Alghamedi, Ahmad Ali A

Designing an Appointment Management System for
the Mother and Child Health Department of the

Klinik Kesihatan Changlun
Alghamedi, Ahmad Ali A
UNIVERSITI UTARA MALAYSIA
2011
Designing an Appointment Management System for
the Mother and Child Health Department of the
Klinik Kesihatan Changlun
A project submitted to the Academic Dean of Awang Had Salleh Graduate School
of Arts and Sciences in Partial Fulfillment of the requirements for
the degree Master of Science
(Information and Communication Technology)
Universiti Utara Malaysia
By
Alghamedi, Ahmad Ali A
Copyright © 2011 Alghamedi, Ahmad. All rights reserved.

PERMISSION TO USE
In presenting this project in partial fulfillment of the requirement for a postgraduate
degree from Universiti Utara Malaysia, I agree that the Universiti Library may make
it freely available for inspection. I further agree that permission for copying of this
report in any manner, in whole or in part, for scholarly purpose may be granted by
my supervisor(s) or, in their absence by the Dean of Awang Had Salleh Graduate
School of Arts and Sciences. It is understood that any copying or publishing or use
of this or parts thereof for financial gain shall not be allowed without my written
permission. It is also understood that due recognition shall be given to me and to
Universiti Utara Malaysia for any scholarly use which may be made of material from
my report.
Requests for permission to copy or to make other use of materials in this report, in
whole or in part, should be addressed to
Dean of Awang Had Salleh Graduate School of Arts and Sciences
UUM CAS
Universiti Utara Malaysia
06010 UUM Sintok
Kedah Darul Aman
i
Abstract
Information and Communication Technology has been changing the way things have
been carried out. Traditionally many work required people to visit the location where
the work has been carried out. ICT has been making these services available at their
fingertips by hosting these applications online. Klinik Kesihatan Changlun is a
public general clinic in the state of Kedah. The appointment management which is
one of the most important services of a clinic is presently carried out manually here.
Both patients and the staff have to face a lot of problems due to the inefficiency of
the manual system. If the system can be automated and made available on the
internet, it will solve a lot of problems currently faced by them. This project
proposes to design an appointment management system for the Mother and Child
Health Department of the Klinik Kesihatan Changlun. The project has been proposed
to follow the formal research methodology proposed by Kuchler and Vaishnavi due
to its suitability for small to medium sized development projects. Finally it has been
proposed conduct a usability test on the prototype developed for ease of use and user
friendliness with the aid of the questionnaire.
ii
ACKNOWLEDGMENTS
Praise to Allah for guidance and blessing for giving me the strength and
perseverance to complete this project. I would foremost like to thank my
parents and my wife, for providing me with the opportunity to pursue
my goals and for their love and affection, which has helped me through
the most trying times. Equal gratitude goes out to my siblings and
brothers. I would like to thank my supervisor: Prof. Abd Ghani B
Golamdin and Mr. Mustafa Alobaedy for their guidance and constant
motivation that has enabled me to complete my project work. Moreover,
I would also like to thank them for the opportunities that they made
available to me.
ALGHAMEDI, AHMAD ALI
iii
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION
1.1 Introduction 1
1.2 Problem Statement 3
1.3 Research Question 6
1.4 Research Objective 6
1.5 Research Scope 7
1.6 Research significance 7
1.7 Organization of the Thesis 8
1.8 Summary 9
CHAPTER 2: LETERATURE REVIEW
2.1 Introduction 10
2.2 Quality of Service in Healthcare Services 12
2.3 Issue of Waiting Time 14
2.4 Impact of the Internet on Healthcare 18
2.5 Appointment Scheduling Systems 19
2.6 Related Work 21
2.6.1 Dynacrates Clinic Management System 21
2.6.2 Total Clinic Automation Solution 23
2.6.3 Health on Click Hospital Management System 24
iv
2.6.4 MediNous Hospital Management System 26
2.6.5 Profmax Healthcare ERP 27
2.6.6 FreshLogics Clinic Management System 29
2.6.7 MemDB Clinic Management System 30
2.7 Summary 34
CHAPTER 3: RESEARCH METHODOLOGY
3.1 Introduction 36
3.2 Research Design Methodology 37
3.2.1 Awareness of Problem 37
3.2.2 Suggestions 41
3.2.3 Development 41
3.2.3.1 Prototype Development 42
3.2.4 Evaluation 43
3.2.5 Conclusion 43
3.3 Summary 44
CHAPTER 4: SYSTM ANALYSIS AND DESIGN
4.1 Introduction 45
4.2 WBCS System Requirements 45
4.2.1 WBCS Functional Requirements 45
4.2.2 WBCS Non Functional Requirement 47
4.3 WBCS Modeling and System Design 48
4.3.1 Use Case Diagram 48
4.3.2 Use case specification 50
v
4.3.3 Clinic Web Base System (WBCS) Sequence Diagrams 56
4.3.4 WBCS Class Diagram 64
4.4 Prototype Implementation 65
4.5 Summary 70
CHAPTER 5: SYSTEM USABILITY TESTING
5.1 Introduction 71
5.2 System Usability Evaluation 71
5.3 The Instrument of the Survey 72
5.4 Data analysis Results 72
5.4.1 Demographic Data 72
5.4.2 Items Analysis 74
5.5 Summary 75
CHAPTER 6: CONCLUSION
6.1 Discussion 76
6.2 Recommendation and limitations 76
6.3 Conclusion 77
vi
LIST OF FIGURES
Figure 2.1: Dynacrates Clinic Management System 22
Figure 2.2: T-CAS Clinic Management System 23
Figure 2.3: Module Structure of the Health on Click HMS 25
Figure 2.4: Group User Manger of the MediNous HMS 26
Figure 2.5: Architecture of Profmax Healthcare ERP 28
Figure 2.6: Reception Module of the FreshLogics Clinic Management System 29
Figure 2.7: Main Interface of the MemDB Clinic Management System 30
Figure 3.1: Major Phases in Design Cycle 37
Figure 3.2: Main Steps in Prototyping 42
Figure 4.1: Symbols used to Represent Actors and Uses Cases in UML 49
Figure 4.2: WBCS Use Case Diagram 50
Figure 4.3: Log in Sequence Diagram 56
Figure 4.4: Log in Collaboration Diagram 57
Figure 4.5: View info clinic Sequence Diagram 57
Figure 4.6: View info clinic Collaboration Diagram 58
Figure 4.7: New Patient Sequence Diagram
Figure 4.8: New Patient Register Collaboration Diagram
Figure 4.9: Make Appointment Sequence Diagram 61
Figure 4.10: Make Appointment Collaboration Diagram 62
Figure 4.11: Manage Patient profile Sequence Diagram 63
Figure 4.12: Manage Patient profile Collaboration Diagram 6
vii
Figure 4.13: WBCS Class Diagram 65
Figure 4.14: WBCS Home Page 66
Figure 4.15: View clinic information of WBCS 67
Figure 4.16: Register page in WBCS 68
Figure 4.17: WBCS Login Page 69
Figure 4.18: manage patient profile of WBCS 70
Figure 5.1: Respondent Demographic 73
viii
LIST OF TABLES
Table 2.1: Summary of Clinic Management Systems Discussed
Table 4.1: List of Functional Requirements 46
Table 4.2: List of Non-Functional Requirements 47
Table 4.3: Perform Log in Use Case Specification 51
Table 4.4: Register Patient Use Case Specification 52
Table 4.5: Make appointment Use Case Specification 53
Table 4.6: View Clinic Information Use Case Specification. 54
Table 4.7: Manage Patient File Use Case Specification 55
Table 5. 1: Demographic Data 72
Table 5.2: Analysis of the Items 74
ix
CHAPTER 1
INTRODUCTION
1.1 Introduction
With the development of Information and Communication Technologies (ICT),
more and more online services are becoming popular. These online services
provide the users with the flexibility of getting their work done without leaving the
comfort of their living rooms. Traditionally these services required the people to
travel to the place where the services were provided.
Klinik Kesihatan Changlunis a community health clinic under the Ministry of
Health that serves the people in the area around the city of Changlun. The clinic is
of moderate size with two departments namely the Outpatient Department and the
Mother and Child Health Department. The Outpatient Department provides general
clinical services and the Mother and Child Health Department is a specialized unit
providing antenatal and postnatal care for mothers and pediatric care to children up
to the age of six years. The Mother and Child Health Department is staffed by 15
healthcare professionals comprising one specialist, one general physician, seven
staff nurses and six community nurses. All the services are of outpatient type as the
clinic does not have facilities to admit patients for inpatient care. The clinic is
equipped with basic laboratory facilities to carry out urine test, blood pressure,
weight and height measurements and physical examination of pregnant mothers
1
and to provide immunization to children along with monitoring of physical and
growth. Since the clinic does not have in-patient care facilities for handling
deliveries, pregnant mothers are transferred to Alternative Birth Center for
delivery. Once a baby is born the monitoring and care of the new born are handled
by a visiting nurse from the clinic.
Presently, the entire administration of the clinic including patients’ registration and
record management is manually controlled. Patients are given a card where the
appointments are marked along with an entry in the clinic’s patient appointment
file. Even the immunization schedule of children is handled manually through two
immunization cards. One card is given to the mother of the child and the other card
is maintained in the department. The card contains the child’s name, date of birth,
immunization type and date and time to be administered. The growth of the child is
monitored by measuring the height and weight of the child and plotting it on the
growth chart of the child maintained in the clinic.
The working hours of the clinic are from Sunday to Thursday from 8:00 AM to
1:00 PM and 2:00 PM to 5:00 PM. Fridays and Saturdays are off days. Patients
have to queue during the office hours for obtaining appointments to see the doctors.
In order to obtain an appointment suitable for the patients they have to come to the
clinic very early way before 8:00 AM as even a slight delay may result in a long
wait for seeing the physician. This creates a lot of problems for both the patients
and the hospital staff due to the inefficiencies inherent in the present manual
system.
2
The proposed Appointment Management System would help the clinic to improve
its services making them more efficient and flexible. With the implementation of
the proposed system, the clients will be able to book and follow up their
appointments online from their homes making the services available anywhere
anytime. The users can check the available slots beforehand and book a time slot
that is convenient to them avoiding the necessity of travelling to the clinic several
times or waiting in queues unnecessarily. Also, the online alert system included
will help the clinic to notify the clients in case, there are changes to the
appointments. The system will also help mothers to keep track of immunization
schedules of their children and pregnant ladies to keep track of their clinical
appointments. Overall this system would improve the services of the clinic making
it more efficient.
1.2 Problem Statement
Healthcare providers including hospitals, clinics and dispensaries strive
continuously to improve their services to meet the demand of the clients. These
demands faced by healthcare providers become stronger everyday due to the
factors such as more informed customers, increasing emphasis on preventive rather
than curative care, aging population and increasing cost of health care services
along with increase in competition due to liberalization of healthcare services
(Wijewickrama & Takakuwa, 2005). Service time including both waiting time and
treatment time spent at the facility is an important parameter in the quality of
service provided. Many prospective clients had moved away from public healthcare
providers towards private healthcare service providers due to better quality of
3
services provided and to avoid congestion and long waiting times (Najmuddin et
al., 2010).
Several researchers have tried to model the access time for health services using
analytical models in order to understand and identify the dynamics and contributing
factors to the patient waiting time in healthcare facilities (Elkhuizen et al. 2007;
Kumar & Shim, 2007; Zhu et al., 2010). Zhu et al. (2010) have specially analyzed
the appointment scheduling systems in specialist outpatient clinics to detect the
factors causing long patient waiting time/clinic overtime using the data collected
from a government hospital with the view of detecting the possible factors causing
long waiting time. Kumar and Shim (2007) have tried to optimize resource
allocation in terms of allocating consultation rooms, doctors’ time and patients
waiting time. The main conclusion of all these researches is that non availability of
prior information about the appointment schedule with respect to the free slots is a
major hurdle for the proper management of appointments and allocation of other
resources optimally.
A computerized appointment management system will help reduce patient waiting
time as the system can be made accessible over the internet and clients can make a
booking from their home at their convenient time. This would reduce the time
wasted on travelling and waiting as the patient can arrive at the clinic at the
scheduled time to see the physician. Since the appointments can be made from
home, it would also eliminate the disappointment of non availability of
appointment slots. The prior booking system would help the clinic in optimal
4
utilization of its resources as it will smooth the flow of patients eliminating
unexpected surges and long queues.
At present Klinik Kesihatan Changlun keeps the appointment schedule of patients
manually. Also appointments can only be made on the particular day of doctors’
visit from 8:00 AM onwards. There is no special facility for making prior
appointment before the date of appointment or selecting the time slot of patient’s
preference. The present arrangement wastes a lot of time and other resources and
also contributes to environmental pollution due to heavy traffic created around the
clinic by visiting patients eager to obtain an appointment early on the day.
In the light of this development, this project proposes to design an appointment
management system for the gynecology and pediatrics departments with web
capability that would help reduce the problems currently faced by the clinic in
terms of appointment management. The advantage of the proposed system would
be that this prototype system could be used by the Klinik Kesihatan Changlun as
well as similar clinics countrywide. Using an automated system like this would
improve the quality of the services provided by healthcare service providers
resulting in more satisfied customers and better utilization of their own resources.
5
1.3 Research Questions
The following questions have been formulated for the purpose of this study.
What are the requirements that are to be met in an appointment
management system that can be used at the Mother and Child Health
Department of the Klinik Kesihatan Changlun?
How can Web technologies be incorporated into an appointment
management system successfully?
How can such a system be designed using the modern development tools?
1.4 Objectives
The main objective of this study is to come up with requirements and design a
Appointment Management System for the Mother and Child Health Department of
the Klinik Kesihatan Changlun.
The sub objectives of this study are:
To determine the requirements of an appointment management of the
Mother and Child Health Department of the Klinik Kesihatan Changlun.
To design an appointment management system incorporating web
technology modules.
To implement the system using ASP .Net with C#.
6
1.5 Research Scope
The scope of this research is limited to the web based appointment management
along with an electronic mail alerting module. The system will comprise two web
based user interfaces; one for clients to book their appointments and the other one
an administrative interface for the clinic staff. The system will have limited
functionality serving only the Mother and Child Health Department of the Klinik
Kesihatan Changlun.
1.6 Research Significance
The significance of this project is twofold; technical and social.
