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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.
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
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
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
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
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
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.
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.
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.
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.
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.
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
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:
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.
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.
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))
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.
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))
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.
Simplybook.me Interface:
MyPatientSchedule Interface:
This system offers three interfaces for patients, reception and management interface.
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.
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.
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.
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.
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:
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.
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.
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))
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.
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 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))
New Version:
Actor Admin
Actor Patient
New Version:
New Version:
Sequence Diagram for Login
New Version
Appointment
Table Name Appointment
Column Type Data Type Length Description
AppointmentId Primary Varchar 8 Unique ID for appointment
Key
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 Varchar 16 Unique number of the card
Key
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
Hospital
Table Name Hospital
Column Type Data Type Length Description
HospitalId Primary Varchar 8 Unique ID of the branch of
Key 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 char 8 Unique ID for each specialty
Key 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
Payment
Table Name Payment
Column Type Data Type Length Description
PaymentId Primary Int Unique ID for payment.
Key
CardNo Nchar 16 Card number through which
payment is being made.
PaymentDateTime Datetime Time and date of the payment
Amount Money The amount that is being paid
AppointmentId FK Nchar 8 The appointment for which
payment has been made.
Table: Database table for Payment.
Staff
Table Name Staff
System Email
Table Name System Email
Column Type Data Type Length Description
Email Address Primary Varchar 50 Email address of the admin
Key
EmailPassword Varchar 50 Password to login.
Table: Database table for System Email
with .Net platform. C# is a high-level programming language that is free of the backward
compatibility curse with updated features. One of the main benefits for the developer to choose C#
is that, the programing language provides garbage memory collection at runtime, memory access
checking and type. (Rasheed, F. (2006))
The language would maintain the useful operations of C++ like operator overloading, pre-
processor directives, function pointers in the form of delegates. C# is a distributed language with
an executable environment called Common Language Runtime. The developer would have the
advantage of the .Net platform that includes a bundle of standard libraries that provides basic
functionalities, debuggers and compilers. Coding with C# allows the developer to write portable
programs that means once the program is written, they are able to function with any changes on
different hardware platforms and operating systems.
4.5.2 IDE:
The developer has chosen Microsoft Visual Studio Enterprise 2017 as the Integrated Development
Environment for the Online Patient Scheduling. The IDE simplifies the development process of
the .Net Applications. The key benefit of selecting Microsoft Visual Studio Enterprise 2017 is the
auto complete features that automatically completes the syntax as the developer types a (.) dot with
namespaces, objects and enumerations. The Environment has project and solution explorer that
manages applications with multiple files. Microsoft Visual Studio Enterprise 2017 is built with
properties tab that allows the developer to set multiple properties for multiple windows and web
controls. The benefit of this standard debugger is that it allows the programmer to debug the
program using putting break points for observing run-time behavior. Together with Visual Studio
Team Services and Team Foundation Server, the IDE seamlessly deliver software to any targeted
platform. It supports extend DevOps processes to SQL Server through Redgate Data Tools and
safely automates database deployments within Visual Studio. Xamarin Test Recorder, together
with Xamarin test cloud will allow the developer to test on thousands of physical devices right
from within the IDE. (Visual Studio, 2017)
4.5.3 Database Management System:
Database Management System is a collection of interrelated data and a set of programs to access
the data. (Taneja, A. (n.d.)) Database Management System provides efficient data storage and
retrieval of information. In general terms, DBMS are developed to manage large amount of data
that includes defining structure for information storage and providing mechanism for information
manipulation.
Microsoft SQL Server: The developer has chosen Microsoft SQL as the Database Management
System environment. Microsoft SQL Server is a rational DBMS. One of the major reasons for
choosing Microsoft SQL Server is that, the system is scalable. SQL Server features built-in
automated back-up and recovery tools that protects information in case of a system failure. SQL
Server allows the developer to specify security policies at granular level such as, who can see
which column of data and under what circumstances.
While researching on the SQL Server DBMS, the developer focused on the major components of
SQL Server:
Rational Engine, the query processor that manages execution of queries as it requests data
from storage engine and processes the results returned.
SQL OS bridges the host machine and SQL Server. Highly configurable operating system
that handles all the activities performed on the database engine.
