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CHAPTER 1:
CONTEXT AND PRELIMINARY INVESTIGATION
1.1
Introduction
The project makes doctor-patient handling management system that will help doctors in
their work and will as well benefit patients to reserve doctor appointments and view their
medical progress. The scheme allows doctors to manage their booking slits online. Patients are
allowed to book empty slits online, and those slots are reserved concerning their names. The
system achieves the appointment data for multiple doctors of various date and times. Each time
a user visits a doctor his/her medical entry is stored in the database by the doctor. The next time
an operator logs in he/she views his/her medical history when and as required. The doctor may
also see the patient’s medical history at the same time as the patient visits him.
The system also consists of a Blood donor unit. This unit allows for registration for
blood donation and even searching of the Blood group. The module is established to help Blood
requirements with urgency via easy searches. A doctor can examine a blood donor online
according to their blood group requirements with ease and therefore reduce time wastage and
improve the doctor’s efficiency in the treatment. The online booking by the patients will be
assigned to the respective doctors according to specialization and will enable the doctors in the
admission of patients according to the spaces available in the hospital as well as referrals, and
this will help in improving efficiency as well as the quality of care in the health sector.
1.2 Project background
The project was required by the need to lessen the delays and the waiting time that most
of the patients spend before they are attended to by the doctor. The primary motivation was
behind the maximization of the free time for the doctors that mostly went to waste. The need to
improve the quality of care within the hospital was also a contributing factor to the study and
initiation of the project so that the patients could be enhanced and strengthened. The standard
methods of requesting an appointment include walk-in, call-in, an online request. When a patient
arrives at a clinic or calls the hospital to make an appointment, some hospitals will record the
meetings by the use of a scheduled book or a simplified online appointments calendar. The
traditional method of appointment making, while online scheduling of appointments is much
popular currently. A particular Wall Street Journal research was carried out, and it revealed that
the most of the adults prefer the online schedule of meetings., In comparison with other
methods, the online system has three pros: First, availability around the clock: for most health
centres, access to phones is distinctively available in the course of office hours, while online
systems are easier to use for patients. Secondly, saves time: clinic staff uses lesser time on
patients do not need to wait during peak hours in the clinics and phone booking. Thirdly,
Patient’s satisfaction: the online scheduling system allows patients to select physicians and time
slots based on patients’ preference, which will reduce the no-show probability and improve
patient health outcomes (Bowser, Utz, Glick, & Harmon, 2010, Schectman, Schorling, & Voss,
2008).
The project was inspired by the long waiting time that was being witnessed on the
hospitals during doctors’ appointments. The waiting time means merely the period which one is
required to wait for a specific action to occur after that work is requested or mandated
(Fernandes et al., 1994). The patients’ waiting time has been defined as being the length of time
from when the patient enters the outpatient clinic to the period to which the patient receives his
or her prescription (Jamaiah, 2003). The waiting time can also be described as the total time
elapsed from registration till consultation with a physician. There were two noted waiting times;
the first was time spent to see a doctor and the second was time taken to obtain drugs (Suriani,
2003).
The study deals with the waiting time that is spent to see physicians. Long waiting times
are a severe problem for patients using urban health centers in developing countries (Bachmann,
1998). A block meeting system was brought into the picture and evaluated in a prominent South
African health facility. Waiting time for all patients was measured over a weeks span before and
after the actualization of meetings. Focus groups and personal interviews were done with
patients and staff. After introducing appointments, patients with acute and chronic illnesses and
having designations had notable shorter waiting time than patients without appointments booked
(Mahomed, 1998). The meetings had no benefits for the patients who did not need seeing a
doctor or to collect repeated medication. There was an overall increase in patients’ waiting times
after introducing the system, mainly due to one typical day in the follow-up study. Focus groups
and interviews revealed that staff was skeptical at the beginning but after follow-up, they turned
optimistic about the system. Patients were positive about, the appointment system across all
period. The study showed that block meetings could reduce patients’ lounging times for acutely
ill patients, but may not prove suitable for all patients across the board. Both the patients and
staff had different opinions, which were harmonized with experience of the introduced system
(Mahomed, 1998).
Time wasted in waiting along the queues have the most significant set back to the
provision of quality care among the healthcare providers. The relationship between the doctors
and the patients is often deteriorated due to various factors that among them are the long queues
that most of the patients make and end up wasting their productive time doing nothing. The
patients make accusations that the doctors are not working due to the long queues but in the real
sense, a lot of time is taken in the consultations due to the delays in the file retrieval for the
patients. The system, through the online interaction along with the online search for the patient’s
database, is made more straightforward such that a doctor can retrieve the data even when on a
phone call.
The patient appointment system or schedule for health care center started a long time ago
where the patients had to be assigned a specific time to when they could see the doctor (Harper,
2003). Handling patients’ appointments have developed simplified fairly static scheduled
conditions. The other trial was made to calculate the time for waiting between the patient and
doctor with the use of mathematical models on queuing to reduce time wastage (Gamlin, 2003).