The contribution to the society includes;
The reduction of hassle associated with manual operation of appointment
management of the Mother and Child Health Department of the Klinik
Kesihatan Changlun.
The possibility of scheduling appointments from anywhere just with a few
clicks.
The capability of notifying the clients, in case appointments need to be
rescheduled.
Indirectly helping to reduce environmental pollution by reducing the
number of travels made to the clinics by clients.
7
The technical contributions of the project are as follows:
A computer based solution incorporating the advanced technologies to
manage the appointment administration of Mother and Child Health
Department.
A foundation for future researchers and developers to improve towards a
fully fledged clinic management system.
1.7 Organization of the Thesis
This report is organized into five chapters. The major contributions resulting from
this research work is presented in Chapter 4. The organization of the chapters is
given below:
Chapter 1 presents a review on the introduction, problem statement, research
objectives, research questions, scope of the research, and significance of the
research. Chapter 2 discusses the detailed literature survey investigating the prior and
similar work carried out by other researchers. Chapter 3 introduces the methodology
adopted in this research along with requirement gathering process carried out.
Chapter 4 explains the detailed analysis and design of the system. Chapter 5 provides
the evaluation of the system and the evaluation results. Chapter 6 provides the
conclusions of this project.
8
1.8 Summary
Web based applications have been changing landscape of services automating the
non core activities of a business. Healthcare is one area where ICT can be used to
improve the quality of services tremendously. Healthcare is a large industry having
a large number of stakeholders and different levels of services (Meyer & Müller,
2006). In this project it has been proposed to develop an appointment management
system for the Klinik Kesihatan Changlun. It has also been proposed that the
system be developed combining both web and e-mail messaging due to the
ubiquitous nature of these two technologies.
9
Chapter 2
IMPACT OF ICT ON HEALTHCARE
2.1 Introduction
The adoption and diffusion of Information and Communication Technology (ICT)
have considered as indicator of development by many countries. Many countries
including both developed and developing have incorporated the technological
innovation specifically the investment on ICT in the development agenda (Zheng,
2005). The adoption of ICT in the healthcare sector has been considered as one of
the main driving forces in the healthcare reforms in many countries (Gladwin et al.,
2003). The adoption of ICT in the healthcare sector is commonly known as e-health.
The rationale behind the investment and incorporation of ICT in the national
development policies and plans is with the expectation that these ICT based
initiatives will accelerate the social and economic development of these countries
(Avgerou, 2000).
The development of ICT has been adopted successfully in the healthcare sector in
the form of telemedicine. Telemedicine is one of the areas where the ICT and
healthcare have been merged together in order to overcome the deficiencies of the
delivery of healthcare. Telemedicine has been defined as the use Information and
Communication Technology to provide medical information and service. The
services provided under the category of telemedicine can be as simple as two
healthcare professionals exchanging information with each other with the help of
10
modern communication technologies or as sophisticated as using advanced
communication technologies such as teleconferencing for the purpose of online
consultation between providers living in far away locations (Chatrath et al., 2010).
Tang et al. (2010) developed a telemedicine home care management system
combining hospital management system and mobile communication to establish a
long-term and sustainable health monitoring through the transmission of Multimedia
Messaging Service (MMS). They tested this system in Taiwan with the help of 300
participants and 4736 records of blood pressure and sugar measurements. The system
has been connected to the hospital management systems of several hospitals and the
physicians could link to the system through the health record page of the hospital
information system of the respective hospital. The healthcare staff will be alerted
through electronic mail in case of any abnormal conditions and they can arrange for
the patients to be transported to the hospital for further treatment or observation.
Ma et al. (2010) proposed a method to automatically manage the Electronic Health
Records (EHR) of patients using ICT. This system helps manage the health records
in a patient centered fashion opposed to the current practice of hospital centered
health record management. The health information has been stored in a Secure
Digital (SD) card and in a network database. The personal health data has been
fingerprint encrypted and then saved to the SD card and network database. The
functional modules of the system include health information on women's health
during pregnancy, infant and child medical information management. The system
model allows pediatricians and gynecologists to check the past health records of
patients conveniently without going through paper based files manually. The system
11
helps the patients in terms of having their entire health record available at finger tips
irrespective of where they consult the physician.
Similarly, ICT can also be used to increase the reach of healthcare beyond the
conventional boundaries. The recent years have seen an unprecedented increase in
the elderly population all over the world and in Asia in particular. The percentage of
elderly population in the 1950s was only 14.1% and this is expected to increase up to
17.5% by the middle of this century (Menon & Melendez-Nakamura, 2009). With
the growth of the elderly population, the challenge for providing affordable quality
healthcare to this elderly population becomes acute. Several researchers have
proposed that the development in the field of ICT can be harnessed to provide
quality healthcare at an affordable price on a sustainable basis. Firdhous and
Karunaratne (2011) studied the impact of the development of ICT in the developing
countries with special reference to Sri Lanka and proposed that ICT can be
successfully harnessed to meet the healthcare requirements of the elderly.
2.2 Quality of Service in Healthcare Services
Quality in healthcare services is composed of two main components, namely the
quality of core activities and quality of other but related activities. The core activities
include the professional services provided by the specialists, physicians and other
healthcare professionals including nurses, pharmacists and attendants. Other
activities include all the other services provided by the service provider. The quality
of both activities need to be improved in order to improve the overall quality of
services provided (Najmuddin et al., 2010).
12
Service quality has been defined as an assessment how the customers judge the
services provided in meeting their expectations based on their perceptions of the
service (Alamgir & Shamsuddoha, 2004). Grubor et al. (2008) have identified the
following as the dimensions based on which the service quality of an offering will be
assessed.
• Reliability
• Responsiveness or timely delivery
• Assurance (knowledge of the staff and courtesy)
• Empathy or individual customer care
• Tangibles, or service materialization based on physical elements
It can be seen that the timely delivery of the service is an important aspect of service
quality. If the delivery is delayed, clients will reject the services provided even if all
the other dimensions of the service quality are met. Therefore organizations striving
to become the best in the industry must consider the service time as one of the most
important factors while maintaining the quality in terms of other dimensions. The
service time in healthcare especially in the outpatient departments is composed of
two main components, namely the waiting time and the treatment time. In the
healthcare services, the treatment time especially the consultation time is not
normally considered a waste or inefficiency of the physicians by patients. But the
waiting time is always considered to be wasted as it is not spent on any useful work.
Long waiting times has been found to be one of the main reasons for clients moving
towards private healthcare providers against government providers (Najmuddin et
al., 2010). Hence it is important for healthcare service providers to look into the
measures of reducing the waiting time of clients.
13
2.3 Issue of Waiting Time
In healthcare sector, patient waiting is a common issue throughout the world
(Jayaweera et al., 2006). Patient waiting is one of the main reasons for dissatisfaction
among the clients. The dissatisfaction among the patients on waiting time has
normally been expressed as waiting in the patient department, waiting to see a
doctor, waiting to be seen in a casualty department, waiting to get into hospital and
sometimes waiting to get out of hospital. It is often said that patients have to wait too
long in hospitals irrespective of for what it is for (James, 2007). Managing the
patient waiting time is an area that requires special attention of hospitals as waiting
not only creates dissatisfaction but also resources inefficiencies. The increasing cost
of healthcare and the shifting of emphasis towards preventative care as opposed to
curative medicine are encouraging the researchers to investigate new ways to reduce
the cost of healthcare service while improving the efficiency of patient care services.
One of the areas that has attracted the attention of the researchers is the scheduling of
patients at clinics and special care services (Wijewickrama & Takakuwa, 2006).
Traditional manual appointment systems have failed to meet the requirements of
both patients and service providers in terms of matching supply and demand for
urgent or same-day appointments. Traditional appointment systems have also been
identified as one of the main contributor to the decreasing of patient satisfaction
(Belardi et al., 2004).
Due to the rising cost, service providers seek ways and means to reduce the cost of
services. One of the areas that have been considered first for cost cutting is the
14
ancillary services. Ancillary services have always been considered not to add value
to the services provided and hence a cost. In this manner, a service provider always
considers the services provided to awaiting patients are a cost. But, more the
patients waiting more the cost incurred without any positive return. The services
provided to waiting patients include the provision of waiting area, air conditioning,
ventilation, lighting, entertainment, etc. A service provider will be able reduce the
overall cost of services provided by reducing these additional expenditures, but it
will work against the service provider, if alternative methods of improving services
were not provided. Hence with the diminished capacity, there is a clear need for
analytical tools that can provide better services with the dynamics of patient flows in
clinics and hospitals. Variability in both supply and demand, if not managed properly
will result in crowding, staff overloads, unmet patient needs and general frustration
(McManus et al., 2003).
According to Giachetti et al. (2005), the patient waiting time at clinics is twenty
weeks into the future due to the large backlogs. Also patients sometimes spend more
than two hours in the waiting rooms of clinics for a twenty minute appointment.
Usually clinics have a high rate hovering of appointment slots to the rate over 50%.
The researchers state that, it seems the clinics were in crises; yet the managements
were though concerned by the poor performance but not alarmed. The reason for the
indifference of the service providers was that they were of the opinion and attribute
the poor performance of the clinics to the external influences of the patient
community they served.
Block appointment scheduling, that is scheduling more than one patient to the same
slot is practiced by some service providers. This kind of scheduling is also useful
15
during high absenteeism of patients. The high rate of no show by patients is not
unusual; several studies have confirmed this tendency of patients in their studies
(Martin et al., 2003; Moor et al., 2001; Murdock et al., 2002; Tuso et al., 1999). High
rates of no show like this make it difficult to improve the quality of health services.
At the same time, this kind of behavior contributes to the further escalation of costs
of healthcare services. Hence it is necessary educate the patients of good habits. In
order to reduce the impact of no show by patients, clinics use the scheduling policy
where groups or blocks of patients are scheduled to arrive at the same time (Ho &
Lau, 1999).
Many IT solutions have been implemented with the aim of improving the quality of
health services by influencing patient behavior (Revere & Dunbar, 2001). These
solutions share the common objective of delivering a message designed to influence
the behavior of patients. For example, patients are sent alert messages prompting
them to take their scheduled medications, attend appointments or appear for
recommended screenings. But currently there is very little understanding as to how
such messages play a role in influencing the decision making of patients (Krueger et
al., 2003).
Many reasons can be attributed to the long waiting times. These reasons include
unsuitable algorithm of the appointment systems, unsuitable appointment patterns,
insufficient doctors or consultation rooms in a clinic and random arrival of patients.
But a most of the researchers are of the view that an effective appointment
management system can reduce waiting time significantly (Harper & Gamlin, 2003;
Wijewickrama & Takakuwa, 2006).
16
Zhu et al. (2010) have studied the factors causing the long patient waiting time in
outpatient clinics. In this study, they have found that overbooking of appointments
beyond the capacities, not starting the consultation session at the scheduled time,
uneven distribution of schedules, irregular calling disregarding the appointment
schedules, unused session times, are the main reasons leading to long waiting times.
The paper further discusses the inefficiencies in the current scheduling mechanisms
such as Bailey’s rule due to the rigidity of these mechanisms and non consideration
of the uncertainties that are prevalent in outpatient clinics. Using a discrete event
simulation model, they have proposed a model which is virtually focused at
eliminating the anomalies highlighted above to create a smooth appointment
schedule. But the model fails to take into consideration that the appointment slots
may need to be of different lengths depending on the type of patient and the past
information available. Hence the model proposed seems to be too rigid and mainly
focused towards a manual appointment schedule.
Kumar and Shim (2007) have looked at a way to arrange consultation rooms in a
specialist outpatient clinic with view to maximize the utilization factor while
optimizing the patient waiting time. They have carried out a simulation study using
queuing models, but failed to identify any solution that would optimize the waiting
time of patients.
In order to achieve the optimum match between the patient demand and provider
resources, it is necessary to build an appointment management system using modern
technology. This kind of appointment system will improve the effectiveness of the
17
appointment management, continuity of care, and both patient and provider
satisfaction.
2.4 Impact of the Internet on Healthcare
The impact of the Internet has been felt in almost every aspect of our lives.
Healthcare service can be improved with the proper use of the Internet. If the
healthcare information is accessible by both patients and physicians over the
Internet, it would help both the patients and physicians tremendously. A physician
