach is a combination of group of methods. While Agile techniques vary in emphasis and practices, they have common characteristics including iterative development and focus on interaction, communication and the resource-intensive intermediate artifacts. (COHEN, D., LINDVALL, M. and COSTA, P. (2004))
  35. 35. SAMIHA TABASSUM HAQUE (TP034305) 35 ONLINE PATIENT SCHEDULING SYSTEM One of the key reasons why the developer chose Agile Methods for the proposed system is that Agile approach is able to identify and respond to changes more quickly than using project using a traditional approach. Figure 16: Agile overall Process. (www.tutorialspoint.com, (2016)) While selecting a development methodology for the system, Agile method was the developer’s first choice because Agile process requires less planning and it divides tasks into small increments. Following this approach while developing the Online Patient Scheduling system would allow the developer to make necessary changes according to user satisfaction. 3.3 Description of the System Development Methodology: Agile development methods break a problem into smaller tasks. The processes do not require direct ling-term planning for any requirements. Agile method provides modularity to the system. It decomposes the complete system into manageable pieces called modules. Modularity is an important role in software development. Following Agile process would allow the developer to plan iterations that are of short period of time such as one to four weeks. Since the project is an individual final year project, the developer herself would conduct each iteration that works in all functions of software development such as planning, requirement analysis, design, coding, unit testing and acceptance testing. As agile method is iterative in nature, it requires time limits on each module with respective cycle, thus providing the developer with sufficient time window to work on each module. The process produces increments and each increment in independent of others that would allow the developer to integrate all the increments into complete system. Agile approach is adaptive. The adaptive nature of the method would allow the developer to design the system in an order that would adapt possible risks on its way to development.
  36. 36. SAMIHA TABASSUM HAQUE (TP034305) 36 ONLINE PATIENT SCHEDULING SYSTEM 3.3.1 Agile Manifesto Agile methods stress productivity and values over heavy-weight process overhead and artifacts. (Szalvay, V. (2004)) Agile Manifesto is a combination of agile software development methodologies. In 2001, founders of many agile system development methods gathered with others who were also implementing various agile methods in the same field and created ‘Agile Manifesto’. Figure 17: Agile Manifesto Model. (AGILE MODELING AND PROTOTYPING. (n.d.)) The Agile Manifesto addresses features such as, individuals and interactions over processes and tools, working software over comprehensive documentation, customer collaboration over contract negotiation and responding to change over following a plan. The Manifesto stands on twelve basic principles that states:  Customer Satisfaction: Maximum priority is given to satisfy the users’ requirements through early and continuous delivery of valuable software.  Welcoming Changes: Changes are inevitable during any system development. Ever-changing requirements are to be welcome, even late in the development stage. Agile processes work to increase users’ competitive advantage.  Delivering a working software: Delivering a working software frequently, ranging from a few weeks to a few months, considering shorter time-scale.  Collaboration:
  37. 37. SAMIHA TABASSUM HAQUE (TP034305) 37 ONLINE PATIENT SCHEDULING SYSTEM Agile methods signify collaboration between the user and the developer to work together during the entire project life cycle.  Motivation: Projects are built around motivated individuals. The methodology provides an environment to support the developer in decision making.  Face-to-face Conversation: Face-to-face conversation is the most efficient and effective method of conveying information to and within the development phase.  Measure the Progress as per the Working Software: Working software are primary measures of progress during a system development.  Maintaining Constant Pace: Agile processes aim towards sustainable development. The developers, and the users are able to maintain a constant pace with the project. Figure 18: Agile Basic Principles. (AGILE MODELING AND PROTOTYPING. (n.d.))  Monitoring: Paying regular attention to technical excellence and significant design to enhance agility.  Simplicity: Agile methods make the system development simple and easily understandable for users.  Self-organized Teams: As an independent developer for the Online Patient Scheduling System, by following the Agile approach, the developer is able to self-organize the tasks during the system development and implementation.
