Patient Appointment Reservation System

Vilnius 2008

Vilnius University Hospital Santariskes clinics

& Baltic Institute of Information Technologies

Contents
Introduction ......................................................................................................................................... 3 PARS in Lithuania ............................................................................................................................... 4 System operation principles................................................................................................................. 5 Advantages for patients ....................................................................................................................... 5 Advantages for specialists ................................................................................................................... 6 Advantages for reception personnel .................................................................................................... 7 Advantages for administrators ............................................................................................................. 8 MEDPAS (medical personnel record system) ..................................................................................... 8 System messaging ............................................................................................................................... 9 Requirements for the system ............................................................................................................... 9 Other technical details ......................................................................................................................... 9 System operating scheme .................................................................................................................. 10

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Introduction
Patient registration system in most health care institutions in Lithuania is carried out using paper journals or is not carried out at all, and arrival of patients to health care institutions without reservation system results in live queues at consulting rooms. When reservation is made in paper form, it is not possible to combine information flows from different health care institutions: in practice patients are not able to choose the most suitable physician and visit time among different institutions. Paper registration journal allows work for one operator only and in single workplace. This restricts efficiency of work and results in queues at reception desks and blockages of telephone lines. Expediency of such system is low and fails meeting needs of both users of health care services (the patients) and suppliers of these services (physicians, reception desk personnel and

administration staff). Most elements of the reservation system are ineffective, and therefore too much time of human resources, patients and employees is consumed for usual operations, and material costs are too high as well. Patient Appointment Reservation System (PARS) deals with problems related to patient visit reservation in health care institutions. These can be divided as follows: Much personal time spent when registering for a visit and while waiting at consulting rooms; Limited selection possibilities for patients; Inefficient use of human resources in health care institutions; Inefficient management of health care institutions due to inadequate flows of information. Patient Appointment Reservation System (PARS) is a project supported from Structural Funds of the European Union, intended for direct installation and development of information technologies in medicine. The goal of the project is to take advantage of possibilities provided by advanced Internet and GSM technologies, in order to reduce administration costs, provide to the public easily accessible and high-quality health care services, and more efficiently use human and material resources of health care institutions. The System is acknowledged as one of the most effective e-Health initiatives, targeted to the patient.

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PARS in Lithuania (short statistics)

Patient Appointment Reservation System (PARS) has been created to improve the quality of health care services increasing the availability, expedition and the effectiveness of the information of physicians visits time using modern information technologies. For now PARS is one of the most modern projects in Lithuanias medicine sphere, linking registries of 40 different health care institutions: University Hospitals, Regional Hospitals, City Hospitals and Policlinics (Primary and Secondary Outpatient Care Centers). Since the beginning of this project in 2008 patients appointment reservations via Internet have been increasing steadily (see Figure 1). The ability to make and administer their own registrations to

Figure 1. Patients appointment reservations via Internet since 01.01.2008

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doctors online has been a great advantage for the patients and primary care physicians, assisting their patients. By now (since 01.01.2008) 6 % of all appointment reservations among project partners were made via Internet. However at some of healthcare institutions this rate reaches up to 11 %.

System operation principles

1. Specialists prepare a schedule of their planned consultation times. Scheduled consultation times of physicians are entered into the Patient Appointment Reservation System by the reception personnel. There is an opportunity for specialists enter their planned consultation times themselves if they sign into the system. 2. Remain other forms of patients registration. Patients can register for a visit by the phone to a necessary health care institution or at the reception desk. In any case all patients details are entered into Patient Appointment Reservation System and an opportunity to register online becomes available. 3. When making reservations online, a patient or his/her represented family physician reserve consultation time by entering name, family name, mobile phone number and other contact information of patient. A specialist can be chosen by health care institution, family name, speciality and consulting-room or by the set of all these criteria. When finding a proper specialist patient is able to view all available times of visits and select the most convenient one. 4. A feedback among patient and specialist is secured by the assistance of SMS. Patient who has made online reservation automatically receives confirmation of the reservation, reminder about upcoming visit for the next day, information about the cancelation of reserved visit due to a cause of specialist and etc. Patient registered to the system can also cancel the visit and warn specialists about not showing up. 5. A specialist can view a list of registered patients for a particular date and their complaints when signed into the system. A specialist has an opportunity to send SMS for a patient asking to bring all the necessary documents or analysis that might be useful.

Advantages for patients

Patient Appointment Reservation project improved national e-health development in Lithuania with the greatest direct impact on patients. To summarize all the advantages of the Patient Appointment reservation System for patients it can be itemized as following:

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Patient Appointment Reservation is an overall system which allows efficient use of resources and possibility for patients to choose services of specialists from different health care institutions.

The system has a public access to view the list of health care institutions providing medical services and filter the list of available specialists by healthcare institution, specialists name, family name, specialty or consulting hours. A patient can choose a visit to specialist considering his or her individual needs and opportunities. Patient Appointment Reservation is an easy way to choose a visit and avoid irrelevant stress. However it is stressful to decide on the time of the visit when calling or talking to the personnel of the registry feeling indirect pressure to choose quickly.

An installation of Internet Assistance Centre is a huge facilitation for patients who prefer to register by phone. The Internet Assistance Centre has been established for patients to choose time of the visit and register by phone. Calling 1815 in Lithuania from all telecom operators allows patients to get information about available visits to specialists and make reservations any time a day. These voice records are collected as additional information for personnel and specialists of health care institutions.