will be able to access the health report of the patient even at home or from wherever
he is currently at. This would help him to prescribe some emergency medication
even before he has the opportunity to examine the patient physically. This would be
very useful during emergencies. Similarly the internet can be used to improve the
quality of the appointment management at hospitals and clinics (Hai, 2000). Also the
use of the Internet would help the service providers to lower the cost of healthcare
through increased administrative efficiency. The Internet provides both the patients
and doctors the flexibility of accessing the appointment management system from
anywhere and anytime.
The internet based online systems make the task of administrative staff more
flexible. They now will have the capability to carry out their work from anywhere
any time. This may even carryout their work from home during weekends balancing
their career life along with that of the personal life. Internet also provides better
communication facilities and information sharing capabilities among employees
working in different departments (Nelson & Lang, 2002).
18
Internet also can have an impact on healthcare services by improving the service
delivery in a more flexible manner. The number of physicians who use the Internet
in some fashion to improve their service delivery is increasing every day. Similarly
there is an increasing tendency for patients to use the Internet as a medium of
communication to contact their physicians (Virji et al., 2006; Houston et al., 2004).
The number of internet users as well as the amount of information available on the
Internet are growing at tremendous rate (Ackermann & Hartman, 2000). This
provides a new opportunity for patients to become more informed and play an active
role in their treatment process. Internet is a potentially powerful and important tool
for patient, and medical information sites represent a large proportion of web sites
surveys of internet users demonstrate they have great interest in accessing medical
information on internet (Fox & Rainie, 2000). Internet as an effective patient health
information resource relates to information quality. Medical information on the
internet can be highly variable in quality (Croft & Peterson, 2002), as access to the
internet continues to grow it is likely that individuals will increasingly use it as a
source of healthcare information (Ross, Chapman, Murray, Stevenson, Natin, &
Rogstad, 2000). However, there is also a growing concern regarding the quality of
information available on the Internet and the negative impact they might have on the
patients’ mental as well as physical health (Goldschmidt & Liao, 1998).
2.5 Appointment Scheduling Systems
Appointment scheduling systems have been used by various services such as
restaurants, gaming centers, sports facilities and private and public clinics. Most of
the appointment scheduling systems are used in practice tend to minimize the idle
19
time or optimize the utilization rate of the service facility while neglecting clients′
waiting times (Ho et al., 1995). In this section, appointment scheduling with special
reference to patient management will be discussed.
Wijewickrama and Takakuwa (2008) have evaluated the appointment systems used
in hospitals in the light of appointment rules and patient characteristics. In their
study, various scheduling algorithms have been evaluated using the data collected
from the outpatient division of a large internal medicine department. They combined
different scheduling rules to create multiple appointment systems and evaluated
those under two different conditions namely, no show and patient punctuality. The
main deficiency of this analysis is the restriction of evaluation condition only to two
situations leaving the other possible conditions such as delayed arrival, staff
inefficiency, prolonged consultation times etc. Hence these models would work only
under the very restricted conditions of no show and patient punctuality.
Lian et al. (2010) have taken a look at the effect of schedule fragmentation due to
uneven time requirements. They identified that patient-provider cooperation can
effectively reduce schedule fragmentation resulting in higher appointment
acceptance rate and clinic time utilization rate. The patient-provider cooperation is
established by providing a list of available slots ranked in the order of slots starting
from slots that would cause less fragmentation to the slots that would cause the most
fragmentation. The patients are encouraged but not obliged to select a slot ranked
high. They argue that this method would satisfy both patients as well as providers as
it tries to strike a balance between the competing requirements of both patients and
providers. The authors have failed to identify a method that can automate the
20
defragmentation process. Hence this solution lacks practical significance due to the
heavy emphasis based on the patient-provider cooperation.
Hence it is necessary to come up with an automated system that is flexible enough to
manage while handling the uncertainties present in the real world. The system must
be capable of using the past information to improve the system with time in terms of
efficiency and effectiveness. Thus an ICT enabled patient scheduling system that can
take advantage of multiple scheduling rules and past information along with the
advanced features like electronic mail (e-mail) would be an ideal solution.
2.6 Related Work
There are several commercial clinic management systems available in the market.
This section takes a critical look at these software packages with respect to the
technologies used, and advantages and disadvantages of them.
2.6.1 Dynacrates Clinic Management System
Dynacrates Clinic Management System has been developed by Advance Data
Systems Private Limited in Mumbai, India (Dynacrates, 2011). This software can
handle doctor's appointments, medical billing, patients’ treatment history,
diagnostics information and the administrative activities of a clinic or a hospital.
Figure 2.1 shows the basic architecture of the Dynacrates Clinic Management
System. Dynacrates has modules for various users in a clinic. These modules are
integrated thus information once entered is available wherever required without the
need for re-entering it.
21
Figure 2.1: Dynacrates Clinic Management System
From Figure 2.1, it can be seen that it is a generic clinic management system that has
been created to manage a clinic with multiple specialties. Hence, this system is not
suitable for a very specialized clinic like mother and childcare where very
specialized schedules like immunization schedules and regular clinic visits by
pregnant mothers need to be handled. Also, another short coming of this system is
that it lacks a mobile application module that can be used alert clients in situations of
changes to their schedules. The proposed system would overcome both these
shortcomings as it would be designed and developed especially for the Mother and
Child Health Department of the Klinik Kesihatan Changlun and would include an e-
mail module for alerting.
22
2.6.2 Total Clinic Automation Solution
Total Clinic Automation Solution (T-CAS) is a web-based clinic management
solution that manages all the activities involved in the operation and management of
a clinic (T-CAS, 2011). T-CAS is a modular-architecture-based solution that can be
customized to contain features and modules as required by clients. T-CAS also
supports HL7 and EDI integration. T-CAS includes patient registration, complete
patient history, doctor appointments, lab requisitions and results, interfacing with lab
equipments, prescriptions, radiology with DICOM support, billing and insurance
claims, scheduled reporting, customized report generation, and administrative
functions. Figure 2.2 shows the design of the T-CAS clinic management system.
Figure 2.2: T-CAS Clinic Management System
T-CAS is a comprehensive clinic management system that can be used for a general
clinic with multiple specialties. T-CAS lacks the facility of the electronic mail that
can be used by clinic staff to notify the patients. Since this application has been
23
designed to be a fully fledged clinic management system, the cost of the system
beyond the reach of small clinics that need a simple system to manage only their
appointments. The cost of the proposed system would be reasonable, so that even for
small clinic to purchase and use as it would be focused towards managing the
appointment of mother and child health department. Also it will not be required to
employ highly skilled computer administrators to manage the system as it would be
light enough for any person with reasonable computer skills to manage.
2.6.3 Health on Click Hospital Management System
Health on Click Hospital Management System is a comprehensive system that can
manage all the aspects of a large hospital (HoC, 2011). Health on Click is a modular
system that handles each function in an organized fashion without duplicating
information. The data management is handled in a streamlined fashion in Health on
Click using a single database shared by all the applications integrated to the central
system. Figure 2.3 shows the module architecture of the Health on Click hospital
management system.
24
Figure 2.3: Module Structure of the Health on Click HMS
Health on Click is too complicated and expensive for a small clinic to handle its
simple appointment management function as this system would need special high
end hardware and professional support. Also, Health on Click lacks e-mail support
for alerting which is one of the most important functions required in today’s busy
world.
The proposed system would be cost effective so that even small time clinics can
afford it. Since the system would be focused towards managing the appointment of
mother and child health department, it will not be required to employ highly skilled
computer administrators to manage the system. Also the proposed system will
include an e-mail module for alerting patients on changes to the schedule.
25
2.6.4 MediNous Hospital Management System
MediNous Hospital Management System, developed by Nous is an integrated health
information system that addresses the critical requirements of a large hospital
(MediNous, 2011). This software has been designed to address all the major
functional areas of multi-specialty hospitals. The special features of the MediNous
HMS are the multi-currency support, multi-location support that integrates the
different functional units located at different physical locations, online investigation
report availability, capability to support different information access privileges based
on the role, inventory management based on FIFO with earliest expiry date in
Pharmacy etc., Figure 2.4 shows the screen shot of the group user manager of the
MediNous Hospital Management System. Group user manager help configure the
parameters at the group level facilitating to set the most common parameters of a
group once and make it available to all the members of that group.
Figure 2.4: Group User Manger of the MediNous HMS
26
Since the MediNous HMS is a complete application that has been designed for large
hospitals with multiple specialties and operates at multiple locations, it is too
complicated and too expensive for small clinics. Also, the application does not pay
much attention to appointment management as it is a relatively an insignificant
component in a large hospital.
The proposed system is targeted towards the appointment management of a mother
and child health department. Hence the system will be developed with the objective
of maximizing efficiency of appointment management function. This would be a
clear advantage of the proposed system over the MediNous HMS. Also, the proposed
system would be cost effective to fit into the budget of any small time provider.
2.6.5 Profmax Healthcare ERP
Profmax Healthcare ERP is an Enterprise Resource Planning System, especially
designed for the healthcare industry (Profmax, 2011). Profmax is a comprehensive
suit that includes modules for supporting all the core, support services and back
office operations of large hospitals. Figure 2.5 shows the modular architecture of the
Profmax Healthcare ERP.
27
Figure 2.5: Architecture of Profmax Healthcare ERP
Profmax Healthcare ERP has been designed for large hospitals that run operations in
a highly professional and organized manner. In order to manage an ERP system even
with a base package and a few modules needs highly qualified technical
professionals. Hence, the initial cost and the management of the software would be
too high for a small specialized clinic.
The proposed system will have several advantages over the Profmax Healthcare
ERP. The proposed system will cost much less than the Profmax Healthcare ERP.
Also, the proposed system would be more efficient than the appointment
management module of the ProfmaxHealthcare ERP as the appointment
management module is an insignificant component of the bigger system. Also, the
proposed system will include an e-mail module for alerting patients that is totally
missing in the Profmax Healthcare ERP.
28
2.6.6 FreshLogics Clinic Management System
FreshLogicsClinic Management System is fully featured clinic management software
developed by FreshLogics Software Systems, India (FreshLogics, 2011). This
system has many features that can help manage the functions of a clinic. The main
features of the system include management of the reception, printing of prescription,
patient record management, and bill printing. Figure 2.6 shows reception module of
the FreshLogics Clinic Management System.
Figure 2.6: Reception Module of the FreshLogics Clinic Management System
The main shortcoming of the system is that this system has been designed for general
clinic. This software is not suitable for the management of a specialized clinic like
29
the Mother and Child Health Department. It lacks features to store the specific
immunizations schedules of children and the lab test results of pregnant mothers.
Also, this is not a web based system; hence the administration of the system will be
cumbersome as it needs to be installed in each and every computer. The patients will
not be able to access the system from home for the purpose of booking or changing
an appointment. Hence this system will not provide any special services to the
patients or reduce their travelling and waiting requirements.
2.6.7 MemDB Clinic Management System
MemDB Clinic Management System is specially built software for the management
of small clinics (MemDB, 2011). This software can record all patients, drug, illness
and diagnosis information. It also has the capability of supporting historical data
including past record of illness and drug use for better diagnostic capabilities. This
software will help clinics to achieve effective management of patient records and to
improve customer management. Figure 2.7 shows main user interface of the
MemDB Clinic Management System.
Figure 2.7: Main Interface of the MemDB Clinic Management System
30
The main shortcoming of the system is that this is a standalone software that can
support only one user station. Hence this system is not suitable for a clinic with
multiple stations supporting multiple users. The system cannot reduce the patient
travelling and waiting time as the patients will not be able to access the system from
home. Hence this is suitable for physicians running their own private clinics only.
Table 2.1 summarizes the advantages and disadvantages of the HMSs discussed
above.
Table 2.1: Summary of Clinic Management Systems Discussed
System Advantages Disadvantages
Dynacrates Clinic Modular system with Too heavy for
Management System multiple functionalities. deployment at a single
specialized department.
Lacks mobile
communication module
and e-mail functionality.
Total Clinic Automation Comprehensive clinic Too expensive for small
Solution management system clinics.
suitable for a general Lacks the e-mail
clinic with multiple application module.
specialties. Too heavy for
deployment at a single
specialized department.
31
Health on Click Hospital Comprehensive clinic Too complicated for a
Management System management system single specialized
suitable for a large department.
general hospital. Too expensive.