  38. 38. SAMIHA TABASSUM HAQUE (TP034305) 38 ONLINE PATIENT SCHEDULING SYSTEM  Review the Work Regularly: Reviewing the work done at regular intervals in order to produce a more effective system and adjust its behavior accordingly. 3.4 Agile Methodologies There are several methodologies that could be implemented during the Online Patient Scheduling System. Agile Methods are focused on different aspects of the software development life cycle. Though few of the Agile methods are practice centric such as Extreme Programming, Pair Programming, others focus on software projects such as the Scrum Approach. 3.4.1 Scrum Approach for Online Patient Scheduling Among several methods available in Agile Methodology, the developer has chosen the Scrum Approach to develop the proposed system. Scrum is one of the most widely used Agile Methods. Ken Schwaber first described Scrum in 1996 as a process that “accepts that the development process is unpredictable,” formalizing the “do what it takes” mentality, and has found success with numerous independent software vendors. In the Scrum process, a project management is wrapped around a software development methodology. This methodology is flexible and based on incremental software development processes. In Scrum Approach, the entire development cycle is divided into a series of iteration where each iteration is named as a sprint. There are three main artifacts produced by Scrum method, Product Backlog, Sprint Backlog and Sprint Burn-down chart. Figure 19: Scrum Methodology Overview. (COHEN, D., LINDVALL, M. and COSTA, P. (2004)) Product Backlog: It is an evolving, prioritized queue of business and technical functionalities that need to be developed into the system and defects that need to be fixed during the release.
  39. 39. SAMIHA TABASSUM HAQUE (TP034305) 39 ONLINE PATIENT SCHEDULING SYSTEM The Product Backlog contains a unique identifier for each requirement such as categories, feature, enhancement, defect, status and the estimate for the features. It is kept in a spreadsheet-like format. Sprint Backlog: This is a list of all technical and business features, weaknesses and enhancements that have been scheduled for an on-going iteration. These lists are known as Sprints. Maximum duration of a sprint is 30 days. Once these requirements are listed, they are broken down into tasks. For each of these tasks in the backlog, the formatted spreadsheet contains a short task description, the origin of the task and who owns the task, the status and the number of hours remaining to complete the task. The Sprint Backlog is updated each day by the developer to determine the latest estimates of the work remaining to complete the task. Figure 20: Scrum Methodology Simplified. (Sharma, S., Sarkar, D. and Gupta, D. (2012)) Sprint Burn-down Chart: A graphical presentation of the hours remaining to complete Sprint tasks. This is a useful demonstration that determines exact calculations of timeline of a sprint. Figure 21: Sample of a Sprint Burn-down Chart. (Williams, L. (2007)) Overview of the Scrum Process:
  40. 40. SAMIHA TABASSUM HAQUE (TP034305) 40 ONLINE PATIENT SCHEDULING SYSTEM The Scrum Process is composed of three phases: Pre-Sprint Planning: Works that are to be done on the system are kept in ‘release backlog’. During this phase functionalities and features are selected from the release backlog and moved to sprint backlog. For the proposed system, user requirements and functions of the system are gathered in the release blog. Then one by one, the functionalities such as user log in, physicians’ list, available time slots, appointment booking, and updating, sending notifications are moved to the sprint backlog. The tasks in the backlog are generally at a higher level of abstraction, thus pre-sprint planning is able to identify a sprint goal that determines the core and reason of the task. Coding: During the Sprint-backlog phase, code is integrated for each sprint such as home page log in for users, management portal and physicians’ portal. Next the acceptability of each of these functions is tested daily by the developer. Figure 22: Brief picture of Scrum Process. (Williams, L. (2007)) Post Sprint Review: After every sprint, a post-sprint analysis would be carried out by the developer to test project progress and demonstrate the functions, design, strength, weaknesses and trouble spots of the proposed system. 3.5 Scrum Implementation: Product Backlog Sprint Backlog Sprint
  41. 41. SAMIHA TABASSUM HAQUE (TP034305) 41 ONLINE PATIENT SCHEDULING SYSTEM 1.Log-in Admin User log in 1. Admin 2. System Change Control (For Example: Adding new user to the system, updating the system) Admin User Functions 3. Log-in, Register Patient User Log in 2. Patient 4. Department List Patient User functions 5. Physician List 6. Available Slots 7. Book Appointment 8. Make Deposit 9. Update/ Cancel 10. Log-in Doctor User Log in 11. Update Doctor Specification Doctor User Functions 3. Doctor12. View Patient Detail 13. View Appointment Record 14. Log in Nurse, Staff User Log in 15. View and Update Patient Detail Management Staff User Functions 4. Staff16. View and Update Appointment Records Table 1: Scrum Implementation Table
  42. 42. SAMIHA TABASSUM HAQUE (TP034305) 42 ONLINE PATIENT SCHEDULING SYSTEM 3.6 Conclusion: The prime prevalence of Agile Project Management, especially the Scrum-based approach is its simplicity. One of the major components in Scrum Approach is roles, the Scrum Master. In this project, the developer herself is the Scrum Master who is responsible for self-organization and maintain the product’s progress in a series of month-long “sprints”. The developer will be able to develop, test and organize feature of the Online Patent Scheduling effectively. By focusing on eliminating unnecessary bureaucracy, process and practice in managing the project, Agile methodology will make it possible for the developer to eliminate re-occurring errors and actually finish the project in time.