Storage Engine handles storage and retrieval of the data on to the storage system. SQL
Server creates two types of files at the disk level- Data file that stores data in data pages
and Log file are used to store transactions performed on the database.
view the data within the database, configure user accounts, perform backups, replication, transfer data
between databases, and more.
Figure 51: Chrome Architecture. (Burstyn, J., Barleta, K., Berk, L., Cole, P. and Franzon, T. (2009))
The advantage of the multi-process feature is that it allows each tab process to run independently
from the browser so that each of the tab could dedicate to single web-application thus increasing
and stabilizing the browser performance.
4.5.7 AES Encryption for Security Code:
The developer will be implementing AES encryption to encrypt the security codes in the user credit
card credentials. Now-a-days people prefer to use credit cards as opposed to cash when paying for
any online service. Since the Online Patient Scheduling is aimed to offer to online payment, the
developer also has to consider abut protection solutions including fraud and data security. By
reducing any data’s vulnerability, encryption will also reduce the system’s risk of suffering from
data breach and financial and reputational damage.
AES Encryption algorithm is a block cipher that uses an encryption key and several rounds of
encryption. A block cipher is an encryption algorithm that works on a single block of data at a
time. The term rounds mean the way in which the encryption algorithm mixes the data re-
encrypting it ten to fourteen times depending on the length of the key. (AES Encryption: AES
Encryption and Related Concepts, 2016) In order to understand the importance and stability of
encryption process, the developer initially compared two different type of encryption algorithm:
AES and DES algorithm.
Characteristic DES Encryption AES Encryption
itself. These modes of operations use AES in each different way. It is important for the developer
to understand that if she implements strong encryption in a weak way that could result in poor
security. Another important reason for the developer to choose AES over DES is to protect the
sensitive financial data that would increase the users’ trust. One of the prime advantage of
implementing AES would be that, the algorithm is executed in both of the hardware and software.
This is because AES algorithm takes 128-bit plain text and 128-bit secret key that makes a 128-bit
block depicting as 4x4 square matrix. This square matrix is an initial transformation that is
followed by 10 rounds. Among them, 9 rounds contain Sub-bytes that will use S-box performing
byte to byte substitution of the matrix, shift rows, shuffled columns of the matrix from right to left
and addition of round keys. (Tech Differences, 2016)
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).
To rate a consultation, visit experience with a doctor.
Doctor
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”.
Admin
To view patient details.
To update doctors’ personal details.
To view appointment records.
To update appointment record. Example: status of appointment from “New” to
“Completed”.
To register new user in the system: Doctor, Nurse & staff.
Update system control records (Example: Email address of the system to send automatic
Emails).
In order to identify the type and nature of information the researcher needs to collect from the end
users, a set of questionnaires are prepared regarding issues with the existing traditional
appointment scheduling process. Not only that, user location and user accessibility to online
services are also taken into consideration while designing the questionnaires. There are few more
factors mentioned in the questionnaire that would help the researcher to reach a calculation for this
project such as, how often and what percentage of users rely on Online services, how many of
users seek clinical help for non-severe health issues and what percentage of users are comfortable
with the functions proposed in the system. Questionnaires would be give out to thirty end users to
calculate the average opinion about the system functionality.
5.1.2 Interview
Interview is a systemic way of collecting data as well as gain knowledge from a professional about
any on-going project development. Kvale (1996, p.14) defined interview as an interchange of
views between two or more people on a topic of mutual interest. Interviews are an effective way
for participants to get involved and talk about their views regarding a certain topic.
The researcher has chosen Interview as another data collecting tool for the proposed Online Patient
Scheduling System. The interview would be conducted with three physicians and three hospital
management staff in order determine the organizational and productive function of the
appointment system. The reasons the researcher has chosen to interview the specialized physicians
and management staff are that, through this method, accurate information could be gathered
directly from the personnel who are involved with the system functions. There are no chances of
non-response as the interviewer personally collects the data. The collected data is taken to be very
reliable since the interviewer tactfully collects the information by cross examining the responders.
Structured Interview:
There are several types of interviews that could be conducted such as structured interview, semi-
structured interview, unstructured interviews, and non-directive interview.
As a data collecting tool, the researcher would design structured interview questions and would
interview the physicians and staff. A structured interview is defined as a standardized interview.