Requires high end
hardware to run.
Lacks e-mail support.
MediNous Hospital Complete application Too complicated.
Management System that has been designed Too expensive.
for large hospitals Appointment scheduling
operating at multiple module is not
locations. comprehensive enough.
Profmax Healthcare ERP Comprehensive ERP Designed for large
system for the healthcare hospitals that has clearly
industry. defined roles and
procedures.
Requires qualified
personnel to maintain
the system.
Too expensive.
FreshLogicsClinic Fully featured clinic System is not web
32
Management System management software. based; hence the
Suitable for automating administration of the
the day-to-day system will be
operations of a general cumbersome and the
clinic. patients will not be able
access the system from
home.
Cannot support the
special requirements of
mother and child care
department.
May not help reduce or
eliminate the travelling
and waiting of patients.
MemDB Clinic A simple clinic The system is standalone
Management System management system that and can support only one
can support a private user station.
clinic. Will not reduce patient
travelling or waiting
time as it cannot be
accessed by patients.
No support for storing
lab results and children’s
immunization schedules.
33
From the discussion and the summary provided above, it can be seen that most of the
applications available in the market are for large hospitals and the appointment
management module is rather an insignificant component of them. The special clinic
management systems evaluated lack the facility of a web based system that can be
accessed by healthcare professionals, healthcare providers’ employees and patients.
These two clinic management system will not help reduce the patient travelling or
waiting as they only automate the manual operations of the clinics and does not add
any special feature such as the capability to access and schedule appointments
remotely or alerting facilities. Hence a clinical management system specially
designed for gynecology and pediatrics department would help all stakeholders
including healthcare service owners, doctors, nurses, management and patients
immensely.
2.7 Summary
This chapter presented the literature survey carried out in order to identify the
current research, products in the market and to identify the gap in the current
systems. Initially the impact of Information and Communication Technology on
human life in general and healthcare in particular was investigated briefly. Then the
issue of Quality of Service (QoS) in healthcare and the effect of waiting time were
investigated in depth. The probable impact of Internet on healthcare was studied
thoroughly with special emphasis to the current situation, positives and negatives of
using the Internet for healthcare. An in depth look at the appointment scheduling in
clinics was taken with the aid of the published work. Finally the hospital
34
management systems and clinic management system software in the market were
investigated with special reference to their strengths and weaknesses.
35
CHAPTER 3
RESEARCH METHODOLOGY
3.1 Introduction
Research methodology is more than just collection of method to perform a
research; it is a systematic way to solve the research problem (Rajasekar et al.,
2006). The research methods refer to the methods and technique used by the
researcher in performing the research, for example data collection technique, and
data processing techniques. For the purpose of designing and developing the
prototype, the general research methodology proposed by Kuchler and Vaishnavi
would be used (Kuechler & Vaishnavi, 2008). This methodology has been selected
in this study primarily due to the reason that it has been modified several times
taking the advances in technology into consideration. The most recent update for
the methodology has been carried out in 2008 and is very suitable for projects that
are mainly focused on system development rather than theoretical research. The
system developed will be tested for usability through a test on the prototype.
Methodology proposed by Kuchler and Vaishnani consists of five major phases
(Kuechler & Vaishnavi, 2008). They are namely;
Awareness of Problem
Suggestion
Development
36
Evaluation
Conclusion
Figure 3.1 shows these five major phases.
Figure 3.1: Major Phases in Design Cycle (Kuechler & Vaishnavi, 2008)
3.2 Research Design Methodology
3.2.1 Awareness of Problem
A problem needs to be understood properly prior to developing any solution. If the
any solution development is attempted without proper knowledge of the problem
itself, the solution proposed or developed will fall short of meeting its objectives.
Thus requirement analysis is a very important step in any development effort.
Requirement analysis is made up of two major activities, namely understanding or
analysis of the problem and requirement specification. Understanding the problem
37
becomes a major task for large systems with many modules and features that
require performing many different tasks. During this step, the main focus must be
on what is to be performed rather than how it is to be performed. The analyst at this
stage must possess a thorough knowledge of the problem domain and its context in
order to carry out this operation successfully.
When the problem has been correctly identified and understood, the solution
development would be much easier. Many different methods can be used to
understand a problem.
There are many techniques help analyst to extract problems such as interview,
discussion, and questionnaire.
In this project, the problem awareness process was carried out by conducting
interviews with some clients (patients) and a staff member of the Klinik Kesihatan
Changlun.
On April 4, 2011 at 2 PM, the researcher met one of staff members namely Ms.
Shaebah Binti Ahmad a staff nurse at the clinic. She gave the basic information
about the clinic including the physical and other resources, working hours and
services offered by the clinic. She stated that the klinik kesihatan changlun has two
departments namely, outpatient department and mother and child care department.
In the mother and child care department has three rooms. Out of these three rooms,
two rooms are used for mother and child care and the other room is used for family
38
planning. The clinic is staffed by one specialist, one general physician, seven staff
nurses and six community nurses.
The clinic provides both anti natal and post natal care and childcare up to the age of
six years. The main services provided includes immunization, physical assessment
and growth assessment of children and tailing blood specimen, urine test, blood
pressure, weight, height and physical examination of mothers. The clinic does not
handle deliveries. The patients are transferred to the Alternative Birth Center for
deliveries. Any other disease not connected to mother and child care is treated at
the outpatient department.
According Ms. Shaebah, the clinic working hours are Sunday to Thursday from
8AM to 1PM and 2PM to 5PM. Friday and Saturday are off days. Patients have to
come early before 8AM to obtain a queue number. A queue number obtained on
any particular day is valid only for that day and if a patient misses the schedule he
or she has to obtain a fresh queue number again. There is no facility to obtain a
queue number beforehand. All the patients are registered at the clinic manually in a
file. Each appointment is entered in two places, one in the department appointment
file and the other one in the patients’ card by the doctor. The patient’s card is given
to the patient and be brought every time she attends the clinic. Children’s
immunization schedules are maintained in a similar fashion in two cards one
maintained in the department and the other one with the mother. Every detail about
the child is entered in the cards.
39
Ms. Shaebah stated that coming early in the morning for obtaining a queue number
is a problem for many patients. Sometimes even if they come very early they
cannot obtain a queue number due to a large number of patients who had already
arrived there before them. Most of the times, patients have to wait for a long time
to meet the physician due to long queues. This is a big problem for many patients
especially pregnant mothers as the waiting room facilities at the clinic is limited.
Manual maintenance of patient information is also cumbersome and problematic to
both the clinic as well as the patients. Sometimes, the patients forget to bring the
appointment or the immunization cards due to the hurriedness of them to come to
the clinic in order to obtain a queue number or sometimes the patients totally forget
their scheduled clinic dates. Missing appointment may affect the mother and the
child very badly in case of pregnant mothers and missing an immunization
schedule may affect a child later in his or her life. There is presently no way of
reminding the patients about scheduled clinic or immunization dates. She opined
that an automated system will reduce the administrative work load of the staff
dramatically and improve the efficiency and quality of service of the clinic
impressively.
Some of the patients were also interviewed on the same day after the interview of
Ms. Ahmad. All the patients interviewed were of the opinion that the present
manual system is not at all satisfactory. They mainly emphasized the need for an
automated system that can be accessed from their homes in order to reserve a clinic
slot and check their schedules. They also mentioned that an automatic reminder
40
system would help them tremendously as most of them are working mothers and
due to the work load, there is a very high chance of missing schedules.
3.2.2 Suggestion
Problem awareness phase is immediately followed by the suggestion phase. Both
the problem awareness and suggestion phases are closely linked together. The
result of the suggestion phase is a tentative design of the application. During the
suggestion phase, an in depth attention is paid to how to solve the problem
identified in Phase 1. The creative skills and knowledge of the developer are
considered vital for developing the best solution in terms of functionality and
efficiency.
The main aim of this study is to develop a clinic management system for Klinik
Kesihatan Changlun with the main functions of appointment management and
follow-up facilities. The proposed system features will be discussed with a few
selected set of users at the Klinik Kesihatan Changlun in order to verify the
suggestion. The main tools were used at this stage are Use Case diagrams,
sequence diagrams and ER diagrams. All of these was done by using Rational Rose
2002.
3.2.3 Development
During this phase, a prototype of the proposed system was developed. The
prototype has all the functionalities envisaged in the final application but with
limited scope. The prototype developed helped the evaluation of the system
through user testing with the participation of real users. The involvement of the real
41
users helped to understand the shortcomings in the system and fix them fast
compared to testing and fixing the final system. Prototype has been developed
using ASP.Net 2008 with C# as the programming language also data base has been
designed through SQL server 2008.
3.2.3.1 Prototype Development
A reduced system similar to the final product has been developed during this stage.
This would be a complete working model having all the function satisfying the
requirements identified in Phase 1. Prototyping system for the purpose of testing
has certain definite advantages along with a few disadvantages. Table 3.1 lists the
advantages and disadvantage of prototyping.
According to Laudon and Laudon, prototyping involves three deterministic steps
(Laudon & Laudon, 2001). They are namely develop initial prototype, use the
prototype and revise and enhance the prototype. These steps are shown in a
graphical format in Figure 8. From this figure, it can be seen that the development
of a prototype is an iterative process where the prototype is enhanced until a
satisfactory working model is developed.
Figure 3.2: Main Steps in Prototyping (Laudon & Laudon, 2001)
42
Figure 3.2, shows that prototyping is essentially an iterative process going through
a cycle of improvements until a satisfactory solution has been achieved. In Step 1
an initial prototype has been developed. This is mostly a crude version of the
product needing definite improvements before it becomes a usable prototype. Steps
2 and 3 are two main components of the testing phase that involves testing and
modification until the user is satisfied with the model. Final outcome of this
exercise is the fully functional prototype.
3.2.4 Evaluation
Once a fully functional prototype has been developed, it has been tested for ease of
use and usefulness. A set of real users were selected for carrying out the user
testing. The main criteria for the selection of test users have been their prior
experience with such systems and their knowledge in the application domain. At
the end of the testing session, the users filled a detailed questionnaire based on their
experience with the system. The questionnaire for testing the usability and user
experience (USE) has been used. The number of test users would be limited to 40
considering the cost of carrying out this function in terms of time and money. SPSS
program version 16 has been used to analyses the data was gathered from the
questionnaires that filled by staff of klinik kesihatan changlun. The results of the
test have been analyzed and presented in Chapter 5 of the thesis.
3.2.5 Conclusion
Conclusion is the final phase of the research and design methodology. The project
was concluded with the development of documentation of the entire process along
with the writing and defending the thesis. As part of the documentation effort, at
43
the end of the system analysis and design phase, user and system requirements
document containing functional and non-functional requirements that have been
developed. The end of the design phase resulted in a design document comprising
UML, sequence and class diagrams. Finally user and administrative manuals
developed to help the users and administrators. All these documents along with the
program source code have been included in the final thesis submitted to the
university as partial fulfillment of the degree of Master of Science.
3.3 Summary
This chapter has presented the methodology that has been used in this project,
where the methodology was grouped into five phases starting with awareness of the
problem phase and ending with conclusion phase.
44
CHAPTER 4
SYSTEM ANALYSIS AND DESIGN
4.1 Introduction
The design and development of the prototype developed for the purpose of testing
has been presented in this chapter. A prototype has the same functionality as the final
intended system but is a scaled down version. The development of Web-Based
Clinic System (WBCS) process was carried out following all the steps discussed in
Chapter 3. Chapter 3 listed the process of the system development in the three step
process of designing, modeling and prototype development. The Unified Modeling
Language (UML) was used to design and model the system. The UML design
diagrams are discussed in detail in this chapter.
4.2 WBCS Requirements
Determining the requirements for an information system is actually the steps of
gathering relevant and important information on what the system should be able to
do according to the needs of the system’s users (Atle, 2008). User requirements have
been defined and organized under two categories, namely; functional requirements
and non functional requirements.
4.2.1 WBCS Functional Requirements
45
Functional requirements identify the system components, attributes that are required
to achieve the intended results (Bennett, 2002). The objective of determining the
functional requirements are:
to identify the user requirements
to identify the other requirements known as non functional requirements
All the system components must be identified at the system requirement gathering
stage itself (Dennis et al., 2005).Table 4.1 lists the functional requirements of the
WBCS system.
Table 4.1: List of Functional Requirements
Requirement_ ID Function Requirement Priority
WBCS -01 Register Patient Mandatory