  43. 43. SAMIHA TABASSUM HAQUE (TP034305) 43 ONLINE PATIENT SCHEDULING SYSTEM Chapter 4: System Architecture 4.1 Introduction Information systems are complex artifacts lie airplanes and power plants. Because society heavily depends on information system, they have to be developed very carefully. (Van Hee, K., Sidorova, N., Voorhoeve, M. and van der Woude, J. (n.d.)) For a software architecture, software components determines the functional architecture such as database management system, connectivity software and workflow engine. The proposed Online Patient Scheduling aims to follow the two main properties of software architecture: Consistency and Completeness. The components of the Online Patient Scheduling would be consistent internally in order to avoid any contradiction once they are implemented together. System completeness is a modelling framework based on the information gathered from Chapter 2, Chapter 3 and Chapter 4 for developing this system. System completeness would provide a practical test from a set of models to examine the balance of internal and external behavior. The Online Patient Scheduling System is consisting three modules:  Patient  Physician/Nurse/Staff  Administration. System Features: Patient Features: To register new account and to login and logout from the system. Allows to view doctors list according to departments as well as doctors’ specifications. Users are to book, update and cancel an appointment with doctor. Once an appointment is booked, system automatically sends Email to the doctor as well as to the Patient. To make payment for consultation deposit (payment process is simulation only). Patients are able to rate a consultation visit experience with a doctor Physician/ Nurse/Staff Features: Physicians would be to view patient details and to update doctors’ specification details. The system would allow physicians to view appointment records and to update appointment record. For example: status of appointment from “New” to “Completed”. The system would be
  44. 44. SAMIHA TABASSUM HAQUE (TP034305) 44 ONLINE PATIENT SCHEDULING SYSTEM designed that would allow clinical staffs to view patient details and to update doctors’ details. Management staff would be allowed to view appointment records as well as to update appointment record. Example: status of appointment from “New” to “Completed”. Admin Features: Administrative staff would be allowed to register new user in the system such as: Doctor, Nurse & staff as well as Update system control records (For Example: Email address of the system to send automatic Emails). Figure 23: Simple Patient Scheduling Architecture. 4.2 Abstract Architecture 2-tier architecture would be implemented to the Online Patient Scheduling System. In the proposed 2-tier model, on the first-tier, patients are able to access appointment information with the web- browser over the Internet. Now the second tier connects with the first tier in order to exchange information using web-services. This architecture would be using the web-server to connect to the Internet and handle the HTTP requests.
  45. 45. SAMIHA TABASSUM HAQUE (TP034305) 45 ONLINE PATIENT SCHEDULING SYSTEM Figure 24: 2-tier Online Patient Scheduling System Architecture. (S, N. and Sarda, E. (2014)) Then it responses users’ request with HTTP protocol. In case the HTTP request is related to patient appointment scheduling services, the IIS web-server would delegate the dynamic response to another server side application located at application server to process the request. Then the results response from application server is converted into HTML format through the web-server and displayed in the standardized HTML web page. (Karen Davis, Stephen C. Schoenbaum, and Anne- Marie J. Audet. (2005), (S, N. and Sarda, E. (2014))) User login and user registration requests are processed by the portal server located in 2-tier. Application server would be responsible to complete end-to-end appointment tracking and scheduling. Multiple physician scheduling, available appointment searching, rescheduling, confirmation and cancellation would be processed under the Application Server. (S, N. and Sarda, E. (2014)) 4.3 System Design 4.3.1 Use Case Diagram: Previous Version:
  46. 46. SAMIHA TABASSUM HAQUE (TP034305) 46 ONLINE PATIENT SCHEDULING SYSTEM Figure 25: Previous Version of Use Case Diagram. New Version:
  47. 47. SAMIHA TABASSUM HAQUE (TP034305) 47 ONLINE PATIENT SCHEDULING SYSTEM Figure 26: New Version of Use Case.