Through this process, the same questions would be asked to all respondents. Though this type of
interview introduces rigidity to the interview, it helps the interviewer to examine the difference in
answers and conclude a decision.
The questions to be asked during the interviews with physicians and management staff addresses
the respective organizational work-frame, employee productivity and management costs.
Objective: To understand in what percent of the targeted audience have online access.
Summary: From the response gathered, the majority of the participants have daily Internet
access which means 90% of the participants are familiar with online services. This result
establishes the initial objective of the Online Patient Scheduling System.
Question 2:
Objective: In order to know to what extends of the participants understand the online
reservation concept.
Summary: Around 60% of the participants are frequent online buyers. This data helps the
researcher to determine the range of users that would be beneficial with the Online Patient
Scheduling System.
Question 3:
Objective: This question aims to understand the users’ pattern of illness to determine the
users’ usability of the Online Patient Scheduling.
Summary: The majority opinion indicates that, 56.7% of users suffer from seasonal
illness. This result establishes the scope of the system.
Question 5:
Objective: To collect legitimate data to determine the issue faced by users in a traditional
scheduling environment.
Summary: The data collected shows that, 76.7% of participants have agreed to the fact
that they find it tiresome to wait for an appointment especially for non-severe illness. This
data is important to establish the ground that, not only large hospitals but also local clinics
could be beneficial from the Online Patient Scheduling.
Question 7:
Objective: To understand the user range for implementing the system in local clinics.
Summary: 86.7% of participants stated that they do not suffer from any chronical diseases.
This result establishes that small local clinics dealing with non-chronicle illness attends the
majority of users. Thus, local clinics could also be the targeted user base.
Question 8:
Objective: To understand the convenience of users between the traditional way and online
patient scheduling.
Summary: Even though the data collected from the questionnaire, shows a tie result on
this question, majority of the participants agree on facing difficulties while making an
appointment over telephone.
Question 10:
Objective: To determine the primary feature of the online patient scheduling while
comparing with the traditional way of appointment making.
Summary: The data shows that, 50% of the users would choose not to make a phone call
and wait on the line to make appointment. This result helps the researcher to determine the
initial feature of the system where users are able to make appointment sitting at home.
Question 11:
Objective: To establish the ground of how Online Patient Scheduling would cause the
users much less time.
Summary: Majority of the participants agreed on the time-consuming factor on the
traditional appointment making.
Question 12:
Objective: In order to understand the user requirements for the Online Patient Scheduling
System.
Summary: The statistics show that, 50% of the participants agreed that an Online Patient
Scheduling would be suitable replacement as an effective healthcare facility.
Question 13:
Objective: In order to understand the beneficial factors of the Online Patient Scheduling
System.
Summary: 30% of the users would prefer not to wait on the telephone for appointment
confirmation. While 43.3% of users would prefer to be able to make changes in their
appointments. This result also helps the researcher to determine the initial requirements of
the system.
Question 14:
Objective: To gather more user requirements for the Online Patient Scheduling.
Summary: The collected data determines more requirements of the Online Patient
Scheduling. Since majority of the users would prefer a system that is quick-responsive and
is able to provide better quality service, the researcher’s main focus would to working on
these criteria.
Question 15:
Answer: The current system is already offering a bunch new stuff. In there were any
enhancement to be made, I would say the propose system could become the base for a
smart hospital management system.
Question 4: In your opinion, do you think online payment would be a secure function
especially in perspective of Bangladesh?
Answer: Yes, I think paying online for the appointment would be secure. In a real-life
scenario, online transaction can benefit the patients from the risk of hijacking or pick-
pockets in Dhaka city.
Question 5: Do you have any recommendation to enhance the proposed online service for the
future?
Answer: I think generating copy of the physician’s prescription could be an enhancement.
Question 3: Would you prefer if patients were able to make an online deposit prior to the
scheduled appointment?
Answer: Yeah. I think offering the users to make an online deposit could be a new addition
in such systems.
Question 4: In your opinion, do you online payment would be a secure function especially in
perspective of Bangladesh?
Answer: Of course. As long as the patients’ card information is encrypted, it is definitely
a secured functionality that the system could offer.
Question 5: Do you have any recommendation to enhance the proposed online service for the
future?
Answer: As a developer myself, I think the proposed system could be the baseline for an
advanced online medical service with artificial intelligence implemented to prescribe
patients remedies online.