Patient and nurse can register patient information to get
new Account
WBCS -02 Perform Login Mandatory

Patient, doctor, nurse and admin can login to system to
perform his/ her task
WBCS -03 Make appointment Mandatory

Patient and nurse can make patient’s appointment with
doctor
WBCS -04 View Appointment Mandatory

Patient can view his/her appointment
View appointments list

WBCS -05 Mandatory
Doctor , nurse and admin can view list of new
appointments that booked online by patients
WBCS -06 Make Diagnosis Mandatory
46
Doctor can make diagnosis for patient
WBCS -07 Manage Department Mandatory

Admin can add, delete and remove clinic department
WBCS -08 View Patient medical History Mandatory

Doctor can view patient medical history
WBCS -09 Manage patient profile Mandatory

Nurse can manage patient profile
WBCS -10 View clinic information Mandatory

Admin, doctor, nurse and patient can view information
about clinic.
4.2.2 WBCS Non-Functional Requirements
In Software Engineering the role of the system’s Non-Functional Requirements is to
showing and clarifying a pragmatic and systematic approach to `developing quality
into' software systems. Systems should put on view software the measuring quality
attributes, such as security, accuracy, modifiability and performance.
The next coming table a WBCS non-functional requirmens will be listed.
Table 4.2: List of Non-Functional Requirements
Requirement ID Requirement Description Priority
WBCS _11 Reliability Issues