  48. 48. SAMIHA TABASSUM HAQUE (TP034305) 48 ONLINE PATIENT SCHEDULING SYSTEM Figure 27: Use Case Diagram for Patient.
  49. 49. SAMIHA TABASSUM HAQUE (TP034305) 49 ONLINE PATIENT SCHEDULING SYSTEM Figure 28: Use Case for Doctor/Staff and Admin Login. 4.3.2 Use Case Specification  Use Case Specification for Login Use Case Login Brief Description To login to the system Actor Admin, Doctor, Nurse, Patient Precondition Actor needs to have a valid ID and password. Main flow  Actor to identify itself as patient or staff.  Actor to enter ID and password.  System validates the entered ID and password.  If ID and password are validated, system grants access and displays the system main screen. Alternative Flow If invalid ID or password is entered, system denied access to the system. Table: Use Case Specification for Login.  Use Case Specification for Register New Staff Use Case Register new staff
  50. 50. SAMIHA TABASSUM HAQUE (TP034305) 50 ONLINE PATIENT SCHEDULING SYSTEM Brief Description To register new staff user in the system Actor Admin Precondition Actor needs to logon to the system Main flow  Actor to enter all personal details of a new staff.  Select a position for the staff.  Assign the staff to work in a specific hospital.  Confirm registration and a new staff ID will be generated. Alternative Flow If any invalid details are entered, warning message will be displayed. Table: Use Case Specification for Admin  Use Case Specification for Patient Register Use Case Register New Patient Brief Description To register new Patient to use the system Actor Patient Precondition Actor needs to logon to the system Main flow  Actor to enter all personal details of a new user.  Confirm registration and a successful registration message will be displayed. Alternative Flow If any invalid details are entered, warning message will be displayed. Table: Use Case Specification for Patient Register  Use Case Specification for Manage Appointment Use Case Manage Appointment Brief Description To manage patient appointments Actor Patient, Admin
  51. 51. SAMIHA TABASSUM HAQUE (TP034305) 51 ONLINE PATIENT SCHEDULING SYSTEM Precondition Actor needs to logon to the system Main flow  Actor needs to book an appointment.  Actor can save the appointment and reschedule before making payment.  Making payment will send confirmation Email to the user. Alternative Flow If any invalid details are entered, warning message will be displayed. Table: Use Case Specification for Manage Appointment.  Use Case Specification for System Log/Patient Record Use Case Patient Record Brief Description To access system log/patient record Actor Admin Precondition Actor needs to logon to the system Main flow  Actor needs to logon to the system.  If actor is Patient they are only allowed view own account details.  If actor is the admin, he/she is allowed to view all the system logs. Alternative Flow If any invalid details are entered, warning message will be displayed. Table: Use Case Specification for System Log.  Use Case Specification for Post Reviews Use Case Patient Record Brief Description To post consultation ratings. Actor Patient Precondition Actor needs to logon to the system and complete an appointment. Main flow  Actor needs to logon to the system.
  52. 52. SAMIHA TABASSUM HAQUE (TP034305) 52 ONLINE PATIENT SCHEDULING SYSTEM  Actor needs to confirm an appointment.  Make payment and visit the physician.  Review the physician’s service in the consultation rating page. Alternative Flow If any review is not posted, prompt message is displayed. Figure: Use Case Specification for Post Review. 4.3.3 Class Diagram First Version: Figure 29: First Version of Class Diagram. New Version:
  53. 53. SAMIHA TABASSUM HAQUE (TP034305) 53 ONLINE PATIENT SCHEDULING SYSTEM Figure 30: New Version of Class Diagram. Figure 31: Showing Base Cases.