5.4.1 Conclusion from the Data collected through Interview:
All three specialists have similar observation about the Online Patient Scheduling System. All
the comments received from them will help the developer to develop the system in such a way
that will be easy to be use by the patients as well as the hospital staff. Interviewee 1 have
highlighted the importance of the flexibility of the system. That means, allowing the users to
make changes in their appointments. He has also suggested that online deposit would also be
beneficial. Interviewee 2 is a physician herself. She has put more importance on the system
availability. She has also recommended the system to generate prescriptions. Interviewee 3 has
talked about the technical implementation of the system. Encryption algorithm and access
control of the database has brought to the developer’s attention.
Chapter 6: Implementation
This chapter includes all details about the implementation of the system, which includes some
ground rules, technical details such as: programming technique, design consideration, and an
explanation for each key functionality in the system.
Business rules
There are some assumptions and business rules that the developer implemented into the system, to
better reflect the actual processes in a hospital. They are discussed as below.
1. There are multiple branches of hospital using the same system.
2. Each branch has its own staffs, such as: doctors and nurses.
3. One patient can only have one account in the system.
4. A patient can visit any branch under the same hospital group.
5. A hospital staff (doctor, nurse) can only work in a hospital.
6. Consultation fee is decided according to different doctor.
7. Office hour is from 9am to 6pm.
8. An appointment has to be made in at least 7 days in advance.
9. An appointment booked without payment is not a confirmed appointment. Only when
payment is done, the appointment is confirmed to both doctor and patient.
10. Only credit card payment is accepted.
11. A patient can only rate a completed appointment.
12. Rating for an appointment can always be updated, the rating records are for internal
reference only.
6.1 Screenshots
The system has an interactive design, which is very different from a typical hospital website.
Screenshots for the whole system will be documented below, with a description about each what
each page does.
6.1.1 Home page
This is the first page that a user lands to the hospital system, the home page is an interactive
and responsive page that differentiated from other hospital system.
the system for the first time, he or she can register a new account by clicking on the “Register”
button.
6.1.17 Encryption
The credit card detail is encrypted in the database. As figure below shown, the “security
code” field is encrypted and unreadable.
Figure 92: Sample code for new appointment past date validation.
Besides, an appointment has to be made in at least 7 days advance. To achieve this, system checks
the appointment date with the current date for the day difference. If the count is more than 7,
system displays a warning message.
Finally, system insert a new appointment record into the database. For a new appointment record,
the initial status will be “UNPAID”. At this stage, the new appointment is not considered as a
confirmed appointment yet. Not until the payment is settled.
Next, the system will simulate the actual credit card verification process to the bank. All card
details such as: card number, issuer, expiry date and security code will be validated. A payment
can be completed only if the entered card details passed the verification process.
When the payment is completed, system updates the appointment status from “UNPAID” to
“PAID”. Finally, system also trigger an automatic notification e-mail to both the doctor and patient
who made this appointment.
A function is coded for the system to send email, as below shown. This function will use the SMTP
server of Gmail, to send an email. In this case, the developer also created a function for admin user
to maintain a system email address for this purpose. The system will use a Gmail account to send
appointment confirmation email to the users.
The system checks the radio button selected by user, and to assign a point to the rating record. As
the sample code below shown, point is 1 when radio button 1 (“Very good”) is selected.
Then, system insert the rating record into the database. The key for each rating record is the
appointment ID, thus only patient who completed an appointment session can provide feedback
rating.
The same key is being used for decryption, to reverse the encrypted data to be readable.
For the password strength checker, it is implemented by using the Ajax plugin. This is a tool in the
Visual Studio which allows a faster implementation of commonly used tool.
Accessing the
Sprint • Log in Possible
Sprint Registration system
Content • Sign up Product facilities.
Figure 106: Unit Testing Process of Registration Sprint of the Online Patient Scheduling.
This section is to undertake a small part of a testable unit and to test to see whether it runs with
deliverables as expected. Each unit of the system would be tested individually to assure desired
deliverables. For example, the log in/registration module would be programmed to consist of 5-10
characters. Through Unit Testing, the developer would be able to establish that to log into the
system, user has to input 5-10 characters. Only after each unit is tested successfully, the process
follows to the next phase.