The availability of the system must be ensured to Mandatory
provide 24*7 service, with the processing of a
minimum number of reservation within a given time
period with zero errors.
WBCS _12 Usability Issues
47
The system interface must be user friendly with the
Mandatory
required functionalities.
WBCS_13 Response Time / Speed
The system response time must be optimum to provide

a smooth user interaction. A slow response may make Mandatory
people frustrated and abandon the system.
WBCS _14 Security Issues
Private information of users must be protected. No

unauthorized access to the system and user information Mandatory
should be allowed at any time.
4.3 WBCS Modeling and System Design
This section describes the design and modeling of the proposed system using UML
tools. Barclay and Savage (2004) state that the UML diagrams provide developers of
software systems to look at the systems developed from different perspectives and
varying degrees of abstraction Use case diagrams, sequence diagrams and class
diagrams are the commonly created diagrams when modeling systems.
4.3.1 Use Case Diagram
A use case diagram provides a set of scenarios that describe the interaction between
users and the system. It displays the relationship between the actors and use cases.
Actors and use cases are the two main components of a use case diagram. Uses are
used in almost every project as it helps to identify the requirements in the planning
stage. Most of the use cases must be defined in the planning stage itself, but as the
project is being implemented others can be defined (Martin & Kendal, 2000).
48
Figure 4.3 shows the symbols used in UML diagrams to represent actors and use
cases. A user or a system which interacts with the proposed system is called the
Actor and the Use Case is an action the Actor performs while interacting with the
system to perform his intended task.
Figure 4.1: Symbols used to Represent Actors and Uses Cases in UML
The Figure 4.2 describe the WBCS use case diagram
49
Figure 4.2: WBCS Use Case Diagram
4.3.2 Use case specification
The WBCS use cases specifications are depicted in table 4.3 to table 4.7
respectively.
50
Table 4.3: Perform Log in Use Case Specification.
Use Case Name: Perform Login ID: WBCS _01 Importance Level:
High
Primary Actor: User (Admin, Patient, Doctor, Nurse).
Short Description: This use case describes how user can log in function ensures that only
authorized users gain access to the system databases. An authorized user is a user who has
an account on the system. The systems’ users should key-in a valid password and username
to gain access to the system
Trigger: user decides to login through key- in his/her username and password in the log in
panel.
Type: External / Temporal

Major Inputs: Major Outputs:
Description Source Description Destination
User username & password User Display User page user
Login button WBCS System
Major Steps Performed Information for Steps
1. User inserts his/her Username and

Password through log in panel. Username/password.
Login button.
2. The user clicks login button.
Display user page.
3. The system shall verify and validate the
entered information and Displays user
page if it is correct.
51
Table 4.4: Register Patient Use Case Specification.
Use Case Name: Register Patient ID: WBCS _02 Importance Level: High
Primary Actor: User (Patient , Nurse)
Short Description: This use case describes how Patient/Nurse registers new patient profile in the system.
Trigger: User decides to register new patient.
Description Source Description
Apply register link. WBCS System Destination
Name , Gender, date of birth, address, Patient information Display patient form user
email, Marital status ,Phone , username, password
Submit button. WBCS System

1. The user clicks on Register link Register link.
2.The system will display the Patient form Display Patient form
Name , Gender, date of birth,

3. The user Fills up the patient form field (Name , Gender, date of birth,
address,
address, email, phone, username, password). email, Marital status ,Phone ,
username, password
4. The user shall submit the application form by click on submit button. Submit button.
52
Table 4.5: Make appointment Use Case Specification.
Use Case Name: Make Appointment ID: WBCS _03 Importance Level: High
Primary Actor: User (Patient , Nurse)
Short Description: This function allows user to make appointment through the WBCS.
Trigger: User decides to make appointment.

Appointment button WBCS System Appointment page user

Doctor WBCS System
Visit date WBCS System
Time WBCS System
Submit button WBCS System
1. The user click on new Appointment button. Appointment button

2. system display appointment page Appointment page.
3. The user choose the doctor , visit date and Doctor-visit date – time
time.
Submit button
4. The user press submit button.
53
Table 4.6: View Clinic Information Use Case Specification.
Use Case Name: View Clinic Information ID: WBCS _04 Importance Level:
High
Primary Actor: User (Admin, Doctor, Patient , Nurse)
Short Description: This function allows user to view information about clinic through the
WBCS.
Trigger: User decides to view information about clinic.

about button WBCS System Clinic information user
1. The user clicks on button. about button

clinic information page
2. system display clinic information
page
54
Table 4.7: Manage Patient File Use Case Specification.
Use Case Name: Manage Patient’s profile ID: WBCS _05 Importance Level:
High
Primary Actor: Nurse
Short Description:
By this use case, the system allows the Nurse to managing patient profile , can view patient
information / make search information / delete and update

Manage button
Patient list Page nurse
Selected patient Patient Profile nurse
Select Function (Edit/Update/delete) Updated patient file nurse
Display successful message nurse
Major steps performed Information for Steps

1. Press on manage button. Manage button
2. System will display patients’ page Display patients’ page
Selected patient
3. Nurse selects patent
Display patient’s Profile.
4. System display patient’s page
Selected operation
Display successful message

5. Nurse selects operation.
6. System display successful message
55
4.3.3 Clinic Web Base System (WBCS) Sequence Diagrams
According to (Johan, 2004) the sequence diagrams display the time sequence of the
objects participating in the interaction. This consists of the vertical dimension (time)
and horizontal dimension (different objects).
WBCS: Bound WBCS: cont
Figure 4.3: Log in Sequence Diagram
56
WBCS:
WBCS
Bound
WBCS:
WBCS cont
Figure 4.4: Log in Collaboration Diagram
WBCS:Bound WBCS: Ctrl WBCS: Ent
Figure 4.5: View info clinic Sequence Diagram
57
WBCS:
Bound
WBCS: Cont WBCS:

Ent
Figure 4.6: View info clinic Collaboration Diagram
58
WBCS:Boun WBCS: cont
Figure 4.7: New Patient Register Sequence Diagram
59
WBCS:
Boun
WBCS:
Boun
WBCS: Cont
Figure 4.8: New Patient Register Collaboration Diagram
60
WBCS: WBCS:
Boun Cont
Figure 4.9: Make Appointment Sequence Diagram
61
WBCS:
Boun
WBCS: cont
Figure 4.10: Make Appointment Collaboration Diagram
62
WBCS: WBCS: cont
Boun
Figure 4.11: Manage Patient profile Sequence Diagram
63
WBCS:
Bound
WBCS: cont
Figure 4.12: Manage Patient profile Collaboration Diagram
4.3.4 WBCS Class Diagram
Referring to Atle (2008), Class diagrams are the most common diagrams found
in modeling object-oriented systems. A class diagram shows a set of classes,
interfaces and collaborations and their relationships. Before drawing a class
diagram consider the three different perspectives of the system the diagram
will present; conceptual, specification, and implementation. It should not to
focus on one perspective and it is better seeing how it all works together.
64
WBCS:
Bound
Figure 4.13: WBCS Class Diagram
4.4 Prototype Implementation
Prototype has been developed achieving all the requirements identified at the functional
requirements stage. The design has been implemented using C# and ASP.NET. The
backend data store was implemented using Microsoft SQL Server 2008. The following
subsections discuss the details of the prototype application developed.
The Clinic Web based application front end has been developed using JavaScript and
html. The aesthetics of the appearance of the user interface was given a prime attention
to make the user experience as pleasant as possible. The following figures show a
sample of user interfaces.
65
Home Page: Figure 4. 14shows the Home page interface of the WBCS. This is the
first screen a user will be presented with when accessing the system. The systems’
user will be required to enter a web address of the system in Mozilla browser and
access the system.
Figure 4.14: WBCS Home Page
66
View Clinic Information:
Figure 4.15 is accessed from the main screen of WBCS through view information
link in the menu. The systems’ users can view all kind of the announcement.
Figure4.15: View clinic information of WBCS
67
Register Page: The page presented by the Figure 4.16 can be accessed from the
main screen through Register button in the box displayed in the first page (home
page). This secreen shows the user’s registration page and its required fields. For
registering on the system a user required to enter the name , email, password and
retype the password again, ended the register request via clicking on the register
button as shown in the figure below.
Figure4.16: Register page in WBCS.
68
Log in page screen
Figure 4.16 shows the main log-in interface to the system. This is the second screen
a user will be presented with when accessing the system. The user will be required to
enter a valid username and password to log-in and access the system. For security
purposes, the password entered by the user will be shown with dots, instead of plain
text. Once a user enters the username password, they will be verified against the user
information stored in the database. If successful, he would be allowed access to the
other services of the system.
Figure4.17: WBCS Login Page.
69
Manage Patient Profile
Figure 4.18 shows the nurse functionality for managing the interesting place details
such as adding, updating, deleting, and viewing the interesting required information,
for the adding interesting details, admin require inserting the interesting patient
information type that will be interesting to use it.
Figure 4.18: manage patient profile of WBCS
4.5 Summary
This chapter talks about the design, implementation and development of the system
at the prototype level. The functional and non functional requirements of the system
were initially defined and then the system modeling was carried out the Unified
Modeling Language (UML). The sequence diagrams and the class diagrams were
also presented in this chapter as design stage. The system was implemented using C#
.ASP.NET and Microsoft SQL Server 2008. The snapshots of the user interfaces for
different functionalities and operation were finally discussed.

70
CHAPTER 5
SYSTEM USABILITY TESTING
5.1 Introduction
The main aim of this chapter is to discuss the evaluation of the the Clinic Web Based
System. The evaluation method carried out in this study was applied through design
of the questionnaire and the analysis methods that used to involve the usability test
of the system; this chapter explores the using of SPSS 16.0 to analyze the data that
been given from the respondents.
5.2 System Usability Evaluation

The usability test with end users is considered one of the most fundamental methods
in usability evaluation (Holzinger, 2005). The level of usefulness, operabilty and
ease of use of a system are the recommended reasons for conducting usability tests
(Neilson, 2006). In this study a system usability test was conducted through the
adoption of quantitative method . This is achieved through the survey via the use of
questionnaires given to the participants; to evaluate the system of the study; a
questionnaire had been given to 40 candidates. Each of the participants had been
taught to use the prototype software. The objective, description and functionalities
had been informed to the respondents. The main objective to do that is to get the
level of user agreement in terms of the usfellnes and the ease of use with the
operability of the WBCS prototype.
71
5.3 The Instrument of the Survey
The User awareness on the ease of use and the usability of WBCS prototype was
estimated using a testing session followed by a set of questionnaires The study’s
questionnaire was involved two sectionss, the first is “Section A” consists of the
general information of the respondent while the second is “Section B” contains the
Usefulness and Ease of Use variables, where several items are included under each
variable.
A 5-point Likert scale was used to enumerate user preference. It is starting from
"Strongly Disagree" (1) to Strongly Agree (5).
5.4 Data analysis Results
5.4.1 Demographic Data