Patients registered to the system are able to follow the status of their past or future visits in the Internet. Personal and contact information as well as details of planned visit can be edited when registered to the system.

Patients registered to the system are automatically informed about confirmation by SMS of their

registration to the system, visit registration, changes in time of the visit, visit cancelation or any other informative messages.

Advantages for specialists

Patient Appointment Reservation System improved work for specialists of health care institutions in the following way:

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Specialists have an opportunity to review the list of upcoming patients and details about their complaints. Knowing registered patients in advance they have time to prepare properly for the visit saving direct communication time for the patient. A better communication and understanding between a specialist and the patient is being created. Specialists do not loose time waiting for patients who are late or have forgotten about the visit due to unforeseen coincidence or other reasons. Patients are automatically informed about the upcoming visit time by SMS and signed in to the system they can always cancel the visit.

Specialists can contact their patients by sending SMS or calling by phone to the mobile telephone number provided by the system. Patients receive text messages reminding about upcoming visit time, informing about time or the availability changes of the visit.

An Internet Assistance Centre has been implemented to collect voice records of registrations by calling 1815. The personnel and specialists of health care institutions use voice records of made reservations for a better understanding of patients complaints. Collected voice records of registration are a useful source of information on patients complaints.

Sending specialists use Patient Appointment Reservation System to generate dispatches for the consultation of higher level specialists. Specialists or their assistants provide an additional service for patients by completing electronic dispatches form instead of sending to resister to other specialists themselves. Sending specialists signed to the system can monitor status of visits of his/her sent patients.

Advantages for reception personnel

Patient Appointment Reservation System improves daily work of reception personnel in several ways: Queues at reception desks and blockages of telephone lines have decreased in great amount. Less paper work allows reception personnel concentrate full attention on the quality of reservations made and information provided.

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At the same time few receptionists can work with electronic journals not disturbing work of other receptionists. Reception personnel can make reservations at the health care institution not publishing information outwards. Edited data are stored in a separate database (modification journal). The purpose of this journal is to ascertain misunderstandings of registration; Patient Appointment Reservation System has error governor of introduced data. It detects and records system errors without blocking its consistent functioning

Advantages for administrators

Patient Appointment Reservation System is a new development for administrators of health care institutions in the way that: Administrators of health care institutions are able to monitor planned loads of physicians and distribution of patients. Reduced workload on reception personnel allows assigns them other tasks. Analysis of patient registration process has become more efficient and it is easier to make management decisions on the basis of such analysis. Statistical and other reports are automatically generated to various public institutions, allowing nationwide analysis on patient streams among healthcare institutions and make reliable data basis for nationwide healthcare development decisions.

MEDPAS (medical personnel record system) Medical personnel record system is a subsystem of Patient Appointment Reservation System which is created to manage the records of health care institutions, medicine personnel and specialists participating in the project as well as users of Patient Appointment Reservation System. MEDPAS is an online operating database which contains functions of electronic employment; allows administrators to create new and delete unemployed workplaces of medicine personnel.

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System messaging
SMS messages including different kind of information can be sent to patients: information on visit registration; confirmation of the registration; cancelation of the visit and etc.; Administrators of the system and

personnel of health care institutions can manually send text messages to patients or specialists registered to the system; Patient Appointment Reservation System supports functioning of the incident control system (trigger); All automatically sent text messages are registered in a particular database.

Requirements for the system

The standard worldwide networks are used by all the workplaces of the system users. No licensed or additional software are necessary for the workplaces of system users and all they need is a fast enough internet connection. The main server is required to maintain the work of the system and other IT facilities. To run the system the central server must have the following requirements: Operation system - MS Windows server 2003, std. or ENT. editions; MS SQL Server 2005 NET Framework 2.0;

Other technical details

The control of registered patients at register of the national e-health system; Patient Appointment Reservation System is adapted to the software of the Internet Assistance Centre by showing the number of the mobile telephone phone of patients. The software of the Internet Assistance Centre maintains standard communication protocols of call centre;

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Information which is being transferred to patients by the mobile phone is safe. Mobile phone number is safe individual information that provides qualified security measures for the system to operate and inform patients about the status of their visits;

All specialists registered to the system are registered in one journal with their authorization and identification provided; An integration system to integrate different Patient Appointment Registration Systems is developed. Data exchange and synchronization is proceeded by the messages exchanged by systems using SOAP protocol;

The whole system is created for Lithuanian language. However it can be implementations for other languages are possible; Patient as an electronic system user is identified by a mobile phone. However system is open for the possibilities of an additional identifying means PKI smart cards, banking or national identification systems etc. A special mobile phone number control system has been created to escape errors inserting numbers into the system.

Patient Appointment Reservation System suits the requirements of safe internet ( SSL or others). Connections to the system are automatically recorded to the connection list and other preventive measures are being used.

System operating scheme

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The operation of Patient Appointment Reservation System contains several possible procedures to register for a visit: call nationwide short telephone number common to all national telecom operators (Internet Assistance Center); call to the reception of particular health care institution; make reservations online; sending specialists can generate dispatches and make reservations for patients.

Feedback between patient and Patient Appointment Reservation System is provided via SMS. For a proper operation PARS composes of several main servers: Multimedia server which collect voice recordings provided by the Internet Assistance Center; External WEB server which contains registration data from Internet Assistance Centre and patients online reservations; Internal WEB server which generates reservation data from reception and sending specialists; Database server of PARS backup site.

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