Unit Testing for “Login”:
Module: Login
No Test Case Expected Result Actual Result
1. Leave the email and password Warning message displayed As Expected
field empty and press “Login” to prompt email and
button. password.
Completed, Unpaid,
Cancelled.
4. Make a New Appointment and An email will be sent to As Expected
fill up the required steps and person who booked his
press “Confirm”. appointment to inform
about the status change.
5. Select newly made Status of the selected record As Expected
appointment with status = will be updated to
“NEW” and click on “RESCHEDULED”. An
“Reschedule” button. email will be sent to person
who booked his
appointment to inform
about the status change.
Table: Integration for New Appointment and My Appointment Page.
Once the system is thoroughly tested, the developer would ask actual users such as doctors, nurse,
patients to test the system and their response would be collected. Their opinion would be evaluated
in the scale of: 1 = Poor, 2 = Fair, 3 = Good, 4 = Very Good, 5 = Excellent.
Participant Name: Ibrahima Sory Sanoh Nationality: Guinean
Position: Student Date: 19.03.2017
Graphical User Interface Evaluation
Graphical user interface evaluation
No. Question Rating from Tester 1
1 2 3 4 5
1. Easy to access information? √
2. Appropriate font? √
3. Appropriate color? √
Table: User Acceptance Test for GUI.
1 2 3 4 5
1. System content easy to √
understand?
2. Is the validation appropriate? √
3. Does the error message helps? √
4. Is the system interruption clearly √
stated?
5. Is the system interruption √
helpful?
6. Appropriate use of textbox, √
check box and combo box?
Table: User Acceptance Test for Human Computer Interaction.
1. Login √
2. Registration √
3. Update personal information √
4. Make a New Appointment √
5. Updating Appointment. √
6. Making Payment. √
7. View My Appointment √
8. View Doctor Record √
9. Register New Staff. √
10. System Records. √
11. Rate consultation √
12. Sending notification Email. √
13. Password Strength Checker. √
Table: User Acceptance Testing for overall System.
7.5 Conclusion:
The User Acceptance Testing was conducted through the Team Viewer software. The responses
collected from the real users determines the usability of the proposed system. majority of
participants found the system functionality and GUI organized and quick responsive.
during the development phase. While selecting an appropriate methodology, the developer has
looked into several software developer methods and gathered brief knowledge about the concepts.
However, majority number of similar system followed the traditional Waterfall Method, the
developer has chosen the Agile approach. The simplicity and organized framework of the Agile
method would be a great choice for Online Patient Scheduling. A lot of background readings have
been done to plan a primary research design. Questionnaires and Interviews have been conducted
in order to collect initial requirement data. This way the developer was able to determine the
system functionalities. Microsoft Visual Studio is used as the developing environment because the
developer is familiar with IDE. The developer has implemented C# ASP.Net framework for the
execution of the system.
8.2 Conclusion:
One of the prime reasons that Online Patient Scheduling is gaining popularity in recent days is
that, the system provides an easier for receiving healthcare facilities to the general users.
The paper has proposed an Online Patient Scheduling System built on the Web Service
architecture. The Web Service architecture would provide an appropriate paradigm for developing
this integrated healthcare system. The prototype of the system would provide the feasibility of the
proposed architecture. This case study also provides a preliminary research on the consumers’
acceptance and the functionality of each unit.
The system integrates technology of Visual Studio 2017 and c#.Net development environment.
This combination of the two technologies have been used as an experimental teaching technique
in the Hospital Information System field for years. The system is designed to achieve maximum
user satisfactory. Since the functionality of online credit card payment is too complex for the
developer to implement, only stimulation of the online transaction would be implemented. As the
project evaluated, each step of the development process met the system’s objectives and primary
user requirements. Certain enhancements could be suggested for the system in future are to
integrate actual online payment transaction, SMS integrated and implementing Artificial
Intelligence features that could make this Online Patient Scheduling system an automated
intelligence clinic management.
The system was developed following the aims and objectives stated in the initial proposal. Though
it had been a challenging process, the Online Patient Scheduling has been furnished with the notion
of meeting the requirements of the Bachelor Degree in Information System Security in Asia Pacific
University.
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APPENDIX
Project Proposal Form (PPF)
Introduction
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 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) 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.
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.
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.
Problem Statement
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
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.