Table 5. 1: Demographic Data.
Percentage Frequency (N=40)
Gender
Female 17.5% 07
Male 82.5% 33
Age
20-25 years 5.0% 02
26-35 years 57.5% 23
36-45 years 35.0% 14
above 45 years 2.5% 01
Level of Education
Master Qualification 90% 36
Degree Qualification 10% 04
PhD Qualification 00% 00
Other 00% 00
Have you been used similar application before?
No 100% 40
Yes 00 00
72
Table 5.1 gives the profile of the respondents, from these figures it can be seen that
majority of the respondents are males making a share of 82.5 percentage. In the age
group category, 26-35 year olds make the largest respondent group with a 57.5
percent followed by 36-45 year olds with a 14 percent. All the respondents have
postgraduate university education out of which a 10 percent has undergone
qualification at master’s level. Out of all the respondents, 95 percent are working
under educational sector. Figure 5.1 displays the same information in a graphical
format.
Figure5.1: Respondent Demographic.
73
5.4.2 Items Analysis
1 2 3 4 5
Strongly Disagree Disagree Neutral Agree Strongly Agree
Table 5.2: Analysis of the Items
Items 1 2 3 4 5 Mean
The WBCSis useful. 0% 0% 0% 42.5% 57.5% 4.5750
When I use the WBCS, I save my time. 0% 0% 0% 47.5% 52.5% 4.5250
It saves my effort when I use it the WBCS. 0% 0% 0% 42.5% 57.5% 4.5750
The WBCS gives me more control over the activities in my life. 0% 0% 0% 35% 65% 4.6500
The WBCS makes the things I want to accomplish easier to get. 0% 0% 0% 32.5% 67.5% 4.6750
It does everything I would expect it to do. 0% 0% 0% 30% 70% 4.7000

WBCS is easy to use.
0% 0% 0% 52.5% 47.5% 4.4750
WBCSis flexible use.
0% 0% 0% 47.5% 52.5% 4.5250
WBCSis simple to use.
0% 0% 0% 55% 45% 4.4500
WBCSis user friendly.
0% 0% 0% 45% 55% 4.5500
WBCS requires the fewest steps possible to accomplish
0% 0% 0% 40% 60% 4.6000
I can use it without written instructions.
0% 0% 0% 32.5% 67.5% 4.6750
Table 5.2 lists the recapitulation of the responses of the user experience and their
perception of the test usability of the WBCS system Prototype. The usability has
been tested under two broad categories ‘perceived usefulness’ and ‘perceived ease of
use’. Several questions were asked about the usability under these two categories.
From the results depicted in Table 5.2, it can be seen that the usability of the system
is very high with an overall mean value more than 4.50. Hence it can be concluded
74
that most of the respondent are strongly agree and the usability of the system is very
high in terms of usefulness and ease of use.
5.5 Summary
This chapter afforded the survey’s data analysis carried out in this study. At the start
an introduction to the test variables was given referring to the experience of the
senior researchers in this field. The respondents’ general information was presented
before discussing the data collected and the interpretation of the items results. From
the analysis it was found that the usability of the system was very high on both
aspects namely, usefulness and ease of use.
75
CHAPTER 6
CONCLUSION
This chapter reviews the project's overall progress by giving a full view based on the
research objectives. In addition, this chapter presents recommendations and
limitations of this system.
6.1 Discussion
According to the problem statements and research objective, the research has heavily
getting involved in developing requirements to complete the methodology that
described in the third chapter and implemented successfully through managing the
requirements. In order to make requirements more understandable the requirements
have been modeled by using the UML diagrams such as use case diagram, use case
specification and sequence diagram.
The prototype was evaluated and the results confirm that it is useful for patients and
it is capable to help them to make their needs easy, direct and successful regardless
of location and time.
6.2 Recommendations and limitations
Clinic Web Based System (WBCS) prototype was developed to help patient, doctor
and clinic staff via this developed system. The project has been designed by keeping
in view various requirements of a Medical Institute/Hospital so that the workload can
76
be decreased. This project helps in management of Hospital for adding and keeping
the records of patients i.e. all the relevant information about the patients. This project
plays a very important part in handling the attendance process. This project solves
many problems like management of patients & preparing reports by graphical
interface. However, there are some problems and limitations in implementing this
system. Such as;
Web based prototype has been tested using a local server with test data only.
The proper system needs to be tested using real data.
The limited time to do more in depth research and study is another challenge
to gather the complete information and understanding for this study area.
Better result will be achieved if the project period is lengthened.
6.3 Conclusion
In conclusion; all the activities that should be completed in this Project have been
complete successfully What can be concluded here is the use of information
technology is the back bone of the any organization, It is hoped that the findings of
this study will encourage health sector companies to incorporate WBCS into the
existing clinic services in order to improve and enhance the Clinic and hospitals’
services so that it is available to users at any place and any time.
77
References
Ackermann, E., & Hartman, K. (2000). Internet and web essentials. Wilsonville, OR,
USA: Franklin, Beedle and Associates.
Alamgir, M., &Shamsuddoha, M. (2004). Service quality dimensions: a conceptual
analysis. The Chittagong University Journal of Business Administration, 19(3),
42-57.
Atle, K.S. (2008). Extending UML sequence diagrams to model trust-dependent
behavior with the aim to support risk analysis. Electronic Notes in theoretical
computer science, 197(2): 15-29.
Avgerou, C. (2000). Recognizing alternative rationalities in the deployment of
information systems. Electronic Journal of Information System in Developing
Countries, 3(7), 1-15.
Barclay, K., & Savage, J. (2004). Object-Oriented Design with UML and
Java.Burlington, USA: Elsevier Butterworth-Heinemann.
Belardi, F. G., Weir, S., & Craig F. W. (2004). A controlled trial of an advanced
access appointment system in a residency family medicine center, 36(5), 341-
345.
78
Bennett, S., McRobb, S., & Farmer, R. (2002). Object-oriented system analysis and
design (2nd ed.). London: McGraw Hill.
Chatrath, V., Attri, J. P., & Chatrath, R. (2010).Telemedicine and anesthesia. Indian
Journal of Anesthesia, 54(3), 199–204.
Dennis, A., Wixom, B.H., & Tegarden, D. (2005). System analysis and design with
UML version 2.0: an object-oriented approach with UML (2nd ed.). Hoboken,
NJ, USA: John Wiley and Sons, Inc.
Dynacrates.(2011). Dynacrates clinic management system. Retrieved February 15,
2011, from http://www.advancedatasystems.com/clinicpro.htm
Elkhuizen, S., Das, S., Bakker, P., & Hontelez, J. (2007). Using computer simulation
to reduce access time for outpatient departments. Journal of Quality and Safety
in Health Care, 16(5), 382-386.
Firdhous, M. F. M., & Karunaratne, P. M. (2011). An ICT enhanced life quality for
the elderly in developing countries: analysis study applied to Sri Lanka.
Journal of Health Informatics in Developing Countries, 5(1), 1-14.
FreshLogics. (2011). FreshLogics clinic management system. Retrieved April 16,
2011, from http://www.freshlogics.com/clinic_management.php
79
Giachetti, R., Centeno, E., Centeno, M., & Sundaram, R. (2005). Assessing the
viability of an open access policy in an outpatient clinic: a discrete event and
continuous simulation modeling approach. In proceedings of the 2005 Winter
Simulation Conference, WSC2005, Orlando FL, USA, December 4-7, 2005.
Orlando FL, USA: ACM. 2246-2255.
Gladwin, J., Dixon, R. A., & Wilson, T. D. (2003). Implementing a new health
management information system in Uganda. Health Policy and Planning,
18(2), 214-224.
Goldschmidt, P. G., & Liao, J. (1998). Quality of health information on the
Internet—enabling consumers to tell fact from fraud. Health Improvement
Institute. Bethesda, MD, USA. Retrieved March 15, 2011, from
http://www.ahrq.gov/qual/hiirpt.htm
Grubor, A., Salai, S., & Leković, B. (2008). Service quality as a factor of marketing
competitiveness. 4th International Conference of the Association of Economic
Universities of South and Eastern Europe and the Black Sea Region,
Bucharest, Romania, May 22-24, 2008. 273-281.
Gubb, J. (2007). Waiting times in the NHS. CIVITAS Institute for the study of civil
society. London, UK. Retrieved February 15, 2011, from
http://www.civitas.org.uk/nhs/download/waitingtimes_jan_08.pdf
80
Harper, P. R., & Gamlin, H. M. (2003). Reduced outpatient waiting times with
improved appointment scheduling: a simulation modeling approach. Spectrum,
25(2), 207-222.
Ho, C.J., Lau, H.S., & Li, J. (1995). Introducing variable-interval appointment
scheduling rules in service systems. International Journal of Operations &
Production Management, 15(6), 59-68.
Ho, C. J., & Lau, H. S. (1999). Evaluating the impact of operating conditions on the
performance of appointment scheduling rules in service systems. European
Journal of Operational Research, 112(3), 542-553.
HoC.(2011). Health on click hospital management system. Retrieved April 15, 2011,
from http://www.healthonclick.com/
Holzinger, A. (2005). Usability engineering methods for software developers.
Communications of the ACM, 48(1), 71-74.
Houston, T. K., Sands, D.Z., Jenckes, M. W., & Ford, D. E. (2004). Experiences of
patients who were early adopters of electronic communication with their
physician: satisfaction, benefits, and concerns. American Journal of Managed
Care, 10 (9), 601-608.
81
Jayaweera, P., Jayasinghe, J., Malawaraarachchi, L. W. V., & Liyanage, S. (2006).
Clinics management system (CMS) based on patient centered process
ontology. Ruhuna Journal of Science, 1(1), 40-47.
Johan, K. (2004). Information system analysis and design. Retrieved March 1, 2011,
from http://www.cs.toronto.edu/~jm/3405/slides2/sequence D.pdf
Kuechler, W., & Vaishnavi, V. (2008). The emergence of design research in
information systems in North America. Journal of Design Research, 7 (1), 1-
16.
Kumar, A., & Shim, S. J. (2007). Maximizing utilization of consultation rooms at the
hospital clinics. International Conference on Industrial Engineering and
Systems Management, Beijing, China, May 30-June 2, 2007. 1-10.
Krueger, K. P., Felkey. B. G., & Berger. B. A. (2003). Improving adherences and
persistence: a review and assessment of interventions and description of steps
toward a national adherence initiative. Journal of the American Pharmacists
Association, 43(6), 668-679.
Laudon, K. C., & Laudon, J. P. (2001).Management Information Systems:
Organization and Technology in the Networked Enterprise (7th ed.). Upper
Saddle River, NJ, USA: Prentice Hall.
82
Lian, J., DiStefano, K., Shields, S. D., Heinich, C., Giampietri, M., & Wang, L.
(2010). Clinical appointment process: improvement through schedule
defragmentation. IEEE Engineering in Medicine and Biology Magazine, 29(2),
127-134.
Ma, G., Liu, J., & Wei, Z. (2010). The portable personal health records: storage on
SD card and network, only for one’s childhood. International Conference on
Electrical and Control Engineering, Wuhan, China, June 25-27, 2010. 4829-
4833.
Martin, F., & Kendall, S. (2000). UML Distilled: brief guide to the standard object
modeling language (2nd ed.). Boston, USA: Addison-Wesley Longman
Publishing Co.
Martin, R. M., Sterne J. A. C., Gunnell, D., Ebrahim, S., Davey S. G. , Frankel, S.
(2003). NHS waiting list and evidence of national or local failure: analysis of
health service data. British Medical Journal, BMJ, 326, 188-192.
McManus, M. L., Long M. C., Cooper, A., Mandell, J., Berwick, D. M., Pagano, M.,
& Litvak, E. (2003). Variability in surgical caseload and access to intensive
care services, Anesthesiology, 98(6), 1491-1496.
MediNous. (2011). MediNous hospital management system. Retrieved February 15,
2011, from Rehttp://www.medinous.com/
83
MemDB. (2011). MemDB clinic management system. Retrieved April 16, 2011,
from http://www.memdb.com/MemClinicE/MemClinic.htm
Menon, J., & Melendez-Nakamura, A. (2009). Aging in Asia: trends, impacts and
responses (Working Paper Series on Regional Economic Integration No. 25).
Metro Manila, the Philippines: Asian Development Bank.
Meyer, M., & Müller, I. (2006). Networked healthcare: a practical guide to
understanding influence networks in the health-care industry. Journal of
Medical Marketing, 6(4), 250-259.
Moore, C. G., Wilson-Witherspoon, P., & Probst, J. C. (2001). Time and money:
effects of no shows at a family practice residency clinic. Family Medicine,
33(7), 522-527.
Murdock, A., Rodgers, C., Lindsay, H., & Tham, T. C. K. (2002).Why do patients
not keep their appointments? prospective study in a gastroenterology outpatient
clinic. Journal of the Royal Society of Medicine, 95(6), 284-286.
Najmuddin, A. F., Ibrahim, I. M., & Ismail, S. R. (2010). A simulation approach:
improving patient waiting time for multiphase patient flow of obstetrics and
gynecology department (O&G department) in local specialist centre. WSEAS
Transactions on Mathematics, 9 (10), 778-790.
84
Najmuddin, A. F., Ibrahim, I. M., & Ismail, S. R. (2010). Simulation modeling and
analysis of multiphase patient flow in obstetrics and gynecology department
(O&G department) in specialist centre. 4th International Conference on Applied
Mathematics, Simulation, Modeling, ASM '10, Corfu Island, Greece, July 22-
25, 2010. 125-130.
Nielson, J. (2006). Quantitative studies: how many users to test Alertbox. Retrieved
May 03, 2011, from http://www.useit.com/alertbox/ quantitative_testing.html
Profmax. (2011). Profmax healthcare ERP. Retrieved February 15, 2011, from
http://www.profmax.com/pbs/solutions/erp/healthcare/healthcare.aspx
Rajasekar, S., Philominathan, P., & Chinnathambi, V. (2006). Research
Methodology. Retrieved April 15, 2011, from
http://www.scribd.com/doc/6949151/Research-Methodology
Revere, D., & Dunbar, P. J. (2001). Review of computer-generated outpatient health
behavior interventions: clinical encounters “in absentia”. Journal of the
American Medical Informatics Association, 8(1), 62-79.
T-CAS. (2011). T-CAS: Total Clinic Automation Solution. Retrieved February 15,
2011, from http://m2india.com/our-products/t-cas-total-clinic-automation-
solution/
85
Tang, W. T., Hu, C. M., & Hsu, C. Y. (2010). A mobile phone based homecare
management system on the cloud. 3rd International Conference on Biomedical
Engineering and Informatics, BMEI 2010, Yantai, China October 16, 2010.
2442-2445.
Tuso, P. J., Murtishaw, K., & Tadros, W. (1999).The easy access program: A way to
reduce patient no show rate, decrease add-ons to primary care schedules, and
improve patient satisfaction. The Permanente Journal, 3(3). Retrieved April
15, 2011, from http://xnet.kp.org/permanentejournal/fall99pj/ea.html
Virji, A., Yarnall, K. S., Krause, K. M., Pollak, K. I., Scannell, M. A., Gradison, M.
(2006). Use of email in a family practice setting: opportunities and challenges
in patient- and physician-initiated communication. BMC Medicine Journal, 4
(1). Retrieved April 15, 2011, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563473/
Wijewickrama, A., & Takakuwa, S. (2005). Simulation analysis of appointment
scheduling in an outpatient department of internal medicine. In proceedings of
the 2005 Winter Simulation Conference, WSC2005, Orlando FL, USA,
December 4-7, 2005. Orlando FL, USA: ACM. 2264-2273.
Wijewickrama, A. A., & Takakuwa, S. (2006). Simulation analysis of an outpatient
department of internal medicine in a university hospital. In proceedings of the
2006 Winter Simulation Conference, WSC2006, Monterey, CA, USA,
December 3-6, 2006. Monterey, CA, USA: ACM. 425-432.
86
Wijewickrama, A., & Takakuwa, S. (2008). Outpatient appointment scheduling in a
multi facility system. In proceedings of the 2008 Winter Simulation
Conference, WSC2008, Miami, FL, USA, December 7-10, 2008. Miami, FL,
USA: ACM. 1563-1571
Zheng, Y. (2005). Information culture and development: Chinese experience of e-
health. 38th Hawaii International Conference on System Sciences, HICSS'05,
Big Island, HI, USA, January 3-6, 2005. 153-163.
Zhu, Z., Heng, B.H., & Teow, K.L. (2010). Analysis of factors causing long patient
waiting time and clinic overtime in outpatient clinics. Journal of Medical
Systems, 6(2), 1-7.
87
APPENDIX
QUESTIONNAIRE
Clinic Web Based System
System Prototype Evaluation
This questionnaire is divided into two sections (Section A, and B). Section A:
addressing respondent general information; Section B measuring the Perceive of
Usefulness and the Perceive of Ease of Use of WBCS. Respondent are required to
answer all the questions in order to complete the session.
Yours truly
Ahmad
Master of ICT
College of Arts and Sciences (CAS)
Universiti Utara Malaysia (UUM)
88
SECTION A: RESPONDENT GENERAL INFORMATION
This segment is about your background information. Please fill up the blanks and mark
[√] where appropriate.
1. Gender: [ ] Male [ ] Female
2. Age: 20-25[ ] 26-35[ ] 36-45 [ ] Above 45 [ ] .
3. Educational Level: Degree Qualification [ ] Master Qualification [ ] other [ ]
4. Do you use a similar application before [ ] Yes [ ] No
89
SECTION B
For the next segments, please tick or shade the answer to the following questions using
the scale.
1 2 3 4 5
Strongly Disagree Disagree Neutral Agree Strongly Agree
Items 1 2 3 4 5
1. The WBCS is useful.
2. When I use the WBCS, I save my time.
3. It saves my effort when I use it the WBCS.
4. The WBCS gives me more control over the activities in my life.
5. The WBCS makes the things I want to accomplish easier to get.
6. It does everything I would expect it to do.
7. WBCS is easy to use.
8. WBCS is flexible use.
9. WBCS is simple to use.
10. WBCS is user friendly.
11. WBCS requires the fewest steps possible to accomplish
12. I can use it without written instructions.
Thank you
90