Moreover; traditionally the system used in appointments considered that doctor’s time was more
important than the patient’s time (Wijewickrama, 2005). Therefore the appointment system was
created to reduce the doctor’s idle time, the current design of the appointment system was based
on precise factors that concern both the patient and the doctor (Takakuwa, 2005). The
appointment made by the patient system is structured complexly since it symbolizes the patient
meeting time in the health facility and controls the patient’s waiting time (Gamlin, 2003).
Further to this, an appointment system for the patient is entailed in International Journal
“Computer Science & Information Technology” (IJCSIT) Vol 6, August 2014 62, No 4 that was
meant for:, reducing patient’s waiting time, managing doctor’s time, reducing doctor’s idle time,
raising the quality of service in the healthcare and reducing nurse’s idle time (Harper, 2003).
The appointment schedule is a significant aspect of the field of healthcare. Patients
mostly spend a lot of time in seeing the doctor so that they can book an appointment for a later
date. For this case, the system has incorporated the aspect of arrangement whereby the patient
can request for an online meeting with a specific doctor from any of the fields in which he or she
may need some assistance in and the doctor responds to the patient through a communication
chat box.
The research did previously show that the longer the meeting delay; defined as the time
interval in between the day an appointment is booked by the patient and her actual appointment
date, the higher the chances of canceling or deciding never to show up (Gallucci et al. 2005).
The project system suggests a distinct way of minimizing no-shows and cancellations by asking
the patients to go right away and see the doctor or make appointment requests on the day they
want to be attended as per the doctor’s schedule (Murray, 2000). The direct appointment is
referred to as open access (OA) or advanced access policy (Tantau, 2000), and of late it has
become a favorite paradigm in exercise and the area of active research. Many authors report on
their encounters in actualizing OA, both negative and positive (Dixon et al. 2006). Several
practitioners highly advocate for OA (Murray and Tantau 2000), whereas some are staunch
against it (Lamb, 2002).
The appointment delays in addition to the long waiting hours significantly influence the
choice of a person in where to get health care services. A health center that offers fewer delays
may experience huge clients within a shorter duration in comparison with an institution that has
the culture of keeping their clients in waiting for more extended periods. The project system will
reduce the time of delay through direct communications of the patient and the doctor where
immediate feedback is given making both the client and the service provider able to adjust to
their respective schedules. In the cases where the doctor or the patient may not be available at
the scheduled period, a notification may be sent using the reference number assigned to the
respective appointment reference indicating the absenteeism of the individual party. In case the
patient will not be available, the reference appointment is attached to another client while the
patient is offered a later date in the appointment schedule to which he or she may be available.
Rescheduling done via the project system is much convenient with less time wastage as the
client may communicate with the doctor at any time without necessarily having to travel in
person to see the doctor.
Dexter (1999), patient appointment management system is a computer application used
to control and reduce the patient waiting time in the healthcare center. Some hospitals do not use
an appointment system, and thus it has a longer average patients’ time waiting than the health
center adopting the patients’ system. Since patients can wait for more than an hour to be served
by a doctor in a hospital, they also feel that they were being disregarded and mistreated. When
patients were given time to meet in a health facility center, they evaluated the quality of service
offered in the center (Dexter, 1999). Hence, development of patients’ appointment processes for
hospitals creates a necessity for the use of sophisticated queuing models that capture the great
real system’s features that includes saving time as well as reducing idle time. Therefore the
schedules on appointments represent a real situation in the care center faced by the patient
meeting schedulers (Rohleder, 2002).
Alternatively, standard practices for processing and scheduling of patients appointments
were based on the kind of treatments of the patients and that approached patient needs are
desirable (Klassen, 2002). The project system is responsible for keeping track to the
appointment schedules whereby a reference number is offered to the patient while the system
maintains a copy of the reference and thus no one can come in replacement of another person
without being noticed by the system. Also in the health center in the cases where more
appointments have been scheduled, and almost all the patients are in attendance then the system
in the health center may call on the reference numbers, and the corresponding individuals may
be required to visit the doctor, and the schedule is maintained. An orderly way by the system
ensures that none of the clients is mistreated and all are subjected to the same treatment as
human interaction is made to be minimal.
Online systems are also known as a web-based system where most of the
communications are made from the internet. A web is made up of a page that is commonly
known as a web page or website, and a site is a computer-based program that runs on a web
server that provides access to a group of connected web pages (Alex, 2000). A system is a set of
independent components working together to achieve a common objective. Therefore a webbased system is a system that is accessible over the internet by a user to accomplish a particular
task for a given purpose. The Internet is a system that is used to connect many computers and in
computer networking. It helps to join millions of computer networks across the world, and it
enables the users to access information kept on other computers from a long distance (James,
1999).