Literature Review
Studies by Ryan and Farrar (2000), Rubin et al. (2006), Cheraghi-Sohi et al. (2008), Gerard et al.
(2008) and Hole (2008) all point out that patients do have preferences regarding when to visit the
clinic and which physician to see. In general, patients prefer appointments that are sooner than
later, but they may prefer a later day over an earlier one if the appointment on the later day is at a
more convenient time. (Feldman, Jacob et al, 2014) Most of the studies in this area focuses on
inter-day scheduling and is determined in timing and sequencing patients with the objective of
finding the balance between in-clinic patient waiting times and doctor utilization. (Cayirli and
Veral, 2003, Gupta and Denton, 2008) This proposed model is viewed as a daily capacity
management for medical facilities. Online Patient Scheduling allows individuals to view list of
doctors in respective departments, book their schedule and if necessary to make changes and
update conveniently and securely through any Web-connected device such as laptop, smartphone
or tablet. This software is an efficient and affordable choice for all-sized organizations.
Flexibility of online patient scheduling enables it to be beneficial for a vast range of services and
activities at medical and healthcare institutions. While there is limited work on the customer side
behavior in appointment scheduling, there are numerous related papers in the operation side of
managing these paper works. Online scheduling lessens the time spent by staff on phone booking
and handling appointments. It reduces average waiting time for the ones who are to make the
appointments. A scheduling system eliminates the need for a staff to work overtime or for
management to hire new employees to handle reception work that could benefit the healthcare
organization with monetary savings. In addition, the automated appointment reminders reduce the
number of no-shows who fail to make their scheduled appointments. Many surveys have
concluded that these types of reminders can decrease the number of no-show by 50 percent. (The
Benefits Of Online Appointment Scheduling. 1st ed, 2012)
Deliverables
This system is designed to deliver specific facilities to the customers as in the patients as well as
the physicians and the administrative staff to manage their appointment work.
To allow users to view doctor’s list and specifications.
To allow users book appointments online.
To allow admin staffs to monitor the number of patients attended by doctors especially in
large medical institutions.
To allow physicians to manage the number of patients to be attended per day and to manage
their work load.
To allow the administration to maximize customer satisfaction and assure service
efficiency.
If time and my skills are in favor, this system would be able to deliver:
Online transaction for doctor’s fees.
To apply security encryptions that will assure save transaction.
To allow users to book vaccine dates for example flu shots.
To schedule on-site seminars and events.
Online appointment scheduling would reduce the workload of the administrative staff and provide
much better customer satisfaction.
Online Patient Scheduling both has tangible and intangible benefits to both users who would book
appointments and the hospital management including doctors and staffs.
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.
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.
Nature of Challenge:
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.
Brief description of project objectives
Deliverables
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.
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.
Additional Features:
Allow patients to review and rate their experience with the respective doctors.
The system generates daily Patient records and Appointment reports for each specific
doctor-patient encounter.
Once an appointment is booked, the system notifies the users by SMS one day prior to the
appointment.
Publisher: PEARSON
Book: Advances in Security Technology
Author: Haeng-kon Kim, Tai-hoon Kim, Akingbehin Kiumi (Eds)
Publisher: Springer.
Brief description of the development plan for the proposal project
System development methodology is an important framework that is used to structure, plan and
control the process of developing an information system. (SELECTING A DEVELOPMENT
APPROACH. (2008))
Among a wide variety of existing methodologies, I have considered to work under either the Rapid
Application Development or Agile framework. Both these methodologies are distinctive in their
own way and both have a discrete work frame to initiate, compile and implement any software
project.
Rapid Application Development: This iterative framework is commonly accepted for fast
development and high quality deliverables. RAD is less time-consuming than many other
methodologies since it involves the use of iterative Proto-typing especially at any stage of
development, active user involvement and computerized development tools such as Graphical
User Interface (GUI) builders, Database Management System, Code Generators, Object-Oriented
Techniques and Computer Aided Software Engineering (CASE) tools. One of the key strengths of
RAD is that this method concentrates on essential system elements from the user viewpoint that
makes this framework able to change system designs according to user demand rapidly. RAD
framework provides and stores necessary documentation to facilitate future development as well
as maintenance.