Alghamedi, Ahmad Ali A

Uploaded by

Copyright:

Available Formats

Alghamedi, Ahmad Ali A

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Alghamedi, Ahmad Ali A

Uploaded by

Copyright:

Available Formats

Designing an Appointment Management System for

the Mother and Child Health Department of the

Alghamedi, Ahmad Ali A

UNIVERSITI UTARA MALAYSIA

Alghamedi, Ahmad Ali A

Copyright © 2011 Alghamedi, Ahmad. All rights reserved.

In presenting this project in partial fulfillment of the requirement for a postgraduate

permission. It is also understood that due recognition shall be given to me and to

whole or in part, should be addressed to

Dean of Awang Had Salleh Graduate School of Arts and Sciences

Universiti Utara Malaysia

06010 UUM Sintok

Kedah Darul Aman

fingertips by hosting these applications online. Klinik Kesihatan Changlun is a

friendliness with the aid of the questionnaire.

perseverance to complete this project. I would foremost like to thank my

parents and my wife, for providing me with the opportunity to pursue

brothers. I would like to thank my supervisor: Prof. Abd Ghani B

motivation that has enabled me to complete my project work. Moreover,

ALGHAMEDI, AHMAD ALI

1.2 Problem Statement 3

1.3 Research Question 6

1.4 Research Objective 6

1.5 Research Scope 7

1.6 Research significance 7

1.7 Organization of the Thesis 8

CHAPTER 2: LETERATURE REVIEW

2.2 Quality of Service in Healthcare Services 12

2.3 Issue of Waiting Time 14

2.4 Impact of the Internet on Healthcare 18

2.5 Appointment Scheduling Systems 19

2.6 Related Work 21

2.6.1 Dynacrates Clinic Management System 21

2.6.2 Total Clinic Automation Solution 23

2.6.3 Health on Click Hospital Management System 24

2.6.5 Profmax Healthcare ERP 27

2.6.6 FreshLogics Clinic Management System 29

2.6.7 MemDB Clinic Management System 30

CHAPTER 3: RESEARCH METHODOLOGY

3.2 Research Design Methodology 37

3.2.1 Awareness of Problem 37

3.2.3.1 Prototype Development 42

CHAPTER 4: SYSTM ANALYSIS AND DESIGN

4.2 WBCS System Requirements 45

4.2.1 WBCS Functional Requirements 45

4.2.2 WBCS Non Functional Requirement 47

4.3 WBCS Modeling and System Design 48

4.3.1 Use Case Diagram 48

4.3.2 Use case specification 50

4.3.4 WBCS Class Diagram 64

4.4 Prototype Implementation 65

CHAPTER 5: SYSTEM USABILITY TESTING

5.2 System Usability Evaluation 71

5.3 The Instrument of the Survey 72

5.4 Data analysis Results 72

5.4.1 Demographic Data 72

5.4.2 Items Analysis 74

6.2 Recommendation and limitations 76

Figure 2.1: Dynacrates Clinic Management System 22

Figure 2.2: T-CAS Clinic Management System 23