According to Chua (2010), the public demand for improved healthcare systems and the
astonishing number of skipped appointments have forced the healthcare industry to recognize
how they deliver care services. With the advance of IT technology today and the seen healthcare
systems as critical systems, appointment booking systems lay at the center of providing
dependable, efficient and timely health services access. The primary way of appointment
booking is via fax, phone or email. But with the growing internet penetration, the healthcare
industry moves towards the use of online appointment booking system.
The project system works in the same concept; the patient may be required to visit the
website and request an appointment with the health center. The booking for an interview is made
to avoid inconveniences that may arise when the patient visits the health center and fails to be
attended to as all the other colleges have the appointment reference to which they may use to
obtain attention from the healthcare provider. Online booking enables an individual to save the
time taken to get a physical appointment as the patient is only required to visit the health center
at the set date and time.
In regards to the existence of hospital appointment schemes, the application was created
in an attempt of managing the appointments of schedules of the patients. The system that was
used assumed that the date, as well as the time of arrival, didn’t validate the treatment of the
patient. Since the appointments of the years, as well as the scheduling of patients, is done for a
future date, the condition at hand matters a lot. The aspect is due to the fact that the arrival
means as well the time of entry may not alter the form of treatment. Due to this reason, a system
that was able to handle all these aspects needed to be developed. However, there still existed a
challenge of coming up with a system that will handle all these items in a go. The current system
that was used was 100% manual. The system had some drawbacks as some clients ended up
losing relevant data that was very critical for their treatment. Therefore, there was a need to
develop a system that will enable the healthcare giver to allocate the clients to a particular data
that will be suitable for both the physician as well as the patient. Klassen (2004) a healthcare
provider, had to come up with a method of giving different clients appointments in different
periods of time as well as from numerous environments. The aspect was critical as many
patients would receive dates that were suitable for their treatment. It is worth noting that, via the
system; patients were in a position to call off the appointments as ask for rescheduling in days
that they were available. The system ensured that all the patients, as well as the physicians, were
well satisfied.
Besides, the multiple combinations of various appointments, as well as the booking
information, needed to be measured. The aspect was considered suitable for numerous patients
came from different environments. In an attempt at balancing all these concepts, the booking
was made in various operational systems. A lot of scholars who have studied about patients
booking have identified that every facility has its own rules as well as policies that govern the
appointments of their clients. Some healthcare givers give 20 to 30 customers in a particular
clinic day. Others usually place two patients as labels and spread the others uniformly. The
aspect ensures that there is no favoritism in the appointments of different clients. It is worth
noting that uniform distribution of these assignments helps the physician to spend some quality
time with all the clients.
There are cases where a patient doesn’t know the existence if an appointment system. In
such situations, the client may end up calling for an appointment at any date. Such a client may
not realize the existence of a queue that governs who to see the doctor and when. There are also
other cases where the exact duration when the patient is required is unknown. The aspect makes
it difficult for them actually to visit the health center. However, there are other systems where
patients can log in to the hospital’s website and check for their appointments. In such situations,
the patients are given usernames as well as the password that help them to access their data in
the facility. The client can also call for an appointment all book in a near as well as a suitable
date. In such installations, the doctor is even supposed to keep checking the website to
understand the kind of patients that have booked a particular day for their clinic. Such systems
are time as well as money saving. The element is due to the fact that the patients can quickly
check their calendar and take the days they are available. Also, they may take a day that they can
promptly reschedule other things. The system also allows the patients even to book their clinics
at night. In such a situation, the customer is so flexible and doesn’t have to spend a lot of time as
well as money calling the nurses to book an appointment. For instance, according to
Wijewickrama and Takakuwa (2005), the Opine healthcare unit operates from 8:30 in the
morning to 5; 30 in the evening during weekdays. During this time, the patients can book their
appointment depending on their suitability.
Patient booking should be made appropriately. This is because there are patients who
require regular check-ups. For instance, clients with kidney problems need to visit their doctors
more often than those with diabetes. Therefore when booking these appointments, the nurses
should consider the severity of the condition. There are also other cases where the patients who
are suffering from the same disease affected more than others. The aspect means that different
patients may have diabetes but one is affected than the other. Such patients need to be often
booked for careful observations.
Every facility should develop a system that will be inclusive. First, the system should
consider the severity of the condition. The clients who are severely affected should visit the
doctors once or twice a week while others can also be rescheduled after three months. The
system should even consider the availability of the clients. The nurses should seek some
background information about their patients, so us booing is done appropriately. The
environments from which clients live in should also be considered. Those who live in harsh and
prone conditions should often be rescheduled. The aspect is critical in ensuring that all the
categories of patients are well managed.
In most cases, such hospitals receive both patients with appointments as well as those
who don’t have. Under such situations, the patients who have appointments are given more
priority than those who walk in for c …
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