  54. 54. SAMIHA TABASSUM HAQUE (TP034305) 54 ONLINE PATIENT SCHEDULING SYSTEM 4.3.4 Activity Diagram Figure 32: Activity Diagram for Online Patient Scheduling System. 4.3.5 Sequence Diagram First Version:
  55. 55. SAMIHA TABASSUM HAQUE (TP034305) 55 ONLINE PATIENT SCHEDULING SYSTEM Figure 33: First Version of Sequence Diagram. New Version:  Sequence Diagram for Login
  56. 56. SAMIHA TABASSUM HAQUE (TP034305) 56 ONLINE PATIENT SCHEDULING SYSTEM Figure 34: Sequence Diagram for Login.  Sequence Diagram for New Account Register
  57. 57. SAMIHA TABASSUM HAQUE (TP034305) 57 ONLINE PATIENT SCHEDULING SYSTEM Figure 35: Sequence Diagram for New Account Register.  Sequence Diagram for Register New Doctor/Staff Figure 36: Sequence Diagram for Register New Staff.
  58. 58. SAMIHA TABASSUM HAQUE (TP034305) 58 ONLINE PATIENT SCHEDULING SYSTEM  Sequence Diagram for Patient Manage Appointment Figure 37: Sequence Diagram for Patient Manage Appointment.  Sequence Diagram for Admin/System Logs Figure 38: Sequence Diagram for System logs.
  59. 59. SAMIHA TABASSUM HAQUE (TP034305) 59 ONLINE PATIENT SCHEDULING SYSTEM 4.3.6 Entity Relation Diagram Previous Version Figure 39: Previous Version of ERD Online Patient Scheduling. New Version
  60. 60. SAMIHA TABASSUM HAQUE (TP034305) 60 ONLINE PATIENT SCHEDULING SYSTEM Figure 40: New Version of Entity Diagram. 4.3.7 Database Table Structure  Account Table Name Account Column Type Data Type Length Description AccountId Primary Key Varchar 8 Unique ID for account record Email Varchar 50 Email address of user to login to the system Password Varchar 50 Password to login to the system FirstName Varchar 50 First name of user LastName Varchar 50 Last name of user ICNumber Varchar 12 IC number of user
  61. 61. SAMIHA TABASSUM HAQUE (TP034305) 61 ONLINE PATIENT SCHEDULING SYSTEM Telephone Varchar 20 Telephone number of user Address Varchar 100 Address of user Table: Database table for Account  Appointment Table Name Appointment Column Type Data Type Length Description AppointmentId Primary Key Varchar 8 Unique ID for appointment DoctorId Varchar 8 Unique ID for Doctor HospitalId Varchar 8 Unique ID for Hospital Date Datetime Date of the appointment BookedbyAccountId Varchar 8 Account ID through which appointment is being made Status Varchar 20 Status of the appointment such as; paid, unpaid, complete. Table: Database table for Appointment  Credit Card Table Name Credit Card Column Type Data Type Length Description CardNo Primary Key Varchar 16 Unique number of the card ExpiryDate Date Expiration date of the card SecurityCode Varchar 100 Security code of the card CardType nchar 10 Type of the card such as; Visa/Master Card. Table: Database table for Credit Card.  Doctor Table Name Doctor Column Type Data Type Length Description
  62. 62. SAMIHA TABASSUM HAQUE (TP034305) 62 ONLINE PATIENT SCHEDULING SYSTEM DoctorIs Primary Key char 8 Unique ID of Doctor SpecialtyId char 8 Unique ID for each specialty of the doctor. YearOfExperience int Years of expertise of the doctor. ChargesRM decimal 18,2 Fee charged by the doctor. Table: Database table for Doctor  Hospital Table Name Hospital Column Type Data Type Length Description HospitalId Primary Key Varchar 8 Unique ID of the branch of hospitals. HospitalName Varchar 50 Name of the hospital Address Varchar 50 Address of the hospital. Telephone Varchar 50 Telephone of the hospital Email Varchar 50 Official email of the hospital for enquires. Table: Database table for Hospital.  Specialty Table Name Specialty Column Type Data Type Length Description SpecialtyId Primary Key char 8 Unique ID for each specialty according to departments. Description Varchar 50 Detailed information about the specialization. Table: Database table for Specialty.  Rating Table Name Rating. Column Type Data Type Length Description

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