Agile Methodologies: 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. Agile process requires less
planning since it adopts the unit coding as it proceeds. This framework divides tasks into small
increments minimizing the risk by developing the system in short time boxes also known as
iterations. The main objective of Agile method is customer satisfaction and that is the reason it
focuses on single requirement with multiple iterations. (Sharma, S., Sarkar, D. and Gupta, D.
(2012)) The process is believed to be suitable for short-term projects with an effort of progressive
workflow that follows software development life cycle strictly.
Chosen Methodology: I have chosen to follow the Agile method to develop the proposed Patient
Scheduling System. One of the prime factors to go with this framework is that, Agile method
decomposes the complete system into manageable pieces known as modules. Since the Agile
process is iterative in nature, it does demand a certain timeline for each module. In terms of time
consumption, RAD method is less time consuming. Though this process breaks a project into
smaller segment, it mainly focuses on fulfilling business requirements rather than programming
excellence that results in lower system quality overall. RAD follows a structure where often project
objectives are unclear that causes lack of scalability and re-usability. By following the Agile
structure, I could minimize the risk of errors especially in programming field due to its iterative
nature. Moreover, its adaptive behavior would allow adapting the processes to adopt the new risks
as well as the changes in real-time requirements. Agile structures would support collaboration
among the three modules in the Patient Scheduling System that would need to be integrated at the
end of the software development process.
Brief evaluation and test plan for the proposed project
Success Criteria
The main aim of Online Patient Scheduling is to provide users simple accessibility. Easy access is
about patients being able to schedule appointments instantly, within a reasonable timeframe and
pre-book one if they wish. (Practice Management Network. (2009).) In order to ensure system
functionality before delivering, I would team up with 10 regular users and 3 known physicians to
conduct a test run for the system. I would divide the test run process into three categories: Unit
Testing, Integration Testing and Usability Testing.
System Flows:
Registration & Log In
Select Department
View Doctors’ List
Select Doctor
View available Appointment dates
View Appointment
Confirm/Edit/Cancel
Generate reports
1 Designing 2 Weeks
2 Coding 6 Weeks
3 Testing 2 Weeks
4 Tuning 1 week
Register
log in
Send confirmation
Make New View System Record
View Patient Records Update Patient Records email and reschedule of
Appointment Page
appointment
Reschedule view for Consulation
View My Appointments
Appointment Ratings
Make Payment
Only when appointment status is unpaid, user can make changes in the
appointment. Then the system will re-direct the user to the Make Payment page.
Patients are also able to rate their consultation experience with the physician.
5) Doctor/Staff User-
Doctor/Staff is allowed to view appointment record.
Also, allowed to update and delete records.
6) Admin User-
Register new Doctor/Staff.
Update Appointment Records.
Sending confirmation email about the appointment status.
View consultation rating.
View system records.
Questionnaire Sample:
1. How often you use the Internet?
(a) Every other week
(b) Once in a week
(c) Everyday
(d) I do not have internet access
4. How often you suffer from non-severe health issues? (E.g. Headache, cough, flu)
a. Frequently
b. Depends on weather
c. Never
5. Do you seek pharmaceutical drugs while suffering from flu?
a. Yes
b. No
c. Maybe
6. Do you find it tiresome to wait for an appointment at the clinic for a non-severe illness?
a. Yes
b. No
c. Maybe
7. Do you have any chronicle disease?
a. Yes
b. No
8. Do you think the traditional appointment scheduling process in time consuming?
a. Yes
b. No
c. Maybe
9. Have you ever faced any difficulties while making an appointment over the telephone?
a. Often
b. Frequently
c. Never
10. Traditional appointment making process limits your option to update your schedule
because-
a. I have to make a call and wait on the line for my turn to be able to speak to an
administrative staff
b. I have to physically go to the clinic if I want to change my schedule
c. I will neither go nor update (No show)
d. None of the above
11. Having an Online Scheduling system would cause you much less time while making an
appointment
a. Strongly Agree
b. Agree
c. Indifference
d. Disagree
e. Strongly Disagree
12. Effective appointment system shows awareness of healthcare organization about
importance of time of patient-
a. Strongly Agree
b. Agree
c. Indifference
d. Disagree
e. Strongly Disagree
Interview Response from Mr. Yasir Sadullah (System Manager, Robi Axiata Limited,
Dhaka)
Interview Response from Dr. Sharmin Kauser (Physician, BIRDEM Hospital, Dhaka)